This cross-sectional study examined whether DXA-measured visceral adipose tissue (VAT) mass is associated with two biological aging biomarkers — phenotypic age acceleration (PhenoAgeAccel) and leukocyte telomere length (LTL) — in 4,799 middle-aged adults (ages 45–69) from the Busselton Healthy Ageing Study, with sex-stratified analyses adjusting for age and lifestyle factors.
Each 1-SD increase in VAT was linked to **1.40 years** greater PhenoAgeAccel in males (95% CI 1.20–1.60) and **1.92 years** in females (95% CI 1.74–2.10). In females only, higher VAT was associated with shorter LTL (−0.041 T/S ratio per 1 SD, 95% CI −0.069 to −0.013). Associations held after adjusting for other adiposity measures.
- Cross-sectional design prevents causal inference. - LTL was measured in only a subsample of 1,221 participants, limiting statistical power. - The cohort is predominantly one geographic population (Busselton, Australia), which may limit generalizability.
DXA-quantified VAT appears to be a marker of accelerated biological aging beyond general adiposity — clinicians should consider VAT assessment, not just BMI or total body fat, when evaluating aging-related metabolic risk in middle-aged patients. The stronger association in females and the sex-specific LTL finding suggest that VAT reduction strategies may be especially relevant for women in this age group.
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