Body fat distribution is more predictive of all‐cause mortality than overall adiposity

Aims The relationship between directly measured body fat and all‐cause mortality has been rarely studied. The aim of this study was to evaluate the predictive significance of computed tomography (CT)‐measured body fat, including both visceral fat area (VFA) and subcutaneous fat area (SFA), for mortality. Methods The study included 36 656 participants who underwent abdominal CT as part of a health check‐up at a single university‐affiliated healthcare center in 2007 to 2015. Of those, 32 593 participants with data regarding vital status as of May 2016 were included in the final analysis. The main factors evaluated were VFA, SFA and visceral‐to‐subcutaneous fat area ratio (VSR), and the primary outcome was all‐cause mortality. Results There were 253 deaths during a mean follow‐up of 5.7 years. Increased SFA was associated with decreased all‐cause mortality, whereas an increased VFA and VSR were related to increased all‐cause mortality. Compared with the predictive power of body mass index (BMI), SFA and VSR showed a larger area under the curve than did BMI. In Kaplan–Meier survival curve analysis, increased SFA and VSR were associated with decreased and increased hazard of all‐cause death, respectively. However, in multivariate Cox proportional hazard regression analysis, only VSR was independently associated with all‐cause mortality. Moreover, this relationship was paralleled by the harmful impact of increased VSR on metabolic profiles. Conclusion Increased VSR was an independent predictor of all‐cause mortality. This suggests that the location of fat deposits may be more important than the actual amount of body fat.