Association of a Lifestyle Risk Index With Visceral and Subcutaneous Adipose Tissue in the German National Cohort (NAKO).

Participants with the highest Lifestyle Risk Index scores (4 points) had lower adjusted geometric mean volumes of visceral adipose tissue compared to those with the lowest scores (0/1 points).

• Participants with LSRI scores of 4 versus 0/1 had adjusted geometric mean VAT volumes of 2.3 L (95% CI 2.2, 2.3) versus 3.0 L (95% CI 2.9, 3.1)
• The LSRI assigned one point each for: not smoking, adhering to ≥3/7 diet recommendations, consuming ≤1 (women)/≤2 (men) alcoholic drinks/day, and ≥150 min/week physical activity
• The study included 18,508 participants aged 48.2 ± 12.2 years from the German National Cohort (NAKO)
• VAT volume was obtained from whole-body MRI at 3T and analyzed by deep learning-based image segmentation
• These differences were slightly attenuated after adding BMI to the model

The distribution of Lifestyle Risk Index scores showed that the majority of participants scored 3 points.

• The proportions for LSRI scores of 0/1, 2, 3, and 4 points were 7%, 24%, 51%, and 18%, respectively
• The study was cross-sectional in design, based on self-reports at baseline
• 30,920 of >205,000 NAKO eligible participants had MRI scans, of whom 18,508 were included in this analysis

The association between the Lifestyle Risk Index and visceral adipose tissue was weaker for individuals with obesity compared to those with normal weight or overweight.

• Stratified analyses were conducted by sex and BMI categories
• The association between LSRI and VAT was attenuated in participants with obesity relative to those with normal/overweight
• An elevated BMI may have a greater influence on VAT accumulation than lifestyle behaviors alone

The study used a whole-body MRI-based approach with deep learning image segmentation to quantify visceral and subcutaneous adipose tissue volumes.

• VAT volume was obtained from whole-body MRI at 3T
• Deep learning-based image segmentation was applied for adipose tissue quantification
• General linear models estimated adjusted geometric mean adiposity measures by LSRI
• The study was conducted within the German National Cohort (NAKO), one of the largest population-based cohort studies

A combined lifestyle risk factor index was associated with visceral adipose tissue volume beyond individual lifestyle components.

• The LSRI combined smoking status, diet quality, alcohol consumption, and physical activity into a single composite score
• The index ranged from 0 to 4 points, with higher scores reflecting more favorable lifestyle behaviors
• Analyses were stratified by sex and BMI to examine effect modification
• The cross-sectional design limits causal inference between lifestyle behaviors and VAT accumulation