Energy balance
Visceral Adipose Tissue (VAT) and ectopic fat deposition are causal drivers of cardiometabolic disease, whereas subcutaneous fat (specifically gluteofemoral adipose tissue, GFAT) is protective, independent of total body weight.
Focus on preserving subcutaneous fat storage capacity (especially in hips/thighs) and reducing visceral/abdominal fat. This is achieved through diet quality and physical activity, not just weight loss. If you have a 'skinny fat' phenotype (normal weight but high visceral fat), your risk is high. If you have a 'healthy obese' phenotype (high weight but low visceral fat and good metabolism), your risk may be lower than expected.
VAT is richer in saturated fatty acids... plays a predominant pathogenic role in obesity-associated lipid and glucose metabolic abnormalities... GFAT is strongly associated with all cardiometabolic traits studied, that is, protective against the development of an atherogenic lipoprotein-lipid profile... The absolute effect size of genetically predicted GFAT adjusted for BMI was systematically higher than VAT adjusted for BMI... for all cardiometabolic traits and diseases examined.
Why this rating
Supported by genetic (MR), imaging, and mechanistic studies showing causal links between fat depot location and disease.
Source
Adiposity, type 2 diabetes and atherosclerotic cardiovascular disease risk: Use and abuse of the body mass index
Benoît J. Arsenault et al. · Atherosclerosis · 2024
DOI 10.1016/j.atherosclerosis.2024.117546
More from this paper
- Body Mass Index (BMI) is an inadequate and potentially misleading metric for assessing individual cardiometabolic risk because it fails to account for regional fat distribution and ectopic lipid deposition, which are the true drivers of disease.Strong
- Lifestyle interventions (diet and physical activity) improve cardiometabolic risk through mechanisms independent of weight loss, primarily by reducing visceral and ectopic fat and improving metabolic markers.Good
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