Abstract
Background
This review aimed to examine the associations of visceral adipose tissue (VAT) with pulmonary function and asthma in children and adults, and chronic obstructive pulmonary disease (COPD) in adults.
Methods
Five databases were searched up to February 12, 2021, to identify articles that described associations of VAT with pulmonary function, asthma, and COPD. Information on participant characteristics, study design and assessment, and key findings were retrieved.
Results
A total of 43 studies were considered eligible, of which most studies were cross-sectional and in adults. The quality of included studies was generally moderate. In adults, strong evidence was found that a higher abdominal VAT was associated with asthma, and a higher intrathoracic VAT was associated with lower forced expiratory volume in the first second and forced vital capacity. Inconclusive results were found although a substantial number of studies suggested inverse association of abdominal VAT with pulmonary function. There is a limited number of studies addressing the relationship between VAT and COPD.
Conclusion
The literature to date provides strong evidence in adults for the associations of higher abdominal VAT with asthma, and higher intrathoracic VAT with lower lung function parameters. Future high-quality studies are warranted that adjust sufficiently for key confounding factors such as fat distribution.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Dixon AE, Holguin F, Sood A, Salome CM, Pratley RE, Beuther DA, et al. An official American Thoracic Society Workshop report: obesity and asthma. Proc Am Thoracic Society. 2010;7:325–35.
Ladosky W, Botelho M, Albuquerque J Jr. Chest mechanics in morbidly obese non-hypoventilated patients. Respir Med. 2001;95:281–6.
Collet F, Mallart A, Bervar J, Bautin N, Matran R, Pattou F, et al. Physiologic correlates of dyspnea in patients with morbid obesity. Int J Obesity. 2007;31:700–6.
Schachter L, Salome C, Peat J, Woolcock A. Obesity is a risk for asthma and wheeze but not airway hyperresponsiveness. Thorax. 2001;56:4–8.
Zerah F, Harf A, Perlemuter L, Lorino H, Lorino A-M, Atlan G. Effects of obesity on respiratory resistance. Chest. 1993;103:1470–6.
Bhammar DM, Stickford JL, Bernhardt V, Babb TG. Effect of weight loss on operational lung volumes and oxygen cost of breathing in obese women. Int J Obesity. 2016;40:998–1004.
Peroni D, Pietrobelli A, Boner A. Asthma and obesity in childhood: on the road ahead. Int J Obesity. 2010;34:599–605.
Chen Y, Chih A, Chen J, Liou T, Pan W, Lee Y. Rapid adiposity growth increases risks of new-onset asthma and airway inflammation in children. Int J Obesity. 2017;41:1035–41.
Ford ES. The epidemiology of obesity and asthma. J Allergy Clin Immunol. 2005;115:897–909.
Eisner MD, Blanc PD, Sidney S, Yelin EH, Lathon PV, Katz PP, et al. Body composition and functional limitation in COPD. Respir Res. 2007;8:1–10.
Rossi A, Fantin F, Di Francesco V, Guariento S, Giuliano K, Fontana G, et al. Body composition and pulmonary function in the elderly: a 7-year longitudinal study. Int J Obesity. 2008;32:1423–30.
Vogelezang S, Gishti O, Felix J, Van der Beek E, Abrahamse-Berkeveld M, Hofman A, et al. Tracking of abdominal subcutaneous and preperitoneal fat mass during childhood. The Generation R Study. Int J Obesity. 2016;40:595–600.
Bouchard C. BMI, fat mass, abdominal adiposity and visceral fat: where is the ‘beef’? Int J Obesity. 2007;31:1552–3.
Herman T, Ros KP, de Jongste JC, Reiss IK, Jaddoe VW, Duijts L. Body fat mass distribution and interrupter resistance, fractional exhaled nitric oxide, and asthma at school-age. J Allergy Clin Immunol. 2017;139:810–8. e6.
Lazarus R, Sparrow D, Weiss ST. Effects of obesity and fat distribution on ventilatory function: the normative aging study. Chest. 1997;111:891–8.
Leone N, Courbon D, Thomas F, Bean K, Jégo B, Leynaert B, et al. Lung function impairment and metabolic syndrome: the critical role of abdominal obesity. Am J Respir Critc Med. 2009;179:509–16.
Ochs-Balcom HM, Grant BJ, Muti P, Sempos CT, Freudenheim JL, Trevisan M, et al. Pulmonary function and abdominal adiposity in the general population. Chest. 2006;129:853–62.
Hickson DA, Liu J, Bidulescu A, Burchfiel CM, Taylor HA, Petrini MF. Pericardial fat is associated with impaired lung function and a restrictive lung pattern in adults: the Jackson Heart Study. Chest. 2011;140:1567–73.
Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic Rev 2015;4:1.
National Heart L, Institute B. Quality assessment tool for observational cohort and cross-sectional studies. Bethesda: National Institutes of Health, Department of Health and Human Services. 2014.
Slavin RE. Best evidence synthesis: an intelligent alternative to meta-analysis. J Clin Epidemiol. 1995;48:9–18.
Voortman T, van den Hooven E, Vitezova A, Leermakers E, Sedaghat S, Buitrago-Lopez A, et al. Effects of protein intake on cardiometabolic health in children: a systematic review: PO662. Ann Nutr Metabol. 2013;63.
Singh A, Uijtdewilligen L, Twisk JW. Van Mechelen W, Chinapaw MJ. Physical activity and performance at school: a systematic review of the literature including a methodological quality assessment. Arch. Pediatr. Adoles Med. 2012;166:49–55.
Bruijn J, Locher H, Passchier J, Dijkstra N, Arts W-F. Psychopathology in children and adolescents with migraine in clinical studies: a systematic review. Pediatrics. 2010;126:323–32.
Inomoto A, Fukuda R, Deguchi J, Kato G, Kanzaki R, Hiroshige K, et al. The association between the body composition and lifestyle affecting pulmonary function in Japanese workers. J Phys Therapy Sci. 2016;28:2883–9.
Modala S, Dhar U, Thinunaraju KV, Kumar BJP, Krishna BH. Association of visceral fat with deteriorated pulmonary function in newly diagnosed hypothyroid patients. Int J Med Res Health Sci. 2015;4:630.
Capelo AV, da Fonseca VM, Peixoto MV, de Carvalho SR, Azevedo CM, Elsas MI, et al. Visceral adiposity is associated with cytokines and decrease in lung function in women with persistent asthma. Rev Port Pneumol. 2006;2016(22):255–61.
Rasslan Z, Stirbulov R, Junior RS, Curia ST, da Conceicao Lima CA, Perez EA, et al. The impact of abdominal adiposity measured by sonography on the pulmonary function of pre-menopausal females. Multidiscip Respir Med. 2015;10:23.
Inomata M, Kawagishi Y, Taka C, Kambara K, Okazawa S, Fukushima Y, et al. Visceral adipose tissue level, as estimated by the bioimpedance analysis method, is associated with impaired lung function. J Diabetes Investig. 2012;3:331–6.
Kawabata R, Soma Y, Kudo Y, Yokoyama J, Shimizu H, Akaike A, et al. Relationships between body composition and pulmonary function in a community-dwelling population in Japan. PLoS ONE. 2020;15:e0242308.
Fenger RV, Gonzalez-Quintela A, Vidal C, Gude F, Husemoen LL, Aadahl M, et al. Exploring the obesity-asthma link: do all types of adiposity increase the risk of asthma? Clin Exp Allergy. 2012;42:1237–45.
He S, Yang J, Li X, Gu H, Su Q, Qin L. Visceral adiposity index is associated with lung function impairment: a population-based study. Respir Res. 2021;22.
Huang L, Ye Z, Lu J, Kong C, Zhu Q, Huang B, et al. Effects of fat distribution on lung function in young adults. J Physiol Anthropol. 2019;38:7.
Vijetha P, Apoorva P, Harikrishna, Jeevaratnam T. Assessment of Pulmonary Function and Functional Capacity in Overweight Young Adults: Correlation with Visceral Fat. Int J Physiol. 2016;4:155.
Khathlan NA, Salem AM. The effect of adiposity markers on fractional exhaled nitric oxide (FeNO) and pulmonary function measurements. Int J Gen Med. 2020;13:955–62.
Park YS, Kwon HT, Hwang SS, Choi SH, Cho YM, Lee J, et al. Impact of visceral adiposity measured by abdominal computed tomography on pulmonary function. J Korean Med Sci. 2011;26:771–7.
Lessard A, Alméras N, Turcotte H, Tremblay A, Després J-P, Boulet L-P. Adiposity and pulmonary function: relationship with body fat distribution and systemic inflammation. Clin Invest Med . 2011;34:E64–70.
Choe EK, Kang HY, Lee Y, Choi SH, Kim HJ, Kim JS. The longitudinal association between changes in lung function and changes in abdominal visceral obesity in Korean non-smokers. PLoS One. 2018;13:e0193516.
Kwack WG, Kang YS, Jeong YJ, Oh JY, Cha YK, Kim JS, et al. Association between thoracic fat measured using computed tomography and lung function in a population without respiratory diseases. J Thorac Dis. 2019;11:5300–9.
Moualla M, Qualls C, Arynchyn A, Thyagarajan B, Kalhan R, Smith LJ, et al. Rapid decline in lung function is temporally associated with greater metabolically active adiposity in a longitudinal study of healthy adults. Thorax. 2017;72:1113–20.
Babb TG, Wyrick BL, DeLorey DS, Chase PJ, Feng MY. Fat distribution and end-expiratory lung volume in lean and obese men and women. Chest. 2008;134:704–11.
Schweitzer L, Geisler C, Johannsen M, Gluer CC, Muller MJ. Associations between body composition, physical capabilities and pulmonary function in healthy older adults. Eur J Clin Nutr. 2017;71:389–94.
Thijs W, Alizadeh Dehnavi R, Hiemstra PS, de Roos A, Melissant CF, Janssen K, et al. Association of lung function measurements and visceral fat in men with metabolic syndrome. Respir Med. 2014;108:351–7.
Goudarzi H, Konno S, Kimura H, Makita H, Matsumoto M, Takei N, et al. Impact of Abdominal Visceral Adiposity on Adult Asthma Symptoms. J Allergy Clin Immunol Pract. 2019;7:1222–9 e5.
Deng K, Zhang X, Liu Y, Cheng GP, Zhang HP, Wang T, et al. Visceral obesity is associated with clinical and inflammatory features of asthma: A prospective cohort study. Allergy Asthma Proc. 2020;41:348–56.
De Blasio F, Rutten EP, Wouters EF, Scalfi L, De Blasio F, Akkermans MA, et al. Preliminary study on the assessment of visceral adipose tissue using dual-energy x-ray absorptiometry in chronic obstructive pulmonary disease. Multidiscip Respir Med. 2016;11:33.
Higami Y, Ogawa E, Ryujin Y, Goto K, Seto R, Wada H, et al. Increased Epicardial Adipose Tissue Is Associated with the Airway Dominant Phenotype of Chronic Obstructive Pulmonary Disease. PLoS One. 2016;11:e0148794.
Martin M, Almeras N, Despres JP, Coxson HO, Washko GR, Vivodtzev I, et al. Ectopic fat accumulation in patients with COPD: an ECLIPSE substudy. Int J Chron Obstruct Pulmon Dis. 2017;12:451–60.
den Dekker HT, Ros KPI, de Jongste JC, Reiss IK, Jaddoe VW, Duijts L. Body fat mass distribution and interrupter resistance, fractional exhaled nitric oxide, and asthma at school-age. J Allergy Clin Immunol. 2017;139:810–8 e6.
Mensink-Bout SM, Santos S, van Meel ER, Oei EH, de Jongste JC, Jaddoe VW, et al. General and organ fat assessed by magnetic resonance imaging and respiratory outcomes in childhood. Am J Respir Crit Care Med. 2020;201:348–55.
de Oliveira PD, Wehrmeister FC, Horta BL, Perez-Padilla R, de Franca GVA, Gigante DP, et al. Visceral and subcutaneous abdominal adiposity and pulmonary function in 30-year-old adults: a cross-sectional analysis nested in a birth cohort. BMC Pulm Med. 2017;17:157.
Rossi AP, Watson NL, Newman AB, Harris TB, Kritchevsky SB, Bauer DC, et al. Effects of body composition and adipose tissue distribution on respiratory function in elderly men and women: the health, aging, and body composition study. J Gerontol A Biol Sci Med Sci. 2011;66:801–8.
Lim S, Kwon SY, Yoon JW, Kim SY, Choi SH, Park YJ, et al. Association between body composition and pulmonary function in elderly people: the Korean Longitudinal Study on Health and Aging. Obesity (Silver Spring). 2011;19:631–8.
Yang MS, Choi S, Choi Y, Jin KN. Association Between Airway Parameters and Abdominal Fat Measured via Computed Tomography in Asthmatic Patients. Allergy Asthma Immunol Res. 2018;10:503–15.
Kim KM, Kim SS, Kwon JW, Jung JW, Kim TW, Lee SH, et al. Association between subcutaneous abdominal fat and airway hyperresponsiveness. Allergy Asthma Proc. 2011;32:68–73.
Murakami D, Anan F, Masaki T, Umeno Y, Shigenaga T, Eshima N, et al. Visceral Fat Accumulation Is Associated with Asthma in Patients with Type 2 Diabetes. J Diabetes Res. 2019;2019:3129286.
Song WJ, Kim SH, Lim S, Park YJ, Kim MH, Lee SM, et al. Association between obesity and asthma in the elderly population: potential roles of abdominal subcutaneous adiposity and sarcopenia. Ann Allergy Asthma Immunol. 2012;109:243–8.
Lenártová P, Habánová M, Mrázová J, Chlebo P, Wyka J. Analysis of visceral fat in patients with chronic obstructive pulmonary disease (COPD). Roczniki Państwowego Zakładu Higieny. 2016;67.
Furutate R, Ishii T, Wakabayashi R, Motegi T, Yamada K, Gemma A, et al. Excessive visceral fat accumulation in advanced chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2011;6:423–30.
Viglino D, Martin M, Piche ME, Brouillard C, Despres JP, Almeras N, et al. Metabolic profiles among COPD and controls in the CanCOLD population-based cohort. PLoS One. 2020;15:e0231072.
Coats V, Despres JP, Almeras N, Martin M, Sin DD, Rabasa-Lhoret R, et al. Ectopic adiposity and cardiometabolic health in COPD. Int J Chron Obstruct Pulmon Dis. 2018;13:3331–40.
Yilmaz M, Bozkurt Yilmaz HE, Sen N, Altin C, Tekin A, Muderrisoglu H. Investigation of the relationship between asthma and subclinical atherosclerosis by carotid/femoral intima media and epicardial fat thickness measurement. J Asthma. 2018;55:50–6.
Yilmaz HEB, Yilmaz M, Sen N, Unsal ZE, Eyuboglu FO, Akcay S. Investigation of the Relationship between Asthma and Visceral Obesity by Epicardial Fat Thickness Measurement. Turk Thorac J. 2019;20:1–5.
Kaplan O, Kurtoglu E, Gozubuyuk G, Dogan C, Acar Z, EyupKoca F, et al. Epicardial adipose tissue thickness in patients with chronic obstructive pulmonary disease having right ventricular systolic dysfunction. Eur Rev Med Pharmacol Sci. 2015;19:2461–7.
Zagaceta J, Zulueta JJ, Bastarrika G, Colina I, Alcaide AB, Campo A, et al. Epicardial adipose tissue in patients with chronic obstructive pulmonary disease. PLoS One. 2013;8:e65593.
Gaisl T, Schlatzer C, Schwarz EI, Possner M, Stehli J, Sievi NA, et al. Coronary artery calcification, epicardial fat burden, and cardiovascular events in chronic obstructive pulmonary disease. PLoS One. 2015;10:e0126613.
Fantuzzi G. Adipose tissue, adipokines, and inflammation. J Allergy Clin Immunol. 2005;115:911–9.
Trayhurn P, Wood IS. Adipokines: inflammation and the pleiotropic role of white adipose tissue. Br J Nutr. 2004;92:347–55.
Ibrahim MM. Subcutaneous and visceral adipose tissue: structural and functional differences. Obes Rev. 2010;11:11–8.
Gyllenhammer LE, Alderete TL, Toledo-Corral CM, Weigensberg M, Goran MI. Saturation of subcutaneous adipose tissue expansion and accumulation of ectopic fat associated with metabolic dysfunction during late and post-pubertal growth. Int J Obes. 2016;40:601–6.
Salome CM, King GG, Berend N. Physiology of obesity and effects on lung function. J Appl Physiol. 2010;108:206–11.
Ray CS, Sue DY, Bray G, Hansen JE, Wasserman K. Effects of obesity on respiratory function. Am Rev Resp Disease. 1983;128:501–6.
Naimark A, Cherniack R. Compliance of the respiratory system and its components in health and obesity. J Appl Physiol. 1960;15:377–82.
Peters U, Suratt BT, Bates JH, Dixon AE. Beyond BMI: obesity and lung disease. Chest. 2018;153:702–9.
Littleton SW. Impact of obesity on respiratory function. Respirology. 2012;17:43–9.
Malli F, Papaioannou AI, Gourgoulianis KI, Daniil Z. The role of leptin in the respiratory system: an overview. Resp Res. 2010;11:1–16.
Hwang Y, Hayashi T, Fujimoto W, Kahn S, Leonetti D, McNeely M, et al. Visceral abdominal fat accumulation predicts the conversion of metabolically healthy obese subjects to an unhealthy phenotype. Int J Obes. 2015;39:1365–70.
Goodpaster BH, Kelley DE, Thaete FL, He J, Ross R. Skeletal muscle attenuation determined by computed tomography is associated with skeletal muscle lipid content. J Appl Physiol. 2000;89:104–10.
Lim U, Ernst T, Buchthal S, Latch M, Albright CL, Wilkens LR, et al. Asian women have greater abdominal and visceral adiposity than Caucasian women with similar body mass index. Nutr Diabetes. 2011;1:e6–e.
Kujawska-Łuczak M, Suliburska J, Markuszewski L, Pupek-Musialik D, Jabłecka A, Bogdański P. The effect of L-arginine and ascorbic acid on the visceral fat and the concentrations of metalloproteinases 2 and 9 in high-fat-diet rats. Endokrynologia polska. 2015;66:526–32.
Miczke A, Suliburska J, Pupek-Musialik D, Ostrowska L, Jabłecka A, Krejpcio Z, et al. Effect of L-arginine supplementation on insulin resistance and serum adiponectin concentration in rats with fat diet. Int J Clin Exp Med. 2015;8:10358.
Chen Y-C, Fan H-Y, Huang Y-T, Huang S-Y, Liou T-H, Lee YL. Causal relationships between adiposity and childhood asthma: bi-directional Mendelian randomization analysis. Int J Obes. 2019;43:73–81.
Bustos P, Amigo H, Oyarzun M, Rona R. Is there a causal relation between obesity and asthma? Evidence from Chile. Int J Obes. 2005;29:804–9.
Salome C, Munoz P, Berend N, Thorpe C, Schachter L, King G. Effect of obesity on breathlessness and airway responsiveness to methacholine in non-asthmatic subjects. Int J Obes. 2008;32:502–9.
Brock JM, Billeter A, Müller-Stich BP, Herth F. Obesity and the lung: what we know today. Respiration. 2020;99:856–66.
Blum A, Simsolo C, Sirchan R, Haiek S. Obesity paradox” in chronic obstructive pulmonary disease. Israel Med Association J: IMAJ. 2011;13:672–5.
Schols AMWJ, Slangen JOS, Volovics L, Wouters EFM. Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1998;157:1791–7.
Sin DD, Anthonisen N, Soriano J, Agusti A. Mortality in COPD: role of comorbidities. Eur Resp J. 2006;28:1245–57.
Soeters P, Dingemans A. Prevalence and characteristics of nutritional depletion in patients with stable COPD eligible for pulmonary rehabilitation. Am Rev Respir Dis. 1993;147:1151–6.
Tai A, Tran H, Roberts M, Clarke N, Wilson J, Robertson CF. The association between childhood asthma and adult chronic obstructive pulmonary disease. Thorax. 2014;69:805–10.
De Marco R, Accordini S, Marcon A, Cerveri I, Antó JM, Gislason T, et al. Risk factors for chronic obstructive pulmonary disease in a European cohort of young adults. Am J Respir Crit Care Med. 2011;183:891–7.
Fenger R, Gonzalez‐Quintela A, Vidal C, Gude F, Husemoen L, Aadahl M, et al. Exploring the obesity‐asthma link: do all types of adiposity increase the risk of asthma? Clin Exp Allergy. 2012;42:1237–45.
Cheng X, Zhang Y, Wang C, Deng W, Wang L, Duanmu Y, et al. The optimal anatomic site for a single slice to estimate the total volume of visceral adipose tissue by using the quantitative computed tomography (QCT) in Chinese population. Eur J Clin Nutr. 2018;72:1567–75.
Segal KR, Gutin B, Presta E, Wang J, Van Itallie TB. Estimation of human body composition by electrical impedance methods: a comparative study. J Appl Physiol. 1985;58:1565–71.
Roubenoff R. Applications of bioelectrical impedance analysis for body composition to epidemiologic studies. Am J Clin Nutr. 1996;64:459S–62S.
Treuth MS, Hunter GR, Kekes-Szabo T. Estimating intraabdominal adipose tissue in women by dual-energy X-ray absorptiometry. Am J Clin Nutr. 1995;62:527–32.
Clasey JL, Bouchard C, Teates CD, Riblett JE, Thorner MO, Hartman ML, et al. The use of anthropometric and dual‐energy X‐ray absorptiometry (DXA) measures to estimate total abdominal and abdominal visceral fat in men and women. Obesity Res. 1999;7:256–64.
Lear SA, Humphries KH, Kohli S, Chockalingam A, Frohlich JJ, Birmingham CL. Visceral adipose tissue accumulation differs according to ethnic background: results of the Multicultural Community Health Assessment Trial (M-CHAT). Am J Clin Nutr. 2007;86:353–9.
Loftus PA, Wise SK. Epidemiology of asthma. Curr Opin Otolaryngol Head Neck Surg. 2016;24:245–9.
Masoli M, Fabian D, Holt S, Beasley R. Global Initiative for Asthma P. The global burden of asthma: executive summary of the GINA Dissemination Committee report. Allergy. 2004;59:469–78.
Acknowledgements
The authors wish to thank Biomedical Information Specialist Sabrina T.G. Meertens-Gunput, PhD from the Erasmus MC Medical Library for developing and updating the search strategies.
Funding
TW is supported by China Scholarship Council (CSC) PhD Fellowship for his PhD study in Erasmus Medical Center, Rotterdam, the Netherlands. The scholarship file number is 201906260304, CSC URL: http://www.csc.edu.cn/. LD is supported by funding for projects from the European Union’s Horizon 2020 research and innovation program (LIFECYCLE, grant agreement No 733206, 2016; EUCAN-Connect grant agreement No 824989; ATHLETE, grant agreement No 874583). The funders had no role in the study design, data collection, management, analysis and interpretation of data, preparation or writing the manuscript.
Author information
Authors and Affiliations
Contributions
TW, MRJ, SK, LD, and EHGO conceived the study; TW, MRJ, SMM-B, LD, and EHGO performed the literature search and selected the studies; TW, MRJ, SMM-B, LD, and EHGO collected the data from all included studies; Quality of included studies was assessed by TW, MRJ, LD and EHGO; Study results were summarized and analyzed by TW, MRJ, SK, LD, and EHGO; TW and MRJ drafted the manuscript; SK, LD, EHGO made significant revisions; EHGO had primary responsibility for final content; All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary information
Rights and permissions
About this article
Cite this article
Wu, T., Jahangir, M.R., Mensink-Bout, S.M. et al. Visceral adiposity and respiratory outcomes in children and adults: a systematic review. Int J Obes 46, 1083–1100 (2022). https://doi.org/10.1038/s41366-022-01091-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41366-022-01091-6
This article is cited by
-
Visceral fat and cardiometabolic future in children and adolescents: a critical update
Pediatric Research (2023)