MRI Analysis of Cardiac Fat, Abdominal Adiposity and Cardiac Function After Vertical Sleeve Gastrectomy in Youth With Type 2 Diabetes

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BACKGROUND: Adolescents with youth-onset type 2 diabetes (YO-T2D) have an increased risk for cardiometabolic complications. The impact of vertical sleeve gastrectomy (VSG) on fat distribution and cardiac morphology/function in YO-T2D is unknown. OBJECTIVES: To evaluate changes in body composition, abdominal and cardiac fat depots, and cardiometabolic health in adolescents with YO-T2D undergoing VSG. METHODS: Anthropometrics, labs and imaging were used to assess participants pre-surgery and 3-12 months post-surgery. MRI quantified pericardial (PAT), epicardial (EAT), subcutaneous (SAT) and visceral adipose tissue (VAT), hepatic fat fraction (HFF) and cardiac morphology/function. Mixed-effects models assessed longitudinal changes. RESULTS: , HFF 23.2% ± 2.3% to 5.3% ± 2.3% and PAT and EAT by 27% and 33% (all p < 0.01). Homeostatic model assessment of insulin resistance (HOMA-IR) improved (7.8 ± 1.2 to 1.7 ± 1.2 [p < 0.01]). BMI, SAT, resting heart rate (RHR), left ventricular (LV) mass and cardiac output (CO) also decreased (all p < 0.05). VAT decreases correlated with decreases in HFF (r = 0.70, p = 0.01), HOMA-IR (r = 0.60, p = 0.04) and CO (r = 0.70, p = 0.03). HFF decreases correlated with decreases in BMI (r = 0.70, p = 0.03), HOMA-IR (r = 0.90, p < 0.001), RHR (r = 0.90, p = 0.002), CO (r = 0.80, p = 0.007) and LV mass (r = 0.70, p = 0.02). CONCLUSIONS: VSG reduces ectopic and regional fat and improves associated insulin sensitivity and cardiac health in adolescents with YO-T2D.

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