The ratio of visceral to subcutaneous fat, a metric of body fat distribution, is a unique correlate of cardiometabolic risk.
OBJECTIVE
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
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.
National Heart, Lung and Blood Institute's Framingham Heart Study, 73 Mt Wayte Ave Suite no. 2, Framingham, MA, 01702, USA.|Klinik und Poliklinik für Innere Medizin II, University of Regensburg, Regensburg, Germany.
B M
BM
Kaess
National Heart, Lung and Blood Institute's Framingham Heart Study, 73 Mt Wayte Ave Suite no. 2, Framingham, MA, 01702, USA.
A
A
Pedley
Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
J M
JM
Massaro
Boston University School of Medicine, Boston, MA, USA.
J
J
Murabito
Radiology Department, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
U
U
Hoffmann
National Heart, Lung and Blood Institute's Framingham Heart Study, 73 Mt Wayte Ave Suite no. 2, Framingham, MA, 01702, USA. foxca@nhlbi.nih.gov.|Brigham and Women's Division of Endocrinology, Hypertension, and Metabolism and Harvard Medical School, Boston, MA, USA. foxca@nhlbi.nih.gov.
C S
CS
Fox
D000328:Adult; D050218:Body Fat Distribution; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000503:physiopathology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D012307:Risk Factors; D050151:Subcutaneous Fat / Q000000981:diagnostic imaging*