New research highlights importance of fat distribution in End-Stage Liver Disease
A newly published review in Obesity Reviews, a journal of the World Obesity Federation, provides a comprehensive overview of how abdominal adipose tissue—particularly its type and distribution—can influence the prognosis of patients with end-stage liver disease (ESLD).
Authored by researchers from Tianjin Medical University General Hospital, the review explores how visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) contribute differently to liver disease progression, complications, and outcomes. It also highlights the limitations of traditional metrics like body mass index (BMI), which can be misleading in patients with cirrhosis due to fluid retention and muscle loss.
Instead, advanced imaging techniques such as CT and MRI scans offer more precise assessments through indices like the visceral adipose tissue index (VATI), subcutaneous adipose tissue index (SATI), and the visceral-to-subcutaneous fat area ratio (VSR). These measures are shown to have important predictive and prognostic value in ESLD, including liver cirrhosis and hepatocellular carcinoma (HCC).
Key findings include:
Key findings
High VATI
High VATI is linked with liver inflammation, fibrosis, and increased mortality risk, especially in female patients and those undergoing liver transplantation.
Key findings
Low SATI
Low SATI correlates with frailty, liver-related complications, and mortality, though moderate levels appear protective.
Key findings
High VSR
High VSR (a greater proportion of visceral to subcutaneous fat) is associated with malnutrition and poorer survival outcomes, making it a potentially strong prognostic marker.
The review also outlines emerging strategies to address fat distribution abnormalities in ESLD patients. Nutritional approaches, including high-protein, high-energy diets and reduced sugar intake, are recommended. Exercise—particularly moderate to vigorous aerobic training—can help reduce VAT. Pharmacological therapies such as thiazolidinediones and pemafibrate are also being explored for their potential to shift fat distribution in a beneficial direction.
The authors advocate for a shift in clinical practice away from BMI alone, recommending the integration of more sophisticated body composition indicators in both assessment and treatment planning. These insights could inform more effective, targeted interventions for people living with advanced liver disease.
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