NORFOLK, Va. Doctors
at Eastern Virginia Medical Schools
Strelitz Diabetes Center have been studying
weightloss surgery patients to determine
if certain types of fat are more likely
to result in the development of negative
health factors such as Type 2 diabetes and
cardiovascular disease.
Their findings were presented at the American
Diabetes Association meeting in Orlando,
Fla., June 27. The study is being conducted
in conjunction with Stephen G. Wohlgemuth,
MD, medical director of bariatric surgery
at Sentara Norfolk General Hospitals
Metabolic & Weight Loss Surgery Center
and assistant professor of clinical surgery
at EVMS.
The primary goal of the study is to
identify important new factors in visceral
fat that might explain the link between
obesity, diabetes and heart disease,
explains Jerry Nadler, MD, director of the
EVMS Strelitz Diabetes Center and chair
of internal medicine.
Initial data indicate that people with diabetes
have increased levels of an inflammatory
enzyme called lipoxygenase in their visceral
fat that is fat surrounding their
internal organs. According to Dr. Wohlgemuth,
people with large amounts of visceral fat
are more likely to have metabolic syndrome
(high blood pressure, high cholesterol,
insulin resistance) relative to people with
primarily subcutaneous fat fat lying
directly under the skin layers such
as cellulite. People with large amounts
of visceral fat generally have large bellies
and are an apple shape; individuals with
larger amounts of subcutaneous fat are typically
a pear shape with a bigger bottom and thighs.
The doctors believe that inflammation is
a key factor in the development of diabetes,
and the presence of these proteins may explain
why visceral fat is linked to Type 2 diabetes
and cardiovascular disease.
For a long time, people thought that
fat cells just stored excess calories for
energy, but theyre actually very productive
cells, says David Lieb, MD, assistant
professor at the Diabetes Center and a co-author
of the abstract. They [fat cells]
may make good and bad things. We think that
they likely make bad things (inflammation)
when people gain excess weight people
get sick because their fat cells are stressed.
Individuals with Type 2 diabetes are
at increased risk for developing cardiovascular
disease, and have two to four times the
risk for developing heart disease compared
to people without diabetes. We know that
increased visceral fat increases the risk
for cardiovascular disease and diabetes.
Currently it is unclear why this occurs,
our goal is to find out, Dr. Lieb
says.
To accomplish this, the researchers are
working to identify the different hormones
and inflammatory proteins (lipoxygenases)
found in obese individuals, with and without
diabetes, before and after their surgical
procedure. We found lipoxygenase in
both the blood vessels and immune cells
of visceral fat, says Anca D. Dobrian,
PhD, assistant professor of physiological
sciences and lead author of the study. We
are currently following up with additional
research to investigate both the mechanisms
that contribute to visceral fat inflammation
and cardiovascular complications.
Dobrian and the research team anticipate
that these studies will translate well into
treatments for patients with diabetes and
cardiovascular disease.