Journal Article

Cardiac autonomic neuropathy is associated with ectopic fat distribution in autoimmune but not in type 2 diabetes

Watanabe, Mikiko, Gnessi, Lucio, D’Onofrio, Luca, Pantano, Angelo Lauria, Luverà, Daniela, Buzzetti, Raffaella, Amendolara, Rocco, Fassino, Valeria, Masi, Davide, Risi, Renata, Coraggio, Lucia, Maddaloni, Ernesto

2025

Overview

Background Cardiac autonomic neuropathy (CAN) is a life-threatening complication of diabetes. While obesity is a well-known risk factor of dysautonomia, the association between CAN and body fat distribution has not been fully clarified, especially in autoimmune diabetes (AD). Aim To evaluate if the association between CAN and body fat distribution differs between AD and type 2 diabetes (T2D). Methods Body fat distribution was evaluated by Dual X-Ray Absorptiometry in 143 people with diabetes (44 with ADand 99 with T2D) undergoing clinical screening for CAN. The association of CAN with markers of ectopic fat distribution was evaluated in multivariate regression models adjusting for confounders and testing for the interaction between diabetes type and CAN. Results A significant interaction between CAN and diabetes type was found with respect to markers of ectopic fat distribution. Specifically, people with CAN had significantly higher amount of visceral adipose tissue (530 [376–665]g versus 251[189–360]g, p = 0.001), total fat mass (22708[20200–27845]g versus 15434[12981–21879]g, p = 0,016), and trunk-to-leg ratio (0.88 [0.75–1.04] versus 0.70 [0.56–0.78], p = 0,023) compared to those without CAN only in participants with AD, but not in T2D (p-values for interaction < 0.05 for all comparisons). Conclusion Ectopic fat distribution is more strongly associated with CAN in AD than in T2D. This highlights the distinct role of fat distribution in the cardiometabolic health of people with AD, suggesting the need for further studies to better understand the pathophysiology and implications of overweight in this population.

• Publisher: BioMed Central,Springer Nature B.V,BMC
• Subject: Absorptiometry / Absorptiometry, Photon / Adipose tissue / Adipose tissue distribution / Adiposity / Adult / Aged / Angiology / Autoimmune diabetes / Autoimmune diseases / Autonomic nervous system / Autonomic Nervous System Diseases - diagnosis / Autonomic Nervous System Diseases - diagnostic imaging / Autonomic Nervous System Diseases - etiology / Autonomic Nervous System Diseases - physiopathology / Body fat / Body Fat Distribution / Body mass index / Cardiac autonomic neuropathy / Cardiology / Cholesterol / Cross-Sectional Studies / Data collection / Diabetes / Diabetes mellitus (non-insulin dependent) / Diabetes Mellitus, Type 1 - complications / Diabetes Mellitus, Type 1 - diagnosis / Diabetes Mellitus, Type 1 - physiopathology / Diabetes Mellitus, Type 2 - complications / Diabetes Mellitus, Type 2 - diagnosis / Diabetes Mellitus, Type 2 - physiopathology / Diabetic Neuropathies - diagnosis / Diabetic Neuropathies - diagnostic imaging / Diabetic Neuropathies - etiology / Diabetic Neuropathies - physiopathology / Diabetic neuropathy / Diabetic retinopathy / Dual energy X-ray absorptiometry / Dysautonomia / Female / Heart / Heart - innervation / Heart Diseases - diagnostic imaging / Heart Diseases - etiology / Heart Diseases - physiopathology / Heart rate / High density lipoprotein / Humans / Hypertension / Insulin resistance / Intra-Abdominal Fat - diagnostic imaging / Intra-Abdominal Fat - physiopathology / Male / Medicine / Medicine & Public Health / Metabolic syndrome / Middle Aged / Nervous system / Neuropathy / Obesity / Regression analysis / Risk Assessment / Risk Factors / Software / Type 2 diabetes / Weight control