The following is a summary of “Cardiac autonomic neuropathy is associated with ectopic fat distribution in autoimmune but not in type 2 diabetes,” published in the February 2025 issue of the Cardiovascular Diabetology by Risi et al.
Cardiac autonomic neuropathy (CAN) is a severe and potentially life-threatening complication of diabetes, significantly impacting cardiovascular function. While obesity is widely recognized as a risk factor for dysautonomia, the specific relationship between CAN and body fat distribution remains incompletely understood, particularly in individuals with autoimmune diabetes (AD). This study aimed to investigate whether the association between CAN and ectopic fat distribution differs between AD and type 2 diabetes (T2D). A total of 143 individuals with diabetes (44 with AD and 99 with T2D) who underwent clinical screening for CAN were included. Body fat distribution was assessed using Dual X-ray Absorptiometry (DXA), and the relationship between CAN and markers of ectopic fat deposition was analyzed using multivariate regression models adjusted for confounding variables.
Additionally, interactions between diabetes type and CAN were evaluated. The results revealed a significant interaction between diabetes type and CAN in relation to ectopic fat markers. Specifically, in individuals with AD, those with CAN exhibited significantly higher levels of visceral adipose tissue (530 [376–665] g vs. 251 [189–360] g, p = 0.001), total fat mass (22,708 [20,200–27,845] g vs. 15,434 [12,981–21,879] g, p = 0.016), and trunk-to-leg fat ratio (0.88 [0.75–1.04] vs. 0.70 [0.56–0.78], p = 0.023) compared to those without CAN. However, these associations were not observed in individuals with T2D, as indicated by significant interaction p-values (< 0.05 for all comparisons).
These findings suggest that ectopic fat distribution plays a more prominent role in the development of CAN in individuals with AD than in those with T2D. This highlights the distinct metabolic and cardiovascular risk profile associated with fat accumulation in AD, suggesting that individuals with AD may be more susceptible to autonomic dysfunction due to differences in fat deposition patterns. Given the clinical implications of these findings, further research is needed to elucidate the underlying mechanisms linking adiposity to CAN in AD and to explore potential preventive and therapeutic strategies tailored to this population.
Source: cardiab.biomedcentral.com/articles/10.1186/s12933-025-02635-6
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