Research Article: Lifestyle factors and visceral adipose tissue: Results from the PREDIMED-PLUS study

Date Published: January 25, 2019

Publisher: Public Library of Science

Author(s): Aina M. Galmes-Panades, Jadwiga Konieczna, Itziar Abete, Antoni Colom, Núria Rosique-Esteban, Maria Angeles Zulet, Zenaida Vázquez, Ramón Estruch, Josep Vidal, Estefanía Toledo, Nancy Babio, Miguel Fiol, Rosa Casas, Josep Vera, Pilar Buil-Cosiales, José Antonio de Paz, Albert Goday, Jordi Salas-Salvadó, J. Alfredo Martínez, Dora Romaguera, Raul M. Luque.


Visceral adipose tissue (VAT) is a strong predictor of cardiometabolic health, and lifestyle factors may have a positive influence on VAT depot. This study aimed to assess the cross-sectional associations between baseline levels of physical activity (PA), sedentary behaviours (SB) and adherence to the Mediterranean diet (MedDiet) with VAT depot in older individuals with overweight/obesity and metabolic syndrome.

Baseline data of the PREDIMED-Plus study including a sample of 1,231 Caucasian men and women aged 55–75 years were used. Levels of leisure-time PA (total, light, and moderate-to-vigorous, in METs·min/day) and SB (total and TV-viewing, in h/day) were evaluated using validated questionnaires. Adherence to the MedDiet was evaluated using a 17-item energy-restricted MedDiet (erMedDiet) screener. The chair-stand test was used to estimate the muscle strength. VAT depot was assessed with DXA-CoreScan. Multivariable adjusted linear regression models were used to evaluate the association between lifestyle factors and VAT. For the statistics we had used multiadjusted linear regression models.

Total leisure-time PA (100 METs·min/day: β -24.3g, -36.7;-11.9g), moderate-to-vigorous PA (β -27.8g, 95% CI -40.8;-14.8g), chair-stand test (repeat: β -11.5g, 95% CI -20.1;-2.93g) were inversely associated, and total SB (h/day: β 38.2g, 95% CI 14.7;61.7) positively associated with VAT. Light PA, TV-viewing time and adherence to an erMedDiet were not significantly associated with VAT.

In older adults with overweigh/obesity and metabolic syndrome, greater PA, muscle strength, and lower total SB were associated with less VAT depot. In this study, adherence to an erMedDiet was not associated with lower VAT.

Partial Text

Excess of visceral adipose tissue (VAT), which appears with increasing age, has been shown to be associated with cardiovascular disease (CVD), type 2 diabetes (T2D), and all cause-mortality, beyond general obesity [1]. The evaluation of how modifiable lifestyle factors such as diet and physical activity (PA) influence VAT depot, may help to develop preventive strategies to combat the morbimortality associated to obesity.

Table 1 presents comparison of participants’ characteristics at baseline between sample taken to the analysis and total sample randomized for the trial. In general terms, the sample used in our analysis was to a large degree representative of the total sample from PREDIMED-Plus trial. For some characteristics, the difference between samples reached statistical significance, although the magnitude of the difference was low. S2 Table shows the same participants´ characteristics for study sample by recruiting center.

It is well accepted that an excessive VAT accumulation, which appears while aging, carries associated metabolic disturbances, and increased mortality risk. Therefore, identification and development of strategies to prevent or decrease VAT is of high importance. Yet, it is unclear the contribution of lifestyle factors toward VAT modification, as most of the studies addressing this issue are severely hampered by small sample size or lack of accurate methods for VAT measurement. Thus, we used here DXA imaging technique to precisely measure visceral fat in the large cohort of older adults with overweight/obesity and MetS. Among the lifestyle factors studied, we found that total and MVPA (but not light PA), as well as total SB (but not TV-viewing SB) were associated with VAT depot (opposite directions). In this cross-sectional study, adherence to MedDiet was not significantly related to this pathogenic fat depot. Results of this study on the negative association between total PA, in terms of total energy expenditure, and imaging defined VAT depot corroborate most of previous cross-sectional [3,32,33] and interventional studies [6,34], conducted among different populations of adults, using self-reported [33,35,36] and accelerometry-derived PA data [3,32].

In conclusion, results from this cross-sectional study revealed that in older subjects with overweigh/obesity and MetS, total and moderate-to-vigorous PA (but not light PA) is associated inversely, and total time spent on SB positively with VAT depot. In a broader context, our findings give valuable clue for clinical practice and research on which lifestyle-based methods are effective in combating morbimortality associated with obesity in this particular group of subjects. However, more studies are needed to confirm and broaden obtained data. Fortunately, since PREDIMED-Plus is an ongoing clinical trial, it will allow to extend the associations addressed here in the future longitudinal and/or interventional analysis.




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