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Lancet Diabetes Endocrinol. 2019 Sep;7(9):715-725. doi: 10.1016/S2213-8587(19)30084-1. Epub 2019 Jul 10.

Visceral and ectopic fat, atherosclerosis, and cardiometabolic disease: a position statement.

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Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
School of Medicine, Division of Endocrinology and Metabolism, Queen's University, Kingston, ON, Canada.
Quebec Heart and Lung Institute Research Centre, Quebec City, QC, Canada; Department of Kinesiology, Faculty of Medicine, Université Laval, Quebec City, QC, Canada. Electronic address:
Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan.
Departments of Cardiovascular Medicine and Community Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, Netherlands.
Department of Pharmacological and Biomolecular Sciences, Universita' degli Studi di Milano, Milan, Italy.
Lipid Clinic Heart Institute, University of São Paulo, Medical School Hospital and Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
Quebec Heart and Lung Institute Research Centre, Quebec City, QC, Canada; Department of Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada.
Department of Clinical Nutrition and Metabolism, Clínica Las Condes, Santiago, Chile.
Departments of Nutrition and Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA.
Department of Nutritional Sciences, University of Surrey, Guildford, UK.
Department of Medicine, University of Padua, Padova, Italy.
School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia.
Fondation Cœur et Artères, Lille, France.
Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, CO, USA.


Findings from epidemiological studies over the past 30 years have shown that visceral adipose tissue, accurately measured by CT or MRI, is an independent risk marker of cardiovascular and metabolic morbidity and mortality. Emerging evidence also suggests that ectopic fat deposition, including hepatic and epicardial fat, might contribute to increased atherosclerosis and cardiometabolic risk. This joint position statement from the International Atherosclerosis Society and the International Chair on Cardiometabolic Risk Working Group on Visceral Obesity summarises the evidence for visceral adiposity and ectopic fat as emerging risk factors for type 2 diabetes, atherosclerosis, and cardiovascular disease, with a focus on practical recommendations for health professionals and future directions for research and clinical practice. We discuss the measurement of visceral and ectopic fat, pathophysiology and contribution to adverse health outcomes, response to treatment, and lessons from a public health programme targeting visceral and ectopic fat. We identify knowledge gaps and note the need to develop simple, clinically applicable tools to be able to monitor changes in visceral and ectopic fat over time. Finally, we recognise the need for public health messaging to focus on visceral and ectopic fat in addition to excess bodyweight to better combat the growing epidemic of obesity worldwide.

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