title: Metabolic correlates of subcutaneous and visceral abdominal fat measured by ultrasonography: a comparison with waist circumference.
abstract: BACKGROUND
  The relative contribution of visceral (VAT) and subcutaneous (SAT) adipose tissue to cardiometabolic disease is controversial. The aim of this study was to evaluate whether dissecting abdominal fat in VAT and SAT using US may detect stronger and more specific association with MS, MS components, hyperuricemia and altered liver enzymes compared to waist circumference.
  
  
  METHODS
  We performed a cross-sectional study on 2414 subjects aged 18 to 66 years (71 % women) followed at the International Center for the Assessment of Nutritional Status (ICANS, Milan, Italy). VAT and SAT were measured using ultrasonography. Multivariable logistic regression controlling for age and gender was used to evaluate the association of the parameters of interest (waist circumference (WC), VAT, SAT and VAT + SAT) with the MS (international harmonized definition), its components (high triglycerides, low HDL, high blood pressure, high glucose), high uric acid (≥7 mg/dl), high alanine transaminase (ALT, ≥ 30 U/l) and high gamma-glutamyl-transferase (GGT, ≥ 30 U/l).
  
  
  RESULTS
  VAT was independently associated with all the outcomes of interest, while SAT was independently associated with MS and only with high blood pressure and high ALT when we considered the single parameters of MS and NAFLD. VAT had the strongest association with high triglycerides, high ALT and high GGT. The VAT + SAT association had the strongest association with MS. WC had the strongest association with low HDL and high blood pressure. VAT and WC were similarly associated to high glucose and high uric acid.
  
  
  CONCLUSIONS
  US-determined VAT and SAT are both independently associated with MS. Moreover, to our knowledge, we are the first to show that VAT, being associated to all of the MS components in addition to hyperuricemia and altered liver enzymes, performs equally or better than WC except for high blood pressure and low HDL.
authors.affiliation: Department of Food, Environmental and Nutritional Sciences (DEFENS), International Center for the Assessment of Nutritional Status (ICANS), University of Milan, Via Botticelli 21, 20133, Milano, Italy. simona.bertoli@unimi.it.
authors.forename: Simona
authors.initials: S
authors.lastname: Bertoli
authors.affiliation: Department of Food, Environmental and Nutritional Sciences (DEFENS), International Center for the Assessment of Nutritional Status (ICANS), University of Milan, Via Botticelli 21, 20133, Milano, Italy. alessandro.leone1@unimi.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Leone
authors.affiliation: Department of Food, Environmental and Nutritional Sciences (DEFENS), International Center for the Assessment of Nutritional Status (ICANS), University of Milan, Via Botticelli 21, 20133, Milano, Italy. laila.vignati@unimi.it.
authors.forename: Laila
authors.initials: L
authors.lastname: Vignati
authors.affiliation: Department of Food, Environmental and Nutritional Sciences (DEFENS), International Center for the Assessment of Nutritional Status (ICANS), University of Milan, Via Botticelli 21, 20133, Milano, Italy. angela.spadafranca@unimi.it.
authors.forename: Angela
authors.initials: A
authors.lastname: Spadafranca
authors.affiliation: Department of Food, Environmental and Nutritional Sciences (DEFENS), International Center for the Assessment of Nutritional Status (ICANS), University of Milan, Via Botticelli 21, 20133, Milano, Italy. giorgiobedogni@gmail.com.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bedogni
authors.affiliation: Division of Radiology, Ospedale Niguarda Cà Granda, Milan, Italy. angelo.vanzulli@unimi.it.
authors.forename: Angelo
authors.initials: A
authors.lastname: Vanzulli
authors.affiliation: Department of Food, Environmental and Nutritional Sciences (DEFENS), International Center for the Assessment of Nutritional Status (ICANS), University of Milan, Via Botticelli 21, 20133, Milano, Italy. elena.rodeschini@unimi.it.
authors.forename: Elena
authors.initials: E
authors.lastname: Rodeschini
authors.affiliation: Department of Food, Environmental and Nutritional Sciences (DEFENS), International Center for the Assessment of Nutritional Status (ICANS), University of Milan, Via Botticelli 21, 20133, Milano, Italy. alberto.battezzati@unimi.it.
authors.forename: Alberto
authors.initials: A
authors.lastname: Battezzati
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001794:Blood Pressure; D015992:Body Mass Index; D001835:Body Weight; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging*; D007558:Italy; D016015:Logistic Models; D008297:Male; D024821:Metabolic Syndrome / Q000378:metabolism / Q000503:physiopathology*; D008875:Middle Aged; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D009752:Nutritional Status; D012307:Risk Factors; D050151:Subcutaneous Fat / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D014527:Uric Acid / Q000097:blood; D055105:Waist Circumference; D055815:Young Adult; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D014527:Uric Acid; D005723:gamma-Glutamyltransferase; D000410:Alanine Transaminase