Fatty liver and belly fat travel together: What your waist size reveals about future diabetes risk

Belly fat, which can be easily measured by a simple tool as waist circumference, is a very strong predictor to assess the risk of fatty liver and diabetes. It is also very relevant clinically and is one of the criteria to diagnose metabolic syndrome. High belly fat is a marker of central obesity. With real fat in some simple terms, we can say the fat around organs. This high fat causes increase in the inflammatory markers and can cause increase in the free fatty acids which when travel to the liver, cause inflammation in the liver. They are stored in the liver and can eventually cause liver damage and scarring. Resulting in fibrosis.It should be measured around the belly, just above the hip bones. The Range which for the abdominal circumference has been defined as in men. If it is more than 40 inches or more than 102 centimetres, they are at high risk of getting fatty liver. In women, if it is more than 35 inches or more than 88 centimetres, it is considered abnormal. Different studies and recommendations by the Indian Council of Medical Research suggests that for Indians the cut off should be lower. For men it should be considered abnormal if it is more than 90 centimetres and in women it is abnormal if it is more than 80 centimetres. Why is abdominal circumference or increased belly fat more relevant in Indians? In Indians, lean fat phenotype is more common, which essentially means that we tend to have high chances of getting metabolic associated liver disease or diabetes at relatively lower weight or a lower BMI as compared to the Western counterparts. So even a small increase in base circumference can increase the metabolic risk factor significantly. Various research studies have been done and they show a very strong correlation that every 5-centimetre increase in base circumference can increase the fatty liver risk by as much as 20%. Similarly, if we Modify a lifestyle and able to decrease the waist circumference through aggressive diet and exercise. It can reduce the liver fat by as much as 30 to 50%. While waist circumference is an important risk factor for fatty liver, it is also very strongly related to diabetes.As we saw in terms of liver, these in increased inflammatory markers and fatty deposition in the liver cause insulin resistance, which means the insulin does not work properly. and It is the underlying mechanism through which the risk of diabetes is increased in increased belly fat or increased obesity. The cut off for both. Diabetes in terms of waist circumference are similar. Another important tool when we are trying to assess clinically is the waist hip ratio. Waist hip ratio is a stronger predictor than waist circumference or body mass index to assess the risk for type 2 diabetes. The usual range for waist hip ratio for men if it is more than. 0.90 is considered abnormal in women if it is more than 0.85 is considered abnormal and different studies have shown that higher waist hip ratio is associated with higher fasting glucose, higher HBA 1C and even a small increase of 0.01 in the waist hip ratio can increase diabetes risk significantly. Waist hip ratio is measured by dividing the waist circumference by the hip circumference. Baist circumference is usually measured above navel, and hip circumference is usually measured at the widest part of the buttocks.While the underlying mechanism is very closely related for both fatty liver, pre diabetes, or diabetes when it comes to increased very fat. It is important to understand that timely intervention and understanding the importance of this simple clinical tool can help us decrease our risk. So next time that we notice change in few if we have gained a few kilograms and we notice change in the belt size, we have to remember that. Even us in that, every change that is noticed in our belt could be indicative of increasing risk of both fatty liver and diabetes. But the good thing is that to a large extent, if we are careful and we are able to decrease the belly fat through lifestyle changes, many of these factors can be reduced to a large extent.Dr. Anshu, Senior Consultant, Endocrinology & Diabetes, Max Smart Super Speciality Hospital, Saket