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

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• 作者：Eylem Levelt ; MBBS ; DPhil^a ; ^b ; Michael Pavlides ; MBBS^a ; ^c ; Rajarshi Banerjee ; BMBCh ; DPhil^d ; Masliza Mahmod ; DPhil^a ; Catherine Kelly ; PhD^d ; Joanna Sellwood ; BSc^a ; Rina Ariga ; MBBS ; BSc^a ; Sheena Thomas ; PgC ; BsC ; BA^e ; Jane Francis ; DCR(R) ; DNM^a ; Christopher Rodgers ; MChem ; DPhil^a ; William Clarke ; MChem^a ; Nikant Sabharwal ; BSc ; BM ; BCh ; DM^f ; Charalambos Antoniades ; MD ; PhD^e ; Jurgen Schneider ; PhD^a ; Matthew Robson ; PhD^a ; Kieran Clarke ; PhD^b ; Theodoros Karamitsos ; MD ; PhD^a ; Oliver Rider ; BMBCh ; DPhil^a ; Stefan Neubauer ; MD^a ; ^d ; ^{stefan.neubauer@cardiov.ox.ac.uk" class="auth_mail" title="E-mail the corresponding author}
• 关键词：diabetic cardiomyopathy ; epicardial fat deposition ; fatty liver disease ; magnetic resonance imaging ; magnetic resonance spectroscopy
• 刊名：Journal of the American College of Cardiology
• 出版年：2016
• 出版时间：5 July 2016
• 年：2016
• 卷：68
• 期：1
• 页码：53-63
• 全文大小：1909 K

文摘

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.