The relationship of omental and subcutaneous adipocyte size to metabolic disease in severe obesity

Jean O'Connell, Lydia Lynch, Tom J Cawood, Anna Kwasnik, Niamh Nolan, Justin Geoghegan, Aiden McCormick, Cliona O'Farrelly, Donal O'Shea, Jean O'Connell, Lydia Lynch, Tom J Cawood, Anna Kwasnik, Niamh Nolan, Justin Geoghegan, Aiden McCormick, Cliona O'Farrelly, Donal O'Shea

Abstract

Objective: Several studies have reported the existence of a subgroup of obese individuals with normal metabolic profiles. It remains unclear what factors are responsible for this phenomenon. We proposed that adipocyte size might be a key factor in the protection of metabolically healthy obese (MHO) individuals from the adverse effects of obesity.

Subjects: Thirty-five patients undergoing bariatric surgery were classified as MHO (n = 15) or metabolically unhealthy obese (MUO, n = 20) according to cut-off points adapted from the International Diabetes Federation definition of the metabolic syndrome. Median body mass index (BMI) was 48 (range 40-71).

Results: There was a moderate correlation between omental adipocyte size and subcutaneous adipocyte size (r = 0.59, p<0.05). The MHO group had significantly lower mean omental adipocyte size (80.9+/-10.9 microm) when compared with metabolically unhealthy patients (100.0+/-7.6 microm, p<0.0001). Mean subcutaneous adipocyte size was similar between the two groups (104.1+/-8.5 microm versus 107.9+/-7.1 microm). Omental, but not subcutaneous adipocyte size, correlated with the degree of insulin resistance as measured by HOMA-IR (r = 0.73, p<0.0005), as well as other metabolic parameters including triglyceride/HDL-cholesterol ratio and HbA1c. Twenty-eight patients consented to liver biopsy. Of these, 46% had steatohepatitis and fibrosis. Fifty percent (including all the MHO patients) had steatosis only. Both omental and subcutaneous adipocyte size were significantly associated with the degree of steatosis (r = 0.66, p<0.0001 and r = 0.63, p<0.005 respectively). However, only omental adipocyte size was an independent predictor of the presence or absence of fibrosis.

Conclusion: Metabolically healthy individuals are a distinct subgroup of the severely obese. Both subcutaneous and omental adipocyte size correlated positively with the degree of fatty liver, but only omental adipocyte size was related to metabolic health, and possibly progression from hepatic steatosis to fibrosis.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Adipocyte size results (micrometers) for…
Figure 1. Adipocyte size results (micrometers) for Method I and Method II.
Figure 2. Adipocyte size in obese subjects…
Figure 2. Adipocyte size in obese subjects grouped by metabolic profile.
Metabolically healthy obese  =  MHO, metabolically unhealthy obese  =  MUO, metabolically unhealthy obese patients with Type 2 Diabetes  =  DM2. Mean omental adipocyte diameter (represented by the horizontal lines) was 80.9±10.9 µm in MHO, 98.2±10.2 µm in MUO, and 104.3+/−4.2 µm in DM2. Mean subcutaneous diameter was 104.1±8.5 µm in MHO, 104.9±5.0 µm in MUO, and 113.2±6.9 µm in DM2.
Figure 3. Correlations of adipocyte size with…
Figure 3. Correlations of adipocyte size with metabolic parameters.
Omental adipocyte size (A, B and C) and subcutaneous adipocyte size (D, E and F) correlated with the degree of insulin resistance as measured by HOMA-IR, the TGL/HDL ratio, and the degree of hepatic steatosis. X  =  MHO, • =  MUO, ○ =  DM2
Figure 4. Omental adipocyte size, metabolic parameters…
Figure 4. Omental adipocyte size, metabolic parameters and hepatic fibrosis.
A) Omental and subcutaneous adipocyte size, B) TGL/HDL and HOMA-IR ratios and C) Age, BMI and degree of steatosis, in subjects with hepatic steatosis alone, compared with subjects with evidence of hepatic fibrosis (** p

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Source: PubMed

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