Background/Aims: The purpose was to determine whether lifestyle interventions have different effects on regional fat in women with normal glucose tolerance vs. impaired glucose tolerance (NGT vs. IGT). Methods: Changes in glucose metabolism (2-h oral glucose-tolerance tests), android to gynoid fat mass ratio (dual energy X-ray absorptiometry [DXA]), visceral to subcutaneous abdominal fat area ratio (CT), and abdominal to gluteal subcutaneous fat cell weight (FCW; adipose tissue biopsies) were determined in 60 overweight postmenopausal women (45-80 years) following 6 months of weight loss alone (WL; n = 28) or with aerobic exercise (AEX + WL; n = 32). Results: The interventions led to ∼8% decrease in weight, but only the AEX + WL group improved fitness (↑11% in VO2max) and reduced the android-to-gynoid fat mass ratio (↓5%; p < 0.05). Both NGT and IGT groups reduced visceral and subcutaneous abdominal fat areas and abdominal and gluteal FCWs, which related to improvements in homeostatic model assessment (r = 0.34-0.42) and 2-h glucose (r = 0.34-0.35), respectively (p < 0.05). The decline in FCW was 2× greater in women with IGT following WL (p < 0.05). The ratios of abdominal-to-gluteal FCW did not change following either intervention. Conclusions: The mechanisms by which WL with and without exercise impact regional fat loss should be explored as reductions in abdominal fat area and subcutaneous FCW appear to influence glucose metabolism. This is a work of the U.S. Government and is not subject to copyright protection in the United States. Foreign copyrights may apply. Published by S. Karger AG, Basel

1.
Shuster A, Patlas M, Pinthus JH, Mourtzakis M: The clinical importance of visceral adiposity: a critical review of methods for visceral adipose tissue analysis. Br J Radiol 2012;85:1-10.
2.
Sekikawa A, Eguchi H, Igarashi K, Tominaga M, Abe T, Fukuyama H, Kato T: Waist to hip ratio, body mass index, and glucose intolerance from Funagata population-based diabetes survey in Japan. Tohoku J Exp Med 1999;189:11-20.
3.
Krotkiewski M, Bjorntorp P, Sjostrom L, Smith U: Impact of obesity on metabolism in men and women. Importance of regional adipose tissue distribution. J Clin Invest 1983;72:1150-1162.
4.
Weyer C, Foley JE, Bogardus C, Tataranni PA, Pratley RE: Enlarged subcutaneous abdominal adipocyte size, but not obesity itself, predicts type II diabetes independent of insulin resistance. Diabetologia 2000;43:1498-1506.
5.
Ryan AS: Insulin resistance with aging: effects of diet and exercise. Sports Med 2000;30:327-346.
6.
Goodpaster BH, Thaete FL, Simoneau JA, Kelley DE: Subcutaneous abdominal fat and thigh muscle composition predict insulin sensitivity independently of visceral fat. Diabetes 1997;46:1579-1585.
7.
Davis SR, Castelo-Branco C, Chedraui P, Lumsden MA, Nappi RE, Shah D, Villaseca P; Writing Group of the International Menopause Society for World Menopause Day: Understanding weight gain at menopause. Climacteric 2012;15:419-429.
8.
Gurr MI, Jung RT, Robinson MP, James WP: Adipose tissue cellularity in man: the relationship between fat cell size and number, the mass and distribution of body fat and the history of weight gain and loss. Int J Obes 1982;6:419-436.
9.
Lofgren P, Andersson I, Adolfsson B, Leijonhufvud BM, Hertel K, Hoffstedt J, Arner P: Long-term prospective and controlled studies demonstrate adipose tissue hypercellularity and relative leptin deficiency in the postobese state. J Clin Endocrinol Metab 2005;90:6207-6213.
10.
Singh P, Somers VK, Romero-Corral A, Sert-Kuniyoshi FH, Pusalavidyasagar S, Davison DE, Jensen MD: Effects of weight gain and weight loss on regional fat distribution. Am J Clin Nutr 2012;96:229-233.
11.
Andersson DP, Eriksson Hogling D, Thorell A, Toft E, Qvisth V, Naslund E, Thorne A, Wiren M, Lofgren P, Hoffstedt J, Dahlman I, Mejhert N, Ryden M, Arner E, Arner P: Changes in subcutaneous fat cell volume and insulin sensitivity after weight loss. Diabetes Care 2014;37:1831-1836.
12.
Ryan AS, Ortmeyer HK, Sorkin JD: Exercise with calorie restriction improves insulin sensitivity and glycogen synthase activity in obese postmenopausal women with impaired glucose tolerance. Am J Physiol Endocrinol Metab 2012;302:E145-E152.
13.
You T, Murphy KM, Lyles MF, Demons JL, Lenchik L, Nicklas BJ: Addition of aerobic exercise to dietary weight loss preferentially reduces abdominal adipocyte size. Int J Obes (Lond) 2006;30:1211-1216.
14.
Nicklas BJ, Wang X, You T, Lyles MF, Demons J, Easter L, Berry MJ, Lenchik L, Carr JJ: Effect of exercise intensity on abdominal fat loss during calorie restriction in overweight and obese postmenopausal women: a randomized, controlled trial. Am J Clin Nutr 2009;89:1043-1052.
15.
Rossi AP, Fantin F, Zamboni GA, Mazzali G, Zoico E, Bambace C, Antonioli A, Pozzi Mucelli R, Zamboni M: Effect of moderate weight loss on hepatic, pancreatic and visceral lipids in obese subjects. Nutr Diabetes 2012;2:e32.
16.
Lesser IA, Dick TJ, Guenette JA, Hoogbruin A, Mackey DC, Singer J, Lear SA: The association between cardiorespiratory fitness and abdominal adiposity in postmenopausal, physically inactive South Asian women. Prev Med Rep 2015;2:783-787.
17.
Kim MJ, Maachi M, Debard C, Loizon E, Clement K, Bruckert E, Hainque B, Capeau J, Vidal H, Bastard JP: Increased adiponectin receptor-1 expression in adipose tissue of impaired glucose-tolerant obese subjects during weight loss. Eur J Endocrinol 2006;155:161-165.
18.
Steven S, Hollingsworth KG, Small PK, Woodcock SA, Pucci A, Aribisala B, Al-Mrabeh A, Daly AK, Batterham RL, Taylor R: Weight loss decreases excess pancreatic triacylglycerol specifically in type 2 diabetes. Diabetes Care 2016;39:158-165.
19.
Jenkins NT, Hagberg JM: Aerobic training effects on glucose tolerance in prediabetic and normoglycemic humans. Med Sci Sports Exerc 2011;43:2231-2240.
20.
Malin SK, Kirwan JP: Fasting hyperglycaemia blunts the reversal of impaired glucose tolerance after exercise training in obese older adults. Diabetes Obes Metab 2012;14:835-841.
21.
Dietary guidelines for healthy American adults. A statement for physicians and health professionals by the Nutrition Committee, American Heart Association. Circulation 1988;77:721A-724A.
22.
National Health and Nutrition Examination Survey. Dual Energy X-Ray Absorptiometry - Android/Gynoid Measurements. 2013 03/10/2015. http://wwwn.cdc.gov/nchs/nhanes/2005-2006/DXXAG_D.htm.
23.
Kerner W, Bruckel J: Definition, classification and diagnosis of diabetes mellitus. Exp Clin Endocrinol Diabetes 2014;122:384-386.
24.
Purves RD: Optimum numerical integration methods for estimation of area-under-the-curve (AUC) and area-under-the-moment-curve (AUMC). J Pharmacokinet Biopharm 1992;20:211-226.
25.
Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC: Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:412-419.
26.
Lavau M, Susini C, Knittle J, Blanchet-Hirst S, Greenwood MR: A reliable photomicrographic method to determining fat cell size and number: application to dietary obesity. Proc Soc Exp Biol Med 1977;156:251-256.
27.
Hirsch J, Gallian E: Methods for the determination of adipose cell size in man and animals. J Lipid Res 1968;9:110-119.
28.
Lundgren M, Svensson M, Lindmark S, Renstrom F, Ruge T, Eriksson JW: Fat cell enlargement is an independent marker of insulin resistance and ‘hyperleptinaemia'. Diabetologia 2007;50:625-633.
29.
Usui C, Asaka M, Kawano H, Aoyama T, Ishijima T, Sakamoto S, Higuchi M: Visceral fat is a strong predictor of insulin resistance regardless of cardiorespiratory fitness in non-diabetic people. J Nutr Sci Vitaminol (Tokyo) 2010;56:109-116.
30.
Wing RR, Jeffery RW, Burton LR, Thorson C, Kuller LH, Folsom AR: Change in waist-hip ratio with weight loss and its association with change in cardiovascular risk factors. Am J Clin Nutr 1992;55:1086-1092.
31.
Pasquali R, Antenucci D, Casimirri F, Venturoli S, Paradisi R, Fabbri R, Balestra V, Melchionda N, Barbara L: Clinical and hormonal characteristics of obese amenorrheic hyperandrogenic women before and after weight loss. J Clin Endocrinol Metab 1989;68:173-179.
32.
Hainer V, Stich V, Kunesova M, Parizkova J, Zak A, Wernischova V, Hrabak P: Effect of 4-wk treatment of obesity by very-low-calorie diet on anthropometric, metabolic, and hormonal indexes. Am J Clin Nutr 1992;56(1 suppl):281S-282S.
33.
Park HS, Lee KU: Postmenopausal women lose less visceral adipose tissue during a weight reduction program. Menopause 2003;10:222-227.
34.
Maiorana A, O'Driscoll G, Goodman C, Taylor R, Green D: Combined aerobic and resistance exercise improves glycemic control and fitness in type 2 diabetes. Diabetes Res Clin Pract 2002;56:115-123.
35.
Nalini M, Moradi B, Esmaeilzadeh M, Maleki M: Does the effect of supervised cardiac rehabilitation programs on body fat distribution remained long time? J Cardiovasc Thorac Res 2013;5:133-138.
36.
Chaston TB, Dixon JB: Factors associated with percent change in visceral versus subcutaneous abdominal fat during weight loss: findings from a systematic review. Int J Obes (Lond) 2008;32:619-628.
37.
Busetto L: Visceral obesity and the metabolic syndrome: effects of weight loss. Nutr Metab Cardiovasc Dis 2001;11:195-204.
38.
Ohkawara K, Tanaka S, Miyachi M, Ishikawa-Takata K, Tabata I: A dose-response relation between aerobic exercise and visceral fat reduction: systematic review of clinical trials. Int J Obes (Lond) 2007;31:1786-1797.
39.
Kanai H, Tokunaga K, Fujioka S, Yamashita S, Kameda-Takemura KK, Matsuzawa Y: Decrease in intra-abdominal visceral fat may reduce blood pressure in obese hypertensive women. Hypertension 1996;27:125-129.
40.
Fujioka S, Matsuzawa Y, Tokunaga K, Kawamoto T, Kobatake T, Keno Y, Kotani K, Yoshida S, Tarui S: Improvement of glucose and lipid metabolism associated with selective reduction of intra-abdominal visceral fat in premenopausal women with visceral fat obesity. Int J Obes 1991;15:853-859.
41.
Park HS, Lee K: Greater beneficial effects of visceral fat reduction compared with subcutaneous fat reduction on parameters of the metabolic syndrome: a study of weight reduction programmes in subjects with visceral and subcutaneous obesity. Diabet Med 2005;22:266-272.
42.
Gallagher D, Heshka S, Kelley DE, Thornton J, Boxt L, Pi-Sunyer FX, Patricio J, Mancino J, Clark JM; MRI Ancillary Study Group of Look AHEAD Research Group: Changes in adipose tissue depots and metabolic markers following a 1-year diet and exercise intervention in overweight and obese patients with type 2 diabetes. Diabetes Care 2014;37:3325-3332.
43.
Presta E, Leibel RL, Hirsch J: Regional changes in adrenergic receptor status during hypocaloric intake do not predict changes in adipocyte size or body shape. Metabolism 1990;39:307-315.
44.
Berman DM, Nicklas BJ, Ryan AS, Rogus EM, Dennis KE, Goldberg AP: Regulation of lipolysis and lipoprotein lipase after weight loss in obese, postmenopausal women. Obes Res 2004;12:32-39.
45.
Mauriege P, Prud'Homme D, Marcotte M, Yoshioka M, Tremblay A, Despres JP: Regional differences in adipose tissue metabolism between sedentary and endurance-trained women. Am J Physiol 1997;273(3 pt 1):E497-E506.
46.
Bjorntorp P: Regional obesity; in Bjorntorp P, Brodoff BN (eds): Obesity. Philadelphia, JB Lippincott, 1992, pp 579-586.
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