Epicardial fat thickness: threshold values and lifestyle association in male adolescents H. Cena 1 , M. L. Fonte 1 , P. M. Casali 2 , S. Maffoni 1 , C. Roggi 1 and G. Biino 3 1 Department of Public Health, Experimental and Forensic Medicine – Unit of Human Nutrition, University of Pavia, Pavia, Italy; 2 Medical Sport Centre ‘Medica Sport Minerva’, Pavia, Italy; 3 Institute of Molecular Genetics, National Research Council of Italy, Pavia, Italy Received 15 November 2013; revised 28 January 2014; accepted 24 February 2014 Summary Background: Obese adolescents with high proportion of visceral fat are at higher risk of developing the metabolic syndrome. Objectives: The study aims to investigate if echocardiographic epicardial fat thickness (EF) could be predictive of visceral obesity (VO) early in life and to provide EF threshold values specific for male adolescents. Further aim was to investigate the association between EF, lifestyle and metabolic disease familiarity. Methods: Anthropometric data were collected from 102 normal weight and overweight, healthy male adolescents (mean age: 14.91 ± 1.98 years); bioelectrical impedance analysis and transthoracic echocar- diogram were performed in the same sample. Each participant fulfilled a validated self-administered lifestyle questionnaire. Results: We found higher EF values in sedentary adolescents (P < 0.05), in those who never eat fruit and vegetables (P < 0.05), and in those with overweight mothers (P < 0.05). The strongest independent predictor of EF was waist circumference (P < 0.0001). Using the waist to height ratio as a marker of VO, logistic regression analysis revealed that 1 mm EF gain is responsible for seven times higher VO risk (P < 0.0001). Receiver Operating Characteristic (ROC) analysis showed that the optimal cut-off for EF thickness associated to youth VO is 3.2 mm. Conclusion: Ultrasonography EF measurement might be a second-level assessment tool, useful to detect early cardiometabolic damage stage. Keywords: Adolescent obesity, epicardial fat, lifestyle, visceral fat. Introduction It is well known that obese adolescents with a high proportion of visceral fat and relatively low abdominal subcutaneous tissue suffer from severe metabolic complications and are at higher risk of developing the metabolic syndrome (1). Because in childhood obesity thickening of the adipose organ occurs both in the visceral and in the subcutaneous districts, an important clinical issue is to differentiate the abdominal fat from the subcuta- neous one. Abdominal visceral fat is typically measured by waist circumference (WC), which has been strongly proved to be a predictor of multiple risk factors (2). More recently, computed tomography, magnetic resonance imaging (MRI) and ultrasounds (US) have been used to measure abdominal fat (3–5). In addition, epicardial fat (EF) thickness measured by US has been demon- strated to strongly correlate with the visceral abdomi- nal fat, thus becoming a potential non-invasive and repeatable marker of cardiovascular risk and adverse metabolic profile development in adulthood (6–9). EF is the actual visceral fat depot of the heart and, under physiologic conditions, it serves several distinct functions such as protecting the heart against high fatty acids levels and being a local energy source at times of high demand (10) but, at the same time, it also may release factors that promote harmful myocardial changes (11). Because untreated childhood obesity usually per- sists during adulthood with a higher risk of comorbidity later in life (12), it seems important to establish if, starting from childhood, there is an effec- tive connection between EF and the potential risk of cardiometabolic diseases. Address for correspondence: Dr H. Cena, Department of Public Health, Experimental and Forensic Medicine – Unit of Human Nutrition, University of Pavia, Via Bassi, 21–27100 Pavia, PV, Italy. E-mail: hcena@unipv.it © 2014 The Authors Pediatric Obesity © 2014 World Obesity. Pediatric Obesity ••, ••–•• PEDIATRICOBESITY ORIGINALRESEARCH doi:10.1111/ijpo.227 ORIGINALRESEARCH