Kral JG, Näslund E, Surgical treatment of obesity, Nat Clin Pract Endocrinol Metab, 2007;3:574–83. However, although the Mendelian randomization analyses did not demonstrate a causal relationship between genetic instruments linked to blood lipid levels and VAT volume, a reverse directionality is more likely in that excess VAT may cause an atherogenic dyslipidemia. 1 One factor that contributes to the heterogeneity of risk among obese individuals is the amount of visceral adipose tissue (VAT).

Osei-Hyiaman D, Liu J, Zhou L, et al., Hepatic CB1 receptor is required for development of diet-induced steatosis, dyslipidemia, and insulin and leptin resistance in mice, J Clin Invest 2008;48:2080–2. Interreader and intrareader reliability for visceral fat area was 0.99 for all measures. Furthermore, prior work showed good agreement (<3% difference in Bland‐Altman analysis) between computed tomography and MRI for the measurement of VAT.27 Although the cohorts varied both geographically and demographically, and metabolites in each cohort were measured using different algorithms, the replication observed across cohorts despite these differences in study populations (different amounts of VAT, different demographics, and different metabolomics platforms) makes our findings robust. Verrijken A, Francque S, Mertens I, et al., Visceral adipose tissue and inflammation correlate with elevated liver tests in a cohort of overweight and obese patients, Int J Obes (Lond), 2010;34:899–907. Harrison SA, Fincke C, Helinski D, et al., A pilot study of orlistat treatment in obese, non-alcoholic steatohepatitis patients, Aliment Pharmacol Ther, 2004;15:623–8.

Figure 2. White adipose tissue is the principal tissue for energy storage in humans. Neuschwander-Tetri BA, Fatty liver and the metabolic syndrome, Curr Opin Gastroenterol, 2007;23:193–8. β Coefficients represent the difference in visceral adipose tissue area (in cm2) per SD metabolite intensity and are from a model adjusted for age, sex, race/ethnicity, socioeconomic status, smoking, physical activity, glucose and lipid‐lowering medication use, and body mass index. 2020;16(1):47–50 DOI: https://doi.org/10.17925/USE.2020.16.1.47, McCune–Albright syndrome (MAS) is a genetic disorder first described by McCune1 and Albright2  in the 1930s as a triad of polyostotic fibrous dysplasia, café-au-lait spots, and precocious puberty (Figure 1). Therefore, we aimed to use data from 2 large independent cohorts, MESA (Multi‐Ethnic Study of Atherosclerosis) and the NEO (Netherlands Epidemiology of Obesity) study, to discover and replicate metabolites reflecting various pathways related to visceral fat; and we performed a mendelian randomization analysis to explore the potential causal effects of atherogenic dyslipidemia on VAT deposition. The authors thank the investigators, staff, and participants of MESA (Multi‐Ethnic Study of Atherosclerosis) for their valuable contributions. Visceral fat area was quantified by converting the number of pixels to square centimeters for all 3 slides, and the mean area of the 3 slides was used in the analyses. These findings provide insight into potential mechanisms underpinning visceral adipose tissue metabolism distinct from generalized obesity defined by the body mass index. Xu A, Wang Y, Keshaw H, et al., The fat-derived hormone adiponectin alleviates alcoholic and nonalcoholic fatty liver disease in mice, J Clin Invest, 2003;112:91–100.

Vilà L, Roglans N, Alegret M, et al., Suppressor of cytokine signaling-3 (SOCS-3) and a deficit of serine/threonine (Ser/Thr) phosphoproteins involved in leptin transduction mediate the effect of fructose on rat liver lipid metabolism, Hepatology, 2008;48:1506–16. In the Diabetes reduction assessment with ramipril and rosiglitazone medication (DREAM) study, rosiglitazone increased the likelihood of regression to normoglycaemia, but also led to a reduction in ALT levels.146 The first Fatty liver improvement by rosiglitazone therapy (FLIRT) trial demonstrated that, in patients with NASH, rosiglitazone improved steatosis and transaminase levels in the first year of treatment.147 The extension trial, FLIRT 2, showed that there was no additional benefit with longer therapy, despite a maintained effect in insulin sensitivity and transaminase levels.148, Adipokines and their receptors are considered to be novel targets in the pharmacological management of fatty liver disease. examined the effect of adjustable gastric banding on the histological features of NAFLD and on plasma aminotransferase levels. Neels JG, Olefsky JM, Inflamed fat: what starts the fire?, J Clin Invest, 2006;116:33–5.

Adams LA, Angulo P, Lindor KD, Nonalcoholic fatty liver disease, Can Med Assoc J, 2005;172:899–905.

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