Although both visceral adipose tissue (VAT) and liver fat (LF) are associated with features of the cardiometabolic risk (CMR) profile, their respective and independent contributions are not fully understood. The objectives of this study were i) to document the variability in the association between VAT and LF in a large multiethnic cohort of men and women, and ii) to compare the CMR profile and related diseases (CMD) across subgroups of subjects defined on the basis of their levels of VAT and LF.


Baseline data of a sample of 3620 subjects from the INSPIRE ME IAA study with both VAT cross-sectional area and LF attenuation (a marker of liver density negatively associated with LF content) assessed by computed tomography were analyzed. Subjects’ medical history was evaluated using a questionnaire administrated by physicians. A fasting blood sample was obtained followed by a 75g oral glucose tolerance test to assess CMR. Subjects were categorized into 4 groups: i) Low VAT/Low LF; ii) Low VAT/High LF; iii) High VAT/Low LF; iv) High VAT/High LF.


VAT was negatively associated with LF (r=-0.41; p<0.001). The proportion of subjects concordant for VAT and LF accumulation (low/low, high/high) was 57%.The Low VAT/High LF group was the least prevalent in both sexes (5%), whereas the most frequent phenotype was High VAT/Low LF in men (43%), and Low VAT/Low LF in women (39%). Subjects in the High VAT/High LF group had more disturbed CMR factors and more CMD than other groups (p<0.001). The Low VAT/High LF and High VAT/Low LF groups had more CMR factors and CMD compared to the Low VAT/LF group, without significant differences between them.


The shared variance between VAT and LF is lower than 25%, and the concordance between VAT/LF profiles is below 60%, reflecting the large inter-individual variability in the VAT/LF deposition. High levels of VAT and/or LF are independently associated with a deteriorated CMR profile.