Evaluation of Visceral and Subcutaneous Fat by Ultrasound and Its Relationship with Clinical and Metabolic Parameters of Insulin Resistance and Subclinical Atherosclerosis


Objective: this study set out to investigate the association between abdominal obesity ultrasound measurements, waist circumference and body mass index (BMI), metabolic syndrome (MS) components and subclinical atherosclerosis. Methods: sixty patients were recruited and divided equally into two groups, according to the presence of MS. All subjects had an ultrasound examination for measurement of visceral and subcutaneous fat thickness and carotid IMT. Results: the values of visceral fat thickness, preperitoneal circumference and carotid IMT were higher in patients with MS than in control subjects. Visceral fat thickness showed significant correlations with many cardiovascular risk factors (waist circumference, BMI, fasting plasma glucose, HDL and LDL cholesterol). All abdominal obesity measurements were correlated with BMI. Carotid IMT showed correlations with age, visceral fat and preperitoneal circumference. Visceral fat was independently associated with systolic and diastolic blood pressures and fasting plasma glucose. Systolic and diastolic blood pressures and BMI were independent determinants of carotid IMT. Conclusion: visceral fat thickness showed the best correlation with MS components, suggesting that it could be a useful parameter in cardiovascular risk assessment. Age, systolic and diastolic blood pressures and BMI were independent determinants of subclinical atherosclerosis. MS was associated with a higher carotid IMT.

Share and Cite:

C. Miranda Prado, G. Augusto de Vasconcelos, E. Tenorio A. M. Godoi, É. Nogueira Bezerra Cavalcanti, T. Matos de Arruda, E. Trovão Diniz, C. Salgado Lucena, L. Griz and F. Bandeira, "Evaluation of Visceral and Subcutaneous Fat by Ultrasound and Its Relationship with Clinical and Metabolic Parameters of Insulin Resistance and Subclinical Atherosclerosis," Open Journal of Endocrine and Metabolic Diseases, Vol. 2 No. 4, 2012, pp. 63-69. doi: 10.4236/ojemd.2012.24010.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] S. M. Grundy, H. B. Brewer Jr. and J. I. Cleeman, “Definition of Metabolic Syndrome. Report of the National Heart, Lung, and Blood Institute/American Heart Association Conference on Scientific Issues Related to Definition,” Circulation, Vol. 109, No. 3, 2004, pp. 443-438. doi:10.1161/01.CIR.0000111245.75752.C6
[2] H. M. Lakka, D. E. Laaksonen, T. A. Lakka, L. K. Niskanem, et al., “The Metabolic Syndrome and Total and Cardiovascular Disease Mortality in Middle-Aged Men,” Journal of American Medical Association, Vol. 288, No. 21, 2002, pp. 2709-2716. doi:10.1001/jama.288.21.2709
[3] H. Gang, Q. Qiao, J. Tuomilehto, B. Balkau, et al., “Prevalence of the Metabolic Syndrome and Its Relation to All Causes and Cardiovascular Mortality in Nondiabetic European Men and Women,” Archives of Internal Medicine, Vol. 164, No. 10, 2004, pp. 1066-1076. doi:10.1001/archinte.164.10.1066
[4] S. Malik, N. Wong, S. S. Franklin, et al., “Impact of the Metabolic Syndrome on Mortality from Coronary Heart Disease, Cardiovascular Disease, and All Causes in United States Adults,” Circulation, Vol. 110, No. 10, 2004, pp. 1245-1250. doi:10.1161/01.CIR.0000140677.20606.0E
[5] Y. He, B. Jiang, J. Wang, et al., “Prevalence of the Metabolic Syndrome and Its Relation to Cardiovascular Disease in an Elderly Chinese Population,” Journal of the American College of Cardiology, Vol. 47, No. 8, 2005, pp. 1588-1594. doi:10.1016/j.jacc.2005.11.074
[6] P. Wilson, R. D’Agostino, H. Parise, et al., “Metabolic Syndrome as a Precursor of Cardioavascular Disease and Type 2 Diabetes Mellitus,” Circulation, Vol. 112, No. 20, 2005, pp. 3066-3072. doi:10.1161/CIRCULATIONAHA.105.539528
[7] A. Scuteri, S. S. Najjar, D. C. Muller, R. Andres, et al., “Metabolic Syndrome Amplifies the Age-Associated Increases in Vascular Thickness and Stiffness,” Journal of the American College of Cardiology, Vol. 43, No. 8, 2004, pp. 1388-1395. doi:10.1016/j.jacc.2003.10.061
[8] E. Bonora, S. Kiechl, J. Willeit, F. Oberhollenzer, et al., “Carotid Atherosclerosis and Coronary Heart Disease in the Metabolic Syndrome,” Diabetes Care, Vol. 26, No. 4, 2003, pp. 1251-1257. doi:10.2337/diacare.26.4.1251
[9] R. Kawamoto, H. Tomita, Y. Oka, A. Kodama, et al., “Metabolic Syndrome Amplifies the LDL-Cholesterol Associated Increases in Carotid Atherosclerosis,” Internal Medicine, Vol. 44, No. 12, 20205, pp. 1232-1238. doi:10.1056/NEJM199901073400103
[10] D. H. O’Leary, J. F. Polak, R. A. Kronmal, T. A. Manolio, et al., “Carotid-Artery Intima Media Thickness as a Risk Factor for Myocardial Infarction and Stroke in Older Adults,” New England Journal of Medicine, Vol. 340, No. 1, 1999, pp. 14-22.
[11] W. S. Tzou, P. S. Douglas, S. R. Srinivasan, M. G. Bond, et al., “Increased Subclinical Atherosclerosis in Young Adults with Metabolic Syndrome,” Journal of the American College of Cardiology, Vol. 46, No. 3, 2005, pp. 457-463. doi:10.1016/j.jacc.2005.04.046
[12] R. H. Y. Yu, S. C. Ho, S. S. Y. Ho, J. L. F. Woo, et al., “Association of General and Abdominal Obesities and Metabolic Syndrome with Subclinical Atherosclerosis in Asymptomatic Chinese Postmenopausal Women,” Menopause, Vol. 15, No. 1, 2008, pp. 185-192.
[13] A. H. Kissebah, N. Vydelingum, R. Murray, et al., “Relation of Body Fat Distribution to Metabolic Complications of Obesity,” The Journal of Clinical Endocrinology and Metabolism, Vol. 54, No. 2, 1982, pp. 254-260. doi:10.1210/jcem-54-2-254
[14] M. P. Reilly and D. J. Rader, “The Metabolic Syndrome: More than the Sum of Its Parts?” Circulation, Vol. 108, No. 13, 2003, pp. 1546-1551. doi:10.1161/01.CIR.0000088846.10655.E0
[15] D. J. Nieves , M. Cnop, B. Retzlaff, et al., “The Atherogenic Lipoprotein Profile Associated with Obesity and Insulin Resistance Is Largely Attributable to Intra-Abdominal Fat,” Diabetes, Vol. 52, No. 1, 2003, pp. 172-179. doi:10.2337/diabetes.52.1.172
[16] K. H. Liu, Y. L. Chan, W. B. Chan, J. C. N. Chan, et al., “Mesenteric Fat Thickness Is an Independent Determinant of Metabolic Syndrome and Identifies Subjects with Increased Carotid Intima-Media Thickness,” Diabetes Care, Vol. 29, No. 2, 2006, pp. 379-384. doi:10.2337/diacare.29.02.06.dc05-1578
[17] S. R. Smith, J. C. Lovejoy, F. Greenway, et al., “Contributions of Total Body Fat, Abdominal Subcutaneous Adipose Tissue Compartments and Visceral Adipose Tissue to the Metabolic Complications of Obesity,” Metabolism, Vol. 50, No. 4, 2001, pp. 425-435. doi:10.1053/meta.2001.21693
[18] K. H. Liu, Y. L. Chan, J. C. N. Chan and W. B. Chan, “Association of Carotid Intima-Media Thickness with Mesenteric, Preperitoneal and Subcutaneous Fat Thickness,” Atherosclerosis, Vol. 179, No. 2, 2005, pp. 299-304. doi:10.1016/j.atherosclerosis.2004.10.038
[19] F. Armellini, M. Zamboni, L. Rigo, T. Todesco, et al., “The Contribution of Sonography to the Measurement of Intra-Abdominal Fat,” Journal of Clinical Ultrasound, Vol. 18, No. 7, 1990, pp. 563-567. doi:10.1002/jcu.1870180707
[20] E. Merino-Ibarra, M. Artieda, A. Cenarro, J. Goicoechea, et al., “Ultrasonography for the Evaluation of visceral Fat and the Metabolic Syndrome,” Metabolism Clinical and Experimental, Vol. 54, No. 9, 2005, pp. 1230-1235. doi:10.1016/j.metabol.2005.04.009
[21] S. M. Grundy, J. I. Cleeman, S. R. Daniels, K. A. Donato, et al., “Diagnosis and Management of the Metabolic Syndrome: An American Heart Association/ National Heart, Lung, and Blood Institute Scientific Statement,” Circulation, Vol. 112, No. 17, 2005, pp. 2735-2752. doi:10.1161/CIRCULATIONAHA.105.169404
[22] R. A. Dehnavi, E. D. Beishuizen, M. A. Van de Ree, S. Le Cessie, et al., “The Impact of Metabolic Syndrome and CRP on Vascular Phenotype in Type 2 Diabetes Mellitus,” European Journal of Internal Medicine, Vol. 19 No. 2, 2008, pp. 115-121. doi:10.1016/j.ejim.2007.06.011
[23] B. Iglseder, P. Cip, L. Malaimare, G. Ladurner, et al., “The Metabolic Syndrome Is a Stronger Risk Factor for Early Carotid Atherosclerosis in Women than in Men,” Stroke, Vol. 36, No. 6, 2005, pp. 1212-1217. doi:10.1161/01.STR.0000166196.31227.91
[24] M. Hassinen, P. Komulainen, T. A. Lakka, et al., “Metabolic Syndrome and the Progression of Carotid Intima-Media Thickness in Elderly Women,” Archives of Internal Medicine, Vol. 166, No. 4, 2006, pp. 444-449.
[25] J. P. Empana, M. Zureik, J. Gariepy, D. Courbon, et al., “The Metabolic Syndrome and the Carotid Artery Structure in Noninstitutionalized Elderly Subjects,” Stroke, Vol. 38, No. 3, 2007, pp. 893-899. doi:10.1161/01.STR.0000257983.62530.75
[26] R. B. Radominski, D. P. Vezozzo, G. G. Cerri and A. Halpern, “O Uso da Ultra-Sonografia na Avaliacao da Distribuicao de Gordura Abdominal,” Arquivos Brasile Endocrinol Metabolism, Vol. 44, No. 1, 2000, pp. 5-12. doi:10.1590/S0004-27302000000100003
[27] N. Sabir, Y. Sermez, S. Kazil and M. Zencir, “Correlation of Abdominal Fat Accumulation and Liver Steatosis: Importance of Ultrasonographic and Anthropometric Measurements,” European Journal of Ultrasound, Vol. 14, No. 2-3, 2001, pp. 121-128. doi:10.1016/S0929-8266(01)00153-7
[28] S. Guldiken, N. Tuncbilek, O. O. Okten, E. Arikan, et al., “Visceral Fat Thickness Determined Using Ultrasonography Is Associated with Anthropometric and Clinical Parameters of Metabolic Syndrome,” International Journal of Clinical Practice, Vol. 60, No. 12, 2006, pp. 1576-1581. doi:10.1111/j.1742-1241.2005.00803.x
[29] E. Meri?o-Ibarra, M. Artieda, A. Cenarro, J. Goicoechea, et al., “Ultrasonography for the Evaluation of Visceral Fat and the Metabolic Syndrome,” Metabolism Clinical and Experimental, Vol. 54, No. 9, 2005, pp. 1230-1235. doi:10.1016/j.metabol.2005.04.009
[30] G. P. Fadini, A. Coracina, S. Inchiostro, A. Tiengo, et al., “A Stepwise Approach to Assess the Impact of Clustering Cardiometabolic Risk Factors on Carotid Intima-Media Thickness: The Metabolic Syndrome No-More-Than-Additive,” European Journal of Cardiovascular Prevention and Rehabilitation, Vol. 15, No. 2, 2008, pp. 190-196. doi:10.1097/HJR.0b013e3282f17bc3
[31] N. Mattsson, T. Ronnemaa, M. Juonala, J. S. A. Viikari, et al., “Arterial Structure and Function in Young Adults with the Metabolic Syndrome: The Cardiovascular Risk in Young Finns Study,” European Heart Journal, Vol. 29, No. 6, 2008, pp. 784-791. doi:10.1093/eurheartj/ehm576

Copyright © 2022 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.