title: Epicardial and pericardial fat in type 2 diabetes: favourable effects of biliopancreatic diversion.
abstract: OBJECTIVE
  Ectopic fat is often identified in obese subjects who are susceptible to the development of type 2 diabetes mellitus (T2DM). The ectopic fat favours the decrease in insulin sensitivity (IS) and adiponectin levels. We aimed to evaluate the effect of biliopancreatic diversion (BPD) on the accumulation of ectopic fat, adiponectin levels and IS in obese with T2DM.
  
  
  METHODS
  A nonrandomised controlled study was performed on sixty-eight women: 19 lean-control (23.0 ± 2.2 kg/m(2)) and 18 obese-control (35.0 ± 4.8 kg/m(2)) with normal glucose tolerance and 31 obese with T2DM (36.3 ± 3.7 kg/m(2)). Of the 31 diabetic women, 20 underwent BPD and were reassessed 1 month and 12 months after surgery. The subcutaneous adipose tissue, visceral adipose tissue, epicardial adipose tissue and pericardial adipose tissue were evaluated by ultrasonography. The IS was assessed by a hyperglycaemic clamp, applying the minimal model of glucose.
  
  
  RESULTS
  One month after surgery, there was a reduction in visceral and subcutaneous adipose tissues, whereas epicardial and pericardial adipose tissues exhibited significant reduction at the 12-month assessment (p < 0.01). Adiponectin levels and IS were normalised 1 month after surgery, resembling lean-control values and elevated above the obese-control values (p < 0.01). After 12 months, the improvement in IS and adiponectin was maintained, and 17 of the 20 operated patients exhibited fasting glucose and glycated haemoglobin within the normal range.
  
  
  CONCLUSIONS
  After BPD, positive physiological adaptations occurred in grade I and II obese patients with T2DM. These adaptations relate to the restoration of IS and decreased adiposopathy and explain the acute (1 month) and chronic (12 months) improvements in the glycaemic control.
authors.affiliation: School of Applied Sciences (FCA), State University of Campinas, UNICAMP, Limeira, São Paulo, Brazil, ana.vasques@fca.unicamp.br.
authors.forename: Ana Carolina Junqueira
authors.initials: AC
authors.lastname: Vasques
authors.forename: José Carlos
authors.initials: JC
authors.lastname: Pareja
authors.forename: José Roberto Mattos
authors.initials: JR
authors.lastname: Souza
authors.forename: Ademar
authors.initials: A
authors.lastname: Yamanaka
authors.forename: Maria da Saúde
authors.initials: Mda S
authors.lastname: de Oliveira
authors.forename: Fernanda Satake
authors.initials: FS
authors.lastname: Novaes
authors.forename: Élinton Adami
authors.initials: ÉA
authors.lastname: Chaim
authors.forename: Francesca
authors.initials: F
authors.lastname: Piccinini
authors.forename: Chiara
authors.initials: C
authors.lastname: Dalla Man
authors.forename: Claudio
authors.initials: C
authors.lastname: Cobelli
authors.forename: Bruno
authors.initials: B
authors.lastname: Geloneze
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging* / Q000473:pathology; D050154:Adiposity; D000328:Adult; D015904:Biliopancreatic Diversion; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000601:surgery*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000000981:diagnostic imaging / Q000378:metabolism / Q000601:surgery; D007333:Insulin Resistance / Q000502:physiology; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000601:surgery*; D010496:Pericardium / Q000000981:diagnostic imaging* / Q000473:pathology; D050151:Subcutaneous Fat / Q000000981:diagnostic imaging / Q000503:physiopathology; D014463:Ultrasonography
chemical_list: D006442:Glycated Hemoglobin