Determination of the cut-off ultrasound values of the perirenal visceral adipose tissue amount in patients with metabolic syndrome
Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Republic of Belarus
Vestnik VGMU. 2019;18(2):74-80.
Objectives. To determine the cut-off ultrasound values of perirenal visceral adipose tissue (VAT) amount in patients with metabolic syndrome (MS) and in healthy subjects, using various ultrasound techniques.
Materials and methods. 162 patients, including 103 men and 59 women, were enrolled in this cross-sectional study. The average age of the patients was Me (25th and 75th quartile) 43.00 (36.00; 48.00). Out of all persons, 96 patients had MS and 66 were healthy subjects.
Ultrasound measurements of the thickness of visceral adipose tissue in the posterior perirenal space (PPVAT) and the thickness of the anterior perirenal visceral adipose tissue (APVAT) on the right side, as well as the thickness of para- and perirenal fat (PAPEVAT) and the area of the inferior part of the perirenal visceral adipose tissue (AIPVAT) from the both sides were performed in all patients. ROC analysis was used to determine the cut-off values of the enumerated parameters between healthy subjects and patients with MS.
Results. The amount of perirenal VAT, measured by all four methods is significantly higher in patients with MS compared with the same indicators in the control group (p<0.001). For all this the differences between all values of perinephral VAT in men and women with MS were statistically insignificant. The cut-off value of the PPVAT amount made up 8.2 mm, that of APVAT –2.2 mm, PAPEVAT 28.9 mm and AIPVAT – 21.1 сm2.
The area under the ROC curve (AUC) for ultrasound parameters characterizing the amount of PPVAT, APVAT and PAPEVAT testifies to good and very good quality of the model, and amounted to 0.845, 0.827 and 0.783, respectively. AUC for AIPVAT represents the excellent quality of the model (0.972).
Conclusions. The obtained results demonstrate that the ultrasound parameters of the amount of perirenal visceral adipose tissue in patients with MS are significantly higher than those in healthy individuals. The determined cut-off values of these parameters can be proposed for the use in order to identify patients with the risk of developing MS, the measurement of AIPVAT being more significant.
Key words: perirenal visceral adipose tissue, ultrasound investigation, metabolic syndrome.
1. Britton KA, Fox CS. Ectopic fat depots and cardiovascular disease. Circulation. 2011 Dec;124(24):e837-41. doi: http://dx.doi.org/10.1161/CIRCULATIONAHA.111.077602
2. Tobias D, Pan A, Hu FB. Body-mass index and mortality among adults with incident type 2 diabetes. N Engl J Med. 2014 Apr;370(14):1363-4. doi: http://dx.doi.org/10.1056/NEJMc1401876
3. Després JP, Lemieux I. Abdominal obesity and metabolic syndrome. Nature. 2006 Dec;444(7121):881-7.
4. Smith U. Abdominal obesity: a marker of ectopic fat accumulation. J Clin Invest. 2015 May;125(5):1790-2. doi: http://dx.doi.org/10.1172/JCI81507
5. Lim S. Ectopic fat assessment focusing on cardiometabolic and renal risk. Endocrinol Metab (Seoul). 2014 Mar;29(1):1-4. doi: http://dx.doi.org/10.3803/EnM.2014.29.1.1
6. Roever L, Resende ES, Veloso FC, Diniz AL, Penha-Silva N, Casella-Filho A, et al. Perirenal Fat and Association With Metabolic Risk Factors: The Uberlândia Heart Study. Medicine (Baltimore). 2015 Sep;94(38):e1105. doi: http://dx.doi.org/10.1097/MD.0000000000001105
7. De Pergola G, Campobasso N, Nardecchia A, Triggiani V, Caccavo D, Gesualdo L, et al. Para- and perirenal ultrasonographic fat thickness is associated with 24-hours mean diastolic blood pressure levels in overweight and obese subjects. BMC Cardiovasc Disord. 2015 Sep;15:108. doi: http://dx.doi.org/10.1186/s12872-015-0101-6
8. Cornier MA, Després JP, Davis N, Grossniklaus DA, Klein S, Lamarche B, et al. Assessing adiposity: a scientific statement from the American Heart Association. Circulation. 2011 Nov;124(18):1996-2019. doi: http://dx.doi.org/10.1161/CIR.0b013e318233bc6a
9. Vlachos IS, Hatziioannou A, Perelas A, Perrea DN. Sonographic assessment of regional adiposity. AJR Am J Roentgenol. 2007 Dec;189(6):1545-53. doi: http://dx.doi.org/10.2214/AJR.07.2366
10. Wagnerm DR. Ultrasound as a tool to assess body fat. J Obes. 2013;2013(2):280713. вщш: 10.1155/2013/280713
11. Pimanov SI, Bondarenko VM, Marchuk VP, Mikhaylova NA, Sapego AL, Makarenko EV. Evaluation of the results of measurement of visceral fat tissue amount in ultrasound and computed tomography. Ul'trazvukovaia Funktsional Diagnostika. 2016;(4):59-72. (In Russ.)
12. Bondarenko VM, Marchuk VP, Pimanov SI, Mikhaylova NA, Makarenko EV. Correlation of visceral fat tissue content according to CT data with anthropometric parameters and ultrasound results. Vestn VGMU. 2013;12(1):31-8. (In Russ.)
13. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009 Oct 20;120(16):1640-5. doi: http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192644
14. Hirooka M, Kumagi T, Kurose K, Nakanishi S, Michitaka K, Matsuura B, et al. A technique for the measurement of visceral fat by ultrasonography: comparison of measurements by ultrasonography and computed tomography. Intern Med. 2005 Aug;44(8):794-9.
15. Grima P, Guido M, Chiavaroli R, Zizza A. Ultrasound-assessed perirenal fat is related to increased ophthalmic artery resistance index in HIV-1 patients. Cardiovasc Ultrasound. 2010 Jun;8:24. doi: http://dx.doi.org/10.1186/1476-7120-8-24
16. Kawasaki S, Aoki K, Hasegawa O, Numata K, Tanaka K, Shibata N, et al. Sonographic Evaluation of Visceral Fat by Measuring Para- and Perirenal Fat. J Clin Ultrasound. 2008 Mar-Apr;36(3):129-33.
17. Gong W, Ren H, Tong H, Shen X, Luo J, Chen S, et al. A comparison of ultrasound and magnetic resonance imaging to assess visceral fat in the metabolic syndrome. Asia Pac J Clin Nutr. 2007;16 Suppl 1:339-45.
18. Schober P, Boer C, Schwarte LA. Correlation Coefficients: Appropriate Use and Interpretation. Anesth Analg. 2018 May;126(5):1763-1768. doi: http://dx.doi.org/10.1213/ANE.0000000000002864
19. Bondarenko VM, Pimanov SI. Reproducibility of ultrasound methods for determining the amount of visceral fat tissue. Vestn VGMU. 2017;16(3):73-81. (In Russ.)
20. Montani JP, Carroll JF, Dwyer TM, Antic V, Yang Z, Dulloo AG. Ectopic fat storage in heart, blood vessels and kidneys in the pathogenesis of cardiovascular diseases. Int J Obes Relat Metab Disord. 2004 Dec;28 Suppl 4:S58-65. doi: http://dx.doi.org/10.1038/sj.ijo.0802858
21. Reisin E, Jack AV. Obesity and hypertension: mechanisms, cardio-renal consequences, and therapeutic approaches. Med Clin North Am. 2009 May;93(3):733-51. doi: http://dx.doi.org/10.1016/j.mcna.2009.02.010
22. Bondarenko VM, Pimanov SI, Dosta NI. Correlation of testosterone levels in blood serum with visceral fatty tissue. Vestn VGMU. 2014;13(1):98-103. (In Russ.)
Information about authors:
Bondarenko V.M. – postgraduate of the Chair of Internal Medicine No.2 of the Faculty for Advanced Training & Retraining, senior teacher of the Chair of Hospital Surgery with the courses of Urology & Pediatric Surgery, Vitebsk State Order of Peoples’ Friendship Medical University.