Insulin sensitivity of splanchnic and peripheral adipose tissue in vivo in morbidly obese man

Lipid metabolism in omental adipose tissue during operative surgery1

BACKGROUND

Omental adipose tissue is a pure depot of visceral adipose tissue. We investigated the regulation of lipid metabolism in human omental tissue in vivo by the arterio-venous technique.

MATERIALS AND METHODS

Six adults were studied while undergoing elective colonic surgery. Their omental vein was cannulated intraoperatively, and after obtaining the baseline blood samples, 50 ml of 50% dextrose solution was given intravenously and simultaneous arterio-venous samples were taken for the next 2 h. Concentration differences of lipid metabolites, glucose, and lactate were measured across the arterio-venous bed. The rates of action of hormone-sensitive lipase (HSL) and lipoprotein lipase (LPL) were calculated by stoichiometric analysis and the rate of re-esterification of nonesterified fatty acids (NEFA) was determined.

RESULTS

After an overnight fast there was a significant release of NEFA and glycerol from the omental adipose tissue (P <0.05, P <0.05). Intravenous glucose load caused a significant reduction in the arterial NEFA and glycerol concentrations (P <0.05, P <0.05), but only the arterio-venous concentration of NEFA decreased significantly (P <0.05). There was no significant change in the arterio-venous concentration difference of glycerol, and the relative rate of action of HSL decreased, but not significantly (P=0.09 at 30 min; P=0.054 at 120 min). The ratio of release of NEFA to glycerol changed significantly (ANOVA; P <0.05) from 2.93:1 to 0.1:1.

CONCLUSION

The net release of NEFA by omental adipose tissue is primarily regulated by their local re-esterification. The change in the rate of action of HSL and LPL plays a minor role in the net release of NEFA by omental adipose tissue.

Visceral fat and insulin resistance--causative or correlative?

The association between abdominal fat accumulation and risk of chronic diseases, including type II diabetes and coronary heart disease, has long been recognized. Insulin resistance may be a key factor in this link. Many studies have pointed to an association between insulin resistance and intra-abdominal fat accumulation (visceral obesity). However there is no clear proof of a causal link between visceral fat accumulation and insulin resistance. In assessing the probability of a causal link, it is useful to consider potential mechanisms. One such potential causal link is the release of non-esterified fatty acids from visceral fat into the portal vein, so that they have direct effects on hepatic metabolism. Visceral fat has been shown in many studies to exhibit a high rate of lipolysis compared with subcutaneous fat depots. However, if the idea that visceral fat releases fatty acids into the portal vein at a high rate is examined critically, a number of difficulties appear. Not least of these is the fact that continued high rates of lipolysis should lead to the disappearance of the visceral fat depot, unless these high rates of fat mobilization are matched by high rates of fat deposition. There is far less evidence for high rates of fat deposition in visceral adipose tissue, and some contrary evidence. Evidence for high rates of visceral lipolysis in vivo from studies involving catheterization of the portal vein is not strong. If this potential link is discounted, then other reasons for the relationship between visceral fat and insulin resistance must be considered. One is that there is no direct causal link, but both co-correlate with some other variable. A possibility is that this other variable is subcutaneous abdominal fat, which usually outweighs intra-abdominal fat several-fold. Subcutaneous fat probably plays the major role in determining systemic plasma non-esterified fatty acid concentrations, which are relevant in determining insulin resistance. In conclusion, there is at present no proof of a causal link between visceral fat accumulation and insulin resistance, or the associated metabolic syndrome. The possibility of co-correlation with some other factor, such as subcutaneous abdominal fat accumulation, must not be forgotten.

Marked impairment of protein tyrosine phosphatase 1B activity in adipose tissue of obese subjects with and without type 2 diabetes mellitus

Protein tyrosine phosphatases (PTPs) are required for the dephosphorylation of the insulin receptor (IR) and its initial cellular substrates, and it has recently been reported that PTP-1B may play a role in the pathogenesis of insulin resistance in obesity and type 2 diabetes mellitus (DM). We therefore determined the amount and activity of PTP-1B in abdominal adipose tissue obtained from lean nondiabetic subjects (lean control (LC)), obese nondiabetic subjects (obese control (OC)), and subjects with both type 2 DM (DM2) and obesity (obese diabetic (OD)). PTP-1B protein levels were 3-fold higher in OC than in LC (1444 +/- 195 U vs 500 +/- 146 U (mean +/- SEM), P < .015), while OD exhibited a 5.5-fold increase (2728 +/- 286 U, P < .01). PTP activity was assayed by measuring the dephosphorylating activity toward a phosphorus 32-labeled synthetic dodecapeptide. In contrast to the increased PTP-1B protein levels, PTP-1B activity per unit of PTP-1B protein was markedly reduced, by 71% and 88% in OC and OD, respectively. Non-PTP-1B tyrosine phosphatase activity was comparable in all three groups. Similar results were obtained when PTP-1B activity was measured against intact human IR. A significant correlation was found between body mass index (BMI) and PTP-1B level (r = 0.672, P < .02), whereas BMI and PTP-1B activity per unit of PTP-1B showed a strong inverse correlation (r = -0.801, P < .002). These data suggest that the insulin resistance of obesity and DM2 is characterized by the increased expression of a catalytically impaired PTP-1B in adipose tissue and that impaired PTP-1B activity may be pathogenic for insulin resistance in these conditions.

Regulation of lipolysis by the sympathetic nervous system: a microdialysis study in normal and spinal cord-injured subjects

To evaluate the regulation of lipolysis by the sympathetic nervous system, eight spinal cord-injured (SCI) subjects with a lesion above T5 resulting in a decentralization of the lower-body sympathetic nervous system and adrenal medulla (age, 36 +/- 2 years; weight, 82 +/- 5 kg; body fat mass, 26.8 +/- 3.0 kg; all mean +/- SE) and nine control subjects (age, 33 +/- 2; weight, 80 +/- 3; NS; body fat mass, 16.1 +/- 1.5 kg; P < .01) were investigated after fasting overnight. Each subject was studied with subcutaneous microdialysis and 133Xe-clearance adipose tissue blood flow (ATBF) in the umbilical and clavicular regions during postabsorptive rest and after sympathoexcitatory stimulation by means of mental stress and isometric handgrip exercise. SCI subjects had an increased body fat mass, hyperinsulinemia, and an elevated lipolytic rate at rest compared with control subjects. ATBF and lipolysis were activated to a normal extent following mental stress and isometric handgrip exercise in the umbilical region in control subjects. ATBF was increased in tissue above but not below the lesion level in SCI subjects following mental stress. Glycerol release was not different between groups in either tissue region despite significantly lower noradrenaline and adrenaline levels in SCI subjects. This finding argues against a significant adrenergic control of the lipolytic rate at rest. Furthermore, the small differences in stimulated glycerol release between groups, as well as the increased plasma glycerol levels in SCI subjects, cast doubt on the view that interruption of adrenergic activity below the lesion is the sole mechanism underlying the increased body fat mass in SCI subjects.

The endocrinology of obesity

Numerous endocrine alterations are associated with obesity (Table 1). The majority of the alterations are secondary to obesity and must be considered simply associated and potentially in the pathogenesis of the complications of obesity. The discovery of new endocrine peptides such as leptin that signal body fat content will increase our understanding of the regulation of body fat content. As a result, therapies will most certainly be developed that are directly targeted at the alterations in endocrine function.

Effect of lipectomy and long-term dexamethasone on visceral fat and metabolic variables in rats

Intraperitoneal (IP) fat accumulation in humans is a risk factor for a number of diseases. We tried to increase this particular adipose mass in rats by long-term administration of low-dose dexamethasone (Dex) and/or elimination of other fat depots. Male adult Wistar rats were lipectomized (Lip) or sham-operated (Sh). Bilateral lipectomy of retroperitoneal and inguinal fat pads was performed under anesthesia with Na pentobarbital 40 mg/kg supplemented with ether. After 8 days, half the animals of each group received Dex in their drinking water (0.1 microgram/mL) while the other half received water (W), for a total of four groups: Sh-W, Lip-W, Sh-Dex, and Lip-Dex. Body weight (BW) and food and water intake were measured throughout the treatment period. A glucose tolerance test was performed 34 days after starting Dex treatment, and then rats were killed, fat depots were weighed, and plasma and liver were obtained for metabolic determinations. Dex rats ate the same amount of food as W controls, but gained significantly less weight (2.02 +/- 0.18 v 3.82 +/- 0.10 g/d, P < .01). Mean daily W intake was approximately 40 mL/d in all groups, which means that Dex rats ingested approximately 4 micrograms/d Dex. Average glycemic values during the 180-minute glucose tolerance test were as follows: Sh-W, 162 +/- 13; Lip-W, 166 +/- 7; Sh-Dex, 118 +/- 6; and Lip-Dex, 229 +/- 27 mg/dL. These values show that glucose tolerance was improved by Dex treatment alone, but was impaired in Lip-Dex animals. The same trend was evident for the relative weights (percent of BW) of two intact adipose depots: IP and epididymal (EPI) (Sh-W, 2.08 +/- 0.13 and 1.35 +/- 0.11, respectively; Lip-W, 1.67 +/- 0.15 and 1.17 +/- 0.11; Sh-Dex, 1.66 +/- 0.10 and 1.28 +/- 0.07; Lip-Dex, 2.41 +/- 0.11 and 1.53 +/- 0.09). Average glycemia for all rats was significantly correlated with IP (r = .55, P < .01) but not with EPI; moreover it was correlated in the Sh-W control group (r = .81, P < .05), suggesting a normal relation between these variables. Liver triglycerides (LTG), which were elevated in Dex rats, were also correlated with IP (r = .51, P < .02 for all rats and r = .82, P < .05 for Sh-W rats). The results show that long-term administration of low-dose Dex has some different effects in normal versus Lip rats concerning mainly the IP fat depot, the relative mass of which seems to significantly affect glucose tolerance.