title: High visceral fat with low subcutaneous fat accumulation as a determinant of atherosclerosis in patients with type 2 diabetes.
abstract: BACKGROUND
  Abdominal visceral obesity has been reported to be associated with cardiovascular risks than body mass index, waist circumference, and abdominal subcutaneous fat. On the other hand, there is evidence that subcutaneous fat has a beneficial role against cardio-metabolic risks such as diabetes or dyslipidemia. However, little is known regarding the association between high visceral fat with low subcutaneous fat accumulation and the risk for atherosclerosis.
  
  
  METHODS
  This study was designed to elucidate whether high visceral fat with low subcutaneous fat accumulation enhances the risk for atherosclerosis in patients with type 2 diabetes. This is a cross-sectional study of 148 patients with type 2 diabetes (mean age 65 ± 12 years; 44.5% female). Visceral fat area (VFA, cm(2)) and subcutaneous fat area (SFA, cm(2)) were assessed by abdominal computed tomography. Carotid intima media thickness (CIMT, mm) measured by ultrasonography was used for the assessment of atherosclerosis. Patients were divided into four groups: SFA < 100 cm(2) and VFA < 100 cm(2) [S(-)V(-)], SFA ≥ 100 cm(2) and VFA < 100 cm(2) [S(+)V(-)], SFA < 100 cm(2) and VFA ≥ 100 cm(2) [S(-)V(+)], and SFA ≥ 100 cm(2) and VFA ≥ 100 cm(2) [S(+)V(+)]. Linear regression analysis with a stepwise procedure was used for the statistical analyses.
  
  
  RESULTS
  Among the patients examined, 16.3% were S(-)V(+). Mean (95 % confidence interval) of CIMT adjusting for age and gender were 0.80 (0.69-0.91), 0.86 (0.72-1.01), 1.28 (1.11-1.44) and 0.83 (0.77-0.88) in patients with S(-)V(-), S(+)V(-), S(-)V(+) and S(+)V(+), respectively (p < 0.001). The S(-)V(+) patients exhibited significantly older than S(-)V(-) patients and those with S(+)V(+) and had a highest VFA-SFA ratio (V/S ratio) among the four groups. S(-)V(+) patients were male predominant (100% male), and S(+)V(-) patients showed female predominance (82% female). In multivariate linear regression analysis (Adjusted R(2) = 0.549), S(-)V(+) was significantly associated with CIMT (Standardized β 0.423, p < 0.001). Notably, S(+)V(+) was inversely associated with CIMT in the multivariate model.
  
  
  CONCLUSIONS
  This study provides evidence that high visceral fat with low subcutaneous fat accumulation is an important determinant of carotid atherosclerosis and high subcutaneous fat could be protective against atherosclerosis in patients with type 2 diabetes.
authors.affiliation: Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Bunkyo-ku, Yushima, Tokyo, 113-8510, Japan. bouchi.mem@tmd.ac.jp.
authors.forename: Ryotaro
authors.initials: R
authors.lastname: Bouchi
authors.affiliation: Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Bunkyo-ku, Yushima, Tokyo, 113-8510, Japan. takeuchi.mem@tmd.ac.jp.
authors.forename: Takato
authors.initials: T
authors.lastname: Takeuchi
authors.affiliation: Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Bunkyo-ku, Yushima, Tokyo, 113-8510, Japan. momokoakihisa@gmail.com.
authors.forename: Momoko
authors.initials: M
authors.lastname: Akihisa
authors.affiliation: Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Bunkyo-ku, Yushima, Tokyo, 113-8510, Japan. oohara.mem@tmd.ac.jp.
authors.forename: Norihiko
authors.initials: N
authors.lastname: Ohara
authors.affiliation: Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Bunkyo-ku, Yushima, Tokyo, 113-8510, Japan. nakano.mem@tmd.ac.jp.
authors.forename: Yujiro
authors.initials: Y
authors.lastname: Nakano
authors.affiliation: Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Bunkyo-ku, Yushima, Tokyo, 113-8510, Japan. rie.hatakeyama@gmail.com.
authors.forename: Rie
authors.initials: R
authors.lastname: Nishitani
authors.affiliation: Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Bunkyo-ku, Yushima, Tokyo, 113-8510, Japan. mmurakami.mem@tmd.ac.jp.
authors.forename: Masanori
authors.initials: M
authors.lastname: Murakami
authors.affiliation: Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Bunkyo-ku, Yushima, Tokyo, 113-8510, Japan. transatlantic@yellow.plala.or.jp.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Fukuda
authors.affiliation: Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Bunkyo-ku, Yushima, Tokyo, 113-8510, Japan. masamichi.fujita.med@gmail.com.
authors.forename: Masamichi
authors.initials: M
authors.lastname: Fujita
authors.affiliation: Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Bunkyo-ku, Yushima, Tokyo, 113-8510, Japan. iminami.mem@tmd.ac.jp.
authors.forename: Isao
authors.initials: I
authors.lastname: Minami
authors.affiliation: Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Bunkyo-ku, Yushima, Tokyo, 113-8510, Japan. hizumiyama.cme@tmd.ac.jp.|Center for Medical Welfare and Liaison Services, Tokyo Medical and Dental University, Tokyo, Japan. hizumiyama.cme@tmd.ac.jp.
authors.forename: Hajime
authors.initials: H
authors.lastname: Izumiyama
authors.affiliation: Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Bunkyo-ku, Yushima, Tokyo, 113-8510, Japan. khashimoto.mem@tmd.ac.jp.|Department of Preemptive Medicine and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan. khashimoto.mem@tmd.ac.jp.
authors.forename: Koshi
authors.initials: K
authors.lastname: Hashimoto
authors.affiliation: Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Bunkyo-ku, Yushima, Tokyo, 113-8510, Japan. tyoshimoto.mem@tmd.ac.jp.
authors.forename: Takanobu
authors.initials: T
authors.lastname: Yoshimoto
authors.affiliation: Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Bunkyo-ku, Yushima, Tokyo, 113-8510, Japan. ogawa.mem@tmd.ac.jp.|CREST, Japan Agency for Medical Research and Development, Tokyo, Japan. ogawa.mem@tmd.ac.jp.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Ogawa
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D050218:Body Fat Distribution; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D059168:Carotid Intima-Media Thickness; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D050151:Subcutaneous Fat / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed