Epicardial adipose tissue and cardiometabolic risk factors in overweight and obese children and adolescents



What is already known about this subject

  • The prevalence of childhood obesity has increased markedly in the past 2 decades.
  • Abdominal fat is a better predictor of risk than body mass index.
  • Waist circumference (WC) as a measure of abdominal fat has limited sensitivity and specificity.

What this study adds

  • Epicardial adipose tissue (EAT) as measured by echocardiography represents a simple and reliable marker of visceral adiposity.
  • In children, both body mass index and EAT show a similar or better correlation with markers of cardiometabolic risk than does waist circumference.


Epicardial adipose tissue (EAT) is the visceral fat deposit around the heart and is commonly increased in obese subjects. EAT is related to cardiometabolic risk factors and non-alcoholic fatty liver disease (NAFLD) in adults, but this relationship is not well known in children.


Echocardiographic assessment of EAT and its association with cardiometabolic risk factors in overweight and obese children.

Study groups and methods

In 25 (mean age 13.0 ± 2.3) overweight and obese subjects and 24 lean controls, blood pressure (BP), WC, fasting plasma glucose and insulin, lipids, uric acid and hepatic enzymes were measured. EAT thickness was measured by transthoracic echocardiography.


In overweight and obese subjects, EAT was significantly higher compared to normal weight children. Overweight and obese children had significantly higher body mass index (BMI), WC, BP, triglycerides (TAG), low-density lipoprotein and total cholesterol, hepatic enzymes alanine aminotransferase (ALT) and γ-glutamyl transferase, and lower high-density lipoprotein cholesterol (HDL-C). EAT correlated significantly with BP, TAG, uric acid, HDL-C, apoprotein B and ALT. Correlation coefficients were similar or better than for WC, but similar or lower than for BMI.


EAT thickness in children is associated with an unfavourable cardiometabolic risk profile including biochemical signs of NAFLD and hyperuricaemia, but is not a stronger indicator than BMI.