**2. Visceral adiposity, liver fat, and cardiovascular risk**

There is a strongly correlation between overall obesity and abdominal obesity; although, there are two kinds of patients: either the ones with overall obesity but not abdominal obesity.

Abdominal obesity is linked to increased cardiovascular diseases. Along these lines, there still exists underdiagnosis to classify the CVD risk among obese patients. Trying to unmask and making a good clinical patient evaluation, organizations, expert panels, and a lot of evidence support have shown and recommended the waist circumference (WC) measurements with body mass index (BMI) applied in the clinical practice may add critical information and successful prediction of cardiovascular risk and mortality focusing on visceral adiposity.

Fortunately imaging techniques can be used to quantify adipose tissue and ectopic fat depots volumes. The National Library of Medicine described the adipose tissue as a storage of energy in the form of triacylglycerols and ectopic fat depots and is defined by excess adipose tissue in locations not classically associated with adipose tissue storage, some fat depots are more linked to risk factors for disease than others. Techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) are extraordinary and the most advanced in the study of human body composition and of its relationship with CVD risk. However, other techniques such as bio-impedance body composition are more available in the practice [5].

The abdominal adiposity can be divided into: obesity, subcutaneous, and visceral obesity. Overweight or obese patients with low levels of visceral adipose tissue (VAT) have been identified as having a more favorable cardiovascular risk profile, commonly known as metabolically healthy obese patients. Some recent data suggest that metabolically healthy obesity may be a transitory phenotype, the time of which may be variable by race, ethnicity, and gender. The relationship between visceral adipose tissue and cardiovascular risk is known, the first one being a clear accelerator for the development of cardiovascular diseases.

The concept called adipose tissue expandability refers to the ability of the adipocyte to be contained in the places where it normally lives. When this expansion capacity of adipose tissue is exceeded, it begins to be located in organs abnormally, developing diseases such as hepatic steatosis, which is directly related to a higher risk of developing cardiovascular events. Thus, it is important to identify that patients with increased visceral adiposity are the ones with the highest risk independent of weight.
