eligible subjects were healthy individuals who voluntarily received routine comprehensive health check - ups , including computed tomography ( ct ) scan analyses of abdominal adipose tissue , from january to december 2008 at the seoul national university hospital healthcare system gangnam center .
data were collected through a questionnaire , anthropometric measurements , blood samples , and ct scans .
detailed descriptions of the method used for the measurement of abdominal adipose tissue have been published previously ( 8) . in brief , a 5-mm thick umbilical level abdominal section from 16-detector row ct imaging of the abdomen was obtained .
the cross - sectional area ( cm ) of the abdominal fat was calculated using rapidia 2.8 ct software ( infinitt , seoul , korea ) .
the vat area was defined as intra - abdominal fat bound by parietal peritoneum or transversalis fascia , and the sat area was calculated by subtracting the vat area from the total adipose tissue area . because of the high colinearity between sat and vat , adjustments to the regression model or stratification of vat are insufficient to control for the effects of vat on sat .
the ratio between sat and vat ( sat / vat ratio [ svr ] ) was therefore calculated and used in the current study .
mets was defined according to the modified national cholesterol education program adult treatment panel iii ( 9 ) and asia - pacific abdominal obesity criterion ( 10 ) . means with 95% ci and
numbers of participants ( % ) with metabolic risk factors were compared across the svr quintiles .
we used multivariate logistic regressions to evaluate the association between mets and svr after adjusting for age , smoking , alcohol consumption , bmi , menopausal status , and hormonal replacement therapy ( women only ) .
data are expressed as odds ratio ( or ) [ 95% ci ] ; and p for trend .
detailed descriptions of the method used for the measurement of abdominal adipose tissue have been published previously ( 8) . in brief , a 5-mm thick umbilical level abdominal section from 16-detector row ct imaging of the abdomen was obtained .
the cross - sectional area ( cm ) of the abdominal fat was calculated using rapidia 2.8 ct software ( infinitt , seoul , korea ) .
the vat area was defined as intra - abdominal fat bound by parietal peritoneum or transversalis fascia , and the sat area was calculated by subtracting the vat area from the total adipose tissue area . because of the high colinearity between sat and vat , adjustments to the regression model or stratification of vat are insufficient to control for the effects of vat on sat .
the ratio between sat and vat ( sat / vat ratio [ svr ] ) was therefore calculated and used in the current study .
mets was defined according to the modified national cholesterol education program adult treatment panel iii ( 9 ) and asia - pacific abdominal obesity criterion ( 10 ) .
means with 95% ci and numbers of participants ( % ) with metabolic risk factors were compared across the svr quintiles .
we used multivariate logistic regressions to evaluate the association between mets and svr after adjusting for age , smoking , alcohol consumption , bmi , menopausal status , and hormonal replacement therapy ( women only ) .
data are expressed as odds ratio ( or ) [ 95% ci ] ; and p for trend .
forty percent of men and 25% of women had elevated blood pressure , 31% of men and 15% of women had elevated fasting glucose , and 25% of men and 14% of women had mets .
the mean sat and vat areas were 139.8 cm and 134.4 cm in men and 173.1 cm and 80.0 cm in women , respectively .
the prevalence of elevated fasting glucose , elevated triglycerides ( tgs ) , and reduced hdl cholesterol ( hdl - c ) significantly decreased as the svr quintile increased ( 26 , 16 , and 37% in quintile 1 vs. 5 , 4 , and 11% in quintile 5 , respectively ; all p for linear trend < 0.05 ) robust linear decreases in these risk factors were also seen among men ( supplementary table 1b ) .
ors of mets significantly decreased across all 5 quintiles of the svr after adjusting for covariates in both men ( or 1.0 for quintile 1 vs. 0.5 in quintile 5 ; 95% ci 0.30.7 for quintile 5 ; p for linear trend < 0.01 ) and women ( or 1.0 for quintile 1 vs. 0.2 in quintile 5 ; 95% ci 0.10.5 for quintile 5 ; p for linear trend < 0.01 ) ( table 1 ) .
unadjusted and adjusted ors and 95% ci from logistic regressions predicting the likelihood of mets for each of the svr quintiles * adjusted ors take into consideration age , smoking , alcohol consumption , bmi , and menopausal status , hormone replacement therapy ( women only ) .
ors of mets significantly decreased across all 5 quintiles of the svr after adjusting for covariates in both men ( or 1.0 for quintile 1 vs. 0.5 in quintile 5 ; 95% ci 0.30.7 for quintile 5 ; p for linear trend < 0.01 ) and women ( or 1.0 for quintile 1 vs. 0.2 in quintile 5 ; 95% ci 0.10.5 for quintile 5 ; p for linear trend < 0.01 ) ( table 1 ) .
unadjusted and adjusted ors and 95% ci from logistic regressions predicting the likelihood of mets for each of the svr quintiles * adjusted ors take into consideration age , smoking , alcohol consumption , bmi , and menopausal status , hormone replacement therapy ( women only ) .
the purpose of this study was to assess the cross - sectional correlation of abdominal sat with mets in a korean study population .
we found that as the svr increased , mets components such as reduced hdl - c , elevated tgs , and elevated fasting glucose decreased in both sexes . furthermore , this relationship was maintained even after the adjustment for a variety of variables .
small adipocytes in sat play the role of powerful buffers , uptaking circulating free fatty acids and tgs in the postprandial period .
but if they lose their function in adipogenesis or fat storage capacity in sat , fat begins to accumulate in tissues not suited for lipid storage such as vat .
peroxisome proliferatoractivated receptor- ( ppar- ) agonists stimulate the differentiation of adipocytes , resulting in increased accumulation capacity in sat ( 12 ) .
the ppar- coactivator 1 mrna expression is significantly higher in subcutaneous fat than in omental fat ( 13).this mechanism explained the finding that treatment with thiazolidinedione improves insulin sensitivity ( 6 ) . vat and sat differ in cytokine secretion profile such as leptin , adiponectin , interleukin-6 , interleukin-8 , plasminogen activator inhibitor 1 , and angiotensin , which may play some role in the development of mets ( 14,15 ) .
longitudinal associations of vat / sat change with mets , and with leptin and/or adiponectin level should be the focus of future studies .
gluteofemoral sat , which may act as a confounding factor , was not considered in the study .
however , the current study included the analysis of a large dataset of ct - measured sat and vat .
moreover , the study population was generally healthy , which implies that the results can be applied to the general korean population .
 objectivethis study aimed to assess the correlation between abdominal subcutaneous adipose tissue ( sat ) and metabolic syndrome ( mets ) in korean adults after adjusting for the effects of visceral adipose tissue ( vat).research design and methodsthe sat / vat ratio ( svr ) was calculated using abdominal computed tomography in 2,655 subjects . 
 we used regression analyses to assess whether the svr predicted mets.resultsfor both sexes , the prevalence of elevated triglycerides , reduced hdl , and elevated fasting glucose significantly decreased with increasing quintiles of svr ( p for trend < 0.05 ) . the prevalence and odds ratios of mets significantly decreased as the svr increased ( men : odds ratio 0.5 [ 95% ci 0.30.7 ] ; women : 0.2 [ 0.10.5 ] for comparisons of lowest vs. highest quintile ; p for trend < 0.05).conclusionsafter adjustment for vat , abdominal sat was inversely correlated with the occurrence of mets . 