Epicardial fat, abdominal adiposity and insulin resistance in obese pre-pubertal and early pubertal children

• Published in: Atherosclerosis 2013-02, Vol.226 (2), p.490-495
• Main Authors: Manco, Melania, Morandi, Anita, Marigliano, Marco, Rigotti, Francesca, Manfredi, Riccardo, Maffeis, Claudio
• Format: Article
• Language: English
• Subjects: abdominal fat; adiponectin; adipose tissue; Adiposity; atherosclerosis; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; body mass index; C-reactive protein; Cardiology. Vascular system; Cardiovascular; Child; children; Diseases of the aorta; dual-energy X-ray absorptiometry; Epicardial fat; Female; Homeostasis; Humans; inflammation; insulin; Insulin Resistance; interleukin-10; interleukin-6; Intra-Abdominal Fat - pathology; leptin; liver function; Magnetic Resonance Imaging; Male; males; Medical sciences; Metabolic syndrome; Models, Biological; necrosis; Non alcoholic fatty liver disease; Obese children; Obesity - pathology; Obesity - physiopathology; patients; Pericardium - pathology; Puberty - physiology; regression analysis; risk; risk factors; tumor necrosis factor-alpha; Visceral fat
• ISSN: 0021-9150; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2012.11.023

Abstract Objective To assess the cross-sectional association of epicardial fat with insulin resistance, major abdominal adipose depots, and cardiovascular disease (CVD) risk factors in obese pre-pubertal and early pubertal children. Methods By using magnetic resonance imaging in 30 pre-pubertal and early pubertal patients [21 males, Tanner Stage I-II, median age 11.2 (2.95) y, BMI z -score 2.56 ± 0.11 SDS], visceral (VAT), subcutaneous (SAT), epicardial adipose tissues (EAT) and hepatic fat fraction (HFF) were estimated. Lipid profile, liver function tests, circulating adipokines and markers of inflammation [leptin, adiponectin, tumor necrosis factors-alpha (TNF-alpha), C-reactive protein (CRP), interleukins 6 and 10 (IL-6, IL-10)] were assayed. Insulin resistance was estimated by the homeostasis model assessment of insulin resistance (HOMA-IR). Body composition was measured by dual-energy X-ray absorptiometry. Results In 14 insulin resistant children (HOMA-IR >2.5), median values of EAT were significantly higher than in insulin sensitive mates [54.0 (35.45) cm3 vs. 27.2 (17.03) cm3 ; p  = 0.03]. Moreover, EAT performed no differently in identifying insulin resistant patients (AUC 0.737; 95% CI 0.538–0.936; p  = 0.028) from VAT (AUC 0.772; 95% CI 0.599–0.945; p  = 0.011); SAT (AUC 0.795; 95% CI 0.628–0.0.962; p  = 0.006); and HFF (AUC 0.777; 95% CI 0.607–0.947; p  = 0.010). Stepwise regression analysis showed that EAT ( β  = 0.025; 95% CI 0.012–0.038, p  = 0.001) and CRP ( β  = 0.622; 95% CI 0.069–0.238, p  = 0.002) predicted HOMA-IR ( R2  = 0.71; p  = 0.001), while VAT, SAT and HFF were excluded from the model. Conclusions In pre-pubertal and early pubertal obese children, EAT is a significant marker of increased insulin resistance and associated cardiovascular risk.