A long-term follow-up of the CENTRAL and DIRECT-PLUS trials published in Circulation suggests that despite long-term weight regain, visceral fat reduction during lifestyle intervention is associated with sustained improvements in metabolic health.

The 18-month CENTRAL (2012-2014) and DIRECT-PLUS (2017-2018) trials evaluated dietary patterns (low-fat, healthy dietary guidelines and Mediterranean diet variants, including standard, low-carbohydrate and polyphenol-enriched "green" Mediterranean diets) combined with structured physical activity. Participants achieved considerable reductions in ectopic and abdominal fat, as assessed with MRI.

During this five- and 10-year follow-up, Hadar Klein, RD, MSc, et al., reached 366 (96%) study participants (mean age of 57 years) to examine the long-term postintervention cardiometabolic profile associated with changes in ectopic and abdominal fat.

Results showed that despite complete weight regain, reductions in waist circumference and abdominal fat depots (including visceral adipose tissue, deep subcutaneous adipose tissue [SAT], and superficial SAT), were partially maintained (false discovery rate ≤0.01 for all), but reductions of intrahepatic fat and intrapancreatic fat were not maintained and excessively gained during the follow-up period (false discovery rate ≤0.01 for both).

For every 10% intervention-induced reduction in visceral adipose tissue (VAT), superficial SAT and intrapancreatic fat, there was associated long-term postintervention improvements in Metabolic Score for Insulin Resistance, composite risk score and Metabolic Syndrome Severity Score (all p<0.05, adjusted for weight change, Mediterranean diet adherence, physical activity and other factors).

Notably, only a 10% reduction in visceral adipose tissue was independently associated to a lower risk of developing type 2 diabetes, a 28% reduction in risk.

In what they believe is the first large-scale, long-term follow-up of its kind, researchers write that their follow-up "demonstrated that visceral fat loss achieved during lifestyle intervention is associated with durable metabolic benefits up to a decade later." Their findings "emphasize the importance of shifting clinical focus from general weight loss to targeted fat reduction, highlighting VAT loss as a key therapeutic target for both metabolic disease prevention and management."