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Impact of different ectopic fat depots on cardiovascular and metabolic diseases
Abstract
A growing body of evidence is pointing out the pathophysiological role of fat accumulation in different organs. Ectopic fat depots within heart, liver, skeletal muscle, kidney, and pancreas as well as around blood vessels might be more associated to cardiometabolic risk than classical variables, such as body mass index. Among different mechanisms, lipid metabolism appears to be particularly influenced by ectopic fat depots. Indeed, intracellular accumulation of nonesterified fatty acids, and triglycerides promotes endoplasmic reticulum stress, mitochondrial uncoupling, oxidative stress, and altered membrane composition/function, finally promoting inflammatory response and cell death. The dysfunctional adipose tissue was shown to induce both local and systemic effects, with relevant clinical consequences. Epicardial fat and myocardial steatosis have been associated with the development of atrial fibrillation and ventricular dysfunction. Similarly perivascular adipose tissue appears to trigger atherosclerosis and hypertension. Nonalcoholic fatty liver disease has been recognized both as the hepatic manifestation of metabolic syndrome and as a cardiovascular (CV) risk factor. Importantly, the renal sinus fat emerged as a potential player in kidney dysfunction. Finally, both skeletal muscle and pancreatic fat depots have been indicated as potential endocrine modulators of insulin resistance. Considering the global rise in the prevalence of obesity, the understanding of mechanisms underlying ectopic fat accumulation represents an urgent need, with potential clinical implications for CV risk stratification. Here, we attempt to update the current knowledge of the different ectopic fat depots, focusing on underlying mechanisms and potential clinical implications.
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“The consequent heart overfeeding may promote a myocardial steatosis that has been associated with the development of ventricular dysfunction [87].”
From Dysregulated epicardial adipose tissue as a risk factor and potential therapeutic target of heart failure with preserved ejection fraction in diabetes (2022) · cites this paper as [87]
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Associations of renal sinus fat with blood pressure and ectopic fat in a diverse cohort of adults
Couch, C. A., Fowler, L. A., Goss, A. M., & Gower, B. A. (2022) · International Journal of Cardiology Cardiovascular Risk and Prevention · doi:10.1016/j.ijcrp.2022.200165 · Cited by 12
Effects of Lifestyle Intervention in Tissue-Specific Lipidomic Profile of Formerly Obese Mice
Dahdah, N., González-Franquesa, A., Samino, S., Gama-Pérez, P., Herrero, L., Perales, J. C., Yanes, Ó., Malagón, M. M., & García-Rovés, P. M. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms22073694 · Cited by 13
“The extent of ectopic fat accumulation is significantly linked to the ability of visceral AT to expand [2,57,60].”
BackgroundGentile, A., Lhamyani, S., Clemente‐Postigo, M., Estepa, E., Mesa, M. M., Bermúdez‐Silva, F. J., Rodríguez‐Cañete, A., Tinahones, F. J., Olveira, G., & Bekay, R. E. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms242417449 · Cited by 11
“Dysfunctional adipose tissue (AT) has been extensively proven to be involved in the development of these obesity-associated comorbidities [2,3].”
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Lee, E. H., Kim, J. Y., & Yang, H. R. (2021) · Pediatric Obesity · doi:10.1111/ijpo.12793 · Cited by 11
“NAFLD is considered a hepatic manifestation of MetS, as well as an independent risk factor for cardiovascular disease.(7,43) The present study suggests that PFF may predispose children with NAFLD to HTN.”
BackgroundSun, P., Fan, C., Wang, R., Chu, T., Sun, X., Zhang, D., & Du, X. (2021) · Diabetes Metabolic Syndrome and Obesity · doi:10.2147/dmso.s299060 · Cited by 11
“Relationship Between Pancreatic Steatosis and Carotid Plaque Ectopic fat deposition is closely related to atherosclerotic plaque and cardiovascular disease.(23) Pancreatic steatosis is Table 3 Univariate Logistic Regression Models for Carotid Plaque and Hypoechoic Plaque”
BackgroundSerum Acylglycerols Inversely Associate with Muscle Oxidative Capacity in Severe COPD
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Uncoupling Lipid Synthesis from Adipocyte Development
Wan, Q., Calhoun, C., Zahr, T., & Qiang, L. (2023) · Biomedicines · doi:10.3390/biomedicines11041132 · Cited by 11
Malaikah, S., Willis, S. A., Henson, J. J., Sargeant, J. A., Yates, T. E., Thackray, A. E., Goltz, F. R., Roberts, M. J., Bodicoat, D. H., Aithal, G. P., et al. (2023) · International Journal of Obesity · doi:10.1038/s41366-023-01350-0 · Cited by 11
“Written informed consent was obtained from all participants before partaking in these studies.”
Urinary metabolomic profiling of a cohort of Colombian patients with systemic lupus erythematosus
Rojo-Sánchez, A., Carmona-Martes, A., Díaz-Olmos, Y., Santamaría-Torres, M. A., Cala, M. P., Orozco‐Acosta, E., Aroca, G., Pacheco‐Londoño, L. C., Quiroz, E. N., & Pacheco-Lugo, L. (2024) · Scientific Reports · doi:10.1038/s41598-024-60217-0 · Cited by 10
“Thus, high CXCL16 and oxidized LDL levels have been reported in the renal tissue of patients with different glomerular diseases 20,21 .”
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“, metabolic syndrome, insulin resistance, non-alcoholic fatty liver disease (NAFLD), hypertension and atherosclerosis) [8,61].”
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Association of Epicardial and Pericardial Adipose Tissue Volumes with Coronary Artery Calcification
Liu, J., Fan, W., Liu, Y., Bu, H., Song, J., & Sun, L. (2022) · International Heart Journal · doi:10.1536/ihj.22-006 · Cited by 9
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Фенотипы ожирения у детей, клинические проявления и генетические ассоциации
Абатуров, А. Е., & Нікуліна, А. О. (2020) · CHILD`S HEALTH · doi:10.22141/2224-0551.15.4.2020.208476 · Cited by 9
Cogollo, V. J., Rivera, C. E., Valera, R. J., Sarmiento-Cobos, M. F., Montorfano, L. M., Wasser, E., Menzo, E. L., Szomstein, S., & Rosenthal, R. J. (2021) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2021.01.031 · Cited by 9
Ghanemi, A., Yoshioka, M., & St‐Amand, J. (2021) · Biomolecules · doi:10.3390/biom11121830 · Cited by 9
“Cardiovascular diseases, which have their risks increased in obese patients [25,58,59], also represent risk factors for COVID-19 [60].”
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“This is quite interesting because, in general, visceral fat is considered to be more (patho)physiologically active with respect to the induction of cardiovascular and metabolic complications of obesity [5].”
BackgroundLee, E. H., Kim, J. Y., & Yang, H. R. (2021) · Journal of Clinical Hypertension · doi:10.1111/jch.14326 · Cited by 9
Meng, Z., Zhang, Q., Zhang, R., Liu, G., Xiang, W., He, Y., Zhang, Q., & Tang, J. (2025) · Journal of Agricultural and Food Chemistry · doi:10.1021/acs.jafc.5c07080 · Cited by 8
Ledda, R. E., Milanese, G., Cademartiri, F., Maffei, E., Benedetti, G., Goldoni, M., Silva, M., & Sverzellati, N. (2021) · La radiologia medica · doi:10.1007/s11547-020-01321-9 · Cited by 8
“It has been hypothesized that fat deposits might have a combined effect in promoting inflammation [11], which is known to play a crucial role in atherosclerosis initiation and development, but it only partly explains the link [32].”
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Beller, E., Lorbeer, R., Keeser, D., Galiè, F., Meinel, F. G., Grosu, S., Bamberg, F., Storz, C., Schlett, C. L., Peters, A., et al. (2021) · Nutrients · doi:10.3390/nu13041275 · Cited by 8
“MRI-based fat depots included total adipose tissue (TAT), VAT, and hepatic fat as risk factors for metabolic and cardiovascular disease [26].”
BackgroundStrategies for Imaging Metabolic Remodeling of the Heart in Obesity and Heart Failure
Haidar, A., & Taegtmeyer, H. (2022) · Current Cardiology Reports · doi:10.1007/s11886-022-01650-3 · Cited by 8
Novel Cardiovascular Risk Biomarkers in Metabolic Syndrome
Montecucco, F., Liberale, L., & Carbone, F. (2019) · Biomarkers in Medicine · doi:10.2217/bmm-2019-0366 · Cited by 8
Pericardial fat volume and coronary atherosclerotic markers among body mass index groups
Hassan, M. B., Nafakhi, H., & Al‐Mosawi, A. A. (2020) · Clinical Cardiology · doi:10.1002/clc.23396 · Cited by 8
“Obesity is a heterogeneous disease associated with the clustering of several cardiac risk factors and different degrees of cardiovascular and metabolic disturbances.(1,2) In the literature, obesity-related cardiometabolic disturbances have been associated with coronary atherosclerosis and the development of poor long-…”
BackgroundKatsiki, N., & Mikhailidis, D. P. (2020) · Journal of Cellular Physiology · doi:10.1002/jcp.29573 · Cited by 8
“Ferrara et al. (2019) also mention the potential benefit of statins, sodium‐glucose cotransporter 2 inhibitors (SGLT2i), and glucagon‐ like peptide‐1 receptor agonists (GLP‐1 RAs) in patients with nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH).”
BackgroundMelatonin Alleviates Liver Mitochondrial Dysfunction in Leptin-Deficient Mice
de Luxán‐Delgado, B., Potes, Y., Rubio‐González, A., Solano, J. J., Boga, J. A., Antuña, E., Cachán-Vega, C., Bermejo-Millo, J. C., Menéndez-Coto, N., García-González, C., et al. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms25168677 · Cited by 7
Kazeminasab, F., Mohebinejad, M., Mahboobi, M. H., Nojoumi, M., Belyani, S., Bagheri, R., & Dutheil, F. (2025) · Journal of the International Society of Sports Nutrition · doi:10.1080/15502783.2025.2528534 · Cited by 11
“Therefore, reducing ectopic fat deposits is a suitable target for interventions to prevent cardiovascular and metabolic diseases [9].”
Modulation of adipose tissue metabolism by exosomes in obesity
Xu, Y., Huang, L., Zhuang, Y., & Huang, H. (2024) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.00155.2023 · Cited by 7
Metadata
- Authors
- Ferrara, D., Montecucco, F., Dallegri, F., & Carbone, F.
- Affiliations
- University of Genoa (IT)
- Ospedale Policlinico San Martino (IT)
- Corresponding author
- Carbone, Federico
- Venue
- Journal of Cellular Physiology
- Publisher
- Wiley
- Published
- 2019-05-20
- Volume
- 234
- Issue
- 12
- Pages
- 21630-21641
- ISSN
- 0021-9541 (ISSN-L)
- 1097-4652
- OpenAlex
- W2944904922
- Cited by
- 195
- References
- 140
- Citations by year
- 2026: 20 · 2025: 23 · 2024: 19 · 2023: 32 · 2022: 22 · 2021: 36 · 2020: 29 · 2019: 13
- FWCI
- 4.52
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Cellular Physiology (publishedVersion)
- PubMed (publishedVersion)
- CINECA IRIS Institutial Research Information System (University of Genoa) (submittedVersion)
- Funders
- Ministero della Salute
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Disease and Adiposity
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adipokines, Inflammation, and Metabolic Diseases
- Health Sciences › Medicine › Physiology (medical) › Adipose Tissue and Metabolism
- Keywords
- cardiometabolic risk, epicardial adipose tissue, myocardial steatosis, perivascular adipose tissue, non-alcoholic fatty liver disease, renal sinus fat, skeletal muscle fat, pancreatic fat, insulin resistance, lipid metabolism, endoplasmic reticulum stress, mitochondrial uncoupling, oxidative stress, inflammation, atrial fibrillation, ventricular dysfunction, atherosclerosis, hypertension, obesity
- MeSH terms
- Adipose Tissue, Animals, Cardiovascular Diseases, Fats, Humans, Liver, Metabolic Diseases, Body Mass Index
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