Disentangling the impact of gluteofemoral versus visceral fat accumulation on cardiometabolic health using sex-stratified Mendelian randomization

Gender-Specific Dietary and Lifestyle Patterns Associated with Cardiometabolic Risk: A Cross-Sectional Analysis

BACKGROUND

Gender differences in dietary patterns and lifestyle behaviours may influence abdominal adiposity and cardiometabolic risk, but comprehensive analyses integrating these factors remain limited.

METHODS

We conducted a cross-sectional study including 1631 adults recruited from a centre specialising in nutrition and metabolic health. Food intake was assessed by 7-day food diaries and lifestyle behaviours were assessed by structured questionnaires. Z scores of a body shape index (zABSI) were calculated as a marker of abdominal adiposity. zABSI represents the standardised value of ABSI, an index specifically designed to assess abdominal adiposity independently of BMI Multivariable linear regression models, stratified by sex and adjusted for age, examined associations between dietary patterns, physical activity and zABSI.

RESULTS

Higher intake of plant-based protein was significantly associated with lower zABSI values in women (β = -0.052, p = 0.0053) but not in men (β = -0.015, p = 0.2675). Stratified analyses revealed that women in the middle tertile of plant-based protein intake showed significantly lower zABSI values than men. Combined analyses showed that women classified as physically active and high consumers of plant-based protein had the most favourable abdominal adiposity profiles (p = 0.0036). Participation in endurance and strength sports was associated with lower zABSI values in both sexes, whereas women engaged in team sports had the lowest zABSI values. No significant interaction terms between sex and lifestyle were identified; however, male sex remained an independent predictor of higher zABSI values.

CONCLUSIONS

In this cross-sectional study, plant-based dietary patterns and physical activity were associated with lower abdominal adiposity, especially among women. These findings suggest the importance of gender-specific strategies to address cardiometabolic risk and emphasise the need for prospective studies to confirm these associations and clarify the underlying mechanisms.

Clinical staging to guide management of metabolic disorders and their sequelae: a European Atherosclerosis Society consensus statement

Obesity rates have surged since 1990 worldwide. This rise is paralleled by increases in pathological processes affecting organs such as the heart, liver, and kidneys, here termed systemic metabolic disorders (SMDs). For clinical management of SMD, the European Atherosclerosis Society proposes a pathophysiology-based system comprising three stages: Stage 1, where metabolic abnormalities such as dysfunctional adiposity and dyslipidaemia occur without detectable organ damage; Stage 2, which involves early organ damage manifested as Type 2 diabetes, asymptomatic diastolic dysfunction, metabolic-associated steatohepatitis (MASH), and chronic kidney disease (CKD); and Stage 3, characterized by more advanced organ damage affecting multiple organs. Various forms of high-risk obesity, driven by maintained positive energy balance, are the most common cause of SMD, leading to ectopic lipid accumulation and insulin resistance. This progression affects various organs, promoting comorbidities such as hypertension and atherogenic dyslipidaemia. Genetic factors influence SMD susceptibility, and ethnic disparities in SMD are attributable to genetic and socioeconomic factors. Key SMD features include insulin resistance, inflammation, pre-diabetes, Type 2 diabetes, MASH, hypertension, CKD, atherogenic dyslipidaemia, and heart failure. Management strategies involve lifestyle changes, pharmacotherapy, and metabolic surgery in severe cases, with emerging treatments focusing on genetic approaches. The staging system provides a structured approach to understanding and addressing the multi-faceted nature of SMD, which is crucial for improving health outcomes. Categorization of SMD abnormalities by presence and progression is aimed to improve awareness of a multi-system trait and encourage a tailored and global approach to treatment, ultimately aiming to reduce the burden of obesity-related comorbidities.

Chain effect of lifecourse reproductive characteristics and body fat and muscle on cardiovascular disease in women: a Mendelian randomization study

BACKGROUND

Delineating the causal chain effects of reproductive traits and fat- and muscle-related traits on cardiovascular disease (CVD) is essential for optimizing precision prevention and control of cardiovascular health in women.

METHODS

In this study, we applied the two-sample Mendelian randomization (MR) analyses and two-step MR framework to investigate the causal chain effects and the mediating effect pathways among reproductive factors and fat- and muscle-related traits on CVD outcomes in women, applying the genome-wide association study summary statistics of 16 women's reproductive traits across puberty and pre-pregnancy, pregnancy and postpartum, and menopausal transition stages, 16 women's fat- and muscle-related traits, and five CVD outcomes of coronary artery disease (CAD), myocardial infarction (MI), heart failure, atrial fibrillation, and ischemic stroke (IS) from over one million individuals of European descent.

RESULTS

The MR analyses revealed the associations of genetically predicted nine reproductive traits (i.e., age at menarche [odds ratio (OR) for CAD: 0.92], age at first sexual intercourse [AFS; 0.71], age at first birth [AFB; 0.89], hypertensive disorders of pregnancy [HDP; 1.21], pre-eclampsia [PE; 1.34], preterm birth [PTB; 1.09], sex hormone-binding globulin [SHBG; 0.73], bioavailable testosterone [BT; 1.17], and number of stillbirths [OR for IS: 2.14]) and 13 fat- and muscle-related traits with at least one of five CVD outcomes. Two-step MR identified 30 causal pathways where AFS, AFB, HDP, PE, PTB, SHBG, and BT mediated the effects of body composition on five CVD outcomes, and nine pathways where waist-to-hip ratio, trunk-trunk fat ratio, abdominal subcutaneous adipose tissue, and gluteofemoral adipose tissue mediated the effects of reproductive traits on CAD and MI.

CONCLUSIONS

Lifecourse reproductive characteristics and fat- and muscle-related traits manifested reciprocal mediating effects on CVD, informing targeted strategies for bridging cardiovascular health inequalities in women.

Integrative metabolism in MASLD and MASH: Pathophysiology and emerging mechanisms

The liver acts as a central metabolic hub, integrating signals from the gastrointestinal tract and adipose tissue to regulate carbohydrate, lipid, and amino acid metabolism. Gut-derived metabolites, such as acetate and ethanol and non-esterified fatty acids from white adipose tissue, influence hepatic processes, which rely on mitochondrial function to maintain systemic energy balance. Metabolic dysregulation caused by obesity, insulin resistance, and type 2 diabetes disrupts these pathways, leading to metabolic dysfunction-associated steatotic liver disease (MASLD) and steatohepatitis (MASH). In this review, we explore the metabolic fluxes within the gut-adipose tissue-liver axis, focusing on the pivotal role of de novo lipogenesis, dietary substrates like glucose and fructose, and changes in mitochondrial function during MASLD progression. We also highlight the contributions of white adipose tissue insulin resistance and impaired mitochondrial dynamics to hepatic lipid accumulation. Further understanding how the interplay between substrate flux from the gastro-intestinal tract integrates with adipose tissue and intersects with structural and functional alterations to liver mitochondria will be important to identify novel therapeutic targets and advance the treatment of MASLD and MASH.

Adiposity, type 2 diabetes and atherosclerotic cardiovascular disease risk: Use and abuse of the body mass index

The worldwide prevalence of individuals with an elevated body weight has increased steadily over the past five decades. Billions of research dollars have been invested to improve our understanding of the causes and consequences of having an elevated body weight. All this knowledge has, however, failed to influence populational body weight trajectories of most countries around the world. Research on the definition of "obesity" has also evolved. Body mass index (BMI), the most commonly used tool to make its diagnosis, has major limitations. In this review article, we will highlight evidence from observational studies, genetic association studies and randomized clinical trials that have shown the remarkable inter-individual differences in the way humans store energy as body fat. Increasing evidence also suggests that, as opposed to weight inclusive, lifestyle-based approaches, weight-centric approaches advising people to simply eat less and move more are not sustainable for most people for long-term weight loss and maintenance. It is time to recognize that this outdated approach may have produced more harm than good. On the basis of pathophysiological, genetic and clinical evidence presented in this review, we propose that it may be time to shift away from the traditional clinical approach, which is BMI-centric. Rather, emphasis should be placed on actionable lifestyle-related risk factors aiming at improving overall diet quality and increasing physical activity level in the general population.