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Effects of metformin on epicardial adipose tissue and atrial electromechanical delay of obese children with insulin resistance

Published online by Cambridge University Press:  27 July 2020

Hatice Güneş*
Affiliation:
Department of Pediatrics, Sutcu Imam University, Kahramanmaras, Turkey
Hakan Güneş
Affiliation:
Department of Cardiology, Sutcu Imam University, Kahramanmaras, Turkey
Şebnem Özmen
Affiliation:
Department of Pediatrics, Sutcu Imam University, Kahramanmaras, Turkey
Enes Çelik
Affiliation:
Department of Cardiology, Sutcu Imam University, Kahramanmaras, Turkey
Fatih Temiz
Affiliation:
Department of Pediatric Endocrinology and Metabolism, Sutcu Imam University, Kahramanmaras, Turkey
*
Author for correspondence: Assistant Prof., Hatice Güneş, MD, Department of Pediatrics, Kahramanmaras Sutcu Imam, University School of Medicine, Kahramanmaras, Turkey. Tel: +90 344 3003785; Fax: +90 344 300 3409. E-mail: [email protected]

Abstract

Introduction:

Obesity is usually related to insulin resistance and glucose metabolism disorders. The relationship between insulin resistance and epicardial adipose tissue and atrial electromechanical delay has been described in previous studies.

Aim:

This study aims to demonstrate the effects of metformin on epicardial adipose tissue and electromechanical delay in patients using metformin for insulin resistance.

Materials and methods:

A total of 30 patients using metformin for insulin resistance were included in the study. Pre-treatment and post-treatment epicardial adipose tissue and electromechanical delay were evaluated.

Results:

There was a statistically significant decrease in epicardial adipose tissue thickness after 3 months of metformin therapy (6.4 ± 2.1 versus 4.7 ± 2.0; p = 0.008). Furthermore, the inter-atrial and intra-atrial electromechanical delay also significantly decreased after 3 months of metformin monotherapy (23.6 ± 8.2 versus 18.1 ± 5.8; p < 0.001, 9.1 ± 2.9 versus 6.3 ± 3.6; p = 0.003, respectively).

Conclusion:

In this study, we show that metformin monotherapy significantly decreases epicardial adipose tissue thickness and electromechanical delay in obese children.

Type
Original Article
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

World Health Organization. Global and regional trends by UN Regions, 1990–2025; Overweight: 1990–2015 June 2016. Retrieved April 14, 2020 from http://apps.who.int/gho/data/node.main.NUTUNREGIONS? Google Scholar
Lobstein, T, Jackson-Leach, R, Moodie, ML, et al. Child and adolescent obesity: part of a bigger picture. Lancet 2015; 385: 25102520.CrossRefGoogle ScholarPubMed
de Onis, M, Blössner, M, Borghi, E. Global prevalence and trends of overweight and obesity among preschool children. Am J Clin Nutr 2010; 92: 12571264.CrossRefGoogle ScholarPubMed
Iacobellis, G, Leonetti, F. Epicardial adipose tissue and insulin resistance in obese subjects. J Clin Endocrinol Metab 2005; 90: 63006302.CrossRefGoogle ScholarPubMed
Tagi, VM, Giannini, C, Chiarelli, F. Insulin resistance in children. Front Endocrinol (Lausanne) 2019; 4: 342.CrossRefGoogle Scholar
Akhlaghi, F, Matson, KL, Mohammadpour, AH, Kelly, M, Karimani, A. Clinical pharmacokinetics and pharmacodynamics of antihyperglycemic medications in children and adolescents with type 2 diabetes mellitus. Clin Pharmacokinet 2017; 56: 561571.CrossRefGoogle ScholarPubMed
Chao, AM, Wadden, TA, Berkowitz, RI., Chao, AM, Wadden, TA. The safety of pharmacologic treatment for pediatric obesity. Expert Opin Drug Safety 2018; 17: 379385.CrossRefGoogle ScholarPubMed
Khokhar, A, Umpaichitra, V, Chin, VL, Perez-Colon, S. Metformin use in children and adolescents with prediabetes. Pediatr Clin N Am 2017; 64: 13411353.CrossRefGoogle ScholarPubMed
Schmidt, M, Bøtker, HE, Pedersen, L, Sørensen, HT. Young adulthood obesity and risk of acute coronary syndromes, stable angina pectoris, and congestive heart failure: a 36-year cohort study. Ann Epidemiol 2014; 24: 356361.e1.CrossRefGoogle ScholarPubMed
Sommer, A, Twig, G. The impact of childhood and adolescent obesity on cardiovascular risk in adulthood: a systematic review. Curr Diab Rep 2018; 18: 91.CrossRefGoogle ScholarPubMed
El-Assaad, I, Al-Kindi, SG, Saarel, EV, Aziz, PF. Lone pediatric atrial fibrillation in the United States: analysis of over 1500 cases. Pediatr Cardiol 2017; 38: 10041009.CrossRefGoogle ScholarPubMed
Temiz, F, Güneş, H, Güneş, H. Evaluation of atrial electromechanical delay in children with obesity. Medicina (Kaunas) 2019; 55: E228.CrossRefGoogle ScholarPubMed
Ziyrek, M, Kahraman, S, Ozdemir, E, Dogan, A. Metformin monotherapy significantly decreases epicardial adipose tissue thickness in newly diagnosed type 2 diabetes patients. Rev Port Cardiol 2019; 38: 419423.CrossRefGoogle ScholarPubMed
van der Aa, MP, Fazeli Farsani, S, Kromwijk, LA, de Boer, A, Knibbe, CA, van der Vorst, MM. How to screen obese children at risk for type 2 diabetes mellitus? Clin Pediatr (Phila) 2014; 53: 337342.CrossRefGoogle ScholarPubMed
Shashaj, B, Luciano, R, Contoli, B, et al. Reference ranges of HOMA-IR in normal-weight and obese young Caucasians. Acta Diabetol 2016; 53: 251260.CrossRefGoogle ScholarPubMed
Iacobellis, G., Lonn, E., Lamy, A. Epicardial fat thickness and coronary artery disease correlate independently of obesity. Int J Cardiol 2011; 146: 452454.CrossRefGoogle ScholarPubMed
Gunes, H, Sokmen, A, Kaya, H, et al. Evaluation of atrial electromechanical delay to predict atrial fibrillation in hemodialysis patients. Medicina (Kaunas) 2018; 54: E58.CrossRefGoogle ScholarPubMed
Gastaldelli, A, Basta, G. Ectopic fat and cardiovascular disease: what is the link? Nutr Metab Cardiovasc Dis 2010; 20: 481490.CrossRefGoogle ScholarPubMed
Iacobellis, G, Corradi, D, Sharma, AM. Epicardial adipose tissue: anatomic, biomolecular and clinical relationships with the heart. Nat Clin Pract Cardiovasc Med 2005; 2: 536543.CrossRefGoogle ScholarPubMed
Schejbal, V. Epicardial fatty tissue of the right ventricle morphology, morphometry and functional significance. Pneumologie 1989; 43: 490499.Google ScholarPubMed
Marchington, JM, Mattacks, CA, Pond, CM. Adipose tissue in the mammalian heart and pericardium: structure, foetal development and biochemical properties. Comp Biochem Physiol B 1989; 94: 225232.CrossRefGoogle ScholarPubMed
Iacobellis, G, Ribaudo, MC, Assael, F, et al. Echocardiographic epicardial adipose tissue is related to anthropometric and clinical parameters of metabolic syndrome: a new indicator of cardiovascular risk. J Clin Endocrinol Metab 2003; 88: 51635168.CrossRefGoogle ScholarPubMed
Gastaldelli, A, Morales, MA, Marraccini, P, Sicari, R. The role of cardiac fat in insulin resistance. Curr Opin Clin Nutr Metab Care 2012; 15: 523528.CrossRefGoogle ScholarPubMed
Güneş, H, Güneş, H, Temiz, F. The relationship between epicardial adipose tissue and insulin resistance in obese children. Arq Bras Cardiol 2020; 114: 675682.Google ScholarPubMed
Wróbel, MP, Marek, B, Kajdaniuk, D, Rokicka, D, Szymborska-Kajanek, A, Strojek, K. Metformin - a new old drug. Endokrynol Pol 2017; 68: 482496.CrossRefGoogle ScholarPubMed
Yanovski, JA, Krakoff, J, Salaita, CG, et al. Effects of metformin on body weight and body composition in obese insulin-resistant children: a randomized clinical trial. Diabetes 2011; 60: 477485.CrossRefGoogle ScholarPubMed
Erdem, FH, Ozturk, S, Baltaci, D,et al. Detection of atrial electromechanical dysfunction in obesity. Acta Cardiol 2015; 70: 678684.CrossRefGoogle ScholarPubMed
Yagmur, J, Cansel, M, Acikgoz, N, et al. Assessment of atrial electromechanical delay by tissue Doppler echocardiography in obese subjects. Obesity (Silver Spring). 2011; 19: 779783.CrossRefGoogle ScholarPubMed
Nerlekar, N, Brown, AJ, Muthalaly, RG, et al. Association of epicardial adipose tissue and high-risk plaque characteristics: a systematic review and meta-analysis. J Am Heart Assoc 2017; 6: e006379.CrossRefGoogle ScholarPubMed
Saisho, Y. Metformin and inflammation: its potential beyond glucose lowering effect. Endocr Metab Immune Disord Drug Targets 2015; 15: 196205.CrossRefGoogle ScholarPubMed
Zheng, Z, Chen, H, Li, J, et al. Sirtuin 1-mediated cellular metabolic memory of high glucose via the LKB1/AMPK/ROS pathway and therapeutic effects of metformin. Diabetes 2012; 61: 217228.CrossRefGoogle ScholarPubMed
Rena, G, Hardie, DG, Pearson, ER. The mechanisms of action of metformin. Diabetologia 2017; 60: 15771585.CrossRefGoogle ScholarPubMed