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by Dennis Thompson
HealthDay Reporter
THURSDAY, May 18, 2023 (HealthDay News) — It’s well known that the accumulation of belly fat around the abdominal organs is unhealthy, but there’s a more insidious form of fat that could be even more dangerous to your health, according to a recent study.
Fat that seeps into muscle appears to dramatically increase the risk of death, according to findings published May 16 in the journal Radiology.
Fatty muscle, a condition called myosteatosis, was associated with a 15.5 percent increased absolute risk of death in a group of healthy adults, the researchers found.
By comparison, obesity appeared to increase participants’ absolute risk of mortality by only 7.6%, the results show. Fatty liver disease increased the risk by 8.5% and muscle wasting by 9.7%.
“The signal [for muscle fat risk] it was much stronger for this otherwise healthy cohort,” said lead investigator Dr. Perry Pickhardt, chief of gastrointestinal imaging at the University of Wisconsin School of Medicine and Public Health. “It really stood out as a strong biomarker beyond the things that I think we all accept as important measures.
“I think there will be profiles of patients where if you align myosteatosis with a very fatty liver or maybe a lot of visceral fat, you could be much worse off than if you only had one or two of those,” Pickhardt added. .
Muscle fat has been a topic of growing interest in the fields of obesity and diabetes, said Dr. Steven Heymsfield, a professor of metabolism and body composition at Louisiana State University’s Pennington Biomedical Research Center.
There is a small, healthy amount of fat naturally found within each muscle cell that can be used for energy, said Heymsfield, who was not involved in the study.
The real health problem comes from excess fat that accumulates outside the cells and around the muscle fibers and bundles.
think of a steak
“If you think about a steak, the marbling on the steak, that’s what we’re dealing with here,” Heymsfield said. “Over the last decade or two, it has been shown to correlate with adverse health outcomes, as shown in this study.”
On average, people carry a few kilograms of muscle fat distributed throughout their bodies, Heymsfield said. It is more likely to accumulate in the legs than in other parts of the body.
Pickhardt and his colleagues conducted their study on a group of nearly 9,000 healthy patients who underwent low-dose CT scans for colon cancer screening, a procedure known as virtual colonoscopy, between 2004 and 2016.
The researchers realized that these CT scans could be useful in evaluating other potential health problems, given the large amount of data that CT scans collect about a person’s physique.
“When we look at measurements of visceral fat and muscle and aortic calcium or liver fat or bone marrow density, all these things add up and basically you can end up with this kind of prognostic virtual physical exam really powerful, if you will, and just take advantage of that from CTs done for whatever reason,” Pickhardt said.
“We call it ‘opportunistic detection’ for now, because it’s taking data that basically used to be ignored or discarded and leveraging it in new ways,” he added.
So the research team trained an artificial intelligence tool to extract body composition measures from abdominal CT scans, specifically assessing each person’s abdominal fat, muscle fat, liver fat and muscle atrophy.
Automated software simplified the process. “It would have taken a lifetime to do that with the older methods,” Heymsfield said.
The researchers then followed the participants for an average of nine years to see if any of these measures might be linked to major health problems or early death.
Not only was muscle fat associated with the highest risk of death, but the association held even after the researchers accounted for each person’s BMI (body mass index), the best available measure for obesity.
Thin people are also at risk
“BMI was actually a very poor predictor and had a very weak signal,” Pickhardt said. “Clearly, there are patients who were not obese who had this poor muscle measurement. That’s what makes this so important: there are people who are skinny in terms of BMI who actually have a worse profile than you think.”
However, this study cannot establish a clear cause-and-effect relationship between muscle fat and the risk of death, noted Dr. Angela Tong, a clinical assistant professor of radiology at New York University School of Medicine.
Muscle fat could be accumulating because of another health problem that is the real risk, said Tong, co-author of an editorial published with the study.
“I think of it more as a sign that maybe something else is going on, maybe something else in your health that’s not allowing you to be as active,” Tong said. “You have to watch carefully if there are any heart problems or diabetes.”
Other studies have established a link between fatty muscles and poor results. For example, a 2020 evidence review published in Critical Reviews in Oncology/Hematology found that cancer patients diagnosed with myosteatosis had a 75% higher risk of mortality than those without fatty muscles.
How does it happen?
It’s not exactly clear why your muscles might start to pack on fat, Heymsfield said.
“There may be some genetics involved, and it increases as you get older, despite your best intentions to lift weights or exercise,” Heymsfield said.
Muscle fat is also known to accumulate if muscles atrophy, Heymsfield said.
“Let’s say you have a leg in a cast and the muscle atrophies, sometimes those muscle cells are replaced by fat cells,” Heymsfield said. “That’s probably the biggest source of what these researchers found.”
For example, myosteatosis is a hallmark of certain types of muscular dystrophy, Heymsfield said.
It’s also unclear how you can get rid of unwanted muscle fat, Heymsfield said.
“The science is evolving, but I think for the most part, if you lose weight and exercise, I would say those are two really good ways to reduce it,” Heymsfield said. “There may be something in there that just won’t go away no matter what you do, possibly the genetic part or the part that comes from muscle cell death.”
A 2021 evidence review in the Applied Physiology Journal found that “exercise can significantly improve muscle quality in populations at risk of developing obesity,” thereby reducing fat in the muscles.
This study shows that CT scans could be a useful tool for a variety of health exams, including fat muscle, Pickhardt said.
“I could envision a time in the not too distant future where this is an anticipated screening measure,” Pickhardt said. “You can do it with about the same amount of radiation as a standard X-ray of the abdomen.
“I’m a little hesitant to call it a virtual physical, but that’s the concept,” Pickhardt added.
Heymsfield said that CT scans appear to be the best way to assess muscle fat levels at this time. “You could get an estimate with ultrasound, but not with the same degree of precision,” he said.
But people shouldn’t actively worry about whether their muscles are fatty, since the science surrounding this is so new, he added.
“I think what will happen now is that as AI and other analytical methods become ubiquitous, radiologists will automatically get this data right when they do an abdominal CT scan,” Heymsfield said. “As a result, people will start saying, ‘Wait a minute, what do I do about this?’ The answer is, if you’re overweight or not exercising enough, those are two things you could easily do in response.”
More information
The American Council on Exercise has more about fat and exercise.
SOURCES: Perry Pickhardt, MD, chief, gastrointestinal imaging, University of Wisconsin School of Medicine and Public Health; Steven Heymsfield, MD, professor, metabolism and body composition, Louisiana State University Pennington Biomedical Research Center; Angela Tong, MD, clinical assistant professor, radiology, New York University Grossman School of Medicine; RadiologyMay 16, 2023
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