MRI-based quantification of renal fat in obese individuals using different image analysis approaches

Gjela, Mimoza; Askeland, Anders; Frøkjær, Jens Brøndum; Mellergaard, Maiken; Handberg, Aase

doi:10.1007/s00261-022-03603-4

Cited by 10 publications

(6 citation statements)

References 23 publications

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“…They are also approved in the treatment of renal impairment 37 and some mechanisms have been proposed to explain its capacity in preventing major cardiovascular events 6 – 9 . Major attention has been paid in measuring renal fat infiltration (MRI), particularly in sinus 38 . But little is known about the relationship between kidney’s surrounding Perirenal fat and cardiovascular risk.…”

Section: Discussionmentioning

confidence: 99%

Dapagliflozin added to metformin reduces perirenal fat layer in type 2 diabetic patients with obesity

Cuatrecasas,

De Cabo,

Coves

et al. 2024

Sci Rep

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Sodium-glucose co-transporters type 2 inhibitors (SLGT2i) are highly effective in controlling type 2 diabetes, but reported beneficial cardiovascular effects suggest broader actions on insulin resistance. Weight loss may be initially explained by glycosuria-induced net caloric output and secondary volumetric reduction, but its maintenance could be due to loss of visceral fat mass. Structured ultrasound (US) imaging of abdominal adipose tissue (“eco-obesity”) is a recently described methodology used to measure 5 consecutive layers of abdominal fat, not assessable by DEXA or CT scan: superficial subcutaneous (SS), deep subcutaneous (DS), preperitoneal (PP), omental (Om) and right perirenal (RK). PP, Om and RK are predictors of metabolic syndrome (MS) with defined cut-off points. To assess the effect of SLGT2i on every fat depot we enrolled 29 patients with type 2 Diabetes (HbA1c 6.5–9%) and Obesity (IMC > 30 kg/m2) in an open-label, randomized, phase IV trial (EudraCT: 2019-000979-16): the Omendapa trial. Diabetes was diagnosed < 12 months before randomization and all patients were treatment naïve. 14 patients were treated with metformin alone (cohort A) and 15 were treated with metformin + dapaglifozin (cohort B). Anthropometric measures and laboratory tests for glucose, lipid profile, insulin, HOMA, leptin, ultrasensitive-CRP and microalbuminuria (MAL) were done at baseline, 3rd and 6th months. At 6th month, weight loss was −5.5 ± 5.2 kg (5.7% from initial weight) in cohort A and −8.4 ± 4.4 kg (8.6%) in cohort B. Abdominal circumference showed a −2.7 ± 3.1 cm and −5.4 ± 2.5 cm reduction, respectively (p = 0.011). Both Metformin alone (−19.4 ± 20.1 mm; −21.7%) or combined with Dapaglifozin (−20.5 ± 19.4 mm; −21.8%) induced significant Om fat reduction. 13.3% of cohort A patients and 21.4% of cohort’s B reached Om thickness below the cut-off for MS criteria. RK fat loss was significantly greater in cohort B group compared to cohort A, at both kidneys. Only in the Met + Dapa group, we observed correlations between Om fat with leptin/CRP/MAL and RK fat with HOMA-IR. US is a useful clinical tool to assess ectopic fat depots. Both Metformin and Dapaglifozin induce fat loss in layers involved with MS but combined treatment is particularly effective in perirenal fat layer reduction. Perirenal fat should be considered as a potential target for cardiovascular dapaglifozin beneficial effects.

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Section: Discussionmentioning

confidence: 99%

Dapagliflozin added to metformin reduces perirenal fat layer in type 2 diabetic patients with obesity

Cuatrecasas,

De Cabo,

Coves

et al. 2024

Sci Rep

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“…The true prevalence of fatty kidney disease is unknown because, until now, there was no precise modality for diagnosing fatty kidneys. In addition, various studies have measured fat deposition in different parts of the kidneys [21][22][23][24][25]. Most studies have measured fat deposition in the renal hilum, while some measured it in the pararenal space or the perirenal space, and some measured it in the renal parenchyma.…”

Section: Discussionmentioning

confidence: 99%

Obesity Is Associated with Fatty Liver and Fat Changes in the Kidneys in Humans as Assessed by MRI

Raphael,

Klang,

Konen

et al. 2024

Nutrients

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Background: Obesity is associated with metabolic syndrome and fat accumulation in various organs such as the liver and the kidneys. Our goal was to assess, using magnetic resonance imaging (MRI) Dual-Echo phase sequencing, the association between liver and kidney fat deposition and their relation to obesity. Methods: We analyzed MRI scans of individuals who were referred to the Chaim Sheba Medical Center between December 2017 and May 2020 to perform a study for any indication. For each individual, we retrieved from the computerized charts data on sex, and age, weight, height, body mass index (BMI), systolic and diastolic blood pressure (BP), and comorbidities (diabetes mellitus, hypertension, dyslipidemia). Results: We screened MRI studies of 399 subjects with a median age of 51 years, 52.4% of whom were women, and a median BMI 24.6 kg/m2. We diagnosed 18% of the participants with fatty liver and 18.6% with fat accumulation in the kidneys (fatty kidneys). Out of the 67 patients with fatty livers, 23 (34.3%) also had fatty kidneys, whereas among the 315 patients without fatty livers, only 48 patients (15.2%) had fatty kidneys (p < 0.01). In comparison to the patients who did not have a fatty liver or fatty kidneys (n = 267), those who had both (n = 23) were more obese, had higher systolic BP, and were more likely to have diabetes mellitus. In comparison to the patients without a fatty liver, those with fatty livers had an adjusted odds ratio of 2.91 (97.5% CI; 1.61–5.25) to have fatty kidneys. In total, 19.6% of the individuals were obese (BMI ≥ 30), and 26.1% had overweight (25 < BMI < 30). The obese and overweight individuals were older and more likely to have diabetes mellitus and hypertension and had higher rates of fatty livers and fatty kidneys. Fat deposition in both the liver and the kidneys was observed in 15.9% of the obese patients, in 8.3% of the overweight patients, and in none of those with normal weight. Obesity was the only risk factor for fatty kidneys and fatty livers, with an adjusted OR of 6.3 (97.5% CI 2.1–18.6). Conclusions: Obesity is a major risk factor for developing a fatty liver and fatty kidneys. Individuals with a fatty liver are more likely to have fatty kidneys. MRI is an accurate modality for diagnosing fatty kidneys. Reviewing MRI scans of any indication should include assessment of fat fractions in the kidneys in addition to that of the liver.

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“…They are also approved in the treatment of renal impairment (36) and some mechanisms have been proposed to explain its capacity in preventing major cardiovascular events (6, 7, 8, 9). Major attention has been paid in measuring renal fat in ltration (MRI), particularly in sinus (37). But little is known about the relationship between kidney's surrounding Perirenal fat and cardiovascular risk.…”

Section: Discussionmentioning

confidence: 99%

Dapagliflozin added to metformin reduces perirenal fat layer in type 2 diabetic patients with Obesity

Cuatrecasas,

De Cabo,

Coves

et al. 2023

Preprint

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Sodium-glucose co-transporters type 2 inhibitors (SLGT2i) are highly effective in controlling type 2 diabetes, mainly by inducing net glucose output at the proximal renal tubule, but reported beneficial cardiovascular effects suggest broader actions on insulin resistance. Weight loss may be initially explained by glycosuria net caloric output and secondary volumetric excretion, but its maintenance is mainly due to loss of visceral fat mass. Structured ultrasound (US) imaging of abdominal adipose tissue (“eco-obesity”) is a recently described, noninvasive, easily reproducible methodology used to measure 5 consecutive layers of abdominal fat (superficial subcutaneous (SS), deep subcutaneous (DS), preperitoneal (PP), omental (Om) and right perirenal (RK), not assessable by DEXA or CT scan. PP, Om and RK are predictors of metabolic syndrome (MS) with defined cut-off points. To assess the effect of SLGT2i effect on every fat depot we enrolled 29 patients with type 2 Diabetes (HbA1c 6,5–9%) and Obesity (IMC > 30 Kg/m2) in an open-label, randomized, single-center, phase IV trial (EudraCT: 2019-000979-16): the Omendapa trial. Diabetes was diagnosed < 12 months before randomization and all patients were treatment naïve. 14 patients were treated with metformin alone (cohort A) and 15 were treated with metformin + dapaglifozin (cohort B). Anthropometric measures and laboratory tests for glucose, lipid profile, insulin, HOMA, leptin, ultrasensitive-CRP and microalbuminuria (MAL) were done at baseline, 3rd and 6th months. At 6th month, weight loss was − 5.5 ± 5.2 Kg (5.7% from initial weight) in cohort A and − 8.4 ± 4.4 Kg (8.6%) in cohort B. Waist circumference showed a -2.7 ± 3.1cm and − 5.4 ± 2.5cm reduction, respectively (p = 0.011). Both Metformin (-19.4 ± 20.1mm; -21.7%) alone or combined with Dapaglifozin (-20.5 ± 19.4mm; -21.8%) induced significant Om fat reduction. 13.3% of cohort A patients and 21.4% of cohort’s B reached Om thickness below the cut-off for MS criteria. DS, PP, Om and RK fat thickness showed significant reduction within the Met + Dapa group, whereas only DS and RK fat reduced with metformin alone. RK fat relative change was significantly higher in cohort B group compared to cohort A at both kidneys. Om fat loss correlated with leptin, CRP and MAL and RK fat loss correlated with HOMA-IR, only in the Met + Dapa group. US is a useful clinical tool to assess pharmacological efficacy to reduce ectopic fat depots. Both Metformin and Dapaglifozin induce fat loss in layers involved with MS (Om) but combined treatment is particularly effective in RK fat layer reduction and correlates with cardiovascular risk markers. Perirenal fat should be considered as a potential target for cardiovascular dapaglifozin beneficial effects.

show abstract

MRI-based quantification of renal fat in obese individuals using different image analysis approaches

Cited by 10 publications

References 23 publications

Dapagliflozin added to metformin reduces perirenal fat layer in type 2 diabetic patients with obesity

Dapagliflozin added to metformin reduces perirenal fat layer in type 2 diabetic patients with obesity

Obesity Is Associated with Fatty Liver and Fat Changes in the Kidneys in Humans as Assessed by MRI

Dapagliflozin added to metformin reduces perirenal fat layer in type 2 diabetic patients with Obesity

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