Impact of Visceral and Hepatic Fat on Cardiometabolic Health

Abstract

Purpose of review: Body fat distribution plays a significant role in the cardiometabolic consequences of obesity. We review the impact of visceral and hepatic fat and highlight important interventions.

Recent findings: Several epidemiologic studies have established a clear association between visceral fat and cardiovascular disease. The association between hepatic fat and cardiovascular disease is less clear with discordant results. Novel evidence demonstrates sodium glucose co-transporter-2 (SGLT2) inhibitors facilitate modest weight loss and reductions in ectopic fat depots in patient with type 2 diabetes. Glucagon-like peptide-1 (GLP-1) receptor agonists have been associated with decreased visceral/hepatic fat and reductions in MACE in populations with type 2 diabetes and with overweight/obesity. Clear associations between visceral fat and cardiometabolic outcomes have been established, whereas the impact of hepatic fat remains less clear. Lifestyle modification and pharmacologic interventions remain the initial therapies, while surgical intervention is associated with improved long-term outcomes. Emerging therapies have demonstrated a profound impact on body fat distribution and cardiometabolic risk.

Keywords: Cardiometabolic risk; GLP-1 RA; Hepatic fat; Obesity; SGLT2i; Visceral fat.

Fig. 1

Ectopic fat depots and their potential systemic and local effects. (Figure reproduced with permission from Britton KA, Fox CS. Circulation. 2011;124:e837–41, with permission of Wolters Kluwer Health, Inc.) [1]