Study analysis · Journal of the Endocrine Society · 2024
Mild cortisol excess may not change how much fat you have—but it might change where your body puts it.
In a cross-sectional study, adults with mild autonomous cortisol secretion had a higher visceral fat-to-total-mass ratio and less hip/thigh fat than similar adults without the condition, even though total fat and lean mass were similar.
Overview
What the study found
The study in plain English — the bottom line, every takeaway we extracted, and what to do with them.
In simple terms
This study took a snapshot of people at one point in time to see if those with a hormone condition had more belly fat. It can show a link, but it can't prove that the hormone condition causes the belly fat, because we don't know which came first.
What’s the bottom line?
Researchers compared body fat using DXA scans in people with mild autonomous cortisol secretion (MACS) and people without adrenal disorders. They adjusted for sex and body mass index.
How strong is this study?
The study compared two groups and tried to account for sex and body size, which is good. But it was done at only one center, and we only have a short summary, so we can't check all the details. That means we should be careful about trusting the results too much.
40 / 100
- COI disclosure+40/40
- Data availabilitydata not shared
- Code availabilitycode not shared
32 / 100
- Randomizationrandomization unclear
- Blindingblinding unclear
- Control group+15/15
- Sample size (n=150)+10.6/20
- Follow-upno follow-up reported
100 / 100
54 / 100
- P-values+15/15
- Effect size+20/20
- Confidence intervalsno confidence intervals
- Pre-registrationnot pre-registered
Each component is scored out of 100 and then capped by the study design — a case series cannot reach the ceiling a randomised trial can, however well it is reported.
Where it sits
RCT reviewsReviews of RCTs (Meta-analyses)
Max 100Randomized TrialsRandomized Trials
Max 90Reviews of Cohort StudiesReviews of Cohort Studies
Max 85Cohort StudiesCohort Studies
Max 72Reviews of Case-Control StudiesReviews of Case-Control Studies
Max 63Case-Control StudiesCase-Control Studies
Max 58Cross-Sectional & Case SeriesCross-Sectional & Case Series
Max 50Expert OpinionExpert Opinion
Max 544 / 100
Probability of being correct
Snapshots of a population at a single point in time, or descriptions of small groups. Can identify correlations and prevalence, but cannot determine cause and effect.
This design cannot establish causation — the findings describe an association, not a cause. Cross-sectional design measures exposure and outcome at the same time, so temporality cannot be established. Residual confounding is possible despite adjustment for sex and BMI. No randomization or intervention. Cannot infer that MACS causes increased visceral adiposity.
No Conflicts
No conflicts of interest identified
No conflicts identified; all authors declared no disclosures and no funding information was provided.
Abstract only; no funding or role of funder described. Disclosure statement reports no conflicts for all listed authors.
Key takeaways
- 01
After adjustment, people with MACS had a higher visceral fat-to-total-mass ratio (absolute difference estimate -0.007, p=0.026) and lower gynoid fat mass (estimate 400, p=0.007).
- 02
Total fat and lean mass were similar.
- 03
VAT fat mass was higher but not statistically significant (p=0.084).
- 04
This is a cross-sectional study, so it cannot show whether MACS causes visceral fat gain.
- 05
No absolute risk or long-term outcomes were reported.
- 06
The findings are associations after adjustment, and the VAT mass difference was borderline.
Surprising findings
- Total fat and lean mass were similar despite higher BMI in MACS.Higher BMI usually indicates more total fat, but after adjustment, total fat and lean mass did not differ; only fat distribution differed.
- VAT fat mass alone was not statistically significant, but VAT/total mass ratio was.A ratio can be significant even when the raw measure is not, highlighting how normalization changes interpretation.
Practical takeaways
For patients with MACS, discuss whether DXA body composition assessment might be useful for monitoring visceral fat, as authors suggest it could be a safer/less expensive alternative to CT.
Based on abstract only; cross-sectional design, small single-center sample, no full text; clinical utility not proven.
low confidenceWhy this study matters
Visceral fat ratio higher in MACS
After adjusting for sex and BMI, patients with MACS (n=75) had a higher VAT fat mass/total mass ratio (estimate=-0.007, p=0.026) than referent subjects (n=75). VAT fat mass alone was higher but did not reach conventional statistical significance (estimate=-225, p=0.084). This is a cross-sectional association, not proof of causation.
Visceral fat is linked to cardiovascular risk; even mild cortisol excess may shift fat storage toward the organs.
Total fat and lean mass similar
Despite higher BMI in MACS (median 31.7 vs 28.7 kg/m², P=0.004), adjusted total body fat (estimate=846, p=0.28) and lean mass (estimate=-201, p=0.83) were similar to referents. The difference is in distribution, not overall amount.
People often assume cortisol excess means overall weight gain, but this study found similar total fat after BMI adjustment.
Less gynoid fat in MACS
MACS patients had lower gynoid fat mass (hip/thigh area) after adjustment (estimate=400, p=0.007). This pattern—more visceral, less gynoid—is a known cardiometabolic risk profile.
Fat location matters for health, and hip/thigh fat is often considered protective.
DXA as alternative tool
Authors conclude DXA could be a safer and less expensive alternative to CT for body composition evaluation and follow-up in MACS. However, this is based on abstract only; full validation is not available.
CT scans expose patients to radiation; DXA is already used for bone density.
Want the whole report?
Detailed mode opens the full scientific breakdown — every score component, the methodology, conflicts of interest, the evidence analysis behind each claim, and the raw study data.
Overview
What the study found
The study in plain English — the bottom line, every takeaway we extracted, and what to do with them.
Not medical advice. For informational purposes only. Always consult a healthcare professional. Terms
Researchers compared body fat using DXA scans in people with mild autonomous cortisol secretion (MACS) and people without adrenal disorders. They adjusted for sex and body mass index.
Research results
After adjustment, people with MACS had a higher visceral fat-to-total-mass ratio (absolute difference estimate -0.007, p=0.026) and lower gynoid fat mass (estimate 400, p=0.007). Total fat and lean mass were similar. VAT fat mass was higher but not statistically significant (p=0.084).
What this means - more context
This is a cross-sectional study, so it cannot show whether MACS causes visceral fat gain. No absolute risk or long-term outcomes were reported. The findings are associations after adjustment, and the VAT mass difference was borderline.
To determine the impact of mild autonomous cortisol secretion (MACS) on visceral adipose tissue (VAT) using dual-energy X-ray absorptiometry (DXA) compared with referent subjects without adrenal disorders.
In a single-center cross-sectional study of 75 adults with MACS and 75 referent subjects, DXA measurements adjusted for sex and BMI showed similar total body fat and lean mass, similar android fat mass, but lower gynoid fat mass and a higher VAT fat mass/total mass ratio in MACS. VAT fat mass alone was higher but not statistically significant (p=0.084). Absolute risk is not applicable because this is a cross-sectional study; no absolute risk increase was reported.
Methods Used
Single-center cross-sectional study of 75 adults with MACS and 75 referent subjects. MACS was defined as serum cortisol >1.8 mcg/dL after 1 mg dexamethasone suppression test in patients with adrenal adenomas and no overt hypercortisolism. Referents had abdominal imaging and no adrenal disorders. All participants underwent full-body DXA with CoreScan software. Linear regression models adjusted for sex and BMI were used to compare measurements.
Main Finding
After adjustment for sex and BMI, patients with MACS had similar total body fat (estimate=846, p=0.28) and lean mass (estimate=-201, p=0.83), similar android fat mass (estimate=59, p=0.64), but lower gynoid fat mass (estimate=400, p=0.007). They also had a higher VAT fat mass/total mass ratio (estimate=-0.007, p=0.026) and higher VAT fat mass that did not reach conventional statistical significance (estimate=-225, p=0.084). Absolute risk was not reported and is not applicable to this cross-sectional design.
Confidence Level
Limited - based on abstract only; full methodology, confounders, and absolute measures are not available. Cross-sectional design cannot establish causality.
Study Flags
Red Flags
- •Full text not available - methodology details cannot be verified
- •Cross-sectional design cannot establish causality
- •VAT fat mass difference was not statistically significant (p=0.084); single-center small sample (n=150)
No biological mechanisms were identified in this study. This may be an epidemiological, observational, or survey-based study that reports associations rather than proposing causal biological pathways.
Surprising Findings
Total fat and lean mass were similar despite higher BMI in MACS.
Higher BMI usually indicates more total fat, but after adjustment, total fat and lean mass did not differ; only fat distribution differed.
Practical Takeaways
For patients with MACS, discuss whether DXA body composition assessment might be useful for monitoring visceral fat, as authors suggest it could be a safer/less expensive alternative to CT.
RCT reviewsReviews of RCTs (Meta-analyses)
Max 100Randomized TrialsRandomized Trials
Max 90Reviews of Cohort StudiesReviews of Cohort Studies
Max 85Cohort StudiesCohort Studies
Max 72Reviews of Case-Control StudiesReviews of Case-Control Studies
Max 63Case-Control StudiesCase-Control Studies
Max 58Cross-Sectional & Case SeriesCross-Sectional & Case Series
Max 50Expert OpinionExpert Opinion
Max 544 / 100
Probability of being correct
Snapshots of a population at a single point in time, or descriptions of small groups. Can identify correlations and prevalence, but cannot determine cause and effect.
Human Cross-Sectional
Subject
Moderate probability
on the GRADE evidence scale
This study took a snapshot of people at one point in time to see if those with a hormone condition had more belly fat. It can show a link, but it can't prove that the hormone condition causes the belly fat, because we don't know which came first.
No conflicts of interest were detected in this study. No score impact.
Strengths
- Includes a referent control group
- Adjusts for sex and BMI in linear regression models
- Clearly defines MACS using post-dexamethasone cortisol
Weaknesses
- Full methodology not available - based on abstract only
- Cross-sectional design cannot establish causality
- No temporal sequence between MACS and VAT
Methodology
Evidence Keywords
Statistical Reporting
Not medical advice. For informational purposes only. Always consult a healthcare professional. Terms
Researchers compared body fat using DXA scans in people with mild autonomous cortisol secretion (MACS) and people without adrenal disorders. They adjusted for sex and body mass index.
Research results
After adjustment, people with MACS had a higher visceral fat-to-total-mass ratio (absolute difference estimate -0.007, p=0.026) and lower gynoid fat mass (estimate 400, p=0.007). Total fat and lean mass were similar. VAT fat mass was higher but not statistically significant (p=0.084).
What this means - more context
This is a cross-sectional study, so it cannot show whether MACS causes visceral fat gain. No absolute risk or long-term outcomes were reported. The findings are associations after adjustment, and the VAT mass difference was borderline.
To determine the impact of mild autonomous cortisol secretion (MACS) on visceral adipose tissue (VAT) using dual-energy X-ray absorptiometry (DXA) compared with referent subjects without adrenal disorders.
In a single-center cross-sectional study of 75 adults with MACS and 75 referent subjects, DXA measurements adjusted for sex and BMI showed similar total body fat and lean mass, similar android fat mass, but lower gynoid fat mass and a higher VAT fat mass/total mass ratio in MACS. VAT fat mass alone was higher but not statistically significant (p=0.084). Absolute risk is not applicable because this is a cross-sectional study; no absolute risk increase was reported.
Methods Used
Single-center cross-sectional study of 75 adults with MACS and 75 referent subjects. MACS was defined as serum cortisol >1.8 mcg/dL after 1 mg dexamethasone suppression test in patients with adrenal adenomas and no overt hypercortisolism. Referents had abdominal imaging and no adrenal disorders. All participants underwent full-body DXA with CoreScan software. Linear regression models adjusted for sex and BMI were used to compare measurements.
Main Finding
After adjustment for sex and BMI, patients with MACS had similar total body fat (estimate=846, p=0.28) and lean mass (estimate=-201, p=0.83), similar android fat mass (estimate=59, p=0.64), but lower gynoid fat mass (estimate=400, p=0.007). They also had a higher VAT fat mass/total mass ratio (estimate=-0.007, p=0.026) and higher VAT fat mass that did not reach conventional statistical significance (estimate=-225, p=0.084). Absolute risk was not reported and is not applicable to this cross-sectional design.
Confidence Level
Limited - based on abstract only; full methodology, confounders, and absolute measures are not available. Cross-sectional design cannot establish causality.
Study Flags
Red Flags
- •Full text not available - methodology details cannot be verified
- •Cross-sectional design cannot establish causality
- •VAT fat mass difference was not statistically significant (p=0.084); single-center small sample (n=150)
No biological mechanisms were identified in this study. This may be an epidemiological, observational, or survey-based study that reports associations rather than proposing causal biological pathways.
Surprising Findings
Total fat and lean mass were similar despite higher BMI in MACS.
Higher BMI usually indicates more total fat, but after adjustment, total fat and lean mass did not differ; only fat distribution differed.
Practical Takeaways
For patients with MACS, discuss whether DXA body composition assessment might be useful for monitoring visceral fat, as authors suggest it could be a safer/less expensive alternative to CT.
RCT reviewsReviews of RCTs (Meta-analyses)
Max 100Randomized TrialsRandomized Trials
Max 90Reviews of Cohort StudiesReviews of Cohort Studies
Max 85Cohort StudiesCohort Studies
Max 72Reviews of Case-Control StudiesReviews of Case-Control Studies
Max 63Case-Control StudiesCase-Control Studies
Max 58Cross-Sectional & Case SeriesCross-Sectional & Case Series
Max 50Expert OpinionExpert Opinion
Max 544 / 100
Probability of being correct
Snapshots of a population at a single point in time, or descriptions of small groups. Can identify correlations and prevalence, but cannot determine cause and effect.
Human Cross-Sectional
Subject
Moderate probability
on the GRADE evidence scale
This study took a snapshot of people at one point in time to see if those with a hormone condition had more belly fat. It can show a link, but it can't prove that the hormone condition causes the belly fat, because we don't know which came first.
No conflicts of interest were detected in this study. No score impact.
Strengths
- Includes a referent control group
- Adjusts for sex and BMI in linear regression models
- Clearly defines MACS using post-dexamethasone cortisol
Weaknesses
- Full methodology not available - based on abstract only
- Cross-sectional design cannot establish causality
- No temporal sequence between MACS and VAT
Methodology
Evidence Keywords
Statistical Reporting
Scoring
How strong is this study?
The study compared two groups and tried to account for sex and body size, which is good. But it was done at only one center, and we only have a short summary, so we can't check all the details. That means we should be careful about trusting the results too much.
40 / 100
- COI disclosure+40/40
- Data availabilitydata not shared
- Code availabilitycode not shared
32 / 100
- Randomizationrandomization unclear
- Blindingblinding unclear
- Control group+15/15
- Sample size (n=150)+10.6/20
- Follow-upno follow-up reported
100 / 100
54 / 100
- P-values+15/15
- Effect size+20/20
- Confidence intervalsno confidence intervals
- Pre-registrationnot pre-registered
Each component is scored out of 100 and then capped by the study design — a case series cannot reach the ceiling a randomised trial can, however well it is reported.
Where it sits
RCT reviewsReviews of RCTs (Meta-analyses)
Max 100Randomized TrialsRandomized Trials
Max 90Reviews of Cohort StudiesReviews of Cohort Studies
Max 85Cohort StudiesCohort Studies
Max 72Reviews of Case-Control StudiesReviews of Case-Control Studies
Max 63Case-Control StudiesCase-Control Studies
Max 58Cross-Sectional & Case SeriesCross-Sectional & Case Series
Max 50Expert OpinionExpert Opinion
Max 544 / 100
Probability of being correct
Snapshots of a population at a single point in time, or descriptions of small groups. Can identify correlations and prevalence, but cannot determine cause and effect.
This design cannot establish causation — the findings describe an association, not a cause. Cross-sectional design measures exposure and outcome at the same time, so temporality cannot be established. Residual confounding is possible despite adjustment for sex and BMI. No randomization or intervention. Cannot infer that MACS causes increased visceral adiposity.
No Conflicts
No conflicts of interest identified
No conflicts identified; all authors declared no disclosures and no funding information was provided.
Abstract only; no funding or role of funder described. Disclosure statement reports no conflicts for all listed authors.
Standing
Who’s using this study?
The videos and claims on this site that lean on this study, and the researchers who wrote it.
1 video from Ben Azadi cite this study, drawing 1 claim from it.
- Indication only
Weak evidence — fewer than 20 studies, so treat this as a starting point, not a fact.
Evidence
Authored by
6 researchersIf this is your work, this is how we attribute it on Fit Body Science. Jasmine Saini is listed as the lead author.