Relationship of para- and perirenal fat and epicardial fat with metabolic parameters in overweight and obese subjects

  • Carlo MannoEmail author
  • Nicla Campobasso
  • Adele Nardecchia
  • Vincenzo Triggiani
  • Roberta Zupo
  • Loreto Gesualdo
  • Franco Silvestris
  • Giovanni De Pergola
Original Article



The accumulation of visceral body fat, has been shown to be associated with higher risk of metabolic and cardiovascular disease. This study was addressed to examine whether para- and perirenal fat thickness and epicardial fat thickness were correlated with anthropometric- and cardiometabolic risk factors.


A cohort of 102 uncomplicated overweight and obese patients was examined. BMI, waist circumference, blood pressure, fasting insulin, glucose, triglycerides, total cholesterol, HDL-cholesterol, LDL-cholesterol serum levels, and insulin resistance (assessed by HOMAIR) were measured. Para- and perirenal fat thickness (PUFT) and epicardial fat thickness (EUFT) were measured by ultrasounds.


PUFT was positively correlated with BMI (p < 0.001), waist circumference (p < 0.001), insulin (p < 0.001), HOMAIR (p < 0.001), triglycerides (p < 0.05), systolic (p < 0.05) and diastolic (p < 0.05) blood pressure, and negatively correlated with HDL-cholesterol (p < 0.01). EUFT was positively associated with age (p < 0.01), BMI (p < 0.001), waist circumference (p < 0.001), systolic (p < 0.01) and diastolic (p < 0.001) blood pressure, and LDL-cholesterol (p < 0.05). A multivariate analysis by multiple linear regression was performed, and the final model showed a direct association of waist circumference with both PUFT and EUFT, a correlation of PUFT with HOMAIR (positive) and HDL-cholesterol (negative), and a direct association of EUFT (both long axis and short axis) with LDL-cholesterol. All these correlations were independent of other anthropometric, metabolic and hemodynamic parameters.


This study shows that accumulation of central fat in apparently healthy overweight and obese subjects is associated to a simultaneous increase of pararenal, perirenal and epicardial fat. Moreover, it shows that only para- and perirenal fat is independently associated to insulin resistance and lower HDL-cholesterol, and only epicardial fat is independently associated to higher LDL cholesterol.

Level of evidence Level V, cross-sectional descriptive study.


Obesity Para- and perirenal fat Epicardial fat Insulin resistance 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the local ethics committee (Comitato Etico Indipendente Azienda Ospedaliero-Universitaria “Consorziale Policlinico”, Bari).

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Cornier MA, Marshall JA, Hill JO, Maahs DM, Eckel RH (2011) Prevention of overweight/obesity as a strategy to optimize cardiovascular health. Circulation 124:840–850CrossRefGoogle Scholar
  2. 2.
    Balagopal P, de Ferranti SD, Cook S et al for the American Heart Association Committee on Atherosclerosis Hypertension and Obesity in Youth (2011) Nontraditional risk factors and biomarkers for cardiovascular disease: mechanistic, research, and clinical considerations for youth. Circulation 123:2749–2769CrossRefGoogle Scholar
  3. 3.
    De Pergola G, De Mitrio V, Giorgino F et al (1997) Increase in both pro-thrombotic and anti-thrombotic factors in obese premenopausal women: relationship with body fat distribution. Int J Obes Relat Metab Disord 21:527–535CrossRefGoogle Scholar
  4. 4.
    Vgontzas AN, Papanicolaou DA, Bixler EO et al (2000) Sleep apnea and daytime sleepiness and fatigue: relation to visceral obesity, insulin resistance, and hypercytokinemia. J Clin Endocrinol Metab 85:1151–1158CrossRefGoogle Scholar
  5. 5.
    De Pergola G, Ciampolillo A, Paolotti S et al (2007) Free triiodothyronine and thyroid stimulating hormone serum levels are directly associated with waist circumference, independently of insulin resistance, metabolic parameters and blood pressure levels in overweight and obese women. Clin Endocrinol 67:265–269CrossRefGoogle Scholar
  6. 6.
    De Pergola G, Nardecchia A, Guida P, Silvestris F (2011) Arterial hypertension in obesity: relationship with hormone and anthropometric parameters. Eur J Cardiovas Prev Rehab 18:240–247CrossRefGoogle Scholar
  7. 7.
    Pasquali R (2012) The hypothalamic-pituitary-adrenal axis and sex hormones in chronic stress and obesity: pathophysiological and clinical aspects. Ann N Y Acad Sci 1264:20–35CrossRefGoogle Scholar
  8. 8.
    De Pergola G, Silvestris F (2013) Obesity as a major risk factor for cancer. J Obesity. Google Scholar
  9. 9.
    Després JP (2012) Body fat distribution and risk of cardiovascular disease: an update. Circulation 126:1301–1313CrossRefGoogle Scholar
  10. 10.
    Third Report of the National Cholesterol Education Program (NCEP) (2002) Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation 106:3143CrossRefGoogle Scholar
  11. 11.
    Fox CS, Massaro JM, Hoffmann U et al (2007) Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Circulation 116:39–48CrossRefGoogle Scholar
  12. 12.
    Heilbronn L, Smith S, Ravussin E (2004) Failure of fat cell proliferation, mitochondrial function and fat oxidation results in ectopic fat storage, insulin resistance and type II diabetes mellitus. Int J Obes Relat Metab Disord 28(S4):S12–S21CrossRefGoogle Scholar
  13. 13.
    Britton KA, Fox CS (2011) Ectopic fat depots and cardiovascular disease. Circulation 124:e837–e841CrossRefGoogle Scholar
  14. 14.
    Lamacchia O, Nicastro V, Camarchio D et al (2011) M. Para- and perirenal fat thickness is an independent predictor of chronic kidney disease, increased renal resistance index and hyperuricaemia in type-2 diabetic patients. Nephrol Dial Transpl 26:892–898CrossRefGoogle Scholar
  15. 15.
    Iacobellis G, Willens HJ (2009) Echocardiographic epicardial fat: a review of research and clinical applications. J Am Soc Echocardiogr 22:1311–1319CrossRefGoogle Scholar
  16. 16.
    Iacobellis G (2015) Local and systemic effects of the multifaceted epicardial adipose tissue depot. Nat Rev Endocrinol 11:363–371CrossRefGoogle Scholar
  17. 17.
    McAninch EA, Fonseca TL, Poggioli R et al (2015) Epicardial adipose tissue has a unique transcriptome modified in severe coronary artery disease. Obesity 23:1267–1278CrossRefGoogle Scholar
  18. 18.
    Bonora E, Targher G, Alberiche M et al (2000) Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity: studies in subjects with various degrees of glucose tolerance and insulin sensitivity. Diabetes Care 23:57–63CrossRefGoogle Scholar
  19. 19.
    De Pergola G, Campobasso N, Nardecchia A et al (2015) Para- an perirenal ultrasonographic fat thickness is associated with 24-hours mean diastolic blood pressure levels in overweight and obese subjects. BMC Cardiovasc Disord 15:108. CrossRefGoogle Scholar
  20. 20.
    Iacobellis G, Assael F, Ribaudo MC et al (2003) Epicardial fat from echocardiography: a new method for visceral adipose tissue prediction. Obes Res 11:304–310CrossRefGoogle Scholar
  21. 21.
    Iacobellis G, Barbarini G, Letizia C, Barbaro G (2014) Epicardial fat thickness and nonalcoholic fatty liver disease in obese subjects. Obesity 22:332–336CrossRefGoogle Scholar
  22. 22.
    Nakazato R, Rajani R, Cheng VY et al (2012) Weight change modulates epicardial fat burden: a 4-year serial study with non-contrast computed tomography. Atherosclerosis 220:139–144CrossRefGoogle Scholar
  23. 23.
    Pierdomenico SD, Pierdomenico AM, Cuccurullo F, Iacobellis G (2013) Meta-analysis of the relation of echocardiographic epicardial adipose tissue thickness and the metabolic syndrome. Am J Cardiol 111:73–78CrossRefGoogle Scholar
  24. 24.
    Ahn SG, Lim HS, Joe DY et al (2008) Relationship of epicardial adipose tissue by echocardiography to coronary artery disease. Heart 94(3):e7CrossRefGoogle Scholar
  25. 25.
    Nerlekar N, Brown AJ, Muthalaly RG et al (2017) Association of epicardial adipose tissue and high-risk plaque characteristics: a systematic review and meta-analysis. J Am Heart Assoc 6(8):e006379. CrossRefGoogle Scholar
  26. 26.
    Iacobellis G, Zaki MC, Garcia D, Willens HJ (2014) Epicardial fat in atrial fibrillation and heart failure. Horm Metab Res 46:587–590CrossRefGoogle Scholar
  27. 27.
    Canpolat U, Bahadir N, Coteli C (2016) Chicken or egg causality paradox between insulin resistance and epicardial fat. Angiology 67:970–971CrossRefGoogle Scholar
  28. 28.
    Gaggini M, Saponaro C, Gastaldelli A (2015) Not all fats are created equal: adipose vs. ectopic fat, implication in cardiometabolic diseases. Horm Mol Biol Clin Investig 22:7–18. Google Scholar
  29. 29.
    Iacobellis G (2014) Epicardial adipose tissue in endocrine and metabolic diseases. Endocrine 46:8–15CrossRefGoogle Scholar
  30. 30.
    Jermendy AL, Kolossvary M, Drobni ZD et al (2017) Assessing genetic and environmental influences on epicardial and abdominal adipose tissue quantities: a classical twin study. Int J Obes Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Section of Nephrology, Department of Emergency and Organ Transplantation, School of MedicineUniversity of BariBariItaly
  2. 2.Clinical Nutrition Unit, Medical Oncology, Department of Biomedical Science and Human Oncology, School of MedicineUniversity of BariBariItaly
  3. 3.Section of Endocrinology and Metabolic Diseases, Department of Emergency and Organ Transplantation, School of MedicineUniversity of Bari70124 BariItaly

Personalised recommendations