Key result
Multi-organ fat phenotypes are linked to differential cardiometabolic risks, including higher HF with muscle-dominant adiposity.
Why the study?
A systems-level framework integrating key organ fat measurements was needed to disentangle the heterogeneous pathways through which adiposity shapes differential cardiometabolic risk profiles and enable precise risk stratification.
Do distinct MRI-derived multi-organ adiposity phenotypes associate with differential cardiometabolic disease risk and cardiac remodelling in individuals without overt cardiac disease?
Observational (n=24,935)
Do distinct MRI-derived multi-organ adiposity phenotypes associate with differential cardiometabolic disease risk and cardiac remodelling in individuals without overt cardiac disease?
MRI-derived multi-organ fat phenotyping identifies distinct cardiometabolic risk profiles beyond general weight measures, enabling more precise risk stratification.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“We believe our findings support a more personalised approach to assessing health risks related to body fat distribution. Rather than treating excess weight as a single condition, we may need to consider which organs are affected, how fat is distributed and whether muscle health is also reduced.”
“In this study, we wanted to build a more holistic picture of how fat is distributed across various organs and tissues, and determine whether this could help us better understand differences in future disease risk. By identifying different patterns of fat build-up and linking them to changes in the heart and risk of cardiometabolic diseases, we hope that this approach could ultimately help shift healthcare from reacting to established disease towards earlier, more personalised prevention based on an individual's risk profile.”
Visceral adiposity may accelerate cardiac ageing in a sex-specific manner; leaves open whether fat-distribution interventions alter outcomes in prospective trials.
BACKGROUND AND AIMS: Adiposity exerts multisystem insults that influence multiple organs and physiological pathways. This underscores the need for a systems-level framework integrating key organ fat measurements to disentangle the heterogeneous pathways through which adiposity shapes differential cardiometabolic risk profiles. Such an approach could advance mechanistic understanding and enable more precise risk stratification. METHODS: In the UK Biobank, 24 935 participants without overt cardiac disease were studied. Six adiposity phenotypic groups were identified using unsupervised clustering of magnetic resonance imaging-derived adiposity measures (subcutaneous, visceral, pericardial, liver, pancreatic, and muscle fat). These phenotypes were characterised in terms of body composition, cardiac remodelling, and the development of major cardiometabolic diseases. RESULTS: Each phenotype showed distinct organ-dominant fat accumulation and body composition pattern. A pancreatic fat dominant phenotype, marked by visceral adiposity and sarcopenic features, showed a cardiorenal-metabolic risk profile. A muscle fat dominant phenotype, characterised by subcutaneous adiposity and sarcopenic features, was associated with increased heart failure risk. While pericardial fat dominant and liver fat dominant phenotypes did not associate with cardiac disease risk, they exhibited distinctive cardiac remodelling patterns, revealing phenotypespecific metabolic-cardiac interactions. Lastly, normal-weight individuals with mild multi-organ fat showed elevated chronic ischaemic heart disease risk, highlighting the value of phenotype-based risk assessment beyond general weight measures. CONCLUSIONS: Distinct patterns of multi-organ fat accumulation were associated with differential body composition, cardiac remodelling, and cardiometabolic disease risk profiles. The identified adiposity phenotypic groups capture clinically meaningful heterogeneity across the cardiorenal-metabolic spectrum and may inform future personalised, multisystem approaches to prevention and management.
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Kway et al. (2026) conducted an observational in Cardiometabolic disease risk (n=24,935). Multi-organ fat accumulation patterns (adiposity phenotypes) was evaluated on Body composition, cardiac remodelling, and the development of major cardiometabolic diseases. Distinct multi-organ fat accumulation phenotypes were associated with differential cardiometabolic risk, such as increased heart failure risk in the muscle fat dominant phenotype.
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