title: Individual contributions of visceral fat and total body fat to subclinical atherosclerosis: The NEO study.
abstract: BACKGROUND
  Both overall and abdominal adiposity are established risk factors for cardiovascular disease. Visceral adipose tissue (VAT) and total body fat (TBF) are strongly correlated and previous studies did not make this distinction.
  
  
  OBJECTIVE
  We aimed to distinguish individual contributions of TBF, VAT, and the ratio of VAT to abdominal subcutaneous adipose tissue (VAT/SAT) to subclinical atherosclerosis in men and women.
  
  
  METHODS
  In this cross-sectional analysis of the Netherlands Epidemiology of Obesity (NEO) study, we assessed VAT and SAT with magnetic resonance imaging, TBF with bio-electrical impendence analysis, and carotid Intima-Media Thickness (cIMT) with ultrasound. We performed linear regression analyses of standardized values of TBF, VAT, VAT/SAT with cIMT. We adjusted the models for confounding factors (age, sex, ethnicity, education, smoking, alcohol, physical activity), and either for VAT or TBF.
  
  
  RESULTS
  This analysis included 2451 participants, 53% men with mean (SD) cIMT of 615 (91)μm. After adjustment for confounding factors, the difference in cIMT (95% CI) per SD in VAT was 14 (8,21)μm in men and 18 (13,24)μm in women. After adjustment for TBF, this attenuated to 5 (-3,13)μm in men and 13 (5,20)μm in women. In the full model, differences in cIMT (95% CI) per SD of TBF were 14 (6,22)μm in men and 8 (0,16)μm in women, and per SD of VAT/SAT were 7 (-1,15)μm and 9 (3,16)μm respectively.
  
  
  CONCLUSIONS
  In this population-based study, VAT contributed beyond overall adiposity to subclinical atherosclerosis, particularly in women. This implies a specific role of VAT in the early development of atherosclerosis.
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands; Department of Internal Medicine, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. Electronic address: k.b.gast@lumc.nl.
authors.forename: Karin B
authors.initials: KB
authors.lastname: Gast
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands; Department of Endocrinology, VU Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands. Electronic address: m.den_heijer@lumc.nl.
authors.forename: Martin
authors.initials: M
authors.lastname: den Heijer
authors.affiliation: Department of Endocrinology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands; Department of Internal Medicine, The Radboud University Nijmegen Medical Center, PO Box 9102, 6525 HP Nijmegen, The Netherlands. Electronic address: Jan.Smit@radboudumc.nl.
authors.forename: Johannes W A
authors.initials: JW
authors.lastname: Smit
authors.affiliation: Department of Radiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. Electronic address: r.l.widya@lumc.nl.
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Widya
authors.affiliation: Department of Radiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. Electronic address: h.j.lamb@lumc.nl.
authors.forename: Hildo J
authors.initials: HJ
authors.lastname: Lamb
authors.affiliation: Department of Radiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. Electronic address: a.de_roos@lumc.nl.
authors.forename: Albert
authors.initials: A
authors.lastname: de Roos
authors.affiliation: Department of Cardiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. Electronic address: j.w.jukema@lumc.nl.
authors.forename: J Wouter
authors.initials: JW
authors.lastname: Jukema
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. Electronic address: f.r.rosendaal@lumc.nl.
authors.forename: Frits R
authors.initials: FR
authors.lastname: Rosendaal
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. Electronic address: r.de_mutsert@lumc.nl.
authors.forename: Renée
authors.initials: R
authors.lastname: de Mutsert
mesh_terms: D050153:Abdominal Fat / Q000473:pathology*; D050154:Adiposity; D050197:Atherosclerosis / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*; D002318:Cardiovascular Diseases / Q000473:pathology*; D059168:Carotid Intima-Media Thickness; D003430:Cross-Sectional Studies; D017097:Electric Impedance; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009765:Obesity / Q000453:epidemiology* / Q000503:physiopathology*; D012737:Sex Factors; D050507:Subcutaneous Fat, Abdominal / Q000473:pathology
keywords: Cardiovascular disease; Carotid intima-media thickness; Epidemiology; MRI; Obesity; Total body fat; Visceral fat