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

Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System (T.H., E.J.B., S.E.K.), Departments of Medicine (T.H., E.J.B., M.J.M, S.E.K., W.Y.F.), and Anthropology (D.L.L.), University of Washington, and The Department of Preventive Medicine and Environmental Health, Graduate School of Medicine, Osaka City University (T.H.)

Objective: Visceral adiposity is generally considered to play a key role in the metabolic syndrome. But not known is 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 (TFA) was estimated by the sum of all of these fat areas. Visceral adiposity was measured as intra-abdominal fat area (IAFA) at the umbilicus level. Total subcutaneous fat area (TSFA) was defined as TFA minus IAFA. 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 IAFA (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, gender, 2-hour plasma glucose level, and incremental insulin response. IAFA remained a significant predictor of increased HOMA-IR at 10-11 years even after adjustment for TSFA, TFA, 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 IAFA. 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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