Cross-sectional analysis of visceral adipose tissue associations with obesity-related disease

Body mass index (BMI) and waist circumference (WC) have served as primary metrics of obesity disease risk for the past 50+ y, but visceral adipose tissue (VAT) is the more direct etiological basis of obesity-related metabolic disease. Increasing availability of technologies for VAT estimation now makes it possible to practically apply this more precise assessment of individual risk.

We hypothesized that VAT is a stronger predictor of metabolic syndrome, type 2 diabetes mellitus (T2DM), and insulin resistance [as measured by homeostasis model assessment of insulin resistance (HOMA-IR)] in United States adults than BMI, percent body fat (%BF), or WC. This hypothesis was tested using data from the National Health and Nutrition Examination Survey (NHANES).

Cross-sectional data from 4139 men and 4147 women, aged 18-59 y, from NHANES survey years 2011-2018, were analyzed for BMI, %BF, WC, WC/height, and VAT determined by dual-energy X-ray absorptiometry, compared with MetS disease risk outcomes classified as ≥3 markers, T2DM (glycated hemoglobin ≥6.5), insulin resistance (by HOMA-IR ≥2.0).

Receiver operating characteristic curves and area under the curve (AUC) revealed high classification performance for VAT to MetS [AUC 0.84 ± 0.01 standard error (SE)], T2DM (AUC 0.80 ± 0.01 SE), and HOMA-IR (AUC 0.79 ± 0.01 SE). VAT risk thresholds for MetS were observed at 103 cm² (95% confidence interval: 0.83-0.85), slightly higher for T2DM (119 cm²; 0.78-0.81), and lower for HOMA-IR (84 cm²; 0.78-0.80). WC performed similarly to VAT in several of these comparisons.

These data suggest that VAT estimates may improve individual obesity risk management although this analysis did not demonstrate a clear advantage of VAT or a simple WC or WC/height. These data suggest a sex-independent threshold could be set for metabolic disease risk at approximately VAT ≥ 100 cm².