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
Hadar Klein,
Hila Zelicha,
Anat Yaskolka Meir,
Ehud Rinott,
Gal Tsaban,
Alon Kaplan,
Yoash Chassidim,
Yftach Gepner,
Matthias Blüher,
Uta Ceglarek,
Berend Isermann,
Michael Stumvoll,
Ilan Shelef,
Lu Qi,
Jun Li,
Frank B. Hu,
Meir J. Stampfer,
Iris Shai
Affiliations
Hadar Klein
The Health & Nutrition Innovative International Research Center, Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the Negev
Hila Zelicha
The Health & Nutrition Innovative International Research Center, Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the Negev
Anat Yaskolka Meir
The Health & Nutrition Innovative International Research Center, Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the Negev
Ehud Rinott
The Health & Nutrition Innovative International Research Center, Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the Negev
Gal Tsaban
The Health & Nutrition Innovative International Research Center, Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the Negev
Alon Kaplan
The Health & Nutrition Innovative International Research Center, Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the Negev
Yoash Chassidim
Department of Engineering, Sapir Academic College
Yftach Gepner
Department of Health Promotion, School of Public Health, Faculty of Medicine and Sylvan Adams Sports Institute, Tel-Aviv University
Matthias Blüher
Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig
Uta Ceglarek
Institute of Laboratory Medicine, University of Leipzig Medical Center
Berend Isermann
Institute of Laboratory Medicine, University of Leipzig Medical Center
Michael Stumvoll
Department of Medicine, University of Leipzig
Ilan Shelef
Soroka University Medical Center
Lu Qi
Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University
Jun Li
Brigham and Women’s Hospital and Harvard Medical School
Frank B. Hu
Department of Nutrition, Harvard T.H. Chan School of Public Health
Meir J. Stampfer
Department of Nutrition, Harvard T.H. Chan School of Public Health
Iris Shai
The Health & Nutrition Innovative International Research Center, Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the Negev
Abstract 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 (VATcm2) 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 VATcm2 was 144.8cm2 and VAT% = 28.2%; over 18 months, participants lost 28cm2 VATcm2 (− 22.5%), and 1.3 VAT% units. Baseline VATcm2 and VAT% were similarly associated with metabolic syndrome, hypertension, and diabetes status, while VAT% better classified hypertriglyceridemia. Conversely, higher VATcm2 was associated with elevated high-sensitivity C-reactive protein (hsCRP), while VAT% was not. After 18 months of lifestyle intervention, both VATcm2 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 VATcm2 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 VATcm2 and VAT% exhibit similar clinical manifestations, it might be preferable to examine VAT% when exploring lipid status, while VATcm2 may better reflect inflammatory and glycemic states. Trial registration CENTRAL (Clinical-trials-identifier: NCT01530724); DIRECT PLUS (Clinical-trials-identifier: NCT03020186).
