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Jung, M.* ; Reisert, M.* ; Rieder, H.* ; Rospleszcz, S. ; Lu, M.T.* ; Bamberg, F.* ; Raghu, V.K.* ; Weiss, J.*

Association between body composition and cardiometabolic outcomes : A prospective cohort study.

Ann. Intern. Med., DOI: 10.7326/ANNALS-24-01863 (2025)

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Open Access Green: Postprint online available 04/2026

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BACKGROUND: Current measures of adiposity have limitations. Artificial intelligence (AI) models may accurately and efficiently estimate body composition (BC) from routine imaging. OBJECTIVE: To assess the association of AI-derived BC compartments from magnetic resonance imaging (MRI) with cardiometabolic outcomes. DESIGN: Prospective cohort study. SETTING: UK Biobank (UKB) observational cohort study. PARTICIPANTS: 33 432 UKB participants with no history of diabetes, myocardial infarction, or ischemic stroke (mean age, 65.0 years [SD, 7.8]; mean body mass index [BMI], 25.8 kg/m² [SD, 4.2]; 52.8% female) who underwent whole-body MRI. MEASUREMENTS: An AI tool was applied to MRI to derive 3-dimensional (3D) BC measures, including subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), skeletal muscle (SM), and SM fat fraction (SMFF), and then calculate their relative distribution. Sex-stratified associations of these relative compartments with incident diabetes mellitus (DM) and major adverse cardiovascular events (MACE) were assessed using restricted cubic splines. RESULTS: Adipose tissue compartments and SMFF increased and SM decreased with age. After adjustment for age, smoking, and hypertension, greater adiposity and lower SM proportion were associated with higher incidence of DM and MACE after a median follow-up of 4.2 years in sex-stratified analyses; however, after additional adjustment for BMI and waist circumference (WC), only elevated VAT proportions and high SMFF (top fifth percentile in the cohort for each) were associated with increased risk for DM (respective adjusted hazard ratios [aHRs], 2.16 [95% CI, 1.59 to 2.94] and 1.27 [CI, 0.89 to 1.80] in females and 1.84 [CI, 1.48 to 2.27] and 1.84 [CI, 1.43 to 2.37] in males) and MACE (1.37 [CI, 1.00 to 1.88] and 1.72 [CI, 1.23 to 2.41] in females and 1.22 [CI, 0.99 to 1.50] and 1.25 [CI, 0.98 to 1.60] in males). In addition, in males only, those in the bottom fifth percentile of SM proportion had increased risk for DM (aHR for the bottom fifth percentile of the cohort, 1.96 [CI, 1.45 to 2.65]) and MACE (aHR, 1.55 [CI, 1.15 to 2.09]). LIMITATION: Results may not be generalizable to non-Whites or people outside the United Kingdom. CONCLUSION: Artificial intelligence-derived BC proportions were strongly associated with cardiometabolic risk, but after BMI and WC were accounted for, only VAT proportion and SMFF (both sexes) and SM proportion (males only) added prognostic information. PRIMARY FUNDING SOURCE: None.

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