Internal and Emergency Medicine

, Volume 5, Issue 2, pp 111–119 | Cite as

Visceral obesity and metabolic syndrome: two faces of the same medal?

  • Rosario ScaglioneEmail author
  • Tiziana Di Chiara
  • Tiziana Cariello
  • Giuseppe Licata
IM - Review


In this review, we have analyzed the role of visceral obesity in the occurrence of metabolic syndrome (MetS). MetS is a common metabolic disorder that has been related recently to the increasing prevalence of obesity. The disorder is defined in various ways, but in the near future a new definition(s) should be applicable worldwide. The pathophysiology has been largely attributed, in the past years, to insulin resistance, although several epidemiological and pathophysiological data now indicate visceral obesity as a main factor in the occurrence of all the components of MetS. In view of this, relationships among visceral obesity, free fatty acids, dyslipidemia and insulin resistance have been reported. In addition, the effects of some adipocytokines and other proinflammatory factors produced by fat accumulation on the occurrence of MetS have been also emphasized. Accordingly, the “hypoadiponectinemia hypothesis” has been proposed as the most interesting to explain the pathophysiology of MetS. The epidemiologic, pathophysiologic and clinical data reported seem to indicate that MetS might be considered a fatal consequence of visceral obesity.


Metabolic syndrome Visceral obesity Adipocytokines Adiponectin 


Conflict of interest statement

The authors declare that they have no conflict of interest related to the publication of this manuscript.


  1. 1.
    Avogaro P, Crepaldi G (1965) Essential hyperlipidemia, obesity and diabetes. Diabetologia 1:137Google Scholar
  2. 2.
    Reaven GM (1988) Banting lecture 1988. Role of insulin resistance in human disease. Diabetes 37:1595–1607CrossRefPubMedGoogle Scholar
  3. 3.
    Bays H, Abate N, Chandalia M (2005) Adiposopathy: sick fat causes high blood sugar, high blood pressure and dyslipidemia. Future Cardiol 1:39–59CrossRefPubMedGoogle Scholar
  4. 4.
    Licata G, Corrao S, Parrinello G, Scaglione R (1996) Obesity and Cardiovascular diseases. Excerpta Med 1:5–166Google Scholar
  5. 5.
    Vague J (1947) La differenciation sexuelle, facteur determinant des formes de l’obesite. Press Med 30:339–340Google Scholar
  6. 6.
    Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW (1999) Body mass index and mortality in a prospective cohort of US adults. N Engl J Med 341:1097–1105CrossRefPubMedGoogle Scholar
  7. 7.
    Kaplan RC, Heckbert SR, Furberg CD, Psaty BM (2002) Predictors of subsequent coronary events, stroke and death among survivors of first hospitalized myocardial infarction. J Clin Epidemiol 55:654–664CrossRefPubMedGoogle Scholar
  8. 8.
    Bergman RN, Kim SP, Hsu IR, Catalano KJ, Chiu JD, Kabir M et al (2007) Abdominal obesity: role in the patophysiology of metabolic disease and cardiovascular risk. Am J Med 120:S3–S8CrossRefPubMedGoogle Scholar
  9. 9.
    Reaven GM (2005) The metabolic syndrome: requiescat in pace. Clin Chem 51:931–938CrossRefPubMedGoogle Scholar
  10. 10.
    Definition and classification of diabetes mellitus and its complications. Report of a WHO document. WHO/NCD/NCS/99. pp 31–33, 1999Google Scholar
  11. 11.
    Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (2001) Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 285:2486–2497Google Scholar
  12. 12.
    Balkau B, Charles MA (1999) Comment on the provisional report from the WHO consultation. European Group for the Study of Insulin Resistance (EGIR). Diabet Med 16:442–443CrossRefPubMedGoogle Scholar
  13. 13.
    Grundy SM (2005) Metabolic syndrome scientific statement by the American Heart Association and the National Heart, Lung, and Blood Institute. Arterioscl Thromb Vasc Biol 25:2243–2244CrossRefPubMedGoogle Scholar
  14. 14.
    Alberti KG, Zimmet P, Shaw J (2006) Metabolic syndrome: a world-wide definition. A consensus statement of the International Diabetes Federation. Diabet Med 23:469–480CrossRefPubMedGoogle Scholar
  15. 15.
    Strazzullo P, Barbaro A, Siani A, Cappuccio FP, Versiero M, Schiattarella P et al (2008) Diagnostic criteria for metabolic syndrome: a comparative analysis in an unselected sample of adult male population. Metabolism 57:355–361CrossRefPubMedGoogle Scholar
  16. 16.
    Matsuzawa Y (2006) The metabolic syndrome and adipocytokines. FEBS 580:2917–2921CrossRefGoogle Scholar
  17. 17.
    Galletti F, Barbato A, Versiero M, Iacone R, Russo O, Barba G et al (2007) Circulating leptin levels predict the development of metabolic syndrome in middle-aged men: an 8 year follow-up study. J Hypert 25:1671–1677CrossRefGoogle Scholar
  18. 18.
    Yaney GC, Corkey BE (2003) Fatty acid metabolism and insulin secretion in pancreatic beta cells. Diabetologia 46:1297–1312CrossRefPubMedGoogle Scholar
  19. 19.
    Dandona P, Aljada A, Chaudhuri A, Mohanty P, Garg R (2005) Metabolic syndrome. A comprehensive perspective based on interactions between obesity, diabetes and inflammation. Circulation 111:1448–14542CrossRefPubMedGoogle Scholar
  20. 20.
    Licata G, Scaglione R, Avellone G, Ganguzza A, Corrao S, Arnone S et al (1995) Haemostatic function in young subjects with central obesity: relationship with left ventricular function. Metabolism 44:1417–1421CrossRefPubMedGoogle Scholar
  21. 21.
    Licata G, Di Chiara T, Licata A, Triolo G, Argano C, Parrinello G et al (2003) Relationship between circulating E-selectin, DD genotype of angiotensin converting enzyme, and cardiovascular damage in central obese subjects. Metabolism 52:999–1004CrossRefPubMedGoogle Scholar
  22. 22.
    Licata G, Volpe M, Scaglione R, Rubattu S (1994) Salt regulating hormones in young normotensive obese subjects. Effects of saline load. Hypertension 23(Suppl I):20–24Google Scholar
  23. 23.
    Scaglione R, Dichiara MA, Indovina A, Lipari R, Ganguzza A, Parrinello G, Capuana G, Merlino G, Licata G (1992) Left ventricular diastolic and systolic function in normotensive obese subjects: influence of degree and duration of obesity. Eur Heart J 13:738–742PubMedGoogle Scholar
  24. 24.
    Licata G, Scaglione R, Paterna S, Parrinello G, Indovina A, Dichiara MA, Alaimo G, Merlino G (1992) Left ventricular function response to exercise in normotensive obese subjects: influence of degree and duration of obesity. Int J Cardiol 37:223–230CrossRefPubMedGoogle Scholar
  25. 25.
    Galletti F, Strazzullo P (2007) Involvement of the renin-angiotensin system in obesity: older and newer patways. NMCD 17:699–674Google Scholar
  26. 26.
    Sarzani R, Salvi F, Dessì-Fulgheri P, Rappelli A (2008) Renin-angiotensin system, natriuretic peptides, obesity, metabolic syndrome and hypertension: an integrated view in humans. J Hypert 26:831–843CrossRefGoogle Scholar
  27. 27.
    Takahashi M, Arita Y, Yamagata K (2000) Genomic structure and mutations in adipose-specific gene, adiponectin. Int J Obes Rel Metab Disord 24:861–868CrossRefGoogle Scholar
  28. 28.
    Kadowaki T, Yamauchi T (2005) Adiponectin and adiponectin receptors. Endocrine Rev 26:439–451CrossRefGoogle Scholar
  29. 29.
    Ouchi N, Ohishi M, Kihara S, Funahashi T, Nakamura T, Nagaretani H et al (2003) Association of hypoadiponectinemia with impaired vasoreactivity. Hypertension 42:231–232CrossRefPubMedGoogle Scholar
  30. 30.
    Shibata R, Ouchi N, Ito M, Kihara S, Shiojima I, Pimentel DR et al (2004) Adiponectin-mediated modulation of hypertrophic signals in the heart. Nat Med 10:1384–1389CrossRefPubMedGoogle Scholar
  31. 31.
    Tarquini R, Lazzeri C, Laffi G, Genuini GF (2007) Adiponectin and the cardiovascular system: from risk to disease. Intern Emerg Med 2:165–176CrossRefPubMedGoogle Scholar
  32. 32.
    Hu E, Liang P, Spiegelman BM (1996) AdipoQ is a novel adipose-specific gene dysregulated in obesity. J Biol Chem 271:10697–10703CrossRefPubMedGoogle Scholar
  33. 33.
    Arita Y, Kihara S, Ouchi N, Takahashi M, Maeda K, Miyagawa J et al (1999) Paradoxical decrease of an adipose-specific protein, adiponectin, in obesity. Biochem Biophys Res Commun 257:79–83CrossRefPubMedGoogle Scholar
  34. 34.
    Weyer C, Funahashi T, Tanaka S, Hotta K, Matsuzawa Y, Pratley RE et al (2001) Hypoadiponectinemia in obesity and type 2 diabetes: close association with insulin resistance and hyperinsulinemia. J Clin Endocrinol Metab 86:1930–1935CrossRefPubMedGoogle Scholar
  35. 35.
    Halleux CM, Takahashi M, Delporte ML, Detry R, Funahashi T, Matsuzawa Y et al (2001) Secretion and regulation of apM 1 gene expression in human visceral adipose tissue. Biochem Biophys Res Commun 288:1102–1107CrossRefPubMedGoogle Scholar
  36. 36.
    Maeda N, Takanashi M, Funashashi T, Kihara S, Nishizawa H, Kishida K et al (2001) PPAR gamma ligands increase expression and plasma concentration of adiponectin, an adipose-derived protein. Diabetes 50:2094–2099CrossRefPubMedGoogle Scholar
  37. 37.
    Diez JJ, Iglesias P (2003) The role of novel adipocyte-derived hormone adiponectin in human disease. Eur J Endocrinol 148:293–300CrossRefPubMedGoogle Scholar
  38. 38.
    Shargorodsky M, Boaz M, Goldberg Y, Matas Z, Gavish D, Fux A, Wolfson N (2009) Adiponectin and vascular properties in obese patients: is it a novel biomarker of early atherosclerosis? Int J Obes 33:553–558CrossRefGoogle Scholar
  39. 39.
    Pischon T, Girman CJ, Hotamisligil GS, Rifai N, Hu FB, Rimm EB (2004) Plasma adiponectin levels and risk of myocardial infarction in men. JAMA 291:1730–1737CrossRefPubMedGoogle Scholar
  40. 40.
    Kumada M, Kihara S, Sumitsuji S, Kawamoto T, Matsumoto S, Ouchi N et al (2003) Association of hypoadiponectinemia with coronary artery disease in men. Arterioscl Thromb Vasc Biol 23:85–89CrossRefPubMedGoogle Scholar
  41. 41.
    Zoccali C, Mallamaci F, Tripepi G, Benedetto FA, Cutrupi S, Parlongo S et al (2002) Adiponectin, metabolic risk factors, and cardiovascular events among patients with end-stage renal disease. J Am Soc Nephrol 13:134–141CrossRefPubMedGoogle Scholar
  42. 42.
    Koenig W, Khuseyinova N, Baumert J, Meisinger C, Lowel H (2006) Serum concentration of adiponectin and risk of type 2 diabetes mellitus and coronary heart disease in apparently healthy middle-aged men: results from the 18-year follow-up of a large cohort from southern Germany. JACC 48:1369–1372PubMedGoogle Scholar
  43. 43.
    Frystyk J, Berne C, Berglund L, Jensevik K, Flyvbjerg A, Zetelius B (2007) Serum adiponectin is a predictor of coronary heart disease: a population-based 10-year follow-up study in elderly men. J Clin Endocrinol Metab 92:571–576CrossRefPubMedGoogle Scholar
  44. 44.
    Sattar N, Wannamethee G, Sarwar N, Tchernova J, Cherry L, Wallace AM et al (2006) Adiponectin and coronary heart disease: a prospective study and meta-analysis. Circulation 114:623–629CrossRefPubMedGoogle Scholar
  45. 45.
    Lawlor DA, Dawey Smith G, Ebrahim S, Thompson C, Sattar N (2005) Plasma adiponectin levels are associated with insulin resistance, but do not predict future risk of coronary heart disease in women. J Clin Endocrinol Metab 90:5677–5683CrossRefPubMedGoogle Scholar
  46. 46.
    Yang WS, Yang YC, Chen CL, Wu IL, Lu JK, Lu FH et al (2007) Adiponectin SNP276 is associated with obesity, the metabolic syndrome, and diabetes in the elderly. Am J Clin Nutr 86:509–513PubMedGoogle Scholar
  47. 47.
    Vozarova B, Stefan N, Lindsay RS, Krakoff J, Knowler WC, Funahashi T et al (2002) Low plasma adiponectin concentration do not predict weight gain in humans. Diabetes 51:2964–2967CrossRefPubMedGoogle Scholar
  48. 48.
    Duncan BB, Scmidt ML, Pankow JS, Bang H, Couper D, Ballantyne CN et al (2004) Adiponectin and the development of type 2 diabetes in the atherosclerosis risk in communities study. Diabetes 53:2473–2478CrossRefPubMedGoogle Scholar
  49. 49.
    Yang WS, Jeng CY, Wu TJ, Tanaka S, Funahashi T, Matsuzawa Y et al (2002) Synthetic peroxisome proliferators-activated receptor gamma agonist, rosiglitazone, increases plasma levels of adiponectin in type 2 diabetic patients. Diabetes Care 25:376–380CrossRefPubMedGoogle Scholar
  50. 50.
    Furuhashi M, Ura N, Higashiura K, Murakami H, Tanaka M, Moniwa N et al (2003) Blockade of the renin-angiotensin system increases adiponectin concentration in patients with essential hypertension. Hypertension 42:76–81CrossRefPubMedGoogle Scholar

Copyright information

© SIMI 2009

Authors and Affiliations

  • Rosario Scaglione
    • 1
    Email author
  • Tiziana Di Chiara
    • 1
  • Tiziana Cariello
    • 1
  • Giuseppe Licata
    • 1
  1. 1.Dipartimento Bio-Medico di Medicina Interna e SpecialisticaUniversity of PalermoPalermoItaly

Personalised recommendations