title: High visceral and low abdominal subcutaneous fat stores in the obese adolescent: a determinant of an adverse metabolic phenotype.
abstract: OBJECTIVE
  To explore whether an imbalance between the visceral and subcutaneous fat depots and a corresponding dysregulation of the adipokine milieu is associated with excessive accumulation of fat in the liver and muscle and ultimately with insulin resistance and the metabolic syndrome.
  
  
  METHODS
  We stratified our multi-ethnic cohort of 118 obese adolescents into tertiles based on the proportion of abdominal fat in the visceral depot. Abdominal and liver fat were measured by magnetic resonance imaging and muscle lipid (intramyocellular lipid) by proton magnetic resonance spectroscopy.
  
  
  RESULTS
  There were no differences in age, BMI Z score, or fat-free mass across tertiles. However, as the proportion of visceral fat increased across tertiles, BMI and percentage of fat and subcutaneous fat decreased, while hepatic fat increased. In addition, there was an increase in 2-h glucose, insulin, c-peptide, triglyceride levels, and insulin resistance. Notably, both leptin and total adiponectin were significantly lower in tertile 3 than 1, while C-reactive protein and interleukin-6 were not different across tertiles. There was a significant increase in the odds ratio for the metabolic syndrome, with subjects in tertile 3 5.2 times more likely to have the metabolic syndrome than those in tertile 1.
  
  
  CONCLUSIONS
  Obese adolescents with a high proportion of visceral fat and relatively low abdominal subcutaneous fat have a phenotype reminiscent of partial lipodystrophy. These adolescents are not necessarily the most severely obese, yet they suffer from severe metabolic complications and are at a high risk of having the metabolic syndrome.
authors.affiliation: Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street, P.O. Box 208064, New Haven, CT 06520, USA.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Taksali
authors.forename: Sonia
authors.initials: S
authors.lastname: Caprio
authors.forename: James
authors.initials: J
authors.lastname: Dziura
authors.forename: Sylvie
authors.initials: S
authors.lastname: Dufour
authors.forename: Anna M G
authors.initials: AM
authors.lastname: Calí
authors.forename: T Robin
authors.initials: TR
authors.lastname: Goodman
authors.forename: Xenophon
authors.initials: X
authors.lastname: Papademetris
authors.forename: Tania S
authors.initials: TS
authors.lastname: Burgert
authors.forename: Bridget M
authors.initials: BM
authors.lastname: Pierpont
authors.forename: Mary
authors.initials: M
authors.lastname: Savoye
authors.forename: Melissa
authors.initials: M
authors.lastname: Shaw
authors.forename: Aisha A
authors.initials: AA
authors.lastname: Seyal
authors.forename: Ram
authors.initials: R
authors.lastname: Weiss
mesh_terms: D000005:Abdomen; D054392:Adipokines / Q000502:physiology; D000273:Adipose Tissue / Q000033:anatomy & histology*; D000293:Adolescent; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D002096:C-Peptide / Q000097:blood; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005260:Female; D018149:Glucose Intolerance / Q000175:diagnosis; D005951:Glucose Tolerance Test; D006801:Humans; D007328:Insulin / Q000097:blood; D008099:Liver / Q000033:anatomy & histology; D008279:Magnetic Resonance Imaging; D008297:Male; D009765:Obesity / Q000473:pathology*; D011237:Predictive Value of Tests; D053763:Presenilins / Q000097:blood; D014781:Viscera
chemical_list: D054392:Adipokines; D001786:Blood Glucose; D002096:C-Peptide; D007328:Insulin; D053763:Presenilins