Faculty Collaboration Database

Visceral adiposity and hepatic steatosis at abdominal CT: association with the metabolic syndrome. AJR Am J Roentgenol 2012 May;198(5):1100-7

Date

04/25/2012

Pubmed ID

22528899

DOI

10.2214/AJR.11.7361

Scopus ID

2-s2.0-84860330650 (requires institutional sign-in at Scopus site)   107 Citations

Abstract

OBJECTIVE: Visceral adiposity and hepatic steatosis may correlate with the metabolic syndrome but are not currently among the diagnostic criteria. We evaluated these features at unenhanced MDCT.

MATERIALS AND METHODS: Semiautomated measurements of subcutaneous fat area, visceral fat area, and visceral fat percentage were obtained at the umbilical level at unenhanced MDCT of 474 adults (217 men, 257 women; mean age, 58.3 years) using a dedicated application (Fat Assessment Tool, EBW version 4.5). Unenhanced liver attenuation was also recorded. Metabolic syndrome was defined using the criteria proposed by the International Diabetes Federation in 2005.

RESULTS: The prevalence of metabolic syndrome was 35.0% (76/217) among men and 35.8% (92/257) among women. The area under the receiver operating characteristic curve (AUC) for visceral fat area was 0.830 (95% CI, 0.784-0.867) in men and 0.887 (0.848-0.918) in women (p = 0.162). The AUC for subcutaneous fat area was 0.865 (0.823-0.899) in men and 0.762 (0.711-0.806) in women (p = 0.024). The AUC for visceral fat percentage was 0.527 (0.472-0.581) in men and 0.820 (0.774-0.859) in women (p < 0.001). The AUC for liver attenuation was 0.706 (0.653-0.754). Thresholds of subcutaneous fat area greater than 204 cm(2) in men, visceral fat area greater than 70 cm(2) in women, and liver attenuation less than 50 HU yielded a sensitivity and specificity of 80.3% and 83.7%; 83.7% and 80.0%; and 22.0% and 96.7%, respectively. Visceral fat area was elevated in 55% of patients without metabolic syndrome (11/20) but with a documented cardiovascular event or complication and in 32.1% of patients with a body mass index of 30 kg/m(2) or less.

CONCLUSION: Accumulation of visceral fat was the best predictor for metabolic syndrome in women. Unexpectedly, the percentage of visceral fat was a poor predictor for metabolic syndrome in men and subcutaneous fat area was best. Decreased liver attenuation was insensitive but was highly specific for metabolic syndrome. The implications of these sex-specific differences and the relationship of fat-based CT measures to cardiovascular risk warrant further investigation.

Author List

Pickhardt PJ, Jee Y, O'Connor SD, del Rio AM

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Area Under Curve
Chi-Square Distribution
Fatty Liver
Female
Humans
Intra-Abdominal Fat
Male
Metabolic Syndrome
Middle Aged
Prevalence
ROC Curve
Radiographic Image Interpretation, Computer-Assisted
Statistics, Nonparametric
Tomography, X-Ray Computed