Rare variants in the melanocortin 4 receptor gene (MC4R) are associated with abdominal fat and insulin resistance in youth with obesity: Pediatrics

Background: Rare variants in melanocortin 4 receptor gene (MC4R) result in a severe form of early-onset obesity; however, it is unclear how these variants may affect abdominal fat distribution, intrahepatic fat accumulation, and related metabolic sequelae. Methods: Eight hundred seventy-seven youth (6–21 years) with overweight/obesity, recruited from the Yale Pediatric Obesity Clinic in New Haven, CT, underwent genetic analysis to screen for functionally damaging, rare variants (MAF < 0.01) in MC4R. Participants were assigned to a Pathogenic Variant or No Pathogenic Variant group and completed a 10-timepoint 180-min oral glucose tolerance test (OGTT) and abdominal MRI. Results: Compared to the No Pathogenic Variant group, the Pathogenic Variant group demonstrated significantly greater glucose concentrations (AUC_tot: 24.7 ± 1.22 g/dL × 180 min vs. 21.9 ± 1.41 g/dL × 180 min; p = 0.001), insulin levels (AUC_tot: 57.4 ± 11.5 mU/mL × 180 min vs. 35.5 ± 8.90 mU/mL × 180 min; p = 0.002), and lower insulin sensitivity (WBISI: 1.01 ± 0.137 vs. 1.85 ± 0.036; p = 0.0008) during the OGTT. The Pathogenic Variant group also presented with greater visceral adipose tissue (VAT) (85.1 cm² ± 10.3 vs. 56.1 cm² ± 1.64; p = 0.003) and intrahepatic fat content (HFF%) (19.4% ± 4.94 vs. 8.21% ± 0.495; p = 0.012) than the No Pathogenic Variant group despite the two groups having similar BMI z-scores (p = 0.255), subcutaneous adipose tissue (SAT) (p = 0.643), and total body fat (p = 0.225). Conclusions: Pathogenic variants in MC4R are associated with increased VAT, HFF%, and insulin resistance, independent from the degree of obesity in youth.