title: Alterations in white matter volume and integrity in obesity and type 2 diabetes.
abstract: Type 2 diabetes mellitus (T2DM) is characterized by obesity, hyperglycemia and insulin resistance. Both T2DM and obesity are associated with cerebral complications, including an increased risk of cognitive impairment and dementia, however the underlying mechanisms are largely unknown. In the current study, we aimed to determine the relative contributions of obesity and the presence of T2DM to altered white matter structure. We used diffusion tensor imaging (DTI) and voxel-based morphometry (VBM) to measure white matter integrity and volume in obese T2DM patients without micro- or macrovascular complications, age- gender- and BMI-matched normoglycemic obese subjects and age- and gender-matched normoglycemic lean subjects. We found that obese T2DM patients compared with lean subjects had lower axial diffusivity (in the right corticospinal tract, right inferior fronto-occipital tract, right superior longitudinal fasciculus and right forceps major) and reduced white matter volume (in the right inferior parietal lobe and the left external capsule region). In normoglycemic obese compared with lean subjects axial diffusivity as well as white matter volume tended to be reduced, whereas there were no significant differences between normoglycemic obese subjects and T2DM patients. Decreased white matter integrity and volume were univariately related to higher age, being male, higher BMI, HbA1C and fasting glucose and insulin levels. However, multivariate analyses demonstrated that only BMI was independently related to white matter integrity, and age, gender and BMI to white matter volume loss. Our data indicate that obese T2DM patients have reduced white matter integrity and volume, but that this is largely explained by BMI, rather than T2DM per se.
authors.affiliation: Diabetes Center / Department of Internal Medicine, VU University Medical Center, PO BOX 7057, 1007 MB, Amsterdam, The Netherlands. l.vanbloemendaal@vumc.nl.
authors.forename: Liselotte
authors.initials: L
authors.lastname: van Bloemendaal
authors.affiliation: Diabetes Center / Department of Internal Medicine, VU University Medical Center, PO BOX 7057, 1007 MB, Amsterdam, The Netherlands.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Ijzerman
authors.affiliation: Diabetes Center / Department of Internal Medicine, VU University Medical Center, PO BOX 7057, 1007 MB, Amsterdam, The Netherlands.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Ten Kulve
authors.affiliation: Department of Radiology & Nuclear Medicine, VU University Medical Center, 1007 MB, Amsterdam, The Netherlands.
authors.forename: Frederik
authors.initials: F
authors.lastname: Barkhof
authors.affiliation: Diabetes Center / Department of Internal Medicine, VU University Medical Center, PO BOX 7057, 1007 MB, Amsterdam, The Netherlands.
authors.forename: Michaela
authors.initials: M
authors.lastname: Diamant
authors.affiliation: Department of Psychiatry, VU University Medical Center, 1007 MB, Amsterdam, The Netherlands.
authors.forename: Dick J
authors.initials: DJ
authors.lastname: Veltman
authors.affiliation: Diabetes Center / Department of Internal Medicine, VU University Medical Center, PO BOX 7057, 1007 MB, Amsterdam, The Netherlands.|Department of Medical Psychology, VU University Medical Center, 1007 MB, Amsterdam, The Netherlands.|Department of Psychology, Pontifícia Universidade Católica (PUC-Rio), Rio de Janeiro, RJ, Brazil.
authors.forename: Eelco
authors.initials: E
authors.lastname: van Duinkerken
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging*; D003924:Diabetes Mellitus, Type 2 / Q000000981:diagnostic imaging*; D056324:Diffusion Tensor Imaging; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000000981:diagnostic imaging*; D009929:Organ Size; D066127:White Matter / Q000000981:diagnostic imaging*
keywords: Brain; DTI; Integrity; Obesity; Type 2 diabetes; VBM; Volume; White matter
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