Relationship between visceral adipose tissue and triglyceride glucose index with liver status in men and women with metabolic syndrome features: sex differences

Abstract

BackgroundMetabolic syndrome (MetS) comprises several clinical and metabolic risk factors that increase the risk to develop cardiovascular disease and other comorbidities. Meanwhile, ageing and biological differences between men and women play an important role in body fat distribution and health status. The current study aimed to evaluate the association of visceral adipose tissue (VAT) and the triglyceride and glucose index (TyG) with metabolic and liver risk factors among subjects diagnosed with MetS with emphasis on differences attributable to sex.MethodsA cross-sectional study was performed including 326 individuals with MetS (54–75 years) from the PREDIMED-Plus study. Liver markers, visceral fat (VAT) and the triglyceride glucose index (TyG) were assessed. Participants were stratified according to VAT and TyG tertiles. Receiver operating characteristic (ROC) curve was used to analyze the efficiency of TyG for VAT.ResultsSubjects with greater visceral fat depots showed worse lipid profile, higher HOMA-R, TyG, ALT, fibroblast growth factor-21 (FGF-21), fatty liver index (FLI) and hepatic steatosis index (HSI) compared to participants in the 1st tertile. The multi-adjusted linear regression analyses indicated that individuals in the third tertile of TyG (> 9.1–10.7 units) had a positive association with HOMA-IR (β = 3.07 [95% CI, 2.28–3.86]; p-trend < 0.001), ALT (β = 7.43 [95%CI, 2.23–12.63]; p-trend = 0.005), GGT (β = 14.12 [95% CI, 3.64–24.61; p-trend = 0.008]), FGF-21 (β = 190.69 [95% CI, 93.13-288.25; p-trend < 0.001]), FLI (β = 18.65 [95%CI, 14.97–22.23]; p-trend < 0.001) and HSI (β = 3.46 [95% CI, 2.23–4.68; p-trend < 0.001]) versus participants from the first tertile. Interestingly, the TyG showed the largest AUC for women (AUC = 0.713; 95%CI, 0.62–0.79) compared to men (AUC = 0.570; 95%CI, 0.48–0.66), despite the differences in VAT content associated to sex.ConclusionsBoth, VAT and the TyG are strongly associated with cardiometabolic and liver risk factors linked with non-alcoholic fatty liver disease in men and women diagnosed with MetS. The TyG could be used as suitable marker estimator of VAT in women.Trial registrationRetrospectively registered at the International Standard Randomized Controlled Trial (http://www.isrctn.com/ISRCTN89898870), registration date: 24 July 2014.

Loss of Visceral Fat is Associated with a Reduction in Inflammatory Status in Patients with Metabolic Syndrome

“…It is well-established that VAT is associated with CVD and metabolic disturbances, including non-alcoholic fatty liver disease, but the mechanisms underlying these effects are still unclear. [14] This excess VAT may induce chronic low-grade systemic inflammation mediated by macrophage infiltration and the secretion of several proinflammatory cytokines. [8,9] Clinical studies with insulin-resistant obese participants described adipose tissue macrophage infiltration, initiating the recruitment of other immune cells to promote the secretion of several cytokines to regulate the inflammatory response.…”

“…[11,12] This excess adipose tissue and inflammatory response can be reversed by lifestyle modification, including physical activity promotion and following a healthy dietary pattern, such as the Mediterranean Diet (MD). [11,13,14] MD is rich in polyphenols, plant-derived bioactive compounds characterized by the presence of aromatic ring and attached hydroxyl groups, which are present in the main key-foods of this dietary pattern (extra virgin olive oil (EVOO), nuts, vegetables, wine, vegetables, fruits, and whole-grain cereals). Its intake has been associated to anti-inflammatory and anti-oxidative properties, which may also improve obesity-related inflammatory response.…”