title: The relationship between DXA-based and anthropometric measures of visceral fat and morbidity in women.
abstract: BACKGROUND
  Excess accumulation of visceral fat is a prominent risk factor for cardiovascular and metabolic morbidity. While computed tomography (CT) is the gold standard to measure visceral adiposity, this is often not possible for large studies - thus valid, but less expensive and intrusive proxy measures of visceral fat are required such as dual-energy X-ray absorptiometry (DXA). Study aims were to a) identify a valid DXA-based measure of visceral adipose tissue (VAT), b) estimate VAT heritability and c) assess visceral fat association with morbidity in relation to body fat distribution.
  
  
  METHODS
  A validation sample of 54 females measured for detailed body fat composition - assessed using CT, DXA and anthropometry - was used to evaluate previously published predictive models of CT-measured visceral fat. Based upon a validated model, we realised an out-of-sample estimate of abdominal VAT area for a study sample of 3457 female volunteer twins and estimated VAT area heritability using a classical twin study design. Regression and residuals analyses were used to assess the relationship between adiposity and morbidity.
  
  
  RESULTS
  Published models applied to the validation sample explained >80% of the variance in CT-measured visceral fat. While CT visceral fat was best estimated using a linear regression for waist circumference, CT body cavity area and total abdominal fat (R2 = 0.91), anthropometric measures alone predicted VAT almost equally well (CT body cavity area and waist circumference, R2 = 0.86). Narrow sense VAT area heritability for the study sample was estimated to be 58% (95% CI: 51-66%) with a shared familial component of 24% (17-30%). VAT area is strongly associated with type 2 diabetes (T2D), hypertension (HT), subclinical atherosclerosis and liver function tests. In particular, VAT area is associated with T2D, HT and liver function (alanine transaminase) independent of DXA total abdominal fat and body mass index (BMI).
  
  
  CONCLUSIONS
  DXA and anthropometric measures can be utilised to derive estimates of visceral fat as a reliable alternative to CT. Visceral fat is heritable and appears to mediate the association between body adiposity and morbidity. This observation is consistent with hypotheses that suggest excess visceral adiposity is causally related to cardiovascular and metabolic disease.
authors.affiliation: Department of Twin Research and Genetic Epidemiology, London, UK.
authors.forename: Kenan
authors.initials: K
authors.lastname: Direk
authors.forename: Marina
authors.initials: M
authors.lastname: Cecelja
authors.forename: William
authors.initials: W
authors.lastname: Astle
authors.forename: Phil
authors.initials: P
authors.lastname: Chowienczyk
authors.forename: Tim D
authors.initials: TD
authors.lastname: Spector
authors.forename: Mario
authors.initials: M
authors.lastname: Falchi
authors.forename: Toby
authors.initials: T
authors.lastname: Andrew
mesh_terms: D015502:Absorptiometry, Photon; D050154:Adiposity / Q000235:genetics; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000886:Anthropometry; D050197:Atherosclerosis / Q000453:epidemiology; D015992:Body Mass Index; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D004200:Diseases in Twins; D005260:Female; D020022:Genetic Predisposition to Disease; D040941:Heredity; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016013:Likelihood Functions; D016014:Linear Models; D008099:Liver / Q000503:physiopathology; D008111:Liver Function Tests; D016015:Logistic Models; D008875:Middle Aged; D009765:Obesity / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D012307:Risk Factors; D012737:Sex Factors; D036542:Tomography, Spiral Computed; D006113:United Kingdom / Q000453:epidemiology; D055105:Waist Circumference
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