Socio-economic position modifies the relation of adipose tissue and cardiac structure only in women
Abstract
Background: Low Socio-economic position (SEP) is associated with both unfavorable adipose tissue (AT) distribution and adverse cardiac remodeling. However, a sex-specific interplay between AT, SEP and cardiac remodeling is not far examined. We aimed to assess whether SEP modifies the association of AT with parameters of cardiac remodeling differently for women and men.
Methods: We used cross-sectional data from the magnetic resonance imaging substudy of the population-based German National Cohort (NAKO). SEP indicators included employment status, relative income category and education attainment. The panel of exposures included e.g. visceral AT (VAT), skeletal muscle fat fraction (SMFF) and pancreatic fat. Outcomes were e.g. left ventricular wall thickness (LVWT) and concentricity index (LVCI). Interaction between SEP and AT was assessed in sex-specific linear regression models. Models were confounder adjusted and an FDR-corrected p < 0.05 was considered significant.
Results: The sample comprised 8,368 women and 10,987 men. Mean age was 48 and 47 years; mean BMI was 26 kg/m2 and 27 kg/m2, respectively. Women showed overall lower SEP indicators. In women, currently non-working or working in a mini job compared to a full-time job showed significant interactions with VAT, SMFF and pancreas fat on LVWT (e.g., VAT*mini job β = 0.11, 95%CI [0.04, 0.17], SMFF*non-working β = 0.12, 95%CI [0.08, 0.17]). Increases in SMFF were associated with increased LVCI only in non-working women (βinteraction=0.1, 95%CI [0.05, 0.16]). Women in lower income groups compared to the highest income group showed increased estimates of SMFF and VAT on LVWT (VAT*income β = 0.09, 95%CI [0.04, 0.14]). No significant interactions were found for men, or for SEP indicator education.
Conclusions: Lower SEP might disproportionately exacerbate the relation of unfavorable AT distribution and adverse cardiac remodeling in women compared to men. SEP should be considered in sex-specific prevention of cardiac disease.
Key messages: • Lower socio-economic position (SEP) might contribute to sex-specific cardiac remodeling. Women with low SEP show exacerbated relation of unfavorable adipose tissue distribution and cardiac remodeling.
• Among individuals with lower socio-economic position, women might be more susceptible than men to an exacerbated link between unfavorable adipose tissue distribution and adverse cardiac remodeling.
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BibTeX
@article{maushagen2026socioeconomic,
title = {{Socio-economic position modifies the relation of adipose tissue and cardiac structure only in women}},
author = {J Maushagen and C Schuppert and CL Schlett and E Grune and M Flis and M Reisert and J Weiß and F Bamberg and J Schulz-Menger and S Rospleszcz},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.985},
url = {https://doi.org/10.1093/eurpub/ckag169.985},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Socio-economic position modifies the relation of adipose tissue and cardiac structure only in women
AU - J Maushagen
AU - C Schuppert
AU - CL Schlett
AU - E Grune
AU - M Flis
AU - M Reisert
AU - J Weiß
AU - F Bamberg
AU - J Schulz-Menger
AU - S Rospleszcz
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.985
UR - https://doi.org/10.1093/eurpub/ckag169.985
AB - Background: Low Socio-economic position (SEP) is associated with both unfavorable adipose tissue (AT) distribution and adverse cardiac remodeling. However, a sex-specific interplay between AT, SEP and cardiac remodeling is not far examined. We aimed to assess whether SEP modifies the association of AT with parameters of cardiac remodeling differently for women and men. Methods: We used cross-sectional data from the magnetic resonance imaging substudy of the population-based German National Cohort (NAKO). SEP indicators included employment status, relative income category and education attainment. The panel of exposures included e.g. visceral AT (VAT), skeletal muscle fat fraction (SMFF) and pancreatic fat. Outcomes were e.g. left ventricular wall thickness (LVWT) and concentricity index (LVCI). Interaction between SEP and AT was assessed in sex-specific linear regression models. Models were confounder adjusted and an FDR-corrected p < 0.05 was considered significant. Results: The sample comprised 8,368 women and 10,987 men. Mean age was 48 and 47 years; mean BMI was 26 kg/m2 and 27 kg/m2, respectively. Women showed overall lower SEP indicators. In women, currently non-working or working in a mini job compared to a full-time job showed significant interactions with VAT, SMFF and pancreas fat on LVWT (e.g., VAT*mini job β = 0.11, 95%CI [0.04, 0.17], SMFF*non-working β = 0.12, 95%CI [0.08, 0.17]). Increases in SMFF were associated with increased LVCI only in non-working women (βinteraction=0.1, 95%CI [0.05, 0.16]). Women in lower income groups compared to the highest income group showed increased estimates of SMFF and VAT on LVWT (VAT*income β = 0.09, 95%CI [0.04, 0.14]). No significant interactions were found for men, or for SEP indicator education. Conclusions: Lower SEP might disproportionately exacerbate the relation of unfavorable AT distribution and adverse cardiac remodeling in women compared to men. SEP should be considered in sex-specific prevention of cardiac disease. Key messages: • Lower socio-economic position (SEP) might contribute to sex-specific cardiac remodeling. Women with low SEP show exacerbated relation of unfavorable adipose tissue distribution and cardiac remodeling. • Among individuals with lower socio-economic position, women might be more susceptible than men to an exacerbated link between unfavorable adipose tissue distribution and adverse cardiac remodeling.
SN - 1101-1262
SN - 1464-360X
ER -