Hormonal
High intrahepatic triglyceride (IHTG) content, rather than visceral adipose tissue (VAT) volume, is the primary independent marker and driver of metabolic complications (insulin resistance and dyslipidemia) in obesity.
If you are obese, your liver fat content is a more critical indicator of your metabolic health than your waist size. While reducing visceral fat is good, strategies that specifically target liver fat accumulation (such as reducing fructose intake or alcohol, and improving insulin sensitivity) may yield better metabolic outcomes than focusing solely on waist circumference reduction.
These data demonstrate that IHTG, not VAT, is a better marker of the metabolic derangements associated with obesity.
Why this rating
High-quality observational/mechanistic study using gold-standard clamp techniques and stable isotopes in matched human subjects, though causality is acknowledged as not fully proven.
Source
Intrahepatic fat, not visceral fat, is linked with metabolic complications of obesity
Elisa Fabbrini et al. · Proceedings of the National Academy of Sciences · 2009
DOI 10.1073/pnas.0904944106
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