Associations of quantitative computed tomography measured abdominal and ectopic fat with impaired glucose metabolism in overweight/obese Chinese adults

doi:10.4239/wjd.123878

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World Journal of Diabetes

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1948-9358

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Diabetes. Oct 15, 2026; 17(10): 123878
Published online Oct 15, 2026. doi: 10.4239/wjd.123878

Associations of quantitative computed tomography measured abdominal and ectopic fat with impaired glucose metabolism in overweight/obese Chinese adults

Xiao-Li Ma, Yang Liu, Bo-Han Li, Hui-Chen Zhao, Yan-Pei Sun, He-Li Han, Wan-Jiang Yu, Hua Lin, Wei-Na Mu, Yuan-Tao Liu

Xiao-Li Ma, Hui-Chen Zhao, Wei-Na Mu, Department of Endocrinology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao 266035, Shandong Province, China

Yang Liu, Bo-Han Li, Yan-Pei Sun, Hua Lin, Department of Clinical Nutrition, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao 266035, Shandong Province, China

He-Li Han, Wan-Jiang Yu, Department of Radiology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao 266035, Shandong Province, China

Yuan-Tao Liu, Department of Endocrinology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao 266035, Shandong Province, China

Co-first authors: Xiao-Li Ma and Yang Liu.

Co-corresponding authors: Wei-Na Mu and Yuan-Tao Liu.

Author contributions: Ma XL and Liu Y played important and indispensable roles in the experimental design as co-first authors; Ma XL, Liu Y, Zhao HC, and Sun YP were responsible for patient recruitment and data collection; Li BH and Lin H were responsible for data analysis; Han HL and Yu WJ were responsible for quantitative computed tomography measurements; Mu WN and Liu YT contributed to study design and manuscript drafting, supervised the study, and reviewed and edited the manuscript as co-corresponding authors; all authors participated in revising the manuscript and approved the final version prior to submission.

AI contribution statement: We confirm that AI-assisted tools were used solely to polish the English language and grammar of the authors' initial draft. These tools were not employed to generate scientific content, process data, or contribute to study design. All AI-generated outputs were reviewed and verified by all authors, who take full responsibility for the scientific content of the final manuscript.

Supported by the Natural Science Foundation of Shandong, No. ZR2022MH086.

Institutional review board statement: The study protocol was reviewed and approved by the Medical Ethics Committee of Qingdao Municipal Hospital (approval number: 2022 LSZ No. 90). The committee concluded that the study protocol complied with the principles of the Declaration of Helsinki. The technical approaches employed were advanced and scientifically sound, the sampling and research procedures adhered to standard medical practice, and the project fulfilled the requirements of medical ethics.

Informed consent statement: Given that the data collection process posed only minimal risk, with potential harm to participants not exceeding the minimum threshold, and that the data analysis was primarily retrospective and observational in nature, the Medical Ethics Committee granted a waiver of written informed consent.

Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.

STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.

Data sharing statement: The data that support the findings of this study are not publicly available due to privacy reasons, but are available from the corresponding author or the data sharing committee upon reasonable request.

Corresponding author: Yuan-Tao Liu, PhD, Professor, Department of Endocrinology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, No. 758 Hefei Road, Shibei District, Qingdao 266035, Shandong Province, China. sduliuyuantao@126.com

Received: June 8, 2026
Revised: July 20, 2026
Accepted: August 25, 2026
Published online: October 15, 2026
Processing time: 125 Days and 3.8 Hours

Abstract

BACKGROUND

Obesity and ectopic fat deposition are well-established correlates of metabolic disorders, including type 2 diabetes mellitus (DM). However, the respective contributions of distinct adipose depots—namely, visceral adipose tissue (VAT), hepatic fat fraction (HFF), and subcutaneous adipose tissue (SAT)—to impaired glucose metabolism remain insufficiently elucidated. Furthermore, whether the associations between these fat depots and glucose metabolism differ according to sex remains poorly understood.

AIM

To evaluate the sex-specific associations of abdominal and ectopic fat with impaired glucose metabolism in overweight/obese Chinese adults using quantitative computed tomography.

METHODS

This study included 205 participants (100 males, 105 females) with a body mass index ≥ 24 kg/m², aged between 18 and 50 years. All participants underwent a standard 75-g oral glucose tolerance test. Subjects were classified into three categories according to glucose status: Normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and DM, in both sexes. Abdominal computed tomography was performed to quantify abdominal fat and fat deposition within the liver, pancreas, and skeletal muscle. Impaired glucose metabolism (IGM) was defined as the presence of IGT or DM. All data were analyzed separately by sex.

RESULTS

HFF was found to be significantly higher in IGM patients than in NGT subjects in both sexes. After adjusting for age and dyslipidemia, the odds ratios for IGM prevalence in the highest tertile of HFF were 5.24 (95%CI: 1.64–16.73) in males and 6.45 (95%CI: 2.12–19.63) in females. Further analysis demonstrated that VAT was also significantly elevated in IGM patients compared with NGT subjects in both sexes. For VAT, the odds ratios for IGM were 6.56 (95%CI: 1.55–27.86) in males and 3.29 (95%CI: 1.17–9.29) in females. SAT levels were significantly lower in participants with DM than in those with NGT or IGT. In males, the odds ratio for IGM associated with SAT was 0.13 (95%CI: 0.03–0.60).

CONCLUSION

The results demonstrated that both HFF and VAT were independently associated with IGM in Chinese overweight/obese subjects of both sexes. In male subjects, higher SAT was associated with lower odds of IGM. These findings suggest that hepatic fat accumulation and visceral adiposity are closely related to glucose metabolism disorders, and that sex differences in abdominal fat distribution may contribute to heterogeneity in glucose metabolism among Chinese overweight/obese individuals.

Keywords: Obesity; Fat distribution; Impaired glucose metabolism; Type 2 diabetes; Metabolic disease

Core Tip: This cross-sectional study of overweight/obese Chinese adults utilized quantitative computed tomography to evaluate the sex-specific associations of abdominal and ectopic fat depots with impaired glucose metabolism (IGM). Hepatic fat fraction (HFF) and visceral adipose tissue (VAT) were independently associated with IGM in both sexes, with odds ratios ranging from 5.24 to 6.45 for HFF and from 3.29 to 6.56 for VAT. Notably, higher subcutaneous adipose tissue (SAT) was associated with lower odds of IGM exclusively in males (odds ratio = 0.13). These findings underscore that sex differences in abdominal fat distribution may contribute to heterogeneity in glucose metabolism disorders.