Imaging-Based Changes in Visceral Adipose Tissue and Metabolic Risk: A Systematic Review

Abstract

Background:
Visceral adipose tissue is a high-risk fat compartment linked to insulin resistance, dyslipidaemia, and hepatic steatosis. Imaging enables direct quantification of visceral adipose tissue and depot-specific change.
Methods:
PubMed was searched for human clinical trials and longitudinal cohorts reporting serial visceral adipose tissue quantified by magnetic resonance imaging, ultrasonography, or dual-energy X-ray absorptiometry and at least one metabolic outcome. Reference lists were hand-searched, screening and data extraction were performed in duplicate, and findings were synthesised narratively without meta-analysis.
Results:
Thirteen studies (10 trials, 3 cohorts; sample size 32–598; follow-up 8 weeks–2 years) were included, most commonly reporting glycaemic or insulin-resistance indices, lipid profile measures, and hepatic fat. In a cohort, each 10 cm² increase in visceral adipose tissue was associated with higher odds of metabolic syndrome (odds ratio 1.23; 95% confidence interval 1.09–1.39). In randomised trials, dapagliflozin reduced visceral adipose tissue volume by 0.35 L and liver fat by 3.74 percentage points versus placebo (8 weeks), and semaglutide reduced visceral fat mass by 27.4% versus 2.4% (68 weeks).
Conclusions:
Imaging-detected reductions in visceral adipose tissue were generally accompanied by improved metabolic risk markers, with the most consistent co-improvements in hepatic fat and lipid risk. Standardised imaging protocols and longer multicentre studies are needed to define clinically meaningful thresholds of visceral adipose tissue change across modalities.