Risk stratification using magnetic resonance imaging-derived, personalized z-scores of visceral adipose tissue, subcutaneous adipose tissue, and liver fat in persons with obesity

• Background: Individual patterns of fat accumulation (visceral, subcutaneous, and/or liver fat) can determine cardiometabolic risk profile. Objective: To investigate risk stratification using personalized fat z -scores in persons with a body mass index (BMI) of 30-40 kg/m2 from the UK Biobank imaging study. Setting: Population -based study. Methods: Whole -body magnetic resonance (MR) images of 40,174 participants from the UK Biobank imaging study were analyzed for visceral adipose tissue (VAT), abdominal subcutaneous adipose tissue (aSAT), and liver fat (LF) and used to calculate sex- and body size -invariant fat zscores (VATz, aSATz, LFz). Associations between z -scores and later incident cardiovascular disease (CVD) and type 2 diabetes (T2D) were investigated using Cox proportional hazards modeling and Kaplan -Meier curves in participants with BMI 30-40 kg/m(2). Results: A total of 6716 participants had BMI 30-40 kg/m2 and within this group, CVD was positively associated with VATz (crude hazard ratio (cHR) [95% CI]: 1.30 [1.20-1.40], P < .001) and negatively associated with aSATz and LFz (cHR: 0.91 [0.85-0.99], P = .028, and 0.88 [0.82- 0.95], P = .002). All z -scores remained significant after adjustment for sex, BMI, and age, but only VATz was significant when previous CVD was added. T2D was positively associated with VATz and LFz (cHR: 1.53 [1.40-1.67], P <.001, and 1.35 [1.23-148], P <.001) and negatively associated with aSATz (cHR: 0.90 [0.81-0.99], P = .026). All z -scores remained significant after adjustment for sex, BMI, and age. Conclusions: Personalized MR -derived fat z -scores can identify phenotypes of obesity with specific cardiometabolic risk profiles regardless of BMI. Current guidelines for bariatric surgery based on BMI exclude some of these high -risk patients. (Surg Obes Relat Dis 2024;20:419-424.) (c) 2024 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskap -- Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Health Sciences -- Public Health, Global Health, Social Medicine and Epidemiology (hsv//eng)

Keyword

Fat distribution; Body composition; Magnetic resonance imaging; UK Biobank

Publication and Content Type

ref (subject category)

art (subject category)