title: Visceral fat is associated with lower brain volume in healthy middle-aged adults.
abstract: OBJECTIVE
  Midlife obesity has been associated with an increased risk of dementia. The underlying mechanisms are poorly understood. Our aim was to examine the cross-sectional association of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and computed tomography (CT)-based measurements of subcutaneous (SAT) and visceral (VAT) adipose tissue with various magnetic resonance imaging (MRI) markers of brain aging in middle-aged community adults.
  
  
  METHODS
  Participants from the Framingham Offspring cohort were eligible if in addition to having measurements of BMI, WC, WHR, SAT, and VAT, they had undergone a volumetric brain MRI scan with measurements of total brain volume (TCBV), temporal horn volume (THV), white matter hyperintensity volume (WMHV), and MRI-defined brain infarcts (BI). All analyses were adjusted for age, sex, and time interval between abdominal CT and brain MRI.
  
  
  RESULTS
  In a sample of 733 community participants (mean age, 60 years; 53% women), we observed an inverse association of BMI (estimate by standard deviation unit +/- standard error = -0.27 +/- 0.12; p = 0.02), WC (-0.30 +/- 0.12; p = 0.01), WHR (-0.37 +/- 0.12; p = 0.02), SAT (-0.23 +/- 0.11; p = 0.04), and VAT (-0.36 +/- 0.12; p = 0.002) with TCBV, independent of vascular risk factors. The association between VAT and TCBV was the strongest and most robust, and was also independent of BMI (-0.35 +/- 0.15; p = 0.02) and insulin resistance (-0.32 +/- 0.13; p = 0.01). When adjusting for C-reactive protein levels, the associations were attenuated (-0.17 +/- 0.13; p = 0.17 for VAT). No consistently significant association was observed between the anthropometric or CT-based abdominal fat measurements and THV, WMHV, or BI.
  
  
  CONCLUSIONS
  In middle-aged community participants, we observed a significant inverse association of anthropometric and CT-based measurements of abdominal, especially visceral, fat with total brain volume.
authors.affiliation: Department of Neurology, Boston University School of Medicine, MA, USA.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Debette
authors.forename: Alexa
authors.initials: A
authors.lastname: Beiser
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.forename: Charles
authors.initials: C
authors.lastname: Decarli
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: O'Donnell
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Massaro
authors.forename: Rhoda
authors.initials: R
authors.lastname: Au
authors.forename: Jayandra J
authors.initials: JJ
authors.lastname: Himali
authors.forename: Philip A
authors.initials: PA
authors.lastname: Wolf
authors.forename: Caroline S
authors.initials: CS
authors.lastname: Fox
authors.forename: Sudha
authors.initials: S
authors.lastname: Seshadri
mesh_terms: D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D001921:Brain / Q000000981:diagnostic imaging / Q000502:physiology*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D050151:Subcutaneous Fat / Q000000981:diagnostic imaging / Q000502:physiology; D014057:Tomography, X-Ray Computed