Visceral Fat Loss Leaves Metabolic Legacy
BGU-led MRI study links lasting visceral fat loss to lower long-term type 2 diabetes risk despite weight regain.
Lifestyle-induced loss of visceral fat (and not liver fat, pancreatic fat or subcutaneous fats) may have lasting health benefits years after the end of an intervention, even when body weight is fully regained, according to researchers from Ben-Gurion University of the Negev and their international collaborators. The findings suggest that a reduction in visceral (intra-abdominal) fat, the harmful fat stored deep in the abdomen around internal organs, may be partially preserved long term and is associated with better cardiometabolic health and lower future risk of type 2 diabetes.
With an unprecedented 96% retention rate over a decade, the study tracked 366 participants from the original cohorts by MRI to provide the first large-scale assessment of how these specific internal fat depots behave over time, after a long-term clinical trial.
Their findings were just published in the top journal in the field of Cardiology- Circulation.
By long-term follow-up, body weight had returned to baseline on average. However, waist circumference and abdominal fat depots, including visceral, deep subcutaneous, and superficial subcutaneous fat, remained lower than baseline. Liver fat also returned to baseline, while pancreatic fat increased above baseline.
Most importantly, each 10% reduction in visceral fat achieved during the original intervention was independently associated with about 30% lower risk of developing type 2 diabetes during long-term follow-up. Visceral fat reduction was also associated with sustained improvements in insulin resistance, composite cardiometabolic risk score, and metabolic syndrome severity. These associations remained significant even after accounting for weight change, diet adherence, physical activity levels, and other clinical factors measured at follow-up.
According to Prof. Iris Shai, the study’s principal investigator from Ben-Gurion University of the Negev, dean of the School of Sustainability at Reichman University, an adjunct professor at Harvard T.H. Chan School of Public Health, and an honorary professor at Leipzig University, Germany: “These findings challenge the traditional narrative that weight regain equals clinical failure because the human body retains a cardiometabolic memory of visceral fat loss. This durable target protects against systemic aging and metabolic decay long after a diet ends, suggesting that every successful period of healthy living leaves behind a mark of protection within the visceral fat cells. Our findings indicate that visceral fat reduction, rather than weight loss alone, may be a key target for long-term cardiometabolic health and lower future type 2 diabetes risk”.
The study is based on the Follow Interventions Trials (FIT) project, a unique long-term follow-up of participants from two 18-month randomized controlled dietary trials, CENTRAL and DIRECT-PLUS. These trials explored lifestyle strategies including low-fat, healthy dietary guidelines, and Mediterranean diet variants (standard, low-carbohydrate, and polyphenol-enriched “green” Mediterranean diets), combined with structured physical activity. Researchers invited participants for repeat clinical assessments and MRI scans five and ten years after trial completion, measuring visceral fat, deep and superficial subcutaneous fat, liver fat, and pancreatic fat.
The FIT study sets a new gold standard in high-resolution adiposity phenotyping by moving beyond the limitations of BMI to map the mobilization of "hidden" internal fat pools. Utilizing high-field 3.0-Tesla MRI, researchers achieved precise quantification of deep abdominal layers. The methodology allowed for the granular separation of abdominal fat into visceral, deep subcutaneous, and superficial layers, while simultaneously quantifying ectopic deposits in the liver and pancreas.
Hadar Klein, RD MSc, a doctoral student and lead author, explains the clinical significance: “Our findings suggest that not all weight loss is equal. Reducing visceral fat may have a more lasting impact on metabolic health than changes in body weight alone, and may help support healthier aging over time”.
Visceral fat is increasingly recognized as a central driver of insulin resistance, dyslipidemia, and cardiometabolic disease. In this study, it was the only fat deposit whose loss consistently predicted lower future type 2 diabetes risk: a 5% reduction in visceral fat was linked to a 17% lower risk, a 10% reduction to a 30% lower risk, a 15% reduction to about a 40% lower risk, and a 20% reduction to nearly a 50% lower risk. Other fat deposits, including deep and superficial subcutaneous fat and fat in the liver and pancreas, showed some association with later metabolic markers, but not with future diabetes risk.
The trials were conducted at Ben-Gurion University of the Negev, Israel, together with researchers from Harvard, Leipzig, and Tulane and in collaboration with the Dimona Nuclear Research Center, Briuta Medical Center, and Soroka University Medical Center.
This work was supported by grants from the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation Grants No. – EXC-3105/1 and SFB-1052/B11). Funding providers did not participate in any stage of the study's design, conduct, or analysis, and they had no access to the study results before publication.
“Lifestyle-induced visceral fat loss- a key target for durable cardiometabolic health; 5- and 10-year MRI-assessed Follow Interventions Trials (FIT) after two clinical trials” Circulation 2026
Hadar Klein RD MSc1*, Liav Alufer RD MSc1*, Dana Tamar Goldberg Toren RD MSc1*, Dafna Pachter RD PhD1, Omer Kamer RD MSc1, Noa Ebstein Karamani B.Med.Sc1, Yoash Chassidim PhD2, Ilan Shelef MD3, Assaf Rudich MD PhD4,5, Uri Yoel MD3,6, Gal Ben-Arie MD3, Hila Zelicha RD PhD1, Anat Yaskolka Meir RD PhD1, Gal Tsaban MD MPH1, Carmi Bartal MD7, Matthias Blüher MD8, Michael Stumvoll MD PhD9, Uta Ceglarek PhD10, Berend Isermann MD PhD10, Lu Qi MD PhD11,12, Meir J Stampfer MD DrPH11, Frank B Hu MD PhD11, Iris Shai† RD PhD1,9,11,13
* Equal contributions
† Corresponding author: Prof. Iris Shai
1 The Health & Nutrition Innovative International Research Center, Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, 8410501, Israel
2 Department of Engineering, Sapir Academic College, Shaar Hanegev, Israel
3 Soroka University Medical Center, Beer-Sheva, Israel
4 Department of Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
5 The National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beer-Sheva, Israel
6 Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
7 Briuta Care Medical Center, Beer-Sheva, Israel
8 Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany
9 Department of Medicine, University of Leipzig, Germany
10 University of Leipzig Medical Center, Institute of Laboratory Medicine, Leipzig, cc
11 Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
12 Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
13 School of Sustainability, Reichman University, Israel
