High visceral and low abdominal subcutaneous fat stores in the obese adolescent: a determinant of an adverse metabolic phenotype.
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.
Taksali
Sara E
SE
Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street, P.O. Box 208064, New Haven, CT 06520, USA.
Caprio
Sonia
S
Dziura
James
J
Dufour
Sylvie
S
Calí
Anna M G
AM
Goodman
T Robin
TR
Papademetris
Xenophon
X
Burgert
Tania S
TS
Pierpont
Bridget M
BM
Savoye
Mary
M
Shaw
Melissa
M
Seyal
Aisha A
AA
Weiss
Ram
R
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
D054392:Adipokines; D001786:Blood Glucose; D002096:C-Peptide; D007328:Insulin; D053763:Presenilins