title: Follow-up whole-body assessment of adipose tissue compartments during a lifestyle intervention in a large cohort at increased risk for type 2 diabetes.
abstract: OBJECTIVE
  To assess adipose body compartments with magnetic resonance (MR) imaging and MR spectroscopy during a lifestyle intervention program that included optimized nutrition and controlled physical activity in subjects at increased risk for type 2 diabetes to determine factors that may help predict an increase in insulin sensitivity following the intervention.
  
  
  METHODS
  This prospective study was approved by the local review board. All participants gave written informed consent. MR imaging and MR spectroscopy were performed in 243 subjects (99 men and 144 women) before and 9 months after enrollment in a lifestyle intervention program. The results of whole-body MR imaging were used to calculate tissue profiles, differentiating between adipose tissue--especially visceral adipose tissue--and lean tissue. The concentration of hepatic lipids and intramyocellular lipids in the anterior tibial and soleus muscles was determined with MR spectroscopy, and insulin sensitivity was estimated by using an oral glucose tolerance test. The Student t test was used to assess differences between groups, and multivariate regression models were used to assess the value of adipose tissue compartments in the prediction of insulin sensitivity.
  
  
  RESULTS
  Compared with women, men had almost twice the amount of visceral adipose tissue and a smaller amount of total adipose tissue (25.9% for men and 36.9% for women) at baseline. In addition, their insulin sensitivity was significantly lower than that of women. The most pronounced changes in adipose tissue were detected for visceral adipose tissue (from 4.9 L to 4.1 L [ie, -15.1%] in men and from 2.3 L to 1.9 L [ie, -15.8%] in women) and hepatic lipids (from 8.6% to 5.4% [ie, -36.8%] in men and from 5.1% to 4.3% [ie, -16.5%] in women). The mean insulin sensitivity improved significantly (from 11.3 arbitrary units [au] to 14.6 au [ie, +29.9%] in men and from 13.6 au to 14.6 au [ie, +7.5%] in women), with 70 of the 99 men (71%) and 84 of 144 women (58%) showing an increase in insulin sensitivity. In men, low concentrations of visceral adipose tissue, hepatic lipids, and abdominal subcutaneous fat at baseline were predictive of successful intervention in terms of changes in insulin sensitivity; in women, only low hepatic lipid levels were significantly predictive of successful intervention.
  
  
  CONCLUSIONS
  Visceral adipose tissue and hepatic lipids, as assessed with MR imaging and MR spectroscopy, can be significantly reduced during lifestyle intervention. Their baseline values emerged as predictive factors for an improvement of insulin sensitivity.
authors: Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str 3, 72076 Tübingen, Germany. juergen.machann@med.uni-tuebingen.de
authors: Jürgen
authors: J
authors: Machann
authors: Claus
authors: C
authors: Thamer
authors: Norbert
authors: N
authors: Stefan
authors: Nina F
authors: NF
authors: Schwenzer
authors: Konstantinos
authors: K
authors: Kantartzis
authors: Hans-Ulrich
authors: HU
authors: Häring
authors: Claus D
authors: CD
authors: Claussen
authors: Andreas
authors: A
authors: Fritsche
authors: Fritz
authors: F
authors: Schick
mesh_terms: D000328:Adult; D000368:Aged; D050218:Body Fat Distribution; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007333:Insulin Resistance; D008019:Life Style; D050356:Lipid Metabolism; D008099:Liver / Q000378:metabolism*; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000378:metabolism; D011446:Prospective Studies; D012044:Regression Analysis; D012737:Sex Factors