Editing Abdominal obesity (section)

== Causes ==

===Diet===

{{see also|Diet and obesity}}
The currently prevalent belief is that the immediate cause of obesity is net [[energy]] imbalance—the organism consumes more usable [[calories]] than it expends, wastes, or discards through [[Metabolic waste|elimination]]. Some studies indicate that visceral adiposity, together with [[lipid]] dysregulation and [[Insulin resistance|decreased insulin sensitivity]],<ref>{{cite journal | vauthors = Stanhope KL, Havel PJ | title = Fructose consumption: recent results and their potential implications | journal = Annals of the New York Academy of Sciences | volume = 1190 | issue = 1 | pages = 15–24 | date = March 2010 | pmid = 20388133 | pmc = 3075927 | doi = 10.1111/j.1749-6632.2009.05266.x | bibcode = 2010NYASA1190...15S }}</ref> is related to the excessive consumption of [[fructose]].<ref>{{cite journal | vauthors = Elliott SS, Keim NL, Stern JS, Teff K, Havel PJ | title = Fructose, weight gain, and the insulin resistance syndrome | journal = The American Journal of Clinical Nutrition | volume = 76 | issue = 5 | pages = 911–22 | date = November 2002 | pmid = 12399260 | doi = 10.1093/ajcn/76.5.911 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Perez-Pozo SE, Schold J, Nakagawa T, Sánchez-Lozada LG, Johnson RJ, Lillo JL | title = Excessive fructose intake induces the features of metabolic syndrome in healthy adult men: role of uric acid in the hypertensive response | journal = International Journal of Obesity | volume = 34 | issue = 3 | pages = 454–61 | date = March 2010 | pmid = 20029377 | doi = 10.1038/ijo.2009.259 | s2cid = 4344197 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Choi ME | title = The not-so-sweet side of fructose | journal = Journal of the American Society of Nephrology | volume = 20 | issue = 3 | pages = 457–9 | date = March 2009 | pmid = 19244571 | doi = 10.1681/asn.2009010104 | url = http://jasn.asnjournals.org/content/20/3/457.full | series = 3 | doi-access = free }}</ref> Some evidence shows that in regards to juveniles, when [[Free sugars|free fructose]] is present as children's fat cells mature, it makes more of these cells mature into fat cells in the abdominal region. It also caused both visceral fat and subcutaneous fat to be less sensitive to insulin. These effects were not attenuated when compared to similar [[glucose]] consumption.<ref>{{Cite web|title=Fructose sugar makes maturing human fat cells fatter, less insulin-sensitive, study finds|url=https://www.sciencedaily.com/releases/2010/06/100621091203.htm|access-date=2021-03-08|website=ScienceDaily|language=en}}</ref>

Intake of [[Trans fatty acids|trans fat]] from industrial oils has been associated with increased abdominal obesity in men<ref>{{cite journal | vauthors = Koh-Banerjee P, Chu NF, Spiegelman D, Rosner B, Colditz G, Willett W, Rimm E | title = Prospective study of the association of changes in dietary intake, physical activity, alcohol consumption, and smoking with 9-y gain in waist circumference among 16 587 US men | journal = The American Journal of Clinical Nutrition | volume = 78 | issue = 4 | pages = 719–27 | date = October 2003 | pmid = 14522729 | doi = 10.1093/ajcn/78.4.719 | doi-access = free }}</ref> and increased weight and waist circumference in women.<ref>{{cite journal | vauthors = Bendsen NT, Chabanova E, Thomsen HS, Larsen TM, Newman JW, Stender S, Dyerberg J, Haugaard SB, Astrup A | display-authors = 6 | title = Effect of trans fatty acid intake on abdominal and liver fat deposition and blood lipids: a randomized trial in overweight postmenopausal women | journal = Nutrition & Diabetes | volume = 1 | issue = 1 | pages = e4 | date = January 2011 | pmid = 23154296 | pmc = 3302130 | doi = 10.1038/nutd.2010.4 }}</ref> These associations were not attenuated when fat intake and calorie intake was accounted for.<ref>{{cite journal | vauthors = Micha R, Mozaffarian D | title = Trans fatty acids: effects on cardiometabolic health and implications for policy | journal = Prostaglandins, Leukotrienes, and Essential Fatty Acids | volume = 79 | issue = 3–5 | pages = 147–52 | date = 1 September 2008 | pmid = 18996687 | doi = 10.1016/j.plefa.2008.09.008 | url= | pmc = 2639783 }}</ref><ref>{{cite journal | vauthors = Kavanagh K, Jones KL, Sawyer J, Kelley K, Carr JJ, Wagner JD, Rudel LL | title = Trans fat diet induces abdominal obesity and changes in insulin sensitivity in monkeys | journal = Obesity | volume = 15 | issue = 7 | pages = 1675–84 | date = July 2007 | pmid = 17636085 | doi = 10.1038/oby.2007.200 | s2cid = 4835948 | doi-access = free }}</ref> Greater [[meat]] ([[processed meat]], [[red meat]], and [[poultry]]) consumption has also been positively associated with greater weight gain, and specifically abdominal obesity, even when accounting for calories.<ref>{{cite journal | vauthors = Vergnaud AC, Norat T, Romaguera D, Mouw T, May AM, Travier N, Luan J, Wareham N, Slimani N, Rinaldi S, Couto E, Clavel-Chapelon F, Boutron-Ruault MC, Cottet V, Palli D, Agnoli C, Panico S, Tumino R, Vineis P, Agudo A, Rodriguez L, Sanchez MJ, Amiano P, Barricarte A, Huerta JM, Key TJ, Spencer EA, Bueno-de-Mesquita B, Büchner FL, Orfanos P, Naska A, Trichopoulou A, Rohrmann S, Hermann S, Boeing H, Buijsse B, Johansson I, Hellstrom V, Manjer J, Wirfält E, Jakobsen MU, Overvad K, Tjonneland A, Halkjaer J, Lund E, Braaten T, Engeset D, Odysseos A, Riboli E, Peeters PH | display-authors = 6 | title = Meat consumption and prospective weight change in participants of the EPIC-PANACEA study | journal = The American Journal of Clinical Nutrition | volume = 92 | issue = 2 | pages = 398–407 | date = August 2010 | pmid = 20592131 | doi = 10.3945/ajcn.2009.28713 | doi-access = free }}</ref><ref>{{cite journal |title=Reply to A Astrup et al |journal=The American Journal of Clinical Nutrition |date=2010-11-01 |issn=0002-9165 |pages=1275–1276 |volume=92 |issue=5 |doi=10.3945/ajcn.110.000786 | vauthors = Vergnaud AC, Norat T, Romaguera D, Peeters PH |doi-access=free }}</ref> Conversely, studies suggest that oily [[Fish as food|fish]] consumption is negatively associated with total body fat and abdominal fat distribution even when body mass remains constant.<ref>{{cite journal | vauthors = Hosseini-Esfahani F, Mirmiran P, Koochakpoor G, Daneshpour MS, Guity K, Azizi F | title = Some dietary factors can modulate the effect of the zinc transporters 8 polymorphism on the risk of metabolic syndrome | journal = Scientific Reports | volume = 7 | issue = 1 | pages = 1649 | date = May 2017 | pmid = 28490771 | pmc = 5431973 | doi = 10.1038/s41598-017-01762-9 | bibcode = 2017NatSR...7.1649H | url = }}</ref><ref>{{cite journal | vauthors = Noreen EE, Sass MJ, Crowe ML, Pabon VA, Brandauer J, Averill LK | title = Effects of supplemental fish oil on resting metabolic rate, body composition, and salivary cortisol in healthy adults | journal = Journal of the International Society of Sports Nutrition | volume = 7 | pages = 31 | date = October 2010 | pmid = 20932294 | pmc = 2958879 | doi = 10.1186/1550-2783-7-31 | doi-access = free }}</ref> Similarly, increased [[soy protein]] consumption is correlated with lower amounts of abdominal fat in postmenopausal women even when calorie consumption is controlled.<ref>{{cite journal | vauthors = Sites CK, Cooper BC, Toth MJ, Gastaldelli A, Arabshahi A, Barnes S | title = Effect of a daily supplement of soy protein on body composition and insulin secretion in postmenopausal women | journal = Fertility and Sterility | volume = 88 | issue = 6 | pages = 1609–17 | date = December 2007 | pmid = 17412329 | pmc = 2200634 | doi = 10.1016/j.fertnstert.2007.01.061 }}</ref><ref>{{cite journal | vauthors = Bakhtiari A, Yassin Z, Hanachi P, Rahmat A, Ahmad Z, Sajadi P, Shojaei S | title = Effects of Soy on Body Composition: A 12-Week Randomized Controlled Trial among Iranian Elderly Women with Metabolic Syndrome | journal = Iranian Journal of Public Health | volume = 41 | issue = 4 | pages = 9–18 | date = 2012-04-30 | pmid = 23113160 | pmc = 3481610 }}</ref>

Numerous large studies have demonstrated that [[ultra-processed foods]] have a positive dose-dependent relationship with both abdominal obesity and general obesity in both men and women.<ref>{{cite journal|last1=Monteiro|first1=Carlos Augusto|last2=Cannon|first2=Geoffrey|last3=Moubarac|first3=Jean-Claude|last4=Levy|first4=Renata Bertazzi|last5=Louzada|first5=Maria Laura C.|last6=Jaime|first6=Patrícia Constante|date=January 2018|title=The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing|journal=Public Health Nutrition|language=en|volume=21|issue=1|pages=5–17|doi=10.1017/S1368980017000234|issn=1368-9800|pmid=28322183|pmc=10261019 |doi-access=free}}</ref> Consuming a diet rich in unprocessed food and minimally processed food is linked with lower obesity risk, lower waist circumference and less chronic disease. These findings are consistent among American,<ref>{{Cite web|title=Processed foods highly correlated with obesity epidemic in the US|url=https://www.sciencedaily.com/releases/2020/01/200106122009.htm|access-date=2021-03-08|website=ScienceDaily|language=en}}</ref> Canadian,<ref>{{cite journal |last1=Nardocci |first1=Milena |last2=Leclerc |first2=Bernard-Simon |last3=Louzada |first3=Maria-Laura |last4=Monteiro |first4=Carlos Augusto |last5=Batal |first5=Malek |last6=Moubarac |first6=Jean-Claude |title=Consumption of ultra-processed foods and obesity in Canada |journal=Canadian Journal of Public Health |date=20 September 2018 |volume=110 |issue=1 |pages=4–14 |doi=10.17269/s41997-018-0130-x |pmid=30238324 |issn=0008-4263|pmc=6964616 }}</ref> Latin American,<ref>{{cite book |last1=Organization |first1=Pan American Health |title=Ultra-processed food and drink products in Latin America: Sales, sources, nutrient profiles, and policy implications |date=17 June 2019 |url=https://iris.paho.org/handle/10665.2/51094 |access-date=15 March 2021 |language=en |isbn=978-92-75-12032-3}}</ref> Australian,<ref>{{cite journal | vauthors = Machado PP, Steele EM, Levy RB, da Costa Louzada ML, Rangan A, Woods J, Gill T, Scrinis G, Monteiro CA | display-authors = 6 | title = Ultra-processed food consumption and obesity in the Australian adult population | journal = Nutrition & Diabetes | volume = 10 | issue = 1 | pages = 39 | date = December 2020 | pmid = 33279939 | doi = 10.1038/s41387-020-00141-0 | pmc = 7719194 | doi-access = free }}</ref> British,<ref>{{cite journal | vauthors = Rauber F, Steele EM, Louzada ML, Millett C, Monteiro CA, Levy RB | title = Ultra-processed food consumption and indicators of obesity in the United Kingdom population (2008-2016) | journal = PLOS ONE | volume = 15 | issue = 5 | pages = e0232676 | date = 2020-05-01 | pmid = 32357191 | pmc = 7194406 | doi = 10.1371/journal.pone.0232676 | bibcode = 2020PLoSO..1532676R | doi-access = free }}</ref> French,<ref>{{cite journal | vauthors = Beslay M, Srour B, Méjean C, Allès B, Fiolet T, Debras C, Chazelas E, Deschasaux M, Wendeu-Foyet MG, Hercberg S, Galan P, Monteiro CA, Deschamps V, Calixto Andrade G, Kesse-Guyot E, Julia C, Touvier M | display-authors = 6 | title = Ultra-processed food intake in association with BMI change and risk of overweight and obesity: A prospective analysis of the French NutriNet-Santé cohort | journal = PLOS Medicine | volume = 17 | issue = 8 | pages = e1003256 | date = August 2020 | pmid = 32853224 | pmc = 7451582 | doi = 10.1371/journal.pmed.1003256 | doi-access = free }}</ref> Spaniard,<ref>{{cite journal | vauthors = Sandoval-Insausti H, Jiménez-Onsurbe M, Donat-Vargas C, Rey-García J, Banegas JR, Rodríguez-Artalejo F, Guallar-Castillón P | title = Ultra-Processed Food Consumption Is Associated with Abdominal Obesity: A Prospective Cohort Study in Older Adults | journal = Nutrients | volume = 12 | issue = 8 | date = August 2020 | page = 2368 | pmid = 32784758 | pmc = 7468731 | doi = 10.3390/nu12082368 | doi-access = free }}</ref> Swedish,<ref>{{Cite journal |last1=Juul |first1=Filippa |last2=Hemmingsson |first2=Erik |date=December 2015 |title=Trends in consumption of ultra-processed foods and obesity in Sweden between 1960 and 2010 |journal=Public Health Nutrition |volume=18 |issue=17 |pages=3096–3107 |doi=10.1017/S1368980015000506 |issn=1475-2727 |pmid=25804833|pmc=10277202 |s2cid=22016427 }}</ref> South Korean,<ref>{{Cite journal|last1=Sung|first1=Hyuni|last2=Park|first2=Ji Min|last3=Oh|first3=Se Uk|last4=Ha|first4=Kyungho|last5=Joung|first5=Hyojee|date=February 2021|title=Consumption of Ultra-Processed Foods Increases the Likelihood of Having Obesity in Korean Women|journal=Nutrients|language=en|volume=13|issue=2|pages=698|doi=10.3390/nu13020698|pmid=33671557| pmc=7926298|doi-access=free}}</ref> Chinese<ref>{{Cite journal|last1=Li|first1=Ming|last2=Shi|first2=Zumin|date=August 2021|title=Ultra-Processed Food Consumption Associated with Overweight/Obesity among Chinese Adults—Results from China Health and Nutrition Survey 1997–2011|journal=Nutrients|language=en|volume=13|issue=8|pages=2796| pmid=34444957|  doi=10.3390/nu13082796 | pmc=8399660 |doi-access=free}}</ref> and Sub-Saharan African<ref>{{Cite journal|last1=Reardon|first1=Thomas|last2=Tschirley|first2=David|last3=Liverpool-Tasie|first3=Lenis Saweda O.|last4=Awokuse|first4=Titus|last5=Fanzo|first5=Jessica|last6=Minten|first6=Bart|last7=Vos|first7=Rob|last8=Dolislager|first8=Michael|last9=Sauer|first9=Christine|last10=Dhar|first10=Rahul|last11=Vargas|first11=Carolina|date=2021-03-01|title=The processed food revolution in African food systems and the double burden of malnutrition|journal=Global Food Security|language=en|volume=28|pages=100466|doi=10.1016/j.gfs.2020.100466|pmid=33868911| pmc=8049356|bibcode=2021GlFS...2800466R |issn=2211-9124}}</ref> populations.

Obesity plays an important role in the impairment of [[Lipid metabolism|lipid]] and [[carbohydrate metabolism]] shown in high-[[carbohydrate]] diets.<ref>{{cite journal | vauthors = Ibrahim IA, Abd El-Aziz MF, Ahmed AF, Mohamed MA |title=Is the effect of high fat diet on lipid and carbohydrate metabolism related to inflammation? |volume=4 |issue=3 |pages=203–209 |doi=10.1007/s12349-011-0056-9 |journal=Mediterranean Journal of Nutrition and Metabolism |year=2011|s2cid=83758966 }}</ref>{{Unreliable source? |date=February 2012 |reason=Source claims high-fat diet causes obesity, which is a vast oversimplification.}} It has also been shown that quality [[protein]] intake during a 24-hour period and the number of times the [[essential amino acid]] threshold of approximately 10&nbsp;g<ref>{{cite journal | vauthors = Cuthbertson D, Smith K, Babraj J, Leese G, Waddell T, Atherton P, Wackerhage H, Taylor PM, Rennie MJ | display-authors = 6 | title = Anabolic signaling deficits underlie amino acid resistance of wasting, aging muscle | journal = FASEB Journal | volume = 19 | issue = 3 | pages = 422–4 | date = March 2005 | pmid = 15596483 | doi = 10.1096/fj.04-2640fje | doi-access = free | s2cid = 22609751 }}</ref> has been achieved is inversely related to the percentage of central abdominal fat. Quality protein uptake is defined as the ratio of essential amino acids to daily dietary protein.<ref>{{cite journal | vauthors = Loenneke JP, Wilson JM, Manninen AH, Wray ME, Barnes JT, Pujol TJ | title = Quality protein intake is inversely related with abdominal fat | journal = Nutrition & Metabolism | volume = 9 | issue = 1 | pages = 5 | date = January 2012 | pmid = 22284338 | pmc = 3284412 | doi = 10.1186/1743-7075-9-5 | doi-access = free }}</ref>

Visceral fat cells will release their metabolic by-products in the [[portal circulation]], where the blood leads straight to the [[liver]]. Thus, the excess of [[triglyceride]]s and [[fatty acid]]s created by the visceral fat cells will go into the liver and accumulate there. In the liver, most of it will be stored as fat. This concept is known as '[[lipotoxicity]]'.<ref>President and fellows of Harvard College. (2006). Abnormal obesity and your health. Retrieved from http://www.health.harvard.edu/fhg/updates/abdominal-obesity-and-your-health.shtml {{Webarchive|url=https://web.archive.org/web/20130315182221/http://www.health.harvard.edu/fhg/updates/abdominal-obesity-and-your-health.shtml |date=2013-03-15 }}</ref>

=== Alcohol consumption ===
A study has shown that [[alcohol consumption]] is directly associated with waist circumference and with a higher risk of abdominal obesity in men, but not in women. After controlling for energy under-reporting, which have slightly attenuated these associations, it was observed that increasing alcohol consumption significantly increased the risk of exceeding recommended energy intakes in male participants – but not in the small number of female participants (2.13%) with elevated alcohol consumption, even after establishing a lower number of drinks per day to characterize women as consuming a high quantity of alcohol. [[Further research is needed]] to determine whether a significant relationship between alcohol consumption and abdominal obesity exists among women who consume higher amounts of alcohol.<ref>{{cite journal | vauthors = Schröder H, Morales-Molina JA, Bermejo S, Barral D, Mándoli ES, Grau M, Guxens M, de Jaime Gil E, Alvarez MD, Marrugat J | display-authors = 6 | title = Relationship of abdominal obesity with alcohol consumption at population scale | journal = European Journal of Nutrition | volume = 46 | issue = 7 | pages = 369–76 | date = October 2007 | pmid = 17885722 | doi = 10.1007/s00394-007-0674-7 | url = http://redheracles.net/media/upload/research/pdf/17885722.pdf | s2cid = 7185367 }}</ref>

A systemic review and meta-analysis failed to find data pointing towards a dose-dependent relationship between [[beer]] intake and general obesity or abdominal obesity at low or moderate intake levels (under ~500&nbsp;mL/day). However, high beer intake (above ~4&nbsp;L/wk) appeared to be associated with a higher degree of abdominal obesity specifically, particularly among men.<ref>{{cite journal | vauthors = Bendsen NT, Christensen R, Bartels EM, Kok FJ, Sierksma A, Raben A, Astrup A | title = Is beer consumption related to measures of abdominal and general obesity? A systematic review and meta-analysis | journal = Nutrition Reviews | volume = 71 | issue = 2 | pages = 67–87 | date = February 2013 | pmid = 23356635 | doi = 10.1111/j.1753-4887.2012.00548.x | doi-access = free }}</ref>

===Other factors===
The prevalence of abdominal obesity is increasing in Western populations, possibly due to a combination of low physical activity and high-calorie diets, and also in developing countries, where it is associated with the urbanization of populations.<ref name="Carey1998">{{cite journal |last=Carey |first=D. G. P. |year=1998 |title=Abdominal Obesity |journal=Current Opinion in Lipidology |pages=35–40 |volume=9 |issue=1|doi=10.1097/00041433-199802000-00008 |pmid=9502333 }}</ref><ref>{{cite journal |vauthors=Després J |year=2006 |title=Abdominal obesity: the most prevalent cause of the metabolic syndrome and related cardiometabolic risk |journal=European Heart Journal |volume=8 |issue=Supplements |pages=B4–B12 |doi=10.1093/eurheartj/sul002 |doi-access=free}}</ref>

Other environmental factors, such as [[Smoking and pregnancy|maternal smoking]], [[estrogenic]] [[Chemical compound|compound]]s in the diet, and [[endocrine]]-disrupting chemicals may be important also.<ref>{{cite book | vauthors = Heindel J |title=Obesity Before Birth |chapter=The Obesogen Hypothesis of Obesity: Overview and Human Evidence |series=Endocrine Updates |year=2011 |volume=4 |pages=355–365 |doi=10.1007/978-1-4419-7034-3_17 |isbn=978-1-4419-7033-6|publisher=Springer }}</ref>

[[Hypercortisolism]], such as in [[Cushing's syndrome]], also leads to central obesity. Many [[prescription drug]]s, such as [[dexamethasone]] and other [[steroid]]s, can also have [[side effect]]s resulting in central obesity,<ref name="Does central obesity reflect Cushi"/> especially in the presence of elevated insulin levels.