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Updated: Aug 23, 2025
Whole Body and Regional Quantification of Active Human Brown Adipose Tissue Using 18F-FDG PET/CT
Published on: April 1, 2019
Impact of White Adipose Tissue on Brain Structure, Perfusion, and Cognitive Function in Patients With Severe Obesity:
Debby Vreeken1, Florine Seidel1, Guido de La Roij1
1From the Department of Medical Imaging (D.V., F.S., G.L.R., M.W., A.J.K.), Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Bariatric Surgery (D.V., W.V., W.A.H., E.J.H.), Vitalys, Part of Rijnstate Hospital, Arnhem, The Netherlands; Donders Institute for Brain (D.V., F.S., R.P.C.K., M.W., A.J.K.), Cognition, and Behavior and Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Metabolic Health Research (F.S., R.K.), Netherlands Organisation for Applied Scientific Research (TNO), Leiden; Department of Microbiology and Systems Biology (L.V., S.Ö.), Netherlands Organisation for Applied Scientific Research (TNO), Zeist; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray, The Netherlands; Department of Medical Psychology and Radboudumc Alzheimer Center (R.P.C.K.), Radboud University Medical Center, Nijmegen, The Netherlands; Medical Image Analysis Center (MIAC) and Qbig (M.D.), and Department of Biomedical Engineering, University of Basel, Switzerland; Department of Radiology and Nuclear Medicine (H.J.M.M.M.), Amsterdam UMC, Amsterdam Neuroscience, The Netherlands; and Division of Human Nutrition and Health (E.J.H.), Wageningen University, The Netherlands.
Background And Objective:
While underlying pathophysiology linking obesity to brain health is not completely understood, white adipose tissue (WAT) is considered a key player. In obesity, WAT becomes dysregulated, showing hyperplasia, hypertrophy, and eventually inflammation. This disbalance leads to dysregulated secretion of adipokines influencing both (cardio)vascular and brain health. Within this study, we investigated the association between omental WAT (oWAT) and subcutaneous WAT (scWAT) with brain structure and perfusion and cognition in adults with severe obesity.
Methods:
Within the cross-sectional BARICO study, brain structure and perfusion and cognitive function were measured before bariatric surgery (BS) using MRI and cognitive assessments. During BS, oWAT and scWAT depots were collected and analyzed by histopathology. The number and diameter of adipocytes were quantified together with the amount of crown-like structures (CLS) as an indication of inflammation. Blood samples were collected to analyze adipokines and inflammatory markers. Neuroimaging outcomes included brain volumes, cortical thickness, white matter (WM) integrity, WM hyperintensities, cerebral blood flow using arterial spin labeling (ASL), and the ASL spatial coefficient of variation (sCoV), reflecting cerebrovascular health.
Results:
Seventy-one patients were included (mean age 45.1 ± 5.8 years; 83.1% women; mean body mass index 40.8 ± 3.8 kg/m2). scWAT showed more CLS (z = -2.72, p < 0.01, r = -0.24) and hypertrophy compared with oWAT (F(1,64) = 3.99, p < 0.05, η2 = 0.06). Adiponectin levels were inversely associated with the average diameter of scWAT (β = -0.31, 95% CI -0.54 to -0.08) and oWAT (β = -0.33, 95% CI -0.55 to -0.09). Furthermore, the adipocyte diameter in oWAT was positively associated with the sCoV in the parietal cortex (β = 0.33, 95% CI 0.10-0.60), and the number of adipocytes (per mm2) was positively associated with sCoV in the nucleus accumbens (NAcc) (β = 0.34, 95% CI 0.09-0.61). Cognitive function did not correlate with any WAT parameter or plasma marker. These associations were highly influenced by age and sex. sCoV in the NAcc was positively associated with fasting plasma glucose (β = 0.35, 95% CI 0.10-0.56).
Discussion:
scWAT and oWAT are different in morphology and in their relationship with plasma markers and cerebrovascular health. Although scWAT showed more CLS and hypertrophy, scWAT was not associated with brain readouts. This study showed, however, important relationships between oWAT morphology and cerebrovascular health in obesity.
Trial Registration Information:
Trial Registration Number NTR7288 (trialregister.nl/trial/7090).
