title: Patterns of abdominal fat distribution: the Framingham Heart Study.
abstract: OBJECTIVE
  The prevalence of abdominal obesity exceeds that of general obesity. We sought to determine the prevalence of abdominal subcutaneous and visceral obesity and to characterize the different patterns of fat distribution in a community-based sample.
  
  
  METHODS
  Participants from the Framingham Heart Study (n = 3,348, 48% women, mean age 52 years) underwent multidetector computed tomography; subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) volumes were assessed. Sex-specific high SAT and VAT definitions were based on 90th percentile cut points from a healthy referent sample. Metabolic risk factors were examined in subgroups with elevated SAT and VAT.
  
  
  RESULTS
  The prevalence of high SAT was 30% (women) and 31% (men) and that for high VAT was 44% (women) and 42% (men). Overall, 27.8% of the sample was discordant for high SAT and high VAT: 19.9% had SAT less than but VAT equal to or greater than the 90th percentile, and 7.9% had SAT greater than but VAT less than the 90th percentile. The prevalence of metabolic syndrome was higher among women and men with SAT less than the 90th percentile and high VAT than in those with high SAT but VAT less than the 90th percentile, despite lower BMI and waist circumference. Findings were similar for hypertension, elevated triglycerides, and low HDL cholesterol.
  
  
  CONCLUSIONS
  Nearly one-third of our sample has abdominal subcutaneous obesity, and >40% have visceral obesity. Clinical measures of BMI and waist circumference may misclassify individuals in terms of VAT and metabolic risk.
authors.affiliation: Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Karla M
authors.initials: KM
authors.lastname: Pou
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Massaro
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.forename: Kathrin
authors.initials: K
authors.lastname: Lieb
authors.forename: Ramachandran S
authors.initials: RS
authors.lastname: Vasan
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: O'Donnell
authors.forename: Caroline S
authors.initials: CS
authors.lastname: Fox
mesh_terms: D050153:Abdominal Fat / Q000378:metabolism*; D000328:Adult; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis / Q000378:metabolism; D050151:Subcutaneous Fat / Q000378:metabolism; D014057:Tomography, X-Ray Computed; D055105:Waist Circumference