Ethnic influences on the relations between abdominal subcutaneous and visceral adiposity, liver fat, and cardiometabolic risk profile: the International Study of Prediction of Intra-Abdominal Adiposity and Its Relationship With Cardiometabolic Risk/Intra-Abdominal Adiposity

Am J Clin Nutr. 2012 Oct;96(4):714-26. doi: 10.3945/ajcn.112.035758. Epub 2012 Aug 29.


Background: Ethnic differences in cardiometabolic risk (CMR) may be related to patterns of ethnic-specific body fat distribution.

Objective: We aimed to identify differences across ethnic groups in interrelations between BMI, abdominal adiposity, liver fat, and CMR profile.

Design: In the International Study of Prediction of Intra-Abdominal Adiposity and Its Relationship With Cardiometabolic Risk/Intra-Abdominal Adiposity, 297 physicians recruited 4504 patients (from 29 countries). In the current cross-sectional analyses, 2011 whites, 166 African Caribbean blacks, 381 Hispanics, 1192 East Asians, and 347 Southeast Asians were included. Computed tomography was used to assess abdominal fat distribution and to estimate liver fat content. Anthropometric variables and CMR profile were measured.

Results: Higher ranges of BMI were associated with higher levels of visceral [visceral adipose tissue (VAT)] and deep subcutaneous [deep subcutaneous adipose tissue (DSAT)] adiposity, with significant ethnic differences regarding the slope of these relations. Despite lower absolute BMI values, East Asians presented the largest accumulation of VAT but the lowest accumulation of DSAT with increasing adiposity. The association of BMI with liver fat did not differ between ethnic groups. Liver fat and DSAT were positively correlated with VAT with no ethnic variation. All ethnic groups had a similar association between a 1-SD increase in VAT, DSAT, or liver fat with hypertension, type 2 diabetes, hypertriglyceridemia, low HDL-cholesterol concentration, or high C-reactive protein concentration.

Conclusions: Ethnicity significantly affects abdominal adiposity and liver fat partitioning, and East Asians have the most deleterious abdominal fat distribution. Irrespective of ethnicity, abdominal and hepatic fat depots are strongly interrelated and increased with obesity. Higher amounts of VAT or liver fat are associated with a more deteriorated CMR profile in all ethnic groups.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adiposity* / ethnology
  • Aged
  • Asian People
  • Body Mass Index
  • C-Reactive Protein / analysis
  • Cholesterol, HDL / blood
  • Cohort Studies
  • Cross-Sectional Studies
  • Fatty Liver / physiopathology
  • Humans
  • Insulin Resistance
  • Intra-Abdominal Fat / pathology*
  • Lipid Metabolism*
  • Liver / metabolism*
  • Male
  • Metabolic Syndrome / ethnology
  • Metabolic Syndrome / etiology
  • Metabolic Syndrome / metabolism*
  • Metabolic Syndrome / pathology*
  • Middle Aged
  • Obesity, Abdominal / physiopathology
  • Prospective Studies
  • Sex Characteristics
  • Subcutaneous Fat, Abdominal / pathology*
  • White People


  • Cholesterol, HDL
  • C-Reactive Protein