Prediction of Visceral Adipose Tissue from Simple Anthropometric Measurements in Youths with Obesity

OWENS, SCOTT, MARK LITAKER, JERRY ALLISON, SHARON RIGGS, MICHAEL FERGUSON, AND BERNARD GUTIN. Prediction of visceral adipose tissue from simple anthropometric measurements in youths with obesity. Obes Res. 1999;7:16–22. Objective : Although visceral adipose tissue (VAT) is the component of body composition most highly associated with cardiovascular risk factors, its measurement requires expensive procedures, such as magnetic resonance imaging. This study examined the ability of simple demographic and anthropometric measurements to predict magnetic resonance imaging-derived VAT in 76 apparently healthy, black and white youths with obesity who were 7 years to 16 years of age. Research Methods and Procedures : Stepwise multiple linear regression was used to develop a prediction equation for VAT based on 13 simple anthropometric variables (height, weight, body mass index, triceps skinfold, calf skinfold, sagittal diameter, waist circumference, hip circumference, thigh circumference, waist/hip ratio, waist/thigh ratio, sagittal diameter/thigh ratio, and percent body fat from the sum of calf and triceps skinfolds) and three demographic variables (age, gender and ethnicity). Results : The stepwise multiple regression procedure yielded a final model that included two anthropometric variables (sagittal diameter and waist/hip ratio) and one demographic variable (ethnicity). The prediction equation was: VAT = ?124.06+16.67 (ethnicity)+4.15 (sagittal diameter)-+17.89 (waist/hip ratio), where ethnicity was coded as 0 = black and 1 = white. The model explained 63% of the variance in VAT and was associated with a measurement error of 23.9%. Discussion : Although the model seems to lack sufficient explanatory power for routine use in clinical settings with individual patients, it may have some utility in epidemiological studies given its relatively small (<25%) standard error of estimate.     

Prediction of Visceral Adipose Tissue Using Air Displacement Plethysmography in Children

Objective: To determine the ability of air displacement plethysmography (ADP) to predict visceral adipose tissue (VAT) volume in children. Research Methods and Procedures: Fifty‐five (33 boys/22 girls) white children 13 to 14 years old were studied. Anthropometric measures were collected for body mass, stature, BMI, and waist‐to‐hip ratio (WHR), and body fat percentage was estimated from triceps and subscapular skinfolds, bioelectrical impedance analysis, and ADP. VAT volume was determined using magnetic resonance imaging, using a multiple slice protocol at levels L1 to L5. Results: Boys had significantly (p ≤ 0.05) less VAT volume than girls [645.1 (360.5) cm³ vs. 1035.8 (717.3) cm³]. ADP explained the greatest proportion of the variance in VAT volume compared with the other anthropometric measures. Multiple regression analysis indicated that VAT volume was best predicted by ADP body fat percentage in boys [r² = 0.81, SE of the estimate (SEE) = 160.1, SEE coefficient of variation = 25%] and by WHR and BMI in girls (r² = 0.80, SEE = 337.71, SEE coefficient of variation = 33%). Discussion: Compared with the other anthropometric measures, ADP explains the greatest proportion of the variance in VAT volume in children 13 to 14 years old. For boys, ADP is the tool of choice to predict VAT volume, yet using the more simply collected measures of BMI and WHR is recommended for girls. However, large SE of the estimates remained, suggesting that if precision is needed, there is no surrogate for direct imaging of VAT.     

心外膜脂肪组织与心血管疾病的研究进展

心外膜脂肪组织(epicardial adipose tissue,EAT)是一种特殊的具有局部和全身效应的多功能脂肪组织,其解剖位置特殊,代谢和组织学特征明显区别于其他脂肪组织.在生理条件下,EAT具有产热和保护心脏的作用;而在病理状态下,EAT通过分泌多种促炎细胞因子/脂肪因子,参与心血管疾病(cardiovascular disease,CVD)的发生发展.EAT的厚度/体积及其引发的慢性炎症反应与CVD的严重程度呈显著正相关,运动、减轻体重和药物等均可恢复EAT对心血管的保护作用,提示其有望成为CVD诊断、治疗和预后评价的指标.本文通过对EAT的特征、功能、调节机制以及在血管损伤后重构、动脉粥样硬化、高血压病、心律失常、心功能不全等CVD中的作用做一综述,以期为CVD的防治提供新靶点.     

Visceral Adipose Tissue in Women: Longitudinal Study of the Effects of Fat Gain,Time, and Race

Objective: To determine the effects of fat gain, time, and race on the accumulation of visceral adipose tissue (VAT) in a group of normal‐weight premenopausal women. Research Methods and Procedures: Sixty‐five women participated in the study (32 African American and 33 white). The mean age of subjects was 34 ± 6 years (range, 22 to 47 years). Eligible subjects were women who had body mass indices <25 kg/m² at baseline and who had completed evaluations at baseline and at follow‐up year 1, without intervention. A subset of subjects was reevaluated annually for up to 4 years. Body composition was assessed by DXA, and VAT was determined from a single computed tomography scan. A linear mixed model was used to examine changes in VAT over time, with total body fat as a covariate Results: Total fat mass was not significantly different between races at baseline and increased significantly in both groups over time (p < 0.001). Time‐related increases in total body fat were greater in African‐American women (p < 0.01). VAT was significantly higher in white women at baseline (p < 0.01) and increased significantly over time in both races (p < 0.01), but remained higher in white women (p < 0.001). Increases in VAT, relative to total body fat, were greater than the increases in total body fat over time, independent of age and race (p < 0.001). Discussion: Gaining total body‐fat mass results in a higher increase in VAT, relative to total body fat, regardless of race and age, although African‐American women maintain a lower VAT levels across time.     

Epicardial Adipose Tissue in Patients with Chronic Obstructive Pulmonary Disease

Rationale

Epicardial Adipose Tissue (EAT) volume as determined by chest computed tomography (CT) is an independent marker of cardiovascular events in the general population. COPD patients have an increased risk of cardiovascular disease, however nothing is known about the EAT volume in this population.

Objectives

To assess EAT volume in COPD and explore its association with clinical and physiological variables of disease severity.

Methods

We measured EAT using low-dose CT in 171 stable COPD patients and 70 controls matched by age, smoking history and BMI. We determined blood pressure, cholesterol, glucose and HbA1c levels, microalbuminuria, lung function, BODE index, co-morbidity index and coronary artery calcium score (CAC). EAT volume were compared between groups. Uni and multivariate analyses explored the relationship between EAT volume and the COPD related variables.

Results

COPD patients had a higher EAT volume [143.7 (P_25–75, 108.3–196.6) vs 129.1 (P_25–75, 91.3–170.8) cm³, p = 0.02)] and the EAT volume was significantly associated with CAC (r = 0.38, p<0.001) and CRP (r = 0.32, p<0.001) but not with microalbuminuria (r = 0.12, p = 0.13). In COPD patients, EAT volume was associated with: age, pack-years, BMI, gender, FEV₁%, 6 MWD, MMRC and HTN. Multivariate analysis showed that only pack-years (B = 0.6, 95% CI: 0.5–1.3), BMI (B = 7.8, 95% CI: 5.7–9.9) and 6 MWD (B = −0.2, 95% CI: −0.3–−0.1), predicted EAT volume.

Conclusions

EAT volume is increased in COPD patients and is independently associated with smoking history, BMI and exercise capacity, all modifiable risk factors of future cardiovascular events. EAT volume could be a non-invasive marker of COPD patients at high risk for future cardiovascular events.     

Larger Amounts of Visceral Adipose Tissue in Asian Americans

Objective: Excess visceral adipose tissue (VAT) is recognized as an important risk factor for the development of coronary heart disease and type 2 diabetes. Several studies have reported less VAT in African Americans compared with whites. As little is known about the levels of VAT in Asians, we compared whole‐body VAT in Asian Americans with European Americans. Research Methods and Procedures: VAT was measured using whole‐body multislice magnetic resonance imaging in 54 women (18 Asian Americans, 36 European Americans) and 53 men (19 Asian Americans, 34 European Americans) with body mass index (measured in kilograms per square meter) < 30. Data were analyzed by multiple regression modeling. Results: Asian American women had higher log‐transformed VAT compared with European American women (p < 0.05), after adjusting for age and total body fat. There was a significant age by race interaction such that race differences in VAT were most evident over the age of 30 years. No differences in VAT could be detected between Asian American and European American men, even after adjusting for potential covariates, including total adiposity. %Discussion: These data are the first to demonstrate higher amounts of VAT in healthy Asian Americans, a finding that suggests normative VAT values or standards derived from whites may not be applicable to Asians.     

Fat Storage-inducing Transmembrane Protein 2 Is Required for Normal Fat Storage in Adipose Tissue

Triglycerides within the cytosol of cells are stored in a phylogenetically conserved organelle called the lipid droplet (LD). LDs can be formed at the endoplasmic reticulum, but mechanisms that regulate the formation of LDs are incompletely understood. Adipose tissue has a high capacity to form lipid droplets and store triglycerides. Fat storage-inducing transmembrane protein 2 (FITM2/FIT2) is highly expressed in adipocytes, and data indicate that FIT2 has an important role in the formation of LDs in cells, but whether FIT2 has a physiological role in triglyceride storage in adipose tissue remains unproven. Here we show that adipose-specific deficiency of FIT2 (AF2KO) in mice results in progressive lipodystrophy of white adipose depots and metabolic dysfunction. In contrast, interscapular brown adipose tissue of AF2KO mice accumulated few but large LDs without changes in cellular triglyceride levels. High fat feeding of AF2KO mice or AF2KO mice on the genetically obese ob/ob background accelerated the onset of lipodystrophy. At the cellular level, primary adipocyte precursors of white and brown adipose tissue differentiated in vitro produced fewer but larger LDs without changes in total cellular triglyceride or triglyceride biosynthesis. These data support the conclusion that FIT2 plays an essential, physiological role in fat storage in vivo.     

Serum Glycated Albumin Is Inversely Influenced by Fat Mass and Visceral Adipose Tissue in Chinese with Normal Glucose Tolerance

Background

Recent studies have revealed that body mass index (BMI) inversely influenced serum glycated albumin (GA), which may cause an underestimation of GA-monitored short-term hyperglycemic control.

Objective

This study was to investigate the association between anthropometric variables (BMI and waist circumference (W)) and accurate adiposity variables (percentage of body fat (%fat), fat mass, free fat mass (FFM), subcutaneous fat area (SFA), and visceral fat area (VFA)) with serum GA.

Design

A total of 2563 subjects (1037 men, 593 premenopausal women, and 933 postmenopausal women) with normal glucose tolerance underwent bioelectrical impedance body fat content measurement and magnetic resonance imaging. Serum GA and absolute value of GA (aGA) were measured by enzymatic assay.

Results

Compared to the BMI <25.0 kg/m² group, the BMI ≥25.0 kg/m² group had significantly higher fasting plasma glucose, glycated hemoglobin A1c, and body fat parameters including W, %fat, fat mass, FFM, SFA, and VFA, but significantly lower aGA, and GA in all the three sex- and menopause-stratified groups (all P<0.05). GA decreased with the increment of fat mass for all three groups (all P for trend <0.001). In the same BMI category, men and postmenopausal women with elevated %fat (men, ≥25%; women, ≥35%) still had significantly lower GA than those with normal %fat (men, <25%; women, <35%) (all P<0.05). Multiple stepwise regression showed that %fat, fat mass, and VFA were independently associated with GA.

Conclusions

Serum GA was inversely influenced by fat mass and visceral adipose tissue in Chinese with normal glucose tolerance.     

Visceral and Subcutaneous Adipose Tissue Diacylglycerol Acyltransferase Activity in Humans

Diacylglycerol acyltransferase (DGAT) could be a rate limiting step in triglyceride (TG) synthesis as it is the final step in this pathway. As such, between depot differences in DGAT activity could influence regional fat storage. DGAT activity and in vitro rates of direct free fatty acid (FFA) storage were measured in abdominal subcutaneous and omental adipose tissue samples from 12 nonobese (BMI <30 kg/m²) and 23 obese men and women (BMI >30 kg/m²) undergoing elective surgery. DGAT activity was greater in omental than in abdominal subcutaneous adipose tissue from nonobese patients (2.0 ± 0.9 vs. 0.9 ± 0.3 pmol/min/mg lipid, respectively, P = 0.003), but not from obese patients (1.4 ± 0.6 vs. 1.7 ± 0.7 pmol/min/mg lipid, respectively, P = 0.10). DGAT activity per unit adipose weight was negatively correlated with adipocyte size (P < 0.01) and positively correlated with direct FFA storage in omental (P < 0.001) but not in abdominal subcutaneous fat. Tissue DGAT activity varies as a function of adipocyte size, but this relationship differs between visceral and abdominal subcutaneous fat in obese and nonobese humans. Our results are consistent with the hypothesis that interindividual variations in DGAT activity may be an important regulatory step in visceral adipose tissue FFA uptake/storage.     

Characteristic Expression of Extracellular Matrix in Subcutaneous Adipose Tissue Development and Adipogenesis; Comparison with Visceral Adipose Tissue

Adipose tissue is a connective tissue specified for energy metabolism and endocrines, but functional differences between subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) have not been fully elucidated. To reveal the physiological role of SAT, we characterized in vivo tissue development and in vitro adipocyte differentiation. In a DNA microarray analysis of SAT and VAT in Wistar rats, functional annotation clusters of extracellular matrix (ECM)-related genes were found in SAT, and major ECM molecules expressed in adipose tissues were profiled. In a histological analysis and quantitative expression analysis, ECM expression patterns could be classified into two types: (i) a histogenesis-correlated type such as type IV and XV collagen, and laminin subunits, (ii) a high-SAT expression type such as type I, III, and V collagen and minor characteristic collagens. Type (i) was related to basal membrane and up-regulated in differentiated 3T3-L1 cells and in histogenesis at depot-specific timings. In contrast, type (ii) was related to fibrous forming and highly expressed in 3T3-L1 preadipocytes. Exceptionally, fibronectin was abundant in developed adipose tissue, although it was highly expressed in 3T3-L1 preadipocytes. The present study showed that adipose tissues site-specifically regulate molecular type and timing of ECM expression, and suggests that these characteristic ECM molecules provide a critical microenvironment, which may affect bioactivity of adipocyte itself and interacts with other tissues. It must be important to consider the depot-specific property for the treatment of obesity-related disorders, dermal dysfunction and for the tissue regeneration.     

Stromal Cells Derived from Visceral and Obese Adipose Tissue Promote Growth of Ovarian Cancers

Obesity, and in particular visceral obesity, has been associated with an increased risk of developing cancers as well as higher rates of mortality following diagnosis. The impact of obesity on adipose-derived stromal cells (ASC), which contribute to the formation of tumor stroma, is unknown. Here we hypothesized that visceral source and diet-induced obesity (DIO) changes the ASC phenotype, contributing to the tumor promoting effects of obesity. We found that ASC isolated from subcutaneous (SC-ASC) and visceral (V-ASC) white adipose tissue(WAT) of lean(Le) and obese(Ob) mice exhibited similar mesenchymal cell surface markers expression, and had comparable effects on ovarian cancer cell proliferation and migration. Obese and visceral derived ASC proliferated slower and exhibited impaired differentiation into adipocytes and osteocytes in vitro as compared to ASC derived from subcutaneous WAT of lean mice. Intraperitoneal co-injection of ovarian cancer cells with obese or visceral derived ASC, but not lean SC-ASC, increased growth of intraperitoneal ID8 tumors as compared to controls. Obese and V-ASC increased stromal infiltration of inflammatory cells, including CD3+ T cells and F4/80+ macrophages. Obese and visceral derived ASC, but not lean SC-ASC, increased expression of chemotactic factors IL-6, MIP-2, and MCP-1 when cultured with tumor cells. Overall, these results demonstrate that obese and V-ASC have a unique phenotype, with more limited proliferation and differentiation capacity but enhanced expression of chemotactic factors in response to malignant cells which support infiltration of inflammatory cells and support tumor growth and dissemination.     

睾酮缺乏对高脂诱导小型猪内脏脂肪组织DNA甲基化的影响

为探讨DNA甲基化在睾酮缺乏促进高脂饮食诱导的小型猪肥胖中的作用,本研究采用甲基化DNA免疫共沉淀测序(MeDIP-Seq)技术分析高脂饲喂的不去势、去势和去势+睾酮3组小型猪内脏脂肪组织DNA甲基化差异,对筛选出的差异甲基化基因进行注释和功能富集分析,并运用RT-qPCR技术检测差异甲基化基因的表达.结果 表明,不去势、去势和去势+睾酮3组样本在基因组上的甲基化分布情况相似,即Genebody区的甲基化水平高于3'UTR和5'UTR区.另外,在去势Vs.不去势和去势Vs.去势+睾酮两组样本中分别筛选得到2839个和2510个差异甲基化基因,这些基因主要富集在脂肪细胞因子转导、抗原处理以及呈递、脂肪酸代谢和氨基酸代谢等通路.睾酮缺乏导致高脂饲喂小型猪内脏脂肪组织LEP以及NCF1内含子区甲基化和SLC-27A1启动子区甲基化水平升高,并且LEP和NCF1 mRNA表达与甲基化呈正相关,而SLC27A1 mR-NA表达与甲基化呈负相关.本研究推测,睾酮缺乏可能通过影响脂质代谢和炎症反应等多个途径基因DNA甲基化参与调控脂肪沉积和肥胖发生.     

心外膜脂肪组织与心房颤动的分子机制研究进展

心房颤动(atrial fibrillation,AF)是临床上常见的心律失常,与心血管疾病的发病率和死亡率增加相关.心外膜脂肪组织(epicardial adipose tissue,EAT)是具有重要内分泌功能的生物活性器官.近年来已有大量的研究显示EAT的体积、厚度与AF的发生、严重程度及复发相关,但EAT在AF发病机理中的确切作用尚需进一步阐明,为通过干预EAT来治疗AF提供新思路.     

Impacts of Visceral Adipose Tissue and Subcutaneous Adipose Tissue on Metabolic Risk Factors in Middle‐aged Japanese

Regional fat distribution rather than overall fat volume has been considered to be important to understanding the link between obesity and metabolic disorders. We aimed to evaluate the independent associations of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) with metabolic risk factors in apparently healthy middle‐aged Japanese. Participants were 1,119 men and 854 women aged 38–60 years who were not taking medications for diabetes, hypertension, or dyslipidemia. VAT and SAT were measured by use of computed tomography (CT) scanning. VAT and SAT were significantly and positively correlated with each other in men (r = 0.531, P < 0.001) and women (r = 0.589, P < 0.001). In multiple regression analyses, either measure of abdominal adiposity (VAT or SAT) was positively associated with blood pressure, fasting plasma glucose, and log triglyceride (P < 0.001) and inversely with high‐density lipoprotein (HDL)‐cholesterol (P < 0.001). When VAT and SAT were simultaneously included in the model, the association of VAT with triglycerides was maintained (P < 0.001) but that of SAT was lost. The same was true for HDL‐cholesterol in women. For fasting plasma glucose, the association with VAT was strong (P < 0.001) and the borderline association with SAT was maintained (P = 0.060 in men and P = 0.020 in women). Both VAT and SAT were independently associated with blood pressure (P < 0.001). Further adjustment for anthropometric indices resulted in the independent association only with VAT for all risk factors. In conclusion, impacts of VAT and SAT differed among risk factors. VAT showed dominant impacts on triglyceride concentrations in both genders and on HDL‐cholesterol in women, while SAT also had an independent association with blood pressure.     

Evaluation of Epicardial Fat Tissue Thickness in Patients with Primary Hyperparathyroidism

ObjectivePrimary hyperparathyroidism (pHPT) affects the cardiovascular system, and epicardial fat tissue (EFT) thickness is closely associated with cardiovascular diseases and atherosclerosis. Despite this, the association between EFT thickness and pHPT has not been studied in a clinical setting. This study aimed to assess EFT thickness in patients with pHPT.MethodsThe study included 38 patients with pHPT and 40 healthy controls. EFT thickness, carotid intima-media thickness (CIMT), serum levels of parathormone (PTH) and calcium, and blood chemistry profiles were determined in all subjects. Correlation and regression analyses were performed with EFT thickness and CIMT as dependent variables and age; systolic and diastolic blood pressure; body mass index (BMI); presence of diabetes mellitus; and free plasma glucose (FPG), PTH, and serum calcium (Ca) levels as independent variables.ResultsBoth the mean EFT thickness and the mean CIMT were significantly greater in the pHPT group than the control group (P < .001 for both). Correlation analysis showed that EFT thickness was significantly correlated with CIMT, age, systolic blood pressure, and PTH and serum Ca levels. Furthermore, the regression analysis revealed that EFT thickness retained its independent and positive association with FPG and serum Ca levels.ConclusionsThe results of this study indicate that EFT thickness may be a useful marker of early atherosclerosis in patients with pHPT. Furthermore, the increase in EFT thickness appears to be due to hypercalcemia. (Endocr Pract. 2014;20:26-32)     

阿托伐他汀对肥胖家兔心房肌及心外膜脂肪中致心房颤动炎症因子的影响

目的:探讨肥胖家兔心外膜脂肪、血液、心房肌中致房颤炎症因子C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、白细胞介素-12(IL-12)、肿瘤坏死因子a(TNF-α)水平及阿托伐他汀的干预作用.方法:45只家兔随机分为普通饮食组(n=15)、肥胖饮食组(n=15)和阿托伐他汀干预组(n=15),肥胖饮食组预先给予高蛋白高脂饲料喂养4周制成肥胖模型(超重20％),肥胖组给予他汀喂养4周.ELISA法测定三组家兔血液、心肌、心外膜脂肪hs-CRP、IL-6、IL-12、TNF-α的水平.比较普通组、肥胖组、他汀干预组hs-CRP、IL-6、IL-12、TNF-α的水平,并进行统计学分析.结果:①肥胖组血清、心房肌、心外膜脂肪hs-CRP、IL-6、IL-12、TNF-α.的水平均高于普通组(P＜0.05);心房肌、心外膜脂肪中hs-CRP、IL-6、IL-12、TNF-α的水平均明显高于血液(P＜0.05).②肥胖他汀干预组血清、心房肌、心外膜脂肪hs-CRP、IL-6、IL-12、TNF-α的水平均低于肥胖组(P＜0.05).结论:肥胖可导致促房颤炎症因子的表达升高,心外膜脂肪中炎症因子表达高于心房肌,心房肌中炎症因子表达高于血液,心外膜脂肪组织可能是促房颤炎性因子的来源,参与了房颤的发生、发展,可能为始动环节,肥胖患房颤风险增高,阿托伐他汀可降低这种危险.     

The Effect of Exercise on Visceral Adipose Tissue in Overweight Adults: A Systematic Review and Meta-Analysis

Excessive visceral adipose tissue appears to trigger a cascade of metabolic disturbances that seem to coexist with ectopic fat storage in muscle, liver, heart and the ß-cell. Therefore, the reduction of visceral adipose tissue potentially plays a pivotal role in the treatment of the metabolic syndrome. The purpose of this systematic review and meta-analysis is to describe the overall effect of exercise on visceral adipose tissue and to provide an overview of the effect of different exercise regimes, without caloric restriction, on visceral adipose tissue in obese persons. A systematic literature search was performed according to the PRISMA statement for reporting systematic reviews and meta-analyses. The initial search resulted in 87 articles after removing duplicates. After screening on title, abstract and full-text 15 articles (totalling 852 subjects) fulfilled the a priori inclusion criteria. The quality of each eligible study was assessed in duplicate with “The Critical Review Form for Quantitative Studies”. Using random-effects weights, the standardized mean difference (Hedge''s g) of the change in visceral adipose tissue was −0.497 with a 95% confidence interval of −0.655 to −0.340. The Z-value was −6.183 and the p-value (two tailed) was <0.001. A subgroup analysis was performed based on gender, type of training and intensity. Aerobic training of moderate or high intensity has the highest potential to reduce visceral adipose tissue in overweight males and females. These results suggest that an aerobic exercise program, without hypocaloric diet, can show beneficial effects to reduce visceral adipose tissue with more than 30 cm² (on CT analysis) in women and more than 40 cm² in men, even after 12 weeks.     

Autonomic Nervous System Regulation of Epicardial Adipose Tissue: Potential Roles for Regulator of G Protein Signaling-4

The epicardial adipose tissue (EAT) or epicardial fat is a visceral fat depot in the heart that contains intrinsic adrenergic and cholinergic nerves, through which it interacts with the cardiac sympathetic (adrenergic) and parasympathetic (cholinergic) nervous systems. These EAT nerves represent a significant source of several adipokines and other bioactive molecules, including norepinephrine, epinephrine, and free fatty acids. The production of these molecules is biologically relevant for the heart, since abnormalities in EAT secretion are implicated in the development of pathological conditions, including coronary atherosclerosis, atrial fibrillation, and heart failure. Sympathetic hyperactivity and parasympathetic (cholinergic) derangement are associated with EAT dysfunction, leading to a variety of adverse cardiac conditions, such as heart failure, diastolic dysfunction, atrial fibrillation, etc.; therefore, several studies have focused on exploring the autonomic regulation of EAT as it pertains to heart disease pathogenesis and progression. In addition, Regulator of G protein Signaling (RGS)-4 is a protein with significant regulatory roles in both adrenergic and muscarinic receptor signaling in the heart. In this review, we provide an overview of the autonomic regulation of EAT, with a specific focus on cardiac RGS4 and the potential roles this protein plays in this regulation.