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The Complex Relationship Between Visceral Adipose Tissue and Metabolic Syndrome Risk

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Excessive visceral adipose tissue (VAT) has emerged as a significant contributor to metabolic syndrome (MetS) risk, beyond the influence of general obesity. Despite this, determining a universal threshold for VAT that indicates elevated MetS risk across diverse populations remains elusive. This study investigates whether a common VAT threshold exists, taking into account variables such as sex, age, BMI, and race/ethnicity, to offer a more standardized approach to MetS risk assessment.

Methodology and Findings

A comprehensive literature review was undertaken in September 2023, focusing on papers that presented threshold values for increased MetS risk. A total of 52 studies were identified, with results harmonized using standardization equations from DXA, CT, and MRI systems. The harmonization aimed to facilitate the comparison of threshold variations across different studies. The analysis revealed that no single VAT threshold accurately indicated elevated risk for both males and females across varying BMI, race/ethnicity, and age groups.

Threshold values for VAT spanned from 70 to 165.9 cm², with consistently lower values reported in females. Furthermore, premenopausal females and younger adults exhibited higher risks at lower VAT levels compared to older counterparts. Asian populations displayed increased MetS risks at lower VAT areas (70-136 cm²) compared to Caucasian populations (85.6-165.9 cm²). All studies reported associations of VAT without adjusting for covariates, highlighting a gap in comprehensive risk assessment.

Demographic-Specific Variations

The variability in VAT thresholds across different demographics underscores the complexity of establishing a universal marker for elevated MetS risk. The data suggest that age, sex, race/ethnicity, and BMI significantly influence the VAT levels associated with increased MetS risk. This variation necessitates demographic-specific thresholds to improve the accuracy of MetS risk assessments.

Key Takeaways for Clinical Practice

– Asian populations exhibit MetS risk at lower VAT levels compared to Caucasian populations.
– Females, particularly premenopausal, show elevated MetS risk at lower VAT values than males.
– Younger adults are at risk of MetS at lower VAT thresholds compared to older individuals.
– Standardization across different imaging technologies and measurement units is crucial for accurate comparisons.

Given these findings, it is evident that a one-size-fits-all approach to VAT thresholds for MetS risk is not feasible. Further research is necessary to explore the interactions between VAT area and other risk factors specific to different demographics. This nuanced understanding is essential for tailoring MetS risk assessments and interventions in clinical practice.

Original Article: Obes Rev. 2024 May 18:e13767. doi: 10.1111/obr.13767. Online ahead of print.

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