Patterns of Abdominal Fat Distribution

The Framingham Heart Study

  1. Karla M. Pou, MD1,
  2. Joseph M. Massaro, PHD2,
  3. Udo Hoffmann, MD, MPH3,
  4. Kathrin Lieb, MD4,
  5. Ramachandran S. Vasan, MD4,
  6. Christopher J. O'Donnell, MD, MPH45 and
  7. Caroline S. Fox, MD, MPH14
  1. 1Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
  2. 2Department of Mathematics, Boston University and School of Public Health, Boston, Massachusetts
  3. 3Radiology Department, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
  4. 4National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts
  5. 5Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
  1. Corresponding author: Caroline S. Fox, foxca{at}


OBJECTIVE—The prevalence of abdominal obesity exceeds that of general obesity. We sought to determine the prevalence of abdominal subcutaneous and visceral obesity and to characterize the different patterns of fat distribution in a community-based sample.

RESEARCH DESIGN AND METHODS—Participants from the Framingham Heart Study (n = 3,348, 48% women, mean age 52 years) underwent multidetector computed tomography; subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) volumes were assessed. Sex-specific high SAT and VAT definitions were based on 90th percentile cut points from a healthy referent sample. Metabolic risk factors were examined in subgroups with elevated SAT and VAT.

RESULTS—The prevalence of high SAT was 30% (women) and 31% (men) and that for high VAT was 44% (women) and 42% (men). Overall, 27.8% of the sample was discordant for high SAT and high VAT: 19.9% had SAT less than but VAT equal to or greater than the 90th percentile, and 7.9% had SAT greater than but VAT less than the 90th percentile. The prevalence of metabolic syndrome was higher among women and men with SAT less than the 90th percentile and high VAT than in those with high SAT but VAT less than the 90th percentile, despite lower BMI and waist circumference. Findings were similar for hypertension, elevated triglycerides, and low HDL cholesterol.

CONCLUSIONS—Nearly one-third of our sample has abdominal subcutaneous obesity, and >40% have visceral obesity. Clinical measures of BMI and waist circumference may misclassify individuals in terms of VAT and metabolic risk.


  • Published ahead of print at on 15 December 2008.

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    • Accepted November 21, 2008.
    • Received July 22, 2008.
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  1. Diabetes Care vol. 32 no. 3 481-485
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