Visceral adipose tissue area and proportion provide distinct reflections of cardiometabolic outcomes in weight loss; pooled analysis of MRI-assessed CENTRAL and DIRECT PLUS dietary randomized controlled trials
Abstract Background Visceral adipose tissue (VAT) is well established as a pathogenic fat depot, whereas superficial subcutaneous adipose tissue (SAT) is associated with either an improved or neutral cardiovascular state. However, it is unclear to what extent VAT area (VATcm2) and its proportion of...
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2025-02-01
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| Online Access: | https://doi.org/10.1186/s12916-025-03891-9 |
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| author | Hadar Klein Hila Zelicha Anat Yaskolka Meir Ehud Rinott Gal Tsaban Alon Kaplan Yoash Chassidim Yftach Gepner Matthias Blüher Uta Ceglarek Berend Isermann Michael Stumvoll Ilan Shelef Lu Qi Jun Li Frank B. Hu Meir J. Stampfer Iris Shai |
| author_facet | Hadar Klein Hila Zelicha Anat Yaskolka Meir Ehud Rinott Gal Tsaban Alon Kaplan Yoash Chassidim Yftach Gepner Matthias Blüher Uta Ceglarek Berend Isermann Michael Stumvoll Ilan Shelef Lu Qi Jun Li Frank B. Hu Meir J. Stampfer Iris Shai |
| author_sort | Hadar Klein |
| collection | DOAJ |
| description | Abstract Background Visceral adipose tissue (VAT) is well established as a pathogenic fat depot, whereas superficial subcutaneous adipose tissue (SAT) is associated with either an improved or neutral cardiovascular state. However, it is unclear to what extent VAT area (VATcm2) and its proportion of total abdominal adipose tissue (VAT%) are distinguished in predicting cardiometabolic status and clinical outcomes during weight loss. Methods We integrated magnetic resonance imaging (MRI) measurements of VAT, deep-SAT, and superficial-SAT from two 18-month lifestyle weight loss clinical trials, CENTRAL and DIRECT PLUS (n = 572). Results At baseline, the mean VATcm2 was 144.8cm2 and VAT% = 28.2%; over 18 months, participants lost 28cm2 VATcm2 (− 22.5%), and 1.3 VAT% units. Baseline VATcm2 and VAT% were similarly associated with metabolic syndrome, hypertension, and diabetes status, while VAT% better classified hypertriglyceridemia. Conversely, higher VATcm2 was associated with elevated high-sensitivity C-reactive protein (hsCRP), while VAT% was not. After 18 months of lifestyle intervention, both VATcm2 and VAT% loss were significantly associated with decreased triglycerides, HbA1c, ferritin, and liver enzymes, and increased HDL-c levels beyond weight loss (FDR < 0.05). Only VATcm2 loss was correlated with decreased HOMA-IR, chemerin, and leptin levels. Conclusions MRI follow-up of 572 participants over 18 months of weight loss intervention suggests that although increased VATcm2 and VAT% exhibit similar clinical manifestations, it might be preferable to examine VAT% when exploring lipid status, while VATcm2 may better reflect inflammatory and glycemic states. Trial registration CENTRAL (Clinical-trials-identifier: NCT01530724); DIRECT PLUS (Clinical-trials-identifier: NCT03020186). |
| format | Article |
| id | doaj-art-9fb60ef6a1354c9e952d3cc8b73fcff5 |
| institution | Kabale University |
| issn | 1741-7015 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medicine |
| spelling | doaj-art-9fb60ef6a1354c9e952d3cc8b73fcff52025-02-09T12:40:52ZengBMCBMC Medicine1741-70152025-02-0123111210.1186/s12916-025-03891-9Visceral adipose tissue area and proportion provide distinct reflections of cardiometabolic outcomes in weight loss; pooled analysis of MRI-assessed CENTRAL and DIRECT PLUS dietary randomized controlled trialsHadar Klein0Hila Zelicha1Anat Yaskolka Meir2Ehud Rinott3Gal Tsaban4Alon Kaplan5Yoash Chassidim6Yftach Gepner7Matthias Blüher8Uta Ceglarek9Berend Isermann10Michael Stumvoll11Ilan Shelef12Lu Qi13Jun Li14Frank B. Hu15Meir J. Stampfer16Iris Shai17The Health & Nutrition Innovative International Research Center, Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the NegevThe Health & Nutrition Innovative International Research Center, Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the NegevThe Health & Nutrition Innovative International Research Center, Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the NegevThe Health & Nutrition Innovative International Research Center, Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the NegevThe Health & Nutrition Innovative International Research Center, Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the NegevThe Health & Nutrition Innovative International Research Center, Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the NegevDepartment of Engineering, Sapir Academic CollegeDepartment of Health Promotion, School of Public Health, Faculty of Medicine and Sylvan Adams Sports Institute, Tel-Aviv UniversityHelmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig and University Hospital LeipzigInstitute of Laboratory Medicine, University of Leipzig Medical CenterInstitute of Laboratory Medicine, University of Leipzig Medical CenterDepartment of Medicine, University of LeipzigSoroka University Medical CenterDepartment of Epidemiology, School of Public Health and Tropical Medicine, Tulane UniversityBrigham and Women’s Hospital and Harvard Medical SchoolDepartment of Nutrition, Harvard T.H. Chan School of Public HealthDepartment of Nutrition, Harvard T.H. Chan School of Public HealthThe Health & Nutrition Innovative International Research Center, Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the NegevAbstract Background Visceral adipose tissue (VAT) is well established as a pathogenic fat depot, whereas superficial subcutaneous adipose tissue (SAT) is associated with either an improved or neutral cardiovascular state. However, it is unclear to what extent VAT area (VATcm2) and its proportion of total abdominal adipose tissue (VAT%) are distinguished in predicting cardiometabolic status and clinical outcomes during weight loss. Methods We integrated magnetic resonance imaging (MRI) measurements of VAT, deep-SAT, and superficial-SAT from two 18-month lifestyle weight loss clinical trials, CENTRAL and DIRECT PLUS (n = 572). Results At baseline, the mean VATcm2 was 144.8cm2 and VAT% = 28.2%; over 18 months, participants lost 28cm2 VATcm2 (− 22.5%), and 1.3 VAT% units. Baseline VATcm2 and VAT% were similarly associated with metabolic syndrome, hypertension, and diabetes status, while VAT% better classified hypertriglyceridemia. Conversely, higher VATcm2 was associated with elevated high-sensitivity C-reactive protein (hsCRP), while VAT% was not. After 18 months of lifestyle intervention, both VATcm2 and VAT% loss were significantly associated with decreased triglycerides, HbA1c, ferritin, and liver enzymes, and increased HDL-c levels beyond weight loss (FDR < 0.05). Only VATcm2 loss was correlated with decreased HOMA-IR, chemerin, and leptin levels. Conclusions MRI follow-up of 572 participants over 18 months of weight loss intervention suggests that although increased VATcm2 and VAT% exhibit similar clinical manifestations, it might be preferable to examine VAT% when exploring lipid status, while VATcm2 may better reflect inflammatory and glycemic states. Trial registration CENTRAL (Clinical-trials-identifier: NCT01530724); DIRECT PLUS (Clinical-trials-identifier: NCT03020186).https://doi.org/10.1186/s12916-025-03891-9Visceral adipose tissueSubcutaneous adipose tissueWeight lossDiabetesMetabolic syndrome |
| spellingShingle | Hadar Klein Hila Zelicha Anat Yaskolka Meir Ehud Rinott Gal Tsaban Alon Kaplan Yoash Chassidim Yftach Gepner Matthias Blüher Uta Ceglarek Berend Isermann Michael Stumvoll Ilan Shelef Lu Qi Jun Li Frank B. Hu Meir J. Stampfer Iris Shai Visceral adipose tissue area and proportion provide distinct reflections of cardiometabolic outcomes in weight loss; pooled analysis of MRI-assessed CENTRAL and DIRECT PLUS dietary randomized controlled trials BMC Medicine Visceral adipose tissue Subcutaneous adipose tissue Weight loss Diabetes Metabolic syndrome |
| title | Visceral adipose tissue area and proportion provide distinct reflections of cardiometabolic outcomes in weight loss; pooled analysis of MRI-assessed CENTRAL and DIRECT PLUS dietary randomized controlled trials |
| title_full | Visceral adipose tissue area and proportion provide distinct reflections of cardiometabolic outcomes in weight loss; pooled analysis of MRI-assessed CENTRAL and DIRECT PLUS dietary randomized controlled trials |
| title_fullStr | Visceral adipose tissue area and proportion provide distinct reflections of cardiometabolic outcomes in weight loss; pooled analysis of MRI-assessed CENTRAL and DIRECT PLUS dietary randomized controlled trials |
| title_full_unstemmed | Visceral adipose tissue area and proportion provide distinct reflections of cardiometabolic outcomes in weight loss; pooled analysis of MRI-assessed CENTRAL and DIRECT PLUS dietary randomized controlled trials |
| title_short | Visceral adipose tissue area and proportion provide distinct reflections of cardiometabolic outcomes in weight loss; pooled analysis of MRI-assessed CENTRAL and DIRECT PLUS dietary randomized controlled trials |
| title_sort | visceral adipose tissue area and proportion provide distinct reflections of cardiometabolic outcomes in weight loss pooled analysis of mri assessed central and direct plus dietary randomized controlled trials |
| topic | Visceral adipose tissue Subcutaneous adipose tissue Weight loss Diabetes Metabolic syndrome |
| url | https://doi.org/10.1186/s12916-025-03891-9 |
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