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Abdominal Visceral and Subcutaneous Adipose Tissue Compartments: Association With Metabolic Risk Factors in the Framingham Heart Study
Abstract
Background— Visceral adipose tissue (VAT) compartments may confer increased metabolic risk. The incremental utility of measuring both visceral and subcutaneous abdominal adipose tissue (SAT) in association with metabolic risk factors and underlying heritability has not been well described in a population-based setting. Methods and Results— Participants (n=3001) were drawn from the Framingham Heart Study (48% women; mean age, 50 years), were free of clinical cardiovascular disease, and underwent multidetector computed tomography assessment of SAT and VAT volumes between 2002 and 2005. Metabolic risk factors were examined in relation to increments of SAT and VAT after multivariable adjustment. Heritability was calculated using variance-components analysis. Among both women and men, SAT and VAT were significantly associated with blood pressure, fasting plasma glucose, triglycerides, and high-density lipoprotein cholesterol and with increased odds of hypertension, impaired fasting glucose, diabetes mellitus, and metabolic syndrome ( P range <0.01). In women, relations between VAT and risk factors were consistently stronger than in men. However, VAT was more strongly correlated with most metabolic risk factors than was SAT. For example, among women and men, both SAT and VAT were associated with increased odds of metabolic syndrome. In women, the odds ratio (OR) of metabolic syndrome per 1–standard deviation increase in VAT (OR, 4.7) was stronger than that for SAT (OR, 3.0; P for difference between SAT and VAT <0.0001); similar differences were noted for men (OR for VAT, 4.2; OR for SAT, 2.5). Furthermore, VAT but not SAT contributed significantly to risk factor variation after adjustment for body mass index and waist circumference ( P ≤0.01). Among overweight and obese individuals, the prevalence of hypertension, impaired fasting glucose, and metabolic syndrome increased linearly and significantly across increasing VAT quartiles. Heritability values for SAT and VAT were 57% and 36%, respectively. Conclusions— Although both SAT and VAT are correlated with metabolic risk factors, VAT remains more strongly associated with an adverse metabolic risk profile even after accounting for standard anthropometric indexes. Our findings are consistent with the hypothesized role of visceral fat as a unique, pathogenic fat depot. Measurement of VAT may provide a more complete understanding of metabolic risk associated with variation in fat distribution.
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“Body fat has better predictive validity on the development of the metabolic syndrome192 and cardiovascular disease risk193 than BMI.”
From Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies (2018) · cites this paper as [192]
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“Moreover, ectopic fat depots, such as epicardial and perivascular fat, might exert local pathogenic effects on heart and blood vessels.[7][8][9]”
From Semaglutide and cardiovascular outcomes by baseline and changes in adiposity measurements: a prespecified analysis of the SELECT trial (2025) · cites this paper as [7]
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“In addition to the association between triglyceride levels and BMI, the Framingham Heart Study 155 reported strong associations of triglyceride levels with both subcutaneous abdominal adipose tissue and visceral adipose tissue in men and women (mean age 50 years).”
From Triglycerides and Cardiovascular Disease: A Scientific Statement From the American Heart Association (2011) · cites this paper as [155]
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“Thus, although it is clear that excess adiposity is associated with elevated triglyceride levels, visceral adiposity is a greater contributor than subcutaneous adipose tissue.155,156”
From Triglycerides and Cardiovascular Disease: A Scientific Statement From the American Heart Association (2011) · cites this paper as [155]
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“In humans, the risk of cardiovascular disease, including hypertension, is directly correlated to V-fat size, as assessed by waist circumference or more directly via computed tomography (Tchernof and Despres, 2013; Liu et al., 2010; Fox et al., 2007).”
Keimling, M., Renehan, A. G., Behrens, G., Fischer, B., Hollenbeck, A. R., Cross, A. J., & Leitzmann, M. F. (2013) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-13-0353 · Cited by 61
“considered to be more closely related with insulin resistance than total body fat (11), and may be a stronger predictor for cardiovascular disease and type II diabetes than BMI (12, 13).”
BackgroundViewpoints on the Way to the Consensus Session
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Heritable components of the human fecal microbiome are associated with visceral fat
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Metabolically healthy obesity: Misleading phrase or healthy phenotype?
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Regional fat distribution and cardiometabolic risk in healthy postmenopausal women
Peppa, Μ., Koliaki, C. C., Hadjidakis, D. I., Garoflos, E., Papaefstathiou, A., Katsilambros, N. L., Raptis, S., & Dimitriadis, G. (2013) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2013.07.001 · Cited by 60
“Abdominal, particularly visceral, adiposity is causally involved in the pathogenesis of metabolic syndrome [9], while the”
BackgroundRichardson, K., Louie‐Gao, Q., Arnett, D. K., Parnell, L. D., Lai, C., Dávalos, A., Fox, C. S., Demissie, S., Cupples, L. A., Fernandez-Hernando, C. F., et al. (2011) · PLoS ONE · doi:10.1371/journal.pone.0017944 · Cited by 60
Self-citationRole of developmental transcription factors in white, brown and beige adipose tissues
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Human omental and subcutaneous adipose tissue exhibit specific lipidomic signatures
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“For instance, in the Framingham Heart Study, the omental and subcutaneous adipose tissue volumes of 3001 subjects were investigated in relation to several metabolic risk factors, with the conclusion that the omental adipose tissue is a unique, pathogenic fat depot (1).”
BackgroundUpper Body Subcutaneous Fat Is Associated with Cardiometabolic Risk Factors
Lee, J., Pedley, A., Therkelsen, K. E., Hoffmann, U., Massaro, J. M., Levy, D. A., & Long, M. T. (2017) · The American Journal of Medicine · doi:10.1016/j.amjmed.2017.01.044 · Cited by 62
“1) Visceral Adipose Tissue, cm3 1,641 (1,026) 2,936 (1,353) Continuous Cardiometabolic Risk Factors Systolic Blood Pressure, mm Hg 120.”
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“Further, abdominal visceral fat has been strongly associated with cardiovascular risk [13, 14].”
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Abdominal adiposity and family income-to-poverty ratio in American women
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Genome-Wide Association of Pericardial Fat Identifies a Unique Locus for Ectopic Fat
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Self-citationImpact of Abdominal Visceral Adipose Tissue on Disease Outcome in Pediatric Crohnʼs Disease
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“Obesity-related metabolic disorders have been shown to correlate with relative increases in VAT volume.(3) Higher VAT volumes have been shown to correlate with increased odds of colorectal adenoma and cardiovascular disease in adult patients.”
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“This is consistent with cross-sectional associations of VAT with serum glucose, lipids, and BP (35,36).”
ResultFree Fatty Acid Storage in Human Visceral and Subcutaneous Adipose Tissue
Ali, A. H., Koutsari, C., Mundi, M., Stegall, M. D., Heimbach, J. K., Taler, S. J., Nygren, J., Thorell, A., Bogachus, L. D., Turcotte, L. P., et al. (2011) · Diabetes · doi:10.2337/db11-0219 · Cited by 58
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Did the American Medical Association make the correct decision classifying obesity as a disease?
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Mapping body fat distribution: A key step towards the identification of the vulnerable patient?
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Sagittal Abdominal Diameter as a New Predictor for Incident Diabetes
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Cohort Profile: The Saguenay Youth Study (SYS)
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Longitudinal associations of active commuting with body mass index
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“…adiposity to increase the precision of the outcome measures (Wong et al., 2003) and to shed mechanistic insight into the relationship between active travel and cardio-metabolic disease by testing associations with specific types of body fat linked to disease (Fox et al., 2007; Preis et al., 2010).”
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“Consistent with previous observational researches, we confirmed detrimental impacts of VAT on cardiometabolic traits including lipid profiles and glucose profiles (Fox et al., 2007; Liu et al., 2010).”
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Metadata
- Authors
- Fox, C. S., Massaro, J. M., Hoffmann, U., Pou, K. M., Maurovich-Horvat, P., Liu, C.-Y., Vasan, R. S., Murabito, J. M., Meigs, J. B., Cupples, L. A., D’Agostino, R. B., & O’Donnell, C. J.
- Affiliations
- Boston University (US)
- From the National Heart, Lung and Blood Institute’s Framingham Heart Study (C.S.F., C.J.O.), Framingham, Mass; Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine (C.S.F., K.M.P.), Brigham and Women’s Hospital and Harvard Medical School, Boston, Mass; Boston University, Department of Mathematics (J.M.M.; R.B.D.) and School of Public Health, Division of Biostatistics (C.-Y.L., L.A.C.), Boston, Mass; Radiology Department (U.H.) and Department of Medicine (J.B.M., C.J.O.),...
- ORCID
- Venue
- Circulation
- Published
- 2007-07-03
- Volume
- 116
- Issue
- 1
- Pages
- 39-48
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W1989400130
- Cited by
- 2,882
- References
- 78
- Citations by year
- 2026: 102 · 2025: 163 · 2024: 172 · 2023: 164 · 2022: 190 · 2021: 196 · 2020: 162 · 2019: 161 · 2018: 161 · 2017: 157 · 2016: 182 · 2015: 182 · 2014: 184 · 2013: 151 · 2012: 124
- FWCI
- 68.66
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (n01hc25195-41-0-1)
- National Heart, Lung, and Blood Institute (N01‐HC25195, K24HL004334)
- National Institute of Diabetes and Digestive and Kidney Diseases (T32DK007529)
- 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 › Endocrinology, Diabetes and Metabolism › Adipokines, Inflammation, and Metabolic Diseases
- Keywords
- visceral adipose tissue, subcutaneous adipose tissue, metabolic risk factors, metabolic syndrome, sex differences, hypertension, impaired fasting glucose, diabetes mellitus, body fat distribution, obesity, body mass index, waist circumference
- MeSH terms
- Adult, Calcium, Cardiovascular Diseases, Coronary Disease, Diabetes Mellitus, Female, Humans, Hypercholesterolemia, Hyperglycemia, Hypertension, Male, Middle Aged, Obesity, Organ Size, Risk, Sex Factors, United States, Hypertriglyceridemia, Cohort Studies, Comorbidity, Body Mass Index, Glucose Intolerance, Metabolic Syndrome, Tomography, Spiral Computed, Intra-Abdominal Fat, Overweight, Subcutaneous Fat, Abdominal
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