{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T14:23:32Z","timestamp":1790346212226,"version":"4.1.0"},"reference-count":41,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,4,5]],"date-time":"2023-04-05T00:00:00Z","timestamp":1680652800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100019266","name":"Korea Medical Device Development Fund","doi-asserted-by":"publisher","award":["202011A03"],"award-info":[{"award-number":["202011A03"]}],"id":[{"id":"10.13039\/100019266","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J cachexia sarcopenia muscle"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The prognostic role of increased visceral fat attenuation (VFA) remains underexplored. We investigated the long\u2010term prognostic implications of computed tomography (CT)\u2010derived VFA in a health check\u2010up population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study included consecutive individuals who had positron\u2010emission tomography\/CT scans for health check\u2010ups between January 2004 and December 2010. The primary outcome was overall survival (OS), and the secondary outcomes were cancer\u2010specific survival (CSS) and non\u2010cancer\u2010specific survival (NCS). Commercially available body composition analysis software was used to obtain abdominal waist VFA, visceral fat volume index (VFI) and skeletal muscle index (SMI) at the L3 level. Sarcopenia was determined using sex\u2010specific SMI references. VFA and VFI were dichotomized using the thresholds for the highest quartiles. The relationship between CT\u2010derived body composition parameters and body mass index (BMI) was evaluated with Pearson correlation coefficients. The prognostic implications of VFA and sarcopenic obesity (SO) defined by VFA were assessed by multivariable Cox regression analysis and Kaplan\u2013Meier plots with log\u2010rank tests.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 2720 individuals (1530 men [56.3%] and 1190 women [43.7%]; median age: 53\u00a0years, inter\u2010quartile range: 47\u201360\u00a0years) were included. During the median follow\u2010up of 138\u00a0months, 128 individuals (5%) died (cancer mortality: 2%; non\u2010cancer mortality: 3%), with 0.2% (5 of 2720) and 1.1% (30 of 2720) of 1\u2010 and 5\u2010year mortality rates. VFA was negatively correlated with BMI (\n                      <jats:italic>r<\/jats:italic>\n                      \u00a0=\u00a0\u22120.62;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a00.001) and VFI (\n                      <jats:italic>r<\/jats:italic>\n                      \u00a0=\u00a0\u22120.69;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). After adjusting for clinical variables, sarcopenia and VFI, high VFA was a negative prognostic factor for OS (hazard ratio [HR]: 1.05 per Hounsfield unit; 95% confidence interval [CI]: 1.02, 1.08;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.001), CSS (HR: 1.07 per Hounsfield unit; 95% CI: 1.02, 1.12;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.006) and NCS (HR: 1.03 per Hounsfield unit; 95% CI: 1.01, 1.06;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.009). Individuals with high VFA had higher high\u2010sensitivity C\u2010reactive protein levels than those with low VFA (0.11 vs. 0.03\u00a0mg\/dL;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). Individuals with SO defined by VFA had worse OS (9% vs. 4%;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a00.001), CSS (3% vs. 2%;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.02) and NCS (6% vs. 3%;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a00.001) than those without SO, even in the same BMI (underweight\u2010to\u2010normal BMI, OS: 8% vs. 4%; overweight\u2010to\u2010obese BMI, OS: 38% vs. 4%;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a00.001 in both) or VFI category (high VFI, OS: 43% vs. 6%; low VFI, OS: 8% vs. 3%;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a00.001 in both).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>High VFA was associated with long\u2010term mortality and low\u2010grade inflammation. VFA can further stratify the current SO by BMI or VFI, and SO defined by VFA can identify individuals who are most vulnerable to long\u2010term mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jcsm.13226","type":"journal-article","created":{"date-parts":[[2023,4,5]],"date-time":"2023-04-05T03:59:43Z","timestamp":1680667183000},"page":"1495-1507","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["High visceral fat attenuation and long\u2010term mortality in a health check\u2010up population"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9594-683X","authenticated-orcid":false,"given":"Jong Hyuk","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Radiology Seoul National University College of Medicine  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung Ho","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center Seoul National University Hospital  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keum Ji","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Health Promotion, Institute for Health Promotion, Graduate School of Public Health Yonsei University  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin Mo","family":"Goo","sequence":"additional","affiliation":[{"name":"Department of Radiology Seoul National University College of Medicine  Seoul Korea"},{"name":"Institute of Radiation Medicine Seoul National University Medical Research Center  Seoul Korea"},{"name":"Cancer Research Institute Seoul National University  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3700-0165","authenticated-orcid":false,"given":"Soon Ho","family":"Yoon","sequence":"additional","affiliation":[{"name":"Department of Radiology Seoul National University College of Medicine  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,4,5]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"World Health Organization.Obesity and overweight in the Western Pacific. 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