CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 3, May/June 2011
AFRICA
147
Review Article
Once fat was fat and that was that: our changing
perspectives on adipose tissue
WF FERRIS, NJ CROWTHER
Abstract
Past civilisations saw excess body fat as a symbol of wealth
and prosperity as the general population struggled with food
shortages and famine. Nowadays it is recognised that obesity
is associated with co-morbidities such as cardiovascular
disease and diabetes. Our views on the roll of adipose tissue
have also changed, from being solely a passive energy store,
to an important endocrine organ that modulates metabolism,
immunity and satiety. The relationship between increased
visceral adiposity and obesity-related co-morbidities has lead
to the recognition that variation in fat distribution contrib-
utes to ethnic differences in the prevalence of obesity-related
diseases. Our current negative view of adipose tissue may
change with the use of pluripotent adipose-derived stromal
cells, which may lead to future autologous stem cell therapies
for bone, muscle, cardiac and cartilage disorders. Here, we
briefly review the concepts that adipose tissue is an endocrine
organ, that differences in body fat distribution underline the
aetiology of obesity-related co-morbidities, and the use of
adipose-derived stem cells for future therapies.
Keywords:
adipocytes, obesity, cardiovascular disease, stem
cells
Submitted 14/7/10, accepted 31/8/10
Cardiovasc J Afr
2011;
22
: 147–154
DOI: CVJ-21.066
A changing view of adiposity through the ages
The incidence of obesity and obesity-related co-morbidities
has risen dramatically in the last century. The latest global data
shows that in 2004 cardiovascular disease was the primary cause
of death, above infectious and parasitic diseases, with the major-
ity of cases attributed to an unhealthy lifestyle. This includes
over-nutrition.
1
The increase in obesity has been accompanied
by increased interest in fat and an abundance of research inves-
tigating the link between excessive adiposity and the associated
pathologies. Currently there are over 130 000 research articles
on obesity cited on PubMed and these publications show that our
perception of the function of fat mass has changed considerably
since the first entry cited from 1880. However, our knowledge of
adiposity stretches back far beyond the 19th century. Although it
is not known whether classical scholars recognised that adipose
tissue is our major energy store, they did observe that excessive
adiposity has negative health implications.
The Indian physician Sushruta (sixth century BCE) was prob-
ably the first to document a relationship between obesity and
co-morbidities such as diabetes and heart disease. Not unlike
today, he recommended exercise to remedy conditions that had
arisen from a sedentary lifestyle and ‘pampering the belly’.
2
Later
in Europe, Hippocrates (460–377 BC) independently recognised
the relationship between body composition, exercise and health,
exemplified in his quote: ‘If we could give every individual the
right amount of nourishment and exercise, not too little and not
too much, we would have found the safest way to health’. In a
time of scant medical knowledge, his insight extended further,
beyond his contemporaries, to include the pathogenicity of
obesity, in writing: ‘Repletion, carried to extremes, is perilous’
and ‘Corpulence is not only a disease in itself, but the harbinger
of others’. He then subsequently noted that life expectancy was
far shorter in the obese compared to lean individuals.
3
Although the detrimental effects of obesity have therefore
long been known, in the intervening millennia since Sushruta
and Hippocrates, portliness was generally regarded as a symbol
of affluence. This was primarily due to periodic food short-
ages and famine, which were only brought under control in the
Western world in the last century yet still ravish the developing
world today. This association between wealth and increased body
mass was often reflected in the art of European masters such as
Rubens (1577–1640) who depicted women with a full-bodied,
hour-glass shape; a shape which was associated with opulence
and fertility.
4
By the 20th century, the use of intensive farming in conjunc-
tion with the mechanisation of the food industry helped to eradi-
cate famine in the developed world. The increasing availability
of highly palatable, high-energy foods and decreased levels of
physical activity has lead to an increasing imbalance between
energy input and expenditure in the general population. The
consequence of this is a burgeoning of portliness and obesity.
This rise in the prevalence of obesity is a global phenomenon,
occurring in both the developed and the developing worlds. Data
from the USA shows that in the period 1988–1994 the preva-
lence of obesity was 22.5%,
5
and rose to 32.2% in the period
Division of Endocrinology, Department of Medicine,
Faculty of Health Sciences, University of Stellenbosch,
Stellenbosch, South Africa
WF FERRIS,
Department of Chemical Pathology, National Health
Laboratory Services, University of Witwatersrand Medical
School, Johannesburg, South Africa
NJ CROWTHER
