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Visceral Adiposity, Not Abdominal Subcutaneous Fat Area, Is Associated With an Increase in Future Insulin Resistance in Japanese Americans

¹ Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System
² Department of Preventive Medicine and Environmental Health, Graduate School of Medicine, Osaka City University, Osaka, Japan
³ Department of Medicine, University of Washington, Seattle, Washington
⁴ Department of Anthropology, University of Washington, Seattle, Washington

Corresponding author: Edward J. Boyko, MD, MPH, Veterans Affairs Puget Sound Health Care System (S-152E), 1660 S. Columbian Way, Seattle, WA 98108. E-mail: eboyko{at}u.washington.edu

Abbreviations: AUC, area under the oral glucose tolerance test curve; CT, computed tomography; HOMA-IR, homeostasis model assessment for insulin resistance

OBJECTIVE—Visceral adiposity is generally considered to play a key role in the metabolic syndrome. We sought to determine whether greater visceral adiposity directly measured by computed tomography (CT) is associated with increased future insulin resistance independent of other adipose depots.

RESEARCH DESIGN AND METHODS— We followed 306 nondiabetic Japanese Americans over 10–11 years. Baseline variables included BMI; waist circumference; and abdominal, thoracic, and thigh fat areas measured by CT. Total fat area was estimated by the sum of all of these fat areas. Visceral adiposity was measured as intra-abdominal fat area at the umbilicus level. Total subcutaneous fat area was defined as total fat area minus intra-abdominal fat area. Insulin resistance was evaluated by homeostasis model assessment for insulin resistance (HOMA-IR), fasting plasma insulin level, Matsuda index, and area under the oral glucose tolerance test curve (AUC) of insulin.

RESULTS— Both baseline intra-abdominal fat area (P = 0.002) and HOMA-IR (P < 0.001) were independently associated with increased HOMA-IR at 10–11 years in a multiple linear regression model after adjustment for abdominal subcutaneous fat area, age, sex, 2-h plasma glucose level, and incremental insulin response. Intra-abdominal fat area remained a significant predictor of increased HOMA-IR at 10–11 years even after adjustment for total subcutaneous fat area, total fat area, BMI, or waist circumference, but no other measure of CT-measured regional or total adiposity was significantly related with HOMA-IR at 10–11 years in models that contained intra-abdominal fat area. Similar results were obtained for predicting future fasting plasma insulin level, Matsuda index, and AUC of insulin.

CONCLUSIONS— Greater visceral adiposity is associated with an increase in future insulin resistance.

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