title: High visceral fat mass and high liver fat are associated with resistance to lifestyle intervention.
abstract: OBJECTIVE
  High visceral adipose tissue (VAT) and high liver fat (LF) are associated with the metabolic syndrome and diabetes. We studied changes in these two fat depots during weight loss and analyzed whether VAT and LF at baseline predict the response to lifestyle intervention.
  
  
  METHODS
  One hundred twelve subjects (48 men and 64 women; age, 46 +/- 11 years; BMI, 29.2 +/- 4.4 kg/m(2)) were studied after a follow up-time of 264 +/- 60 (SD) days. Insulin sensitivity was estimated from the oral glucose tolerance test. Body fat depots were quantified using magnetic resonance imaging and spectroscopy.
  
  
  RESULTS
  Cross-sectionally high VAT (r = -0.22, p = 0.02) and high LF (r = -0.36, p < 0.0001) were independently associated with low insulin sensitivity. With intervention, BMI (-3.0%), VAT (-12.0%), and LF (-33.0%) were reduced (all p < 0.001). Insulin sensitivity was improved (+17%, p < 0.01). The changes in BMI (r = -0.41), VAT (r = -0.28), and LF (r = -0.39) were associated with the increase in insulin sensitivity (all p < 0.01). High VAT (r = -0.28, p = 0.01) and high LF (r = -0.38, p < 0.01) at baseline were associated with a lesser increase in insulin sensitivity.
  
  
  CONCLUSIONS
  Baseline values and changes in BMI, VAT, and LF are related to changes in insulin sensitivity during lifestyle intervention. Subjects with high VAT and LF have a lower chance of profiting from lifestyle intervention and may require intensified lifestyle prevention strategies or even pharmacological approaches to improve insulin sensitivity.
authors.affiliation: Department of Endocrinology and Metabolism, Eberhard-Karls-University, Tübingen, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Thamer
authors.forename: Juergen
authors.initials: J
authors.lastname: Machann
authors.forename: Norbert
authors.initials: N
authors.lastname: Stefan
authors.forename: Michael
authors.initials: M
authors.lastname: Haap
authors.forename: Silke
authors.initials: S
authors.lastname: Schäfer
authors.forename: Sonja
authors.initials: S
authors.lastname: Brenner
authors.forename: Konstantin
authors.initials: K
authors.lastname: Kantartzis
authors.forename: Claus
authors.initials: C
authors.lastname: Claussen
authors.forename: Fritz
authors.initials: F
authors.lastname: Schick
authors.forename: Hans
authors.initials: H
authors.lastname: Haring
authors.forename: Andreas
authors.initials: A
authors.lastname: Fritsche
mesh_terms: D000328:Adult; D015992:Body Mass Index; D001835:Body Weight; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control / Q000523:psychology; D005234:Fatty Liver / Q000523:psychology*; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D050152:Intra-Abdominal Fat / Q000033:anatomy & histology*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D040242:Risk Reduction Behavior