In women, compared with men, increased vital exhaustion (VE) (i.e., excessive fatigue, feelings of demoralization, increased irritability) is more strongly associated with indices of cardiovascular disease (CVD) and type 2 diabetes (T2D) risk. Although the contribution of regional fat depositions, such as visceral (VAT), liver (LAT), epicardial (EAT), and subcutaneous (SAT) adipose tissue, to CVD and T2D risk has been examined, it is unknown whether these fat depots differentially mediate the relationship of VE with subclinical cardiometabolic risk. Thus, the present study examined this question, and also whether the associations among VE, regional fat deposition, and subclinical indices of cardiometabolic risk differ in women and men.


The study enrolled 143 adults (65% male, 18-55 years), of which 39.2% were classified as overweight and 41.3% as obese. Participants completed the Maastricht Questionnaire to assess VE. VAT, SAT, and LAT were measured using computed tomography, and EAT using 2-D echocardiography. Path analyses by sex were conducted using structural equation modeling, controlling for age, education, and fitness (via graded exercise maxVO2 test).


The final model (x2=51, p=.67) had good fit (CFI=1.00, RMSEA<.001). For women, paths were found from VE to: 1) SAT (β=.29, p<.02), and from SAT to mean arterial pressure, insulin resistance (IR), and C-reactive protein (.40<βs<.46, ps<.02); 2) LAT (β=.38, p<.01), and from LAT to total cholesterol to HDL ratio (TC/HDL) (β=.30, p<.03); and 3) VAT (β=.23, p<.08), and from VAT to IR, TC/HDL, and triglycerides (.32<βs<.41, ps<.03). For men, no significant paths from VE to fat depots were found.


VE indirectly affects cardiometabolic function through certain fat depositions (SAT, LAT) in women, but not in men. Future research should examine potential sex-specific biobehavioral factors explaining the link between VE and subclinical CVD and T2D pathophysiology in women.