Volume 20, Issue 1 p. 141-147
ORIGINAL ARTICLE

Body fat distribution is more predictive of all-cause mortality than overall adiposity

Sung Woo Lee MD

Sung Woo Lee MD

Department of Internal Medicine, Seoul National University Postgraduate School, Seoul, South Korea

Department of Internal Medicine, Eulji Medical Center, Eulji University, Seoul, South Korea

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Jee Young Son MD

Jee Young Son MD

Department of Radiology, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea

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Jeong Min Kim MD

Jeong Min Kim MD

Department of Internal Medicine, Eulji Medical Center, Eulji University, Seoul, South Korea

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Seung-sik Hwang MD, PhD

Seung-sik Hwang MD, PhD

Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea

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Jin Suk Han MD, PhD

Jin Suk Han MD, PhD

Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea

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Nam Ju Heo MD, PhD

Corresponding Author

Nam Ju Heo MD, PhD

Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea

Correspondence

Nam Ju Heo MD, PhD, Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Gangnam-gu, Teheran-ro152, Seoul 06236, South Korea. Email: njheo@snuh.org

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First published: 03 July 2017
Citations: 79

Abstract

Aims

The relationship between directly measured body fat and all-cause mortality has been rarely studied. The aim of this study was to evaluate the predictive significance of computed tomography (CT)-measured body fat, including both visceral fat area (VFA) and subcutaneous fat area (SFA), for mortality.

Methods

The study included 36 656 participants who underwent abdominal CT as part of a health check-up at a single university-affiliated healthcare center in 2007 to 2015. Of those, 32 593 participants with data regarding vital status as of May 2016 were included in the final analysis. The main factors evaluated were VFA, SFA and visceral-to-subcutaneous fat area ratio (VSR), and the primary outcome was all-cause mortality.

Results

There were 253 deaths during a mean follow-up of 5.7 years. Increased SFA was associated with decreased all-cause mortality, whereas an increased VFA and VSR were related to increased all-cause mortality. Compared with the predictive power of body mass index (BMI), SFA and VSR showed a larger area under the curve than did BMI. In Kaplan–Meier survival curve analysis, increased SFA and VSR were associated with decreased and increased hazard of all-cause death, respectively. However, in multivariate Cox proportional hazard regression analysis, only VSR was independently associated with all-cause mortality. Moreover, this relationship was paralleled by the harmful impact of increased VSR on metabolic profiles.

Conclusion

Increased VSR was an independent predictor of all-cause mortality. This suggests that the location of fat deposits may be more important than the actual amount of body fat.