title: Threshold value of subepicardial adipose tissue to detect insulin resistance in obese children.
abstract: OBJECTIVE
  Until now, the association between subepicardial adipose tissue (SAT), insulin resistance and intima-media thickness (IMT) has not been evaluated in obese children. In this study, we evaluated whether echocardiographic SAT is related to insulin resistance and IMT in obese children.
  
  
  METHODS
  A total of 46 obese subjects (10.2+/-2.5 years of age, 25 male patients) and 30 age- and gender-matched lean subjects (10.8+/-3.1 years of age, 13 male patients) were included in this study. The criterion for diagnosing obesity was defined as the body mass index (BMI) being over 97% percentile of the same gender and age. Serum triglyceride (TG), low- and high-density lipoprotein, cholesterol, glucose and insulin levels were measured during the fasting state. Each subject underwent a transthoracic echocardiogram and the SAT thickness was measured during end-diastole from the parasternal long-axis views.
  
  
  RESULTS
  The obese subjects had significantly higher SAT thickness and IMT values compared with the subjects in the control group (5.7+/-1.4 vs 3.0+/-0.7 mm, 0.78+/-0.15 vs 0.51+/-0.11 mm, P=0.001, respectively). Simple linear regression analysis showed no significant correlation between SAT and insulin resistance (r=0.170, P=0.253), whereas there was significant correlation between SAT and BMI, age and IMT (r=0.625, P=0.02, r=0.589, P=0.001, r=0.343, P=0.02, respectively). As an optimal cutoff point, a SAT thickness of 4.1 mm determined insulin resistance with 90% sensitivity and 61% specificity.
  
  
  CONCLUSIONS
  Our study showed that SAT was significantly correlated with age, BMI and IMT, but not insulin resistance. However, our findings suggest that a 4.1 mm cutoff of SAT thickness might be used as a simple, inexpensive and non-invasive screening method because of its ability to predict insulin resistance with high sensitivity in obese children.
authors.affiliation: Department of Pediatric Endocrinology, Gulhane Military Medical Academy, Ankara, Turkey. ayhanabaci@gmail.com
authors.forename: A
authors.initials: A
authors.lastname: Abaci
authors.forename: M E
authors.initials: ME
authors.lastname: Tascilar
authors.forename: T
authors.initials: T
authors.lastname: Saritas
authors.forename: Y
authors.initials: Y
authors.lastname: Yozgat
authors.forename: E
authors.initials: E
authors.lastname: Yesilkaya
authors.forename: A
authors.initials: A
authors.lastname: Kilic
authors.forename: V
authors.initials: V
authors.lastname: Okutan
authors.forename: M K
authors.initials: MK
authors.lastname: Lenk
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging* / Q000378:metabolism; D000886:Anthropometry; D002648:Child; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D009765:Obesity / Q000150:complications / Q000378:metabolism*; D010496:Pericardium / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017539:Tunica Intima / Q000000981:diagnostic imaging*; D017540:Tunica Media / Q000000981:diagnostic imaging*; D014463:Ultrasonography