Posted On: August 24, 2009 – 7:30pm
New findings from nutrition researchers at Washington University School of Medicine in St. Louis suggest that it’s not whether body fat is stored in the belly that affects metabolic risk factors for diabetes, high blood triglycerides, and cardiovascular disease, but whether it collects in the liver.
Having too much liver fat is known as nonalcoholic fatty liver disease. The researchers report in the journal PNAS that when fat collects in the liver, people experience serious metabolic problems such as insulin resistance, which affects the body’s ability to metabolize sugar. They also have increases in production of fat particles in the liver that are secreted into the bloodstream and increase the level of triglycerides.
For years, scientists have noted that where individuals carried body fat influences their metabolic and cardiovascular risk. Increased fat inside the belly, known as visceral fat, is associated with an increased risk of diabetes and heart disease.
"Data from a large number of studies shows that visceral fat is associated with metabolic risk, which has led to the belief that visceral fat might even cause metabolic dysfunction," says senior investigator Samuel Klein, M.D. "However, visceral fat tracks closely with liver fat. We have found that excess fat in the liver, not visceral fat, is a key marker of metabolic dysfunction. Visceral fat might simply be an innocent bystander that is associated with liver fat."
Klein, the Danforth Professor of Medicine and Nutritional Science, directs the Division of Geriatrics and Nutritional Science and the Center for Applied Research Studies, as well as Washington University’s Center for Human Nutrition. He says most of our body fat, called subcutaneous fat, is located under our skin, but about 10 percent is present inside the belly, while much smaller amounts are found inside organs such as the liver and muscle.
This study compared obese people with elevated and normal amounts of liver fat. All subjects were matched by age, sex, body mass index, percent body fat and degree of obesity. Through careful evaluations of obese people with different amounts of visceral fat or liver fat, Klein’s team determined that excess fat inside the liver identifies those individuals who are at risk for metabolic problems.
"We don’t know exactly why some fats, particularly triglycerides, will accumulate inside the liver and muscle in some people but not in others," says first author Elisa Fabbrini, M.D., Ph.D., assistant professor of medicine. "But our data suggest that a protein called CD36, which controls the transport of fatty acids from the bloodstream into different tissues, is involved."
Fatty acids are the building blocks for making fats, known as triglycerides. Klein, Fabbrini and their colleagues found that CD36 levels were lower in fat tissue and higher in muscle tissue among people with elevated liver fat.
Fabbrini and Klein say changes in CD36 activity could be responsible for diverting circulating fatty acids away from fat tissue and into liver and muscle tissue, where they are converted to triglyceride. Increased tissue uptake of fatty acids could be responsible for metabolic dysfunction.
Klein says those who are obese but don’t have high levels of fat in the liver should be encouraged to lose weight, but those with elevated liver fat are at particularly high risk for heart disease and diabetes. He says they need to be treated aggressively to help them lose weight because dropping pounds can make a big difference.
"Fatty liver disease is completely reversible," he says. "If you lose a small amount of weight, you can markedly reduce the fat content in your liver. In fact, even two days of calorie restriction can cause a large reduction in liver fat and improvement in liver insulin sensitivity."
By Allen Smith
The Basics of Weight Management
- As the old saying goes, "calories in, calories out." And so it is with managing your weight. For the majority of the 191 million American adults who are obese, struggling with their weight is a daily occurrence. In 2008, overweight men and women spent more than $109 million on the grapefruit, Atkins, South Beach, cabbage soup and hundreds of other fad diets in an effort to lose extra fat. Some work, some don’t. But what happens to all that fat when you lose it?
Scientists and exercise physiologists will tell you that the most basic unit of energy is the calorie or, more accurately, the "kilo-calorie," abbreviated as Kcal. Kilo-calories are units of heat and can either store or produce energy. One pound of fat is equal to 3,500 Kcal. So, in order to lose 1 pound of fat, you must either eat fewer calories or find a way to burn 3,500 Kcal with physical activity. The best approach is to do both.
How Fat Is Stored
- When you eat food, it is broken down in the stomach and intestinal tract into fat, carbohydrate and protein. If you live an active lifestyle, most of the calories from the food you eat will be burned before it has a chance to be stored. If you lead a sedentary lifestyle, any calories that aren’t burned will be stored, mostly in the form of fat.
What Happens to the Fat
- Some of the fuel you use for maintaining normal body functions and for exercise comes from two ready sources: glucose and triglycerides. Both circulate in the blood, so they are easily available as fuel sources, even though they are in relatively short supply. More abundant supplies are found in the liver and stored fat cells.
If the demands of your activity are greater than what circulating fat and glucose can supply, your body will need to dip into the stored energy in the liver and fat cells. Hormones in the body activate an enzyme called lipase that tells the fat cells to release triglycerides. The triglycerides are broken down into glycerol and free fatty acids and enter the bloodstream. The liver recycles the glycerol, and the muscles use the free fatty acids for energy. When the free fatty acids are consumed by working muscles and other tissues, they are converted to heat, water, carbon dioxide and adenosine triphosphate, or ATP. Your body releases heat through your skin, water as you sweat and carbon dioxide as you breathe; it converts the energy in the bonds of ATP into energy your body can use.