Posted by: Sophie Khatib20 JAN 2013
It has been well established that obesity predisposes a person to a multitude of other health problems, commonly including type 2 diabetes, hypertension, stroke, MI, the list goes on. But there is strong evidence that visceral fat, causing central obesity, is directly responsible for secreting adipokines and cytokines.
Cytokines are well researched and known to be proinflammatory and procoagulant, with adipokines known to be linked with insulin resistance.
The level of visceral fat, over and above BMI measurements, can predict insulin resistance, hypertension and stroke: namely metabolic syndrome.
Many inflammatory mediators such as fibroblasts have been linked to cancers, which is one of the reasons that long term inflammation increases a person’s risk of developing certain cancers. Since obesity increases the level of adipocytes and they are then, in turn, proinflammatory and inflammation predisposes a person to any number of cancers, it’s not surprising that there are links!
Areas with high levels of adipose tissue have also been shown to become hypoxic, leading to stabilisation and activation of HIF-1a. This in turn, then has the ability to affect multiple genes that code for a range of processes including angiogenesis, cell proliferation, apoptosis and importantly glycolysis.
Adipose tissue also has the propensity to upregulate nuclear factor-?B, which in turn, increases the levels of nitric oxide, which then acts as a substrate for reactive oxygen species. Both cytokines, released from adipose tissue directly, and reactive oxygen species can contribute to insulin resistance. The inflammation caused by adipose tissue increases the transcription of certain genes that control cell proliferation, angiogenesis and metastasis.
So where do pharmacists come into this? If patients with a high BMI, type 2 diabetes and hypertension commonly visit a community pharmacy, they could be screened for biomarkers that would show if a patient was at increased risk of developing a specific type of cancer. Or those patients with increased levels of inflammatory mediators could be given a newly developed drug that reduces or blocks the multiple effects of these mediators. Not only will it help us to learn more about the links between 2 incredibly common diseases, but we might just be able to help some people along the way!