J Korean Med Sci.  2011 Jun;26(6):771-777. 10.3346/jkms.2011.26.6.771.

Impact of Visceral Adiposity Measured by Abdominal Computed Tomography on Pulmonary Function

• Park YS
• Kwon HT
• Hwang SS
• Choi SH
• Cho YM
• Lee J
• Yim JJ

• KMID: 1785963
• DOI: http://doi.org/10.3346/jkms.2011.26.6.771

Abstract

Although an inverse relationship between abdominal adiposity and pulmonary function has been suggested, direct measurement of abdominal adipose tissue has rarely been attempted. Our object is to determine the impact of abdominal adiposity on pulmonary function by directly measuring abdominal adipose tissue with abdominal computed tomography (CT). In this cross-sectional study, we included never-smokers between the ages of 18 and 85 yr, who had undergone spirometry and abdominal adipose tissue analysis with CT scans during November 1, 2005 to October 31, 2009 as part of the comprehensive health examination. Among a total of 3,469 participants, 890 (25.7%) were male. The mean body mass index and waist circumference among males and females were 24.6 kg/m2 and 87.8 cm and 23.0 kg/m2 and 83.0 cm, respectively. Although total adipose tissue (TAT) of the abdomen in males (269.1 cm2) was similar to that in females (273.6 cm2), the ratio of visceral adipose tissue (VAT)/subcutaneous adipose tissue (SAT) was different; 0.99 in males and 0.50 in females. In males, TAT, SAT, and VAT were inversely associated with the absolute value of forced vital capacity (FVC), and TAT and VAT were inversely associated with forced expiratory volume in one second (FEV1). However, in females, TAT and VAT, but not SAT, were inversely associated with absolute FVC and FEV1 values. In conclusion, the amount of abdominal adipose tissue directly measured using CT is inversely associated with lung function.

Keyword

Obesity; Intra-Abdominal Fat; Pulmonary function; CT scan

MeSH Terms

*Adiposity
Adolescent
Adult
Aged
Aged, 80 and over
Cross-Sectional Studies
Female
Humans
Intra-Abdominal Fat/*radiography
Lung/*physiology
Male
Middle Aged
Radiography, Abdominal
Smoking
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 The measurement of abdominal adiposity using CT imaging of the abdomen. Visceral adipose tissue area (A) and total adipose tissue area (B) were measured using CT image of the abdomen at the umbilicus level.

• 

  Fig. 2 Participants in this study. *Healthcare System Gangnam Center; †Health Promotion/Disease Prevention Center.

• 

  Fig. 3 Scatter plot of predicted forced vital capacity (FVC % pred.) and predicted forced expiratory volume in 1 sec (FEV1 % pred.) according to the amount of visceral adipose tissue in overweight population (BMI > 23 kg/m2). Both predicted FVC (%) (A, B) and FEV1 (%) (C, D) show negative correlation with the amount of visceral adipose tissue.

Reference

1. Obesity and overweight. Fact sheet No. 311. World Health Organization. accessed on 18 Mar 2011. Available at http://www.who.int/mediacentre/factsheets/fs311/en/index.html.

2. McClean KM, Kee F, Young IS, Elborn JS. Obesity and the lung. 1. Epidemiology. Thorax. 2008. 63:649–654.

3. Ochs-Balcom HM, Grant BJ, Muti P, Sempos CT, Freudenheim JL, Trevisan M, Cassano PA, Iacoviello L, Schünemann HJ. Pulmonary function and abdominal adiposity in the general population. Chest. 2006. 129:853–862.

4. Chen Y, Rennie D, Cormier YF, Dosman J. Waist circumference is associated with pulmonary function in normal-weight, overweight, and obese subjects. Am J Clin Nutr. 2007. 85:35–39.

5. Leone N, Courbon D, Thomas F, Bean K, Jégo B, Leynaert B, Guize L, Zureik M. Lung function impairment and metabolic syndrome: the critical role of abdominal obesity. Am J Respir Crit Care Med. 2009. 179:509–516.

6. Zavorsky GS, Murias JM, Kim DJ, Gow J, Sylvestre JL, Christou NV. Waist-to-hip ratio is associated with pulmonary gas exchange in the morbidly obese. Chest. 2007. 131:362–367.

7. Samaras K, Botelho NK, Chisholm DJ, Lord RV. Subcutaneous and visceral adipose tissue gene expression of serum adipokines that predict type 2 diabetes. Obesity (Silver Spring). 2010. 18:884–889.

8. Oka R, Miura K, Sakurai M, Nakamura K, Yagi K, Miyamoto S, Moriuchi T, Mabuchi H, Koizumi J, Nomura H, Takeda Y, Inazu A, Nohara A, Kawashiri MA, Nagasawa S, Kobayashi J, Yamagishi M. Impacts of visceral adipose tissue and subcutaneous adipose tissue on metabolic risk factors in middle-aged Japanese. Obesity (Silver Spring). 2010. 18:153–160.

9. Preis SR, Massaro JM, Robins SJ, Hoffmann U, Vasan RS, Irlbeck T, Meigs JB, Sutherland P, D'Agostino RB Sr, O'Donnell CJ, Fox CS. Abdominal subcutaneous and visceral adipose tissue and insulin resistance in the Framingham heart study. Obesity (Silver Spring). 2010. 18:2191–2198.

10. Babb TG, Wyrick BL, DeLorey DS, Chase PJ, Feng MY. Fat distribution and end-expiratory lung volume in lean and obese men and women. Chest. 2008. 134:704–711.

11. Sutherland TJ, Goulding A, Grant AM, Cowan JO, Williamson A, Williams SM, Skinner MA, Taylor DR. The effect of adiposity measured by dual-energy X-ray absorptiometry on lung function. Eur Respir J. 2008. 32:85–91.

12. WHO/IASO/IOTF. The Asia-Pacific perspective: redefining obesity and its treatment. 2000. International Obesity Task Force.

13. WHO. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000. 894:i–xii. 1–253.

14. Haffner SM, Miettinen H, Stern MP. The homeostasis model in the San Antonio Heart Study. Diabetes Care. 1997. 20:1087–1092.

15. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972. 18:499–502.

16. Chung SJ, Kim D, Park MJ, Kim YS, Kim JS, Jung HC, Song IS. Metabolic syndrome and visceral obesity as risk factors for reflux oesophagitis: a cross-sectional case-control study of 7078 Koreans undergoing health check-ups. Gut. 2008. 57:1360–1365.

17. American Thoracic Society. Standardization of Spirometry, 1994 Update. American Thoracic Society. Am J Respir Crit Care Med. 1995. 152:1107–1136.

18. Choi JK, Paek D, Lee JO. Normal predictive values of spirometry in Korean population. Tuberc Respir Dis. 2005. 58:230–242.

19. Suganami T, Ogawa Y. Adipose tissue macrophages: their role in adipose tissue remodeling. J Leukoc Biol. 2010. 88:33–39.

20. Weisberg SP, McCann D, Desai M, Rosenbaum M, Leibel RL, Ferrante AW Jr. Obesity is associated with macrophage accumulation in adipose tissue. J Clin Invest. 2003. 112:1796–1808.

21. Xu H, Barnes GT, Yang Q, Tan G, Yang D, Chou CJ, Sole J, Nichols A, Ross JS, Tartaglia LA, Chen H. Chronic inflammation in fat plays a crucial role in the development of obesity-related insulin resistance. J Clin Invest. 2003. 112:1821–1830.

22. Fontana L, Eagon JC, Trujillo ME, Scherer PE, Klein S. Visceral fat adipokine secretion is associated with systemic inflammation in obese humans. Diabetes. 2007. 56:1010–1013.

23. Kuhn C 3rd, Homer RJ, Zhu Z, Ward N, Flavell RA, Geba GP, Elias JA. Airway hyperresponsiveness and airway obstruction in transgenic mice. Morphologic correlates in mice overexpressing interleukin (IL)-11 and IL-6 in the lung. Am J Respir Cell Mol Biol. 2000. 22:289–295.

24. Neveu WA, Allard JL, Raymond DM, Bourassa LM, Burns SM, Bunn JY, Irvin CG, Kaminsky DA, Rincon M. Elevation of IL-6 in the allergic asthmatic airway is independent of inflammation but associates with loss of central airway function. Respir Res. 2010. 11:28.

25. Landbo C, Prescott E, Lange P, Vestbo J, Almdal TP. Prognostic value of nutritional status in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999. 160:1856–1861.

26. Lim SY, Rhee EJ, Sung KC. Metabolic syndrome, insulin resistance and systemic inflammation as risk factors for reduced lung function in Korean nonsmoking males. J Korean Med Sci. 2010. 25:1480–1486.

27. Oka R, Miura K, Sakurai M, Nakamura K, Yagi K, Miyamoto S, Moriuchi T, Mabuchi H, Yamagishi M, Takeda Y, Hifumi S, Inazu A, Nohara A, Kawashiri MA, Kobayashi J. Comparison of waist circumference with body mass index for predicting abdominal adipose tissue. Diabetes Res Clin Pract. 2009. 83:100–105.

28. He H, Ni Y, Chen J, Zhao Z, Zhong J, Liu D, Yan Z, Zhang W, Zhu Z. Sex difference in cardiometabolic risk profile and adiponectin expression in subjects with visceral fat obesity. Transl Res. 2010. 155:71–77.

29. Ditomasso D, Carnethon MR, Wright CM, Allison MA. The associations between visceral fat and calcified atherosclerosis are stronger in women than men. Atherosclerosis. 2010. 208:531–536.