Visceral, subcutaneous, and total fat mass accumulation in a prospective cohort of adolescents

The Critical Role of Body Composition Assessment in Advancing Research and Clinical Health Risk Assessment across the Lifespan

Obesity and low muscle mass are major public health concerns, especially in older adults, due to their strong links to cardiovascular disease, cancer, and mortality. Beyond body mass index, body composition metrics including skeletal muscle, fat mass, and visceral adipose tissue offer deeper insights into nutrition and disease risk. These measures are essential for both cross-sectional assessments and longitudinal tracking, providing a clearer picture of health changes over time. Selecting body composition assessment tools requires balancing cost, practicality, accuracy, and data quality. The right tools enhance research, refine clinical assessments, and inform targeted interventions. Aligning methods with specific research or clinical goals improves disease risk stratification and advances personalized treatments. This review highlights the importance of integrating body composition assessment into research and clinical practice, addressing knowledge gaps across diverse populations and emphasizing its potential in advancing precision medicine. It also highlights recent advancements in body composition assessment techniques that warrant consideration when evaluating techniques for a specific application. Future efforts should focus on refining these tools, expanding their accessibility, and developing comprehensive risk models that incorporate body composition alongside behavioral, environmental, and genetic factors to improve disease prediction and prevention strategies.

Correlation analysis of dynamic changes of abdominal fat during rapid weight loss after bariatric surgery: A prospective magnetic resonance imaging study

OBJECTIVE

The factors related to the changes in the liver and abdominal adipose tissue during the rapid weight loss after bariatric surgery remain uncertain.

METHODS

This study included 44 participants who had undergone sleeve gastrectomy. The study aimed to analyze changes and correlations of body weight (BW), laboratory tests, and magnetic resonance imaging (MRI) indicators of the liver and abdominal adipose tissue conducted before and after bariatric surgery at 1, 3, and 6 months.

RESULTS

Following a rapid weight loss within 6 months of surgery, there was a concurrent decrease in blood glucose, blood lipids, and fat content of the liver and abdomen and the changes showed a correlation. The change of BW (ΔBW) was positively correlated with the change of hepatic proton density fat fraction (ΔPDFF) in one and three months after surgery and was positively correlated with the change of abdominal visceral fat area (ΔAVFA) in six months after surgery, (P<0.05). In one month after surgery, ΔPDFF was positively correlated with the change of aspartate aminotransferase (ΔAST), change of alanine aminotransferase (ΔALT), and change of triglyceride glucose (ΔTYG) index (P<0.05). ΔPDFF was positively correlated with the change of hepatic native T1 values (P<0.001) and was moderately negatively correlated with the change of hepatic apparent diffusion coefficient (ΔADC) values in three months after surgery (P<0.05).

CONCLUSION

ΔBW can serve as an indirect indicator for evaluating changes in liver fat fraction at 1 and 3 months after bariatric surgery and indicative of changes in visceral fat 6 months after surgery. ΔPDFF was positively correlated with ΔAST, ΔALT and ΔTYG index in 1 months after surgery.

Evaluation of visceral adipose tissue thresholds for elevated metabolic syndrome risk across diverse populations: A systematic review

Beyond obesity, excess levels of visceral adipose tissue (VAT) significantly contribute to the risk of developing metabolic syndrome (MetS), although thresholds for increased risk vary based on population, regions of interest, and units of measure employed. We sought to determine whether a common threshold exists that is indicative of heightened MetS risk across all populations, accounting for sex, age, BMI, and race/ethnicity. A systematic literature review was conducted in September 2023, presenting threshold values for elevated MetS risk. Standardization equations harmonized the results from DXA, CT, and MRI systems to facilitate a comparison of threshold variations across studies. A total of 52 papers were identified. No single threshold could accurately indicate elevated risk for both males and females across varying BMI, race/ethnicity, and age groups. Thresholds fluctuated from 70 to 165.9 cm2, with reported values consistently lower in females. Generally, premenopausal females and younger adults manifested elevated risks at lower VAT compared to their older counterparts. Notably, Asian populations exhibited elevated risks at lower VAT areas (70-136 cm2) compared to Caucasian populations (85.6-165.9 cm2). All considered studies reported associations of VAT without accommodating covariates. No single VAT area threshold for elevated MetS risk was discernible post-harmonization by technology, units of measure, and region of interest. This review summarizes available evidence for MetS risk assessment in clinical practice. Further exploration of demographic-specific interactions between VAT area and other risk factors is imperative to comprehensively delineate overarching MetS risk.

Predictors of visceral and subcutaneous adipose tissue and muscle density: The ShapeUp! Kids study

BACKGROUND AND AIMS

Body fat distribution, i.e., visceral (VAT), subcutaneous adipose tissue (SAT) and intramuscular fat, is important for disease prevention, but sex and ethnic differences are not well understood. Our aim was to identify anthropometric, demographic, and lifestyle predictors for these outcomes.

METHODS AND RESULTS

The cross-sectional ShapeUp!Kids study was conducted among five ethnic groups aged 5-18 years. All participants completed questionnaires, anthropometric measurements, and abdominal MRI scans. VAT and SAT areas at four lumbar levels and muscle density were assessed manually. General linear models were applied to estimate coefficients of determination (R2) and to compare the fit of VAT and SAT prediction models. After exclusions, the study population had 133 male and 170 female participants. Girls had higher BMI-z scores, waist circumference (WC), and SAT than boys but lower VAT/SAT and muscle density. SAT, VAT, and VAT/SAT but not muscle density differed significantly by ethnicity. R2 values were higher for SAT than VAT across groups and improved slightly after adding WC. For SAT, R2 increased from 0.85 to 0.88 (girls) and 0.62 to 0.71 (boys) when WC was added while VAT models improved from 0.62 to 0.65 (girls) and 0.57 to 0.62 (boys). VAT values were significantly lower among Blacks than Whites with little difference for the other groups.

CONCLUSION

This analysis in a multiethnic population identified BMI-z scores and WC as the major predictors of MRI-derived SAT and VAT and highlights the important ethnic differences that need to be considered in diverse populations.

Association of weight-adjusted-waist index with non-alcoholic fatty liver disease and liver fibrosis: a cross-sectional study based on NHANES

AIM

The purpose of this study was to explore the association of weight-adjusted-waist index (WWI) with non-alcoholic fatty liver disease (NAFLD) and liver fibrosis.

METHODS

A cross-sectional study including 6587 participants was conducted in the National Health and Nutrition Examination Survey (NHANES). Multiple linear regression was used to validate the association of WWI with NAFLD and liver fibrosis, and smoothed curve fitting and threshold effect models were used to validate non-linear relationships. Subgroup analyses were used to verify the stability of the relationship between the independent and dependent variables in different populations.

RESULTS

There was a positive association of WWI with NAFLD and liver fibrosis. In the model adjusted for all covariates, the effect values of WWI with NAFLD and liver fibrosis were (OR = 3.44, 95% CI: 3.09-3.82) and (OR = 2.40, 95% CI: 2.05-2.79), respectively. This positive correlation became more significant as WWI increased when WWI was presented in quartiles (P for trend < 0.01). Smoothed curve fitting and threshold effects analysis suggested a non-linear correlation between WWI and NAFLD (LLR < 0.01), with the positive correlation between WWI and NAFLD becoming more significant when WWI was less than 11.44 [5.93 (95% CI: 5.04-6.98)]. However, there was a linear correlation between WWI and liver fibrosis (LLR = 0.291). When subgroup analyses were performed by indicators such as age, race and gender, we found that the positive association between WWI and the dependent variables (NAFLD and liver fibrosis) was more pronounced in white male participants aged < 40 years.

CONCLUSIONS

Among adults in the United States, WWI was positively associated with the prevalence of NAFLD and liver fibrosis. Participants with a WWI less than 11.44 should be cautious about the possibility of an increased risk of NAFLD development due to a higher WWI. Meanwhile, white males younger than 40 years of age should be more cautious about the higher risk of NAFLD and liver fibrosis that might be associated with an increased WWI.