title: Visceral adiposity and the risk of metabolic syndrome across body mass index: the MESA Study.
abstract: OBJECTIVE
  This study sought to evaluate differential effects of visceral fat (VF) and subcutaneous fat and their effects on metabolic syndrome (MetS) risk across body mass index (BMI) categories.
  
  
  BACKGROUND
  The regional distribution of adipose tissue is an emerging risk factor for cardiometabolic disease, although serial changes in fat distribution have not been extensively investigated. VF and its alterations over time may be a better marker for risk than BMI in normal weight and overweight or obese individuals.
  
  
  METHODS
  We studied 1,511 individuals in the MESA (Multi-Ethnic Study of Atherosclerosis) with adiposity assessment by computed tomography (CT). A total of 253 participants without MetS at initial scan underwent repeat CT (median interval 3.3 years). We used discrete Cox regression with net reclassification to investigate whether baseline and changes in VF area are associated with MetS.
  
  
  RESULTS
  Higher VF was associated with cardiometabolic risk and coronary artery calcification, regardless of BMI. After adjustment, VF was more strongly associated with incident MetS than subcutaneous fat regardless of weight, with a 28% greater MetS hazard per 100 cm(2)/m VF area and significant net reclassification (net reclassification index: 0.44, 95% confidence interval [CI]: 0.29 to 0.60) over clinical risk. In individuals with serial imaging, initial VF (hazard ratio: 1.24 per 100 cm(2)/m, 95% CI: 1.08 to 1.44 per 100 cm(2)/m, p = 0.003) and change in VF (hazard ratio: 1.05 per 5% change, 95% CI: 1.01 to 1.08 per 5% change, p = 0.02) were associated with MetS after adjustment. Changes in subcutaneous fat were not associated with incident MetS after adjustment for clinical risk and VF area.
  
  
  CONCLUSIONS
  VF is modestly associated with BMI. However, across BMI, a single measure of and longitudinal change in VF predict MetS, even accounting for weight changes. Visceral adiposity is essential to assessing cardiometabolic risk, regardless of age, race, or BMI, and may serve as a marker and target of therapy in cardiometabolic disease.
authors.affiliation: Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Ravi V
authors.initials: RV
authors.lastname: Shah
authors.affiliation: Department of Medicine (Cardiovascular Medicine Division) and Department of Radiology (Nuclear Medicine and Cardiothoracic Imaging Divisions), University of Michigan, Ann Arbor, Michigan. Electronic address: vlmurthy@med.umich.edu.
authors.forename: Venkatesh L
authors.initials: VL
authors.lastname: Murthy
authors.affiliation: Non-Invasive Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Siddique A
authors.initials: SA
authors.lastname: Abbasi
authors.affiliation: Non-Invasive Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Ron
authors.initials: R
authors.lastname: Blankstein
authors.affiliation: Non-Invasive Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Raymond Y
authors.initials: RY
authors.lastname: Kwong
authors.affiliation: Joslin Diabetes Center, Boston, Massachusetts.
authors.forename: Allison B
authors.initials: AB
authors.lastname: Goldfine
authors.affiliation: Non-Invasive Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Michael
authors.initials: M
authors.lastname: Jerosch-Herold
authors.affiliation: Division of Cardiology, Johns Hopkins Medical Institute, Baltimore, Maryland.
authors.forename: João A C
authors.initials: JA
authors.lastname: Lima
authors.affiliation: Department of Medicine, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina.
authors.forename: Jingzhong
authors.initials: J
authors.lastname: Ding
authors.affiliation: Department of Family and Preventative Medicine, University of California-San Diego, San Diego, California.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Allison
mesh_terms: D050154:Adiposity / Q000208:ethnology; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D015992:Body Mass Index; D016009:Chi-Square Distribution; D006801:Humans; D015994:Incidence; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008055:Lipids / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000175:diagnosis / Q000208:ethnology / Q000503:physiopathology*; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000000981:diagnostic imaging / Q000208:ethnology / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D008055:Lipids
keywords: cardiometabolic risk; metabolic syndrome; obesity