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Summary   Objective  Abdominal fat ultrasound (US) is a simple clinical tool that may allow measures of fat depots not visible using common dual‐energy X‐ray absorptiometry (DEXA) or computerized tomography (CT) imaging. The aim of this study was to validate the technique, give measures of  superficial  and  profound subcutaneous ,  preperitoneal ,  omental  and  perirenal  (retroperitoneal) fat and correlate them with MS markers.    Methods  Sequential US measures of these five abdominal fat layers were done at 397 adults. Blood pressure (BP), body mass index (BMI), waist, body fat %, HOMA‐IR index (homeostatic model assessment of insulin resistance), lipid profile and leptin were recorded. Metabolic syndrome (MS) was defined according to Cholesterol education programme adult treatment panel III (ATPIII) criteria.    Results   Subcutaneous  and  omental  fat were increased among people with obesity, whereas  preperitoneal  and  perirenal  fat did not show any difference according to BMI or waist. Women showed thicker  subcutaneous  fat (both superficial and profound), whereas men had bigger  omental  fat. Both postmenopausal and diabetic patients had changes in  omental  fat only, whereas patients with fatty liver showed thicker  preperitoneal  and  perirenal  fat, as well. MS patients showed both thicker  perirenal  and  omental  fat. A cut‐off of 54 mm in male (M)/34 mm in female (F) of  omental  fat and 22.5 mm (M)/12.5 mm (F) of  perirenal  fat could be predictive of later MS onset.    Conclusions  US is a valid method to measure all different abdominal fat depots.  Omental  and  perirenal  fat measures may classify patients at risk for MS.  Preperitoneal  fat depot may also correlate with fatty liver disease.

Ultrasound measures of abdominal fat layers correlate with metabolic syndrome features in patients with obesity