High Visceral and Low Abdominal Subcutaneous Fat Stores in the Obese Adolescent

A Determinant of an Adverse Metabolic Phenotype

  1. Sara E. Taksali1,
  2. Sonia Caprio1,
  3. James Dziura2,
  4. Sylvie Dufour3,
  5. Anna M.G. Calí1,
  6. T. Robin Goodman4,
  7. Xenophon Papademetris4,
  8. Tania S. Burgert1,
  9. Bridget M. Pierpont1,
  10. Mary Savoye1,
  11. Melissa Shaw1,
  12. Aisha A. Seyal1 and
  13. Ram Weiss5
  1. 1Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
  2. 2Yale Clinical Research Center, Yale University School of Medicine, New Haven, Connecticut
  3. 3Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, Connecticut
  4. 4Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut
  5. 5Department of Pediatrics, Hadassah-Hebrew University Medical School, Jerusalem, Israel
  1. Address correspondence and reprint requests to Sonia Caprio, MD, Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street, P.O. Box 208064, New Haven, CT 06520. E-mail: sonia.caprio{at}yale.edu


OBJECTIVE— To explore whether an imbalance between the visceral and subcutaneous fat depots and a corresponding dysregulation of the adipokine milieu is associated with excessive accumulation of fat in the liver and muscle and ultimately with insulin resistance and the metabolic syndrome.

RESEARCH DESIGN AND METHODS— We stratified our multi-ethnic cohort of 118 obese adolescents into tertiles based on the proportion of abdominal fat in the visceral depot. Abdominal and liver fat were measured by magnetic resonance imaging and muscle lipid (intramyocellular lipid) by proton magnetic resonance spectroscopy.

RESULTS— There were no differences in age, BMI Z score, or fat-free mass across tertiles. However, as the proportion of visceral fat increased across tertiles, BMI and percentage of fat and subcutaneous fat decreased, while hepatic fat increased. In addition, there was an increase in 2-h glucose, insulin, c-peptide, triglyceride levels, and insulin resistance. Notably, both leptin and total adiponectin were significantly lower in tertile 3 than 1, while C-reactive protein and interleukin-6 were not different across tertiles. There was a significant increase in the odds ratio for the metabolic syndrome, with subjects in tertile 3 5.2 times more likely to have the metabolic syndrome than those in tertile 1.

CONCLUSIONS— Obese adolescents with a high proportion of visceral fat and relatively low abdominal subcutaneous fat have a phenotype reminiscent of partial lipodystrophy. These adolescents are not necessarily the most severely obese, yet they suffer from severe metabolic complications and are at a high risk of having the metabolic syndrome.


  • Published ahead of print at http://diabetes.diabetesjournals.org on 31 October 2007. DOI: 10.2337/db07-0932.

  • Additional information for this article can be found in an online appendix at http://dx.doi.org/10.2337/db07-0932.

  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Accepted October 28, 2007.
    • Received July 6, 2007.
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  1. Diabetes vol. 57 no. 2 367-371
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