title: Associations between ultrasound measures of abdominal fat distribution and indices of glucose metabolism in a population at high risk of type 2 diabetes: the ADDITION-PRO study.
abstract: OBJECTIVE
  Visceral adipose tissue measured by CT or MRI is strongly associated with an adverse metabolic risk profile. We assessed whether similar associations can be found with ultrasonography, by quantifying the strength of the relationship between different measures of obesity and indices of glucose metabolism in a population at high risk of type 2 diabetes.
  
  
  METHODS
  A cross-sectional analysis of 1342 participants of the ADDITION-PRO study. We measured visceral adipose tissue and subcutaneous adipose tissue with ultrasonography, anthropometrics and body fat percentage by bioelectrical impedance. Indices of glucose metabolism were derived from a three point oral glucose tolerance test. Linear regression of obesity measures on indices of glucose metabolism was performed.
  
  
  RESULTS
  Mean age was 66.2 years, BMI 26.9kg/m2, subcutaneous adipose tissue 2.5cm and visceral adipose tissue 8.0cm. All measures of obesity were positively associated with indicators of glycaemia and inversely associated with indicators of insulin sensitivity. Associations were of equivalent magnitude except for subcutaneous adipose tissue and the visceral/subcutaneous adipose tissue ratio, which showed weaker associations. One standard deviation difference in BMI, visceral adipose tissue, waist circumference, waist/height ratio and body fat percentage corresponded approximately to 0.2mmol/l higher fasting glucose, 0.7mmol/l higher 2-hr glucose, 0.06-0.1% higher HbA1c, 30 % lower HOMA index of insulin sensitivity, 20% lower Gutt's index of insulin sensitivity, and 100 unit higher Stumvoll's index of beta-cell function. After adjustment for waist circumference visceral adipose tissue was still significantly associated with glucose intolerance and insulin resistance, whereas there was a trend towards inverse or no associations with subcutaneous adipose tissue. After adjustment, a 1cm increase in visceral adipose tissue was associated with ~5% lower insulin sensitivity (p≤0.0004) and ~0.18mmol/l higher 2-hr glucose (p≤0.001).
  
  
  CONCLUSIONS
  Visceral and subcutaneous adipose tissue assessed by ultrasonography are significantly associated with glucose metabolism, even after adjustment for other measures of obesity.
authors: Steno Diabetes Center A/S, Gentofte, Denmark.
authors: Annelotte
authors: A
authors: Philipsen
authors: Steno Diabetes Center A/S, Gentofte, Denmark.
authors: Marit E
authors: ME
authors: Jørgensen
authors: Steno Diabetes Center A/S, Gentofte, Denmark.
authors: Dorte
authors: D
authors: Vistisen
authors: Department of Public Health, Section for General Practice, Aarhus University, Aarhus, Denmark.
authors: Annelli
authors: A
authors: Sandbaek
authors: Department of Internal Medicine F, Gentofte Hospital, Gentofte, Denmark.
authors: Thomas P
authors: TP
authors: Almdal
authors: Department of Endocrinology, Aarhus University Hospital, Aarhus, Denmark.
authors: Jens S
authors: JS
authors: Christiansen
authors: Department of Public Health, Section for General Practice, Aarhus University, Aarhus, Denmark.
authors: Torsten
authors: T
authors: Lauritzen
authors: Department of Public Health, Section for General Practice, Aarhus University, Aarhus, Denmark.
authors: Daniel R
authors: DR
authors: Witte
mesh_terms: D050153:Abdominal Fat / Q000000981:diagnostic imaging* / Q000378:metabolism*; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D050218:Body Fat Distribution; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology* / Q000503:physiopathology; D005215:Fasting; D005260:Female; D018149:Glucose Intolerance / Q000378:metabolism; D005951:Glucose Tolerance Test; D006801:Humans; D007328:Insulin / Q000378:metabolism; D007333:Insulin Resistance; D050417:Insulin-Secreting Cells / Q000378:metabolism; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000378:metabolism; D014463:Ultrasonography
chemical_list: D001786:Blood Glucose; D007328:Insulin