What does this research mean for the field?

Quantitative multi-organ MRI significantly improves risk stratification for adverse health outcomes in individuals with obesity compared to standard clinical measures alone, and can optimize the allocation of obesity treatments. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

Evaluate if multi-organ imaging can better predict obesity-related health outcomes and guide treatment allocation.

June 7, 2026

2650-P: Multiorgan Magnetic Resonance–Based Imaging Improves Risk Stratification and Supports Treatment Allocation in Individuals with Clinical Obesity

Key Points

Evaluate if multi-organ imaging can better predict obesity-related health outcomes and guide treatment allocation.
Evaluated associations between 14 imaging-derived phenotypes and various health outcomes including type 2 diabetes and cardiovascular events.
Included 23,087 UK Biobank participants with a median age of 64 and a follow-up of 4.3 years.
Assessed the impact of risk-guided treatment using tirzepatide based on imaging data.
Clinical obesity and elevated liver measures significantly increased risk for new-onset type 2 diabetes (HR 27, 95% CI 16-47).
Multi-organ MRI improved prediction of hospitalizations (HR 6.3, 95% CI 2.0-19) compared to clinical measures alone (HR 2.5, 95% CI 2.0-3.2).
Using MRI for treatment allocation reduced the number needed to treat from 159 to 20 to prevent one death.

Abstract

Introduction and Objective: BMI-based criteria may not be sufficiently sensitive to identify people at-risk of poor cardiometabolic outcomes. We evaluated whether multi-organ imaging could improve prediction of obesity-related health outcomes and inform treatment allocation. Methods: We tested associations between 14 imaging-derived phenotypes and incident type 2 diabetes (T2D), cardiovascular (CV) and liver events (LRE), and mortality. Associations between clinical measures in standard of care (BMI ≥30 kg/m2, adiposity-based preclinical and clinical obesity, T2D, hypertension, dyslipidaemia) were also examined. We modelled the impact of risk-guided treatment from published outcome data, using tirzepatide as an example. Results: 23,087 UK Biobank participants were included (median age 64 years, 50% female, 18% BMI ≥30 kg/m2, 30% had preclinical obesity and 31% had clinical obesity). The median follow-up time was 4.3 years.Clinical obesity, elevated pancreatic and liver fat and elevated iron-corrected T1 (cT1, a measure of liver disease activity and severity) were associated with an increased risk of incident T2D (adjusted Cox proportional hazard ratio, HR, 27, 95% CI 16-47).Addition of information from multi-organ MRI improved stratification of individuals at highest risk of any incident hospitalisation (HR 6.3, 2.0-19) compared to clinical measures alone (HR 2.5, 2.0-3.2).Elevated liver cT1, reduced LVEF, and low skeletal muscle were together associated with increased all-cause mortality (HR 4.4, 1.1-18.0). Adding MRI measurements of LVEF and cT1, to obesity status for guiding allocation of tirzepatide treatment, reduced the number needed to treat to prevent one death from 159 to 20. Conclusion: Quantitative multi-organ MRI, of the liver, pancreas, heart and body composition, could refine stratification of individuals with obesity to predict new-onset diabetes, and provides a framework for identifying individuals likely to benefit most from obesity treatment. Disclosure E. Jackson: Employee; Current; Perspectum Ltd. T. Kailayanathan: Employee; Current; Perspectum. H.B. Thomaides Brears: Employee; Current; Perspectum Ltd. Stock/Shareholder; Current; Perspectum Ltd. M. Harhay: None. L.F. Cardiel Castro: None. A. Dinani: Consultant; Current; Madrigal Pharmaceuticals, Inc. Advisory Panel; Current; Madrigal Pharmaceuticals, Inc., Novo Nordisk. Consultant; Current; Novo Nordisk, Petauri. Other - Site PI; Current; Akero Therapeutics, Inc., 89bio, Inc. Other - SITE PI; Current; Hanmi Pharm. Co., Ltd. Other - FUNDING TO INSTITUTION; Current; National Institutes of Health. N. Desai: Consultant; Current; Amgen Inc. Research Support; Current; AstraZeneca. Consultant; Current; Bayer AG. Research Support; Current; Boehringer Ingelheim International GmbH. Consultant; Current; Merck Ended; Novo Nordisk. Research Support; Current; GlaxoSmithKline plc., Eli Lilly and Company, Regeneron Pharmaceuticals Inc. M. Davies: Advisory Panel; Current; AbbVie Inc., Amgen Inc., Biomea Fusion, Roche Pharmaceuticals, Regeneron Pharmaceuticals Inc., Daewoong Pharmaceutical. Other - Advisory Panel and Speaker Bureau; Current; Sanofi. Advisory Panel; Current; Zealand Pharma A/S, GlaxoSmithKline plc. Other - Advisory Panel, Speaker Bureau, Grants in support of Trials; Current; AstraZeneca. Other - Consultant/Advisor/Speaker Bureau/Grants in support of Trials; Current; Boehringer Ingelheim International GmbH. Other - Consultant/Advisor/Speaker Bureau; Current; Eli Lilly and Company. Other - Consultant/Advisor/Speaker Bureau/Grants in support of Trials; Current; Novo Nordisk. Speaker's Bureau; Current; Zuellig Pharma Holdings Pte. Ltd. Advisory Panel; Current; EktaH. D.J. Cuthbertson: Consultant; Current; Madrigal Pharmaceuticals, Inc. Research Support; Current; Novo Nordisk, AstraZeneca. J. Almandoz: Consultant; Current; AbbVie Inc., Amgen Inc., Boehringer Ingelheim International GmbH, Eli Lilly and Company, Kailera, Novo Nordisk, Metsera, Rhythm Pharmaceuticals, Inc., Rivus. A. Banerjee: None. Funding UK Biobank accessed under application 9914

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2650-P: Multiorgan Magnetic Resonance–Based Imaging Improves Risk Stratification and Supports Treatment Allocation in Individuals with Clinical Obesity

Key Points

Abstract

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