Association Between Visceral and Subcutaneous Adipose Depots and Incident Cardiovascular Disease Risk Factors
Background—Visceral and subcutaneous adipose tissue (VAT and SAT) vary in volume and quality. We evaluated whether fat volume or attenuation (indirect measure of quality) predicts metabolic risk factor changes.
Methods and Results—Framingham Heart Study Multi-detector Computed Tomography Substudy participants (n=1730, 45% women) were followed over a mean of 6.2 years. Baseline VAT and SAT volume (in cm3) and attenuation (in Hounsfield units, HU) were assessed. Outcomes included blood pressure, lipids and glucose. We constructed multivariable regression models predicting change from baseline to follow-up. Baseline VAT was associated with metabolic risk factors at follow-up. Per 500 cm3 increment in baseline VAT, glucose was 2.34 mg/dL higher (95% CI 1.71-2.97) and HDL was 1.62 mg/dL lower (95% CI 0.97-2.28) in women (p<0.0001 for both). These findings remained significant after adjustment for BMI. Results for SAT were similar, although less striking. Lower (more negative) fat attenuation was associated with more adverse metabolic profiles at follow-up. For example, per 5 unit decrease in baseline VAT HU, log triglycerides increased by 0.08 mg/dL (95% CI 0.05-0.12, p=0.005), which remained significant after adjustment for baseline VAT. Among men, VAT and SAT HU were associated with changes in CVD risk factors, but were mostly attenuated after baseline volume adjustment.
Conclusions—VAT and SAT volume are associated with incident metabolic risk factors beyond their contributions to overall adiposity. Decrements in fat attenuation are also associated with incident risk factors. These findings suggest that both volume and quality of VAT and SAT contribute to metabolic risk.
- Received December 20, 2014.
- Revision received August 7, 2015.
- Accepted August 12, 2015.