Metformin effects on abdominal fat
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Metformin and Abdominal Fat Reduction
Research consistently shows that metformin can help reduce abdominal fat, including both subcutaneous and visceral fat, in various populations such as those with obesity, prediabetes, type 2 diabetes, and polycystic ovary syndrome (PCOS) 1269.
Effects on Visceral and Subcutaneous Fat
Multiple studies demonstrate that metformin leads to significant reductions in visceral adipose tissue (the fat surrounding internal organs) and subcutaneous fat (the fat under the skin) 1269. In women with abdominal obesity, both with and without PCOS, metformin combined with a low-calorie diet reduced body weight, BMI, and specifically decreased visceral fat more than placebo . Similarly, in patients with prediabetes, heart failure, and abdominal obesity, extended-release metformin for six months led to notable decreases in waist circumference, subcutaneous fat, and preperitoneal fat, while the control group saw no such changes . In adults with type 1 diabetes, metformin reduced visceral fat over 26 weeks, even though it did not improve insulin resistance .
Mechanisms of Action on Fat Metabolism
Metformin’s effects on abdominal fat are linked to several mechanisms. It appears to shift the body’s fuel usage toward increased fat oxidation, which means the body burns more fat for energy . This is supported by findings in both humans and animal models, where metformin treatment led to a reduction in visceral fat mass and upregulation of enzymes related to fat oxidation and thermogenesis . Additionally, metformin directly affects fat cells by reducing lipogenesis (fat creation), limiting lipolysis (fat breakdown and release), and increasing glucose transport into adipocytes, which may help regulate fat storage and release .
Impact on Inflammation and Metabolic Health
Metformin also improves the inflammatory profile of abdominal fat. In prediabetic obese patients, metformin therapy increased the expression of SIRT6, a protein involved in reducing inflammation, and decreased markers of inflammation such as NF-κB, PPAR-γ, and SREBP-1 in abdominal fat tissue . This suggests that metformin not only reduces fat but also makes abdominal fat less inflammatory, which is beneficial for metabolic health .
Weight Loss and Appetite Regulation
Metformin is associated with modest but durable weight loss, primarily through decreased appetite and changes in how the body stores and burns fat . Changes in hormones like leptin and improvements in insulin sensitivity may contribute to these effects . In clinical studies, metformin consistently led to reductions in body weight and waist circumference, which are key indicators of abdominal fat 129.
Combination Therapies and Additional Benefits
When combined with other medications, such as GLP-1 analogues or SGLT2 inhibitors, metformin’s effects on abdominal fat can be enhanced. For example, metformin alone or with dapagliflozin significantly reduced omental (deep abdominal) fat, and the combination was especially effective in reducing perirenal fat, another marker of metabolic risk . In patients unresponsive to metformin alone, adding exenatide (a GLP-1 analogue) further reduced intra-abdominal fat and improved inflammatory markers .
Conclusion
Metformin consistently reduces abdominal fat, particularly visceral fat, across a range of populations. Its benefits are seen in both direct fat loss and improvements in the metabolic and inflammatory environment of abdominal fat. These effects are achieved through mechanisms involving increased fat oxidation, improved insulin sensitivity, and reduced inflammation. Metformin’s impact on abdominal fat makes it a valuable tool in managing obesity-related metabolic risks.
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