Visceral Adiposity and Cardiometabolic Risk: Clinical Insights and Assessment

With obesity assuming pandemic proportion, cardiometabolic diseases are also increasing across the globe. Obesity defined as excess and dysfunctional adipose tissue that is detrimental to health, is very heterogeneous with many subtypes based on the distribution of body fat. These subtypes vary in their risk of cardiometabolic diseases. The adipose tissue comprises of visceral adipose tissue (VAT) and subcutaneous adipose tissue, which differ not only in their anatomical location but also in their cellular composition, molecular structure, physiological function, and pathological consequences. VAT is a metabolically active component with several physiological functions and pathophysiological links to cardiometabolic diseases. VAT has unique adipocytes with various paracrine and endocrine functions. It not only stores lipids but also contributes significantly to energy homeostasis. Sexual dimorphism in relation to VAT and cardiometabolic health has been described. VAT is metabolically active, with higher insulin resistance and increased sensitivity to lipolysis. Excess accumulation of VAT termed visceral obesity, leads to the secretion of adipocytokines, ectopic fat storage, and an alteration in the immune landscape of the VAT, resulting in the clustering of the cardiometabolic risk factors. Visceral obesity is correlated with cardiometabolic diseases and higher mortality. Many epidemiological studies have shown the link between visceral adiposity and cardiometabolic diseases such as diabetes, hypertension, dyslipidemia, cerebrovascular disease, heart failure, and unexpected cardiac death. Obesity phenotypes describing body composition and adipose density distribution are better at defining the cardiometabolic risk profile. Several imaging modalities with advancements in technology, such as dual-energy X-ray absorptiometry, computed tomography, MRI, and Bioimpedance, have explored the link between visceral fat and cardiometabolic risk. Calorie restriction, structured exercise, pharmacotherapy, and metabolic surgeries have shown beneficial effects in reducing VAT. Preferential VAT loss has been shown to have a favorable effect on cardiometabolic diseases.