Correspondence

Relation between Chubby Cheeks and Visceral Fat

N Engl J Med 1998; 339:1946-1947December 24, 1998

Article

To the Editor:

An upper-body distribution of fat, especially with increased visceral fat, is more predictive of the metabolic complications of obesity than is the degree of overweight.1 Insulin resistance, type 2 diabetes mellitus, dyslipidemia, and hypertension are associated with upper-body and visceral obesity. We noted that patients with chubby facial cheeks tended to have upper-body obesity and hypothesized that cheek and visceral fat might accumulate in concert. To assess this observation, we measured cheek (buccal), visceral, and abdominal subcutaneous fat in 25 consecutive patients who underwent computed tomographic (CT) scanning of the head and abdomen for clinical purposes within a two-week period.

The patients were being evaluated at the Mayo Clinic for a variety of medical problems, including the evaluation or follow-up of cancer (17 patients), trauma (5 patients), and fever of unknown origin, vascular aneurysms, and nonmalignant masses (1 patient each). None of the patients were seen by us, preventing us from selecting patients whose appearance was consistent with our hypothesis. No patients were taking or had recently taken a glucocorticoid, none had Cushing's syndrome or other disorders of the pituitary or adrenal glands, and none had recently gained or lost a substantial amount of weight. Using the original digital files from the CT scans, we measured the cross-sectional areas of buccal adipose tissue, visceral (intraabdominal) adipose tissue at the L2–3 interspace, and abdominal subcutaneous adipose tissue at the L2–3 interspace.2 The mean values were 17.7 cm² for buccal fat (range, 8.3 to 30.7), 114 cm² for visceral fat (range, 16 to 292), and 109 cm² for abdominal subcutaneous fat (range, 20 to 389). The coefficient of variation for repeated measurements of the same scans was less than 3 percent. There was a significant positive correlation between the areas of buccal fat and visceral fat (Figure 1Figure 1Cross-Sectional Areas of Buccal Fat and Visceral Fat in 25 Patients Undergoing CT Scanning of the Head and Abdomen.). The correlations between the areas of buccal fat and abdominal subcutaneous fat (r=0.22, P=0.29) and between the area of buccal fat and body-mass index (r=0.38, P=0.07) were not statistically significant.

Our results indicate that subjects with increased buccal fat are more likely to have increased visceral fat. This relation appears to be specific, rather than representing a nonspecific association between buccal fat and general adiposity. The observations that in patients with Cushing's syndrome, moon facies and increased visceral fat develop and that the changes in these adipose-tissue depots after treatment are similar3 suggest that the adipose tissue in these two anatomically separate depots have similar metabolic properties. Patients with chubby cheeks may be at higher risk for the metabolic complications of obesity.

James A. Levine, M.D.
Amrit Ray, M.B., Ch.B.
Michael D. Jensen, M.D.
Mayo Clinic, Rochester, MN 55905

3 References

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   Kissebah AH, Peiris AN. Biology of regional body fat distribution: relationship to noninsulin-dependent diabetes mellitus. Diabetes Metab Rev 1989;5:83-109
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   Jensen MD, Kanaley JA, Reed JE, Sheedy PF. Measurement of abdominal and visceral fat with computed tomography and dual-energy x-ray absorptiometry. Am J Clin Nutr 1995;61:274-278
   Web of Science | Medline

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   Lonn L, Kvist H, Ernest I, Sjostrom L. Changes in body composition and adipose tissue distribution after treatment of women with Cushing's syndrome. Metabolism 1994;43:1517-1522
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