Visceral adiposity and the risk of metabolic syndrome across body mass index: the MESA Study.
Visceral adiposity and the risk of metabolic syndrome across body mass index: the MESA Study.
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DOI：
10.1016/j.jcmg.2014.07.017
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发表时间：
2014-12
影响因子：
14
通讯作者：
Allison, Matthew A
中科院分区：
文献类型：
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作者：
Shah, Ravi V;Murthy, Venkatesh L;Abbasi, Siddique A;Blankstein, Ron;Kwong, Raymond Y;Goldfine, Allison B;Jerosch-Herold, Michael;Lima, Joao A C;Ding, Jingzhong;Allison, Matthew A
本研究旨在评估内脏脂肪（VF）和皮下脂肪的差异效应及其对不同体重指数（BMI）类别代谢综合征（MetS）风险的影响。脂肪组织的区域分布是心脏代谢疾病的一个新的危险因素，尽管脂肪分布的系列变化尚未得到广泛研究。在正常体重和超重或肥胖个体中，VF及其随时间的变化可能是比BMI更好的风险标志物。我们研究了梅萨（多种族动脉粥样硬化研究）中的1，511名个体，通过计算机断层扫描（CT）进行肥胖评估。共有253名初次扫描时无MetS的参与者接受了重复CT（中位间隔3.3年）。我们使用离散考克斯回归和净重新分类来研究VF面积的基线和变化是否与MetS相关。较高的VF与心脏代谢风险和冠状动脉钙化相关，与BMI无关。校正后，无论体重如何，VF与MetS事件的相关性均强于皮下脂肪，每100 cm 2/m VF面积的MetS风险高出28%，并且与临床风险相比具有显著的净重新分类（净重新分类指数：0.44，95%置信区间[CI]：0.29至0.60）。在连续成像的个体中，校正后，初始VF（风险比：1.24/100 cm 2/m，95% CI：1.08 - 1.44/100 cm 2/m，p = 0.003）和VF变化（风险比：1.05/5%变化，95% CI：1.01 - 1.08/5%变化，p = 0.02）与MetS相关。在调整临床风险和VF面积后，皮下脂肪的变化与MetS事件无关。VF与BMI适度相关。然而，在整个BMI中，VF的单一测量和纵向变化预测MetS，甚至考虑到体重变化。内脏肥胖对于评估心脏代谢风险是必不可少的，无论年龄、种族或BMI如何，并且可以作为心脏代谢疾病治疗的标志物和靶点。
This study sought to evaluate differential effects of visceral fat (VF) and subcutaneous fat and their effects on metabolic syndrome (MetS) risk across body mass index (BMI) categories. The regional distribution of adipose tissue is an emerging risk factor for cardiometabolic disease, although serial changes in fat distribution have not been extensively investigated. VF and its alterations over time may be a better marker for risk than BMI in normal weight and overweight or obese individuals. We studied 1,511 individuals in the MESA (Multi-Ethnic Study of Atherosclerosis) with adiposity assessment by computed tomography (CT). A total of 253 participants without MetS at initial scan underwent repeat CT (median interval 3.3 years). We used discrete Cox regression with net reclassification to investigate whether baseline and changes in VF area are associated with MetS. Higher VF was associated with cardiometabolic risk and coronary artery calcification, regardless of BMI. After adjustment, VF was more strongly associated with incident MetS than subcutaneous fat regardless of weight, with a 28% greater MetS hazard per 100 cm2/m VF area and significant net reclassification (net reclassification index: 0.44, 95% confidence interval [CI]: 0.29 to 0.60) over clinical risk. In individuals with serial imaging, initial VF (hazard ratio: 1.24 per 100 cm2/m, 95% CI: 1.08 to 1.44 per 100 cm2/m, p = 0.003) and change in VF (hazard ratio: 1.05 per 5% change, 95% CI: 1.01 to 1.08 per 5% change, p = 0.02) were associated with MetS after adjustment. Changes in subcutaneous fat were not associated with incident MetS after adjustment for clinical risk and VF area. VF is modestly associated with BMI. However, across BMI, a single measure of and longitudinal change in VF predict MetS, even accounting for weight changes. Visceral adiposity is essential to assessing cardiometabolic risk, regardless of age, race, or BMI, and may serve as a marker and target of therapy in cardiometabolic disease.