23
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Ectopic and Visceral Fat Deposition in Lean and Obese Patients With Type 2 Diabetes

      research-article
      , MBBS, DPhil a , b , , MBBS a , c , , BMBCh, DPhil d , , DPhil a , , PhD d , , BSc a , , MBBS, BSc a , , PgC, BsC, BA e , , DCR(R), DNM a , , MChem, DPhil a , , MChem a , , BSc, BM, BCh, DM f , , MD, PhD e , , PhD a , , PhD a , , PhD b , , MD, PhD a , , BMBCh, DPhil a , , MD a , d ,
      Journal of the American College of Cardiology
      Elsevier Biomedical
      diabetic cardiomyopathy, epicardial fat deposition, fatty liver disease, magnetic resonance imaging, magnetic resonance spectroscopy, 1H-MRS, proton magnetic resonance spectroscopy, 31P-MRS, phosphorus magnetic resonance spectroscopy, ATP, adenosine triphosphate, BMI, body mass index, BP, blood pressure, CT, computed tomography, cT1, iron-corrected T1, HOMA-IR, homeostasis model assessment of insulin resistance, Ln-T2D, lean patients with type 2 diabetes, LV, left ventricular, MR, magnetic resonance, MRI, magnetic resonance imaging, NAFLD, nonalcoholic fatty liver disease, Ob-T2D, obese patients with type 2 diabetes, PCr, phosphocreatine, T2D, type 2 diabetes

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          Type 2 diabetes (T2D) and obesity are associated with nonalcoholic fatty liver disease, cardiomyopathy, and cardiovascular mortality. Both show stronger links between ectopic and visceral fat deposition, and an increased cardiometabolic risk compared with subcutaneous fat.

          Objectives

          This study investigated whether lean patients (Ln) with T2D exhibit increased ectopic and visceral fat deposition and whether these are linked to cardiac and hepatic changes.

          Methods

          Twenty-seven obese patients (Ob) with T2D, 15 Ln-T2D, and 12 normal-weight control subjects were studied. Subjects underwent cardiac computed tomography, cardiac magnetic resonance imaging (MRI), proton and phosphorus MR spectroscopy, and multiparametric liver MR, including hepatic proton MRS, T 1- and T 2*-mapping yielding “iron-corrected T 1” [cT 1].

          Results

          Diabetes, with or without obesity, was associated with increased myocardial triglyceride content (p = 0.01), increased hepatic triglyceride content (p = 0.04), and impaired myocardial energetics (p = 0.04). Although cardiac structural changes, steatosis, and energetics were similar between the T2D groups, epicardial fat (p = 0.04), hepatic triglyceride (p = 0.01), and insulin resistance (p = 0.03) were higher in Ob-T2D. Epicardial fat, hepatic triglyceride, and insulin resistance correlated negatively with systolic strain and diastolic strain rates, which were only significantly impaired in Ob-T2D (p < 0.001 and p = 0.006, respectively). Fibroinflammatory liver disease (elevated cT 1) was only evident in Ob-T2D patients. cT 1 correlated with hepatic and epicardial fat (p < 0.001 and p = 0.01, respectively).

          Conclusions

          Irrespective of body mass index, diabetes is related to significant abnormalities in cardiac structure, energetics, and cardiac and hepatic steatosis. Obese patients with T2D show a greater propensity for ectopic and visceral fat deposition.

          Related collections

          Most cited references36

          • Record: found
          • Abstract: found
          • Article: not found

          Diabetes and cardiovascular disease. The Framingham study.

          Based on 20 years of surveillance of the Framingham cohort relating subsequent cardiovascular events to prior evidence of diabetes, a twofold to threefold increased risk of clinical atherosclerotic disease was reported. The relative impact was greatest for intermittent claudication (IC) and congestive heart failure (CHF) and least for coronary heart disease (CHD), which was, nevertheless, on an absolute scale the chief sequela. The relative impact was substantially greater for women than for men. For each of the cardiovascular diseases (CVD), morbidity and mortality were higher for diabetic women than for nondiabetic men. After adjustment for other associated risk factors, the relative impact of diabetes on CHD, IC, or stroke incidence was the same for women as for men; for CVD death and CHF, it was greater for women. Cardiovascular mortality was actually about as great for diabetic women as for diabetic men.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Human epicardial adipose tissue is a source of inflammatory mediators.

            Inflammatory mediators that originate in vascular and extravascular tissues promote coronary lesion formation. Adipose tissue may function as an endocrine organ that contributes to an inflammatory burden in patients at risk of cardiovascular complications. In this study, we sought to compare expression of inflammatory mediators in epicardial and subcutaneous adipose stores in patients with critical CAD. Paired samples of epicardial and subcutaneous adipose tissues were harvested at the outset of elective CABG surgery (n=42; age 65+/-10 years). Local expression of chemokine (monocyte chemotactic protein [MCP]-1) and inflammatory cytokines (interleukin [IL]-1beta, IL-6, and tumor necrosis factor [TNF]-alpha) was analyzed by TaqMan real-time reverse transcription-polymerase chain reaction (mRNA) and by ELISA (protein release over 3 hours). Significantly higher levels of IL-1beta, IL-6, MCP-1, and TNF-alpha mRNA and protein were observed in epicardial adipose stores. Proinflammatory properties of epicardial adipose tissue were noted irrespective of clinical variables (diabetes, body mass index, and chronic use of statins or ACE inhibitors/angiotensin II receptor blockers) or plasma concentrations of circulating biomarkers. In a subset of samples (n=11), global gene expression was explored by DNA microarray hybridization and confirmed the presence of a broad inflammatory reaction in epicardial adipose tissue in patients with coronary artery disease. The above findings were paralleled by the presence of inflammatory cell infiltrates in epicardial adipose stores. Epicardial adipose tissue is a source of several inflammatory mediators in high-risk cardiac patients. Plasma inflammatory biomarkers may not adequately reflect local tissue inflammation. Current therapies do not appear to eliminate local inflammatory signals in epicardial adipose tissue.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Myocardial steatosis is an independent predictor of diastolic dysfunction in type 2 diabetes mellitus.

              The purpose of this study was to compare myocardial triglyceride content and function between patients with uncomplicated type 2 diabetes mellitus (T2DM) and healthy subjects within the same range of age and body mass index (BMI), and to study the associations between myocardial triglyceride content and function. T2DM is a major risk factor for cardiovascular disease. Increasing evidence is emerging that lipid oversupply to cardiomyocytes plays a role in the development of diabetic cardiomyopathy, by causing lipotoxic injury and myocardial steatosis. Myocardial triglyceride content and myocardial function were measured in 38 T2DM patients and 28 healthy volunteers in the same range of age and BMI by proton magnetic resonance (MR) spectroscopy and MR imaging, respectively. Myocardial triglyceride content was calculated as a percentage relative to the signal of myocardial water. Myocardial triglyceride content was significantly higher in T2DM patients compared with healthy volunteers (0.96 +/- 0.07% vs. 0.65 +/- 0.05%, p < 0.05). Systolic function did not significantly differ between both groups. Indexes of diastolic function, including the ratio of maximal left ventricular early peak filling rate and the maximal left ventricular atrial peak filling rate (E/A) and E peak deceleration, were significantly impaired in T2DM compared with those in healthy subjects (1.08 +/- 0.04 ml/s(2) x 10(-3) vs. 1.24 +/- 0.06 ml/s(2) x 10(-3) and 3.6 +/- 0.2 ml/s(2) x 10(-3) vs. 4.4 +/- 0.3 ml/s(2) x 10(-3), respectively, p < 0.05). Multivariable analysis indicated that myocardial triglyceride content was associated with E/A and E peak deceleration, independently of diabetic state, age, BMI, heart rate, visceral fat, and diastolic blood pressure. Myocardial triglyceride content is increased in uncomplicated T2DM and is associated with impaired left ventricular diastolic function, independently of age, BMI, heart rate, visceral fat, and diastolic blood pressure.
                Bookmark

                Author and article information

                Contributors
                Journal
                J Am Coll Cardiol
                J. Am. Coll. Cardiol
                Journal of the American College of Cardiology
                Elsevier Biomedical
                0735-1097
                1558-3597
                05 July 2016
                05 July 2016
                : 68
                : 1
                : 53-63
                Affiliations
                [a ]University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, Oxford, United Kingdom
                [b ]Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
                [c ]Translational Gastroenterology Unit, University of Oxford, Oxford, United Kingdom
                [d ]Perspectum Diagnostics Ltd., Oxford, United Kingdom
                [e ]Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
                [f ]Cardiology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
                Author notes
                [] Reprint requests and correspondence: Dr. Stefan Neubauer, University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom.University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR)John Radcliffe HospitalHeadley WayOxford OX3 9DUUnited Kingdom stefan.neubauer@ 123456cardiov.ox.ac.uk
                Article
                S0735-1097(16)33014-5
                10.1016/j.jacc.2016.03.597
                4925621
                27364051
                491b4db2-f72c-47ac-ba4b-1f19ab012576
                © 2016 Elsevier Inc. All rights reserved.

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                : 5 March 2016
                : 27 March 2016
                : 29 March 2016
                Categories
                Original Investigation

                Cardiovascular Medicine
                diabetic cardiomyopathy,epicardial fat deposition,fatty liver disease,magnetic resonance imaging,magnetic resonance spectroscopy,1h-mrs, proton magnetic resonance spectroscopy,31p-mrs, phosphorus magnetic resonance spectroscopy,atp, adenosine triphosphate,bmi, body mass index,bp, blood pressure,ct, computed tomography,ct1, iron-corrected t1,homa-ir, homeostasis model assessment of insulin resistance,ln-t2d, lean patients with type 2 diabetes,lv, left ventricular,mr, magnetic resonance,mri, magnetic resonance imaging,nafld, nonalcoholic fatty liver disease,ob-t2d, obese patients with type 2 diabetes,pcr, phosphocreatine,t2d, type 2 diabetes

                Comments

                Comment on this article