ARS | Publication request: Association of lifestyle factors with abdominal subcutaneous and visceral adiposity: The Framingham Heart Study

Submitted to: Diabetes Care
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: December 5, 2008
Publication Date: March 1, 2009
Citation: Molenaar, E., Massaro, J., Jacques, P., Pou, K., Ellison, R., Hoffmann, U., Pencina, K., Shadwick, S., Vasan, R., O'Donnell, C., Fox, C. 2009. Association of lifestyle factors with abdominal subcutaneous and visceral adiposity: The Framingham Heart Study. Diabetes Care. 32(3):505-510.

Interpretive Summary: Abdominal adiposity is strongly associated with metabolic and cardiovascular (CVD) risk. Visceral adipose tissue (VAT) in particular may be a pathogenic fat compartment. Numerous studies have demonstrated that central obesity is associated with lifestyle factors. However, the majority of these studies used waist circumference as a proxy for abdominal obesity, which does not allow to differentiate between subcutaneous adipose tissue (SAT) and VAT. As VAT is more strongly associated with metabolic risk factors than SAT, it is important to identify whether VAT is more correlated with lifestyle factors. This may provide more understanding of the relationship between a healthy lifestyle and VAT and the contribution of individual lifestyle factors to metabolic risk for CVD. Thus, the aim of the present study was to examine the relation between lifestyle factors (dietary quality, physical activity, smoking and alcohol consumption) and SAT and VAT volumes, as assessed by multidetector computed tomography (MDCT), in a large population-based cohort of 2926 women and men free of CVD. We observed that a diet consistent with the 2005 Dietary Guidelines for Americans and greater physical activity were inversely associated with SAT and VAT. In men, former smoking was associated with higher SAT as compared to current or never smokers. Both former and current smoking was associated with higher VAT in men and women. Women with high amounts of alcohol intake (>7 drinks/week) had lower SAT than those who consumed less; no association was seen between alcohol intake and VAT in women. In men, high amounts of alcohol intake (>14 drinks/week) were associated with higher VAT compared with those consuming less alcohol (14 drinks or less per week) whereas SAT did not differ between men consuming higher and lower amounts of alcohol. An increasing number of healthy lifestyle factors was associated with lower SAT and VAT volumes. In conclusion, a healthy diet and physical activity are associated with lower SAT and VAT volumes. However, both smoking and high alcohol intake are differentially associated with higher VAT volumes. Further research to uncover the putative mechanisms is warranted.

Technical Abstract: The objective of the present study was to assess the relationship between lifestyle factors and abdominal subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) in a community-based setting. Cross-sectional associations between lifestyle factors (dietary quality, physical activity, smoking and alcohol consumption) and SAT and VAT volumes were examined in 2926 Framingham Heart Study participants (48.6% women, age 50+/-10 years). A diet consistent with the 2005 Dietary Guidelines Adherence Index and greater physical activity were inversely associated with SAT and VAT (p-value<0.0001 to 0.002). In men, former smoking was associated with higher SAT (2743+/-56 cm^3) as compared to current (2629+/-88 cm^3) or never smokers (2538+/-44 cm^3; p=0.02). Both former and current smoking was associated with higher VAT (p=0.03 [women]; p=0.005 [men]). Women with high amounts of alcohol intake (>7 drinks/week) had lower SAT (2869+/-106 cm^3) than those who consumed less (3184+/-44 cm^3, p=0.006); significant differences in VAT were not observed (p=0.18). In men, high amounts of alcohol intake (>14 drinks/week) were associated with higher VAT (2272+/-59 cm^3) compared to </=14 drinks/week (2139+/-25 cm^3, p=0.04), whereas SAT did not differ (p=0.91). An increasing number of healthy lifestyle factors was associated with lower SAT and VAT volumes (all p-values<0.003). In conclusion, a healthy diet and physical activity are associated with lower SAT and VAT volumes. However, both smoking and high alcohol intake are differentially associated with higher VAT volumes. Further research to uncover the putative mechanisms is warranted.