Magnetic Resonance Imaging–defined visceral adiposity beyond Body Mass Index is associated with insulin resistance and early glycemic dysregulation in adults without diabetes - 23/10/26

Doi : 10.1016/j.diabet.2026.101800

Yuhong Kong ^1,^{^{#
These authors contributed equally as co-first authors.}}, Weiwei Wang ^1,^{^{#
These authors contributed equally as co-first authors.}}, Xuren Sun ^3,^{^{#
These authors contributed equally as co-first authors.}}, Chi Zhang ¹, Zhaobo Wang ¹, Haoyu Wang ^1,^⁎ , Xiaoyan Yue ^2,^⁎ , Yaxin Lai ^1,^⁎

¹ Department of Endocrinology and Metabolism, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China

² Department of Neurosurgery, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China

³ Department of Gastroenterology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China

^⁎ Corresponding authors: Haoyu Wang, Department of Endocrinology and Metabolism, First Affiliated Hospital of China Medical University Department of Endocrinology and Metabolism First Affiliated Hospital of China Medical University ^⁎⁎ Corresponding authors: Xiaoyan Yue, Department of Neurosurgery, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China Department of Neurosurgery First Affiliated Hospital of China Medical University Shenyang Liaoning China ^⁎⁎⁎ Corresponding authors: Yaxin Lai, Department of Endocrinology and Metabolism, First Affiliated Hospital of China Medical University, No. 155 Nanjing North Street, Heping District, Shenyang, Liaoning 110001, China Department of Endocrinology and Metabolism First Affiliated Hospital of China Medical University No. 155 Nanjing North Street, Heping District Shenyang Liaoning 110001 China

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Highlights

•	Visceral fat beyond body mass index is linked to lower insulin sensitivity.
•	Excess visceral fat is linked to higher post-load glucose levels.
•	Visceral fat shows stronger metabolic associations than subcutaneous fat.
•	Fat distribution may refine metabolic phenotyping beyond body mass index.

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Abstract

Objective

- To determine whether magnetic resonance imaging–quantified visceral adiposity beyond that expected from body mass index (BMI) is associated with adverse metabolic phenotypes in adults without diabetes and more strongly than abdominal subcutaneous fat.

Methods

- This community-based cross-sectional study included 474 adults aged 40–65 years without diabetes. Visceral fat area (VFA) and subcutaneous fat area (SFA) were measured by magnetic resonance imaging. Sex-specific BMI-adjusted residual phenotypes were constructed, and associations with oral glucose tolerance test–derived metabolic outcomes were examined using multivariable regression.

Results

- Each 1-SD increase in BMI-adjusted VFA was associated with a lower Matsuda index (β=-0.41), higher log HOMA-IR (β=0.10), higher 2-hour glucose (β=0.22 mmol/l), greater glucose area under the curve (β=16.34 mmol/l × min), and lower oral disposition index (β=-9.10). BMI-adjusted SFA was not significantly associated with these outcomes. BMI-adjusted VFA was also associated with WHO-defined prediabetes (OR=1.32) and isolated impaired glucose tolerance (OR=1.33), with stronger associations than BMI-adjusted SFA, but not with ADA-defined prediabetes (OR=0.89, 95% CI 0.70–1.12).

Conclusions

- Visceral adiposity beyond BMI identified an adverse fat-distribution phenotype characterized by reduced insulin sensitivity, impaired post-load glucose handling, and inadequate β-cell compensation. Regional fat distribution may refine obesity phenotyping beyond BMI.

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