Journal Article

Visceral adipose tissue area and proportion provide distinct reflections of cardiometabolic outcomes in weight loss; pooled analysis of MRI-assessed CENTRAL and DIRECT PLUS dietary randomized controlled trials

Qi, Lu, Tsaban, Gal, Shelef, Ilan, Chassidim, Yoash, Isermann, Berend, Ceglarek, Uta, Gepner, Yftach, Blüher, Matthias, Li, Jun, Yaskolka Meir, Anat, Zelicha, Hila, Kaplan, Alon, Stampfer, Meir J., Klein, Hadar, Stumvoll, Michael, Hu, Frank B., Shai, Iris, Rinott, Ehud

2025

Overview

Background Visceral adipose tissue (VAT) is well established as a pathogenic fat depot, whereas superficial subcutaneous adipose tissue (SAT) is associated with either an improved or neutral cardiovascular state. However, it is unclear to what extent VAT area (VATcm 2 ) and its proportion of total abdominal adipose tissue (VAT%) are distinguished in predicting cardiometabolic status and clinical outcomes during weight loss. Methods We integrated magnetic resonance imaging (MRI) measurements of VAT, deep-SAT, and superficial-SAT from two 18-month lifestyle weight loss clinical trials, CENTRAL and DIRECT PLUS ( n  = 572). Results At baseline, the mean VATcm 2 was 144.8cm 2 and VAT% = 28.2%; over 18 months, participants lost 28cm 2 VATcm 2 (− 22.5%), and 1.3 VAT% units. Baseline VATcm 2 and VAT% were similarly associated with metabolic syndrome, hypertension, and diabetes status, while VAT% better classified hypertriglyceridemia. Conversely, higher VATcm 2 was associated with elevated high-sensitivity C-reactive protein (hsCRP), while VAT% was not. After 18 months of lifestyle intervention, both VATcm 2 and VAT% loss were significantly associated with decreased triglycerides, HbA1c, ferritin, and liver enzymes, and increased HDL-c levels beyond weight loss (FDR < 0.05). Only VATcm 2 loss was correlated with decreased HOMA-IR, chemerin, and leptin levels. Conclusions MRI follow-up of 572 participants over 18 months of weight loss intervention suggests that although increased VATcm 2 and VAT% exhibit similar clinical manifestations, it might be preferable to examine VAT% when exploring lipid status, while VATcm 2 may better reflect inflammatory and glycemic states. Trial registration CENTRAL (Clinical-trials-identifier: NCT01530724); DIRECT PLUS (Clinical-trials-identifier: NCT03020186).

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Abdomen / Adipose tissue / Adipose tissues / Adult / Analysis / Biomarkers / Biomedicine / Body fat / Body mass index / C-reactive protein / Care and treatment / Clinical trials / Diabetes / Diabetes mellitus / Diagnosis / Diet / Female / Ferritin / Glycosylated hemoglobin / Health aspects / High density lipoprotein / Humans / Hypertension / Hypertriglyceridemia / Intervention / Intra-Abdominal Fat - diagnostic imaging / Leptin / Life style / Lifestyles / Lipids / Magnetic Resonance Imaging / Male / Measurement / Medicine / Medicine & Public Health / Metabolic diseases / Metabolic disorders / Metabolic syndrome / Middle Aged / Patient outcomes / Prognosis / Randomized Controlled Trials as Topic / Risk factors / Subcutaneous adipose tissue / Subcutaneous Fat - diagnostic imaging / Triglycerides / Variables / Visceral adipose tissue / Weight / Weight control / Weight loss / Weight Loss - physiology