Apple, Pear, or Liver?

We’ve been told that the two main types of fat distribution, leading to an apple- or a pear-shaped person, are importantly different. In apple-shaped people the excess fat is situated in or around the abdomen, and it’s the dangerous sort to have, from the cardiovascular point of view. Pear-shaped people, on the other hand, have their excess fat around the buttocks, hips and thighs; this is a more natural distribution for women, and isn’t connected with increased cardiovascular risk.

Now Dr Samuel Klein of Washington University School of Medicine, St Louis, has carried the fat distribution story a bit further. It seems that liver fat is the real culprit for insulin resistance and cholesterol abnormalities. This is known as nonalcoholic fatty liver disease.

In a news release from the School of Medicine, Dr Klein describes his findings in obese adolescents. They could be divided into two types – those with excessive liver fat, and those with no signs of fatty liver disease. Those with fatty livers had abnormal blood glucose results and lower high-density lipoprotein (HDL) cholesterol. The other type had no such metabolic problems.

Further studies showed that nonalcoholic liver disease was associated with release of release of large quantities of fatty acids into the blood stream, and these led to raised triglyceride levels and insulin resistance, the precursor of type 2 diabetes.

The importance of this finding is that people diagnosed with fatty liver disease need to be treated aggressively to lose weight and avoid the development of heart disease or diabetes. If the liver fat content is normal there is less need for aggressive action, but excess weight should, of course, be lost.