Why might South Asians be so susceptible to central obesity and its atherogenic consequences? The adipose tissue overflow hypothesis
1Division of Cardiology, McGill University Health Science Centre, Montreal, QC, Canada.
2Division of Community Health Sciences, University of Edinburgh, Edinburgh, Scotland, UK.
3All India Institutes of Medical Sciences, New Delhi, India.
4Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
5Molecular Endocrinology and Oncology Research Centre, Laval University Medical Research Centre, Laval, QC, Canada.
Corresponding author. Mike Rosenbloom Laboratory for Cardiovascular Research, Room H7.22, McGill University Health Centre, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, Quebec, Canada H3A 1A1. E-mail: allan.sniderman{at}muhc.mcgill.ca
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Abstract |
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The rates of coronary disease have accelerated dramatically amongst South Asians, driven to an important extent by the atherogenic dyslipidemia and type 2 diabetes that have become so common amongst them. These precursors of vascular disease appear at lower absolute amounts of adipose tissue in South Asians than in whites. In this paper, we set out a new hypothesis—the adipose tissue overflow hypothesis—to account for these findings. The adipose tissue mass within our bodies can be divided into three different compartments: superficial subcutaneous adipose tissue, deep subcutaneous adipose tissue and visceral adipose tissue. The superficial subcutaneous adipose tissue compartment is the primary compartment, is present throughout the body, and constitutes the vast majority of the adipose tissue in the lower limb. With energy excess, the secondary adipose tissue compartments—the deep subcutaneous (mainly upper body) and the visceral adipose tissue compartments—become more prominent. Superficial subcutaneous adipose tissue is relatively inert metabolically, whereas the other two compartments are characterized by higher transmembrane fatty acid flux rates and thus are more closely linked to dyslipidemia and dysglycemia. We hypothesize that the superficial subcutaneous adipose tissue compartment is larger in whites than in South Asians. If so, as obesity develops, South Asians exhaust the storage capacity of their superficial subcutaneous adipose tissue compartment before whites do and that is why they develop the metabolic complications of upper body obesity at lower absolute masses of adipose tissue than white people.
Keywords Abdominal obesity, WHR ratio, apoB, coronary disease risk, adipose tissue
Accepted 11 October 2006
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