The epidemiology of central fat distribution in relation to disease.

The effect of fat distribution on disease risk is a subject of great interest. Central fat has been measured anthropometrically, by computed tomography, and by magnetic resonance imaging. Both cross-sectional and longitudinal studies have related central fat to type 2 diabetes mellitus and cardiovascular disease, independent of body mass index. The mechanism may relate to increased lipolysis causing the liver to increase glucose and very low density lipoprotein output, while muscle uses less. This leads to a rise in blood glucose and triglycerides, a drop in HDL cholesterol, and an increase in small, dense LDL particles. There is also an increase in blood pressure and inflammatory markers. Certain populations put on excess fat more centrally than others. These include Asian populations. It is likely that with better differentiation of abdominal fat into visceral and subcutaneous depots, clearer data will accrue on their impact on disease risk.