PuSH - Publikationsserver des Helmholtz Zentrums München: 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.

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Klein, H.* ; Zelicha, H.* ; Yaskolka Meir, A.* ; Rinott, E.* ; Tsaban, G.* ; Kaplan, A.* ; Chassidim, Y.* ; Gepner, Y.* ; Blüher, M. ; Ceglarek, U.* ; Isermann, B.* ; Stumvoll, M.* ; Shelef, I.* ; Qi, L.* ; Li, J.* ; Hu, F.B.* ; Stampfer, M.J.* ; Shai, I.*

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 Med. 23:57 (2025)

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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).

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