Body Fat Distribution and Metabolic Health Outcomes

Body fat is not a homogeneous risk factor but comprises anatomically and functionally distinct depots that exert divergent effects on metabolic health. Visceral fat, stored around internal organs, is closely linked to insulin resistance, dyslipidaemia and cardiovascular disease, whereas gluteofemoral and subcutaneous fat may confer protective benefits. Depot-specific characteristics—such as adipocyte size, secretory profile and local inflammation—shape systemic metabolism and influence the development of type 2 diabetes, coronary artery disease and other cardiometabolic disorders. Ethnic and sex differences in fat distribution further modulate individual susceptibility, with some populations gaining metabolic risk at lower body mass indices. Advances in imaging, machine learning and biochemical indices have enabled precise quantification of adipose depots, improving risk stratification and opening avenues for targeted interventions. Understanding the interplay between regional adiposity and metabolic endpoints is critical to refining prevention strategies and informing clinical practice worldwide.

Research from Nature Portfolio

Recent large-scale analyses have demonstrated that when adjusted for overall adiposity, specific fat depots show opposing associations with disease. A body-MRI study of over 40 000 participants applied deep-learning to quantify visceral, abdominal subcutaneous and gluteofemoral volumes. After accounting for body mass index, excess visceral fat emerged as a strong predictor of type 2 diabetes and coronary artery disease, whereas elevated gluteofemoral fat was linked to reduced risk. Apportioning adipose burden in this way clarifies why individuals with similar BMI can have markedly different metabolic outcomes.

Ethnic disparities in depot physiology have also been elucidated by controlled overfeeding experiments in South Asian and white European men. Despite similar gains in total adipose tissue following weight increase, South Asian participants exhibited a greater decline in insulin sensitivity, larger baseline adipocytes and altered small-cell recruitment. These morphological differences in subcutaneous fat were associated with disproportionately adverse metabolic responses to overnutrition, emphasising the need for ethnicity-tailored risk assessment and preventive guidelines.

Body Fat Distribution and Metabolic Health Outcomes publication trend

The graph below shows the total number of articles in body fat distribution and metabolic health outcomes across all publications each year (not limited to Nature Index journals).

Technical terms

Visceral adipose tissue (VAT): Fat depot located within the abdominal cavity, surrounding internal organs; strongly associated with insulin resistance and inflammation.

Subcutaneous adipose tissue (SAT): Fat layer beneath the skin; subdivided into abdominal subcutaneous and gluteofemoral depots with differing metabolic effects.

Gluteofemoral adipose tissue (GFAT): Subcutaneous fat around the hips and thighs; often linked to improved insulin sensitivity and cardiometabolic health.

Adipocyte: Fat cell responsible for lipid storage and endocrine functions, varying in size and secretory profile according to depot.

Triglyceride–glucose (TyG) index: Calculated marker combining fasting triglyceride and glucose levels; serves as a surrogate measure of insulin resistance and visceral fat burden.

References

1. BMI-adjusted adipose tissue volumes exhibit depot-specific and divergent associations with cardiometabolic diseases. Nature Communications (2023).
2. Adipose Tissue in Cardiovascular Disease: From Basic Science to Clinical Translation. Annual Review of Physiology (2023).
3. Weight gain leads to greater adverse metabolic responses in South Asian compared with white European men: the GlasVEGAS study. Nature Metabolism (2024).
4. Serum triglyceride glucose index is a valuable predictor for visceral obesity in patients with type 2 diabetes: a cross-sectional study. Cardiovascular Diabetology (2023).
5. Sex differences in body composition in people with prediabetes and type 2 diabetes as compared with people with normal glucose metabolism: the Maastricht Study. Diabetologia (2023).