Reducing visceral adipose tissue mass is essential for improving endothelial function in type 2 diabetes prone individuals

Rittig, K.; Hieronimus, A.; Thamer, C.; Machann, J.; Peter, A.; Stock, J.; Schick, F.; Fritsche, A.; Stefan, N.; Häring, H.-U.; Balletshofer, B.

doi:10.1016/j.atherosclerosis.2010.06.042

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Volume 212, Issue 2 , Pages 575-579, October 2010

Reducing visceral adipose tissue mass is essential for improving endothelial function in type 2 diabetes prone individuals

K. Rittig
- Department of Endocrinology and Diabetes, Vascular Medicine, Nephrology and Clinical Chemistry, University of Tübingen, Otfried-Müller Straße 10, 72076 Tübingen, Germany
A. Hieronimus
- Department of Endocrinology and Diabetes, Vascular Medicine, Nephrology and Clinical Chemistry, University of Tübingen, Otfried-Müller Straße 10, 72076 Tübingen, Germany
C. Thamer
- Department of Endocrinology and Diabetes, Vascular Medicine, Nephrology and Clinical Chemistry, University of Tübingen, Otfried-Müller Straße 10, 72076 Tübingen, Germany
J. Machann
- Department of Radiology, Section of Experimental Radiology, University of Tübingen, Germany
A. Peter
- Department of Endocrinology and Diabetes, Vascular Medicine, Nephrology and Clinical Chemistry, University of Tübingen, Otfried-Müller Straße 10, 72076 Tübingen, Germany
J. Stock
- Department of Endocrinology and Diabetes, Vascular Medicine, Nephrology and Clinical Chemistry, University of Tübingen, Otfried-Müller Straße 10, 72076 Tübingen, Germany
F. Schick
- Department of Radiology, Section of Experimental Radiology, University of Tübingen, Germany
A. Fritsche
- Department of Endocrinology and Diabetes, Vascular Medicine, Nephrology and Clinical Chemistry, University of Tübingen, Otfried-Müller Straße 10, 72076 Tübingen, Germany
N. Stefan
- Department of Endocrinology and Diabetes, Vascular Medicine, Nephrology and Clinical Chemistry, University of Tübingen, Otfried-Müller Straße 10, 72076 Tübingen, Germany
- Corresponding author. Tel.: +49 7071 29 82711; fax: +49 7071 29 5974.
H.-U. Häring
- Department of Endocrinology and Diabetes, Vascular Medicine, Nephrology and Clinical Chemistry, University of Tübingen, Otfried-Müller Straße 10, 72076 Tübingen, Germany
B. Balletshofer
- Department of Endocrinology and Diabetes, Vascular Medicine, Nephrology and Clinical Chemistry, University of Tübingen, Otfried-Müller Straße 10, 72076 Tübingen, Germany

Received 19 August 2009; received in revised form 7 June 2010; accepted 28 June 2010. published online 28 July 2010.

Abstract

Objective

In obesity, particularly increased visceral- (VAT), but not total (TAT) adipose tissue mass is a major source of proinflammatory cytokine expression and secretion. VAT, more than TAT, is associated with endothelial dysfunction (ED), which is an accepted risk factor for atherosclerosis. Consequently, we hypothesized that during a lifestyle intervention specifically a decrease in VAT, rather than TAT, is associated with improved ED and vascular adhesion molecules in type 2 diabetes prone subjects.

Methods

Analyses were done in 189 individuals (age: 45.4±0.8 years) at increased risk of type 2 diabetes, who underwent a 9-month lifestyle intervention. ED expressed as flow mediated dilation (FMD) of the brachial artery, sE-selectin, sV-CAM, sI-CAM, TAT and VAT (measured by magnetic resonance tomography) was determined.

Results

There was a mean decrease in body weight (−3%, p<0.0001), TAT (−7.6%, p<0.0001) and VAT (−12.5%, p<0.0001), while FMD increased (+9.1%, p=0.04). The change in FMD was not associated with change in body weight (p=0.35) or TAT (p=0.21) but with a decrease in VAT (r=−0.19, p=0.009). In a post hoc analysis, the subjects were divided by the median change in VAT into responders and non-responders. FMD increased only in the responders (from 6.2±0.4% to 8.0±0.5%, p=0.0005) but not in the non-responders (p=0.15). Also sE-selectin significantly decreased only in the responders (from 54±4ng/ml to 47±3ng/ml; p=0.03).

Conclusion

During a lifestyle intervention, not weight loss or decrease in TAT, but decrease in VAT is associated with improved ED in individuals prone to type 2 diabetes. Therefore, primary cardiovascular prevention should focus specifically on reducing VAT rather than body weight alone.

Keywords: Visceral adiposity, Endothelial dysfunction, Lifestyle intervention