title: The Association Between Subcutaneous Fat Density and the Propensity to Store Fat Viscerally.
abstract: BACKGROUND
  Alterations in the cellular characteristics of subcutaneous adipose tissue (SAT) may reduce its ability to expand in times of caloric excess, increasing the propensity to store excess calories viscerally (visceral adipose tissue [VAT]). We hypothesized (1) that increased SAT density, an indirect marker of fat quality, would be associated with an increased VAT/SAT ratio and increased cardiovascular disease (CVD) risk and (2) that these associations would be independent of the absolute volume of SAT.
  
  
  METHODS
  We investigated the association of SAT density with the VAT/SAT ratio and CVD risk in 3212 participants (48% women, mean age, 50.7 years) from the Framingham Heart Study. Adipose tissue depot density and volume were quantified by computed tomography; traditional CVD risk factors were quantified.
  
  
  RESULTS
  Higher SAT density was correlated with a higher VAT/SAT ratio in men (r = 0.17; P < .0001) but not in women (r = 0.04; P ≥ .05). More adverse levels of CVD risk factors were observed in the high SAT density/high VAT/SAT ratio group than in the referent group (low density/low ratio). For example, women had an increased risk of diabetes (odds ratio [OR], 6.7; 95% confidence interval [CI], 2.6-17.6; P = .0001) and hypertension (OR, 1.6; 95% CI, 1.1-2.4; P = .009). Additional adjustment for SAT volume generally strengthened these associations (diabetes OR, 10.8; 95% CI, 4.1-29.0; hypertension OR, 2.5; 95% CI, 1.7-3.7; all P < .0001). These trends were similar but generally weaker in men.
  
  
  CONCLUSIONS
  High fat density, an indirect marker of fat quality, is associated with the propensity to store fat viscerally vs subcutaneously and is jointly characterized by an increased burden of CVD risk factors.
authors.affiliation: National Heart, Lung, and Blood Institute Framingham Heart Study (A.J.Y., A.P., K.J.R., C.S.F.), Framingham, Massachusetts 01702-5827; Division of Endocrinology and Metabolism (C.S.F.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115; and Department of Radiology (U.H.), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114.
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Yeoh
authors.affiliation: National Heart, Lung, and Blood Institute Framingham Heart Study (A.J.Y., A.P., K.J.R., C.S.F.), Framingham, Massachusetts 01702-5827; Division of Endocrinology and Metabolism (C.S.F.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115; and Department of Radiology (U.H.), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114.
authors.forename: Alison
authors.initials: A
authors.lastname: Pedley
authors.affiliation: National Heart, Lung, and Blood Institute Framingham Heart Study (A.J.Y., A.P., K.J.R., C.S.F.), Framingham, Massachusetts 01702-5827; Division of Endocrinology and Metabolism (C.S.F.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115; and Department of Radiology (U.H.), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114.
authors.forename: Klara J
authors.initials: KJ
authors.lastname: Rosenquist
authors.affiliation: National Heart, Lung, and Blood Institute Framingham Heart Study (A.J.Y., A.P., K.J.R., C.S.F.), Framingham, Massachusetts 01702-5827; Division of Endocrinology and Metabolism (C.S.F.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115; and Department of Radiology (U.H.), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114.
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.affiliation: National Heart, Lung, and Blood Institute Framingham Heart Study (A.J.Y., A.P., K.J.R., C.S.F.), Framingham, Massachusetts 01702-5827; Division of Endocrinology and Metabolism (C.S.F.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115; and Department of Radiology (U.H.), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114.
authors.forename: Caroline S
authors.initials: CS
authors.lastname: Fox
mesh_terms: D050154:Adiposity / Q000502:physiology*; D000328:Adult; D000368:Aged; D002452:Cell Count; D015331:Cohort Studies; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat / Q000033:anatomy & histology* / Q000166:cytology*; D008297:Male; D008875:Middle Aged; D056128:Obesity, Abdominal / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D012307:Risk Factors; D050151:Subcutaneous Fat / Q000033:anatomy & histology* / Q000166:cytology*; D050507:Subcutaneous Fat, Abdominal / Q000033:anatomy & histology / Q000166:cytology