Methods

After written informed consent, we prospectively recruited 208 subjects with overweight/obesity who were otherwise healthy (94 men, 114 women, age 37 ± 10 years, BMI 35 ± 6 kg/m2). Subjects underwent dual-energy X-ray absorptiometry (DXA) and computed tomography (CT) for fat and muscle mass, proton MR spectroscopy (1H-MRS) for intrahepatic (IHL) and intramyocellular lipids (IMCL), an oral glucose tolerance test, serum insulin, lipids, and inflammatory markers. Men and women were compared by Wilcoxon signed rank test. Linear correlation and multivariate analyses between body composition and cardio-metabolic risk markers were performed.

Results

Women and men were of similar mean age and BMI (p ≥ 0.2). Women had higher %fat mass, extremity fat, and lower lean mass compared to men (p ≤ 0.0005). However, men had higher visceral adipose tissue (VAT) and IMCL and higher age-and BMI-adjusted IHL (p < 0.05). At similar age and BMI, men had a more detrimental cardio-metabolic risk profile compared to women (p < 0.01). However, VAT in women, and IMCL in men, were more strongly associated with cardio-metabolic risk markers, while more lower extremity fat was associated with a more favourable cardio-metabolic profile in women compared to men (p ≤ 0.03).



Conclusions

Although the male pattern of fat distribution is associated with a more detrimental cardio-metabolic risk profile compared to women of similar age and BMI, VAT is more strongly associated with cardio-metabolic risk markers in women, while IMCL are more detrimental in men. Lower extremity fat is relatively protective, in women more than in men. This suggests that detailed anatomic and functional imaging, rather than BMI, provides a more complete understanding of metabolic risk associated with sex differences in fat distribution.

Ethics declarations

Ethics approval and consent to participate

The study was approved by Partners IRB (protocol 2012P002276 and 2012P002410), and written informed consent was obtained from all subjects.

Consent for publication

N/A

Competing interests

The authors declare that they have no competing interests.

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