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Changes in whole-body fat distribution, intrahepatic lipids, and insulin resistance of obese adolescents during a low-level lifestyle intervention

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Abstract

The aim of this study was to analyze changes in adipose tissue (AT) distribution, intrahepatic lipids (IHL), and insulin resistance (IR) among a group of obese adolescents undergoing a 7-months low-level lifestyle intervention. Thirty-nine obese Caucasian adolescents (mean age 13.9 years, body mass index standard deviation score (BMI-SDSLMS) 2.14) were included. AT and IHL were determined by T1-weighted magnetic resonance (MR) imaging and single-voxel MR spectroscopy; IR was estimated using the homeostatic model assessment (HOMA-IR). The lifestyle intervention led to a reduction of both BMI-SDSLMS (boys 2.27 to 2.17; girls 2.00 to 1.82) and HOMA-IR (boys 6.1 to 4.4 (p = 0.008); girls 6.2 to 4.7 (p = 0.030)). IHL dropped in both genders (boys 7.5 to 4.3 %; girls 4.6 to 3.4 %) positively correlating with HOMA-IR (boys r = 0.52; girls r = 0.68), while in contrast visceral AT did not change significantly.

Conclusions: Although the lifestyle intervention only slightly reduced BMI-SDSLMS, insulin sensitivity improved in both genders and came along with a marked reduction of IHL. This suggests that IHL might play the dominant role regarding insulin resistance in the youth, especially if compared to other AT compartments such as visceral AT.

What is Known:

• MR imaging/spectroscopy can be used to evaluate body fat distribution and intrahepatic lipids in the youth.

• The strength of associations between body fat compartments and insulin resistance is under scientific debate.

What is New:

• The study emphasizes that even a low-level lifestyle intervention has a beneficial effect.

• The study suggests that intrahepatic lipids are an important factor in the development of insulin resistance.

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Abbreviations

AT:

Adipose tissue

ATLE :

Adipose tissue of lower extremities

ATUE :

Adipose tissue of upper extremities

BMI:

Body mass index

BMI-SDSLMS :

Body mass index standard deviation score

CT:

Computed tomography

DEXA:

Dual-energy X-ray absorptiometry

DISKUS:

Abbreviation formed from the initial components of the German phrase “Dick Sein im Kindes- und Jugendalter Studie”, which translates as “being obese during childhood and adolescence study” in English

HOMA-IR:

Homeostatic model assessment of insulin resistance

IHL:

Intrahepatic lipids

IR:

Insulin resistance

MR:

Magnetic resonance

MRI:

Magnetic resonance imaging

MRS:

Single-voxel magnetic resonance 1H-spectroscopy

NATLE :

Non-adipose tissue of lower extremities

NATUE :

Non-adipose tissue of upper extremities

SCAT:

Subcutaneous adipose tissue

SCATTR :

Subcutaneous adipose tissue of the body trunk

STEAM:

STimulated Echo Acquisition Mode in magnetic resonance spectroscopy

TAT:

Total adipose tissue

TBV:

Total body volume

TE:

Echo time

TNAT:

Total non-adipose tissue

TM:

Mixing time

TR:

Repetition time

VAT:

Visceral adipose tissue

WHR:

Waist-to-hip ratio

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Acknowledgment

Members of the DISKUS Study Group are Stefan Ehehalt, Roland Schweizer, Nicole Schurr, Coya Pfaff, Andreas Neu, Hans Peter Haber, Michael B. Ranke, and Gerhard Binder, Department of Paediatrics, University Children’s Hospital, Tübingen, Germany; Perikles Simon, Institute of Sport Science, Department of Sports Medicine, Johannes Gutenberg University, Mainz, Germany; Andre Lacroix, Jochen Hansel, and Andreas Nieß, University Department of Medicine, Department of Sports Medicine, Tübingen, Germany; Katrin Giel, Markus Schrauth, Paul Enck, and Stephan Zipfel, University Department of Medicine, Department of Psychosomatic Medicine and Psychotherapy, Tübingen, Germany; Jürgen Machann, Fabian Springer, Verena Ballweg, and Fritz Schick, Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, Tübingen, Germany; Pablo Brockmann and Michael Urschitz, Department of Neonatology, University Children’s Hospital, Tübingen, Germany; and Huu Phuc Nguyen, Institute of Human Genetics, Department of Medical Genetics, Tübingen, Germany

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

Written informed consent was obtained from all participants and their legal guardians prior to their inclusion in the study. The study has been approved by the appropriate ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Authors’ contributions

F.S., V.B., R.S., F.S., M.B.R., G.B., and S.E. prepared the manuscript and performed literature research. F.S. and V.B. performed whole-body MRI/MRS examinations and evaluated the data under the supervision of F.S.; S.E. and R.S. examined the patients during lifestyle intervention and acquired anthropometric/metabolic data. F.S., M.B.R., and G.B. supervised the study and helped in data analysis performed by F.S. V.B., and S.E. All authors reviewed and approved the manuscript on behalf of the DISKUS Study Group.

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Authors and Affiliations

  1. Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany

    Fabian Springer, Verena Ballweg & Fritz Schick

  2. Paediatric Endocrinology and Diabetes, University Children’s Hospital Tübingen, Hoppe-Seyler-Str.1, 72076, Tübingen, Germany

    Roland Schweizer, Michael B. Ranke, Gerhard Binder & Stefan Ehehalt

  3. Public Health Department of Stuttgart, Department of Pediatrics, Dental Health Care, Health Promotion, and Social Services, Schloßstr.91, 70176, Stuttgart, Germany

    Stefan Ehehalt

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  1. Fabian Springer
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Correspondence to Fabian Springer.

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Communicated by Peter de Winter

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Springer, F., Ballweg, V., Schweizer, R. et al. Changes in whole-body fat distribution, intrahepatic lipids, and insulin resistance of obese adolescents during a low-level lifestyle intervention. Eur J Pediatr 174, 1603–1612 (2015). https://doi.org/10.1007/s00431-015-2577-6

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