Visceral and Subcutaneous Adipose Depots and Incident CVD Risk Factors

Study Questions:

Is visceral and subcutaneous adipose volume and quality associated with metabolic risk factors?


Data from the Framingham Heart Study Multi-detector Computed Tomography Substudy were used for the present study. Baseline visceral adipose and subcutaneous adipose volume and attenuation (in Hounsfield units) were measured via positron emission tomography computed tomography scan. Metabolic risk factors were assessed at baseline and follow-up exams, including resting systolic and diastolic blood pressure, and fasting glucose, high-density lipoprotein (HDL) cholesterol, and triglycerides. Metabolic syndrome was defined using the modified Adult Treatment Panel III criteria. Primary outcomes included blood pressure, lipids, and glucose. Multivariate models were created to predict change from baseline to follow-up.


A total of 1,730 participants (45% women, mean age 46.0 years for women and 44.1 years for men) were followed over a mean of 6.2 years. Mean body mass index (BMI) was in the overweight range for both men and women. Baseline visceral adipose was associated with metabolic risk factors at follow-up. Per 500 cm3 increment in baseline visceral adipose tissue, glucose was 2.34 mg/dl higher (95% confidence interval [CI], 1.71-2.97) and HDL was 1.62 mg/dl lower (95% CI, 0.97-2.28) in women, and remained significant after adjustment for BMI. With each additional 500 cm3 in visceral adiposity at baseline, the odds of metabolic syndrome increased significantly (odds ratio [OR], 2.58; 95% CI, 2.05-3.25). In men, increased visceral adiposity at baseline was associated with a higher odds of hypertension (OR, 1.28; 95% CI, 1.12-1.47) and metabolic syndrome (OR, 1.70; 95% CI, 1.45-1.98), and remained significant after adjustment for BMI. Baseline subcutaneous adipose was associated with blood pressure among women, but no associations were observed among men for subcutaneous adipose and metabolic risk factors. In examining attenuation, lower fat attenuation was associated with metabolic risk factors including higher triglycerides. This relationship remained significant for women after adjustment for baseline visceral adiposity tissue volume. Among men, these associations were attenuated after adjustment for volume.


The authors concluded that visceral adipose volume is associated with adverse metabolic risk factors, even after adjustment for BMI. Among women, subcutaneous adiposity was also associated with cardiometabolic risk. Adipose attenuation is also associated with metabolic risk factors. These findings suggest that both volume and quality of visceral and subcutaneous adipose tissue contribute to metabolic risk.


These data suggest that irrespective of BMI, adipose volume and quality, in particular visceral adipose, are associated with increased risk for cardiometabolic risk factors.

Clinical Topics: Diabetes and Cardiometabolic Disease, Clinical Topic Collection: Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins, Hypertension

Keywords: Adipose Tissue, Adiposity, Blood Pressure, Body Mass Index, Cholesterol, HDL, Dyslipidemias, Glucose, Hypertension, Intra-Abdominal Fat, Lipids, Lipoproteins, HDL, Metabolic Syndrome X, Obesity, Obesity, Abdominal, Overweight, Primary Prevention, Risk Factors, Triglycerides

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