Quantitative Analysis of Visceral Fat and Its Correlation With Complicated Colonic Diverticular Disease by Computed Tomography

Background: Colonic diverticular disease is a prevalent gastrointestinal condition, and a substantial proportion of patients develop complications such as inflammation, abscess formation, or perforation. Visceral adiposity has been increasingly recognized as a contributing factor in disease severity due to its metabolic and pro-inflammatory activity. Computed tomography (CT) allows both diagnosis of diverticular disease and objective quantification of abdominal fat compartments, providing an opportunity to evaluate the relationship between visceral fat accumulation and complication risk. Objective: This study aimed to quantitatively assess visceral adipose tissue on CT and to determine its association with complicated colonic diverticular disease. Patients and methods: This prospective cross-sectional study included adult patients with CT-confirmed diverticular disease. Quantitative fat measurements—visceral fat area (VFA), subcutaneous fat area (SFA), total fat area (TFA), and distribution ratios (VFA/SFA and VFA/TFA)—were obtained at the L4–L5 level using standardized attenuation thresholds. Patients were categorized into non-complicated diverticulosis and complicated diverticulitis. Group comparisons and ROC analysis were performed to evaluate diagnostic value. Results: Patients with complicated diverticulitis demonstrated significantly higher VFA and elevated fat distribution ratios compared with those with non-complicated diverticulosis. SFA and TFA alone showed no significant differences between groups. The VFA/SFA ratio exhibited the strongest diagnostic performance, followed by VFA and the VFA/TFA ratio. BMI did not correlate with disease severity. Conclusion: CT-derived visceral fat quantification offerred a valuable biomarker for predicting complication risk in colonic diverticular disease. Elevated visceral fat and disproportionate visceral-to-subcutaneous fat distribution are significantly associated with complicated diverticulitis. Incorporating visceral fat assessment into routine CT interpretation may improve early risk stratification and guide patient management. ？