A new study suggests that the impact of obesity on the brain may depend not only on total body fat, but also on where that fat is stored. The research, published today in Radiology, the flagship journal of the Radiological Society of North America (RSNA), highlights the importance of fat distribution in understanding brain health risks.
Scientists from The Affiliated Hospital of Xuzhou Medical University in Xuzhou, China, identified two previously unrecognized patterns of body fat using MRI scans. These patterns showed the strongest links to harmful changes in brain structure and cognitive function. One pattern, known as “pancreatic predominant,” involves unusually high fat accumulation in the pancreas. The other, referred to as “skinny fat,” describes individuals who carry a large amount of fat despite not appearing severely obese.
Looking Beyond Traditional Measures of Obesity
Earlier studies have already connected obesity to poorer brain and cognitive health, especially in people with high levels of visceral fat. However, this research takes a more targeted approach by examining the risks tied to specific fat storage patterns, said study coauthor Kai Liu, M.D., Ph.D., an associate professor in The Affiliated Hospital’s Department of Radiology.
“Our work leveraged MRI’s ability to quantify fat in various body compartments, especially internal organs, to create a classification system that’s data-driven instead of subjective,” Dr. Liu said. “The data-driven classification unexpectedly discovered two previously undefined fat distribution types that deserve greater attention.”
Large-Scale Imaging Data Links Fat Patterns to Brain Health
The research team analyzed data from 25,997 participants in the UK Biobank, a large database that includes anonymized MRI scans along with physical measurements, demographic details, disease biomarkers, medical histories, and lifestyle information. This extensive dataset allowed researchers to compare patterns of body fat with measures of brain health.
Among all the fat profiles identified, the “pancreatic-predominant” and “skinny fat” patterns were most strongly associated with gray matter loss, faster brain aging, cognitive decline, and a higher risk of neurological disease. These associations were seen in both men and women, although the details varied slightly by sex.
High Pancreatic Fat Emerges as a Hidden Risk
People with the “pancreatic-predominant” pattern showed a proton density fat fraction—an MRI marker that provides a precise estimation of fat concentration in tissue—of about 30 percent in the pancreas.
“This level is about two to three times higher than that of other fat distribution categories, and it can be up to six times higher than that of lean individuals with low overall fat,” Dr. Liu said. “Additionally, this group tends to have a higher BMI and overall body fat load.”
Despite the elevated pancreatic fat, these individuals did not show unusually high levels of liver fat compared with other groups. According to Dr. Liu, the combination of high pancreatic fat and relatively low liver fat represents a distinct pattern that is often overlooked in clinical practice.
“In our daily radiology practice, we often diagnose ‘fatty liver,’” Dr. Liu said. “But from the perspectives of brain structure, cognitive impairment, and neurological disease risk, increased pancreatic fat should be recognized as a potentially higher-risk imaging phenotype than fatty liver.”
Understanding the “Skinny Fat” Profile
The “skinny fat” pattern showed a different distribution. Individuals in this group carried high levels of fat across most areas of the body, except for the liver and pancreas. Unlike people with more evenly distributed obesity, this fat was more concentrated in the abdominal region.
“Most notably, this type does not fit the traditional image of a very obese person, as its actual average BMI ranks only fourth among all categories,” explained Dr. Liu. “The increase is perhaps more in fat proportion. Therefore, if one feature best summarizes this profile, I think, it would be an elevated weight-to-muscle ratio, especially in male individuals.”
Implications for Brain Health and Future Research
The study focused specifically on neurological and cognitive risks linked to different fat distribution patterns. Dr. Liu noted that more research is needed to determine how these patterns may relate to other health concerns, including cardiovascular and metabolic disease.
Better recognition of fat distribution patterns could help health care providers offer more personalized guidance and earlier interventions to protect brain health. As Dr. Liu explained, “Brain health is not just a matter of how much fat you have, but also where it goes.”
Reference: “Association of Body Fat Distribution Patterns at MRI with Brain Structure, Cognition, and Neurologic Diseases” by Miao Yu, Libin Yao, Sanjeev Shahi, Yingqianxi Xu, Meizi Li, Qingtong Zheng, Di Ma, Qi Zhang, Dan Wang, Yang Wu, Xiao Zhou, Haitao Ge, Chunfeng Hu, Yanjia Deng and Kai Liu, 27 January 2026, Radiology.
DOI: 10.1148/radiol.252610
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