Abstract
PURPOSE: To investigate how lifestyle interventions alter fat distribution and organ-specific iron deposition in individuals with obesity, and whether these changes can serve as indicators of glycemic remission in obese patients with dysglycemia. METHODS: This prospective study included individuals with obesity who participated in a 6-month lifestyle intervention, which comprised a caloric-restricted balanced diet and an exercise regimen. Ultimately, 104 participants completed the follow-up phase. Magnetic resonance imaging (MRI) was utilized to monitor the dynamics of fat mobilization and organ iron deposition at baseline and 6-month follow-up. Correlation analysis, logistic regression, and receiver operating characteristic (ROC) curve analysis were employed to examine the relationships between regional fat distribution, organ iron deposition, and glycemic improvement. RESULTS: Initially, the 104 participants were divided into three categories: normal glucose regulation (NGR, n=41), prediabetes (n=23), and type 2 diabetes mellitus (T2DM, n=40). After a 6-month lifestyle change, the number of patients with T2DM and prediabetes decreased, and those with NGR increased. There were also notable decreases in liver and pancreatic fat, as well as visceral and subcutaneous fat, with the largest decrease in liver fat (-43.2%) among obese participants. There were also reductions in liver and pancreatic iron deposition after intervention. ROC curve analysis revealed that the change in liver fat was the best indicator of diabetes remission among obese participants, with an area under the curve of 0.819 (95% confidence interval [CI]: 0.681-0.957). Notably, liver fat reduction ≥38.8% predicted diabetes remission (OR=2.5, 95% CI:1.59-5.60) in individuals with obesity. CONCLUSION: Lifestyle intervention can effectively reduce ectopic fat and iron overload in individuals with obesity. The extent of hepatic fat mobilization has emerged as the most significant indicator of diabetes remission in individuals with obesity, potentially serving as a pivotal focus for future therapeutic interventions.