title: Visceral adiposity is negatively associated with bone density and muscle attenuation.
abstract: BACKGROUND
  The storage of adipose tissue in ectopic compartments is a hallmark attribute linking greater body mass index (BMI) with cardiometabolic diseases. Despite ample evidence to confirm that increased visceral adipose tissue (VAT) deposition occurs with obesity, the interrelations between altered fat partitioning and regional muscle and bone quality are less well understood.
  
  
  OBJECTIVE
  We examined the association between adiposity and spinal muscle and bone quality across a large, heterogeneous cohort of adults.
  
  
  METHODS
  We identified 8833 thoracic or abdominal computed tomography scans from patients in the University of Michigan Health System who were aged 18-64.9 y. We measured trabecular bone densities, cortical bone densities, VAT areas, and subcutaneous adipose tissue (SAT) areas at vertebral levels T7 to L5. Psoas muscle attenuation (an indicator of fat infiltration in muscle) was measured at the L4 level.
  
  
  RESULTS
  Muscle attenuation as well as trabecular and cortical bone densities revealed negative correlations with BMI, SAT, and VAT. The correlation between BMI and psoas attenuation was -0.321, between BMI and the density of cortical bone was -0.250, and between BMI and trabecular bone was -0.143 (all P < 0.001). However, correlations between VAT and lower muscle attenuation were stronger as were those between VAT and lower bone densities. Inverse correlations between VAT and densities of psoas muscle and cortical and trabecular bone were -0.460, -0.407, and -0.434, respectively (P < 0.001). Even after adjustment for age, sex, and BMI, partial correlations between VAT, muscle attenuation, and bone densities remained significant at -0.250, -0.119, and -0.216, respectively (P < 0.001).
  
  
  CONCLUSIONS
  Contrary to previous reports that high body mass is associated with increased bone quality, our data show a significant negative association between BMI and muscle and bone densities, suggesting fat infiltration into these tissues. More importantly, correlations between VAT and decreased bone and muscle densities remained statistically significant even after adjustment for age, sex, and BMI.
authors: From the Departments of Surgery (PZ and SCW) and Physical Medicine and Rehabilitation (MP), VA Ann Arbor Healthcare System, Ann Arbor, MI, and the Department of Internal Medicine and Surgery (GLS), and the Morphomic Analysis Group (PZ, GLS, and SCW), University of Michigan, Ann Arbor, MI.
authors: Peng
authors: P
authors: Zhang
authors: From the Departments of Surgery (PZ and SCW) and Physical Medicine and Rehabilitation (MP), VA Ann Arbor Healthcare System, Ann Arbor, MI, and the Department of Internal Medicine and Surgery (GLS), and the Morphomic Analysis Group (PZ, GLS, and SCW), University of Michigan, Ann Arbor, MI.
authors: Mark
authors: M
authors: Peterson
authors: From the Departments of Surgery (PZ and SCW) and Physical Medicine and Rehabilitation (MP), VA Ann Arbor Healthcare System, Ann Arbor, MI, and the Department of Internal Medicine and Surgery (GLS), and the Morphomic Analysis Group (PZ, GLS, and SCW), University of Michigan, Ann Arbor, MI.
authors: Grace L
authors: GL
authors: Su
authors: From the Departments of Surgery (PZ and SCW) and Physical Medicine and Rehabilitation (MP), VA Ann Arbor Healthcare System, Ann Arbor, MI, and the Department of Internal Medicine and Surgery (GLS), and the Morphomic Analysis Group (PZ, GLS, and SCW), University of Michigan, Ann Arbor, MI.
authors: Stewart C
authors: SC
authors: Wang
mesh_terms: D050154:Adiposity; D000293:Adolescent; D000328:Adult; D001823:Body Composition; D015992:Body Mass Index; D015519:Bone Density; D001842:Bone and Bones / Q000503:physiopathology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000503:physiopathology*; D056128:Obesity, Abdominal / Q000503:physiopathology*; D011859:Radiography; D050151:Subcutaneous Fat / Q000000981:diagnostic imaging; D055815:Young Adult
keywords: analytic morphomics; bone density; computed tomography; muscle attenuation; visceral adiposity
references: Am J Physiol Endocrinol Metab. 2009 Nov;297(5):E987-98
references: 19738037
references: Obesity (Silver Spring). 2014 Mar;22(3):863-7
references: 23625641
references: Curr Opin Clin Nutr Metab Care. 2008 Nov;11(6):693-700
references: 18827572
references: Am J Clin Nutr. 1991 Sep;54(3):509-15
references: 1877507
references: Am J Med. 2011 Nov;124(11):1043-50
references: 22017783
references: Diabetes Care. 2010 Jul;33(7):1652-4
references: 20460442
references: Obesity (Silver Spring). 2010 Dec;18(12):2379-84
references: 20300085
references: FASEB J. 1995 Feb;9(2):273-8
references: 7781930
references: Nature. 2006 Dec 14;444(7121):881-7
references: 17167477
references: J Appl Physiol (1985). 2001 Jun;90(6):2157-65
references: 11356778
references: Ageing Res Rev. 2014 May;15:51-60
references: 24632496
references: J Gerontol A Biol Sci Med Sci. 2010 Mar;65(3):295-9
references: 19864639
references: J Gerontol A Biol Sci Med Sci. 2008 Oct;63(10):1076-81
references: 18948558
references: J Appl Physiol (1985). 2007 Mar;102(3):919-25
references: 17095641
references: Endocr Rev. 2000 Dec;21(6):697-738
references: 11133069
references: J Gerontol A Biol Sci Med Sci. 2002 May;57(5):M326-32
references: 11983728
references: J Aging Res. 2012;2012:172957
references: 22666591
references: Arch Intern Med. 2007 Apr 9;167(7):635-41
references: 17420420
references: Med Sci Sports Exerc. 2009 Nov;41(11):2050-5
references: 19812511
references: Obesity (Silver Spring). 2009 May;17(5):1062-9
references: 19165157
references: Obes Rev. 2010 Jan;11(1):11-8
references: 19656312
references: Arterioscler Thromb Vasc Biol. 2008 Jun;28(6):1039-49
references: 18356555
references: J Am Geriatr Soc. 2010 Nov;58(11):2076-84
references: 21054287
references: J Appl Physiol (1985). 2000 Jul;89(1):104-10
references: 10904041
references: BMJ. 2008;337:a439
references: 18595904
references: Am J Prev Med. 2011 Jan;40(1):39-46
references: 21146766
references: Diabetes. 1999 Apr;48(4):839-47
references: 10102702
references: Am J Clin Nutr. 2009 Dec;90(6):1579-85
references: 19864405
references: Am J Clin Nutr. 2009 Mar;89(3):807-14
references: 19158213
references: Radiology. 2013 Nov;269(2):534-41
references: 23861502
references: J Clin Densitom. 2013 Oct-Dec;16(4):450-4
references: 24063845
references: Curr Opin Clin Nutr Metab Care. 2010 Jul;13(4):382-90
references: 20495453
references: J Gerontol A Biol Sci Med Sci. 2013 Mar;68(3):317-23
references: 22904095
references: Biometrics. 2002 Jun;58(2):332-41
references: 12071406
references: Diabetes. 2002 Jul;51(7):2005-11
references: 12086926
references: PLoS One. 2010 May 26;5(5):e10805
references: 22421977
references: J Gerontol A Biol Sci Med Sci. 2005 Mar;60(3):324-33
references: 15860469
references: Am J Clin Nutr. 2012 Oct;96(4):714-26
references: 22932278
references: Age Ageing. 2013 Nov;42(6):734-40
references: 23761456
references: Am J Clin Nutr. 2007 Feb;85(2):377-84
references: 17284732
references: Circulation. 2012 Sep 4;126(10):1301-13
references: 22949540
references: J Clin Endocrinol Metab. 2013 Jun;98(6):2562-72
references: 23515452
references: J Bone Miner Res. 2012 Jan;27(1):1-10
references: 23348758
references: Nat Cell Biol. 2010 Feb;12(2):102-4
references: 20081844
references: Diabetes. 2002 Jan;51(1):144-51
references: 11756334
references: J Clin Endocrinol Metab. 2009 Apr;94(4):1104-10
references: 19126626
references: Endocrinol Metab Clin North Am. 2008 Dec;37(4):841-56
references: 19026935
references: Am J Clin Nutr. 2000 Apr;71(4):885-92
references: 10731493