The ratio of visceral to subcutaneous fat, a metric of body fat distribution, is a unique correlate of cardiometabolic risk

Abstract

Aims/hypothesis The anatomic location of excess body fat has an impact on associated cardiometabolic morbidity, and visceral adipose tissue (VAT) is more pathogenic than subcutaneous adipose tissue (SAT). However, VAT or SAT alone provides little information regarding the relative distribution of body fat. We hypothesised that the propensity to store energy in VAT relative to SAT depots may be a correlate of cardiometabolic risk, and tested this hypothesis using the VAT/SAT ratio as a metric of fat distribution. Methods We investigated associations of the VAT/SAT ratio with cardiometabolic traits in 3,223 participants (48% women) from the Framingham Heart Study. Fat depots were quantified by multidetector computed tomography (CT) scanning. Results In women and men, higher VAT/SAT ratio was associated (p<0.05) with most assessed cardiovascular risk factors reflecting blood pressure, dyslipidaemia and insulin resistance. Additional adjustment for BMI did not materially change the findings in women, and generally strengthened associations in men. Further adjustment for VAT attenuated some associations in women, but those with lower HDL-cholesterol, higher triacylglycerol (both p<0.0001) and higher prevalence of hypertension (p=0.02), diabetes (p=0.01) and the metabolic syndrome (p=0.005) remained significant. Similarly, in men, associations with higher systolic (p=0.006) and diastolic blood pressure (p=0.03), higher fasting glucose (p=0.0005), lower HDL-cholesterol and higher triacylglycerol (both p<0.0001) and higher prevalence of diabetes (p=0.006) remained significant. Conclusions/interpretation VAT/SAT ratio is a correlate of cardiometabolic risk, above and beyond BMI and VAT. The propensity to store fat viscerally versus subcutaneously may be a unique risk factor independent of absolute fat volumes.

Maintaining Metabolically Healthy Overweight and Risk of Incident Type 2 Diabetes or Cardiovascular Disease

“…Subcutaneous adipose tissue (SAT) has less facilitative or even protective effects on metabolic abnormalities compared to VAT. In fact, higher VAT/SAT ratio is associated with an increased cardio metabolic risk [29]. Taking these finding together, maintaining MHO phenotype was not associated with higher risk of incident Type 2 diabetes or CVD.…”

Factors Associated With the Concentration of Visceral and Subcutaneous Fat

“…Nonetheless, when the lipid storage capacity is exceeded, the store is diverted to other compartments outside the subcutaneous tissue, such as VAT, skeletal muscle and the liver, compromising their normal metabolic pathways and promoting unfavorable situations [34]. Some authors suggested that the SAT may have protective properties and that an absolute quantification of any deposit does not reflect its proportional distribution [8,35,36]. For example, a high volume of VAT or SAT may reflect both a high total abdominal fat mass and propensity to store For the regression, continuous variables (age, BMI, education in years of study, minutes of physical activity per week, food consumption score (simple carbohydrates, fat and processed meats, milk and dairy products, oils and fats, protective foods and alcohol) and dummy variables (SAH, DM, race, social class and smoking) entered the models visceral or subcutaneous fat.…”

“…For example, a high volume of VAT or SAT may reflect both a high total abdominal fat mass and propensity to store For the regression, continuous variables (age, BMI, education in years of study, minutes of physical activity per week, food consumption score (simple carbohydrates, fat and processed meats, milk and dairy products, oils and fats, protective foods and alcohol) and dummy variables (SAH, DM, race, social class and smoking) entered the models visceral or subcutaneous fat. Thus, to separate the absolute amount of fat from a greater predisposition to store viscerally or subcutaneously, the use of the VAT/SAT ratio has been proposed as a relative metric of abdominal fat composition [36]. Hence, higher levels of subcutaneous fat in individuals with higher education levels may imply that these individuals would accumulate more subcutaneous fat than visceral fat.…”

Body Mass Index; Visceral Fat and Total Body Fat Distribution and Its Relation to Body Mass Index in Clinical Setting Using Bio-Impedance Body Composition Monitor

“…Both types are important but attention has been directed to visceral adiposity owing to its association with various metabolic medical disorders 2 , cardiovascular disease and several malignancies. 3,4 Quantitative assessment of visceral obesity is important for evaluating the risk of these pathologies.…”