Association of a Lifestyle Risk Index With Visceral and Subcutaneous Adipose Tissue in the German National Cohort (NAKO)

Gertraud Maskarinec; Rebecca Klapp; Ute Nöthlings; Matthias B. Schulze; Fabian Bamberg; Jürgen Machann; Sabrina Schlesinger; Michael Leitzmann; Anja Sedlmeier; Patricia Bohmann; Susanne Rospleszcz; Johanna Nattenmüller; Tobias Haueise; Karen Steindorf; Thoralf Niendorf; Christopher L. Schlett; Karin Halina Greiser; Leo Panreck; Jakob Linseisen; Christina Alexandra Conzen; Sylvia Gastell; Tamara Schikowski; Henry Völzke; Robin Bülow; Annette Peters; Fiona Niedermayer; Rudolf Kaaks; Heiko Becher; André Karch; Klaus Berger; Thomas Keil; Lilian Krist; Michael Hoffmeister; Ute Mons; Boerge Schmidt; Andreas Stang; Rafael Mikolajczyk; Alexander Kluttig; Wolfgang Lieb; Cara Övermöhle; Antje Hebestreit; Kathrin Günther; Volker Harth; Nadia Obi; Stefanie Castell; Robyn Kettlitz; Katharina Nimptsch; Tobias Pischon

doi:10.1002/oby.70071

Association of a Lifestyle Risk Index With Visceral and Subcutaneous Adipose Tissue in the German National Cohort (NAKO)

Gertraud Maskarinec^*
, Rebecca Klapp
, Ute Nöthlings
, Matthias B. Schulze
, Fabian Bamberg
, Jürgen Machann
, Sabrina Schlesinger
, Michael Leitzmann
, Anja Sedlmeier
, Patricia Bohmann
, Susanne Rospleszcz
, Johanna Nattenmüller
, Tobias Haueise
, Karen Steindorf
, Thoralf Niendorf
, Christopher L. Schlett
, Karin Halina Greiser
, Leo Panreck
, Jakob Linseisen
, Christina Alexandra Conzen

Sylvia Gastell, Tamara Schikowski, Henry Völzke, Robin Bülow, Annette Peters, Fiona Niedermayer, Rudolf Kaaks, Heiko Becher, André Karch, Klaus Berger, Thomas Keil, Lilian Krist, Michael Hoffmeister, Ute Mons, Boerge Schmidt, Andreas Stang, Rafael Mikolajczyk, Alexander Kluttig, Wolfgang Lieb, Cara Övermöhle, Antje Hebestreit, Kathrin Günther, Volker Harth, Nadia Obi, Stefanie Castell, Robyn Kettlitz, Katharina Nimptsch, Tobias Pischon

^*Corresponding author for this work

Research output: Contribution to journal › Article › Research › peer-review

Abstract

Objective: This cross-sectional study examined a Lifestyle Risk Factor Index (LSRI) in relation to adiposity measures including visceral adipose tissue (VAT) in the German National Cohort (NAKO). Methods: Based on self-reports at baseline among 30,920 of > 205,000 NAKO eligible participants with magnetic resonance imaging (MRI) scans, one point each for not smoking, adhering to ≥ 3/7 diet recommendations, consuming ≤ 1 (women)/≤ 2 (men) alcoholic drinks/day, and ≥ 150 min/week physical activity was assigned. VAT volume, obtained from whole-body MRI at 3T, was analyzed by deep learning-based image segmentation. General linear models estimated adjusted geometric mean adiposity measures by LSRI and stratified analyses by sex and BMI. Results: Of 18,508 participants aged 48.2 ± 12.2 years, the respective proportions for 0/1, 2, 3, and 4 LSRI points were 7%, 24%, 51%, and 18%. Participants with LSRI scores of 4 versus 0/1 had lower adjusted geometric mean volumes of VAT (2.3; 95% CI 2.2, 2.3 vs. 3.0; 95% CI 2.9, 3.1 L). These differences were slightly attenuated after adding BMI. This association was weaker for individuals with obesity than normal/overweight. Conclusion: A combination of lifestyle factors appears to be associated with lower VAT volume, but an elevated BMI may have a greater influence on VAT accumulation than lifestyle behaviors alone.

Original language	English
Pages (from-to)	246-257
Number of pages	12
Journal	Obesity
Volume	34
Issue number	1
Early online date	19 Nov 2025
DOIs	https://doi.org/10.1002/oby.70071
Publication status	Published - Jan 2026
Externally published	Yes

Keywords

body fat distribution
cohort study
lifestyle behaviors
obesity
Body Mass Index
Life Style
Cross-Sectional Studies
Humans
Middle Aged
Risk Factors
Germany/epidemiology
Obesity/epidemiology
Male
Intra-Abdominal Fat/diagnostic imaging
Magnetic Resonance Imaging
Exercise
Adiposity
Subcutaneous Fat/diagnostic imaging
Female
Adult
Cohort Studies

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10.1002/oby.70071

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Maskarinec, G., Klapp, R., Nöthlings, U., Schulze, M. B., Bamberg, F., Machann, J., Schlesinger, S., Leitzmann, M., Sedlmeier, A., Bohmann, P., Rospleszcz, S., Nattenmüller, J., Haueise, T., Steindorf, K., Niendorf, T., Schlett, C. L., Greiser, K. H., Panreck, L., Linseisen, J., ... Pischon, T. (2026). Association of a Lifestyle Risk Index With Visceral and Subcutaneous Adipose Tissue in the German National Cohort (NAKO). Obesity, 34(1), 246-257. https://doi.org/10.1002/oby.70071

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title = "Association of a Lifestyle Risk Index With Visceral and Subcutaneous Adipose Tissue in the German National Cohort (NAKO)",

abstract = "Objective: This cross-sectional study examined a Lifestyle Risk Factor Index (LSRI) in relation to adiposity measures including visceral adipose tissue (VAT) in the German National Cohort (NAKO). Methods: Based on self-reports at baseline among 30,920 of > 205,000 NAKO eligible participants with magnetic resonance imaging (MRI) scans, one point each for not smoking, adhering to ≥ 3/7 diet recommendations, consuming ≤ 1 (women)/≤ 2 (men) alcoholic drinks/day, and ≥ 150 min/week physical activity was assigned. VAT volume, obtained from whole-body MRI at 3T, was analyzed by deep learning-based image segmentation. General linear models estimated adjusted geometric mean adiposity measures by LSRI and stratified analyses by sex and BMI. Results: Of 18,508 participants aged 48.2 ± 12.2 years, the respective proportions for 0/1, 2, 3, and 4 LSRI points were 7\%, 24\%, 51\%, and 18\%. Participants with LSRI scores of 4 versus 0/1 had lower adjusted geometric mean volumes of VAT (2.3; 95\% CI 2.2, 2.3 vs. 3.0; 95\% CI 2.9, 3.1 L). These differences were slightly attenuated after adding BMI. This association was weaker for individuals with obesity than normal/overweight. Conclusion: A combination of lifestyle factors appears to be associated with lower VAT volume, but an elevated BMI may have a greater influence on VAT accumulation than lifestyle behaviors alone.",

keywords = "body fat distribution, cohort study, lifestyle behaviors, obesity, Body Mass Index, Life Style, Cross-Sectional Studies, Humans, Middle Aged, Risk Factors, Germany/epidemiology, Obesity/epidemiology, Male, Intra-Abdominal Fat/diagnostic imaging, Magnetic Resonance Imaging, Exercise, Adiposity, Subcutaneous Fat/diagnostic imaging, Female, Adult, Cohort Studies",

author = "Gertraud Maskarinec and Rebecca Klapp and Ute N{\"o}thlings and Schulze, \{Matthias B.\} and Fabian Bamberg and J{\"u}rgen Machann and Sabrina Schlesinger and Michael Leitzmann and Anja Sedlmeier and Patricia Bohmann and Susanne Rospleszcz and Johanna Nattenm{\"u}ller and Tobias Haueise and Karen Steindorf and Thoralf Niendorf and Schlett, \{Christopher L.\} and Greiser, \{Karin Halina\} and Leo Panreck and Jakob Linseisen and Conzen, \{Christina Alexandra\} and Sylvia Gastell and Tamara Schikowski and Henry V{\"o}lzke and Robin B{\"u}low and Annette Peters and Fiona Niedermayer and Rudolf Kaaks and Heiko Becher and Andr{\'e} Karch and Klaus Berger and Thomas Keil and Lilian Krist and Michael Hoffmeister and Ute Mons and Boerge Schmidt and Andreas Stang and Rafael Mikolajczyk and Alexander Kluttig and Wolfgang Lieb and Cara {\"O}verm{\"o}hle and Antje Hebestreit and Kathrin G{\"u}nther and Volker Harth and Nadia Obi and Stefanie Castell and Robyn Kettlitz and Katharina Nimptsch and Tobias Pischon",

note = "{\textcopyright} 2025 The Author(s). Obesity published by Wiley Periodicals LLC on behalf of The Obesity Society.",

year = "2026",

month = jan,

doi = "10.1002/oby.70071",

language = "English",

volume = "34",

pages = "246--257",

journal = "Obesity",

issn = "1930-7381",

publisher = "John Wiley and Sons Inc",

number = "1",

}

Maskarinec, G, Klapp, R, Nöthlings, U, Schulze, MB, Bamberg, F, Machann, J, Schlesinger, S, Leitzmann, M, Sedlmeier, A, Bohmann, P, Rospleszcz, S, Nattenmüller, J, Haueise, T, Steindorf, K, Niendorf, T, Schlett, CL, Greiser, KH, Panreck, L, Linseisen, J, Conzen, CA, Gastell, S, Schikowski, T, Völzke, H, Bülow, R, Peters, A, Niedermayer, F, Kaaks, R, Becher, H, Karch, A, Berger, K, Keil, T, Krist, L, Hoffmeister, M, Mons, U, Schmidt, B, Stang, A, Mikolajczyk, R, Kluttig, A, Lieb, W, Övermöhle, C, Hebestreit, A, Günther, K, Harth, V, Obi, N, Castell, S, Kettlitz, R, Nimptsch, K & Pischon, T 2026, 'Association of a Lifestyle Risk Index With Visceral and Subcutaneous Adipose Tissue in the German National Cohort (NAKO)', Obesity, vol. 34, no. 1, pp. 246-257. https://doi.org/10.1002/oby.70071

TY - JOUR

T1 - Association of a Lifestyle Risk Index With Visceral and Subcutaneous Adipose Tissue in the German National Cohort (NAKO)

AU - Maskarinec, Gertraud

AU - Klapp, Rebecca

AU - Nöthlings, Ute

AU - Schulze, Matthias B.

AU - Bamberg, Fabian

AU - Machann, Jürgen

AU - Schlesinger, Sabrina

AU - Leitzmann, Michael

AU - Sedlmeier, Anja

AU - Bohmann, Patricia

AU - Rospleszcz, Susanne

AU - Nattenmüller, Johanna

AU - Haueise, Tobias

AU - Steindorf, Karen

AU - Niendorf, Thoralf

AU - Schlett, Christopher L.

AU - Greiser, Karin Halina

AU - Panreck, Leo

AU - Linseisen, Jakob

AU - Conzen, Christina Alexandra

AU - Gastell, Sylvia

AU - Schikowski, Tamara

AU - Völzke, Henry

AU - Bülow, Robin

AU - Peters, Annette

AU - Niedermayer, Fiona

AU - Kaaks, Rudolf

AU - Becher, Heiko

AU - Karch, André

AU - Berger, Klaus

AU - Keil, Thomas

AU - Krist, Lilian

AU - Hoffmeister, Michael

AU - Mons, Ute

AU - Schmidt, Boerge

AU - Stang, Andreas

AU - Mikolajczyk, Rafael

AU - Kluttig, Alexander

AU - Lieb, Wolfgang

AU - Övermöhle, Cara

AU - Hebestreit, Antje

AU - Günther, Kathrin

AU - Harth, Volker

AU - Obi, Nadia

AU - Castell, Stefanie

AU - Kettlitz, Robyn

AU - Nimptsch, Katharina

AU - Pischon, Tobias

PY - 2026/1

Y1 - 2026/1

N2 - Objective: This cross-sectional study examined a Lifestyle Risk Factor Index (LSRI) in relation to adiposity measures including visceral adipose tissue (VAT) in the German National Cohort (NAKO). Methods: Based on self-reports at baseline among 30,920 of > 205,000 NAKO eligible participants with magnetic resonance imaging (MRI) scans, one point each for not smoking, adhering to ≥ 3/7 diet recommendations, consuming ≤ 1 (women)/≤ 2 (men) alcoholic drinks/day, and ≥ 150 min/week physical activity was assigned. VAT volume, obtained from whole-body MRI at 3T, was analyzed by deep learning-based image segmentation. General linear models estimated adjusted geometric mean adiposity measures by LSRI and stratified analyses by sex and BMI. Results: Of 18,508 participants aged 48.2 ± 12.2 years, the respective proportions for 0/1, 2, 3, and 4 LSRI points were 7%, 24%, 51%, and 18%. Participants with LSRI scores of 4 versus 0/1 had lower adjusted geometric mean volumes of VAT (2.3; 95% CI 2.2, 2.3 vs. 3.0; 95% CI 2.9, 3.1 L). These differences were slightly attenuated after adding BMI. This association was weaker for individuals with obesity than normal/overweight. Conclusion: A combination of lifestyle factors appears to be associated with lower VAT volume, but an elevated BMI may have a greater influence on VAT accumulation than lifestyle behaviors alone.

AB - Objective: This cross-sectional study examined a Lifestyle Risk Factor Index (LSRI) in relation to adiposity measures including visceral adipose tissue (VAT) in the German National Cohort (NAKO). Methods: Based on self-reports at baseline among 30,920 of > 205,000 NAKO eligible participants with magnetic resonance imaging (MRI) scans, one point each for not smoking, adhering to ≥ 3/7 diet recommendations, consuming ≤ 1 (women)/≤ 2 (men) alcoholic drinks/day, and ≥ 150 min/week physical activity was assigned. VAT volume, obtained from whole-body MRI at 3T, was analyzed by deep learning-based image segmentation. General linear models estimated adjusted geometric mean adiposity measures by LSRI and stratified analyses by sex and BMI. Results: Of 18,508 participants aged 48.2 ± 12.2 years, the respective proportions for 0/1, 2, 3, and 4 LSRI points were 7%, 24%, 51%, and 18%. Participants with LSRI scores of 4 versus 0/1 had lower adjusted geometric mean volumes of VAT (2.3; 95% CI 2.2, 2.3 vs. 3.0; 95% CI 2.9, 3.1 L). These differences were slightly attenuated after adding BMI. This association was weaker for individuals with obesity than normal/overweight. Conclusion: A combination of lifestyle factors appears to be associated with lower VAT volume, but an elevated BMI may have a greater influence on VAT accumulation than lifestyle behaviors alone.

KW - body fat distribution

KW - cohort study

KW - lifestyle behaviors

KW - obesity

KW - Body Mass Index

KW - Life Style

KW - Cross-Sectional Studies

KW - Humans

KW - Middle Aged

KW - Risk Factors

KW - Germany/epidemiology

KW - Obesity/epidemiology

KW - Male

KW - Intra-Abdominal Fat/diagnostic imaging

KW - Magnetic Resonance Imaging

KW - Exercise

KW - Adiposity

KW - Subcutaneous Fat/diagnostic imaging

KW - Female

KW - Adult

KW - Cohort Studies

UR - https://www.scopus.com/pages/publications/105022784675

U2 - 10.1002/oby.70071

DO - 10.1002/oby.70071

M3 - Article

C2 - 41261047

AN - SCOPUS:105022784675

SN - 1930-7381

VL - 34

SP - 246

EP - 257

JO - Obesity

JF - Obesity

IS - 1

ER -

Association of a Lifestyle Risk Index With Visceral and Subcutaneous Adipose Tissue in the German National Cohort (NAKO)

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Keywords

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