"Foie Gras" in Kids Risk Factor for Heart Disease

Nonalcoholic fatty liver disease (NAFLD), is now the most common cause of liver disease in children.

Although this condition is associated with insulin resistance its impact on other features of the "metabolic syndrome" is less clear.

In the July 15 issue of Circulation, Jeffrey Schwimmer and colleagues from the University of California, San Diego report on their findings from a case-control study of 150 overweight children with biopsy-proven NAFLD and 150 overweight children without NAFLD.

Children with NAFLD had significantly higher fasting glucose, insulin, total cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, systolic blood pressure, and diastolic blood pressure than overweight and obese children without NAFLD.

Not only do these findings support the notion that, as in adults, NAFLD in overweight and obese children is strongly associated with multiple cardiovascular risk factors, they also show that as in adults, weight alone is not a reliable measure of cardiovascular or metabolic risk factors in kids.

Identification of NAFLD in a child should prompt global counseling to address nutrition, physical activity, and avoidance of smoking to prevent the development of cardiovascular disease and type 2 diabetes.

AMS
Edmonton, Alberta

Epicardial Fat and Weight Loss

Increased visceral fat or "ectopic" fat deposition is associated with insulin resistance and increased cardiovascular risk.

Traditionally, the term visceral fat has been used to describe the omental and mesenteric fat located inside the abdomen. Over the last several years, this concept has been expanded to include other "ectopic" fat depots including the liver and the heart.

Recognition that the fat located around the heart can be a marker of visceral fat was pioneered by Gianluca Iacobellis, who joined me as a clinical research fellow a few years ago at McMaster University and has since been recruited to their faculty.

In this month's issue of OBESITY, Iacobellis reports on work we collaborated on just before I left McMaster to relocate to the University of Alberta demonstrating that epicardial fat is a sensitive marker of changes in visceral fat associated with weight loss.

In this study in 20 severely obese subjects who underwent a 6-month very low calorie diet weight loss program resulting in a 20% loss of original body weight, waist circumference decreased by 23% whereas epicardial fat thickness decreased by 32% of baseline.

Based on this finding, we suggest that measurement of echocardiographic epicardial fat thickness may provide an additional tool in understanding the metabolic risk associated with variation in fat distribution. Perhaps, more importantly, echocardiographic measurement of epicardial fat can serve as a simple and relatively inexpensive tool to assess changes in visceral fat with weight loss (or gain) in clinical practice.

Certainly beats simply measuring waist circumference (a rather crude surrogate measure of intra-abdominal fat) or the rather more expensive CAT or MRI study.

AMS
Edmonton, Alberta

p.s Thanks to Navneet Singh and Sean Wharton for their great help with this study and to all the patients who volunteered their time for these measurements

Obesity and Atherosclerosis

The next couple of days I will be at the 77th European Atherosclerosis Society Congress in Istanbul, Turkey.

Given the importance of obesity (particularly visceral fat deposition) as a risk factor for atherosclerosis, it is not surprising that there are several talks on various aspects of obesity including its pathophysiology and management at this meeting.

My own talk on Tuesday morning will be on the role of "ectopic" fat on cardiovascular risk.

Generally speaking, ectopic fat is fat that accumulates in depots other than just underneath your skin and includes fat deposits in the gut, liver, muscle and other organs.

Always important to remember that not all fat is bad and that not everyone with a couple of extra pounds of fat tissue is at risk for heart disease.

When it comes to fat and heart disease, the "where" appears to be far more important than the "how much"!

AMS
Istanbul, Turkey