Brady Ryan P, Shah Amy S, Altaye Mekibib, Redel Jacob M, Beebe Dean W, DiFrancesco Mark W
Division of Endocrinology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center & University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA.
Division of Endocrinology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center & University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA.
Neuroimage Clin. 2025 Jun 18;47:103828. doi: 10.1016/j.nicl.2025.103828.
Neurocognitive decline, dementia, and stroke are associated with obesity and type 2 diabetes (T2D) in adults. Youth-onset T2D and obesity are occurring more frequently, increasing the risk of earlier onset brain-related morbidity. Emerging evidence has demonstrated global and regional changes in gray matter volume (GMV) and cerebral blood flow (CBF) in youth with T2D and obesity as well. Understanding brain pathophysiology in youth-onset T2D and obesity requires more complex and multi-modal investigation of the brain, such as integration of brain structure and perfusion. Twenty youth with T2D and nineteen age, race, sex, and body mass index (BMI) similar youth with obesity and normal glycemic control (obese controls) underwent brain MRI to examine GMV (structure) and CBF (perfusion). Voxel-wise analysis was used to examine association between GMV and CBF in all study participants using a linear model. Clusters of voxels with significant model coefficients were determined at p < 0.05 with adjustment for multiple comparisons. Additionally, a systematic algorithm was used to identify clusters of voxels with median effect size exceeding a threshold (f > 0.15) for each model coefficient. Effect size was represented by Cohen's f calculated voxel-wise for each model term. A significant and positive relationship between CBF (perfusion) and GMV (structure) among youth with obesity, with and without T2D, was demonstrated in several clusters encompassing the calcarine, cuneus, precuneus, occipital, fusiform, lingual, right insula, and right precentral brain regions (p < 0.05). Effect size analysis yielded suprathreshold voxel clusters for the interaction coefficient in widespread anatomical regions, including the temporal, precuneus, frontal, occipital, lingual, and insular regions, indicating brain regions where the relationship between GMV and CBF differed by group (T2D vs obese controls). Results of this pilot study identified several brain regions with a significant positive relationship between CBF and GMV suggesting that brain perfusion and structure may be coupled in youth with obesity, with and without T2D. Utilization of obese controls revealed brain regions where the relationship between cerebral perfusion and brain structure may be impacted by T2D.
神经认知功能衰退、痴呆和中风与成年人的肥胖及2型糖尿病（T2D）相关。青年期发病的T2D和肥胖越来越常见，增加了更早出现脑部相关疾病的风险。新出现的证据表明，患有T2D和肥胖的青少年的灰质体积（GMV）和脑血流量（CBF）也出现了整体和区域变化。了解青年期发病的T2D和肥胖中的脑病理生理学需要对大脑进行更复杂的多模式研究，比如整合脑结构和灌注情况。20名患有T2D的青少年以及19名年龄、种族、性别和体重指数（BMI）与之相似的肥胖且血糖控制正常的青少年（肥胖对照组）接受了脑部MRI检查，以检测GMV（结构）和CBF（灌注）。使用体素分析通过线性模型检测所有研究参与者中GMV和CBF之间的关联。在p < 0.05并对多重比较进行校正的情况下，确定具有显著模型系数的体素簇。此外，使用一种系统算法来识别每个模型系数的效应大小中位数超过阈值（f > 0.15）的体素簇。效应大小由针对每个模型项逐体素计算的科恩f值表示。在包括距状裂、楔叶、楔前叶、枕叶、梭状回、舌回、右侧岛叶和右侧中央前回脑区的几个簇中，证明了患有肥胖症（无论是否患有T2D）的青少年中CBF（灌注）与GMV（结构）之间存在显著的正相关关系（p < 0.05）。效应大小分析在广泛的解剖区域（包括颞叶、楔前叶、额叶、枕叶、舌回和岛叶区域）产生了交互系数的超阈值体素簇，表明GMV和CBF之间的关系在不同组（T2D与肥胖对照组）之间存在差异的脑区。这项初步研究的结果确定了几个CBF与GMV之间存在显著正相关关系的脑区，这表明在患有肥胖症（无论是否患有T2D）的青少年中，脑灌注和结构可能是相互关联的。使用肥胖对照组揭示了脑灌注与脑结构之间的关系可能受T2D影响的脑区。
