Optimal Visceral Adipose Tissue Thresholds That Minimize Risk for Osteoporosis and/or Diabetes in Mid-life Women

Abstract Context Visceral adipose tissue (VAT) is increasingly recognized as a key determinant of diabetes and osteoporosis risk. However, clinically relevant VAT thresholds associated with both osteoporosis and type 2 diabetes remain undefined. Objective Utilizing the diametrically opposing effects of VAT for risk of diabetes and osteoporosis, this study aimed to identify a healthy VAT range minimizing risk for both conditions. Methods We used baseline data from the Integrated Women’s Health Program (IWHP), cohort of community-dwelling mid-life Singaporean women, to construct a spline-based odds ratio (OR) curve to assess the nonlinear relationship between VAT and the combined risk of osteoporosis and/or diabetes. A healthy VAT range was defined as the interval where the OR approached 1.0. Validation was conducted using longitudinal follow-up over 6.8 years, with modified Poisson regression models adjusted for age and ethnicity to estimate relative risks for incident (new) disease. Results In mid-life women (n = 1185, mean age: 56.3 ± 6.2, age range: 45.0 to 69.6 years), U-shaped spline OR curve for the combined risk of osteoporosis and/or diabetes was observed. An optimal VAT range of 46.5-116.6 cm2 was identified wherein OR was ≤1.0 for both conditions. Participants with VAT <46.5 cm2 had a twofold increased risk of developing incident osteoporosis (adjusted relative risk, aRR: 2.04, 95% confidence intervals, CI: 0.95-4.40) but no incident diabetes. Conversely, those with VAT >116.6 cm2 had significantly higher risk of incident diabetes (aRR: 2.89, 95% CI: 1.68-4.98) and lower risk of incident osteoporosis (aRR: 0.33, 95% CI: 0.17-0.64). Conclusion These findings establish a clinically actionable VAT range (46.5-116.6 cm2) that may guide metabolic and skeletal disease risk stratification and inform preventive care strategies.