Not All Fat is Created Equal: Stomach Fat and Cardiovascular Disease

Illustration by Amanda Im

Illustration by Amanda Im

Just a few decades ago, researchers and physicians alike assumed that Body Mass Index (BMI) values were a sufficient form of indication to assess the weight profile and well-being of patients. However, as research has continued to explore risk factors for major diseases, it has become increasingly clear that a deeper understanding of specific areas of the body is necessary to provide insight to the patient’s risk level. One of the most directly correlated diseases associated with obesity and high body fat percentage is cardiovascular disease. Cardiovascular diseases of any sort are serious issues that continue to affect an increasing number of Americans every year.

A study conducted by the National Heart Lung and Blood Institute concluded the hypothesis that a lower density of fat is associated with greater risk for heart disease. While this study by no means offers a conclusive causal relationship between abdominal fat and heart disease, it gives insight as to what the next stage of research should examine, and what physicians may potentially wish to focus on when assessing the risk levels of their patients’ for cardiovascular disease.  For the purpose of this study, cardiovascular disease seems to be defined under extremely broad terms, encompassing the likes of both serious and immediate issues like heart attacks or strokes as well as more pedestrian cardiovascular problems such as high blood pressure.

Two forms of fat are present in the abdominal region: subcutaneous and visceral adipose fat. Subcutaneous fat lies just below the skin and is responsible for many of the visual consequences of obesity people generally see from the exterior. Visceral adipose fat on the other hand, lies much deeper under the skin and can extend around the internal organs. As speculated by researchers for many years, the National Heart Lung and Blood Institute’s Framingham Heart Study found a strong correlation between higher body fat percentage and lower density fat (more visceral fat), and risk for heart disease. In this study, 1106 participants were tracked across a 6 year span. The average age of the participants was 45 years old and 44 percent of the participating group were women. The study’s senior researcher, Caroline Fox, explained that “an increase in the amount of stomach fat and a lower density fat is associated with worse heart disease risk factors”. It should be disclaimed that the study used fat density as a proxy for measuring levels of subcutaneous and visceral fat. CT scans were used to scan the abdominal region and determine the adipose density. Here, Fox describes a potential limitation researchers are working to combat, insisting that “[m]easuring fat density is a new measure that we are still working to understand and warrants further investigation”.

While the study produces many questions and fails to offer a definitive explanation for stomach fat and cardiovascular disease, it certainly offers insightful observational content for future research. Further research should aim to focus on whether visceral fat is just the byproduct of a deeper internal working, such as a hypothalamic-pituitary-adrenal axis, or that the visceral adipose is independently harming the functions of vital organs. Furthermore, it has been suggested that ethnic differences should be accounted for as people from different backgrounds may be more prone to gaining visceral adipose tissue than those from other backgrounds. These implications conclusively redirect themselves at the idea that the BMI scale is not enough to fully assess the adiposity of an individual, and further the notion that additional methods of measurement are necessary to achieve understanding of the relationship between stomach fat and cardiovascular disease.


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