{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T05:12:09Z","timestamp":1788844329163,"version":"build-2803163510"},"reference-count":50,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T00:00:00Z","timestamp":1768348800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Visceral adiposity has emerged as a clinically relevant determinant of early cardiometabolic dysfunction in pediatric type 1 diabetes mellitus (T1DM), yet its assessment remains underutilized in routine practice. This study evaluated ultrasonographically measured epicardial adipose tissue thickness (EATT) and perirenal adipose tissue thickness (PrATT) as markers of metabolic risk, insulin sensitivity, and subclinical atherosclerosis in children and adolescents with T1DM. Methods: This cross-sectional study included 150 participants with T1DM and 152 age- and sex-matched healthy controls. Anthropometric data, biochemical parameters, hepatic steatosis grade, and insulin sensitivity indices (eGDR) were collected. EATT and PrATT were measured via standardized echocardiographic and abdominal ultrasonographic protocols. Carotid intima\u2013media thickness (cIMT) was assessed as an indicator of subclinical atherosclerosis. Correlation and multivariable logistic regression analyses were performed to identify independent predictors of T1DM status and cardiometabolic risk. Results: Children with T1DM exhibited significantly higher PrATT and EATT values compared with controls (both p &lt; 0.05). All eGDR indices were markedly lower in the T1DM group, reflecting reduced insulin sensitivity. PrATT and EATT showed strong or moderate correlations with hsCRP, hepatic steatosis, atherogenic index of plasma, and multiple anthropometric markers. Both visceral fat depots were positively associated with cIMT. Logistic regression identified PrATT, EATT, hsCRP, cIMT, and eGDR-BMI as independent predictors of case status. Subgroup analyses demonstrated more pronounced visceral adiposity and metabolic impairment among participants with BMI \u226585th percentile. Conclusions: Ultrasonographically measured PrATT and EATT provide valuable insight into early cardiometabolic risk in youth with T1DM, independent of BMI. Their associations with insulin resistance, inflammation, and subclinical atherosclerosis highlight their potential utility as accessible markers for early risk stratification in pediatric diabetes. Routine incorporation of visceral fat assessment may support earlier identification of high-risk individuals and more targeted preventive strategies.<\/jats:p>","DOI":"10.3390\/children13010124","type":"journal-article","created":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T09:03:10Z","timestamp":1768381390000},"page":"124","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Beyond BMI: Ultrasound-Detected Visceral Adiposity as a Predictor of Early Cardiometabolic Dysfunction in Youth with Type 1 Diabetes"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0053-6222","authenticated-orcid":false,"given":"Sukriye","family":"Ozde","sequence":"first","affiliation":[{"name":"Department of General Pediatric, Faculty of Medicine, Duzce University, Duzce 81620, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8389-5174","authenticated-orcid":false,"given":"Gulsah","family":"Akture","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, Duzce University, Duzce 81620, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8817-5769","authenticated-orcid":false,"given":"Mehmet Ali","family":"Ozel","sequence":"additional","affiliation":[{"name":"Department of Radiology, Faculty of Medicine, Duzce University, Duzce 81620, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1515-8591","authenticated-orcid":false,"given":"Fatma","family":"Yavuzyilmaz","sequence":"additional","affiliation":[{"name":"Department of Radiology, Faculty of Medicine, Duzce University, Duzce 81620, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8846-9185","authenticated-orcid":false,"given":"Cem","family":"Ozde","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, Duzce University, Duzce 81620, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6607-895X","authenticated-orcid":false,"given":"Osman","family":"Kayapinar","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, Duzce University, Duzce 81620, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4975-9718","authenticated-orcid":false,"given":"Ilknur","family":"Arslanoglu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Endocrinology, Faculty of Medicine, Duzce University, Duzce 81620, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1038\/nrendo.2015.58","article-title":"Local and systemic effects of epicardial adipose tissue","volume":"11","author":"Iacobellis","year":"2015","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Grigora\u0219, A., B\u0103lan, R.A., C\u0103runtu, I.D., Giu\u0219c\u0103, S.E., Lozneanu, L., Avadanei, R.E., Rusu, A., Riscanu, L.A., and Amalinei, C. (2021). Perirenal adipose tissue\u2014Current knowledge and future opportunities. J. Clin. Med., 10.","DOI":"10.3390\/jcm10061291"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1016\/j.ahj.2007.03.019","article-title":"Human epicardial adipose tissue: A review","volume":"153","author":"Sacks","year":"2007","journal-title":"Am. Heart J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1016\/j.echo.2009.10.013","article-title":"Echocardiographic epicardial fat: A review of research and clinical applications","volume":"22","author":"Iacobellis","year":"2009","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1111\/j.1467-789X.2006.00293.x","article-title":"Epicardial fat: Properties, function and relationship to obesity","volume":"8","author":"Rabkin","year":"2007","journal-title":"Obes. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1016\/S0140-6736(18)31506-X","article-title":"Excess mortality and cardiovascular disease in type 1 diabetes by age at onset","volume":"392","author":"Rawshani","year":"2018","journal-title":"Lancet"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1001\/jama.2014.16425","article-title":"Estimated life expectancy in a Scottish cohort with type 1 diabetes","volume":"313","author":"Livingstone","year":"2015","journal-title":"JAMA"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1161\/CIRCULATIONAHA.106.628875","article-title":"Prediction of cardiovascular events with carotid IMT","volume":"115","author":"Lorenz","year":"2007","journal-title":"Circulation"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1016\/j.jpeds.2004.06.042","article-title":"Early subclinical atherosclerosis in youth with T1DM","volume":"145","author":"Krantz","year":"2004","journal-title":"J. Pediatr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.2337\/diacare.25.8.1432","article-title":"Elevated C-Reactive Protein Associates With Early-Stage Carotid Atherosclerosis in Young Subjects With Type 1 Diabetes","volume":"25","author":"Yamasaki","year":"2002","journal-title":"Diabetes Care"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1007\/s00125-010-1911-9","article-title":"Development, validation and use of an insulin sensitivity score in youths with diabetes: The SEARCH for Diabetes in Youth study","volume":"54","author":"Dabelea","year":"2011","journal-title":"Diabetologia"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1210\/jc.2015-3272","article-title":"Development and validation of a method to estimate insulin sensitivity in patients with and without type 1 diabetes","volume":"101","author":"Duca","year":"2016","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"280","DOI":"10.4274\/jcrpe.2183","article-title":"Reference values for weight, height, head circumference, and body mass index in Turkish children","volume":"7","author":"Neyzi","year":"2015","journal-title":"J. Clin. Res. Pediatr. Endocrinol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e2022060640","DOI":"10.1542\/peds.2022-060640","article-title":"Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity","volume":"151","author":"Hampl","year":"2023","journal-title":"Pediatrics"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1093\/ndt\/gfq522","article-title":"Para- and perirenal fat thickness is an independent predictor of chronic kidney disease, increased renal resistance index and hyperuricaemia in type 2 diabetic patients","volume":"26","author":"Lamacchia","year":"2011","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1851","DOI":"10.1001\/archinte.1997.00440370091009","article-title":"Cumulative glycemic exposure and microvascular complications in insulin dependent diabetes mellitus: The glycemic threshold revisited","volume":"157","author":"Orchard","year":"1997","journal-title":"Arch. Intern. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2043","DOI":"10.2337\/dc10-0505","article-title":"Early signs of atherosclerosis in diabetic children on intensive insulin treatment: A population-based study","volume":"33","author":"Margeirsdottir","year":"2010","journal-title":"Diabetes Care"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.echo.2007.11.011","article-title":"Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: A consensus statement from the American Society of Echocardiography","volume":"21","author":"Stein","year":"2008","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1186\/s43044-025-00666-8","article-title":"Epicardial adipose tissue in type 1 diabetes mellitus: A systematic review and meta-analysis","volume":"77","author":"Sooragonda","year":"2025","journal-title":"Egypt. Heart J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1111\/pedi.12893","article-title":"Epicardial adipose thickness in youth with type 1 diabetes","volume":"20","author":"Chambers","year":"2019","journal-title":"Pediatr. Diabetes"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1515\/jpem-2020-0001","article-title":"Investigation of the effect of epicardial adipose tissue thickness on cardiac conduction system in children with type 1 diabetes mellitus","volume":"33","author":"Oflaz","year":"2020","journal-title":"J. Pediatr. Endocrinol. Metab."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"278","DOI":"10.5114\/polp.2023.133530","article-title":"Role of epicardial fat thickness and irisin levels in early prediction of cardiac dysfunction in children and adolescents with type 1 diabetes mellitus","volume":"98","author":"Ismail","year":"2023","journal-title":"Pediatr. Pol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Colom, C., Rull, A., Sanchez-Quesada, J.L., and P\u00e9rez, A. (2021). Cardiovascular disease in type 1 diabetes mellitus: Epidemiology and management of cardiovascular risk. J. Clin. Med., 10.","DOI":"10.3390\/jcm10081798"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"03000605231164548","DOI":"10.1177\/03000605231164548","article-title":"Insulin resistance and cardiovascular disease","volume":"51","author":"Kosmas","year":"2023","journal-title":"J. Int. Med. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1161\/CIR.0000000000000034","article-title":"Type 1 diabetes mellitus and cardiovascular disease","volume":"130","author":"Fonseca","year":"2014","journal-title":"Circulation"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2360","DOI":"10.1016\/j.jacc.2018.03.509","article-title":"Epicardial adipose tissue may mediate deleterious effects of obesity and inflammation on the myocardium","volume":"71","author":"Packer","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1016\/j.tem.2011.07.003","article-title":"Epicardial adipose tissue: Emerging physiological, pathophysiological and clinical features","volume":"22","author":"Iacobellis","year":"2011","journal-title":"Trends Endocrinol. Metab."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/j.2040-4603.2019.tb00055.x","article-title":"Contribution of adipose tissue inflammation to development of type 2 diabetes mellitus","volume":"9","author":"Burhans","year":"2018","journal-title":"Compr. Physiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"100130","DOI":"10.1016\/j.ajpc.2020.100130","article-title":"Inflammation and cardiovascular disease: From mechanisms to therapeutics","volume":"4","author":"Alfaddagh","year":"2020","journal-title":"Am. J. Prev. Cardiol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Feij\u00f3o-Band\u00edn, S., Arag\u00f3n-Herrera, A., Mora\u00f1a-Fern\u00e1ndez, S., Anido-Varela, L., Taraz\u00f3n, E., Rosell\u00f3-Llet\u00ed, E., Portol\u00e9s, M., Moscoso, I., Gualillo, O., and Gonz\u00e1lez-Juanatey, J.R. (2020). Adipokines and inflammation. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21207711"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Guo, X.L., Wang, J.W., Tu, M., and Wang, W. (2023). Perirenal fat and subclinical carotid atherosclerosis in T2DM. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1276789"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Wang, W., Lv, F.Y., Tu, M., and Guo, X.L. (2024). Perirenal fat and cardiovascular risk. Front. Endocrinol., 15.","DOI":"10.3389\/fendo.2024.1434333"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e3479","DOI":"10.1002\/dmrr.3479","article-title":"Insulin sensitivity and hepatic steatosis 12 years after T1D onset","volume":"38","author":"Petrelli","year":"2022","journal-title":"Diabetes Metab. Res. Rev."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1038\/nature05485","article-title":"Inflammation and metabolic disorders","volume":"444","author":"Hotamisligil","year":"2006","journal-title":"Nature"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1152\/physrev.00033.2011","article-title":"Pathophysiology of visceral obesity","volume":"93","author":"Tchernof","year":"2013","journal-title":"Physiol. Rev."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1038\/nrcardio.2009.55","article-title":"Obesity, inflammation, and atherosclerosis","volume":"6","author":"Rocha","year":"2009","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1038\/ni.2001","article-title":"The immune system in atherosclerosis","volume":"12","author":"Hansson","year":"2011","journal-title":"Nat. Immunol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1111\/pedi.13322","article-title":"Aortic intima media thickness in children and adolescents with type 1 diabetes: A systematic review","volume":"23","author":"Gow","year":"2022","journal-title":"Pediatr. Diabetes"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1515\/jpem-2012-0070","article-title":"Adiponectin and arterial stiffness in youth with type 1 diabetes: The SEARCH for diabetes in youth study","volume":"25","author":"Shah","year":"2012","journal-title":"J. Pediatr. Endocrinol. Metab."},{"key":"ref_40","first-page":"1792","article-title":"Visceral adiposity and insulin resistance in youth with T1DM","volume":"31","author":"Bjornstad","year":"2017","journal-title":"J. Diabetes Complicat."},{"key":"ref_41","first-page":"1211","article-title":"Insulin resistance in type 1 diabetes: Double diabetes","volume":"65","author":"Cleland","year":"2022","journal-title":"Diabetologia"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"3336","DOI":"10.2337\/dc14-0574","article-title":"The SEARCH for Diabetes in Youth study: Rationale, findings, and future directions","volume":"37","author":"Hamman","year":"2014","journal-title":"Diabetes Care"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1034\/j.1399-5448.2003.00012.x","article-title":"Coexistence of type 1 and type 2 diabetes","volume":"4","author":"Libman","year":"2003","journal-title":"Pediatr. Diabetes"},{"key":"ref_44","first-page":"883","article-title":"Increasing incidence of double diabetes","volume":"42","author":"Oram","year":"2019","journal-title":"Diabetes Care"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.1136\/gutjnl-2020-320622","article-title":"NAFLD and cardiovascular disease","volume":"69","author":"Targher","year":"2020","journal-title":"Gut"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Zheng, Y., Abadi, M.R.H., Gough, J., Johnston, J.J.D., Nour, M., and Kontulainen, S. (2022). Higher body fat in youth with T1DM: Meta-analysis. Front. Pediatr., 10.","DOI":"10.3389\/fped.2022.911061"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Zhuo, L., Lai, M., Wan, L., Zhang, X., and Chen, R. (2024). Cardiometabolic index and risk of chronic disease. Front. Endocrinol., 15.","DOI":"10.3389\/fendo.2024.1446276"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1186\/s12944-024-02415-3","article-title":"Cardiometabolic index and mortality risks: Elevated cancer and reduced cardiovascular mortality risk in a large cohort","volume":"23","author":"Wang","year":"2024","journal-title":"Lipids Health Dis."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.3390\/medicina61061064","article-title":"Association Between Cardiometabolic Index and Mortality Among Patients with Atherosclerotic Cardiovascular Disease: Evidence from NHANES 1999-2018","volume":"61","author":"Yang","year":"2025","journal-title":"Medicina"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1004855","DOI":"10.3389\/fendo.2022.1004855","article-title":"Cardiometabolic index: A new predictor for metabolic associated fatty liver disease in Chinese adults","volume":"13","author":"Duan","year":"2022","journal-title":"Front. Endocrinol"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/1\/124\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T09:39:08Z","timestamp":1768383548000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/1\/124"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,14]]},"references-count":50,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["children13010124"],"URL":"https:\/\/doi.org\/10.3390\/children13010124","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,14]]}}}