A low visceral fat proportion, independent of total body fat mass, protects obese adolescent girls against fatty liver and glucose dysregulation: a longitudinal study

Abstract

Background

The relative proportion of visceral fat (VAT) to subcutaneous fat (SAT) has been described as a major determinant of insulin resistance (IR). Our study sought to evaluate the effect of body fat distribution on glucose metabolism and intrahepatic fat content over time in a multiethnic cohort of obese adolescents.

Subjects/Methods

We examined markers of glucose metabolism by oral glucose tolerance test, and body fat distribution by abdominal MRI at baseline and after 19.2 ± 11.4 months in a cohort of 151 obese adolescents (88 girls, 63 boys; mean age 13.3 ± 3.4 years; mean BMI z-score 2.15 ± 0.70). Hepatic fat content was assessed by fast-gradient MRI in a subset of 93 subjects. We used the median value of VAT/(VAT + SAT) ratio within each gender at baseline to stratify our sample into high and low ratio groups (median value 0.0972 in girls and 0.118 in boys).

Results

Female subjects tended to remain in their VAT/(VAT + SAT) category over time (change over follow-up P = 0.14 among girls, and P = 0.04 among boys). Baseline VAT/(VAT + SAT) strongly predicted the hepatic fat content, fasting insulin, 2-h glucose, and whole-body insulin sensitivity index at follow-up among girls, but not in boys.

Conclusions

The VAT/(VAT + SAT) ratio is a major determinant of impaired glucose metabolism and hepatic fat accumulation over time, and its effects are more pronounced in girls than in boys.

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Acknowledgements

This work has been made possible by R01-DK111038 and R01-HD028016 to SC. NS is funded by the American Heart Association (AHA) through the 13SDG14640038 and the 16IRG27390002. AG was supported by the Robert Leet Patterson and Clara Guthrie Patterson Trust Mentored Research Award and the European Medical Information Framework (EMIF 115372). VS is funded by CTSA Grant Number UL1 RR024139 from the National Center for Research Resources (NCRR) and the National Center for Advancing Translational Science (NCATS), components of the National Institutes of Health (NIH), and NIH roadmap for Medical Research. This work was also made possible by DK045735 to the Yale Diabetes Research Center and Clinical and Translational Science Awards Grant UL1-RR- 024139 from the National Center for Advancing Translational Sciences, a component of the NIH, and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH.

Author contributions

SC initiated the concept of the study and designed it together with AG. BP, JN, and MM were responsible for collecting the data. VS, DT, and GRU performed the statistical analyses. GRU, SC, and NS wrote the manuscript. SC is the guarantor of this work.

Author information

Correspondence to Sonia Caprio.

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The authors declare that they have no conflict of interest.

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