Dual-Energy X-Ray Absorptiometry for Quantification of Visceral Fat

Obesity is the major risk factor for metabolic syndrome and through it diabetes as well as cardiovascular disease. Visceral fat (VF) rather than subcutaneous fat (SF) is the major predictor of adverse events. Currently, the reference standard for measuring VF is abdominal X‐ray computed tomography (CT) or magnetic resonance imaging (MRI), requiring highly used clinical equipment. Dual‐energy X‐ray absorptiometry (DXA) can accurately measure body composition with high‐precision, low X‐ray exposure, and short‐scanning time. The purpose of this study was to validate a new fully automated method whereby abdominal VF can be measured by DXA. Furthermore, we explored the association between DXA‐derived abdominal VF and several other indices for obesity: BMI, waist circumference, waist‐to‐hip ratio, and DXA‐derived total abdominal fat (AF), and SF. We studied 124 adult men and women, aged 18–90 years, representing a wide range of BMI values (18.5–40 kg/m2) measured with both DXA and CT in a fasting state within a one hour interval. The coefficient of determination (r2) for regression of CT on DXA values was 0.959 for females, 0.949 for males, and 0.957 combined. The 95% confidence interval for r was 0.968 to 0.985 for the combined data. The 95% confidence interval for the mean of the differences between CT and DXA VF volume was −96.0 to −16.3 cm3. Bland‐Altman bias was +67 cm3 for females and +43 cm3 for males. The 95% limits of agreement were −339 to +472 cm3 for females and −379 to +465 cm3 for males. Combined, the bias was +56 cm3 with 95% limits of agreement of −355 to +468 cm3. The correlations between DXA‐derived VF and BMI, waist circumference, waist‐to‐hip ratio, and DXA‐derived AF and SF ranged from poor to modest. We conclude that DXA can measure abdominal VF precisely in both men and women. This simple noninvasive method with virtually no radiation can therefore be used to measure VF in individual patients and help define diabetes and cardiovascular risk.

[1]  P-W Lin,et al.  Fully automated large-scale assessment of visceral and subcutaneous abdominal adipose tissue by magnetic resonance imaging , 2006, International Journal of Obesity.

[2]  S. Grundy,et al.  Influence of body fat content and distribution on variation in metabolic risk. , 2006, The Journal of clinical endocrinology and metabolism.

[3]  R. Ross,et al.  Visceral Fat Is an Independent Predictor of All‐cause Mortality in Men , 2006, Obesity.

[4]  S. Cummings,et al.  Adipocytokines attenuate the association between visceral adiposity and diabetes in older adults. , 2004, Diabetes care.

[5]  R. Ross,et al.  Waist circumference and not body mass index explains obesity-related health risk. , 2004, The American journal of clinical nutrition.

[6]  L. Sjöström,et al.  Impact of obesity on metabolism in men and women. Importance of regional adipose tissue distribution. , 1983, The Journal of clinical investigation.

[7]  C. Fox,et al.  Comparison of anthropometric, area- and volume-based assessment of abdominal subcutaneous and visceral adipose tissue volumes using multi-detector computed tomography , 2007, International Journal of Obesity.

[8]  S. Kritchevsky,et al.  The association of regional fat depots with hypertension in older persons of white and African American ethnicity. , 2004, American journal of hypertension.

[9]  M. Ibrahim.  Subcutaneous and visceral adipose tissue: structural and functional differences , 2010, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[10]  A Tremblay,et al.  Regional distribution of body fat, plasma lipoproteins, and cardiovascular disease. , 1990, Arteriosclerosis.

[11]  S. Kahn,et al.  Visceral Adiposity and the Prevalence of Hypertension in Japanese Americans , 2003, Circulation.

[12]  G. Borkan,et al.  Assessment of abdominal fat content by computed tomography. , 1982, The American journal of clinical nutrition.

[13]  J. Després,et al.  Waist circumference, visceral obesity, and cardiovascular risk. , 2003, Journal of cardiopulmonary rehabilitation.

[14]  J. Després,et al.  Abdominal obesity and metabolic syndrome , 2006, Nature.

[15]  C. Bouchard,et al.  Adipose Tissue Distribution and Plasma Lipoprotein Levels in Obese Women: Importance of Intra‐abdominal Fat , 1989, Arteriosclerosis.

[16]  P. Björntorp,et al.  Abdominal adipose tissue distribution, obesity, and risk of cardiovascular disease and death: 13 year follow up of participants in the study of men born in 1913. , 1984, British medical journal.

[17]  C. Christiansen,et al.  Measurement of lean body mass and total body fat using dual photon absorptiometry. , 1986, Metabolism: clinical and experimental.

[18]  J. Hardies,et al.  Effect of pioglitazone on abdominal fat distribution and insulin sensitivity in type 2 diabetic patients. , 2002, The Journal of clinical endocrinology and metabolism.

[19]  S. Kritchevsky,et al.  Association between regional adipose tissue distribution and both type 2 diabetes and impaired glucose tolerance in elderly men and women. , 2003, Diabetes care.

[20]  Tamara B Harris,et al.  Obesity, regional body fat distribution, and the metabolic syndrome in older men and women. , 2005, Archives of internal medicine.

[21]  E. Oda.  Minimum Waist and Visceral Fat Values for Identifying Japanese Americans at Risk for the Metabolic Syndrome , 2007, Diabetes Care.

[22]  T Nakamura,et al.  Contribution of visceral fat accumulation to the development of coronary artery disease in non-obese men. , 1994, Atherosclerosis.

[23]  E. Boyko,et al.  Visceral adiposity and risk of type 2 diabetes: a prospective study among Japanese Americans. , 2000, Diabetes care.

[24]  R B Mazess,et al.  Dual-energy x-ray absorptiometry for total-body and regional bone-mineral and soft-tissue composition. , 1990, The American journal of clinical nutrition.

[25]  S. Yamashita,et al.  Visceral fat accumulation contributes to insulin resistance, small-sized low-density lipoprotein, and progression of coronary artery disease in middle-aged non-obese Japanese men. , 2001, Japanese circulation journal.

[26]  J. Kullberg,et al.  Automated and reproducible segmentation of visceral and subcutaneous adipose tissue from abdominal MRI , 2007, International Journal of Obesity.

[27]  K. Pennert,et al.  Distribution of adipose tissue and risk of cardiovascular disease and death: a 12 year follow up of participants in the population study of women in Gothenburg, Sweden. , 1984, British medical journal.

[28]  S. Kahn,et al.  Visceral adiposity and the risk of impaired glucose tolerance: a prospective study among Japanese Americans. , 2003, Diabetes care.

[29]  J. Després,et al.  Contribution of visceral obesity to the deterioration of the metabolic risk profile in men with impaired glucose tolerance , 2000, Diabetologia.

[30]  M. Jensen,et al.  Preventing overestimation of pixels in computed tomography assessment of visceral fat. , 2004, Obesity research.

[31]  L. Sjöström,et al.  Total and visceral adipose-tissue volumes derived from measurements with computed tomography in adult men and women: predictive equations. , 1988, The American journal of clinical nutrition.

[32]  J. Cauley,et al.  The prediction of visceral fat by dual-energy X-ray absorptiometry in the elderly: a comparison with computed tomography and anthropometry , 2002, International Journal of Obesity.

[33]  S Heshka,et al.  Dual-photon absorptiometry: comparison of bone mineral and soft tissue mass measurements in vivo with established methods. , 1989, The American journal of clinical nutrition.

[34]  C. Bouchard,et al.  Age-related increase in visceral adipose tissue and body fat and the metabolic risk profile of premenopausal women. , 1999, Diabetes care.

[35]  S. Ayis,et al.  A comparison of proxy measures of abdominal obesity in Chinese, European and South Asian adults , 1999, Diabetic medicine : a journal of the British Diabetic Association.

[36]  C. Bouchard,et al.  The use of anthropometric and dual-energy X-ray absorptiometry (DXA) measures to estimate total abdominal and abdominal visceral fat in men and women. , 1999, Obesity research.

[37]  A A Moss,et al.  Quantification of body fat distribution in the abdomen using computed tomography. , 1984, The American journal of clinical nutrition.

[38]  S. Yamashita,et al.  Abdominal fat: standardized technique for measurement at CT. , 1999, Radiology.

[39]  J. Després,et al.  Reduced HDL particle size as an additional feature of the atherogenic dyslipidemia of abdominal obesity. , 2001, Journal of lipid research.

[40]  J P Clarys,et al.  Adipose tissue density, estimated adipose lipid fraction and whole body adiposity in male cadavers. , 1994, International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity.

[41]  R. Mazess,et al.  Total body composition by dual-photon (153Gd) absorptiometry. , 1984, The American journal of clinical nutrition.

[42]  A Cederblad,et al.  Determination of total adipose tissue and body fat in women by computed tomography, 40K, and tritium. , 1986, The American journal of physiology.

[43]  J. Hamers,et al.  [Methods and techniques]. , 1997, Verpleegkunde.