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Obesity is associated with increasing cardiometabolic morbidity and mortality rates worldwide. Not everyone with obesity, however, develops metabolic complications. Brown adipose tissue (BAT) has been suggested to be a promoter of leanness and metabolic health. To date, little is known about the prevalence and metabolic function of BAT in people with severe obesity, a population at high cardiometabolic risk. In this cross-sectional study, we included 40 individuals with World Health Organization class II-III obesity (BMI ≥35 kg/m2). Using a 150-min personalized cooling protocol and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography, cold-activated BAT was detectable in 14 of the participants (35%). Cold-induced thermogenesis was significantly higher in participants with detectable BAT compared with those without. Notably, individuals with obesity and active BAT had 28.8% lower visceral fat mass despite slightly higher total fat mass compared with those without detectable BAT 18F-FDG uptake. The lower amount of visceral fat mass was accompanied by lower insulin resistance and systemic inflammation and improved nonalcoholic fatty liver disease parameters, all adjusted for age, sex, and percent body fat. Contrary to previous assumptions, we show here that a significant fraction of individuals with severe obesity has active BAT. We found that decreased BAT 18F-FDG uptake was not associated with adiposity per se but with higher visceral fat mass. In summary, active BAT is linked to a healthier metabolic phenotype in obesity.

T2DM is a major risk factor for cardiovascular morbidity and mortality in PAD. Clinical assessment of patients at risk for the development of T2DM remains challenging. Visceral obesity is a known risk factor of T2DM, but there is no consensus for a clinically applicable measurement. This study aimed to investigate the potential association of a novel visceral obesity parameter, visceral adiposity index (VAI), with dysglycemia (prediabetes and T2DM) in comparison to established indices in a PAD cohort. 366 patients with diagnosed PAD (defined by an ABI80cm in female and >94cm in male patients (2.38, 1.01-5.62), but not significant for waist-hip ratio (WHR) >0.85 in female and >0.9 in male patients (2.24, 0.91-5.52). BMI, WC and WHR models neither predicted T2DM nor PRE (data not shown). Higher VAI values are associated with different states of dysglycemia alone and combined in a PAD cohort. In these patients VAI is superior to more common parameters of obesity. Disclosure B. Zierfuss: None. C. Hoebaus: None. C.T. Herz: None. R. Koppensteiner: None. G. Schernthaner: None.