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[Subcutaneous fat necrosis with hypercalcemia].

A case of subcutaneous fat necrosis (SFN) is presented. The infant developed late onset hypercalcaemia of severe degree. Calcitonin failed to normalize the hypercalcaemia. Glucocorticoids and withdrawal of dietary calcium and vitamin D are the treatment of choice. Like hypercalcaemia in association with other granulomatous diseases, SFN is possibly secondary to locally produced 1,25-dihydroxy-cholecalciferol. Our results were not able to confirm this theory. Infants with SFN should have calcium levels monitored closely for months.

Fat Necrosis↗

Major gene effect on subcutaneous fat distribution in a sedentary population and its response to exercise training: The HERITAGE Family Study.

Complex segregation analysis of baseline subcutaneous fat distribution and the change in response to exercise training (post-training minus baseline indices) was performed in a sample of 482 individuals from 99 Caucasian families who participated in the HERITAGE Family Study. The sum of skinfold (SF) thicknesses at eight sites, and the waist and hip circumferences were measured at baseline and after completing a 20-week exercise training program. The trunk-to-extremity ratio (TER) was calculated by dividing the sum of skinfold thicknesses at four trunk sites (subscapular + suprailiac + abdominal + midaxillary) by the sum of skinfold thicknesses at four extremity sites (triceps + biceps + medial calf + thigh). While SF was used to assess total subcutaneous adiposity, TER and the ratio of the waist-to-hip circumferences (WHR) were used to characterize subcutaneous fat distribution. Baseline TER and WHR were age-adjusted and age-SF-adjusted within four sex-by-generation groups. The changes of SF, TER, and WHR in response to training were adjusted for age effects alone and for the effects of age and baseline values. Baseline SF was influenced by a multifactorial component (30%) plus a major effect that may be environmental in origin accounting for 47% of the variance. Baseline TER was influenced by a multifactorial component (18%) and a major codominant gene (q(2) = 0.10), which accounted for 56% of the variance. The major gene effect was independent of total subcutaneous adiposity. Baseline WHR was regulated by a major codominant gene (q(2) = 0.15), which accounted for 48% of the variance. However, this major gene effect for baseline WHR should be interpreted with caution, given the estimates of the tau's under the general model. No familial effect was found for the changes in response to training for these subcutaneous adiposity and fat distribution phenotypes. Am. J. Hum. Biol. 12:600-609, 2000. Copyright 2000 Wiley-Liss, Inc.

Journal Article↗

The pattern of subcutaneous fat distribution in middle-aged men and the risk of coronary heart disease: the Paris Prospective Study.

The relationship of subcutaneous fat repartition in a population of 6718 men aged 42-53 employed by the city of Paris with the incidence of coronary heart disease has been studied in the Paris Prospective Study after a follow-up duration of 6.6 years. Fat distribution was described from the measurement of 13 skinfold thicknesses (five on the trunk, four at the triceps level, four at mid-thigh). Principal component analysis of the data disclosed two independent factors which explained most of the total variance of the log measurements: the first one (F1) might be interpreted as a general index of adiposity, the second one (F2) opposed the skinfolds on the trunk to those on the thigh. When men who developed coronary heart disease (CHD) were compared to those who remained free of it, both F1 and F2 differed significantly between the two groups. The combination of F1 and F2 which was the best predictor of CHD in this population (G1) might be interpreted as reflecting trunk adiposity mainly abdominal. Subsequent analysis showed that the combination of F1 and F2 which was statistically independent of G1 (G2) was nearly as correlated with body mass index (BMI) as was G1 (0.49 and 0.59 respectively) but G2 was not a significant predictor of angina pectoris nor myocardial infarction. Moreover mean G2 did not differ between treated diabetics and non-diabetics at entry in the study whereas mean G1 was significantly increased in the former group. Linear correlation coefficients of G2 with systolic blood pressure total cholesterol and triglycerides measured at entry were low (0.08, 0.08, and 0.15 respectively) in comparison with those obtained with G1 (0.26, 0.24 and 0.35 respectively). It is concluded that trunk fat deposit as defined by the G1 index represents the pattern of subcutaneous fat repartition the most tightly associated with CHD complications and their main risk factors in this population of middle-aged men and that it remains a significant CHD predictor after controlling for these factors.

Adipose Tissue↗

Gender differences in leptin levels during puberty are related to the subcutaneous fat depot and sex steroids.

Little is known about the influence of adiposity and hormone release on leptin levels in children and adolescents. We utilized criterion methods to examine the relationships among sex steroids, body composition (4 compartment), abdominal visceral and subcutaneous fat (magnetic resonance imagery), total subcutaneous fat (sum of 9 skinfolds), energy expenditure (doubly labeled water), aerobic fitness, and serum leptin levels in prepubertal and pubertal boys (n = 16; n = 13) and girls (n = 12; n = 15). The sum of skinfolds accounted for more variance in leptin levels of all girls [coefficient of determination (R2) = 0.70, P < 0.001] and all boys (R2 = 0.60, P < 0.001) than the total fat mass (girls, R2 = 0.52, P < 0.001; boys, R2 = 0.23, P < 0.001). Total energy expenditure, corrected for the influence of fat-free mass, correlated inversely with leptin (R2 = 0.18, P = 0.02). Gender differences in leptin disappeared when corrected for sex steroid levels or the combination of adiposity and energy expenditure. In multiple regression, the sum of skinfolds and free testosterone and estrogen levels accounted for 74% of the variance in leptin levels. We conclude that serum leptin levels are positively related to subcutaneous adiposity but negatively related to androgen levels. Energy expenditure may be negatively related to leptin levels by reduction of the adiposity, or a common genetic factor may influence both the activity and serum leptin levels.

Abdomen↗

Fascial planes within subcutaneous fat in humans.

We have used B-mode (brightness-mode) ultrasound to investigate the fascial planes within subcutaneous fat at the triceps and abdominal sites in a group of 17 women attending a weight control group over a 12 month period. In most subjects there was a single intralipid fascial plane at each site. As the thickness of adipose tissue increased, most of the change at the abdominal site was in the deep rather than the superficial layer of fat. At the triceps site both deep and superficial layers increased. Our findings confirm the presence of two different layers in human subcutaneous fat at the triceps and abdominal sites. These layers have been shown to be functionally different in animals and our study supports this in humans at the abdominal site.

Abdomen↗

Subcutaneous fat necrosis in an infant, occurring after hypothermic cardiac surgery. Case report and analysis of etiologic factors.

A female infant developed extensive subcutaneous fat necrosis 3 weeks following induced hypothermia used as an adjuvant in cardiac surgery. All lesions resolved without sequelae within 4 months. In this article we discuss the various causes of panniculitis in infants and the relevance of each cause to our patient. We believe that an underlying defect in composition and metabolism of fat, coupled with a variety of exogenous and endogenous stresses, can precipitate subcutaneous fat necrosis in infants. These stresses include physical trauma (e.g., hypothermia), poor nutrition, infection, and metabolic abnormalities.

Adipose Tissue↗

Exposure to dideoxynucleosides is reflected in lowered mitochondrial DNA in subcutaneous fat.

OBJECTIVES: Nucleoside reverse transcriptase inhibitors (NRTIs), particularly dideoxynucleoside analogs (ddNs), used in the treatment of HIV, inhibit mitochondrial DNA polymerase gamma in vitro. Mitochondrial DNA (mtDNA) depletion is proposed as the underlying mechanism of many of the in vivo side effects of these agents. A reliable and valid laboratory test to detect this is not yet available. The objective of this study was to correlate tissue mtDNA quantification in HIV-infected patients with exposure to nucleoside analogs. METHODS: 60 HIV-infected adults underwent detailed clinical assessment and blood and tissue sampling. Clinical and antiretroviral treatment details were correlated with results of plasma lactate assays, and real-time polymerase chain reaction quantification of mtDNA in peripheral blood mononuclear cells (PBMCs) and subcutaneous fat from the lower limb. RESULTS: Forty-nine (82%) subjects were on combination antiretroviral therapy. Of these, 33 (55%) were currently receiving one or more ddNs (stavudine, didanosine, or zalcitabine). mtDNA in subcutaneous fat was lower in subjects currently on ddNs than in those not taking ddNs (mean [log10] 2.47 vs. 2.74, p =.002). Plasma lactate was somewhat higher in subjects currently taking ddNs than those on no antiretroviral treatment (median 1.5 vs. 1.0, p =.03), but was not significantly different in either of these groups compared with subjects on other NRTIs. mtDNA in PBMCs did not vary with treatment status. CONCLUSIONS: mtDNA in subcutaneous fat was significantly reduced in patients currently taking ddNs. mtDNA in PBMCs was independent of patient exposure to NRTIs.

Adipose Tissue↗

Subcutaneous fat necrosis after paracentesis: Report of a case in a patient with acute pancreatitis.

A patient with acute pancreatitis developed subcutaneous fat necrosis of the anterior abdominal wall secondary to leakage of pancreatic enzymes through a rent in the peritoneum following paracentesis. The same patient also had another subcutaneous complication of pancreatitis, namely, nodular liquifying panniculitis of the lower extremities. The diagnosis was made by the typical histological findings of subcutaneous fat necrosis, foci of necrotic cells with a "ghost-like" appearance, and basophilic-staining calcium soaps deposited around the necrotic cells.

Abdominal Muscles↗

Subcutaneous fat necrosis of newborn: report of two cases.

Subcutaneous fat necrosis of newborn (SFNN) is an uncommon disorder. Submandibular lesion and tissue eosinophilia have not been documented. Two patients with unusual location and unusual pathological findings are reported. Both patients were giant babies, delivered by vaginal route spontaneously with birth injury. Asymptomatic subcutaneous nodules were found over the submandibular area at the ages of 16 and 6 days respectively. Nodules disappeared spontaneously at the age of one month in the first, and two months in the second patient. Histopathological examination of the nodules revealed features typical for SFNN: lobular panniculitis with fat necrosis and radiating needle-shaped clefts within multinucleated histiocytes. In addition to mononuclear cells, eosinophils were abundant in the infiltrate. Because of these unusual features, it is suggested that SFNN should be considered in the differential diagnosis of submandibular subcutaneous nodule in the newborn, clinically; and of lobular panniculitis with eosinophilia, histologically.

Diagnosis, Differential↗

Morphometric analysis of orbital, buccal and subcutaneous fats: their potential in the treatment of enophthalmos.

Retro-orbital fat volume reduction has been reported in patients with enophthalmos but could be restored by a suitable fat autograft. Buccal and subcutaneous adipose tissues were identified as possible donor sites. Samples of these and of orbital fat were obtained from fresh cadavers, and the relative volumes of collagen and of endothelial cells and the numerical density of mast cells were compared since these might influence graft survival. The results demonstrated strong similarities between orbital and buccal fat which were significantly different from subcutaneous fat. It was concluded that the buccal fat pad would be a more suitable donor site than subcutaneous adipose tissue to replace orbital fat loss and that its use merits further investigation.

Adipose Tissue↗

Familial aggregation of body mass index and subcutaneous fat measures in the longitudinal Québec family study.

Family resemblance for several measures of body fat and fat distribution was explored in the longitudinal Québec Family Study (QFS), including an overall measure of adiposity (body mass index, BMI), total subcutaneous fat (the sum of 6 skinfolds, SF6), and subcutaneous fat distribution (the trunk to extremity ratio, TER). Repeated measures were taken twice approximately 12 years apart. A longitudinal familial correlation model was used to assess familial resemblance at each of times 1, 2, and cross-time, and a univariate model was used for the change score. The change score was assumed to index the degree to which different familial factors impacted on the longitudinal resemblance, while the cross-time comparisons indexed similar familial factors across time. For BMI, the maximal heritability was 44 and 36% at times 1 and 2, respectively, 37% for the change score, and 33-43% for the cross-time comparison. While the etiology of the BMI familial effect at times 1, 2, and cross-time was assumed to be primarily polygenic, that for the change score was a function of cohort effects (environmental). For SF6, the maximal heritability (primarily genetic) was low at time 1 and for the change score (16%), but was nonsignificant at time 2 and cross-time. For TER, the maximal heritabilities were significant for each of times 1 (42%), 2 (40%), change score (59%), and cross-time comparisons (35-36%). In summary, simple univariate familial correlation analysis of the change scores and bivariate analysis of the longitudinal measures are useful in delineating the underlying factors leading to both change and stability across time.

Adipose Tissue↗

Subcutaneous fat necrosis associated with pancreatitis and gastric carcinoma.

Subcutaneous fat necrosis associated with acute pancreatitis in a 54-year-old man was reported. The acute pancreatitis was proved histologically after gastrectomy for coincident early gastric carcinoma. The patient was successfully treated with prednisolone and his skin lesions subsided within a month.

Acute Disease↗

Subcutaneous fat modulates insulin sensitivity in mice by regulating TNF-alpha expression in visceral fat.

The distribution of fat in obese persons is related to the risk of developing various metabolic disorders, such as glucose intolerance, dyslipidemia and hypertension, and the combination of these conditions is known as the metabolic syndrome. The aim of this study was to investigate the role of subcutaneous fat in regulating insulin resistance and its influence on TNF-alpha expression in visceral fat, by using mice that were subjected to subcutaneous lipectomy with or without subsequent fat transplantation. After partial subcutaneous lipectomy, mice showed significantly greater accumulation of visceral fat compared with sham-operated control mice. Lipectomy led to higher plasma insulin and lower plasma glucose levels after loading with glucose and insulin, respectively, compared with the levels in control mice. Insulin-induced phosphorylation of IRS-1 was decreased in the skeletal muscles of lipectomized mice. Subcutaneous transplantation of fat pads into lipectomized mice reversed the above-mentioned changes indicating insulin resistance in these animals. The fat storage area of adipocytes and TNF- alpha expression by adipocytes in visceral fat were significantly higher in the lipectomized mice than in controls, while subcutaneous transplantation of fat reduced both the fat storage area and TNF-alpha expression. The insulin resistance of lipectomized mice was also ameliorated by systemic neutralization of TNF-alpha activity using a specific antibody. These findings obtained in mice subjected to subcutaneous lipectomy with/without subsequent fat transplantation indicate that subcutaneous fat regulates systemic insulin sensitivity, possibly through altering fat storage and the expression of TNF-alpha by adipocytes in visceral fat. The balance between accumulation of subcutaneous fat and visceral fat may be important with respect to the occurrence of systemic insulin resistance in the metabolic syndrome.

Animals↗

Subcutaneous fat necrosis of the newborn associated with anemia.

Subcutaneous fat necrosis (SFN) of the newborn characteristically affects full-term infants who have experienced perinatal distress, such as hypothermia, obstetric trauma, or asphyxia. We report a newborn who had pallor, deep breathing, and severe anemia immediately after birth. She developed SFN on the fourth postnatal day. Her condition improved after blood transfusions and the skin lesions resolved in 6 weeks. This appears to be the first report of SFN associated with anemia.

Anemia, Neonatal↗

Sclerema neonatorum and subcutaneous fat necrosis of the newborn.

Sclerema neonatorum and subcutaneous fat necrosis are rare disorders affecting the panniculus of the newborn. This review attempts to put into perspective their similarities and differences in light of historical, biochemical, pathologic, and etiologic considerations. Recent therapeutic modalities and the prognosis are discussed.

Diagnosis, Differential↗

Subcutaneous fat necrosis of the newborn.

A case of subcutaneous fat necrosis of the newborn is described. Severe perinatal asphyxia preceded the appearance of the skin lesions. Premature rupture of membranes and the presence of foul-smelling meconium raised the possibility of infection by anaerobes as an additional etiologic factor. The main hypotheses concerning the cause and pathogenesis of this condition are reviewed. The alarming clinical picture that stands in sharp contrast to the benign prognosis is stressed.

Adipose Tissue↗

[Value of aspiration biopsy of subcutaneous fat in amyloidosis].

Fine-needle aspiration of subcutaneous fat (FNAF) was performed in 24 patients, 12 with previously diagnosed amyloidosis presenting with proteinuria or nephrotic syndrome, and 12 presenting a nephrotic syndrome without amyloidosis on renal biopsy. FNAF was positive in 10 of 12 patients with amyloidosis (sensitivity: 83%) and negative in 12 of 12 patients with non-amyloid nephrotic syndrome (specificity: 100%). Considering a 2.5 to 10% prevalence of amyloidosis in adult patients with proteinuria or nephrotic syndrome, a positive FNAF is diagnostic of amyloidosis, and a negative FNAF rules out the diagnosis with a probability of 98 to 99%. FNAF is a simple and safe method which can be useful in patients who cannot undergo a renal biopsy.

Adipose Tissue↗

Similar PAI-1 expression in visceral and subcutaneous fat of postmenopausal women.

Recent studies showed that intraabdominal visceral fat located in the mesenterium and omentum may significantly influence the circulating plasminogen activator inhibitor type 1 (PAI-1). To substantiate this link, we performed analysis of PAI-1 expression in human visceral and subcutaneous adipose tissues in peri- and postmenopausal women. The samples of both visceral and subcutaneous fat from 28 generally healthy women (aged 45-69 years) with a wide range of body mass index (BMI; 22.30-38.67 kg/m2), who underwent surgical operation due to benign ovary and uterine tumours, were obtained. In these samples, expression of mRNAs for PAI-1, tumour necrosis factor alpha (TNFalpha), acyl-CoA synthetase (ACS), and glucose transporter (GLUT-4) was analysed by relative quantitative RT PCR and correlated with plasma PAI-1 antigen. In addition, visceral fat area was measured with computer tomography. Both types of fat tissues contained similar quantities of PAI-1 mRNA, and there was no correlation between plasma PAI-1, measured both by antigen and activity, with either visceral or subcutaneous fat PAI-1 mRNA. Furthermore, there was no significant association between the expression of PAI-1 mRNA and TNFalpha mRNA in tested fat samples. PAI-1 mRNA in both fat tissues was significantly correlated with plasma levels of estradiol (positive correlation) and follicle-stimulating hormone (FSH; negative correlation). Finally, the expression of PAI-1 mRNA was negatively correlated with mRNA of ACS present in both fat tissues. In summary, this study directly indicates that PAI-1 mRNA is similarly expressed in both subcutaneous and visceral fat of peri- and postmenopausal women and its expression strongly depends upon lipid metabolism.

Adipose Tissue↗