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Hedi Raizer

Journal 7 min read

How Visceral Fat Changes with Age

Visceral adipose tissue (VAT) expands with age, but the pattern is not uniform. This page summarises the clinical evidence on age-related visceral fat changes, including ethnic differences, surgical and pharmacological i

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How Visceral Fat Changes with Age

Visceral adipose tissue (VAT), also called intra-abdominal or organ fat, is the fat stored within the peritoneal cavity around internal organs. Unlike subcutaneous fat, VAT drains into the portal circulation and is strongly linked to insulin resistance, inflammation, and cardiometabolic disease. In clinical research, VAT is quantified by magnetic resonance imaging (MRI), computed tomography (CT), or bioelectrical impedance analysis (BIA), often reported as visceral fat area (VFA) or visceral adipose tissue volume. The evidence base for age-related changes in VAT comes from cross-sectional and longitudinal studies, as well as interventional trials in populations with obesity, type 2 diabetes, and other metabolic conditions.

The work in this area centres on adipokine signalling and adipose tissue dysfunction, particularly the roles of leptin, resistin, and other fat-derived factors in mediating the metabolic consequences of visceral fat accumulation.

Research Studies

Mazdutide and fatty pancreas in overweight or obesity

A randomised, double-blind, placebo-controlled trial is evaluating mazdutide, a dual GLP-1/glucagon receptor agonist, in adults with overweight or obesity and fatty pancreas [1]. The study plans to enrol 194 participants, randomised 1:1 to mazdutide plus standardised lifestyle intervention or placebo plus lifestyle intervention, for 48 weeks. The primary endpoint is change from baseline in pancreatic proton density fat fraction (PDFF) measured by MRI at week 48. Secondary endpoints include changes in body weight, visceral fat, and other metabolic parameters. This trial is ongoing and will provide data on whether mazdutide reduces ectopic fat, including visceral and pancreatic fat, in this population.

Mazdutide and visceral fat in type 2 diabetes with NAFLD

A multicentre, prospective, randomised controlled investigator-initiated trial is assessing mazdutide in Chinese patients with type 2 diabetes mellitus (T2DM) and moderate-to-severe non-alcoholic fatty liver disease (NAFLD) who have achieved glycaemic control on semaglutide [2]. The study background notes that Chinese patients with T2DM are susceptible to visceral fat accumulation, which increases cardiometabolic risk and mortality. The trial aims to determine whether switching to mazdutide improves liver fat and visceral adiposity in this high-risk group. Results are pending.

Sclerostin, irisin, and leptin in Chinese men with obesity

A cross-sectional study of 26 men with normal weight and 78 men with obesity examined serum sclerostin, irisin, and leptin in relation to body composition and bone mineral density [3]. Body composition was measured by dual-emission X-ray absorptiometry, and subcutaneous fat, visceral fat, and fat content in the liver and pancreas were determined by MRI. Compared with normal-weight men, those with obesity had higher serum sclerostin, irisin, and leptin levels, as well as higher whole-body and spinal bone mineral density. The study reported different correlations between these factors and body composition measures, suggesting that visceral fat may interact with bone and muscle metabolism via adipokine and myokine pathways. This was an observational study and cannot establish causality.

BMI versus body fat percentage as predictors of IVF outcomes

A prospective observational cohort study is evaluating whether body composition measured by bioelectrical impedance analysis (BIA), including body fat percentage and visceral fat, predicts in vitro fertilisation (IVF) outcomes better than body mass index (BMI) [4]. Participants undergoing IVF will have body composition assessed prior to treatment. Outcomes include ovarian stimulation requirements, number of mature oocytes retrieved, fertilisation rate, and pregnancy outcomes. This study will help clarify whether visceral fat, independent of BMI, influences reproductive outcomes.

Urolithin A and muscle preservation during weight loss in obesity

A randomised trial is testing whether daily urolithin A (500 mg) for 6 months helps adults with obesity lose weight while preserving functional muscle mass and improving markers of mitochondrial health, inflammation, and metabolism [5]. All participants receive a structured lifestyle program; half receive urolithin A and half placebo. The study background notes that weight loss can reduce skeletal muscle, especially in people with obesity, and that aging and obesity are linked to mitochondrial dysfunction and low-grade inflammation. Urolithin A is a gut-derived compound that may enhance mitophagy. This trial will assess whether urolithin A affects visceral fat and muscle mass during caloric restriction.

Resistin and visceral fat reduction after sleeve gastrectomy

A study is investigating whether serum resistin levels can predict the magnitude of visceral fat loss following sleeve gastrectomy in patients with morbid obesity [6]. Sleeve gastrectomy reduces stomach size and leads to weight loss and metabolic improvement. The study focuses on visceral fat, which is closely linked to inflammation and type 2 diabetes. Resistin is a marker of insulin resistance and is typically elevated in individuals with significant abdominal fat. By measuring resistin before surgery, the study aims to determine its predictive value for visceral fat reduction. This is an ongoing observational study.

Barley green and visceral fat area in high body fat percentage

A randomised controlled trial investigated the effects of barley green supplementation on visceral fat area in individuals with high body fat percentage [7]. Participants were recruited from the Clinical Nutrition Department of Peking University People's Hospital and assigned to either an intervention group receiving barley green plus a calorie-restricted diet or a control group. The study aimed to elucidate the clinical efficacy of barley green on visceral fat and to explore mechanisms via gut microbiota analysis. Results are not yet available.

Ethnic differences in adipose tissue dysfunction and type 2 diabetes

A pilot study is investigating the relationship between type 2 diabetes and adipose tissue dysfunction across different ethnic groups [8]. Adipose tissue dysfunction is characterised by abnormal fat distribution, including increased visceral, hepatic, and pancreatic fat, elevated inflammatory biomarkers, and impaired metabolic function. The study notes that in the UK, type 2 diabetes prevalence is significantly higher among South Asian and Black African/Caribbean populations than among White Europeans, and differences in visceral fat accumulation are thought to contribute. This study will compare adipose tissue distribution and function across ethnicities to better understand disparities in diabetes risk.

Adipokines and body composition in ovarian carcinoma

A study examined circulating adipokines, adipokine receptor expression, and body composition in patients with epithelial ovarian carcinoma [9]. The research integrated nutritional status and adipose tissue-derived mediators, finding associations with disease stage and clinical characteristics. This work supports the broader concept that visceral fat and its secreted factors may influence cancer progression, though the study was not designed to assess age-related changes in visceral fat.

Bitter hop nutraceutical and fat mass loss

A study investigated a bitter hop nutraceutical as an adjunct to diet and exercise advice in individuals with overweight or obesity [10]. The intervention stimulated fat mass loss while preserving muscle mass. While not focused on visceral fat specifically, the findings suggest that non-pharmaceutical adjuncts may modulate body composition during lifestyle interventions. The study population was adults with overweight or obesity, and results may not generalise to other groups.

Tesamorelin and GLP-1 receptor agonists for excess visceral abdominal fat in HIV

Two clinical cases highlighted distinct therapeutic pathways for excess visceral abdominal fat (EVAF) in people living with HIV-1 (PLWH) [11]. EVAF is a prevalent metabolic complication in this population, occurring even in individuals with normal or mildly elevated BMI, and is associated with metabolic dysfunction and cardiovascular risk. The cases described treatment with tesamorelin, a growth hormone-releasing hormone analogue, and glucagon-like peptide-1 receptor agonists, illustrating different approaches to reducing visceral fat. These are case reports and do not establish efficacy.

Partial lipodystrophy after hematopoietic stem cell transplantation

A review described hematopoietic stem cell transplantation-associated partial lipodystrophy (HSCT-PL), a serious metabolic complication that develops in the remote period among childhood cancer survivors treated with HSCT and total body irradiation [12]. Since first proposed in 2013, HSCT-PL is increasingly recognised. This condition involves abnormal fat distribution, often with visceral fat accumulation and subcutaneous fat loss, and highlights how medical interventions can alter visceral fat deposition with age.

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