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

Eylem Levelt, Michael Pavlides, Rajarshi Banerjee, Masliza Mahmod, Catherine Kelly, Joanna Sellwood, Rina Ariga, Sheena Thomas, Jane Francis, Christopher Rodgers, William Clarke, Nikant Sabharwal, Charalambos Antoniades, Jurgen Schneider, Matthew Robson, Kieran Clarke, Theodoros Karamitsos, Oliver Rider, Stefan Neubauer

Research output: Contribution to journalArticle

46 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)53-63
Number of pages11
JournalJournal of the American College of Cardiology
Volume68
Issue number1
DOIs
Publication statusPublished - 5 Jul 2016
Externally publishedYes

Fingerprint

Intra-Abdominal Fat
Type 2 Diabetes Mellitus
Liver
Triglycerides
Fats
Insulin Resistance
Protons
Obesity
Subcutaneous Fat
Cardiomyopathies
Phosphorus
Liver Diseases
Body Mass Index
Magnetic Resonance Spectroscopy
Iron
Tomography
Magnetic Resonance Imaging
Weights and Measures
Mortality

Keywords

  • Diabetic cardiomyopathy
  • Epicardial fat deposition
  • Fatty liver disease
  • Magnetic resonance imaging
  • Magnetic resonance spectroscopy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Levelt, E., Pavlides, M., Banerjee, R., Mahmod, M., Kelly, C., Sellwood, J., ... Neubauer, S. (2016). Ectopic and Visceral Fat Deposition in Lean and Obese Patients with Type 2 Diabetes. Journal of the American College of Cardiology, 68(1), 53-63. https://doi.org/10.1016/j.jacc.2016.03.597

Ectopic and Visceral Fat Deposition in Lean and Obese Patients with Type 2 Diabetes. / Levelt, Eylem; Pavlides, Michael; Banerjee, Rajarshi; Mahmod, Masliza; Kelly, Catherine; Sellwood, Joanna; Ariga, Rina; Thomas, Sheena; Francis, Jane; Rodgers, Christopher; Clarke, William; Sabharwal, Nikant; Antoniades, Charalambos; Schneider, Jurgen; Robson, Matthew; Clarke, Kieran; Karamitsos, Theodoros; Rider, Oliver; Neubauer, Stefan.

In: Journal of the American College of Cardiology, Vol. 68, No. 1, 05.07.2016, p. 53-63.

Research output: Contribution to journalArticle

Levelt, E, Pavlides, M, Banerjee, R, Mahmod, M, Kelly, C, Sellwood, J, Ariga, R, Thomas, S, Francis, J, Rodgers, C, Clarke, W, Sabharwal, N, Antoniades, C, Schneider, J, Robson, M, Clarke, K, Karamitsos, T, Rider, O & Neubauer, S 2016, 'Ectopic and Visceral Fat Deposition in Lean and Obese Patients with Type 2 Diabetes', Journal of the American College of Cardiology, vol. 68, no. 1, pp. 53-63. https://doi.org/10.1016/j.jacc.2016.03.597
Levelt, Eylem ; Pavlides, Michael ; Banerjee, Rajarshi ; Mahmod, Masliza ; Kelly, Catherine ; Sellwood, Joanna ; Ariga, Rina ; Thomas, Sheena ; Francis, Jane ; Rodgers, Christopher ; Clarke, William ; Sabharwal, Nikant ; Antoniades, Charalambos ; Schneider, Jurgen ; Robson, Matthew ; Clarke, Kieran ; Karamitsos, Theodoros ; Rider, Oliver ; Neubauer, Stefan. / Ectopic and Visceral Fat Deposition in Lean and Obese Patients with Type 2 Diabetes. In: Journal of the American College of Cardiology. 2016 ; Vol. 68, No. 1. pp. 53-63.
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T1 - Ectopic and Visceral Fat Deposition in Lean and Obese Patients with Type 2 Diabetes

AU - Levelt, Eylem

AU - Pavlides, Michael

AU - Banerjee, Rajarshi

AU - Mahmod, Masliza

AU - Kelly, Catherine

AU - Sellwood, Joanna

AU - Ariga, Rina

AU - Thomas, Sheena

AU - Francis, Jane

AU - Rodgers, Christopher

AU - Clarke, William

AU - Sabharwal, Nikant

AU - Antoniades, Charalambos

AU - Schneider, Jurgen

AU - Robson, Matthew

AU - Clarke, Kieran

AU - Karamitsos, Theodoros

AU - Rider, Oliver

AU - Neubauer, Stefan

PY - 2016/7/5

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N2 - 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.

AB - 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.

KW - Diabetic cardiomyopathy

KW - Epicardial fat deposition

KW - Fatty liver disease

KW - Magnetic resonance imaging

KW - Magnetic resonance spectroscopy

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