Abstract
Background
Previous studies have indicated that the deposition of abdominal adipose tissue was associated with the abnormalities of cardiometabolic components. The aim of this study was to examine the relationship of visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) and metabolic status and the different effects between males and females.
Methods
The 1388 eligible subjects were recruited in a baseline survey of metabolic syndrome in China, from two communities in Hangzhou and Chengdu. Areas of abdominal VAT and SAT were measured by magnetic resonance imaging (MRI). Serum total triglycerides (TG), high-density lipoprotein cholesterol (HDL-C) were measured by an automated biochemical analyzer. Metabolic abnormality (MA) was defined more than one abnormal metabolic components, which was based on the definition of metabolic syndrome (IDF 2005). Multiple logistic regression was used to calculate the odds ratios (ORs) and 95% confidence intervals (95%CI). Predictive value was assessed by area under the curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI), respectively.
Results
Their mean age was 53.8 years (SD: 7.1 years), the mean body mass index (BMI) was 23.7 kg/m2, and 44.8% of the subjects were male. Both male and female with MA had higher VAT levels compared to subjects with normal metabolism (MN), and male had higher SAT levels than female (P < 0.05). Higher VAT was significantly associated with MA with ORs in the fourth quartile (Q4) of 6.537 (95% CI = 3.394–12.591) for male and 3.364 (95% CI = 1.898–5.962) for female (P for trend < 0.05). In female, VAT could increase the risk of metabolic abnormalities, but SAT could increase the risk of MA in the second and fourth quartiles (Q2 and Q4) only at BMI > 24 kg/m2. In male, VAT improved the predictive value of MA compared to BMI and waist circumference (WC), the AUC was 0.727 (95% CI = 0.687–0.767), the NRI was 0.139 (95% CI = 0.070–0.208) and 0.106 (95% CI = 0.038–0.173), and the IDI was 0.074 (95% CI = 0.053–0.095) and 0.046 (95% CI = 0.026–0.066). Similar results were found in female.
Conclusions
In male, VAT and SAT could increase the risk of metabolic abnormalities both at BMI < 24 kg/m2 and at BMI ≥ 24 kg/m2. In female, VAT could increase the risk of metabolic abnormalities but SAT could increase the risk of MA in the second and fourth quartiles (Q2 and Q4) only at BMI > 24 kg/m2. Deposition of abdominal adipose tissue was associated with metabolic abnormalities. VAT improved the predictive power of MA.
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Introduction
Obesity, especially central obesity, is a well-established risk factor for a several diseases, such as dyslipidemia, type 2 diabetes (T2DM), cardiovascular diseases (CVD), and all-cause mortality [1, 10, 11, 25,26,27]. Several Caucasian studies have shown that VAT is more strongly associated with type 2 diabetes, hypertension and hyperlipidemia in female [10, 25, 28]. In our Additional file 1: Table S3, we observed that the effect of VAT on high TG and low-HDL was higher in male, indicating that VAT may have more striking effect on lipid metabolism in male than female. The possible reason maybe that only a limited number of confounders were adjusted, which may have affected the results. An expanded study of the Chinese population is necessary to determine the gender differences in the contribution of VAT. In general, the relationship between VAT and metabolic outcomes is relatively stable, which may be related to multiple biological effects of VAT.
SAT is known to have adverse effects on a variety of metabolic risk factors and may have unique pathogenic properties independent of BMI [1, 6, 25, 29], and the effects of different levels of SAT on cardiometabolic factors are inconsistent [1, 6, 13, 19, 25, 30]. Consistent with previous studies [30,31,32], our study (See Additional file 1: Tables S1, S2) showed that higher SAT was not associated with hypertension, higher TG, and lower HDL-C risk after adjustment for age, smoke, drink, and menstrual history (for women), and SAT may be a protective factor for blood sugar. Several studies with European or African populations have found independent associations of SAT with high blood pressure (H-BP) and HDL-C [1, 14, 26], suggesting that SAT has different effects in different ethnic groups. A possible explanation for this sex difference in SAT is the different sex steroid hormone profiles, as these sex hormones are important in regulating adipose tissue distribution and energy metabolism [33, 34]. There are also several hypotheses for the protective effect of SAT to explain this observation. One is that smaller adipocytes, SAT are more sensitive to insulin and have a greater capacity to absorb fatty acids and triglycerides and therefore can act as a powerful buffer to prevent excess fat from entering non-adipose tissue [35]. On the other hand, SAT can secrete more favorable adipokines such as adiponectin, with antidiabetics and antiatherogenic properties [18, 23]. Therefore, the different effects of SAT on metabolic outcomes may be related to its biological functions. Since SAT has different effects on metabolic components in different sexes, it may result in a less stable correlation between SAT and metabolic abnormality.
Previous studies have shown that baseline and changes in VAT were independent predictors of future dyslipidemia, but BMI and SAT were not associated with future development of atherosclerotic dyslipidemia [36]. This result is consistent to our study that VAT is a better predictor for MA compared with BMI and WC.
There are some advantages in our study. Areas of SAT and VAT were measured using MRI, which is the gold standard method of determining abdominal adipose tissue [37]. The data, including anthropometric and questionnaire-based information, were collected by trained health professionals, and the biochemical measurements followed the standard protocols. Our study also has some limitations. First, we cannot infer a causal relationship between the adipose indices and the metabolic abnormality because of the cross-sectional design. Second, this study included limited confounding factors, such as not including regional fat distribution, such as deep SAT and superficial SAT, and medication use, which may have biased the results. Thirdly, the sample size of this study was relatively small. Finally, our data were based on only one single ethnic group, thus the results may not be applied to other ethnicities.
Conclusions
In male, VAT and SAT could increase the risk of metabolic abnormalities both at BMI < 24 kg/m2 and at BMI ≥ 24 kg/m2. In female, VAT could increase the risk of metabolic abnormalities but SAT could increase the risk of MA in the second and fourth quartiles (Q2 and Q4) only at BMI > 24 kg/m2. Deposition of abdominal adipose tissue was associated with metabolic abnormalities. VAT improved the predictive power of MA.
Availability of data and materials
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Abbreviations
- SAT:
-
Subcutaneous adipose tissue
- VAT:
-
Visceral adipose tissue
- MRI:
-
Nuclear magnetic resonance imaging
- BMI:
-
Body mass index
- WC:
-
Waist circumference
- WHR:
-
Waist-to-hip ratio
- SBP:
-
Systolic blood pressure
- DBP:
-
Diastolic blood pressure
- FPG:
-
Fasting plasma glucose
- OGTT-2h:
-
2-Hour post oral glucose tolerance test
- TC:
-
Total cholesterol
- TG:
-
Triglyceride
- HDL-C:
-
High density lipoprotein cholesterol
- LDL-C:
-
Low density lipoprotein cholesterol
- MA:
-
Metabolic abnormality
- MN:
-
Metabolic normality
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Acknowledgements
We also would like to thank all the participants and investigators that took part in this study.
Funding
This work was supported by the grants from National Key Research and Development Program of China (2017YFC0907004), Hangzhou Science and Technology Project (20171226Y27), and Zhejiang Health Science and technology Project (2021KY268), Key Medical Discipline of Hangzhou (Disinfection and Vector Biological Control). The funder has no role in the design of the study, collection, analysis, and interpretation of data.
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Conceptualization, YZ; Data curation, QC; Formal analysis, QC and XS; Funding acquisition, XZ and YZ; Investigation, QL and JZ; Project administration, XZ and YZ; Supervision, YZ; Writing—original draft, XZ and QC; Writing—review and editing, YZ, QW, and ZC. All authors read and approved the final manuscript.
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The study was approved by the institutional review board at Zhejiang University, Zhejiang, China. All participants were given their written informed consents.
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Zhang, X., Chen, Q., Sun, X. et al. Association between MRI-based visceral adipose tissues and metabolic abnormality in a Chinese population: a cross-sectional study. Nutr Metab (Lond) 19, 16 (2022). https://doi.org/10.1186/s12986-022-00651-x
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DOI: https://doi.org/10.1186/s12986-022-00651-x