Subcutaneous and Visceral Adipose Tissue Reference Values From the Framingham Heart Study Thoracic and Abdominal CT

Abstract

Background Computed tomography (CT) captures the quantity, density, and distribution of subcutaneous and visceral (SAT and VAT) adipose tissue compartments. These metrics may change with age and sex. Objective The study aims to provide age-, sex-, and vertebral level–specific reference values for SAT on chest CT and for SAT and VAT on abdomen CT. Materials and Methods This secondary analysis of an observational study describes SAT and VAT measurements in participants of the Framingham Heart Study without known cancer diagnosis who underwent at least 1 of 2 CT examinations between 2002 and 2011. We used a previously validated machine learning–assisted pipeline and rigorous quality assurance to segment SAT at the fifth, eighth, and tenth thoracic vertebra (T5, T8, T10) and SAT and VAT at the third lumbar vertebra (L3). For each metric, we measured cross-sectional area (cm2) and mean attenuation (Hounsfield units [HU]) and calculated index (area/height2) (cm2/m2) and gauge (attenuation × index) (HU × cm2/m2). We summarized body composition metrics by age and sex and modeled sex-, age-, and vertebral level–specific reference curves. Results We included 14,898 single-level measurements from up to 4 vertebral levels of 3797 scans of 3730 Framingham Heart Study participants (1889 [51%] male with a mean [standard deviation] age of 55.6 ± 10.6 years; range, 38–81 years). The mean VAT index increased with age from 65 (cm2/m2) in males and 29 (cm2/m2) in females in the <45-year-old age group to 99 (cm2/m2) in males and 60 (cm2/m2) in females in >75-year-old age group. The increase of SAT with age was less pronounced, resulting in the VAT/SAT ratio increasing with age. A free R package and online interactive visual web interface allow access to reference values. Conclusions This study establishes age-, sex-, and vertebral level–specific reference values for CT-assessed SAT at vertebral levels T5, T8, T10, and L3 and VAT at vertebral level L3.