One of the most significant cardiovascular risk factors is obesity, particularly central obesity. Abdominal fat comprises abdominal subcutaneous and intra-abdominal (visceral) fat. In addition to an alarming rise in the prevalence of diabetes mellitus, chronic renal disease, and obstructive sleep apnoea (OSA), there is an epidemic of obesity and obesity-related cardiovascular diseases (CVD), which reduces life expectancy and adds to the health and societal burden globally. Numerous cardiometabolic disorders, such as hypertension, dyslipidaemia (imbalance of lipids), glucose intolerance, and even cardiovascular disease, have been linked to obesity. In particular, metabolic syndrome, CVD, or both may be significantly influenced by visceral obesity as opposed to total obesity. As a result, estimating visceral fat accumulation is critical for identifying people at high risk for CVD. The waist-hip ratio (WHR) determines the regional distribution of adipose tissue, which appears to be less closely related to the amount of abdominal visceral adipose tissue and more dependent on the degree of obesity. The extension of abdominal obesity, which appears to be closely linked to abdominal visceral adipose tissue deposition, is determined by waist circumference, a convenient and straightforward measurement unrelated to height and correlated with BMI and WHR (1).

South Asians have a higher rate of abdominal obesity than general adiposity, in contrast to whites, who have a slightly higher rate of abdominal adiposity, and blacks, who have a lower rate of abdominal obesity than general obesity.

General obesity versus abdominal obesity:

Adipose tissue accumulates in three areas of the abdomen: (i) subcutaneous fat, (ii) retroperitoneal fat, and (iii) visceral fat. However, visceral fat is thought to be the most atherogenic, diabetogenic, and hypertensive fat depot in the human body. Because of its anatomical location and the increased supply of free fatty acids to the liver via portal venous drainage, visceral fat is particularly harmful (2).

Even though the relative importance of general and abdominal obesity is still being debated, abdominal obesity is thought to be the most atherogenic type of adiposity because it appears to promote a cluster of atherogenic risk factors associated with insulin resistance. Although body mass index (BMI) influences coronary heart disease (CHD) risk, abdominal obesity, as measured by waist circumference or waist-hip ratio, has been shown to be a strong predictor of CHD independent of overall obesity. Furthermore, obesity markers such as BMI, waist size, and waist-hip ratio have a positive relationship with major cardiovascular risk factors such as hypertension, metabolic diseases such as diabetes, and dyslipidaemia (imbalance of lipids).

Prevention and Control:

The World Health Organisation (WHO) has made noncommunicable disease prevention and control a global priority, and obesity management is an important component of the strategy in place. Obesity is also becoming more common in children and adolescents. Obesity at this age appears to predispose adults to obesity and cardiovascular diseases (CVD). The significance of early intervention for childhood obesity in the prevention of adult CVD must be emphasized. Adolescent risk stratification could help clinicians identify overweight youth who are at a higher risk of developing pre-diabetes, diabetes, or CVD and lead to timely intervention.

Obesity management should include a wide range of long-term strategies, including weight loss, weight maintenance, and management of obesity-related comorbidities. It also necessitates both a population-based and an individual-based approach. The community-based effort should include schools and the media, while the individual approach should include a multidisciplinary strategy involving physicians, exercise specialists, dieticians, nurses, and other healthcare personnel. Furthermore, strategies must be cost-effective, culturally sensitive, and adaptable to local practices, and messages must be simple and easy to implement in South Asian countries with limited health resources, widespread illiteracy, and blind beliefs (3).

References:

  1. Raghu Teja, K. J. S. S., Durgaprasad, B. K., & Vijayalakshmi, P. (2021). Evaluation and Comparative Correlation of Abdominal Fat Related Parameters in Obese and Non-obese Groups Using Computed Tomography. Current medical imaging, 17(3), 417–424. https://doi.org/10.2174/1573405616666201008145801
  2. Prasad, D. S., Kabir, Z., Dash, A. K., & Das, B. C. (2011, December 2). Abdominal obesity, an independent cardiovascular risk factor in Indian subcontinent: A clinico epidemiological evidence summary. PubMed Central (PMC). Retrieved December 9, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3224439/
  3. Błaszczyk-Bębenek, E., Piórecka, B., Płonka, M., Chmiel, I., Jagielski, P., Tuleja, K., & Schlegel-Zawadzka, M. (2019, May 17). Risk Factors and Prevalence of Abdominal Obesity among Upper-Secondary Students. PubMed Central (PMC). Retrieved December 9, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6572187/