Elsevier

The Journal of Pediatrics

Volume 159, Issue 6, December 2011, Pages 939-944
The Journal of Pediatrics

Original Article
Pediatric Brown Adipose Tissue: Detection, Epidemiology, and Differences from Adults

https://doi.org/10.1016/j.jpeds.2011.06.028Get rights and content

Objectives

To evaluate the prevalence and factors affecting the detection of active brown adipose tissue (BAT) in children and adolescents using 18F-fluorodeoxyglucose positron emission tomography.

Study design

A total of 385 positron emission tomography scans performed for various oncologic indications in 172 patients aged 5-21 years were reviewed. BAT activity was detected by visual inspection as present or absent in the neck, thorax, and abdomen based on its well-characterized and typical appearance and then quantified by comparing the 18F-fluorodeoxyglucose activity in the cervical-supraclavicular depots with that measured in the liver. Clinical indices were recorded.

Results

The BAT detection rate was not significantly different between boys and girls (43.3% vs 45.3%). BAT activity was found most often in the cervical-supraclavicular depots. The highest percentage of patients with detectable BAT and the highest BAT/liver activity were in the 13- to 14.99-year age group in both males and females (P = .005). Body mass index percentile correlated inversely with BAT activity (P = .012). BAT activity did not correlate with outdoor temperature or clinical diagnosis.

Conclusion

Under typical clinical imaging conditions, BAT is detected more frequently in children than in adults. BAT activity increases from childhood into adolescence, when it is detected in almost half of patients, and it correlates inversely with obesity, suggesting that BAT may play a prominent role in pediatric metabolism.

Section snippets

Methods

This study was conducted in accordance with institutional guidelines and was approved by the Ethics Committee of Children’s Hospital Boston. All PET scans performed in patients aged 0.7-20.99 years between November 2004 and November 2007 at Children’s Hospital Boston were reviewed, a total of 428 scans in 196 patients. Forty-three scans were performed in 24 patients who were sedated, and these were excluded from the analysis because of the possibility of reduced BAT activity due to the effects

Results

A total of 385 scans performed in 172 patients (75 females and 97 males) were analyzed. Anatomically, pediatric BAT was found consistently in the cervical and supraclavicular depots and much less frequently in the paraspinal and abdominal depots, similar to the distribution in adults.5, 19, 20 We first determined the presence or absence of BAT uptake in each individual patient. In patients who had undergone multiple scans, the study with the highest activity was used for analysis, to determine

Discussion

It had long been assumed that adult humans have no functional BAT.21, 22 That belief was recently overturned by studies from 5 independent groups reporting functional BAT in adult humans.4, 5, 6, 7, 8 In adults, BAT activation measured by PET has a female predominance, and its activity correlates inversely with age,5 BMI,9 and outdoor temperature.5, 8 In children, it had been assumed that BAT is functional only in neonates, and that its activity declines shortly thereafter.3, 23 Our study

References (27)

  • M.K. Crocker et al.

    Pediatric obesity: etiology and treatment

    Endocrinol Metab Clin North Am

    (2009)
  • B. Cannon et al.

    Brown adipose tissue: function and physiological significance

    Physiol Rev

    (2004)
  • J.M. Heaton

    The distribution of brown adipose tissue in the human

    J Anat

    (1972)
  • J.L. Emery et al.

    Structure of periadrenal brown fat in childhood in both expected and cot deaths

    Arch Dis Child

    (1978)
  • W.D. van Marken Lichtenbelt et al.

    Cold-activated brown adipose tissue in healthy men

    N Engl J Med

    (2009)
  • A.M. Cypess et al.

    Identification and importance of brown adipose tissue in adult humans

    N Engl J Med

    (2009)
  • K.A. Virtanen et al.

    Functional brown adipose tissue in healthy adults

    N Engl J Med

    (2009)
  • M.C. Zingaretti et al.

    The presence of UCP1 demonstrates that metabolically active adipose tissue in the neck of adult humans truly represents brown adipose tissue

    FASEB J

    (2009)
  • M. Saito et al.

    High incidence of metabolically active brown adipose tissue in healthy adult humans: effects of cold exposure and adiposity

    Diabetes

    (2009)
  • C. Pfannenberg et al.

    Impact of age on the relationships of brown adipose tissue with sex and adiposity in humans

    Diabetes

    (2010)
  • C.L. Ogden et al.

    High body mass index for age among US children and adolescents, 2003-2006

    JAMA

    (2008)
  • K.A. Zukotynski et al.

    Constant ambient temperature of 24°C significantly reduces FDG uptake by brown adipose tissue in children scanned during the winter

    Eur J Nucl Med Mol Imaging

    (2009)
  • M.J. Gelfand et al.

    Pre-medication to block [(18)F]FDG uptake in the brown adipose tissue of pediatric and adolescent patients

    Pediatr Radiol

    (2005)
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      Unlike other proteins in the uncoupling protein family, UCP1 is specific to BAT (Klaus et al., 1991). Initially BAT was thought to be negligible in the context of adult human metabolism, with significance only in infants (Drubach et al., 2011; Gilsanz et al., 2011). This view has since changed with evidence that BAT can be generated in adults and exert metabolic activity under the appropriate conditions (Lee et al., 2011; Wang et al., 2015).

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    Supported by the Eli Lilly Foundation, the National Institutes of Health (grants DK046200, DK081604, DK087317, and RR025757, to A.C.), and the National Institute of Diabetes and Digestive and Kidney Diseases (grant P30 DK036836). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the National Institute of Diabetes and Digestive and Kidney Diseases. The authors declare no conflicts of interest.

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