Body Fat Distribution, Glucose Metabolism, and Diabetes Status Among Older Adults: The Multiethnic Cohort Adiposity Phenotype Study

Abstract

Background: As the proportion of visceral (VAT) to subcutaneous adipose tissue (SAT) may contribute to type 2 diabetes (T2D) development, we examined this relation in a cross-sectional design within the Multiethnic Cohort that includes Japanese Americans known to have high VAT. The aim was to understand how ectopic fat accumulation differs by glycemic status across ethnic groups with disparate rates of obesity, T2D, and propensity to accumulate VAT. Methods: In 2013-2016, 1,746 participants aged 69.2 (standard deviation, 2.7) years from five ethnic groups completed questionnaires, blood collections, and whole-body dual X-ray absorptiometry and abdominal magnetic resonance imaging scans. Participants with self-reported T2D and=or medication were classified as T2D, those with fasting glucose >125 and 100-125 mg=dL as undiagnosed cases (UT2D) and prediabetes (PT2D), respectively. Using linear regression, we estimated adjusted means of adiposity measures by T2D status. Results: Overall, 315 (18%) participants were classified as T2D, 158 (9%) as UT2D, 518 (30%) as PT2D, and 755 (43%) as normoglycemic (NG), with significant ethnic differences (P < 0.0001). In fully adjusted models, VAT, VAT=SAT, and percent liver fat increased significantly from NG, PT2D, UT2D, to T2D (P < 0.001). Across ethnic groups, the VAT=SAT ratio was lowest for NG participants and highest for T2D cases. Positive trends were observed in all groups except African Americans, with highest VAT=SAT in Japanese Americans. Conclusions: These findings indicate that VAT plays an important role in T2D etiology, in particular among Japanese Americans with high levels of ectopic adipose tissue, which drives the development of T2D to a greater degree than in other ethnic groups.

The relationship between fat distribution and diabetes in US adults by race/ethnicity

“…Nevertheless, it can be concluded that VATA is independently associated with diabetes. Many studies have investigated the effect of VATA on diabetes ( 4–8 , 10 , 11 , 33 , 35 – 37 ), and some studies on SFA and diabetes ( 6 , 9 , 35 – 37 ), they are limited to (1) single race/ethnicity ( 4 – 8 , 33 ), (2) estimation of fat distribution instead of direct measures ( 10 , 11 ). Although some previous studies examined racial/ethnic specific relationship between fat distribution and diabetes, they were conducted among adults 60 years or older ( 35 – 37 ), who may differ in insulin resistance than adults less than 60 years of age ( 38 ).…”

“…Many studies have investigated the effect of VATA on diabetes ( 4–8 , 10 , 11 , 33 , 35 – 37 ), and some studies on SFA and diabetes ( 6 , 9 , 35 – 37 ), they are limited to (1) single race/ethnicity ( 4 – 8 , 33 ), (2) estimation of fat distribution instead of direct measures ( 10 , 11 ). Although some previous studies examined racial/ethnic specific relationship between fat distribution and diabetes, they were conducted among adults 60 years or older ( 35 – 37 ), who may differ in insulin resistance than adults less than 60 years of age ( 38 ). Most importantly, VATA and SFA was not independently examined even though previous research suggested that they have different deleterious impact on insulin sensitivity ( 17 ), and muscle mass was not adjusted despite its positive influence on blood glucose regulation ( 28 – 31 ).…”

COVID-19 vaccination and the skin to deltoid muscle distance in adults with diabetes

“…Fourthly, it is apparent that a 25mm needle should not be a universal needle length for COVID-19 vaccine administration and particularly not for obese adults with diabetes. While recognising that body fat distribution may differ in diabetes, [26] , [38] it may be reasonable to infer that this interpretation also applies to obese adults generally, regardless of the diagnosis of diabetes; however, this will need to be the subject of further study.…”

Combination of Risks of BMI and Health-Related Lifestyles on Kidney Function in the Prediabetic Japanese Population: A Prospective Cohort Study

“…This could be due to a lower capacity for subcutaneous fat storage, leading to the excess lipid being stored in other areas of the body. It can lead to metabolic disturbances, including insulin resistance and impaired glucose tolerance [ 34 ].…”