Gluteofemoral body fat as a determinant of metabolic health

Abstract

Body fat distribution is an important metabolic and cardiovascular risk factor, because the proportion of abdominal to gluteofemoral body fat correlates with obesity-associated diseases and mortality. Here, we review the evidence and possible mechanisms that support a specific protective role of gluteofemoral body fat. Population studies show that an increased gluteofemoral fat mass is independently associated with a protective lipid and glucose profile, as well as a decrease in cardiovascular and metabolic risk. Studies of adipose tissue physiology in vitro and in vivo confirm distinct properties of the gluteofemoral fat depot with regards to lipolysis and fatty acid uptake: in day-to-day metabolism it appears to be more passive than the abdominal depot and it exerts its protective properties by long-term fatty acid storage. Further, a beneficial adipokine profile is associated with gluteofemoral fat. Leptin and adiponectin levels are positively associated with gluteofemoral fat while the level of inflammatory cytokines is negatively associated. Finally, loss of gluteofemoral fat, as observed in Cushing's syndrome and lipodystrophy is associated with an increased metabolic and cardiovascular risk. This underlines gluteofemoral fat's role as a determinant of health by the long-term entrapment of excess fatty acids, thus protecting from the adverse effects associated with ectopic fat deposition.

Evaluating the Fat Distribution in Idiopathic Intracranial Hypertension Using Dual-Energy X-ray Absorptiometry Scanning

“…These previous findings may be in relation to the tendency for gluteofemoral fat to “accumulate” in the typical female fat distribution, as seen in previous studies. 5 Clinical resolution of IIH occurs following a loss of truncal fat, potentially implicating central obesity in the pathogenesis of IIH. We found that this degree and pattern of weight loss was similar to that in obese controls, although as the number of controls is small, this analysis is limited.…”

“…4 This is of particular interest, given the well-known association between abdominal (upper) and gluteofemoral (lower) body fat ratios and the risk of cardiometabolic diseases. 5,6 …”

Body composition phenotypes in pathways to obesity and the metabolic syndrome

“…58 This fat depot is viewed as a protective 'metabolic sink' functioning as a buffer against the postprandial surge in circulatory fatty acids (fatty acid trapping), and hence protects other tissues from lipid overflow associated with ectopic lipotoxicity. 59 Indeed, femoral fat accumulation that is typical of female fat distribution pattern is associated with an increase in adipose tissue lipoprotein lipase activity, a key enzyme controlling the entry of fatty acids from the circulation into adipose tissue, whereas the activity of hormone-sensitive lipase, a key enzyme in lipolysis, is lower in the gluteal than in the abdominal fat depot.…”

“…59 Indeed, femoral fat accumulation that is typical of female fat distribution pattern is associated with an increase in adipose tissue lipoprotein lipase activity, a key enzyme controlling the entry of fatty acids from the circulation into adipose tissue, whereas the activity of hormone-sensitive lipase, a key enzyme in lipolysis, is lower in the gluteal than in the abdominal fat depot. 58 Furthermore, the low amounts of gluteofemoral fat observed in pathogenic states, such as in partial lipodystrophy or in Cushing's syndrome, are associated with increased metabolic and cardiovascular risks. 58 This underscores the protective properties of gluteofemoral adipose tissue by the long-term entrapment of excess fatty acids, thus protecting from the adverse effects associated with ectopic fat deposition.…”

Lipid accumulation and alkaline phosphatase activity in human preadipocytes isolated from different body fat depots

“…It is important to study the regulation of adipogenesis in the different body fat depots because it is known that visceral adipose tissue is more strongly associated with adverse metabolic risk factors than subcutaneous adipose tissue, 35,36 whilst gluteofemoral adiposity is protective. 37 Thus, an understanding at the molecular level of the regulation of fat storage in these adipose depots may have implications for the treatment of obesity-associated metabolic disorders.…”