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Visceral adipose tissue volume is associated with premature atherosclerosis in early type 2 diabetes mellitus independent of traditional risk factors

  • Melanie Reijrink
    Correspondence
    Corresponding author. University Medical Center Groningen, department of Vascular Medicine, HP AA41 Hanzeplein 1 9713GZ, Groningen, Netherlands.
    Affiliations
    University of Groningen, University Medical Center Groningen, Department of Vascular Medicine, Groningen, the Netherlands
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  • Stefanie A. de Boer
    Affiliations
    University of Groningen, University Medical Center Groningen, Department of Vascular Medicine, Groningen, the Netherlands
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  • Daan S. Spoor
    Affiliations
    University of Groningen, University Medical Center Groningen, Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, Groningen, the Netherlands
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  • Joop D. Lefrandt
    Affiliations
    University of Groningen, University Medical Center Groningen, Department of Vascular Medicine, Groningen, the Netherlands
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  • Hiddo J. Lambers Heerspink
    Affiliations
    University of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, the Netherlands
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  • Ronald Boellaard
    Affiliations
    University of Groningen, University Medical Center Groningen, Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, Groningen, the Netherlands

    VU University Medical Centre, Amsterdam, Department of Radiology and Nuclear Medicine, the Netherlands
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  • Marcel JW. Greuter
    Affiliations
    University of Twente, TechMed Centre, Department of Robotics and Mechatronics, Enschede, the Netherlands

    University of Groningen, University Medical Center Groningen, Medical Imaging Center, Department of Radiology, Groningen, the Netherlands
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  • Ronald J.H. Borra
    Affiliations
    University of Groningen, University Medical Center Groningen, Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, Groningen, the Netherlands

    University of Groningen, University Medical Center Groningen, Medical Imaging Center, Department of Radiology, Groningen, the Netherlands

    University of Turku, Turku University Hospital, Medical Imaging Centre of Southwest Finland, Department of Diagnostic Radiology, Turku, Finland
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  • Jan-Luuk Hillebrands
    Affiliations
    University of Groningen, University Medical Center Groningen, Department of Pathology and Medical Biology, division of Pathology, Groningen, the Netherlands
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  • Riemer H.J.A. Slart
    Affiliations
    University of Groningen, University Medical Center Groningen, Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, Groningen, the Netherlands

    University of Twente, TechMed Centre, Department of Biomedical Photonic Imaging, Enschede, the Netherlands
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  • Douwe J. Mulder
    Affiliations
    University of Groningen, University Medical Center Groningen, Department of Vascular Medicine, Groningen, the Netherlands
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      Highlights

      • T2DM patients with increased VAT volume are at risk for premature atherosclerosis.
      • VAT volume is positively associated with arterial inflammation in early T2DM.
      • Premature atherosclerosis was imaged with FDG and quantified as meanTBR.
      • The association of VAT with meanTBR was independent of VAT dysfunction biomarkers.

      Abstract

      Background and aims

      Type 2 diabetes mellitus (T2DM) is commonly associated with abdominal obesity, predominantly with high visceral adipose tissue (VAT), and is accompanied by premature atherosclerosis. However, the association between VAT and subcutaneous adipose tissue (SAT) with premature atherosclerosis and (i.e. arterial) inflammation is not completely understood. To provide more insight into this association, we investigated the association between arterial 18F-fluordeoxyglucose (FDG) positron emission tomography (PET) uptake, as a measure of arterial inflammation, and metabolic syndrome (MetS) markers in early T2DM patients.

      Methods

      Forty-four patients with early T2DM, without glucose lowering medication, were studied (median age 63 [IQR 54–66] years, median BMI 30.4 [IQR 27.5–35.8]). Arterial inflammation was quantified using glucose corrected maximum standardized uptake value (SUVmax) FDG of the aorta, carotid, iliac, and femoral arteries, and corrected for background activity (blood pool) as target-to-background ratio (meanTBR). VAT and SAT volumes (cm3) were automatically segmented using computed tomography (CT) between levels L1-L5. Non-alcoholic fatty liver disease (NAFLD) was assessed by liver function test and CT.

      Results

      VAT volume, but not SAT volume, correlated with meanTBR (r = 0.325, p = 0.031). Linear regression models showed a significant association, even after sequential adjustment for potentially influencing MetS components. Interaction term VAT volume * sex and additional components including HbA1c, insulin resistance, NAFLD, adiponectin, leptin, and C- reactive protein (CRP) did not change the independent association between VAT volume and meanTBR.

      Conclusions

      CT-assessed VAT volume is positively associated with FDG-PET assessed arterial inflammation, independently of factors thought to potentially mediate these effects. These findings suggest that VAT in contrast to SAT is linked to early atherosclerotic changes in T2DM patients.

      Keywords

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