Saturday, April 25, 2015

Battling Fat W/ Fat: Subcutaneous Fat Implant Improves Glucose Tolerance and Alleviates Inflammation | Plus: Beware of the Potential Ill Health Effects of Liposuction

BMI is not a good predictor of metabolic health. One reason it isn't is the differential contribution of visceral and subcutaneous body fat on diabesity an CVD risk. The rodent study at hand demonstrates that quite drastically.
It is absolute bogus to deny the contribution of the ever-increasing amount of fat many of us are carrying around day by day to all sorts of potentially fatal diseases. In that, it is yet important to differentiate between the accumulation of intra-abdominal or visceral adipose tissue (VAT) which is associated with type 2 diabetes, dyslipidaemia and hypertension and high amounts of subcutaneous fat which are (comparatively "benign").

As Hocking et al. (2014) highlight in their latest paper, "[t]his relationship [between VAT, type 2 diabetes, dyslipidaemia and hypertension] was originally attributed to increased NEFA [non-esterified fatty acid] flux from VAT into the portal circulation" (Hocking. 2014).
HIIT is an excellent way to shed both subcutaneous and visceral body fat!

Never Train To Burn Calories!

Tabata = 14.2kcal /min ≠ Fat Loss

30s Intervals + 2:1 Work/Rec.

Making HIIT a Hit Part I/II

Making HIIT a Hit Part II/II

HIIT Ain't For Everyone
A closer look at the low relative contribution of VAT to the total NEFA concentration in our blood does yet suggest that other factors, such as the proinflammatory cytokine production that is particularly pronounced in visceral (vs. subcutaneous) would be at least as important as the constant efflux of non-esterified fatty acids.

To probe the differential acute and chronic effects of subcutaneous (non-inflammatory) and visceral adipose tissue on glucose metabolism and whole body inflammation, researchers from the Garvan Institute of Medical Research in Australia conducted an interesting experiment in which they performed time course studies to investigate the short- and long-term effects of inguinal subcutaneous→visceral (SubQ→Vis) and  epididymal visceral→visceral (Vis→Vis) adipose tissue transplantation in HFD-fed mice.
Figure 1: The transplantation of subcutaneous fat into the intra-abdominal cavity of the mice did not just improve the glucose tolerance it did also (albeit non-significantly) blunt the HFD-induced weight gain (Hocking. 2014).
Yes, it may sound hilarious, but instead of removing intra-abdominal fat, the scientists transplanted subcutaneous or visceral fat into the abdominal cavity of their lab animals. Ca. 150-225mg of fat that's tantamount to 13% of their total body fat that was thus redistributed.
Yes, the study at hand does also underline the fallacies of liposuction: Unlike lifestly-induced weight loss that will target both visceral and subcutaneous body fat (for the obese the visceral fat will usually go first), liposuction will remove only subcutaneous fat. It is thus not surpFrising that liposuctions will have no effect on insulin action and risk factors for coronary heart disease (Klein. 2004). With significant increases of 16% (range 13 to 21 percent) in women and 13 (10-17%) of the visceral to subcutaneous fat ratio, as they were observed by Matarasso et al. (1998), and post-liposuction gains in total visceral fat, the removal of unaesthetic subcutaneous fat may eventually even worsen a patients' metabolic health (assuming the liposuction is not complemented by profound lifestyle changes | no energy surplus, no fat gain!).
Now, what is intriguing, though, is that "sick" were only those rodents who had been transplanted with metabolically active and highly inflammatory visceral fat. The rodents who harbored an additional 13% of formerly subcutaneous fat in their abdominal cavity actually experienced significant improvements in glucose tolerance and inflammation within the 6 week post-transplantation study period and that despite the fact that they received the same obesogenic high energy + high fat diet as the rodents who were sham operated or received visceral donor fat.

A closer examination of the underlying mechanisms revealed that the SAT transplantation prevented HFD-induced hepatic triacylglycerol accumulation and normalised the expression of hepatic gluconeogenic enzymes.
"Grafted fat displayed a significant increase in glucose uptake and unexpectedly, an induction of skeletal muscle-specific gene expression. Mice receiving subcutaneous fat also displayed a marked reduction in the plasma concentrations of several proinflammatory cytokines (TNF-α, IL- 17, IL-12p70, monocyte chemoattractant protein-1 [MCP-1] and macrophage inflammatory protein-1β [ΜIP-1β]), compared with sham-operated mice. Plasma IL-17 and MIP-1β concentrations were reduced from as early as 4 weeks after transplantation, and differences in plasma TNF-α and IL-17 concentrations predicted glucose tolerance and insulinaemia in the entire cohort of mice (n=40)" (Hocking. 2014).
That's in contrast, mice receiving visceral fat transplants who were glucose intolerant, with increased hepatic triacylglycerol content and elevated plasma IL-6 concentrations.
Being heavy is not the problem. The problem is being fat. Even if your BMI is in rance, men and women with body fat levels >25% / 35%, respectively have significantly increased risks of developing one or all of the central features of metabolic syndrome (Oliveros. 2014) 
Is this a viable treatment option for humans? Probably not, but the results of the study at hand highlight the often overlooked of invisible intra-abdominal fat. Specifically women appear to be at high risk of being "skinny at" or "normalweight obese", which means that they have a normal BMI but body fat levels far above the normal range of <30%. As the data from a 2014 study by scientists from the Mayo Clinic in Rochester indicates, their risk of suffering from one or even all of the features of the metabolic syndrome is significantly increased.

Specifically for this group of subjects, a subcutaneous → visceral fat transplant may actually alleviate he symptoms, but whether that's a sensible treatment option is more than questionable. Rather than that, diet and exercise the unbeloved standard recommendations are still the way to go. In conjunction they are the #1 visceral fat burner - with meds being necessary only for the severely obese to bring the into a situation where they are actually able to adhere to the necessary lifestyle interventions | Comment on Facebook!
References:
  • Hocking, Samantha L., et al. "Subcutaneous fat transplantation alleviates diet-induced glucose intolerance and inflammation in mice." Obesity Research & Clinical Practice 8 (2014): 99-100.
  • Klein, Samuel, et al. "Absence of an effect of liposuction on insulin action and risk factors for coronary heart disease." New England Journal of Medicine 350.25 (2004): 2549-2557.
  • Matarasso, Alan, Richard W. Kim, and John G. Kral. "The impact of liposuction on body fat." Plastic and reconstructive surgery 102.5 (1998): 1686-1689.
  • Oliveros, Estefania, et al. "The concept of normal weight obesity." Progress in cardiovascular diseases 56.4 (2014): 426-433.