The Relationship of Peri and Para-Renal Fat Tissue with Subclinical Atherosclerosis and Myocardial Functions in Newly Diagnosed Type 2 Diabetic Patients

doi:10.21203/rs.3.rs-4813103/v1

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The Relationship of Peri and Para-Renal Fat Tissue with Subclinical Atherosclerosis and Myocardial Functions in Newly Diagnosed Type 2 Diabetic Patients

https://doi.org/10.21203/rs.3.rs-4813103/v1

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Background:Ectopic fatty tissues are known to have adverse effects on systemic inflammation, insulin resistance, and various metabolic profiles and are associated with cardiovascular risk. Among these fatty tissues, peri-renal fat tissue is located adjacent to the kidney and is active in the secretion of various adipokines in metabolism. The effect of peri-renal and para-renal fat tissue thickness on subclinical atherosclerosis and myocardial functions in newly diagnosed Type 2 diabetes mellitus patients was investigated in this study.

Methods: The study included 108 patients newly diagnosed with Type 2 diabetes (59 men, 49 women, mean age: 49.8±9.8 years) and 49 individuals without any disease as a control group (15 men, 34 women, mean age: 48.1±7.5 years). After obtaining the demographic data of all patients, laboratory values were measured following an 8-hour fasting. Peri-renal and para-renal fat tissue thicknesses as well as carotid intima media thickness were measured by ultrasonography. Conventional parameters were measured by transthoracic echocardiography and myocardial velocities by tissue Doppler, as well as epicardial fat tissue thickness.

Results: Carotid intima media thickness, epicardial fat tissue thickness, peri-renal, para-renal fat tissue thicknesses were higher in newly diagnosed T2DM patients than in the control group. While the E/A ratio was significantly lower in T2DM patients compared to the control group, the E wave deceleration time (EDT) E/E'septal and lateral ratios were significantly higher. Peri-renal and para-renal fat tissue thicknesses (CIMT) were significantly correlated with epicardial fat tissue thicknesses. Para-renal and peri-renal fat tissue thicknesses were also negatively correlated with EF and E/A ratio, and positively correlated with E/E'septal. Likewise, there was a significant correlation with insulin, HOMA-IR and glucose values.

Conclusion: Peri-renal and para-renal fat tissue thickness measured by ultrasonography in newly diagnosed diabetic individuals is significantly thicker compared to the normal population and is significantly associated with CIMT and epicardial fat tissue, which are indicators of subclinical atherosclerosis. Noninvasively measured peri-renal and para-renal fat tissue thicknesses are related to glycemic parameters as well as deterioration of diastolic functions, which may indicate subclinical cardiac involvement. Peri-renal and para-renal fat tissue may be useful in predicting subclinical atherosclerosis.

Type 2 diabetes mellitus

peri-renal fat thickness

subclinical atherosclerosis

diastolic dysfunction.

Diabetes mellitus is a condition in which chronic hyperglycaemia occurs due to a defect in the production or action of insulin [1]. Type 2 diabetes mellitus (T2DM), also known as adult-onset diabetes, is the most common form of diabetes and accounts for the majority of diabetes in the world [2]. It is a disease that affects multiple systems, initially associated with microvascular and over time macrovascular complications [3]. Adiposity is known to be associated with various cardiovascular diseases, including hypertension and diabetes. Beyond general body fatness, different fat accumulations are associated with variable cardiovascular risks [4]. It is known that visceral adipose tissue plays a greater role in the pathogenesis of T2DM than subcutaneous adipose tissue [5]. Peri-renal adipose tissue is an important component of visceral adipose tissues, is localized in the retroperitoneal region and surrounds the kidney, and it is known that significant amounts of adipokines released from its tissue have important metabolic roles in the endocrine metabolic system [6].

Subclinical atherosclerosis is the presence of atheromatous disease in one or more arterial territories before there are any signs, symptoms, or events attributable to the clinical resulting atherosclerotic disease [7]. Early detection of subclinical atherosclerosis is important because timely intervention and precautions can prevent future cardiovascular diseases [7].

In our study, we investigated the relationship between peri- and para-renal fat tissue measured by ultrasound and subclinical atherosclerosis in newly diagnosed T2DM patients. Additionally, the relationship between peri-pararenal fat tissue and laboratory findings as well as myocardial functions obtained by echocardiography was investigated.

Patient selection

Our study is a cross-sectional study, and a total of 157 patients, 108 newly diagnosed diabetic patients and 49 non-diabetic patients, who were over 18 years of age, had consent for the study, and had sufficient cooperation and orientation, were included in the study (83 women, 74 men, mean age 49.2 ± 9.1 years). Patients with pre-existing type 1 diabetes, coronary artery disease, chronic liver and kidney disease, severe chronic disease such as malignancy, additional metabolic disease, active infection, history of antidiabetic, antihypertensive and lipid-lowering drug use, morbidly obese and pregnant patients were not included in the study. Individuals using medications that directly or indirectly affect cardiac functions, heart rate, and blood pressure were also excluded from the study. All patients signed the informed consent form. Our study was approved by the local ethics committee of our hospital (approval number: 397).

Detailed medical histories were documented and physical examinations were performed for all individuals who met the inclusion criteria. The patients' systolic and diastolic blood pressure, heart rate, body weight in kilograms, height in centimetres, and hip and waist circumferences in centimetres were measured and recorded with a tape measure. As the patient standing with arms open to the sides, waist circumference was measured by combining the umbilicus level in front and the subcostal region on the sides with a tape measure, and hip circumference was measured by combining the symphysis pubis in front and the most protruding part of the gluteal region in the back with a tape measure.

Type 2 diabetes was diagnosed according to the American Diabetes Association (ADA) criteria.

≥ 126 mg/dL (7.0 mmol/L) fasting plasma glucose level, or
≥ 200 mg/dL (11.1 mmol/L) or higher 2-hour plasma glucose level during a 75-g oral glucose tolerance test, or
≥ 200 mg/dL (11.1 mmol/L) random plasma glucose in a patient with classic symptoms of hyperglycaemia or hyperglycaemic crisis, or
≥ 6.5% (48 mmol/mol) haemoglobin A1c level [8]

Biochemical examination

Fasting blood glucose, urea, creatinine, aspartate aminotransferase (AST), alanine aminotransferase (ALT), HbA1c, gamma-glutamyl transferase (GGT), total cholesterol, low-density lipoprotein (LDL), triglyceride, high density lipoprotein (HDL), uric acid, c-reactive protein (CRP), insulin, hemogram and microalbumin in spot urine levels were measured and recorded through the blood samples taken from all individuals in the morning after an overnight fast of at least 8 hours.

Echocardiographic imaging and carotid intima media thickness measurement

Transthoracic echocardiography was performed on the patients in the left lateral decubitus position, using a Philips EPIQ 7 echocardiography device (Philips Healthcare, 3000 Minuteman Road, Andover, MA, USA) with a 2.5–3.5 MHz transducer. M-mode recordings were made at 50 mm/s and Doppler recordings were made at 100 mm/s. All measurements were made under electrocardiography guidance. M-mode and 2-D measurements were taken from the parasternal long axis view. In addition to conventional echo parameters (left atrium, ventricle dimensions and wall thickness), diastolic functions (mitral E, A, EDT, E/A) and tissue Doppler parameters were measured from the lateral, septal and tricuspid annulus (S', E', A'), as well as ejection fraction (EF) was obtained using the Simpson method in the patients. Diastolic functions were evaluated with diastolic velocities measured from septal and lateral regions (E/E' septal, E/E' lateral). Epicardial fat thickness was measured from at least two locations on the right ventricular free wall from both parasternal long axis and transverse parasternal views. Carotid intima media thickness was measured 2–3 cm above the carotid bifurcation separation in B mode with a linear transducer. All measurements were made by the same imager to avoid interobserver differences, and the average of three separate measurements was recorded to reduce intraobserver differences.

All cases included in our study were examined by the same radiologist with a high-resolution ultrasonography device (Aplio 500, Canon Medical Systems, Otawara, Japan) and a 1–6 MHz convex probe. Measurements of all patients were made separately for the right and left kidneys while lying in the supine position. As a measurement standard, the level at which the kidney is longest in the longitudinal axis was determined and peri-renal and then para-renal fatt tissue measurements were made from this level. Patients with malrotation anomaly, kidneys located outside the normal location, presence of a renal mass, pelvicalyceal ectasia and congenital renal anomalies were considered as exclusion criteria and were not included in the study. In order to ensure standardization, the averages of right and left peri-renal and para-renal fat tissue thicknesses were also calculated. The average of three separate measurements was taken.

Statistical analysis

All data were recorded in the "IBM SPSS (Statistical Package 27 Social Sciences) Statistics 25" program. The suitability of the variables to normal distribution was examined using histogram graphics and the Kolmogorov-Smirnov test. Mean, standard deviation and median values were used when presenting descriptive analyses. To compare continuous variables between groups, student T test was used if the distribution was normal, and Mann Whitney U test (MU) was used if the distribution was not normal. Spearman correlation tests were used in the comparative analysis of the measurement data. Results with a P-value below 0.05 were considered statistically significant.

Two separate study groups were determined: newly diagnosed diabetics (Group 1: 108 patients, 59 men-49 women, mean age: 49.8 ± 9.8 years) and the control group (Group 2: 49 individuals, 15 men-34 women, mean age: 48.1 ± 7.5 years). The male rate was significantly higher in group 1 than in group 2. The smoking rate was similar between groups. Laboratory values such as glucose, triglyceride, CRP, LDL cholesterol and ALT were significantly higher in group 1 than in group 2. HDL cholesterol value was significantly lower in group 1 than in group 2 (Table 1). Insulin and HOMA-IR values were also significantly higher in group 1 compared to group 2.

Table 1

Comparison of demographic, laboratory and ultrasonographic parameters between the groups.
	Group 1 (n = 108)	Group 2 (n = 49)	p
Age (year)	49.8 ± 9.6	48.1 ± 7.5	0.257
Gender (F, n-%)	49–45.4	34–69.4	0.005
Smoking (n-%)	43 (39.8)	19 (38.8)	0.902
BMI (kg/ m²)	29.3 ± 4.5	25.6 ± 3.9	< 0.001
WC (cm)	103.8 ± 11.3	92.3 ± 12.6	< 0.001
HC (cm)	106.4 ± 10.0	100.7 ± 7.9	0.001
SBP (mm/Hg)	138.6 ± 18.8	123.7 ± 13.8	< 0.001
DBP (mm/Hg)	86.1 ± 12.1	77.9 ± 12.4	< 0.001
Heart Rate (/dk)	85.9 ± 13.1	76.7 ± 14.0	< 0.001
Glucose (mg/dL)	191.2 ± 78.4	93.3 ± 8.0	< 0.001
Urea (mg/dL)	26.3 ± 7.6	26.2 ± 7.4	0.355
Creatinine (mg/dL)	0.74 ± 0.17	0.70 ± 0.12	0.308
GFR (ml/dk/1.73 m2)	101.9 ± 12.7	103.7 ± 9.4	0.155
AST (U/L)	21.9 ± 13.4	16.4 ± 11.7	0.061
ALT (U/L)	31.2 ± 30.7	16.4 ± 11.0	0.001
Total Cholesterol (mg/dL)	206.1± 49.3	194.5 ± 33.5	0.091
HDL (mg/dL)	44.7 ± 13.4	57.6 ± 13.9	< 0.001
LDL (mg/dL)	126.6 ± 42.3	116.5 ± 29.1	0.140
Triglyceride (mg/dL)	193.3 ± 123.7	103.8 ± 52.4	< 0.001
HbA1c (%)	8.91 ± 2.39	5.41 ± 0.27	< 0.001
Insulin (mU/L)	14.20 ± 9.20	7.25 ± 3.62	0.002
Homa-IR	6.14 ± 3.88	1.98 ± 1.22	0.001
CRP (mg/L)	7.7 ± 7.2	2.6 ± 3.7	< 0.001
Microalbumin	31.7 ± 61.3	30.6 ± 40.1	0.998
Uric acid	6.98 ± 11.5	5.96 ± 11.5	0.701
WBC ( 10⁹ /L)	7.74 ± 2.16	6.838 ± 1.90	0.011
Carotid IMT (mm)	1.14 ± 0.24	0.68 ± 0.12	< 0.001
Epicardial fat thickness (mm)	7.20 ± 1.9	4.2 ± 0.8	< 0.001
Right perirenal fat thickness	12.4 ± 4.2	6.5 ± 3.1	< 0.001
Right peri + pararenal fat thickness	24.8 ± 7.5	13.4 ± 5.6	< 0.001
Left perirenal fat thickness	11.4 ± 3.6	6.9 ± 3.1	< 0.001
Left peri + pararenal fat thickness	23.7 ± 6.3	13.9 ± 5.7	< 0.001
Mean right and left peri + pararenal FT	24.3 ± 6.1	13.6 ± 5.4	< 0.001
Abbrevations: BMI: Body mass index, WC: Waist circumference, HC: Hip circumference, SBP: Systolic blood pressure, DBP: Diastolic blood pressure, GFR: Glomerular Filtration Rate, AST: Aspartate Transaminase, ALT: Alanine Transaminase, LDL: Low Density Lipoprotein, HDL: High Density Lipoprotein, TyG Index: Triglyceride Glucose Index, HbA1c: Glycated Hemoglobin, CRP: C-Reactive Protein, GGT: Gamma-Glutamyltransferase, Homa-IR: Homeostatic Model Assessment- Insulin Resistance, WBC: White Blood Cell, IMT: Intima Media Thickness, FT: Fat thickness.

When carotid intima media thickness, epicardial fat tissue thickness, mean peri-renal and para-renal fat tissue thicknesses were compared between the groups, all values were significantly higher in group 1 than in group 2 (Table 1).

When echocardiographic findings were compared, interventricular septum and posterior wall thicknesses and left atrium were significantly higher in group 1 than in group 2. Septal, lateral and tricuspid E' velocities among tissue Doppler findings were significantly lower in group 1 than in group 2, while A' velocities were significantly higher (Table 2). In terms of diastolic functions, while the E/A ratio was significantly lower in group 1 than in group 2, E wave deceleration time (EDT), E/E'septal and lateral ratios were significantly higher (Table 2).

Table 2

Comparison of conventional echo parameters, diastolic and systolic functions and myocardial velocities in newly diagnosed type 2 DM patients and control groups
	Group 1 (n = 108)	Group 2 (n = 49)	p
EF (%)	62.3 ± 2.2	68.5 ± 2.0	< 0.001
LVESD (cm)	2.55 ± 0.46	2.46 ± 0.32	0,234
LVEDD (cm)	4.55 ± 0.45	4.59 ± 0.41	0.648
IVS (cm)	1.11 ± 0.20	0.82 ± 0.16	< 0.001
PW (cm)	1.11 ± 0.38	0.857 ± 0.32	< 0.001
Aortic diameter (cm)	2.71 ± 0.30	2.58 ± 0.29	0.014
Left atrium diameter (cm)	3.52 ± 0.42	3.21 ± 0.39	< 0.001
Mitral E (m/sec)	0.62 ± 0.16	0.79 ± 0.16	< 0.001
Mitral A (m/sec)	0.76 ± 0.14	0.58 ± 0.13	0.474
Mitral EDT (ms)	237.9 ± 56.1	200.6 ± 44.4	< 0.001
Lateral S' wave (cm/sec)	9.73 ± 2.18	10.40 ± 2.12	0.860
Lateral E' wave (cm/sec)	9.15 ± 2.80	12.90 ± 2.60	< 0.001
Lateral A' wave (cm/sec)	10.37 ± 2.61	8.62 ± 1.39	0.001
Septal S' wave (cm/sec)	7.66 ± 1.35	8.34 ± 1.29	< 0.001
Septal E' wave (cm/sec)	6.46 ± 1.72	9.99 ± 1.91	< 0.001
Septal A' wave (cm/sec)	9.03 ± 1.77	7.43 ± 1.59	< 0.001
Tricuspid S' wave (cm/sec)	11.92 ± 2.29	12.10 ± 2.53	0.663
Tricuspid E' wave (cm/sec)	8.53 ± 2.23	13.36 ± 2.93	< 0.001
Tricuspid A' wave (cm/sec)	13.21 ± 2.87	9.58 ± 2.16	< 0.001
E/A	0.85 ± 0.28	1.37 ± 0.20	< 0.001
E/E’ lateral	7.44 ± 2.30	6.32 ± 1.76	0.030
E/E’ septal	10.23 ± 2.50	8.06 ± 1.83	< 0.001
EF: Ejection Fraction, LVESD: Left Ventricular End Systolic Diameter, LVEDD: Left Ventricular End Diastolic Diameter, IVS: Interventicular Septum, PW: Posterior Wall, EDT: E Wave Deceleration Time, ET: Ejection Time, IVRT: Isovolumetric Relaxation Time, S’: Systolic Myocardial Rate, E’: Early Diastolic Forward Flow Velocity, A’: Late Diastolic Forward Flow Velocity

In the Spearman correlation test, mean peri-renal, mean para-renal fat tissue thicknesses (CIMT) were significantly correlated with epicardial fat tissue thicknesses (Table 3). In addition, para-renal and peri-renal fat tissue thicknesses showed a significant negative correlation with EF and E/A ratio, and a positive correlation with E/E'septal thickness (Table 3). Likewise, there was a significant correlation with insulin, HOMA-IR and glucose values (Table 3). Similarly, there was a moderate correlation between mean peri-renal and para-renal fat tissue thickness and systolic and diastolic blood pressures (rho = 0.321, rho = 0.429; p < 0.001 and rho = 0.315, rho = 0.336; p < 0.001 respectively).

Table 3

Spearman correlation of mean eft peri-renal and para-renal fat tissue thicknesses with several parameters.
	Mean peri-renal		Mean para-renal
	Rho	P	Rho	P
Carotid IMT (cm)	0.475	< 0.001	0.467	< 0.001
Pericardial fat thickness (cm)	0.566	< 0.001	0.445	< 0.001
BMI (kg/ m²)	0.480	< 0.001	0.441	< 0.001
Waist Circumference (cm)	0.452	< 0.001	0.465	< 0.001
Hip Circumference (cm)	0.313	< 0.001	0.338	< 0.001
HbA1c (%)	0.494	< 0.001	0.578	< 0.001
Homa-IR	0.330	0.001	0.419	< 0.001
E/A	-0.527	< 0.001	-0.385	< 0.001
E/E' septal	0.266	< 0.01	0.314	0.017
E/E' lateral	0.134	0.095	0.192	< 0.001
IMT: Intima-media Thickness, BMI: Body mass index, EF: Ejection Fraction

According to the basic results of our study, peri-renal and para-renal fat tissue thicknesses measured by ultrasonography in newly diagnosed diabetic individuals are significantly thicker than in the normal population and are significantly associated with CIMT, one of the indicators of subclinical atherosclerosis. Noninvasively measured peri- and pararenal fat tissue thicknesses are related to glycemic parameters as well as deterioration of diastolic functions, which may indicate subclinical cardiac involvement. We think that peri- and para-renal fat tissue thicknesses can be used to monitor both cardiovascular involvement and glycemic parameters in these patients.

Preventing the development of atherosclerotic cardiovascular disease in diabetes is an important clinical imperative that should be prioritized to improve quality of life, reduce premature death and reduce the occurrence of associated morbidities, thus reducing the economic costs associated with diabetes [9]. Visceral adipose tissue is thought to be a type of fat focus that has adverse effects on various metabolic profiles, systemic inflammation and insulin resistance, ultimately increasing the risk of developing cardiovascular disease [10, 11]. It is known that T2DM patients have more fat accumulation in internal organs, which results in stroke, cardiovascular diseases, metabolic disorders and comorbid diseases [12]. Visceral adipose tissue is the most important tissue in adipose biology, considering its anatomical and physiological properties. Compared with other fatty tissues, peri-renal fat tissue is known to have a complete blood supply, lymph fluid drainage, innervation and other special morphological features that make it similar to other internal organs but different from traditionally classified connective tissues [13]. Peri-renal fat may regulate the cardiovascular system through neural reflexes, adipokine secretion, adipocyte interactions and paracrine substances [14, 15]. It is known that perirenal fat tissue can regulate the cardiovascular system through adipokine secretion, adipocyte interactions, neural reflexes and various paracrine substances [14, 15]. Adipokines contribute to lipolysis through various autocrine, paracrine and endocrine-mediated pathways [16, 17]. In addition, peri-renal adipose tissue is effective in the synthesis of various cytokines from local immune cells such as T lymphocytes and monocytes/macrophages, which may play an important role in triggering the inflammatory response in the endothelium [18].

In the light of this information, various studies have been conducted to investigate the relationship between visceral fat tissue and cardiovascular diseases. In a study conducted on 670 T2DM patients (mean diabetes duration 5.1 ± 3.2 years), Guo et al. found peri-renal fat tissue to be significantly higher in the group with subclinical atherosclerosis compared to the group without it. They showed that PRFT was associated with subclinical atherosclerosis and carotid intima media thickness. They concluded that PRFT is an important marker in obesity [19]. It is also found in our study that para-renal and peri-renal fat tissue is related to carotid intima media thickness, as well as to myocardial functions. Unlike Guo et al., our study group was newly diagnosed diabetics. We also measured peri-renal and para-renal fat tissue with ultrasound, which is a noninvasive method.

Xu et al. investigated the metabolic risk parameters of obesity indicators in 337 T2DM patients. In addition to anthropometric parameters such as BMI, waist circumference, waist circumference, and waist/hip ratio, the relationship of VAT, SAT and PRFT with metabolic parameters was examined. They showed a significant relationship between PRFT and HDL-C, triglyceride and uric acid [20]. In our study, peri- and para-renal fat tissues were also associated with glucose, triglyceride, HDL-C, and HOMA-IR.

In another study, the relationship between para-renal and peri-renal fat tissue and 24-hour blood pressure was examined in 42 obese-overweight individuals without any medication. As a result of the study, they showed that para-renal and peri-renal fat tissue thicknesses were related to 24-hour average diastolic blood pressure. They also put forward the idea that para-renal and peri-renal fatty tissues have a direct effect on blood pressure elevation. In our study, we found that peri-renal and para-renal fat tissue thicknesses were correlated with resting systolic and diastolic blood pressures in newly diagnosed T2DM patients [21].

Similar to our study in terms of method, Lamacchia et al. examined the relationship between para-renal and peri-renal fat tissue thicknesses measured by ultrasonography and glomerular filtration rate, renal resistance index and hyperuricemia in 151 T2DM patients. They showed that para-renal and peri-renal fat tissue thicknesses were an independent predictor of renal failure in these patients [22]. The relationship between peri-renal adipose tissue thickness measured by tomography in addition to visceral and subcutaneous adipose tissue of fatty liver disease associated with metabolic dysfunction developing in T2DM patients was examined in another study conducted in China. They concluded that PRFT was an independent predictor of fatty liver disease associated with metabolic dysfunction [23]. Koo et al. investigated the presence of atherosclerosis in six different vascular beds with peri-renal fat tissue measured on tomography in CT scans of 3919 asymptomatic individuals. As a result of the study, they concluded that perirenal fat tissue was associated with atherosclerosis in the renal artery and abdominal aorta [24]. With a methodology similar to our study, Okeahialam et al. evaluated the relationship of peri-renal fat tissue with subclinical atherosclerosis in 221 normal individuals and whether it could be used in cardiovascular risk assessment. As a result of the study, they found that PRF tissue was associated with CIMT and anthropometric measurements. They concluded that PRF tissue is associated with parameters that predict atherosclerosis [25]. In contrast to this study, we found that peri-renal and para-renal adipose tissue was associated with carotid intima media thickness in newly diagnosed T2DM patients.

Increased epicardial adipose tissue can induce local inflammation that will have a negative effect on the myocardium and coronary arteries. Epicardial adipose tissue has been shown to be a reliable and easily measurable marker for various cardiovascular outcomes [26]. In a similar study, they examined whether apicardial adipose tissue was associated with anthropometric and clinical parameters of metabolic syndrome in 72 patients with various body mass indexes. As a result of the research, they concluded that there was a significant relationship between epicardial adipose tissue detected by echocardiography and visceral adipose tissue, and that waist circumference was the strongest parameter associated with EAT [27]. In our study, we also found a significant correlation between peri-renal and para-renal fat tissue thickness and EAT, in addition to a significant relationship between EAT and CIMT. It shows that EAT, an important preatherosclerotic inflammatory adipose tissue, can also predict subclinical atherosclerosis. Peri-renal and para-renal fat tissue thickness is also related to EAT.

According to our study, peri-renal and para-renal fat thicknesses increased significantly in individuals with newly diagnosed Type 2 DM compared to the control group. Subclinical atherosclerosis and deterioration in diastolic functions have been detected in individuals with newly diagnosed Type 2 DM. In addition, epicardial fat tissue thickness, which is thought to be related to atherosclerosis, was also related to peri-renal and para-renal fat tissue. These results support many previous studies in the literature. The relationship between peri-renal and para-renal fat thickness measured at the time of new diagnosis and subclinical atherosclerosis, ejection fraction and diastolic dysfunction in Type 2 diabetic patients was found to be statistically significant. Increased peri-renal and para-renal fat thickness may be useful in predicting an increased risk of subclinical atherosclerosis and diastolic dysfunction. The fact that peri-renal and para-renal fat tissue is detected non-invasively by ultrasound without radiation exposure makes our study important. For this reason, we think that peri-renal and para-renal fat thickness measured at the time of diagnosis in diabetic patients can be used to predict the risk of atherosclerotic cardiovascular disease and myocardial dysfunction. We think that the results obtained in our study should be carried forward and the literature data should be supported with new information, with new studies to be conducted on a larger scale and in different populations, under the leadership of our prospective pilot study.

Study Limitations

Our study is primarily a cross-sectional study and individuals who met the study criteria were included in the study over a certain period of time. Therefore, study results may not reflect the entire society. In our study, para-renal and peri-renal fat tissue shapes, which are a marker of visceral fat tissue, vary between individuals and do not exist in a geometric shape, so their measurement by ultrasonography does not include a clear standard. Measurement of fat tissue thickness by magnetic resonance imaging methods may be an alternative, but the application of this examination does not seem to be compatible with good clinical practices in our study group. Since the newly diagnosed Type 2 diabetic patient and control groups include individuals without antihypertensive and lipid-lowering drug use and without a history of coronary artery disease, they may not represent the entire diabetic patient population.

AST Aspartate aminotransferase

ALT Alanine aminotransferase

BMI Body mass index

CIMT Carotis intima media thickness

CRP c-reactive protein

EDT Mitral E wave deceleration time

EF Ejection fraction

EFT Epicardial fat thickness

GGT Gamma-glutamyl transferase

HDL High density lipoprotein

LDL Low-density lipoprotein

PRFT Perirenal fat tissue

SAT Subcutaneous adipose tissue

T2DM Type 2 diabetes mellitus

VAT Visceral adipose tissue

Funding:

None

Author Contribution

I.I. and T.K. contributed to the idea of research, data collection, and writing of the manuscript. M.K. contributed to data collection. T.K. also worked for supervision of the manuscript. All authors reviewed the manuscript

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No competing interests reported.

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The Relationship of Peri and Para-Renal Fat Tissue with Subclinical Atherosclerosis and Myocardial Functions in Newly Diagnosed Type 2 Diabetic Patients

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