Background: Excess visceral adipose tissue (VAT) is associated with an increased risk of prediabetes and type 2 diabetes (T2D) independent of body mass index (BMI). Whether expansion of VAT or other fat depots is associated with diabetes risk independent of weight gain is not fully known.

Methods: Among participants without prevalent diabetes or cardiovascular disease enrolled in the Dallas Heart Study, we measured body fat distribution by dual energy x-ray absorptiometry and biomarkers of glycemia at baseline (2000-2002) and repeated 7 years later. The incidence of prediabetes and T2D per ADA definitions were assessed at follow-up.

Results: The study included 1661 participants (mean age 44, 58% women, 45% black, 39% obese) with median weight gain of 3.0 (-1.1 to 7.2) kg. Eight percent of participants developed T2D and, among those with normal fasting glucose at baseline (n=1551), 36% developed prediabetes or T2D. Changes in fat depots are shown in the Table. VAT and SAT gain were associated with incident T2D and with prediabetes or T2D independent of traditional risk factors, baseline BMI, change in BMI, and baseline fat depot (Table). Increasing lower body fat was not associated with incident diabetes.

Conclusions: Expansion of VAT and SAT are both associated with incident T2D independent of weight gain. Abdominal adiposity may be a modifiable target for diabetes prevention even in the absence of generalized weight loss.

I.J. Neeland: Speaker's Bureau; Self; Boehringer Ingelheim GmbH. Research Support; Self; Novo Nordisk A/S, National Institute of Diabetes and Digestive and Kidney Diseases. Advisory Panel; Self; Advanced MR Analytics AB. C. Ayers: None. K.V. Patel: None. P.H. Joshi: Consultant; Self; Regeneron Pharmaceuticals, Inc. D.K. McGuire: Consultant; Self; AstraZeneca, Sanofi-Aventis, Eli Lilly and Company, Boehringer Ingelheim Pharmaceuticals, Inc., Merck & Co., Inc., Pfizer Inc., Novo Nordisk A/S. Research Support; Self; AstraZeneca, Sanofi-Aventis, Janssen Pharmaceuticals, Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk A/S, Lexicon Pharmaceuticals, Inc., Eisai Inc., GlaxoSmithKline plc., Esperion Therapeutics. S.M. Grundy: None. A. Rohatgi: Research Support; Self; Merck Sharp & Dohme Corp., American Heart Association. Consultant; Self; CSL Behring. Research Support; Self; National Heart, Lung, and Blood Institute. G.L. Vega: None.

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