Apple or pear shape is not main culprit to heart woes -- it's liver fat

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Public release date: 4-Dec-2008

http://www.eurekalert.org/pub_releases/2008-12/wuso-aop120408.php

Contact: Jim Dryden

jdryden@...

Washington University School of Medicine

Apple or pear shape is not main culprit to heart woes -- it's liver fat

For years, pear-shaped people who carry weight in the thighs and

backside have been told they are at lower risk for high blood pressure

and heart disease than apple-shaped people who carry fat in the abdomen.

But new findings from nutrition researchers at Washington University

School of Medicine in St. Louis suggest body-shape comparisons don't

completely explain risk.

In two studies, they report excess liver fat appears to be the real key

to insulin resistance, cholesterol abnormalities and other problems that

contribute to diabetes and cardiovascular disease. Having too much fat

stored in the liver is known as nonalcoholic fatty liver disease.

" Since obesity is so much more common now, both in adults and in

children, we are seeing a corresponding increase in the incidence of

nonalcoholic fatty liver disease, " says senior investigator

Klein, M.D., the Danforth Professor of Medicine and Nutritional Science.

" That can lead to serious liver disorders such as cirrhosis in extreme

cases, but more often it tends to have metabolic consequences. "

Klein, who heads the Division of Geriatrics and Nutritional Science and

runs Washington University's Center for Human Nutrition, studied obese

adolescents. They were divided into two groups: obese with excessive

liver fat and those with no evidence of fatty liver disease. The groups

were matched by age, sex, body mass index, body fat percentage and

degree of obesity.

The researchers determined that children with fatty liver disease also

had abnormalities in glucose and fat metabolism, including lower levels

of HDL cholesterol, the so-called good cholesterol. Those without a

fatty liver did not have markers of metabolic problems. Whether shaped

like pears or apples, it was fat in the liver that influenced metabolic

risk.

" Abdominal fat is not the best marker for risk, " says Klein, who also

directs the Nutrition Support Service at -Jewish Hospital. " It

appears liver fat is the real marker. Abdominal fat probably has been

cited in the past because it tends to track so closely with liver fat.

But if you look at people where the two don't correspond — with excess

fat in the liver but not in the abdomen and vice versa — the only thing

that consistently predicts metabolic derangements is fat in the liver. "

In a second study, Klein's team found nonalcoholic fatty liver disease

was related to the release of larger amounts of fatty acids into the

bloodstream that were, in turn, linked to elevated triglycerides and to

insulin resistance, a key precursor to type 2 diabetes.

" Multiple organ systems become resistant to insulin in these adolescent

children with fatty liver disease, " he says. " The liver becomes

resistant to insulin and muscle tissue does, too. This tells us fat in

the liver is a marker for metabolic problems throughout the entire system. "

The findings indicate that children and adults with fatty liver disease

should be targeted for intensive interventions, according to Klein.

Those who are obese but don't have fatty liver disease still should be

encouraged to lose weight, but those with evidence of fatty liver are at

particularly high risk for heart disease and diabetes. They need to be

treated aggressively with therapies to help them lose weight because

weight loss can make a big difference.

" Fatty liver disease is completely reversible, " he says. " If you lose

weight, you quickly eliminate fat in your liver. As little as two days

of calorie restriction can improve the situation dramatically, and as

fat in the liver is reduced, insulin sensitivity and metabolic problems

improve. "

###

Fabbrini E, deHaseth D, Deivanayagam S, Mohammed BS, Vitola BE, Klein S.

Alterations in fatty acid kinetics in obese adolescents with increased

intrahepatic triglyceride content. Obesity (2008), published online Oct.

2008. doi:10.1038/oby.2008.494

Deivanayagam S, Mohammed BS, Vitola BE, Naguib GH, Keshen TH, Kirk EP,

Klein S. Nonalcoholic fatty liver disease is associated with hepatic and

skeletal muscle insulin resistance in overweight adolescents. American

Journal of Clinical Nutrition, 88(2) pp. 257-262, Aug. 2008.

This research was supported by grants from the National Institute of

Diabetes and Digestive and Kidney Diseases and the National Center for

Research Resources of the National Institutes of Health.

--

ne Holden, MS, RD

" Ask the Parkinson Dietitian " http://www.parkinson.org/

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