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J Am Coll Cardiol. 2016 Jul 5;68(1):53-63. doi: 10.1016/j.jacc.2016.03.597.

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

Author information

1
University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, Oxford, United Kingdom; Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom.
2
University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, Oxford, United Kingdom; Translational Gastroenterology Unit, University of Oxford, Oxford, United Kingdom.
3
Perspectum Diagnostics Ltd., Oxford, United Kingdom.
4
University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, Oxford, United Kingdom.
5
Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom.
6
Cardiology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
7
Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom.
8
University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, Oxford, United Kingdom; Perspectum Diagnostics Ltd., Oxford, United Kingdom. Electronic address: stefan.neubauer@cardiov.ox.ac.uk.

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, T1- and T2*-mapping yielding "iron-corrected T1" [cT1].

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 cT1) was only evident in Ob-T2D patients. cT1 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.

KEYWORDS:

diabetic cardiomyopathy; epicardial fat deposition; fatty liver disease; magnetic resonance imaging; magnetic resonance spectroscopy

PMID:
27364051
PMCID:
PMC4925621
DOI:
10.1016/j.jacc.2016.03.597
[Indexed for MEDLINE]
Free PMC Article

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