People with "beer bellies" may have an increased risk of heart damage, raising fresh concerns about the health risks tied to extra weight around the midsection.
German researchers found that men with fat deposits around the abdomen showed clear signs of early heart damage, even when their overall weight wasn't especially high.
Scientists wanted to better understand whether abdominal fat - the kind stored deep around internal organs - is more harmful to the heart than general body fat.
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Doctors have long suspected that fat distribution, not just total pounds, plays a major role in heart disease. This study tested that idea using cardiac MRI scans.
"Abdominal obesity, a high waist-to-hip ratio, is associated with more concerning cardiac remodeling patterns than high body mass index (BMI) alone," said study lead author Jennifer Erley, M.D., radiology resident at University Medical Center Hamburg-Eppendorf, Germany, in a press release.
The research team examined 2,244 adults between the ages of 46 and 78, none of whom had been diagnosed with heart disease. Each participant underwent high-resolution MRI scans that measured the size, thickness and volume of the heart's chambers.
Researchers also collected detailed health information, including weight, blood pressure, cholesterol, smoking status and diabetes history.
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Instead of relying solely on BMI, which can miss where fat is stored, the team used a measurement of waist-to-hip ratio, which compares the circumference of the waist to the hips and determines how much fat sits around the abdomen.
High ratios point to visceral fat, which is the deeper, metabolically active fat linked to inflammation and organ stress.
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Men with higher waist-to-hip ratios showed a pattern of thicker heart muscles and smaller internal chamber volume. That means the heart muscle becomes bulkier but holds less blood, forcing it to work harder, according to the researchers.
"[Abdominal obesity] appears to lead to a potentially pathological form of cardiac remodeling," said Erley.
Based on BMI alone, 69% of males and 56% of females in the study were overweight or obese. Using waist-to-hip ratio, however, 91% of the males and 64% of females met the criteria for obesity.
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General obesity based on BMI was more often linked to enlarged heart chambers for all participants. Abdominal obesity was associated with thickening of the heart muscle and smaller heart chamber volumes.
Over time, those structural changes can lead to heart failure or other cardiovascular problems, the researchers warned.
These associations remained strong even after researchers accounted for age, smoking, blood pressure and other risk factors.
The same trend appeared in women, but the effect was significantly stronger in men. Researchers noted that men tend to store fat in the abdomen more readily than women, especially as they age, which may explain the sharper impact.
The findings help to clarify why some people with normal or moderately elevated BMI still develop heart disease, while others weighing more do not. It also suggests that simply stepping on a scale may not capture the full picture of heart risk.
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The study did have some limitations, primarily that it was observational in design, meaning that it identified patterns but could not prove direct causation.
Additionally, researchers did not follow participants long enough to see who eventually developed heart disease, they acknowledged.
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And waist-to-hip ratio, while useful, is a simplified measure that doesn't capture all variations in body composition.
The findings are being presented this week at the annual meeting of the Radiological Society of North America in Chicago.
