Cited by 4,399Adipose Tissue and MetabolismCardiovascular Disease and AdiposityAdipokines, Inflammation, and Metabolic Diseases

Identification and Importance of Brown Adipose Tissue in Adult Humans

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Cypess, Aaron M., Lehman, Sanaz, Williams, Gethin, Tal, Ilan, Rodman, Dean, Goldfine, Allison B., Kuo, Frank C., Palmer, Edwin L. +4 more·2009·New England Journal of Medicine

Abstract

BACKGROUND: Obesity results from an imbalance between energy intake and expenditure. In rodents and newborn humans, brown adipose tissue helps regulate energy expenditure by thermogenesis mediated by the expression of uncoupling protein 1 (UCP1), but brown adipose tissue has been considered to have no physiologic relevance in adult humans. METHODS: We analyzed 3640 consecutive (18)F-fluorodeoxyglucose ((18)F-FDG) positron-emission tomographic and computed tomographic (PET-CT) scans performed for various diagnostic reasons in 1972 patients for the presence of substantial depots of putative brown adipose tissue. Such depots were defined as collections of tissue that were more than 4 mm in diameter, had the density of adipose tissue according to CT, and had maximal standardized uptake values of (18)F-FDG of at least 2.0 g per milliliter, indicating high metabolic activity. Clinical indexes were recorded and compared with those of date-matched controls. Immunostaining for UCP1 was performed on biopsy specimens from the neck and supraclavicular regions in patients undergoing surgery. RESULTS: Substantial depots of brown adipose tissue were identified by PET-CT in a region extending from the anterior neck to the thorax. Tissue from this region had UCP1-immunopositive, multilocular adipocytes indicating brown adipose tissue. Positive scans were seen in 76 of 1013 women (7.5%) and 30 of 959 men (3.1%), corresponding to a female:male ratio greater than 2:1 (P<0.001). Women also had a greater mass of brown adipose tissue and higher (18)F-FDG uptake activity. The probability of the detection of brown adipose tissue was inversely correlated with years of age (P<0.001), outdoor temperature at the time of the scan (P=0.02), beta-blocker use (P<0.001), and among older patients, body-mass index (P=0.007). CONCLUSIONS: Defined regions of functionally active brown adipose tissue are present in adult humans, are more frequent in women than in men, and may be quantified noninvasively with the use of (18)F-FDG PET-CT. Most important, the amount of brown adipose tissue is inversely correlated with body-mass index, especially in older people, suggesting a potential role of brown adipose tissue in adult human metabolism.

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Crossref · 10.1056/nejmoa0810780

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  • Larger species, like rabbits, sheep, cows, and humans are born with BAT stores, but most of these are gradually replaced by WAT after birth.

    “Contrastingly, larger species, like rabbits, sheep, cows, and humans are born with BAT stores, but most of these are gradually replaced by WAT after birth [13, 45, 46].”

    From Developmental programming of offspring adipose tissue biology and obesity risk (2021) · cites this paper as [13]

    The Background says newborn humans have brown adipose tissue (BAT), and the Discussion reports less detectable BAT with increasing adult age. The paper does not address BAT at birth in rabbits, sheep, or cows, or say that BAT stores are gradually replaced by white adipose tissue after birth. The Discussion also reports that BAT remains present in many adults. (LLM, conf=0.88)

    Experimental — accuracy not yet measured
  • Women are twice as likely as men to have brown adipose tissue signal, and they also have a greater mass of brown adipose tissue with higher metabolic activity.

    “Cypess et al. found that not only were women twice as likely as men to have brown adipose tissue signal, they also had a greater mass of brown adipose tissue with higher metabolic activity [12].”
  • The thermogenic effect of brown adipose tissue is mediated by the expression of uncoupling protein-1 (UCP1).

    “This thermogenic effect is mediated by the expression of decoupling protein-1 (UCP1; Cypess et al., 2009).”
  • Recent reports revealed significant amounts of metabolically active brown adipose tissue in adults.

    “recent reports revealing significant amounts of metabolically active BAT in adults (146, 147)”
  • Adult humans maintain active depots of brown adipose tissue.

    “adult humans maintain active depots of BAT [54, 55]”

    From Regulation of obesity and insulin resistance by nitric oxide (2014) · cites this paper as [54]

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Authors
Cypess, A. M., Lehman, S., Williams, G., Tal, I., Rodman, D., Goldfine, A. B., Kuo, F. C., Palmer, E. L., Tseng, Y.-H., Doria, A., Kolodny, G. M., & Kahn, C. R.
Affiliations
  • Joslin Diabetes Center (US)
  • Beth Israel Deaconess Medical Center (US)
  • Brigham and Women's Hospital (US)
  • Harvard University (US)
Venue
New England Journal of Medicine
Published
2009-04-09
Volume
360
Issue
15
Pages
1509-1517
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
OpenAlex
W1965079305
Cited by
4,399
References
41
Citations by year
2026: 146 · 2025: 194 · 2024: 214 · 2023: 224 · 2022: 264 · 2021: 305 · 2020: 331 · 2019: 307 · 2018: 295 · 2017: 313 · 2016: 315 · 2015: 309 · 2014: 250 · 2013: 284 · 2012: 223
FWCI
139.97
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK055545, DK 33201, DK070722, R21DK070722, P30DK046200, R01DK056690, DK046200-16, R01DK033201, DK55545, T32DK007260, P30DK040561)
  • National Center for Research Resources (UL1RR025758, KL2RR025757)
Topics
  • Health Sciences › Medicine › Physiology › Adipose Tissue and Metabolism
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Disease and Adiposity
  • Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
Keywords
brown adipose tissue, adults, thermogenesis, UCP1, body mass index, obesity, sex differences, age-related decline, beta-blocker use, outdoor temperature, energy expenditure, non-invasive measurement, immunostaining
MeSH terms
Adrenergic beta-Antagonists, Adult, Age Factors, Aged, Blood Glucose, Adipose Tissue, Brown, Energy Metabolism, Female, Humans, Immunohistochemistry, Male, Middle Aged, Neck, Sex Characteristics, Temperature, Body Mass Index, Multivariate Analysis, Logistic Models, Statistics, Nonparametric, Radiopharmaceuticals, Fluorodeoxyglucose F18, Positron-Emission Tomography, Adiposity, Adipocytes, Brown, Young Adult

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