Objectives: Several reports indicate that the body-fat compartments, especially intraperitonal fat, predict metabolic risk better than total body fat. The objective of the study was to determine whether this can be confirmed and generalized throughout the population.

Participants: A representative sample of 1,934 black and white women and men of the Dallas Heart Study participated in the study.

Design: We measured the fat in total body, trunk, and lower body with dual x-ray absorptiometry and in abdominal compartments (sc, intraperitoneal and retroperitoneal) with magnetic resonance imaging. Other measurements included body mass index (BMI), waist circumference, blood pressure, plasma lipids, glucose, insulin (including homeostasis model [HOMA]), and C-reactive protein (CRP).

Results: In all groups, total body fat correlated positively with key metabolic risk factors, i.e. HOMA, triglyceride/HDL-cholesterol ratios, CRP, and blood pressure; however it explained less than one-third of the variability of all the risk factors. After adjustment for total body fat, truncal fat conferred additional positive correlation with risk factors. Further, with multivariable regression analysis, intraperitonal fat conferred independent correlation with plasma lipids beyond a combination of other compartments including truncal fat. Still, except for insulin levels, all combinations including intraperitonal fat still explained less than one-third of the variability in risk-factor levels. Conversely, lower body fat correlated negatively with risk factors, i.e. lower body fat appeared to offer some protection against risk factors.

Conclusions: Body fat distribution has some influence on risk factors beyond total body fat content. Both waist circumference and BMI significantly predicted risk factors after adjustment for total body fat; and for clinical purposes, most of the predictive power for men was contained in waist circumference, whereas for women, BMI and waist circumference were similarly predictive. Finally, even though the correlations between combined body fat parameters and risk factors explained only a portion of the variation in the latter, the average number of categorical metabolic risk factors increased progressively with increasing obesity. Hence obesity seemingly has more clinical impact than revealed in these correlative studies.