What does this research mean for the field?

Omental fat cell size is significantly associated with metabolic dysfunction-associated liver disease in individuals with severe obesity. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This research aims to explore how fat cell size, particularly in the omental region, relates to metabolic dysfunction in severely obese individuals.

February 27, 2026Open Access

Visceral, not abdominal subcutaneous, fat cell size associates with metabolic dysfunction-associated liver disease in severe obesity

Key Result

In severe obesity, larger omental (visceral) fat cells, especially in women, are significantly associated with metabolic dysfunction-associated liver disease and inflammation.

Key Points

This research aims to explore how fat cell size, particularly in the omental region, relates to metabolic dysfunction in severely obese individuals.
Analyzed biopsy samples from liver and adipose tissues of 337 bariatric surgery patients.
Measured adipocyte diameters using microscopy imaging.
Evaluated histological liver characteristics for signs of liver disease.
Assessed blood samples for lipid-lipoprotein profiles, glucose-insulin homeostasis, and adipokine levels.
Omental fat cell size was significantly larger in participants with metabolic dysfunction-associated liver disease.
Larger omental adipocytes correlated with liver fibrosis and portal inflammation.
In women, larger omental adipocytes were linked to liver injury, but not in men.

Structured PICO

Does adipocyte hypertrophy in omental versus subcutaneous fat associate with cardiometabolic risk factors and liver disease in severe obesity?

Population

337 bariatric surgery patients with severe obesity

Intervention

Measurement of adipocyte diameter in omental and abdominal subcutaneous adipose tissues

Outcome

Association between adipocyte diameter and histological liver characteristics (steatosis, steatohepatitis, portal and lobular inflammation, hepatocellular ballooning and hepatic fibrosis) and cardiometabolic markerssurrogate

In severe obesity, adipocyte hypertrophy in the omental, but not subcutaneous, fat compartment is associated with cardiometabolic risk factors and liver injury, particularly in women.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Introduction: Adipocyte hypertrophy is an important marker of adipose tissue dysfunction which significantly correlates with cardiometabolic risk factors. Fat cell size increases with adiposity and then plateaus at body mass index (BMI) values higher than 30 kg/m2. It is unknown whether fat cell size still associates with markers of dysmetabolism in severe obesity. Our objectives were to examine the associations between adipocyte diameter and markers of cardiometabolic health in a large sample of participants with severe obesity while adjusting for age, BMI and waist circumference. Methods: Biopsy samples of liver as well as abdominal subcutaneous and omental adipose tissues were obtained from 337 bariatric surgery patients. Evaluation of histological liver characteristics (steatosis, steatohepatitis, portal and lobular inflammation, hepatocellular ballooning and hepatic fibrosis) was performed by specialized pathologists. Adipocyte diameters were measured automatically using microscopy imaging. Lipid-lipoprotein profile, glucose-insulin homeostasis and adipokine levels were measured from blood samples. Results: Omental fat cell size was significantly larger with the presence of metabolic dysfunction-associated steatotic liver disease, metabolic dysfunction-associated steatohepatitis, liver fibrosis and lobular inflammation, as well as the presence and severity of portal inflammation. When stratified by gender, omental adipocytes were larger in women with liver injury, but not in men. Conclusion: In participants with severe obesity, associations between adipocyte hypertrophy and cardiometabolic risk factors are mostly seen in the omental fat compartment, and especially in women.