Visceral Fat & ALMI: The Two DEXA Numbers That Matter Most
Quick answer: Visceral fat (VAT) is the fat stored deep in your belly around your organs, and ALMI (appendicular lean mass index) measures the muscle in your arms and legs relative to your height. A whole-body DEXA scan reports both. Lower visceral fat and a healthy ALMI are two of the clearest signs that your body composition supports long-term health, and neither one shows up on a bathroom scale or in your BMI.
Visceral fat (VAT)
Hidden fat around the liver, intestines and other organs. Linked to insulin resistance, type 2 diabetes, high blood pressure and unhealthy cholesterol. Goal: keep it low and trending down.
ALMI
Lean mass in your arms and legs divided by height squared (kg/m²). A practical measure of skeletal muscle, strength reserve and healthy aging. Goal: keep it up, especially as you age or lose weight.
What is visceral fat?
Most body fat sits just under the skin (subcutaneous fat). Visceral fat is different: it is stored inside the abdominal cavity, around your organs. Research consistently links higher visceral fat with insulin resistance, type 2 diabetes, high blood pressure and abnormal cholesterol, even in people whose weight or BMI looks normal2.
You can't see visceral fat in the mirror or measure it with a scale. DEXA estimates it from the android (belly) region of a whole-body scan and reports it as VAT mass (pounds or grams) and often VAT area. Because DEXA uses a very low radiation dose, it's practical for tracking visceral fat over time2. Learn more in how hidden visceral fat can threaten your health.
How to lower visceral fat
- Move more, consistently. Regular aerobic exercise and strength training both help reduce visceral fat.
- Prioritize whole foods and protein, and limit added sugar, refined carbs and alcohol.
- Sleep and manage stress. Poor sleep and chronic stress are associated with more abdominal fat.
- Track it. Visceral fat often drops faster than total weight when habits change; a follow-up DEXA scan shows you whether it's working. See combatting visceral fat with DEXA.
What is ALMI?
ALMI (appendicular lean mass index) is the lean mass of your arms and legs, which is mostly skeletal muscle, divided by your height squared. It is reported in kg/m², and DEXA reports compare it with people of the same age and sex.
ALMI matters because muscle drives strength, metabolism, blood sugar control and independence as you age. The European Working Group on Sarcopenia in Older People (EWGSOP2) uses DEXA-measured appendicular muscle as part of diagnosing sarcopenia, age-related loss of muscle mass and function1:
| Low muscle quantity (EWGSOP2) | Men | Women |
|---|---|---|
| Appendicular skeletal muscle mass (ASM) | < 20 kg | < 15 kg |
| ASM ÷ height² (ALMI-style index) | < 7.0 kg/m² | < 5.5 kg/m² |
These are thresholds for low muscle mass used in sarcopenia diagnosis, not targets. A healthy goal for most adults is well above them. Talk with your healthcare provider about what your numbers mean for you.
For a deeper dive, read ALMI: the DEXA scan number that predicts how well you'll age.
How to raise or protect ALMI
- Lift. Progressive resistance training two to four times a week is the most reliable way to build and keep muscle.
- Eat enough protein, spread across your meals.
- Protect muscle during weight loss. If you're on a GLP-1 medication like Ozempic, Wegovy, Mounjaro or Zepbound, some of the weight you lose can be muscle. See 2026 research on GLP-1 muscle loss.
Why look at visceral fat and ALMI together?
Weight and BMI can't tell fat from muscle. Two people with the same weight can have very different health pictures: one with low visceral fat and strong muscle, another with high visceral fat and low muscle. Watching both numbers tells you whether you're losing the right weight and keeping the right weight. The ideal trend on repeat DEXA scans is visceral fat going down while ALMI holds steady or rises.
New to your report? Here's how to read every number on your DEXA scan report.
How often should you check visceral fat and ALMI?
Get a baseline scan, then rescan every 8–12 weeks while you're actively changing training, nutrition or medication, and once or twice a year for maintenance. Use the same location each time so results are directly comparable. Many people pair DEXA with VO2 Max and RMR testing to see fitness and metabolism too.
Find out your visceral fat and ALMI
DEXASCAN.COM providers are validated, prices are shown upfront, and you can book online in minutes. DEXA, VO2 Max and RMR testing start at $89.
Find a DEXA scan near youVisceral fat and ALMI FAQs
What is a healthy visceral fat level?
Lower is generally better. DEXA reports show your visceral fat mass and often compare it with reference ranges for your age and sex. Because methods and reference data differ between DEXA systems, the most useful step is to track your own trend on the same machine and review your results with a healthcare provider.
What does ALMI stand for?
Appendicular lean mass index: the lean mass of your arms and legs divided by your height squared, reported in kg/m². It is a practical measure of skeletal muscle.
What ALMI is considered low?
The European Working Group on Sarcopenia in Older People (EWGSOP2) uses appendicular skeletal muscle mass divided by height squared below 7.0 kg/m² for men and below 5.5 kg/m² for women as a threshold for low muscle quantity. These are diagnostic cut-offs, not goals.
Can a smart scale measure visceral fat or ALMI?
Many bioimpedance scales estimate visceral fat and muscle, and they're useful for day-to-day trends, but they are less accurate than DEXA, which directly separates fat, lean and bone tissue by region.
Is a DEXA scan safe?
Yes. A whole-body DEXA scan uses a very low radiation dose, about 4 to 77 microsieverts, compared with roughly 8.2 microsieverts of natural background radiation per day in the US3.
Sources
- Cruz-Jentoft AJ, et al. Sarcopenia: revised European consensus on definition and diagnosis (EWGSOP2). Age and Ageing, 2019: academic.oup.com
- Saad RK, et al. Abdominal visceral adipose tissue and all-cause mortality: a systematic review. Frontiers in Endocrinology, 2022: frontiersin.org
- Health Physics Society, whole-body DEXA dose: hps.org
This page is for educational purposes and is not medical advice. Talk with your healthcare provider about your results and before starting a new exercise, nutrition or medication plan.