Objective:

To investigate the association between MRI-derived body fat distribution patterns and brain health outcomes, including gray matter atrophy and cognitive decline, specifically focusing on the implications for clinical assessment.

Key Findings:

• Pancreatic-predominant profile showed the highest proton density fat fraction and significant gray matter atrophy, particularly in anterior brain regions.
• Skinny-fat profile had the highest adiposity burden despite moderate BMI and was linked to cognitive decline, with specific deficits in visual and prospective memory.
• Lower total brain volume and greater white matter hyperintensity volume were observed in profiles 1 through 5 compared to the lean profile, with some sex-specific differences.
• Elevated risks for mood disorders and neurologic diseases were associated with multiple fat distribution profiles, highlighting the need for tailored assessments.

Interpretation:

These findings suggest that body fat distribution patterns, rather than BMI alone, are critical in assessing neurologic risks and cognitive health.

Limitations:

• The study is observational and cannot establish causation, which limits the ability to infer direct relationships.
• Statistical significance was not reached in all pairwise comparisons, indicating variability in the findings.

Conclusion:

The study underscores the importance of considering fat distribution patterns in evaluating brain health and neurologic risks, suggesting a shift in clinical focus from BMI alone.