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Additional file 1: Supplementary Material.

Additional file 2. Thematic Domains Discussed by Small Groups. Table of additional excerpts used in the thematic analysis.

Additional file 6. Facilitator Discussion Packet. Given to the small group facilitators to help them guide the discussions.

Additional file 4. Baseline Survey. Administered at the beginning of the day, before the start of the deliberation.

Additional file 7. Participant Discussion Packet. Given to participants to help them follow the discussions.

Additional file 1 Pre-Post Deliberation Comparison (n = 30). Comparison of survey data from before and after the deliberation.

Additional file 3. Semi-Structured Interview Guide. For preliminary interviews conducted to inform the design of deliberation materials.

Additional file 5. Follow-up Survey. Administered at the end of the day, after the deliberation.

Improvement in NAFLD may lead to improvement of metabolic syndrome, cardiovascular disease, and malignancy and vice versa.

The storage of adipose tissue in ectopic compartments is a hallmark attribute linking greater body mass index (BMI) with cardiometabolic diseases. Despite ample evidence to confirm that increased visceral adipose tissue (VAT) deposition occurs with obesity, the interrelations between altered fat partitioning and regional muscle and bone quality are less well understood.We examined the association between adiposity and spinal muscle and bone quality across a large, heterogeneous cohort of adults.We identified 8833 thoracic or abdominal computed tomography scans from patients in the University of Michigan Health System who were aged 18-64.9 y. We measured trabecular bone densities, cortical bone densities, VAT areas, and subcutaneous adipose tissue (SAT) areas at vertebral levels T7 to L5. Psoas muscle attenuation (an indicator of fat infiltration in muscle) was measured at the L4 level.Muscle attenuation as well as trabecular and cortical bone densities revealed negative correlations with BMI, SAT, and VAT. The correlation between BMI and psoas attenuation was -0.321, between BMI and the density of cortical bone was -0.250, and between BMI and trabecular bone was -0.143 (all P0.001). However, correlations between VAT and lower muscle attenuation were stronger as were those between VAT and lower bone densities. Inverse correlations between VAT and densities of psoas muscle and cortical and trabecular bone were -0.460, -0.407, and -0.434, respectively (P0.001). Even after adjustment for age, sex, and BMI, partial correlations between VAT, muscle attenuation, and bone densities remained significant at -0.250, -0.119, and -0.216, respectively (P0.001).Contrary to previous reports that high body mass is associated with increased bone quality, our data show a significant negative association between BMI and muscle and bone densities, suggesting fat infiltration into these tissues. More importantly, correlations between VAT and decreased bone and muscle densities remained statistically significant even after adjustment for age, sex, and BMI.