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Adipocyte. 2016 Oct-Dec; 5(4): 375–377.
Published online 2016 September 27. doi:  10.1080/21623945.2016.1240138
PMCID: PMC5160386

Subcutaneous abdominal adipose tissue is associated with an index of insulin sensitivity/resistance

ABSTRACT

To assess whether there is any clinical significance for determining the normal range of subcutaneous abdominal fat area, we compared fat area with insulin sensitivity. Visceral and subcutaneous abdominal fat area the L4-L5 thoracic level was determined by computed tomography (CT). Plasma glucose and insulin levels were determined after an overnight fast and calculated by the homeostatic model assessment of insulin resistance (HOMA-IR). We analyzed 350 (180 male and 170 female) subjects whose BMI was 18.5≤BMI<25. The subcutaneous abdominal fat area of the female subjects was 124.7 ± 46.13 cm2 and that of male subjects was 77.53 ± 37.53 cm2 (mean ± SD). We compared HOMA-IR between subjects whose visceral abdominal fat area was above 100 cm2 and subcutaneous abdominal fat area below the mean + 2SD (15 subjects, 6 male and 9 female) with subjects whose visceral abdominal fat area was also above 100 cm2 but whose subcutaneous abdominal fat area was above the mean + 2SD (20 subjects, 7 male and 13 female). The HOMA-IR of the former subjects group was 8.17+/−6.22 and that of the latter subjects group was 3.37+/−2.07 (p = 0.0486). Subjects with increased subcutaneous abdominal fat area displayed lower HOMA-IR values, demonstrating a protective effect of subcutaneous fat for individuals with visceral fat area above 1002 cm.

KEYWORDS: HOMA-IR, insulin resistance, subcutaneous abdominal fat, visceral abdominal fat

Introduction

Multiple studies have reported that intraabdominal (visceral) adipose tissue is a major contributor to metabolic risk.1-4 On the other hand, it was reported that the Health, Aging, and Body Composition Study reported that large subcutaneous thigh fat was independently associated with more favorable glucose (in men) and lipid profile (in both genders).5 Similarly, Porter et al reported that subcutaneous abdominal fat plays a protective role on atherosclerosis and triglyceride unlike visceral abdominal fat.6 These studies suggest that determining the relative range of subcutaneous and visceral abdominal fat area may provide additional clinical significant information for deciding the appropriate treatment of patient with metabolic dysfunction. The data presented in this report clearly demonstrates that for individuals with visceral abdominal fat are >100 cm2, the amount of abdominal subcutaneous abdominal fat is a predictor of insulin sensitivity.

Methods

Our study protocol was reviewed and approved by Kan-etsu Chuo Hospital review boards according to the Declaration of Helsinki. Written informed consent was obtained from each participant. We analyzed 350 (180 male and 170 female) subjects whose BMI was 18.5≤BMI<25 in this clinical study. They were received comprehensive medical check-up annually.

Visceral and subcutaneous abdominal fat area was determined by CT (CT) using L4-L5 level method as previously reported by Matsuzawa et al.2 Plasma glucose and insulin levels following an overnight fast and the homeostatic model assessment of insulin resistance (HOMA-IR) was used to estimate peripheral insulin sensitivity. Total cholesterol, leptin, and TNF-α were determined by LSI Medience Corporation.

Venous blood samples were collected into tubes containing ethylenediaminetetraacetic acid (EDTA) and fluoride. Plasma was separated from whole blood within 1 h after collection, and plasma glucose and HbA1c concentrations were determined as previously reported[7, 8]. Brachial-ankle pulse wave velocity (baPWV) was also measured as previously reported7,8 in order to compare our results and previous results from the point of research objectivity and suitability.

The InStat 2 program was used for statistical analyses.

Results

The subcutaneous abdominal fat area of female was 124.7+/−46.13 (mean±SD) cm2 and that of male was 77.53+/−37.53 cm2. In this study, we considered that upper limit of standard value for the female subcutaneous abdominal fat area was 217 cm2 (mean+2SD) and upper limit of standard value for male subcutaneous abdominal fat area was 153 cm2 (mean+2SD).

The averages of study subjects were as follows. Age was 61.14 ± 11.35 y old, fasted blood glucose (FBS) was 97.7 ± 9.02 mg/dL, glycosylated hemoglobin (HbA1c) was 5.31 ± 0.30 %, immunoreactive Insulin (IRI) was 17.42 ± 13.88 μU/mL, the HOMA-IR was 3.51 ± 3.30, total cholesterol was 188.04 ± 28.35 mg/dL, TNF-α was 1.40 ± 0.71 pg/mL (normal range; <6 pg/mL) and Leptin was 13.75 ± 7.57 ng/mL (normal range; male 0.9–13.0, female 2.5–21.8).

We compared HOMA-IR between subjects whose visceral abdominal fat area was above 100 cm2 but that the subcutaneous abdominal fat area was above the mean + 2SD (20 subjects, 7 male and 13 female) with subjects whose visceral abdominal fat area was above 100 cm2 and also subcutaneous abdominal fat area was below the mean + 2SD (15 subjects, 6 male and 9 female). As shown in Table 1, the HOMA-IR of the former subjects group was 3.37 ± 2.07 and that of the latter subjects group was 8.17 ± 6.22 (p = 0.0486).

Table 1.
Estimation of HOMA-IR.

As shown in Figure 1, baPWV of subjects whose visceral abdominal fat area was above 100 cm2 but with subcutaneous abdominal fat area above the mean + 2SD was significantly lower than that of subjects whose visceral abdominal fat area was above 100 cm2 with subcutaneous abdominal fat area below the mean + 2SD (1,251 ± 286 vs 1,567 ± 238 cm/second, p = 0.012).

Figure 1.
35 Subjects showed 18.5 ≤BMI<25 and visceral fat area was above 100 cm2. Among 35 subjects, 20 subjects (7 male and 13 female) showed that subcutaneous abdominal fat area was above the mean + 2SD and 15 subjects (6 male and 9 female) ...

Discussion

In this clinical study, we estimated that the subcutaneous abdominal fat area of female was 124.7 ± 46.13 cm2 and that of male was 77.53 ± 37.53 cm2. Also in this study, we determined that excess amount of subcutaneous abdominal fat area was larger than the upper limit of standard value (mean + 2SD). In these individuals, baPWV whose visceral abdominal fat area was above 100 cm2 but with subcutaneous abdominal fat area above the mean + 2SD was significantly lower than that of subjects whose visceral abdominal fat area was above 100 cm2 with subcutaneous abdominal fat area below the mean + 2SD. As baPWV assesses atrial stiffness, these data are consistent with the previous study of Porter et al reported6 supporting the role of subcutaneous abdominal fat in protection against the development of atherosclerosis.

As a parameter of insulin resistance/sensitivity, HOMA-IR was selected in this clinical study and the HOMA-IR of subjects whose visceral abdominal fat area was above 100 cm2 but with subcutaneous abdominal fat area above the mean + 2SD was significantly lower than that of subjects whose visceral abdominal fat area was above 100 cm2 with subcutaneous abdominal fat area below the mean + 2SD. Based on these results we considered that large amount of subcutaneous abdominal fat area was beneficial for not only atrial stiffness but also insulin resistance in the case of the population whose BMI was 18.5<BMI≤25 and visceral fat area was above 100 cm2. Thus it can be considered that identification of normal range of subcutaneous abdominal fat area is clinically significant in comparison with the estimation of visceral abdominal fat. However it will be required to analyze larger number of subjects at younger ages and in different ethnic populations to confirm the generality of these results.

Disclosure of potential conflicts of interest

The authors declare that they have no conflicts of interest that could be perceived as prejudicing the impartiality of the information presented in this report.

Acknowledgment

We would like to thank Dr. Jeffrey E. Pessin (Albert Einstein College of Medicine, Bronx, NY, USA) for critical suggestions correcting English about our manuscript.

Funding

This research did not receive any specific grant from any funding agency in the public or commercial sector or from any of the each co-authors.

Author contributions

NK, TS, SO, and YN took care of subjects in this study. SO, EY, YN, and MY analyzed the data and prepared the manuscript.

References

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