title: Visceral adiposity and skeletal muscle mass are independently and synergistically associated with left ventricular structure and function: the Korean Genome and Epidemiology Study.
abstract: BACKGROUND
  Obesity and low muscle mass may coexist as age-related changes in body composition. We aimed to investigate the effect of visceral adiposity and skeletal muscle mass on left ventricular (LV) structure and function in the general population.
  
  
  METHODS
  A total of 1941 participants without known cardiovascular disease were enrolled from the Korean Genome and Epidemiology Study. Visceral fat area (VFA) was assessed by computed tomography. Appendicular skeletal muscle mass (ASM) was estimated by dual-energy X-ray absorptiometry and was used as a percentage of body weight (ASM/Wt). LV structure and function were assessed by tissue Doppler imaging (TDI) echocardiography.
  
  
  RESULTS
  Across VFA tertiles, ASM increased, but ASM/Wt decreased (all P<0.001). In multivariate models adjusted for conventional cardiovascular risk factors, LV mass index and LV diastolic parameters, such as left atrial dimension, TDI Ea velocity, and E/Ea ratio, were significantly impaired as VFA increased. On the other hand, an increase in ASM/Wt was associated with a decrease in LV mass index and improvement of LV diastolic parameters. With regard to LV mass index and TDI Ea velocity, VFA and ASM/Wt showed synergistic effects (all P interaction<0.05). When both VFA and ASM/Wt were simultaneously included in the same model, both remained independent predictors of LV mass index and TDI Ea velocity.
  
  
  CONCLUSIONS
  More visceral fat and less muscle mass are independently and synergistically associated with an increase in LV mass index and impairment of LV diastolic parameters. Further research is needed to explore the complex mechanisms underlying these associations.
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Republic of Korea.
authors.forename: Juri
authors.initials: J
authors.lastname: Park
authors.affiliation: Division of Endocrinology, Korea University Ansan Hospital, Ansan, Republic of Korea.
authors.forename: Nan Hee
authors.initials: NH
authors.lastname: Kim
authors.affiliation: Divison of Cardiology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea. Electronic address: cardioguy@korea.ac.kr.
authors.forename: Seong Hwan
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Divison of Cardiology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea.
authors.forename: Jin-Seok
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Divison of Cardiology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea.
authors.forename: Yong Hyun
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea.
authors.forename: Hong Euy
authors.initials: HE
authors.lastname: Lim
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea.
authors.forename: Eung Ju
authors.initials: EJ
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea.
authors.forename: Jin Oh
authors.initials: JO
authors.lastname: Na
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors.forename: Goo-Yeong
authors.initials: GY
authors.lastname: Cho
authors.affiliation: Department of Foods and Nutrition, Kookmin University, Seoul, Republic of Korea.
authors.forename: Inkyung
authors.initials: I
authors.lastname: Baik
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Republic of Korea.
authors.forename: Doo Man
authors.initials: DM
authors.lastname: Kim
authors.affiliation: Division of Endocrinology, Korea University Anam Hospital, Seoul, Republic of Korea.
authors.forename: Dong Seop
authors.initials: DS
authors.lastname: Choi
authors.affiliation: Institute of Human Genomic Study, Korea University Ansan Hospital, Ansan, Republic of Korea.
authors.forename: Seung Ku
authors.initials: SK
authors.lastname: Lee
authors.affiliation: Institute of Human Genomic Study, Korea University Ansan Hospital, Ansan, Republic of Korea.
authors.forename: Chol
authors.initials: C
authors.lastname: Shin
mesh_terms: D050154:Adiposity; D000368:Aged; D015992:Body Mass Index; D015331:Cohort Studies; D015150:Echocardiography, Doppler; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D050152:Intra-Abdominal Fat; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal; D056910:Republic of Korea; D012307:Risk Factors; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: Diastole; Echocardiography; Epidemiology; Left ventricular mass; Skeletal muscle mass; Visceral adiposity