Visceral fat

Recently at the delicatessen counter of a supermarket, I heard a mother asked her teenage son “Would you like some salami for lunch?”. After receiving an affirmative reply the mother promptly asked for 20 slices of salami. The teenage boy was shorter than me but he was 3 times as broad and deep as me! In other words, he was overweight, if not obese, with a sizeable belly.

Obesity has reached an epidemic proportion worldwide and the incidence of metabolic syndrome (MetS) seems to be paralleling obesity. Metabolic syndrome is strongly linked to insulin resistance, abdominal obesity, diabetes mellitus and dyslipidaemia. The adipose tissue (or more commonly known as fat) in the body can be divided into subcutaneous adipose tissue and visceral adipose tissue (VAT). Overweight and obese people have increased amount of VAT. One of the many sites for VAT accumulation is the liver and this can give rise to a condition called nonalcoholic fatty liver disease (NAFLD). When inflammation sets in, the condition is called nonalcoholic steatohepatits (NASH). If left unchecked, NASH can lead to progressive liver fibrosis and eventual liver cirrhosis. There is increasing evidence that people with visceral fat accumulation have an increased risk of developing primary liver cancer or hepatocellular carcinoma (HCC). Will visceral fat accumulation cause increased risk of HCC recurrence after curative treatment in patients with suspected NASH?

Researchers from the University of Tokyo studied 62 patients with HCC on a background of suspected NASH (Gut 2009; 58: 839 – 844). The visceral fat area (VFA) was determined by CT images at the time of HCC diagnosis. The patients were divided into two groups based on the VFA:- high VFA group (VFA > 130 sq. cm in males, > 90 sq. cm in females) and control group (VFA < 130 sq. cm in males and < 90 sq. cm in females). Using percutaneous radiofrequency ablation, all patients were treated with a curative intent between 1999 and 2006. These patients were followed up until HCC recurrence. The cumulative recurrence rates at 1, 2 and 3 years in the VFA group were 15.9%, 56.5% and 75.1% , respectively. These are significantly higher values than those found in the controls, being 9.7%, 31.1% and 43.1%, respectively.  The researchers concluded that visceral fat accumulation is an independent risk factor for HCC recurrence after curative treatment in patients with suspected NASH.

While I applaud the mother who wanted to look after her child well, perhaps she has been looking after him far too well for his own good. Saddling an adolescent with excess / excessive weight is equivalent to storing up future health problems for the child. When he / she attains adulthood and starts developing diabetes mellitus, arthritis in the hips and knees, he / she might think differently about the excessive amount of food you have been feeding him / her.