Visceral and ectopic fat, atherosclerosis, and cardiometabolic disease: a position statement
Open accessAbstract
Findings from epidemiological studies over the past 30 years have shown that visceral adipose tissue, accurately measured by CT or MRI, is an independent risk marker of cardiovascular and metabolic morbidity and mortality. Emerging evidence also suggests that ectopic fat deposition, including hepatic and epicardial fat, might contribute to increased atherosclerosis and cardiometabolic risk. This joint position statement from the International Atherosclerosis Society and the International Chair on Cardiometabolic Risk Working Group on Visceral Obesity summarises the evidence for visceral adiposity and ectopic fat as emerging risk factors for type 2 diabetes, atherosclerosis, and cardiovascular disease, with a focus on practical recommendations for health professionals and future directions for research and clinical practice. We discuss the measurement of visceral and ectopic fat, pathophysiology and contribution to adverse health outcomes, response to treatment, and lessons from a public health programme targeting visceral and ectopic fat. We identify knowledge gaps and note the need to develop simple, clinically applicable tools to be able to monitor changes in visceral and ectopic fat over time. Finally, we recognise the need for public health messaging to focus on visceral and ectopic fat in addition to excess bodyweight to better combat the growing epidemic of obesity worldwide.
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Reduction in visceral adipose tissue in response to exercise can be obtained in the absence of substantial weight loss.
“Interestingly, there is convincing evidence that reduction in visceral adipose tissue in response to exercise can be obtained in the absence of substantial weight loss.”
Visceral fat is a stronger predictor of disease risk than subcutaneous fat.
“It also overlooks fat distribution patterns; visceral fat, which surrounds internal organs and drives metabolic dysfunction, is a stronger predictor of disease risk than subcutaneous fat but remains invisible to BMI [13].”
From Obesity: Clinical Impact, Pathophysiology, Complications, and Modern Innovations in Therapeutic Strategies (2025) · cites this paper as [13]
The prothrombotic and proinflammatory milieu of fat deposits plays a key role in cardiovascular disease pathogenesis.
“It has been proposed that the prothrombotic and proinflammatory milieu of these fat deposits plays a key role in CVD pathogenesis [1, 2].”
From Semaglutide for cardiovascular event reduction in people with overweight or obesity: <scp>SELECT</scp> study baseline characteristics (2023) · cites this paper as [2]
The extent of ectopic and visceral adipose tissue depots is associated with cardiovascular outcomes independent of other traditional risk factors.
“Prospective studies have shown that the extent of ectopic and visceral adipose tissue depots, visualized by computed tomography or magnetic resonance imaging, is associated with CV outcomes independent of other traditional risk factors [2].”
From Semaglutide for cardiovascular event reduction in people with overweight or obesity: <scp>SELECT</scp> study baseline characteristics (2023) · cites this paper as [2]
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“In particular, the pro-inflammatory state linked to the resultant ectopic lipid deposition and the adipose tissue dysfunction, which favors the insulin resistance in adipose tissue, skeletal muscle and liver, and features of the metabolic syndrome (MetS), represent emerging factors of global cardio-metabolic-risk [8].”
BackgroundPhysical activity and exercise for weight loss and maintenance in people living with obesity
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- Authors
- Neeland, I. J., Ross, R., Després, J.-P., Matsuzawa, Y., Yamashita, S., Shai, I., Seidell, J., Magni, P., Santos, R. D., Arsenault, B., Cuevas, A., Hu, F. B., Griffin, B., Zambon, A., Barter, P., Fruchart, J.-C., & Eckel, R. H.
- Affiliations
- The University of Texas Southwestern Medical Center (US)
- Queen's University (CA)
- Institut universitaire de cardiologie et de pneumologie de Québec (CA)
- The University of Osaka (JP)
- Ben-Gurion University of the Negev (IL)
- University of Milan (IT)
- Universidade de São Paulo (BR)
- Clínica Las Condes (CL)
- Harvard University (US)
- University of Surrey (GB)
- University of Padua (IT)
- UNSW Sydney (AU)
- Fondation Coeur et Artères (FR)
- University of Colorado Anschutz (US)
- Corresponding author
- Després, Jean-Pierre
- ORCID
- Venue
- The Lancet Diabetes & Endocrinology
- Publisher
- Elsevier BV
- Published
- 2019-09
- Volume
- 7
- Issue
- 9
- Pages
- 715-725
- ISSN
- 2213-8587 (ISSN-L)
- OpenAlex
- W2961683851
- Semantic Scholar
- a567c42de3ca04500d8bc2703a40400b95d5d137
- Cited by
- 1,603
- References
- 108
- Citations by year
- 2026: 326 · 2025: 349 · 2024: 244 · 2023: 212 · 2022: 215 · 2021: 154 · 2020: 95 · 2019: 8
- FWCI
- 85.33
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Lancet Diabetes & Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- VU Research Portal (publishedVersion, other-oa)
- Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
- Surrey Research Insight Open Access (The University of Surrey) (submittedVersion)
- Padua Research Archive (University of Padova) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- International Chair on Cardiometabolic Risk
- Université Laval
- International Atherosclerosis Society
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Disease and Adiposity
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
- Keywords
- visceral adipose tissue, ectopic fat, liver fat, epicardial adipose tissue, atherosclerosis, cardiometabolic disease, type 2 diabetes, cardiovascular disease, obesity, visceral obesity, fat measurement, public health communication, obesity epidemic
- MeSH terms
- Humans, Insulin Resistance, Metabolic Syndrome, Waist-Hip Ratio, Intra-Abdominal Fat, Atherosclerosis, Lipid Metabolism, Obesity, Abdominal
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