Barbara Pala (1), Giulia Frank (2), Paola Gualtieri (3), Laura Di Renzo (4), Giulia Nardoianni (5), Thomas Baldi (6), Giuliano Tocci (5)

(1) PhD School of Applied Medical-Surgical Sciences, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy.
(2) PhD School of Applied Medical-Surgical Sciences, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; School of Specialization in Food Science, University of Rome Tor Vergata, 00133 Rome, Italy.
(3) Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy.
(4) School of Specialization in Food Science, University of Rome Tor Vergata, 00133 Rome, Italy. Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy.
(5) Division of Cardiology, Department of Clinical and Molecular Medicine, University of Rome Sapienza, Sant’Andrea Hospital 1035/1039, 00189 Rome, Italy.
(6) Independent researcher, Rome, Italy.

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Background: Epicardial adipose tissue (EAT) has emerged as an early predictor of cardiometabolic risk, but its role in individuals without overt obesity remains underexplored.

Methods: We investigated a cohort of 30 adults who completed dietary assessment, body composition analysis, and vascular evaluation. Mediterranean diet adherence was measured using the MEDAS score; adiposity was assessed through fat mass percentage (FM%), and vascular health through carotid intima-media thickness (cIMT).

Results: Participants showed suboptimal adherence to the Mediterranean diet (mean MEDAS <10), elevated total and LDL cholesterol, and increased EAT thickness (mean 6.8 ± 1.3 mm), above the clinical risk threshold of 5 mm.EAT >5 mm correlated strongly with FM%, with an optimal cut-off at 29.0% (sensitivity 1.0; specificity 1.0). Stratified analysis indicated thresholds of 30.9% for men (sensitivity 1.0; specificity 0.5) and 29.5% for women (sensitivity 1.0; specificity 1.0). FM% was also positively associated with cIMT, reinforcing the link between adiposity and subclinical vascular remodeling.

Conclusions: Even in the absence of overt obesity, moderate adherence to the Mediterranean diet may predispose to a high-risk cardiovascular phenotype characterized by visceral fat accumulation, dyslipidemia, and early vascular changes. EAT and FM% should be considered sensitive markers for early risk stratification.