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Panminerva Medica 2003 September;45(3):189-95


lingua: Inglese

Is visceral obesity a physiological adaptation to stress?

Drapeau V. 1, Therrien F. 2, Richard D. 2, Tremblay A. 1

1 Division of Kinesiology, Laval University, Ste-Foy, Québec, Canada 2 Department of anatomy and physiology, aval University, Ste-Foy, Québec, Canada

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Visceral obes­ity rep­re­sents an impor­tant ­risk fac­tor asso­ciat­ed ­with hyper­ten­sion, dia­betes and car­di­o­vas­cu­lar dis­eas­es. Since ­this con­di­tion is asso­ciat­ed ­with a dis­rup­tion of the func­tion­ing of the HPA ­axis, ­stress-­induced HPA ­axis acti­va­tion has ­been iden­ti­fied to ­play an impor­tant ­role in ­this pref­e­ren­tial ­body fat accu­mu­la­tion. HPA ­axis acti­va­tion increas­es cor­ti­sol (cor­ti­cos­te­rone) pro­duc­tion ­which has ­been ­shown to ­exert hyper­phag­ic and anti­ther­mo­gen­ic ­effects. Since abdom­i­nal adi­pose tis­sue has ­more ­cells per ­mass ­units, high­er ­blood ­flow and ­more glu­co­cor­ti­coid recep­tors, glu­co­cor­ti­coids ­affect abdom­i­nal fat to a great­er ­extent ­than sub­cu­ta­ne­ous adi­pose tis­sue. Cushing’s syn­drome in ­humans is the ­best evi­dence show­ing a ­link ­between hyper­cor­tis­o­le­mia and accu­mu­la­tion of cen­tral fat. The Hervey’s hypoth­e­sis ­which sug­gests ­that fat ­cells ­take up and cat­a­bol­ize glu­co­cor­ti­coids is one of the pos­sible reg­u­la­to­ry ­effect ­that sup­ports the adap­tive ­role of vis­cer­al fat in ­response to ­stress. This is ­also sup­port­ed by oth­er evi­dence show­ing ­that abdom­i­nal obes­ity is asso­ciat­ed ­with an ­increased cor­ti­sol clear­ance. Hormonal and enzy­mat­ic chang­es ­have ­been impli­cat­ed in ­this pref­e­ren­tial ­body fat accu­mu­la­tion in ­response to ­stress. Specific genet­ic back­ground may ­also accen­tu­ate ­this vis­cer­al fat accu­mu­la­tion in ­some indi­vid­u­als ­exposed to ­stress. Alternatively, obes­ity ­could ­also be a ­source of ­stress pro­mot­ing the vis­cer­al fat accu­mu­la­tion ­since vis­cer­al fat is ­able to ­release cyto­kines ­which stim­u­late the HPA ­axis. Even if the avail­able lit­er­a­ture ­does not per­mit to estab­lish clear­ly ­which ­comes ­first, it sug­gests ­that vis­cer­al obes­ity ­could rep­re­sent a non opti­mal phys­io­log­i­cal adap­ta­tion to ­stress. In ­this con­text, vis­cer­al obes­ity treat­ment ­should ­focus on ­stress man­age­ment and ­weight ­loss strat­e­gies in ­order to ­stop ­this ­vicious cir­cle.

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