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New research using whole-body MRI and artificial intelligence reveals that visceral fat — the deep, unseen adipose tissue wrapping organs in the abdomen — is associated with faster biological aging of the heart and blood vessels. The study analyzed imaging and clinical data from 21,241 volunteers in the UK Biobank and used AI-based measures of tissue stiffness and inflammation to calculate a person’s 'heart age' compared with their chronological age. The key finding: higher volumes of visceral adipose tissue correlate with signs of premature cardiac aging, while fat concentrated on the hips and thighs appears to be protective for women.
Study design, methods and key findings
Researchers from the Medical Research Council Laboratory of Medical Sciences and collaborators used MRI scans from over 21,000 UK Biobank participants to map fat distribution across the body and to capture high-resolution images of the heart and blood vessels. Machine learning models trained to detect imaging biomarkers of organ health quantified tissue properties such as myocardial stiffness and perivascular inflammation. Each participant received a computed 'heart age' that could be compared to their actual age at the time of scanning.
The analysis found that greater visceral adipose tissue — fat deposited deep in the abdominal cavity around organs such as the liver, stomach and intestines — was consistently associated with an older heart age. Blood biomarkers in participants with high visceral fat also showed elevated systemic inflammation, a plausible biological mechanism linking visceral fat to tissue aging. Notably, body mass index (BMI) was a poor predictor of heart age compared with direct measures of fat distribution, underscoring limitations of BMI as a sole health metric.
Visceral fat explained: why location matters
Visceral adipose tissue differs from subcutaneous fat: it lies beneath the abdominal wall and surrounds internal organs. This depot is metabolically active and secretes inflammatory cytokines and hormones that can affect distant organs, alter lipid and glucose metabolism, and promote atherosclerosis. Over time, these processes can increase arterial stiffness and provoke low-grade chronic inflammation — hallmarks of accelerated cardiovascular aging.
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Because visceral fat accumulates internally, it is often invisible even in people with a normal overall weight. The study’s imaging approach highlights why assessing where fat is stored — not just how much — is critical for evaluating cardiometabolic risk.
Sex differences: apple versus pear and the role of hormones
The team observed clear sex-specific patterns. A male-type fat distribution (central or 'apple' shaped), marked by higher abdominal and visceral fat, was strongly predictive of earlier heart aging in men. Conversely, a genetic tendency toward female-type fat distribution (fat concentrated on hips and thighs, the 'pear' shape) appeared protective against heart aging in women. The researchers also detected an association between higher oestrogen levels in premenopausal women and slower heart aging, suggesting sex hormones may mediate some of the protective effects seen in female fat distribution.
Professor Declan O'Regan, lead author at the MRC Laboratory of Medical Sciences and Imperial College London, noted: 'We have known about the apple and pear distinction in body fat, but it hasn't been clear how it leads to poor health outcomes. Our research shows that "bad" fat, hidden deep around the organs, accelerates aging of the heart. But some types of fat could protect against aging—specifically fat around the hips and thighs in women.'
Professor Bryan Williams OBE, chief scientific and medical officer at the British Heart Foundation, emphasized the broader implications: 'We already know excess visceral fat around the heart and liver can lead to increased blood pressure and high cholesterol, so it is concerning that it could also help to speed up aging of the heart and blood vessels.'
Clinical and public-health implications
These results have several practical implications. First, they challenge reliance on BMI alone for cardiovascular risk assessment; imaging or surrogate measures of abdominal adiposity (waist circumference, waist-to-hip ratio) provide additional, clinically relevant information. Second, the link between visceral fat and systemic inflammation supports targeting that depot in prevention strategies.
Lifestyle interventions — healthier diets, regular physical activity, and weight loss where appropriate — remain foundational for reducing visceral fat. However, the study also flagged that even physically active individuals may harbor harmful levels of visceral fat, highlighting the need for tailored screening and interventions.
Pharmacological avenues are under consideration: the authors indicate plans to investigate whether GLP-1 receptor agonists (a class that includes medications like semaglutide and others used for diabetes and weight management) can reduce visceral fat and reverse its aging effects on cardiac tissue. If such drugs lower inflammation and improve tissue properties detected by MRI, they could become part of strategies to slow cardiovascular aging.
Related technologies and future directions
This work illustrates the growing role of AI-driven image analysis in population health and precision cardiology. Automated quantification of tissue composition and organ 'age' from large imaging repositories such as UK Biobank enables researchers to link anatomical patterns with molecular markers and long-term outcomes. Future research priorities include longitudinal imaging to determine whether changes in visceral fat predict subsequent cardiovascular events, randomized trials to test whether targeted therapies can slow or reverse heart aging, and refinement of non-invasive biomarkers to screen broader populations.
Expert Insight
Dr. Maya Alvarez, cardiovascular epidemiologist and science communicator, commented: 'This study is a strong example of how imaging and AI can transform our understanding of risk. We’ve long suspected visceral fat is more than a cosmetic issue — these results quantify how it relates to tissue-level aging in the heart. For clinicians, the takeaway is practical: evaluate fat distribution and inflammation, not just overall weight. For researchers, the challenge is to move from association to intervention — can we demonstrably lower heart age by reducing visceral fat?'
Limitations and considerations
While large and well-characterized, the study is observational and cannot on its own prove causation. AI-derived 'heart age' is a promising surrogate marker, but its predictive value for hard outcomes (heart attacks, heart failure, mortality) needs further validation in longitudinal datasets. Genetic analyses indicating sex-specific pathways are hypothesis-generating and should be complemented by mechanistic studies in humans and model systems.
Conclusion
Imaging data from more than 21,000 participants in the UK Biobank indicate that visceral fat — the hidden adipose tissue surrounding internal organs — is linked with advanced heart aging, independent of general obesity or fitness level. Fat stored on hips and thighs may offer protection for women, potentially mediated by oestrogen. These findings highlight the importance of measuring where fat is stored, not only how much a person weighs, and open new avenues for prevention and treatment aimed at reducing visceral adiposity and its inflammatory effects on the cardiovascular system. Continued research combining AI-enabled imaging, genetics, and clinical trials will be essential to translate these insights into strategies that slow heart aging and extend healthy lifespan.
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