Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Sep 3;62(10):921-5.
doi: 10.1016/j.jacc.2013.06.027. Epub 2013 Jul 10.

Body fat distribution, incident cardiovascular disease, cancer, and all-cause mortality

Kathryn A Britton  1 , Joseph M Massaro, Joanne M Murabito, Bernard E Kreger, Udo Hoffmann, Caroline S Fox
Affiliations

Body fat distribution, incident cardiovascular disease, cancer, and all-cause mortality

Kathryn A Britton et al. J Am Coll Cardiol. .

Abstract

Objectives: The aim of this study was to determine whether ectopic fat depots are prospectively associated with cardiovascular disease, cancer, and all-cause mortality.

Background: The morbidity associated with excess body weight varies among individuals of similar body mass index. Ectopic fat depots may underlie this risk differential. However, prospective studies of directly measured fat are limited.

Methods: Participants from the Framingham Heart Study (n = 3,086; 49% women; mean age of 50.2 years) underwent assessment of fat depots (visceral adipose tissue, pericardial adipose tissue, and periaortic adipose tissue) using multidetector computed tomography and were followed up longitudinally for a median of 5.0 years. Cox proportional hazards regression models were used to examine the association of each fat depot (per 1 SD increment) with the risk of incident cardiovascular disease, cancer, and all-cause mortality after adjustment for standard risk factors, including body mass index.

Results: Overall, there were 90 cardiovascular events, 141 cancer events, and 71 deaths. After multivariable adjustment, visceral adipose tissue was associated with cardiovascular disease (hazard ratio: 1.44; 95% confidence interval: 1.08 to 1.92; p = 0.01) and cancer (hazard ratio: 1.43; 95% confidence interval: 1.12 to 1.84; p = 0.005). Addition of visceral adipose tissue to a multivariable model that included body mass index modestly improved cardiovascular risk prediction (net reclassification improvement of 16.3%). None of the fat depots were associated with all-cause mortality.

Conclusions: Visceral adiposity is associated with incident cardiovascular disease and cancer after adjustment for clinical risk factors and generalized adiposity. These findings support the growing appreciation of a pathogenic role of ectopic fat.

Keywords: BMI; CI; CVD; HR; MDCT; NRI; SAT; VAT; body fat distribution; body mass index; cancer; cardiovascular disease; confidence interval; hazard ratio; multidetector computed tomography; net reclassification index; obesity; subcutaneous adipose tissue; visceral adipose tissue; visceral fat.

PubMed Disclaimer

Conflict of interest statement

Disclosures: The authors report no conflicts of interest.

Figures

Figure 1
Figure 1. Multidetector computed tomography images demonstrating SAT, VAT, periaortic fat, and pericardial fat
Fat depots are defined by anatomic landmarks and pixels of adipose tissue within a given fat depot are identified by their characteristic Hounsfield units.
Figure 2
Figure 2. Kaplan Meier Curve of Time to A) CVD and B) Cancer by Tertile of VAT (cm3)
Vertical axes show the percent of subjects developing A) CVD and B) cancer during follow-up; horizontal axes reflect years of follow-up. Tertile cutpoints for VAT are 1242.2 and 2168.4 cm3
Figure 2
Figure 2. Kaplan Meier Curve of Time to A) CVD and B) Cancer by Tertile of VAT (cm3)
Vertical axes show the percent of subjects developing A) CVD and B) cancer during follow-up; horizontal axes reflect years of follow-up. Tertile cutpoints for VAT are 1242.2 and 2168.4 cm3
See this image and copyright information in PMC

References

    1. Mahabadi AA, Massaro JM, Rosito GA, et al. Association of pericardial fat, intrathoracic fat, and visceral abdominal fat with cardiovascular disease burden: the Framingham Heart Study. Eur Heart J. 2009;30:850–856. - PMC - PubMed
    1. Yamaji T, Iwasaki M, Sasazuki S, et al. Visceral Fat Volume and the Prevalence of Colorectal Adenoma. American Journal of Epidemiology. 2009;170:1502–1511. - PubMed
    1. Greenstein AS, Khavandi K, Withers SB, et al. Local Inflammation and Hypoxia Abolish the Protective Anticontractile Properties of Perivascular Fat in Obese Patients. Circulation. 2009;119:1661–1670. - PubMed
    1. Fox CS, Massaro JM, Schlett CL, et al. Peri-Aortic Fat Deposition Is Associated with Peripheral Arterial Disease: The Framingham Heart Study. Circ Cardiovasc Imaging. 2010;3:515–519. - PMC - PubMed
    1. Rosito GA, Massaro JM, Hoffmann U, et al. Pericardial Fat, Visceral Abdominal Fat, Cardiovascular Disease Risk Factors, and Vascular Calcification in a Community-Based Sample: The Framingham Heart Study. Circulation. 2008;117:605–613. - PubMed

Publication types