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Division of Endocrinology and Metabolism, Department of Medicine, and Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania 15261
Whereas truncal (central) adiposity is strongly
associated with the insulin resistant metabolic syndrome, it is
uncertain whether this is accounted for principally by visceral
adiposity (VAT). Several recent studies find as strong or stronger
association between subcutaneous abdominal adiposity (SAT) and insulin
resistance. To reexamine the issue of truncal adipose tissue depots, we
performed cross-sectional abdominal computed tomography, and we
undertook the novel approach of partitioning SAT into the plane
superficial to the fascia within subcutaneous adipose tissue
(superficial SAT) and that below this fascia (deep SAT), as well as
measurement of VAT. Among 47 lean and obese glucose-tolerant men and
women, insulin-stimulated glucose utilization, measured by euglycemic clamp, was strongly correlated with both VAT and deep SAT (r = 
0.61 and 0.64, respectively; both P < 0.001),
but not with superficial SAT (r = 0.29, not
significant). Also, VAT and deep SAT followed a highly congruent
pattern of associations with glucose and insulin area under the curve
(75-g oral glucose tolerance test), mean arterial blood pressure,
apoprotein-B, high-density lipoprotein cholesterol, and triglyceride.
Superficial SAT had markedly weaker association with all these
parameters and instead followed the pattern observed for thigh
subcutaneous adiposity. We conclude that there are two functionally
distinct compartments of adipose tissue within abdominal subcutaneous
fat and that the deep SAT has a strong relation to insulin resistance.
obesity; insulin resistance; visceral adiposity
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