Visceral adiposity is associated with altered myocardial glucose uptake measured by 18FDG-PET in 346 subjects with normal lucose tolerance, prediabetes, and type 2 diabetes

Abstract

Purpose: To evaluate the glucose uptake in hearts among subjects with normoglycemia, impaired fasting glucose (IFG) and type 2 diabetes mellitus (T2D) using [18F] fluorodeoxyglucose- positron emission tomography (18FDG-PET) and investigate its association with various clinical and laboratory profiles. Methods and results: In a total of 387 participants (control, N=75; IFG, N=242; T2D, N=70), enrolled from the health promotion center at university-affiliated tertiary-care hospital, we assessed the myocardial glucose uptake by 18FDG-PET. Visceral and subcutaneous fat areas were evaluated by abdominal computed tomography (CT) and laboratory parameters including glucose, insulin, uric acid, free fatty acids (FFA), and triglycerides were measured. Myocardial glucose uptake was significantly decreased in subjects with T2D compared to control or IFG groups (P for trend=0.001). Individuals in the lowest tertile of myocardial glucose uptake tended to be having T2D (P=0.002). Correlation analysis showed that myocardial glucose uptake was related to body mass index, visceral and subcutaneous fat areas, HOMA-IR, uric acid and fasting/postprandial serum levels of glucose, insulin, triglycerides, and FFA. In a multiple linear regression model, visceral fat area (Standardized β [STD β]=-0.31, P<0.001), fasting FFA (STD β=-0.34, P<0.001), and uric acid levels (STD β=-0.21, P=0.007) were independent determinants of myocardial glucose uptake. Multiple logistic analyses demonstrated that decreased myocardial glucose uptake was associated with the risk of diabetes (odds ratio= 2.56; 95% confidence interval: 1.15-5.70, P=0.021). Conclusion: Myocardial glucose uptake evaluated by 18FDG-PET may predict T2D and was significantly associated with visceral adiposity and fatty acid or uric acid metabolism. 연구목적: 정상환자와 당뇨 전 단계, 그리고 제 2형 당뇨환자에서 양전자방출단층촬영 시행 시에 관찰되는 심근의 FDG 섭취 정도를 다양한 임상적 특징과 혈액학적 검사와 비교하여 그 임상적 의미를 알아 보고자 하였다. 대상 및 방법: 건강검진을 목적으로 양전자방출단층촬영술을 시행한 총 387명을 정상군, 당뇨 전 단계, 제 2형 당뇨병의 세 군으로 구분하여 공복시의 심근 포도당 섭취, 내장 및 피하 지방 영역 분석, 혈액 검사를 시행하였으며 이에 대한 유의미한 차이와 관련성을 조사하였다. 결과: 심근의 FDG 섭취는 제 2형 당뇨병 환자 그룹에서 유의하게 감소하였고, 다변량 선형 회귀 분석에서는 내장 지방 면적, 공복 FFA 및 요산 수치와 심근의 FDG 섭취와의 관련성이 보고되었다. 결론: 심근의 FDG 섭취는 제 2형 당뇨병을 예측할 수 있고, 내장 지방 및 지방산 그리고 요산의 대사와 유의미한 관련이 있음이 보였다.