Cited by 881Cardiovascular Disease and AdiposityDiabetes, Cardiovascular Risks, and LipoproteinsAdipokines, Inflammation, and Metabolic Diseases

Cardiovascular and Metabolic Heterogeneity of Obesity: Clinical Challenges and Implications for Management

Open access
Neeland, Ian J., Poirier, Paul, Després, Jean-Pierre·2018·Circulation

Abstract

The prevalence of obesity has increased globally over the last 2 decades. Although the body mass index has been a convenient and simple index of obesity at the population level, studies have shown that obesity defined by body mass index alone is a remarkably heterogeneous condition with varying cardiovascular and metabolic manifestations across individuals. Adipose tissue is an exquisitely active metabolic organ engaged in cross-talk between various systems; perturbation of adipose tissue results in a pathological response to positive caloric balance in susceptible individuals that directly and indirectly contributes to cardiovascular and metabolic disease. Inadequate subcutaneous adipose tissue expansion in the face of dietary triglycerides leads to visceral and ectopic fat deposition, inflammatory/adipokine dysregulation, and insulin resistance. Conversely, preferential fat storage in the lower body depot may act as a metabolic buffer and protect other tissues from lipotoxicity caused by lipid overflow and ectopic fat. Translational, epidemiological, and clinical studies over the past 30 years have clearly demonstrated a strong link between visceral and ectopic fat and the development of a clinical syndrome characterized by atherogenic dyslipidemia, hyperinsulinemia/glucose intolerance, hypertension, atherosclerosis, and adverse cardiac remodeling/heart failure. This relationship is even more nuanced when clinical entities such as metabolically healthy obesity phenotype and the obesity paradox are considered. Although it is clear that the accumulation of visceral/ectopic fat is a major contributor to cardiovascular and metabolic risk above and beyond the body mass index, implementation of fat distribution assessment into clinical practice remains a challenge. Anthropometric indexes of obesity are easily implemented, but newer imaging-based methods offer improved sensitivity and specificity for measuring specific depots. Lifestyle, pharmacological, and surgical interventions allow a multidisciplinary approach to overweight/obesity that may improve outcomes and align with a public health message to combat the growing epidemic of obesity worldwide and to build healthier lives free of cardiovascular diseases.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1161/circulationaha.117.029617

Cites

114 of 114 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Obesity is associated with increased risks of cardiovascular diseases, diabetes, and musculoskeletal and metabolic disorders.

    “Obesity is a serious worldwide health problem associated with increased risks of cardiovascular diseases, diabetes, and musculoskeletal and metabolic disorders (Welsh et al., 2024; Piche et al., 2018; Neeland, Poirier & Despres, 2018).”

    From Effect of water-based aerobic training on anthropometric, biochemical, cardiovascular, and explosive strength parameters in young overweight and obese women: a randomized controlled trial (2025) · cites this paper as Neeland, Poirier & Despres, 2018

    The sections on obesity classification and adipose effects link obesity with cardiovascular disease, type 2 diabetes, and metabolic disease. The cardiovascular-risk section also lists osteoarthritis as an obesity-related comorbidity, but does not establish an increased risk of musculoskeletal disorders more broadly. The paper emphasizes that risks vary among people with obesity. (LLM, conf=0.82)

    Experimental — accuracy not yet measured
  • Obesity increases cardiometabolic risk and premature mortality.

    “As a chronic disease, obesity increases cardiometabolic risk [1] and ultimately confers an increased risk of premature mortality [2,3].”
  • Excess visceral adipose tissue conveys a higher risk of cardiometabolic disorders, including hypertension and type 2 diabetes mellitus, than excess subcutaneous adipose tissue.

    “Substantial evidence indicates that excess visceral adipose tissue (VAT) conveys a higher risk of cardiometabolic disorders, including hypertension and T2DM, than does excess subcutaneous adipose tissue (SAT)”
  • Among obese individuals with similar BMI or total body adiposity, those with greater visceral and ectopic fat generally have higher cardiometabolic risk than those with less visceral adipose tissue.

    “among obese individuals with similar BMI or total body adiposity, those with greater visceral and ectopic fat generally have higher cardiometabolic risk than those with less VAT13.”

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

2 retracted

Flagged first, then by citations

Cited by

Sorted by citations

Authors
Neeland, I. J., Poirier, P., & Després, J.-P.
Affiliations
  • The University of Texas Southwestern Medical Center (US)
  • Institut universitaire de cardiologie et de pneumologie de Québec (CA)
Venue
Circulation
Published
2018-03-27
Volume
137
Issue
13
Pages
1391-1406
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
OpenAlex
W2789727743
Cited by
881
References
114
Citations by year
2026: 116 · 2025: 141 · 2024: 115 · 2023: 114 · 2022: 108 · 2021: 126 · 2020: 84 · 2019: 44 · 2018: 32 · 2015: 1
FWCI
13.33
Type
journal article
Language
en
Open access
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Canadian Institutes of Health Research
  • National Institute of Diabetes and Digestive and Kidney Diseases (K23DK106520)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Disease and Adiposity
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
Keywords
obesity heterogeneity, body mass index, visceral adipose tissue, ectopic fat, subcutaneous adipose tissue, adipose tissue metabolism, insulin resistance, adipokines, atherogenic dyslipidemia, hypertension, atherosclerosis, heart failure, cardiac remodeling, metabolically healthy obesity, obesity paradox, anthropometric index, obesity treatment
MeSH terms
Adipose Tissue, Appetite Depressants, Cardiovascular Diseases, Humans, Metabolic Diseases, Obesity, Risk Factors, Body Mass Index, Adiposity

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review