Identification of sex-specific thresholds for accumulation of visceral adipose tissue in adults

Objective The purpose of this study was to measure the linearity of visceral adipose tissue (VAT) accumulation with measures of total body adiposity to determine whether a threshold exists and to explore the association with cardiometabolic risk factors in adults. Methods Using a cross-sectional design, data were obtained from 723 adults (324 females) age 19-47 years. Body mass index ranged from 15 to 52 kg/m². Segmented linear regression was used to identify sex-specific percent body fat thresholds at which VAT slope changes. Linear regression measured the association of VAT mass, total fat mass, and subcutaneous fat with cardiometabolic risk factors above and below each threshold. Results Adiposity thresholds were identified at 23.4% body fat in males and 38.3% body fat in females beyond which the slope of VAT per unit of percent body fat increased to strongly positive. Males and females above these adiposity thresholds had significant dyslipidemia (P- <- 0.001), increased insulin resistance (P- <- 0.001), and higher fat mass across all depots. Conclusions From these cross-sectional data, the following were inferred: the accumulation of VAT mass is not linear with increasing adiposity; increases in visceral accumulation above threshold are associated with decreased insulin sensitivity and cardiovascular risk in males and females independent of total body fat.