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Relationship of Abdominal Visceral and Subcutaneous Adipose Tissue to Lipoprotein Particle Number and Size in Type 2 Diabetes

¹Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, Chicago, IL
²Department of Medicine, University of Texas Health Science Center, San Antonio, Texas
³Pritzker School of Medicine, The University of Chicago, Chicago, IL
⁴Department of Mathematics, Statistics and Consulting Unit, Boston University, Boston, MA
⁵Department of Medicine, Section of Cardiology, Rush University Medical Center, Chicago, IL
⁶Department of Medicine, Section of Cardiology, University of Illinois College of Medicine, Chicago, IL
⁷Takeda Global Research and Development, Ltd., Deerfield, IL

Objective: Insulin resistance and type 2 diabetes (DM2) are associated with an atherogenic lipoprotein profile. We examined the role of visceral and subcutaneous fat depots, independent of BMI, on the dyslipidemia associated with DM2.

Research Design and Methods: Three hundred eighty-two subjects with DM2 underwent abdominal computed tomography to evaluate subcutaneous (SAT) and visceral (VAT) adipose tissue distribution, and had anthropometric measurements to determine BMI, waist and hip circumference. Fasting blood was obtained for lipoprotein particle number and size using nuclear magnetic resonance spectroscopy. The relationship of lipoprotein particle number and size to BMI, SAT and VAT was examined using multivariable regression models adjusted for age, sex, diabetes therapy, duration of diabetes, smoking, statin use and hemoglobin A1c levels. The relation of VAT to lipoprotein particle number and size was further evaluated after the addition of BMI, BMI plus SAT, or BMI plus HOMAIR to the model.

Results: VAT was positively related to VLDL particle number (P<0.0001), LDL particle number (P<0.01), VLDL size (P<0.0001) and negatively related to LDL size (P<0.0001) and HDL size (P<0.0001). These relationships remained unchanged after addition of BMI and SAT to the model. After Addition of HOMAIR, VAT remained positively related to VLDL particle number (P<0.0001) and size (P<0.01) and negatively related to LDL and HDL particle size (P<0.0001 for both comparisons). Neither BMI nor SAT were independently related to lipoprotein parameters.

Conclusions: In patients with DM2, higher VAT independent of BMI, was associated with higher VLDL and LDL particle number, larger VLDL particles and smaller LDL and HDL particles. This lipoprotein pattern has been associated with increased risk for atherosclerosis and cardiovascular disease.

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