Endocrine Abstracts

Obesity is associated with a significantly increased risk of diabetes, cardiovascular disease and some cancers together with numerous other medical problems. During the last 10 years in particular, there has been a conceptual transformation of adipose tissue from an inert store of energy into an active endocrine organ that participates in the maintenance of normal energy homeostasis through its interactions with organs such as muscle, liver and the brain. In addition, it has become clear that in obesity there are fundamental changes in adipose tissue endocrinology that play an active part in the pathogenesis of diseases such as diabetes, cardiovascular disease and in certain cancers. Adipose tissue secreted products can be produced in excess in obesity as adipose tissue expands and the spill-over of these products into circulation can explain for example, at least in part, the development of hypertension associated with obesity. The production of a number of pro-inflammatory cytokines can explain the phenomenon of sub-clinical inflammation that is associated with both insulin resistance and the pathogenesis of type-2 diabetes. This is also a factor underlying the tendency for endothelial dysfunction in obesity. Finally ectopic adipose tissue in organs such as liver, muscle, heart and pancreatic islet cells can cause disease through its effects on the metabolic processes within those organs. A modest weight loss of about 10% can help reduce the extent of ectopic adipose deposition and also result in reduction of visceral fat. Reduction of adipose tissue from these depots brings about significant medical benefits and reduces risk of the progression of chronic cardiovascular risk factors. Another approach to treatment would be to change the phenotype of adipose cells by downregulating pathways for inflammation and this approach may be used in conjunction with approaches to help patients lose weight.