High Visceral Fat Mass and High Liver Fat Are Associated with Resistance to Lifestyle Intervention

Abstract

visceral fat mass and high liver fat are associated with resistance to lifestyle intervention. Obesity. 2007;15:531-538. Objective: High visceral adipose tissue (VAT) and high liver fat (LF) are associated with the metabolic syndrome and diabetes. We studied changes in these two fat depots during weight loss and analyzed whether VAT and LF at baseline predict the response to lifestyle intervention. Research Methods and Procedures: One hundred twelve subjects (48 men and 64 women; age, 46 Ϯ 11 years; BMI, 29.2 Ϯ 4.4 kg/m 2 ) were studied after a follow up-time of 264 Ϯ 60 (SD) days. Insulin sensitivity was estimated from the oral glucose tolerance test. Body fat depots were quantified using magnetic resonance imaging and spectroscopy. Results: Cross-sectionally high VAT (r ϭ Ϫ0.22, p ϭ 0.02) and high LF (r ϭ Ϫ0.36, p Ͻ 0.0001) were independently associated with low insulin sensitivity. With intervention, BMI (Ϫ3.0%), VAT (Ϫ12.0%), and LF (Ϫ33.0%) were reduced (all p Ͻ 0.001). Insulin sensitivity was improved (ϩ17%, p Ͻ 0.01). The changes in BMI (r ϭ Ϫ0.41), VAT (r ϭ Ϫ0.28), and LF (r ϭ Ϫ0.39) were associated with the increase in insulin sensitivity (all p Ͻ 0.01). High VAT (r ϭ Ϫ0.28, p ϭ 0.01) and high LF (r ϭ Ϫ0.38, p Ͻ 0.01) at baseline were associated with a lesser increase in insulin sensitivity. Discussion: Baseline values and changes in BMI, VAT, and LF are related to changes in insulin sensitivity during lifestyle intervention. Subjects with high VAT and LF have a lower chance of profiting from lifestyle intervention and may require intensified lifestyle prevention strategies or even pharmacological approaches to improve insulin sensitivity.

The diagnosis and management of non-alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association

“…The results from these studies using a variety of interventions, either by diet alone 81,83,84,89,92,93 or in combination with different exercise prescriptions, 82,[85][86][87][88]92,94 have consistently reported a significant reduction in liver fat by an average of $40% (ranging from 20% to 81%). The degree of hepatic fat reduction was proportional to the intensity of the lifestyle intervention and generally required a body weight loss between $5 to 10%.…”

Simultaneous extraction of metabolome and lipidome with methyl tert-butyl ether from a single small tissue sample for ultra-high performance liquid chromatography/mass spectrometry

“…Acylcarnitines and FFA are highly regulated metabolites during physiologic conditions like fasting and physical exercise that go along with acute changes in the hepatic lipid profile [25,30,31]. On the other hand, lipids, FFA and acylcarnitines have repeatedly been identified as biomarkers of insulin resistance [31][32][33] and elevated FFA levels eventually lead to ectopic lipid depositions in liver and skeletal muscle that are associated with the development of insulin resistance [34,35]. Thus, a concerted analysis of lipids, acylcarnitines and FFA in these tissues may open new perspectives in the understanding of metabolic diseases like insulin resistance and type 2 diabetes.…”

High cerebral insulin sensitivity is associated with loss of body fat during lifestyle intervention

“…Accordingly, VAT and IHL were lowered at 9 months (VAT: −0.46 ± 0.12 kg, p = 0.001; IHL: −3.7 ± 1.9%, p=0.020) and 2 years (VAT: −0.50±0.17 kg, p=0.007; IHL: −1.8±0.6%, p=0.034) compared with baseline. Comparable changes were found in the database of the TULIP study and have been published elsewhere [3].…”

“…These interventions usually aim at a moderate weight loss (~5% of initial body weight), reduction in fat intake (<30% of energy), low intake of saturated fatty acids (<10% of energy), increase in physical activity (>3 h per week) and increase in fibre intake (>15 g per 4,187 kJ [1,000 kcal]). Although the mean loss in body weight observed during lifestyle intervention programmes is relatively small (~3% of initial body weight), a more pronounced loss of visceral fat (12%) and liver fat (33%) and improvement in peripheral insulin sensitivity have been observed, and these effects are considered to mediate diabetes-preventing effects [3]. However, in a considerable number of participants, these lifestyle interventions seem to be ineffective, and, in particular, body weight change is very heterogeneous.…”