title: Beyond central adiposity: liver fat and visceral fat area are associated with metabolic syndrome in morbidly obese patients.
abstract: BACKGROUND
  Despite its widespread clinical use, both body mass index (BMI) and waist circumference have been reported as inaccurate methods to measure abdominal obesity. The main objective of this study was to determine the relation between visceral fat area and fatty liver infiltration with the expression of metabolic syndrome (MS) in morbidly obese patients.
  
  
  METHODS
  We recruited a random selection of 100 morbidly obese patients on pre-operative evaluation for bariatric surgery. A pre-operative CT slice at L4-L5 level, was performed to measure visceral fat and at T12 level to measure hepatic attenuation.
  
  
  RESULTS
  Patients with MS had lower hepatic attenuation values (median 49.9 vs 55.5HU; p = .018) and had more VAT (242 vs 172 cm(2);p = .001). Conventional measures (BMI: p = .729 and waist circumference: p = .356), were not useful in discriminating morbidly obese patients with MS. By multivariable logistic regression, fatty liver infiltration (OR = 5.3; p = .03) and age (OR = 1.08; p = .04) were the only factors independently related to the presence of MS. MS prevalence was 100%, 71% and 55%, respectively for patients with both fatty liver and visceral adiposity; one; or none of this findings (AUC - .715; p = .016).
  
  
  CONCLUSIONS
  CT scan seems to measure 2 important markers of MS: visceral adiposity and hepatic fatty infiltration. In morbidly obese patients, both visceral adiposity and hepatic fatty infiltration increase the risk for the presence of MS.
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Porto, Portugal. Electronic address: gilrfaria@gmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Faria
authors.affiliation: Department of Surgery, São João Medical Center, Portugal.
authors.forename: A
authors.initials: A
authors.lastname: Gonçalves
authors.affiliation: Department of Radiology, São João Medical Center, Porto, Portugal.
authors.forename: R
authors.initials: R
authors.lastname: Cunha
authors.affiliation: Department of Biochemistry, Faculty of Medicine, University of Porto, Portugal; Department of Clinical Pathology, São João Medical Center, Porto, Portugal.
authors.forename: J T
authors.initials: JT
authors.lastname: Guimarães
authors.affiliation: Department of Biochemistry, Faculty of Medicine, University of Porto, Portugal.
authors.forename: C
authors.initials: C
authors.lastname: Calhau
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Porto, Portugal; Department of Surgery, São João Medical Center, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Preto
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Porto, Portugal.
authors.forename: A
authors.initials: A
authors.lastname: Taveira-Gomes
mesh_terms: D050154:Adiposity / Q000502:physiology*; D000328:Adult; D015992:Body Mass Index; D005234:Fatty Liver / Q000453:epidemiology; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging / Q000378:metabolism*; D008099:Liver / Q000000981:diagnostic imaging / Q000378:metabolism*; D016015:Logistic Models; D008297:Male; D024821:Metabolic Syndrome / Q000000981:diagnostic imaging / Q000453:epidemiology*; D008875:Middle Aged; D009017:Morbidity; D009767:Obesity, Morbid / Q000453:epidemiology* / Q000378:metabolism; D014057:Tomography, X-Ray Computed
keywords: CT scan; Fatty liver disease; Metabolic syndrome; Morbid obesity; Visceral adiposity