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Epidemiology and Population Health

Age- and sex-specific visceral fat reference cutoffs and their association with cardio-metabolic risk

Abstract

Background

Although excess visceral fat (VAT) is associated with numerous cardio-metabolic risk factors, measurement of this fat depot has historically been difficult. Recent dual X-ray absorptiometry approaches have provided an accessible estimate of VAT that has shown acceptable validity against gold standard methods. The aims of this study were to (i) evaluate DXA measured VAT as a predictor of elevated blood lipids and blood pressure and (ii) calculate thresholds associated with these cardio-metabolic risk factors.

Subjects/methods

The sample comprised 1482 adults (56.4% women) aged 18–66 years. Total body scans were performed using a GE Lunar Prodigy, and VAT analyses were enabled through Corescan software (v 16.0). Blood pressure and blood lipids were measured by standard procedures. Regression models assessed how VAT mass was associated with each cardio-metabolic risk factor compared to other body composition measures. Measures of sensitivity and specificity were used to determine age- and sex-specific cut points for VAT mass associated with high cardio-metabolic risk.

Results

Similar to waist circumference, VAT mass was a strong predictor of cardio-metabolic risk especially in men over age 40. Four cut-offs for VAT mass were proposed, above which the cardio-metabolic risk increased: 700 g in women <40 yrs; 800 g in women 40+ yrs; 1000g in men <40 yrs; and 1200 g in men 40+ yrs. In general, these cut-offs discriminated well between those with high and low cardio-metabolic risk.

Conclusions

In both sexes, DXA measured VAT was associated with traditional cardio-metabolic risk factors, particularly high blood pressure in those 40+ yrs and low HDL < 40 yrs. These reference values provide a simple, accessible method to assess cardio-metabolic risk in adults.

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Fig. 1: Box plots of VAT mass (g) by high- and low-risk metabolic measures for women.
Fig. 2: Box plots of VAT mass (g) by high- and low-risk metabolic measures for men.

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Acknowledgements

We thank all participants for their involvement in these studies, most notably the Dunedin Study members, their families and friends for their long-term involvement. We also thank the Dunedin Study Unit research staff and Dunedin Study founder, Phil A. Silva.

Funding

No specific funding was sought for these analyses. Phase 45 of the Dunedin Multidisciplinary Health and Development Study is supported by a New Zealand Health Research Council Programme Grant (16–604), The US-National Institute of Aging grant R01AG032282 and The UK Medical Research Council grant MR/P005918/1, and has also received funding from the New Zealand Ministry of Business, Innovation and Employment. The Power study was supported by a research grant (11/188) from the Health Research Council of New Zealand. HIIT and the SNACK Study were funded through grants provided by the University of Otago. The SWIFT study was funded through a private bequest.

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Correspondence to Kim Meredith-Jones.

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Meredith-Jones, K., Taylor, R., Brown, R. et al. Age- and sex-specific visceral fat reference cutoffs and their association with cardio-metabolic risk. Int J Obes 45, 808–817 (2021). https://doi.org/10.1038/s41366-021-00743-3

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