Factors associated with percent change in visceral versus subcutaneous abdominal fat during weight loss: findings from a systematic review

Background: Visceral adipose tissue ( VAT) is associated with greater obesity- related metabolic disturbance. Many studies have reported preferential loss of VAT with weight loss. Objective: This systematic review looks for factors associated with preferential loss of VAT relative to subcutaneous abdominal fat ( SAT) during weight loss. Design: Medline and Embase were searched for imaging- based measurements of VAT and subcutaneous abdominal adipose tissue ( SAT) before and after weight loss interventions. We examine for factors that influences the percentage change in VAT versus SAT (% delta V/% delta S) with weight loss. Linear regression analyses were performed on the complete data set and on subgroups of studies. Factors examined included percentage weight loss, degree of caloric restriction, exercise, initial body mass index ( BMI), gender, time of follow- up and baseline VAT/ SAT. Results: There were 61 studies with a total of 98 cohort time points extracted. Percentage weight loss was the only variable that influenced % dV/% dS ( r =- 0.29, P = 0.005). Modest weight loss generated preferential loss of VAT, but with greater weight loss this effect was attenuated. The method of weight loss was not an influence with one exception. Very- low- calorie diets ( VLCDs) provided exceptional short- term ( <4 weeks) preferential VAT loss. But this effect was lost by 12 - 14 weeks. Conclusions: Visceral adipose tissue is lost preferentially with modest weight loss, but the effect is attenuated with greater weight loss. Acute caloric restriction, using VLCD, produces early preferential loss of VAT. These observations may help to explain the metabolic benefits of modest weight loss.