Epicardial and Pericardial Fat in Type 2 Diabetes: Favourable Effects of Biliopancreatic Diversion
- 251 Downloads
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.
Materials and Methods
A nonrandomised controlled study was performed on sixty-eight women: 19 lean-control (23.0 ± 2.2 kg/m2) and 18 obese-control (35.0 ± 4.8 kg/m2) with normal glucose tolerance and 31 obese with T2DM (36.3 ± 3.7 kg/m2). 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.
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.
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.
KeywordsEpicardial adipose tissue Obesity Type 2 diabetes mellitus Biliopancreatic diversion surgery Hyperglycaemic clamp Insulin sensitivity
The funds were provided by the Sao Paulo Research Foundation—FAPESP, grants n. 2008/09451-7 and n. 2008/07312-0.
Conflict of Interest
The authors Ana Carolina Junqueira Vasques, José Carlos Pareja, José Roberto Mattos Souza, Ademar Yamanaka, Maria da Saúde de Oliveira, Fernanda Satake Novaes, Élinton Adami Chaim, Francesca Piccinini, Chiara Dalla Man, Claudio Cobelli and Bruno Geloneze declare that they have no conflict of interest reported.
“All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.”
- 4.Wajchenberg BL, Giannella-Neto D, da Silva ME, et al. Depot-specific hormonal characteristics of subcutaneous and visceral adipose tissue and their relation to the metabolic syndrome. Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme 2002;34:616–21.Google Scholar
- 7.Standards of medical care in diabetes--2012. Diabetes Care 2012;35:dc12–s011.Google Scholar
- 14.Executive summary: standards of medical care in diabetes--2012. Diabetes Care 2012;35(Suppl 1):S4–S10Google Scholar
- 29.Laferrere B. Diabetes remission after bariatric surgery: is it just the incretins? Int J Obes. 2011;35(3):143.Google Scholar