Response to the Letter: Comment on “Abdominal Fat Distribution and Cardiovascular Risk in Men and Women With Different Levels of Glucose Tolerance” by Scheuer S.H., et al

We appreciate the comments from Kawada (1) in response to our findings on the associations between abdominal fat distribution and cardiovascular risk in men and women with different glucose tolerance status (2). There is emerging evidence that fat depots are important independently of body mass index for cardiometabolic disease, and it is therefore relevant to apply less expensive, invasive, and burdensome measurement options such as ultrasound. Kawada underscores that the protocol we have used for the assessment of abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (3) is reliable and valid. We very much agree with this and would like to add that the reproducibility of the ultrasound technique used in the present study was recently examined and reported to be adequate (4).

Kawada suggests we calculate cutoff values of VAT for the determination of cardiovascular risk. For several reasons we do not believe it is appropriate to calculate such cutoff values in this study. First, cutoff values are often population specific and may therefore not be applicable to the general population or to populations of mixed ethnicities. In our study, there was a higher fraction of individuals with prediabetes or screen-detected diabetes than in the general population; therefore, they are not representative for the general Danish population (2). Second, VAT shows different associations with different cardiovascular risk factors in men and women (2, 5–8), and therefore, one single VAT cutoff value does not exist for cardiovascular risk (eg, the metabolic syndrome). The term, metabolic syndrome, refers to a cluster of risk factors, and there has been considerable disagreement about the definition of the metabolic syndrome between different committees. We therefore do not find it appropriate to use the metabolic syndrome as an outcome in our study.

Disclosure Summary: K.F., M.E.J., N.B.J., B.C., and G.S.A. are employed by Steno Diabetes Center A/S, which is a research and teaching hospital collaborating with the Danish National Health Service and owned by Novo Nordisk A/S. Steno Diabetes Center receives part of its core funding from unrestricted grants from the Novo Foundation and Novo Nordisk A/S. K.F., N.B.J., D.R.W., and M.E.J. own shares in Novo Nordisk A/S. The other authors have nothing to disclose.

Abbreviations

 
• VAT

  visceral adipose tissue.

References