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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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Obesity and Coronary Artery Disease: Evaluation and Treatment
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Visceral fat and coronary artery calcification in patients with chronic kidney disease
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“These results are in agreement with previous reports in community-based studies [4, 6, 18–20, 47], altogether adding further support to the Table 1.”
ResultAge at Adiposity Rebound Is Associated with Fat Mass in Young Adult Males—The GOOD Study
Ohlsson, C., Lorentzon, M., Norjavaara, E., & Kindblom, J. M. (2012) · PLoS ONE · doi:10.1371/journal.pone.0049404 · Cited by 43
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“more strongly associated with metabolic risk factors than subcutaneous abdominal adipose tissue was [32].”
BackgroundBritton, K. A., Wang, N., Palmisano, J. N., Corsini, E. M., Schlett, C. L., Hoffmann, U., Larson, M. G., Vasan, R. S., Vita, J. A., Mitchell, G. F., et al. (2013) · Obesity · doi:10.1002/oby.20166 · Cited by 43
“VAT has previously been shown to be associated with certain measures of vascular functions (16), cardiometabolic risk factors (17,18), and clinical cardiovascular diseases (18-20).”
BackgroundSelf-citationLee, J., Britton, K. A., Pedley, A., Massaro, J. M., Speliotes, E. K., Murabito, J. M., Hoffmann, U., Ingram, C., Keaney, J. F., Vasan, R. S., et al. (2016) · Journal of the American Heart Association · doi:10.1161/jaha.115.002936 · Cited by 43
“Models with SAT as the exposure were not adjusted for BMI because of concerns about multicollinearity.(4)”
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“There is also evidence that the correlation with directly measured adiposity is strong for child and adult BMI [99, 100] and moderate for neonatal weight [101]; furthermore, our results were similar for DXA derived FMI.”
ResultLi, B., Wang, J., Zhou, X. J., Liu, Y., Wang, W., Gao, Z., Tang, X., Yan, L., Wan, Q., Luo, Z., et al. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.921997 · Cited by 44
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“In European Americans from the FHS, the study sample consisted of Offspring (n 1⁄4 1,418) and Third Generation Study (n 1⁄4 2,111) participants between 2002 and 2005 who were part of the multi-detector CT sub-study (1).”
BackgroundMethodInfluentialSelf-citationDeterminants of glycemic control in female diabetic patients: a study from Iran
Ghazanfari, Z., Niknami, S., Ghofranipour, F. F., Larijani, B. A., Agha-Alinejad, H., & Montazeri, A. (2010) · Lipids in Health and Disease · doi:10.1186/1476-511x-9-83 · Cited by 42
Moreno‐Navarrete, J. M., Jové, M., Ortega, F. J., Xifra, G., Ricart, W., Òbis, È., Pamplona, R., Portero‐Otín, M., & Fernández‐Real, J. M. (2016) · Diabetologia · doi:10.1007/s00125-016-3863-1 · Cited by 42
“Obesity-related complications are mainly associated with the presence and amount of omental adipose tissue, leading to the assumption of a distinct deleterious role, as demonstrated in population studies [1].”
BackgroundInsulin action in muscle and adipose tissue in type 2 diabetes: The significance of blood flow
Lambadiari, V., Τriantafyllou, Κ., & Dimitriadis, G. (2015) · World Journal of Diabetes · doi:10.4239/wjd.v6.i4.626 · Cited by 42
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Artificial Intelligence in the Evaluation of Body Composition
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“Impaired circulatory levels of adiponectin correlate with increases in adiposity and cardio-metabolic risk [20, 21], while proinflammatory cytokines and serum leptin levels exponentially increase with increasing body fat mass [9, 22] and systemic insulin resistance [4].”
BackgroundUltrasound Estimates of Visceral and Subcutaneous-Abdominal Adipose Tissues in Infancy
Rolfe, E. D. L., Modi, N., Uthaya, S. N., Hughes, I. A., Dunger, D. B., Acerini, C. L., Stolk, R. P., & Ong, K. K. (2013) · Journal of Obesity · doi:10.1155/2013/951954 · Cited by 42
“In addition, subcutaneous-abdominal adipose tissue (SCA-AT) is also associated with insulin resistance and metabolic disorders in some studies [9, 10].”
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“VAT has been consistently linked with conventional cardiovascular risk factors [34], emergent risk factors [35] and type 2 diabetes [36].”
BackgroundShort-Term Dynamics and Metabolic Impact of Abdominal Fat Depots After Bariatric Surgery
Weiss, R., Appelbaum, L., Schweiger, C., Matot, I., Constantini, N., Idan, A., Shussman, N., Sosna, J., & Keidar, A. (2009) · Diabetes Care · doi:10.2337/dc09-0943 · Cited by 42
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Towards a consensus atlas of human and mouse adipose tissue at single-cell resolution
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“Conversely, excess SAT, especially in the gluteofemoral region (stereotypically seen in women, thus the older term ‘gynoid’ obesity), is associated with a relatively lower risk of metabolic dysfunction 11,14 .”
Kostopoulos, K. G., Alhanatis, E., Παμπούκας, Κ., Georgiopoulos, G. A., Zourla, A., Panoutsopoulos, A., Kallianos, A., Velentza, L., Zarogoulidis, P., & Trakada, G. (2015) · Sleep And Breathing · doi:10.1007/s11325-015-1236-5 · Cited by 41
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Sdralis, E., Argentou, M., Mead, N., Kehagias, I., Alexandridis, T., & Kalfarentzos, F. E. (2013) · Obesity Surgery · doi:10.1007/s11695-013-0925-z · Cited by 41
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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