Skewness in body fat distribution pattern links to specific cardiometabolic disease risk profiles.

Fat distribution pattern could help determine cardiometabolic risk profile. This study aimed to evaluate the association of balance/imbalance between visceral adipose tissue (VAT), abdominal subcutaneous adipose tissue (aSAT), and liver fat (LF) with incident type 2 diabetes (T2D) and cardiovascular disease (CVD) in the UK Biobank prospective cohort study. Magnetic resonance images of 40174 participants were analyzed for VAT, aSAT, and LF using AMRA® Researcher. To assess fat distribution patterns independent of BMI, fat z-scores (z-VAT, z-aSAT, z-LF) were calculated. Participants without prevalent T2D/CVD (N = 35138), were partitioned based on balance between (1) z-VAT & z-LF (z-scores = 0 as cut-points for high/low), (2) z-VAT & z-aSAT, and (3) z-LF & z-aSAT. Associations with T2D/CVD were investigated using Cox-regression (crude and adjusted for sex, age, BMI, lifestyle, arterial hypertension, statin treatment). T2D was significantly associated with z-LF (hazard ratio [95% CI] 1.74 [1.52-1.98], p < 0.001) and z-VAT (1.70 [1.49-1.95], p < 0.001). Both remained significant after full adjustment. For z-scores balance, strongest associations with T2D were z-VAT > 0 & z-LF > 0 (4.61 [2.98-7.12]), z-VAT > 0 & z-aSAT < 0 (4.48, [2.85-7.06]), and z-LF > 0 & z-aSAT < 0 (2.69 [1.76-4.12]), all p < 0.001. CVD was most strongly associated with z-VAT (1.22 [1.16-1.28], p < 0.001) which remained significant after adjustment for sex, age, BMI, and lifestyle. For z-scores balance, strongest associations with CVD were z-VAT > 0 & z-LF < 0 (1.53, [1.34-1.76], p < 0.001) and z-VAT > 0 & z-aSAT < 0 (1.54, [1.34-1.76], p < 0.001). When adjusted for sex, age, BMI, only z-VAT > 0 & z-LF < 0 remained significant. High VAT in relation to BMI (z-VAT > 0) was consistently linked to both T2D and CVD, z-LF > 0 was linked to T2D only. Skewed fat distribution patterns showed elevated risk for CVD (z-VAT > 0 & z-LF < 0 and z-VAT > 0 & z-aSAT < 0) and T2D (z-VAT > 0 & z-aSAT < 0).

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© The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society.