MRI-derived visceral fat ratio reclassifies cardiometabolic risk in lean, healthy adults

In 22,040 metabolically healthy non-obese adults, MRI-based VAT/SAT ratio improved risk classification for MACE (NRI=0.088, p=0.013) and diabetes (NRI=0.102, p=0.010) over waist circumference. High ratio independently predicted MACE (aHR=1.30) and diabetes (aHR=1.77).

• Prospective cohort study of 22,040 UK Biobank participants with median follow-up 4.2 years; VAT/SAT volumes quantified via deep learning from whole-body MRI.
• Adding VAT/SAT ratio to fully adjusted models improved C-index for MACE (0.694 vs 0.690, p=0.036) and diabetes (0.723 vs 0.715, p<0.001).
• VAT/SAT cutoffs were derived from an external German cohort, not internally validated; residual confounding possible in observational design.

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