- Central obesity has to do with deeper fat that builds up in the abdomen.
- One study’s findings indicate that central obesity, or fat around the belly area, is linked to heart failure.
- Further analysis suggests that inflammation may be partially responsible for the link between heart failure and central obesity.
Central obesity is when visceral fat builds up in the abdomen. Visceral fat is deep rather than near the surface and surrounds organs. A recent study explored how central obesity relates to heart failure and how inflammation plays a role in the relationship.
The results showed that greater inflammation was associated with worse heart failure-free survival. Two indicators of central obesity were both predictors of heart failure. Finally, inflammation accounted for about a quarter of the effects of central obesity on heart failure.
These results suggest that evaluating central obesity may be a critical component of addressing heart failure risk.
Researchers looked at data from almost 2,000 adults who were part of the Jackson Heart Study and did not have heart failure at baseline.
Researchers had certain indicators for fat in the body, including weight, body mass index, waist-to-height ratio, and waist circumference. Waist circumference and waist-to-height ratio can both assess central obesity. They looked at
The median follow-up was just under seven years. Having elevated high-sensitivity C-reactive protein was linked to a “lower HF [heart failure]-free survival.” They also found that while body mass index didn’t predict heart failure, waist circumference and waist-to-height ratio did.
Finally, they performed a mediation analysis to examine how high-sensitivity C-reactive protein moderated the effects of waist circumference and waist-to-height ratio on heart failure risk. It accounted for a substantial percentage of the influence: 25.4% of the waist circumference’s effect and 28.5% of the waist-to-height ratio’s effect.
Study author Szu-Han Chen, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, explained the following regarding the research:
“Measures of central obesity, such as waist circumference and waist-to-height ratio, were associated with a higher risk of developing heart failure over time, whereas body mass index (BMI) itself was not significantly associated with heart failure risk in our analysis. We also observed that individuals with higher levels of systemic inflammation, measured by high-sensitivity C-reactive protein (hs-CRP), had a greater likelihood of developing heart failure.”
“Importantly, our analyses suggest that systemic inflammation may partially explain the link between abdominal fat and heart failure risk, accounting for roughly one-quarter to one-third of this association. Taken together, these findings suggest that where fat is distributed in the body may be more important than overall body weight when evaluating cardiovascular risk,” Chen explained to Medical News Today.
Since the full study is not available at this time, a full discussion of its limitations is also unavailable. However, this research used data from participants in the
Kevin Shah, M.D., board certified cardiologist and Program Director of Heart Failure Outreach at MemorialCare Heart & Vascular Institute at Long Beach Medical Center in Long Beach, CA, who was not involved in the study, noted that “The study population was limited to African American adults from the Jackson Heart Study, so we should be cautious about over-generalizing the findings.”
“However, the biological mechanisms linking visceral fat, inflammation, and cardiovascular disease are well established across many populations, so the results are likely relevant more broadly, even if additional studies in diverse groups are needed,” he told Medical News Today.
Patrick Kee, M.D., Ph.D., a cardiologist with Vital Heart & Vein, who was also not involved in the study, noted that the study does have a number of limitations, including a lack of a heart failure definition, limited biomarkers, missing biometric and imaging data, and risk for residual confounding.
“The Chen study provides statistical evidence of mediation, but not definitive biological proof that hsCRP [high sensitivity C-reactive protein] itself is the ‘bullet’ causing heart failure. Statistical mediation can identify a ‘middle-man,’ but it cannot prove if that middle-man is an active participant (a mediator) or merely an observer (a marker). If hsCRP is a marker, it is simply rising in lockstep with the ‘real’ damaging agents (such as IL-6 or TNF-α) without causing the damage itself,” he explained.
Overall, the results suggest that addressing central obesity and inflammation may be critical components of preventing heart failure. It also suggests that doctors should perhaps focus more on central obesity and its possible risks.
Shah noted a few strategies to address central obesity and inflammation:
“The most effective strategies focus on improving overall metabolic health. Regular physical activity, particularly a combination of aerobic exercise and resistance training, maintaining a diet rich in whole foods, fiber, fruits, vegetables, and healthy fats, improving sleep quality, and reducing excess sugar and ultra-processed foods can all help reduce visceral fat and systemic inflammation.”
Why a ‘normal’ BMI is not enough
“One practical takeaway from this study is that clinicians and patients may want to pay more attention to waist circumference and central obesity, since those measures may reveal cardiovascular risk even in individuals whose BMI appears normal,” Shah said.
Chen offered similar sentiments:
“These findings suggest that cardiometabolic risk assessment should not rely solely on BMI. While BMI remains a convenient screening tool, measures of central obesity, such as waist circumference or waist-to-height ratio, may provide additional information about cardiovascular risk.”
“Our results also highlight the potential importance of systemic inflammation as a pathway linking abdominal fat to heart failure. Identifying individuals with excess abdominal adiposity may help clinicians recognize patients who could benefit from earlier preventive strategies, including lifestyle interventions aimed at reducing central obesity,” Chen added.
