Preface
Abdominal or visceral fat comprises fat deposits
between the liver and kidneys that are packed into the
abdominal cavity. This fat is distinct from subcutaneous
and intramuscular fat because it is primarily visceral and
includes several adipose depots. Historically, such fat
has a played a key role in survival in times of famine. As
described in the book, such fat is subject to lifestyle man-
agement as well as to accumulation.
EPIDEMIOLOGY AND CLINICAL
MANAGEMENT OF ABDOMINAL
OBESITY
Appetite-regulating gut hormones, work, diet, and
physical activity in adults, children, and adolescents
have all been described as factors that affect abdominal
fat accumulation. Tarantino describes the efficacy of
physical activity in treating nonalcoholic fatty liver dis-
ease. Its actions in specific populations, for example the
elevated hypertension of African-Americans, are defined
and explained by Hornbuckle. Von Gruenigen shows
how fat plays a role in cancer survivorship, while
Clement reviews massive obesity and its consequences.
Clearly, and historically, lifestyle factors are major fac-
tors that affect abdominal fat; these are defined by Suliga
with Gomez-Martinez in their review of the role of phys-
ical activity in abdominal obesity in adolescents.
Therapies including surgery and sleeve gastrostomy are
reviewed by Ruiz-Tovar, while the beneficial effects of
supplemental magnesium are defined by Kokot.
Fat is constantly being stored and released from adi-
pose tissue. Storage in adipose tissue is regulated by
insulin and stimulated by high serum glucose. Thus, fat
cells have an important role in maintaining triglyceride
and free fatty acid levels. However, abdominal fat is
more prone to inducing insulin resistance; therefore,
central obesity is a marker of impaired glucose tolerance
as a risk factor for many obesity-related diseases. Gasevic
et al. show that adipose tissue affects insulin resistance
and is further modified by ethnicity. In addition, Rossi
and colleagues describe visceral fat as key to ectopic fat
accumulation, while Leblanc and Poirier discuss how
high blood pressure risk is lessened by reducing visceral
obesity. Finally, Prasad defines the problems of advanced
glycation end-products in relation to adiposity.
xiii
DIET, SUPPLEMENTS, AND FOODS IN
THE MANAGEMENT OF VISCERAL
OBESITY
Understanding abdominal obesity will promote its
modification and prevention, thus reducing chronic dis-
ease levels. Under standard conditions, adipose depots
provide feedback on hunger and dietary needs to the
central nervous system. A variety of biochemical, physi-
ological, and food-regulated mechanisms that alter
abdominal obesity and thus disease risk are reviewed.
Maeda identifies glucagon-like peptide 1 as an agonist of
visceral fat adiposity and appetite. Castonguay defines
the role of fructose in hypertriglyceridemia and obesity.
Dietary foods play key roles in visceral fat accumulation
and its removal. The effects of intermittent fasting ver-
sus daily calorie restriction on visceral fat loss are com-
pared by Trepanowski and Varady. Laurant and
colleagues show that gender and exercise, which both
modulate cytokines, affect obesity and thus heart dis-
ease. Stress-induced eating also affects obesity, and
Finch and Tomiyama describe relevant physiological
and behavioral stress responses. Campbell and cowork-
ers review fructose-induced hypertriglyceridemia as a
cause of abdominal obesity that can be modified by
changes in food intake. Yoshinaga describes how the
gender and lifestyle of individuals and their parents
combine to modify obesity.
Adipose tissues play important roles in health; their
primary role is as a reserve of lipids needed to provide
energy. Fat tissues consist of about 86% fat, and a variety
of different cell types regulate fat accumulation. Lipolysis
is modulated by lipolytic -adrenergic receptors and
antilipolysis is regulated by 2A adrenergic receptors.
Dietary foods and supplements can play critical roles in
modifying and preventing such fat accumulation. Park
describes several types of soy protein and fermented
soypastes that can reduce visceral obesity. Reviews by
the Pimentel and Bautista-Castao groups describe
the roles of alcohol, coffee, and bread in modifying
obesity through various mechanisms, including immu-
nomodulation of inflammation, which is obesity
induced. As Nagai and Takatsu review in humans and
Masternak in animal models, these mechanisms are
important in metabolic disorders associated with chronic
diseases. Castonguay and coauthors describe appetite
xiv Preface
and reward signals in the brain, with sugar being a major
mediator, as shown by magnetic resonance imaging.
Additionally, the effects of dietary supplements on fat
regulation and thus visceral obesity are an important
focus of this book. A stringent vegan diet with dietary
restriction produces significant weight loss. A supplement
containing flaxseed components changes visceral obesity,
inflammation, lipids, and chronic hypertension, as Park
summarizes. Damms-Machado shows that nutritional
deficiencies in obese patients are a common condition,
which are additionally impacted by bariatric operations,
like sleeve gastrectomy. Miyashita and Hosokawa show
the importance of plant carotenoids as nutraceutical
therapies for visceral obesity.
Other macromolecules and foods are modulators of
visceral fat and play a key role in a host of diseases,
including diabetes, insulin resistance, cardiovascular
disease, inflammation, and other obesity-related health
problems. Pal and coauthors describe a role for psyllium
as a therapy for obesity comorbidities. Karl and McKeown
describe the role of whole grain (with its intrinsic fiber)
in obesity prevention, while Pal defines a similar role for
dietary whey protein. Vajro and coworkers describe the
role of other complex carbohydrates known as probiotics
in treating hepatic obesity and related diseases. Dinner
carbohydrates, if used as described by Madar and col-
leagues, produce weight loss and have other effects on
visceral fat. Citrus is a food that, as Mukai describes in
animal models and humans, changes visceral fat accu-
mulation. Lipids are the major modulators of fat. Tan
describes the effects of dietary fatty acids on weight, fat
mass and abdominal fat. Park shows that conjugated lin-
oleic acid benefits human health by controlling weight.
Finally, DAntona reviews the current evidence that
amino acid supplementation affects obesity. Free fatty
acids are released from lipoproteins by enzymes and
enter adipocytes to be reassembled into triglycerides for
storage. Through regulating adipose tissues in visceral
fat, different cell types (primarily adipocytes, fibroblasts,
macrophages, lymphocytes, and endothelial cells) can
have wide-ranging effects on health. Matikainen
describes the role of fibroblast growth factor 21 in regu-
lating energy metabolism in adipose tissues to promote
health. Qi discusses how polymorphisms in the gene
encoding neuropeptide Y (and other genes) affect central
obesity. Finally, Garaulet defines site-specific adipose tis-
sue fatty acid composition and its role in the regulation
of abdominal obesity.
In conclusion, the authors describe how factors that
affect the current abdominal obesity epidemic will pro-
vide major benefits by preventing chronic diseases, espe-
cially heart, vascular, and diabetic diseases. A broad
range of disciplines are involved in dealing with the con-
sequences of excessive abdominal fat, including cardiol-
ogy, diabetes research, endocrinology, exercise
physiology, and studies focusing on lipids, metabolism,
nutrition, and obesity. We describe how abdominal obe-
sity, a major cause of mortality and morbidity in much of
the world through its associated diseases, can be regu-
lated by food and dietary therapies.