Relatedly, there is evidence that certain types of "resistant starch" can help reduce visceral fat. This starch comes from green bananas, potatoes, legumes, etc. It has to be either raw (there are supplements for this) or cooked and cooled.

"Resistant starch intake facilitates weight loss in humans by reshaping the gut microbiota"

https://pmc.ncbi.nlm.nih.gov/articles/PMC10963277/

Edit: Ah, HN submission 2 years ago: https://news.ycombinator.com/item?id=39592367

For non-invasive heart disease risk prediction nothing beat ECG, period.

Somehow American Heart Association and its European counterpart are in denial, and still pushing dinasour screening mechanism with very low accuracy for heart disease risk prediction.

The standard risk model for CVD based on PREVENT (US) and SCORE-2 (Europe) like parameters are very poor as reported in the recently published paper on the their accuracy performance by the Swedish team [1]. As all CVD risk stratification with cardiologist review (expert-in-the-loop), the most important accuracy metric is sensivity/recall (avoiding false negative that will escape review) of PREVENT and SCORE-2, 26% and 48%, respectively.

The paper alternative proposal increased the sensitivity to 58% by performing clustering instead of conventional regression models as practiced in the PREVENT and SCORE-2.

These type of models including the latest proposal performed very poorly as indicated by their otherwise excellent and intuitive display of graphical abstract results [1].

[1] Risk stratification for cardiovascular disease: a comparative analysis of cluster analysis and traditional prediction models:

https://academic.oup.com/eurjpc/advance-article/doi/10.1093/...

I thought this was pretty well known already. Being “overfat” is the problem, not being overweight (though they’re often correlated). BMI is really easy to measure, and is mostly accurate, that’s why it’s so pervasive. However it remains a pretty rudimentary metric (and really should use the third power or your height instead of the second).

A nitpick about the title: Not strictly abdominal fat, but visceral abdominal fat, which surrounds the organs. Not all abdominal fat is visceral; in fact, in many people the majority is not. The article mentions visceral early on, which is the subject.

> Those with obesity and low WC [waist circumference] were not found to be associated with a significantly different risk of outcomes compared with those who had normal weight and low WC, except for all-cause mortality, for which risk was significantly lower.

If I'm reading that right, it sounds like obesity (and therefore BMI) is still a better predictor for all-cause mortality. Perhaps waist circumference is better at predicting cardiovascular risk but BMI is still useful.

This is new? I thought they have been saying this for years

You can control your CVD risk.

Cutting saturated fat to under 15g per day and increasing intake of viscose fibre (e.g. beans) will reduce your LDL particle count in a few weeks, which reduces your CVD hazard ratio. You can measure your LDL and look up the papers yourself. Statins will reduce it a lot too (potentially with side effects). Replace solid fats like butter with liquid fats like olive oil.

Literally any amount of regular exercise, including walking, will decrease CVD HR. The more the better (up until quite a large amount e.g. professional athlete). The more your heart is steadily pumping during exercise the better. Every bit helps reduce CVD risk. Movement is medicine.

For the love of God do not smoke. Literally one of the surest ways to die a horrible death. Stopping smoking reduces CVD risk by a large amount.

Do not give yourself diabetes by eating vast amounts of sugar. If you are doing this, stop. Not having diabetes decreases CVD risk.

Other factors you probably can't change so focus on these.

Doctors, if I got anything wrong please correct me.

> Studies have shown that visceral fat, which is fat that surrounds the internal organs in the abdominal area, is associated with chronic diseases like heart disease and diabetes, while subcutaneous fat, which is located directly under the skin, is not as strongly associated.

How does one determine if one has an excess of visceral fat?

take a look at myticker.com

(previously at https://news.ycombinator.com/item?id=45857053)

It doesn’t matter how fat you are or how much cholesterol you have in your blood. What matters is the oxidative stress that oxidizes the lipids.

They need to figure out a way to reliably Measure OXLDL.

The irony of BMI is that people with plenty of muscle mass are more likely to have a high BMI as well as lowered risk for heart disease.

BMI was never meant to be used as a diagnostic measure. BMI is just a rough filter for large data sets, and entirely dependent on the average height and habits of that population.

Anyone taller than about 6'3" could tell you the recommended weight according to their BMI has always been absurdly low. If it's a printed chart on the wall, they might not even be on it.

The 2000's called. We've known this for decades because we did a LOT of studies back in the day when you could still get government funding.

For two people that are the same height, one could have X lbs of pure muscle, and one could have X lbs of pure fat, and they would have the same BMI. Color me shocked that it is not always a good predictor of disease.

“Be athletic don’t eat food” they said

Then basically ALL the athletes die young lol. Particularly of heart conditions

Idk guys

> BMI is really easy to measure, and is mostly accurate, that’s why it’s so pervasive.

BMI is easily misunderstood by people who know just enough to see that it’s imperfect, but not enough to understand why it’s still a valuable screening tool.

I’ve been in the “overweight” BMI range with low body fat before. It’s not too hard to get there if you’re lifting weights and paying attention to your diet consistently for years, but it takes a lot of work to get there. It doesn’t happen accidentally except for people who win some genetic lottery to build a lot of muscle and keep body fat low without trying.

Getting all the way to the obese BMI range while having healthy body fat is only happening for people with an extreme dedication to body building and diet (and let’s be honest, a lot of the people in this category are manipulating hormones too).

Yet whenever BMI comes up some people try to dismiss it as too flawed based on these possible edge cases. The edge cases for BMI exist, but that doesn’t mean it’s not useful. It’s a good general purpose screening tool with numbers that are available. If someone has more precise measurements available, those should be used instead. BMI is a really good first pass screener to determine if a closer look should happen.

Yes, it is a pretty high level metric with good correlation a bunch of diseases, but really many of these is because it is ALSO correlated to percent of fat, which is often the more relevant metric. But as you said BMI is so much simpler to measure.

Many active gym people have pretty high BMIs but fairly low fat (because muscle is dense), and unsurprisingly have better outcomes than the average person (if you ignore the share that uses/overuses anabolic steroids and co)

BMI is at best 66% accurate, so "mostly" is correct, but what is mostly good enough for?

BMI has known biases in gender, age, and race. It misclassified Asians, women, elderly w sarcopenia, and people with high body fat to lean tissue ratio.

How accurate is it, in practice, for a given individual? I'm not that out of the ordinary proportion wise. I have a slightly longer torso and arms versus my legs, a somewhat muscular-ish baseline and broad shoulders, but I accumulate fat almost exclusively abdominally. My teenage self, lifetime peak of my fitness, no visible body fat, hyperactive football player, qualified as solidly overweight. If I was to listen to it, I'd be called obese before I noticeably start to show body fat.

I often wonder far from the median I am in this regard. I was under the impression that it was pretty accurate for assessing populations, but fell apart very quickly at the individual level. How many "normal"/otherwise healthy people do fall outside BMI's numbers?

Yeah BMI is sort of a 'good enough' technique but also has some very obvious areas that it can miss. If you fall outside the typical fat to muscle ratio is a good example.

Genuine question: What is the difference between overfat and overweight? Isn’t the extra weight in an overweight person comprised of fat?

But it's actually not just being "overfat".

It's specifically a high level of visceral body fat.

Genetics determines which parts of the body gain fat first as you gain fat overall, and some people have the unfortunate genetics to gain it first viscerally and some people have the fortune to gain it there last (and everything in between).

This means that you can have different people with the same body fat percentage but drastically different disease risks.

But yes this was also known already.

That's why it's been recommended to take a waist measurement alongside BMI to get a much more informative screening tool. Waist-to-height ratios are another alternative.