Greater ectopic fat deposition and liver fibroinflammation and lower skeletal muscle mass in people with type 2 diabetes

Abstract

Objective Type 2 diabetes (T2D) is associated with significant end‐organ damage and ectopic fat accumulation. Multiparametric magnetic resonance imaging (MRI) can provide a rapid, noninvasive assessment of multiorgan and body composition. The primary objective of this study was to investigate differences in visceral adiposity, ectopic fat accumulation, body composition, and relevant biomarkers between people with and without T2D. Methods Participant demographics, routine biochemistry, and multiparametric MRI scans of the liver, pancreas, visceral and subcutaneous adipose tissue, and skeletal muscle were analyzed from 266 participants (131 with T2D and 135 without T2D) who were matched for age, gender, and BMI. Wilcoxon and χ2 tests were performed to calculate differences between groups. Results Participants with T2D had significantly elevated liver fat (7.4% vs. 5.3%, p = 0.011) and fibroinflammation (as assessed by corrected T1 [cT1]; 730 milliseconds vs. 709 milliseconds, p = 0.019), despite there being no differences in liver biochemistry, serum aspartate aminotransferase (p = 0.35), or alanine transaminase concentration (p = 0.11). Significantly lower measures of skeletal muscle index (45.2 cm2/m2 vs. 50.6 cm2/m2, p = 0.003) and high‐density lipoprotein cholesterol (1.1 mmol/L vs. 1.3 mmol/L, p < 0.0001) were observed in participants with T2D. Conclusions Multiparametric MRI revealed significantly elevated liver fat and fibroinflammation in participants with T2D, despite normal liver biochemistry. This study corroborates findings of significantly lower measures of skeletal muscle and high‐density lipoprotein cholesterol in participants with T2D versus those without T2D.

The use of current knowledge and non‐invasive testing modalities for predicting at‐risk non‐alcoholic steatohepatitis and assessing fibrosis

“…The results produced by multiparametric MRI are correlated with histopathological features of NASH 2,70 and detect changes in inflammation and fibrosis, 70 even in the absence of ALT/AST changes 71 . In a study of 145 NAFLD patients from Japan, cT1 was directly compared with measures of liver stiffness from VCTE and MRE for the identification of at‐risk NASH and was superior to each with AUC for cT1 of 0.74 and AUCs for VCTE and MRE of 0.64 and 0.66 respectively 72 .…”

Medical imaging in the assessment of cardiovascular disease risk

“…Interestingly, lean NAFLD occurs in patients without increased waist circumference or even VAT [34,35]. NAFLD is a major risk factor for type 2 diabetes [36], CVD, and all-cause mortality [24][25][26], and is considered the hepatic manifestation of metabolic syndrome. Indeed, CVD is the leading cause of mortality among individuals with NAFLD [26], and the risk is augmented with the disease severity (e.g.…”

Poor glycaemic control and ectopic fat deposition mediates the increased risk of non-alcoholic steatohepatitis in high-risk populations with type 2 diabetes: Insights from Bayesian-network modelling

“…All participants underwent an abdominal MR scan that included multi-parametric imaging of the liver and pancreas. See (10) for an in-depth description of the MR-protocol.…”

“…In both T2D and NASH, obesity is a significant risk factor, though the clinical utility of the body mass index (BMI) metric is limited since it describes global body mass relative to height and does not describe body fat distribution. People with T2D represent a clinical population, and relative to those without T2D, are characterised by a distinct body composition profile with significantly higher volumes of visceral adipose tissue (VAT), increased liver fat deposition and fibroinflammation and reduced skeletal muscle mass (10,11), when measured by magnetic resonance imaging (MRI). Furthermore, elevated VAT but not subcutaneous adipose tissue (SAT), has been associated with a significant increase in circulating insulin, plasma glucose and incidence of the metabolic syndrome (12,13), highlighting the importance of studying body fat distribution.…”