Scientists are trying to figure out why belly fat affects the liver more than fat under the skin, by comparing how the two types of fat work.

Visceral adipose tissue is metabolically active and secretes pro-inflammatory cytokines that impair insulin signaling in liver, muscle, and brain tissues.

Visceral fat is metabolically active tissue that releases cytokines, which impair insulin sensitivity and disrupt metabolic signaling in the liver, muscles, and brain, leading to systemic metabolic dysfunction.

Visceral adipose tissue releases bioactive molecules directly into the portal venous system, exposing the liver to elevated concentrations of free fatty acids and inflammatory cytokines.

In people with obesity, larger fat cells in the subcutaneous layer are more closely linked to insulin resistance in fat tissue than the presence of immune cells, aging cells, or inflammatory molecules, suggesting that fat cell enlargement, not inflammation, is the main factor disrupting fat breakdown.

When too many fat molecules and inflammatory signals from belly fat reach the liver, it becomes less responsive to insulin.