Nie Hao, Liu Min, Duan Junhong, Liu Hong
Department of Geriatrics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, People's Republic of China.
Department of Nutrition, the Third Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.
Diabetes Metab Syndr Obes. 2025 Jul 14;18:2331-2341. doi: 10.2147/DMSO.S518292. eCollection 2025.
This study investigates the clinical significance of ectopic fat and iron deposition in the liver and pancreas for glucose metabolism in elderly obese patients, with a focus on their potential for early diabetes screening and intervention.
We conducted a cross-sectional study of 140 elderly obese patients (aged 65-80 years, BMI ≥28 kg/m²) who underwent MRI quantification of hepatic and pancreatic fat (MRI-PDFF) and iron content (R2* values), along with measurements of visceral and subcutaneous fat via T2-weighted imaging. Glucose metabolism was assessed through oral glucose tolerance testing and related biomarkers.
Compared to normal glucose tolerance (NGT) and impaired glucose regulation (IGR) groups, elderly obese patients with type 2 diabetes mellitus (T2DM) showed significantly higher ectopic fat in the liver (16.6% vs 6.9-13.4%) and pancreas (13.5% vs 8.5-9.0%), as well as increased visceral fat area (198.0cm² vs 137.8-163.9cm²). Liver fat percentage >11.8% was identified as an independent risk factor for abnormal glucose metabolism (=2.05, 95% 1.22-3.14), with a 2.05-fold increased risk compared to lower levels. The optimal diagnostic thresholds were determined as 11.8% for liver fat (sensitivity 83.2%, specificity 56.1%; AUC = 0.823) and 6.9% for pancreatic fat (sensitivity 72.2%, specificity 50.2%; AUC = 0.688), highlighting their clinical utility for early risk stratification.
Ectopic fat deposition in the liver, particularly when exceeding 11.8%, is a significant independent risk factor for glucose metabolism abnormalities in elderly obese patients. Our findings demonstrate that MRI-based quantification of hepatic fat provides a valuable tool for early identification of diabetes risk, enabling targeted interventions to prevent disease progression. This study highlights the clinical importance of monitoring ectopic fat deposition in clinical practice for elderly obese populations.
本研究探讨肝脏和胰腺中异位脂肪和铁沉积对老年肥胖患者葡萄糖代谢的临床意义，重点关注其在早期糖尿病筛查和干预方面的潜力。
我们对140名老年肥胖患者（年龄65 - 80岁，BMI≥28 kg/m²）进行了横断面研究，这些患者接受了肝脏和胰腺脂肪的MRI定量分析（MRI-PDFF）以及铁含量测定（R2*值），同时通过T2加权成像测量了内脏和皮下脂肪。通过口服葡萄糖耐量试验和相关生物标志物评估葡萄糖代谢情况。
与正常糖耐量（NGT）和糖调节受损（IGR）组相比，2型糖尿病（T2DM）老年肥胖患者肝脏（16.6% vs 6.9 - 13.4%）和胰腺（13.5% vs 8.5 - 9.0%）中的异位脂肪明显更高，内脏脂肪面积也增加（198.0cm² vs 137.8 - 163.9cm²）。肝脏脂肪百分比>11.8%被确定为葡萄糖代谢异常的独立危险因素（=2.05，95% 1.22 - 3.14），与较低水平相比，风险增加2.05倍。肝脏脂肪的最佳诊断阈值确定为11.8%（敏感性83.2%，特异性56.1%；AUC = 0.823），胰腺脂肪为6.9%（敏感性72.2%，特异性50.2%；AUC = 0.688），突出了它们在早期风险分层中的临床实用性。
肝脏中的异位脂肪沉积，尤其是超过11.8%时，是老年肥胖患者葡萄糖代谢异常的重要独立危险因素。我们的研究结果表明，基于MRI的肝脏脂肪定量分析为早期识别糖尿病风险提供了有价值的工具，能够进行有针对性的干预以预防疾病进展。本研究强调了在临床实践中监测老年肥胖人群异位脂肪沉积的临床重要性。
