Abstract P324: Abdominal Visceral Adiposity and Liver Fat in Relation to Sex-Related Differences in Cardiometabolic Risk Profile: The INSPIRE ME IAA Study

Abstract

Objectives: Sex differences in the cardiovascular risk profile are well established. The objectives of the present analyses were 1) to characterize sex differences in visceral adiposity (VA) and estimated liver fat content assessed by computed tomography (CT) and in the cardiometabolic risk (CMR) profile in a large international multiethnic cohort; 2) to determine whether differences between men and women in CMR factors remain after controlling for VA and/or liver fat. Methods: In the International Study of Prediction of Intra-abdominal adiposity and its Relationship with cardioMEtabolic risk/Intra-Abdominal Adiposity (INSPIRE ME IAA), 297 primary care physicians, cardiologists, endocrinologists/diabetologists recruited 4504 patients from 29 countries. VA and liver attenuation (inversely correlated to liver fat) were assessed by CT. Cardiometabolic risk factors (triglyceride (TG), HDL-C, Apolipoprotein B (ApoB), HOMA, 2h-glucose (OGTT), adiponectin, C-Reactive Protein (CRP)) were assessed using standardized methods. The present cross-sectional analyses were performed in 1193 men and 1214 women free of type 2 diabetes. Results: Whereas mean BMI was similar in women and men (27.5±0.1 vs 27.5±0.1 kg/m2), men had higher waist circumference (98.1±0.4 vs 89.6±0.4 cm), higher VA (165±2 vs 131±2 cm2) and lower liver attenuation (54.9±0.3 vs 57.4±0.3 HU) (p<0.0001 for all) than women. Men displayed higher TG and HOMA but lower HDLc, CRP and adiponectin levels (p<0.001 for all) than women. In both sexes, VA and liver fat were significantly correlated positively with CMR variables: TG, HOMA and CRP and negatively with HDLc and adiponectin (p<0.05 simple regression analysis). In multiple regression analyses, VA and liver attenuation independently affected CMR variables. Sex differences in TG were eliminated after adjustment for VA or both variables simultaneously but HDLc remained higher in women even after such adjustment. HOMA was higher in women when adjusted for VA or for both variables and similar to men when adjusted for liver attenuation. Being not different between sexes before adjustment, 2h-glucose was higher in women when controlling for VA/liver fat. Adiponectin remained higher in women after all adjustments. Sex differences in CRP were magnified after adjustment for VA/liver fat and remained higher in women. Conclusion: In this large standardized international CT-imaging/cardiometabolic study, substantial sex differences in abdominal adiposity/liver fat and CMR factors were observed, with men presenting an overall more deteriorated CMR profile than women. Controlling for VA and liver fat was not sufficient to abolish sex differences in all inflammatory, insulin sensitivity or lipid factors.