Inverse association between brown adipose tissue activation and white adipose tissue accumulation in successfully treated pediatric malignancy

Abstract

Background: Although the accumulation of white adipose tissue (WAT) is a risk factor for disease, brown adipose tissue (BAT) has been suggested to have a protective role against obesity.

Objective: We studied whether changes in BAT were related to changes in the amounts of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) in children treated for malignancy.

Design: We examined the effect of BAT activity on weight, SAT, and VAT in 32 pediatric patients with cancer whose positron emission tomography-computed tomography (PET-CT) scans at diagnosis showed no BAT activity. Changes in weight, SAT, and VAT from diagnosis to remission for children with metabolically active BAT at disease-free follow-up (BAT+) were compared with those in children without visualized BAT when free of disease (BAT-).

Results: Follow-up PET-CT studies (4.7 ± 2.4 mo later) after successful treatment of the cancer showed BAT+ in 19 patients but no active BAT (BAT-) in 13 patients. BAT+ patients, in comparison with BAT- patients, gained significantly less weight (3.3 ± 6.6% compared with 11.0 ± 11.6%; P = 0.02) and had significantly less SAT (18.2 ± 26.5% compared with 67.4 ± 71.7%; P = 0.01) and VAT (22.6 ± 33.5% compared with 131.6 ± 171.8%; P = 0.01) during treatment. Multiple regression analysis indicated that the inverse relations between BAT activation and measures of weight, SAT, and VAT persisted even after age, glucocorticoid treatment, and the season when the PET-CT scans were obtained were accounted for.

Conclusion: The activation of BAT in pediatric patients undergoing treatment of malignancy is associated with significantly less adipose accumulation. This trial was registered at clinicaltrials.gov as NCT01517581.

Figures

FIGURE 1.

Mean (±SEM) percentage changes in weight, SAT, and VAT in 32 pediatric cancer patients with respect to BAT depiction at disease-free follow-up (BAT+, n = 19; BAT−, n = 13) (A), 20 male pediatric cancer patients with respect to BAT depiction at disease-free follow-up (BAT+, n = 13; BAT−, n = 7) (B), and 12 female pediatric cancer patients with respect to BAT depiction at disease-free follow-up (BAT+, n = 6; BAT−, n = 6) (C). P values were obtained by using unpaired t tests. BAT, brown adipose tissue; BAT−, subjects without metabolically active brown adipose tissue at disease-free follow-up; BAT+, subjects with metabolically active brown adipose tissue at disease-free follow-up; SAT, subcutaneous adipose tissue; VAT, visceral adipose tissue.

FIGURE 2.

Percentage changes in VAT in 32 pediatric cancer patients with respect to BAT depiction at disease-free follow-up. BAT, brown adipose tissue; BAT−, subjects without metabolically active brown adipose tissue at disease-free follow-up; BAT+, subjects with metabolically active brown adipose tissue at disease-free follow-up; VAT, visceral adipose tissue.