A validated estimate of visceral adipose tissue volume in relation to cancer risk.

Background: Despite the recognized role of visceral adipose tissue in carcinogenesis, its independent association with cancer risk beyond traditional obesity measures remains unknown because of limited availability of imaging data.

Methods: We developed an estimation equation for visceral adipose tissue volume using elastic net regression based on demographic and anthropometric data in a subcohort of participants in the UK Biobank (UKB; n = 23 148) with abdominal magnetic resonance imaging scans. This equation was externally validated in 2713 participants from the 2017-2018 National Health and Nutrition Examination Survey according to sex, age, and race groups. We then applied the equation to the overall UKB cohort of 461 665 participants to evaluate the prospective association between estimated visceral adipose tissue and cancer risk using Cox proportional hazards models. We also calculated the population attributable risk of cancer associated with estimated visceral adipose tissue and body mass index (BMI).

Results: Estimated visceral adipose tissue showed a high correlation with measured visceral adipose tissue in internal and external validations (r = 0.81-0.86). During a median 12-year follow-up in the UKB, we documented 37 397 incident cancer cases; estimated visceral adipose tissue was statistically significantly associated with elevated risk of obesity-related and individual cancers, independent of BMI and waist circumference. Population attributable risk for total cancer associated with high (quartiles 2-4 vs 1) estimated visceral adipose tissue (9.0% for men, 11.6% for women) was higher than high BMI (quartiles 2-4 vs 1 = 5.0% for men, 8.2% for women).

Conclusions: Estimated visceral adipose tissue showed robust performance in UKB and National Health and Nutrition Examination Survey and was associated with cancer risk independent of BMI and waist circumference. This study provides a potential clinical tool for visceral adipose tissue estimation and underscores that visceral adipose tissue can be an important target for cancer prevention.