Herz Carsten T, Kulterer Oana C, Prager Marlene, Schmöltzer Christoph, Langer Felix B, Prager Gerhard, Marculescu Rodrig, Kautzky-Willer Alexandra, Hacker Marcus, Haug Alexander R, Kiefer Florian W
Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
Diabetes. 2021 Oct 18. doi: 10.2337/db21-0475.
Obesity is associated with increasing cardiometabolic morbidity and mortality worldwide. Not everyone with obesity, however, develops metabolic complications. Brown adipose tissue (BAT) has been suggested as a promoter of leanness and metabolic health. To date, little is known about the prevalence and metabolic function of BAT in subjects with severe obesity, a population at high cardiometabolic risk. In this cross-sectional study, we included 40 individuals with WHO class II-III obesity (BMI ≥ 35 kg/m2). Employing a 150-minute personalized cooling protocol and 18F-fluorodeoxyglucose positron emission tomography/computed tomography, cold-activated BAT was detectable in 14 (35%) of the participants. Cold-induced thermogenesis was significantly higher in participants with detectable BAT compared to those without. Notably, individuals with obesity and active BAT had 28.8% lower visceral fat mass despite slightly higher total fat mass compared to those without detectable BAT 18F-FDG uptake. This was accompanied by lower insulin resistance and systemic inflammation and improved NAFLD parameters, all adjusted for age, sex, and percent body fat. Contrary to previous assumptions, we show here that a significant fraction of individuals with severe obesity has active BAT. We found that decreased BAT 18F-FDG uptake was not associated with adiposity per se but with higher visceral fat mass. In summary, active BAT is linked to a healthier metabolic phenotype in obesity.
在全球范围内，肥胖与心血管代谢疾病的发病率和死亡率增加相关。然而，并非所有肥胖者都会出现代谢并发症。棕色脂肪组织（BAT）被认为是瘦素和代谢健康的促进因素。迄今为止，对于严重肥胖（心血管代谢高风险人群）中BAT的患病率和代谢功能知之甚少。在这项横断面研究中，我们纳入了40名世界卫生组织II-III级肥胖（BMI≥35kg/m²）的个体。采用150分钟的个性化冷却方案和18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描，在14名（35%）参与者中检测到了冷激活的BAT。与未检测到BAT的参与者相比，检测到BAT的参与者的冷诱导产热明显更高。值得注意的是，与未检测到BAT 18F-FDG摄取的个体相比，有活跃BAT的肥胖个体尽管总脂肪量略高，但其内脏脂肪量低28.8%。这伴随着较低的胰岛素抵抗和全身炎症以及改善的非酒精性脂肪性肝病参数，所有这些均根据年龄、性别和体脂百分比进行了调整。与先前的假设相反，我们在此表明，相当一部分严重肥胖个体具有活跃的BAT。我们发现，BAT 18F-FDG摄取减少与肥胖本身无关，而是与较高的内脏脂肪量有关。总之，活跃的BAT与肥胖中更健康的代谢表型相关。
