Intraperitoneal Adipose Tissue: Associated Health Risks, Quantification by Advanced Imaging Methods and Future Directions in Children

The prevalence of obesity continues to grow at an alarming rate and currently there are no highly effective long-term treatments for obesity at the population level. Targeting childhood is a critical component of the strategy for fighting the obesity epidemic and there is an important need to understand the relationship among adipose tissue distribution, growth and obesity-related health risks. Growing evidence supports the idea that visceral adipose tissue (VAT) is related to insulin resistance, metabolic syndrome, cardiovascular disease, diabetes and other medical conditions through blood drainage, hormonal factors, inflammation, and adipocytokines. Recent studies suggest that VAT is not a homogenous depot. Intraperitoneal and extraperitoneal adipose tissues (IPAT & EPAT), the two subcomponents of VAT, have different venous blood drainage and may also differ in their associations with metabolic risk. The majority of previous studies have used imaging methods to measure the total amount of VAT. Few studies have established protocols for the analysis IPAT and EPAT and those that have are limited by their approximate nature and relatively large measurement error. To better understand the role of adipose tissue distribution in relation to the health consequences of obesity, accurate methods to separately measure IPAT and EPAT should be developed. Fortunately, children's characteristic VAT distribution permits easier differentiation between IPAT and EPAT than in adults. Future studies need to elaborate the role of regional VAT in growth and obesity with accurate quantification of IPAT and EPAT by advanced magnetic resonance imaging methods.