Hormonal
Intra-abdominal (visceral) fat contributes to insulin resistance through mechanisms including high lipolytic activity, direct portal delivery of fatty acids to the liver, and secretion of inflammatory cytokines, whereas subcutaneous fat (particularly gluteofemoral) is metabolically protective.
Focus on reducing abdominal fat rather than just total body weight. Visceral fat is metabolically active and harmful, while subcutaneous fat (especially on hips/thighs) is protective. Strategies that reduce visceral fat (like exercise and specific dietary patterns) are more effective for improving insulin sensitivity than those that only reduce total mass.
Intra-abdominal fat is associated with insulin resistance, possibly mediated by greater lipolytic activity, lower adiponectin levels, resistance to leptin, and increased inflammatory cytokines... Subcutaneous fat, especially gluteofemoral, appears metabolically protective, illustrated by insulin resistance and dyslipidemia in patients with lipodystrophy.
Why this rating
The paper is a comprehensive review citing numerous human studies, animal models, and clinical observations, though causality in humans is often inferred from correlations and transplantation studies.
Source
Adiposity and Insulin Resistance in Humans: The Role of the Different Tissue and Cellular Lipid Depots
Samantha Hocking et al. · Endocrine Reviews · 2013
DOI 10.1210/er.2012-1041
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