Estimating body fat distribution - a driver of cardiometabolic health - from silhouette images

Background: Inter-individual variation in fat distribution is increasingly recognized as clinically important but is not routinely assessed in clinical practice because quantification requires medical imaging. Objectives: We hypothesized that a deep learning model trained on an individual's body shape outline - or silhouette - would enable accurate estimation of specific fat depots, including visceral (VAT), abdominal subcutaneous (ASAT), and gluteofemoral (GFAT) adipose tissue volumes, and VAT/ASAT ratio. We additionally set out to study whether silhouette-estimated VAT/ASAT ratio may stratify risk of cardiometabolic diseases independent of body mass index (BMI) and waist circumference. Methods: Two-dimensional coronal and sagittal silhouettes were constructed from whole-body magnetic resonance images in 40,032 participants of the UK Biobank and used to train a convolutional neural network to predict VAT, ASAT, and GFAT volumes, and VAT/ASAT ratio. Logistic and Cox regressions were used to determine the independent association of silhouette-predicted VAT/ASAT ratio with type 2 diabetes and coronary artery disease. Results: Mean age of the study participants was 65 years and 51% were female. A deep learning model trained on silhouettes enabled accurate estimation of VAT, ASAT, and GFAT volumes (R2: 0.88, 0.93, and 0.93, respectively), outperforming a comparator model combining anthropometric and bioimpedance measures ({Delta}R2 = 0.05-0.13). Next, we studied VAT/ASAT ratio, a nearly BMI- and waist circumference-independent marker of unhealthy fat distribution. While the comparator model poorly predicted VAT/ASAT ratio (R2: 0.17-0.26), a silhouette-based model enabled significant improvement (R2: 0.50-0.55). Silhouette-predicted VAT/ASAT ratio was associated with increased prevalence of type 2 diabetes and coronary artery disease. Conclusions: Body silhouette images can estimate important measures of fat distribution, laying the scientific foundation for population-based assessment.