Although it is increasingly recognized that intra-abdominal (visceral) obesity plays a key role in chronic diseases, few imaging studies have properly documented human variability in abdominal adipose tissue patterning. This study aimed to compare the association between subcutaneous and intra-abdominal adipose tissue measured by magnetic resonance imaging at different locations with the features of the metabolic syndrome and cardiometabolic risk factors in 713 non-Hispanic whites aged 18-86 years. Intra-abdominal mass was a stronger predictor of the metabolic syndrome than subcutaneous adipose tissue. There was a significant interaction between intra-abdominal and subcutaneous adipose tissue, whereby elevated subcutaneous adipose tissue reduced the probability of finding the metabolic syndrome among men with an elevated intra-abdominal adipose tissue accumulation. Correlations between total intra-abdominal fat mass with cardiometabolic risk factors were not stronger than those obtained using the cross-sectional area obtained from one image. Moreover, no single image was universally better correlated with risk factors than all other images for all risk factors. The range of images that better correlated with cardiometabolic risk factors sometimes included the L4-L5 anatomical region and sometimes did not, depending on sex and the studied risk factor. Based on these results, one cannot suggest another anatomical level than L4-L5 for future imaging studies, but further work is needed to properly document the relationship of intra-abdominal adiposity measured at various levels to cardiometabolic risk in different age, sex, and ethnic groups.
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