-Järvinen. Acquired obesity is associated with increased liver fat, intra-abdominal fat, and insulin resistance in young adult monozygotic twins. Am J Physiol Endocrinol Metab 288: E768 -E774, 2005. First published December 7, 2004; doi:10.1152/ajpendo.00381.2004.-We determined whether acquired obesity is associated with increases in liver or intra-abdominal fat or impaired insulin sensitivity by studying monozygotic (MZ) twin pairs discordant and concordant for obesity. We studied nineteen 24-to 27-yr-old MZ twin pairs, with intrapair differences in body weight ranging from 0.1 to 24.7 kg [body mass index (BMI) range 20.0-33.9 kg/m 2 ], identified from a population-based FinnTwin16 sample. Fat distribution was determined by magnetic resonance imaging, percent body fat by dual-energy X-ray absorptiometry, liver fat by proton spectroscopy, insulin sensitivity by measuring the fasting insulin concentration, and whole body insulin sensitivity by the euglycemic insulin clamp technique. Intrapair differences in BMI were significantly correlated with those in intra-abdominal fat (r ϭ 0.82, P Ͻ 0.001) and liver fat (r ϭ 0.57, P ϭ 0.010). Intrapair differences in fasting insulin correlated with those in subcutaneous abdominal (r ϭ 0.60, P ϭ 0.008), intra-abdominal (r ϭ 0.75, P ϭ 0.0001) and liver (r ϭ 0.49, P ϭ 0.048) fat. Intrapair differences in whole body insulin sensitivity correlated with those in subcutaneous abdominal (r ϭ Ϫ0.72, P ϭ 0.001) and intraabdominal (r ϭ Ϫ0.55, P ϭ 0.015) but not liver (r ϭ Ϫ0.20, P ϭ 0.20) fat. We conclude that acquired obesity is associated with increases in intraabdominal and liver fat and insulin resistance, independent of genetic factors. body composition; fatty liver; genes; environment; spectroscopy; magnetic resonance imaging RECENT STUDIES HAVE IDENTIFIED fat accumulation in the liver as a novel proximal correlate of insulin resistance (2,5,15,29,36). Although subcutaneous and especially intra-abdominal fat are closely correlated with insulin resistance (6,14,30,37), liver fat has been associated with features of insulin resistance independent of obesity and fat distribution in several studies (25,35,45). Increased liver fat has also been shown to predict type 2 diabetes independently of obesity (7, 47). In both mice (2,5,15,29,36) and humans (28), severe insulin resistance can be observed in the absence of subcutaneous and intra-abdominal fat. In such mice, hepatic insulin resistance can be abolished by subcutaneous fat transplantation (15). These data raise the question of whether acquired obesity indeed regulates liver fat content. Alternative regulators would be genetic factors and acquired factors other than obesity, such as dietary fat content and composition (24, 44).Study of monozygotic (MZ) twin pairs discordant for obesity offers a unique opportunity to determine whether acquired obesity increases liver fat. Because MZ twins are perfectly matched for genes as well as for age, sex, and ethnicity and MZ twins also often share the same environment, study of young adults...