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MERLOT study

Intra-abdominal fat is risk factor for metabolic syndrome

Measuring the area of intra-abdominal fat is an effective method of measuring an individual's risk of metabolic syndrome. Photo: Flickr / tobyotter
CT scans for intra-abdominal fat effectively predict later development of metabolic syndrome factors
Effect observed even in normal-weight Japanese adults

A six-year study has found that using CT scans to measure intra-abdominal fat area (IAFA) is an effective predictor of the later development of the symptoms of metabolic syndrome in healthy Japanese adults, even in individuals with a BMI under 25.

The study, “Intra-abdominal fat area is a predictor for new onset of individual components of metabolic syndrome”, examined the long-term metabolic health outcomes of 1,380 healthy workers, comparing the results to their starting IAFA.

During the follow-up period (mean 3.6 years, ranging up to 9.7 years), 54.3% of subjects had developed at least one component of metabolic syndrome, most prevalently high blood pressure; an analysis of the results found that the patients’ IAFA was significantly associated with metabolic syndrome risk. This finding was independent of BMI, and was found to be significant even in those who were not overweight or obese.

The paper is the first published report using data from the MERLOT (MEtabolic syndRome and abdominaL ObesiTy) Study, which surveyed 25,255 employees of the Japanese telecommunications company NTT West. Of the survey subjects, 5,479 volunteered to have their intra-abdominal fat area measured using computed tomography; for the paper, 4,099 were excluded for already having symptoms of metabolic syndrome or for insufficient follow-up period. The remaining 1,380 subjects consisted of 1,053 men and 327 women, with a mean age of 47.3±7.4 years, ranging from 23 to 64.

The study found that 395/615 of the men (64.2%) and 79/137 of the women (57.7%) presented with high blood pressure at some point during follow-up; 54% of the men and 43.1% of the women demonstrated symptoms of dyslipidemia, and 23.4% of men and 26.3% of women had hyperglycemia.

The researchers used multivariate Cox proportional hazards analysis to adjust the hazard ratio of developing metabolic syndrome components for factors including age, gender, and smoking status. When they also adjusted for BMI, they found that IAFA remained an independent predictor for the new onset of metabolic syndrome components (hazard ratio 1.04, 95% confidence interval 1.02-1.07).

The study shows the role of excess IAFA in predicting cardiometabolic risk in the Japanese population, particularly in identifying people who are of normal weight but are “metabolically obese”, demonstrating obesity-related conditions while having a normal weight and BMI.

These individuals, say the researchers, can display premature signs of insulin resistance, hyperinsulinemia, and dylipidemia, which may go undetected for years due to their normal body weight, masking the need for early detection and intervention.

The study authors acknowledge that while using a CT scan to measure IAFA would be an effective measure to predict early onset of metabolic factors, the “considerable” radiation exposure limited its wide-scale use. It suggested, however, that the dual bio-impedance method could successfully detect levels of IAFA without exposing the patient to X-rays.

The paper reinforces recent research which found that excess visceral fat had an increased risk of developing type 2 diabetes.

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