Ectopic fat and adipokines in metabolically benign overweight/obese women: the Kronos Early Estrogen Prevention Study

Abstract

Objective: It is unclear why despite a comparable cardiometabolic risk profile, "metabolically benign" overweight/obese individuals show an elevated risk of cardiovascular disease compared to normal weight individuals.

Design and methods: In cross-sectional analyses, we compared levels of ectopic fat (epicardial, pericardial, and hepatic fat) and adipokines (leptin, soluble leptin receptor, and high molecular weight [HMW] adiponectin) among metabolically benign (MBO) and at-risk overweight/obese (ARO), and metabolically benign normal weight (MBNW) women, screened for the Kronos Early Estrogen Prevention Study. We defined "metabolically benign" with ≤ 1, and "at-risk" with ≥2 components of the metabolic syndrome.

Results: Compared to MBO women, ARO women had significantly elevated odds of being in the top tertile of epicardial fat (OR: 1.76, 95% CI: 1.04-2.99), hepatic fat (OR: 1.90, 95% CI:1.12-3.24) and leptin (OR: 2.15, 95% CI: 1.23-3.76), and the bottom tertile of HMW-adiponectin (OR: 2.90, 95% CI: 1.62-5.19). Compared to MBNW women, MBO women had significantly higher odds of being in the top tertile of epicardial fat (OR: 5.17, 95% CI: 3.22-8.29), pericardial fat (OR: 9.27, 95% CI: 5.52-15.56) and hepatic fat (OR: 2.72, 95% CI: 1.77-4.19) and the bottom tertile of HMW adiponectin levels (OR: 2.51, 95% CI: 1.60-3.94).

Conclusions: Levels of ectopic fat and the adverse adipokine profile increase on a continuum of BMI, suggesting that the metabolically benign phenotype may be a transient state.

Trial registration: ClinicalTrials.gov NCT00154180.

Conflict of interest statement

CONFLICT OF INTEREST

No potential conflicts of interest relevant to this article were reported.

Dr. Brinton was a consultant to Abbott Laboratories for products not related to menopausal hormone therapy.

Copyright © 2013 The Obesity Society.

Figures

Figure 1

Epicardial and Pericardial Fat Depots

Figure 2

Box plots representing median levels of ectopic fat and three adipokines by body size phenotypes. Pericardial and epicardial fat measures are presented as volumes (more volume, more fat); hepatic fat measure is presented as attenuation (more attenuation, less fat). Horizontal lines represent medians, while bottom and top of the boxes represent the 25th and 75th percentiles, respectively. MBNW = metabolically benign normal weight phenotype (n = 251). MBO = metabolically benign overweight/obese phenotype (n = 296). ARO = at-risk overweight/obese phenotype (n = 89). Metabolically benign phenotype was defined as no more than 1 of the following 4 ATP-III components: (1) systolic/diastolic blood pressure ≥130/85mmHg, (2) fasting triglycerides ≥150 mg/dL, (3) HDL-C <50 mg/dL, and (4) fasting glucose ≥100 mg/dL.