New Clues to Cardiometabolic Risk

​At a recent meeting at the Cardiometabolic Health Congress, Dr. Subodh Verma, MD, PhD, FRCSC of the University of Toronto explained that “intra-abdominal visceral fat plays a causal role in the development of almost all components of metabolic syndrome, irrespective of a person’s BMI.” This post will unpack what that statement means, and more importantly, what it means for you.

During that same keynote presentation, Dr. Verma explained that adipose tissue around the gut around is a driving risk factor for a number of other diseases, including type 2 diabetes, dyslipidemia and all types of cancer. He mentioned the range of studies that demonstrated a positive relationship between higher waist-to-hip ratio and higher risk for cardio vascular disease. Finally, Dr. Verma concluded by saying that ethnicity, genetics, biology and diet ALL contribute to fat distribution and overall health.

What do we mean by waist-to-hip ratio?

Numerous studies suggest that there is an inverse relationship between lower-body adipose tissue and risk for cardio vascular (CV) disease. Researchers have shown that adults with a “pear shape” body typically have a reduced CV risk as opposed to those with more fat distributed around the abdominal area. This is an important factor to monitor but is tricky since the distribution of fat may actually be influenced by genetics.

Dr. Verma said, “Individuals with certain phenotypes may predominantly shuttle their fuel into the visceral component allowing for the ‘remodeling’ of fat and increasing their cardiometabolic risk.” This bring us to the controversial concept of “fat but fit.”

What do we mean by 'fat but fit?'

This is the highly debated idea that individuals can be metabolically healthy but technically and physically obese. Dr. Verma explained that new research has shown that the phenotype may prove that metabolically “unfit” adults with obesity have a 2.5 to 3-fold increase in mortality as opposed to adults with obesity who were “fit.”

So what does this mean for you? This notion is an important translational standpoint in the sense that even if the scale number doesn’t move right away, you’re improving your overall health by being more active and conscious of your diet. At Medical Metabolic Specialists, we work with our patients to provide a comprehensive, lifestyle approach to weight loss to help mitigate obesity-related disease risks.

Is fat really bad?

One of the more interesting parts of Dr. Verma’s presentation was when he explained that fat itself is not actually bad – it becomes “bad” when it gets remodeled and becomes inflammatory. He explains, “…under normal physiology, [fat] is the most important endocrine organ that cross talks with the liver, the heart, the kidney, the immune system, the pancreas, the brain… it works to assure appropriate organ function and maintenance of energy homeostasis…”Fat becomes “bad” when white adipose tissue responds to dietary excess and leads to insulin resistance and sensitivity. In short, increased energy intake (over eating) leads to a saturation of the expansion capacity of the adipose tissue. This triggers the body to convert fat to “bad” fat that is difficult to use or burn.

What can we do?

Dr. Verma concluded his keynote presentation by saying, “Adherence to a healthy diet does work.” He cited a recent study where adults were randomly assigned to one of two Mediterranean diets – one with extra virgin olive oil or one with nuts. Neither group saw substantial changes in body weight but both groups experienced changes in body composition and a reduction in inflammation, reducing cardiometabolic risk.
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At Medical Metabolic Specialists, we work with our patients to develop dietary guidelines and goals that reflect your personal needs. We encourage healthy substitutes, moderation and daily activity for a more holistic approach to weight loss.