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Increased epicardial fat in children with type 1 diabetes may explain heightened CV risk
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A cohort of healthy, normal-weight children with type 1 diabetes had on average 18% more epicardial fat than matched children without diabetes, suggesting that the risk for developing atherosclerotic cardiovascular disease begins before adulthood, according to findings published in Pediatric Diabetes.
Although the pathophysiology contributing to the disproportionate risk for CVD morbidity and mortality among people with type 1 diabetes is not completely understood, researchers recently have examined increased epicardial adipose thickness as a possible explanation, Melissa A. Chambers, DO, a staff physician in the division of endocrinology and diabetes at Phoenix Children's Hospital in Arizona, and colleagues wrote in the study background.
“This study identified that children with type 1 diabetes already have increased fat around the heart, regardless of body composition, which may contribute to the increased risk for heart disease seen in adults with type 1 diabetes,” Chambers told Endocrine Today. “This finding indicates a need for further investigation into how heart fat changes over time and the role of heart fat in heart disease in patients with type 1 diabetes, as it may lead to changes in how we screen and treat this population.”
Chambers and colleagues analyzed data from 20 normal-weight children with type 1 diabetes for at least 5 years (mean HbA1c, 9.1%; mean diabetes duration, 7.2 years) and 20 age-, sex- and BMI-matched children without diabetes (mean age, 12 years; 55% boys; 62.5% white; 20% Hispanic). All children underwent ECGs to measure epicardial adipose thickness. Researchers used Pearson correlations and linear regression models to assess associations between epicardial adipose tissue and age, BMI, waist circumference and blood pressure among children with and without type 1 diabetes.
Researchers found that epicardial adipose tissue was 18.5% higher among children with type 1 diabetes vs. controls (mean, 1.65 mm vs. 1.37 mm; P = .02). For the entire cohort, epicardial adipose tissue correlated with age (P < .001); BMI (P < .001), waist circumference (P < .001), systolic BP (P = .03) and diastolic BP (P = .009).
Researchers observed no significant associations between epicardial adipose tissue and HbA1c, insulin dose or disease duration among children with type 1 diabetes.
“Normal-weight youth with [type 1 diabetes] have increased [epicardial adipose tissue] compared with age-, sex- and BMI-matched controls, which indicates that at least one pathophysiologic mechanism leading to atherosclerotic CVD already exists in this pediatric population well before the clinical manifestation of overt disease,” the researchers wrote.
The researchers noted that, given the known contribution of obesity to ectopic fat, additional studies that examine whether obesity further contributes to differences in epicardial adipose tissue among children with type 1 diabetes are warranted. – by Regina Schaffer
For more information:
Melissa A. Chambers, DO, can be reached at Phoenix Children’s Hospital, Division of Endocrinology and Diabetes, 1920 E. Cambridge Ave., Site 301, Phoenix, AZ 85006; email: mchambers@phoenixchildrens.com.
Disclosures: The Phoenix Children’s Hospital Research Award Committee funded this study. The authors report no relevant financial disclosures.
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