Associations between visceral adipose tissue, inflammation and sex steroid concentrations in men

Clin Endocrinol (Oxf). 2013 Mar;78(3):373-8. doi: 10.1111/j.1365-2265.2012.04401.x.


Context: In men, obesity and the metabolic syndrome are accompanied by decreased testosterone levels, but little is known about the associations between visceral adipose tissue (VAT), VAT-related inflammation and sex steroids.

Objective: To examine the relative impact of VAT, abdominal subcutaneous adipose tissue (SAT) and interleukin 6 (IL-6), a marker of VAT-induced inflammation, on testosterone (T) and 17β-oestradiol (E2) levels in dysmetabolic men.

Methods: We study the NUMEVOX cohort of 229 men, aged 27-77 years, who all had at least one metabolic syndrome criterion (on average three). IL-6, C-reactive protein, Homeostasis Model Assessment of (HOMA) insulin resistance index (HOMA-IR), liver enzymes, E2, LH, sex hormone-binding globulin (SHBG), T, waist circumference and body mass index (BMI) were measured; bioavailable testosterone (BT) was calculated from T and SHBG; MRI-assessed VAT and SAT were analysed in 109 of these men.

Results: Visceral adipose tissue was strongly correlated with E2 (Spearman r = 0.38, P < 0.001) and with BT/E2 ratio (r = -0.42, P < 0.001), while SAT was not correlated with either. IL-6 was correlated with E2 (r = 0.19, P = 0.007), BT (r = -0.19, P = 0.006) and BT/E2 ratio (r = -0.30 P < 0.001). In multivariate linear analysis, the relation between VAT and E2 was independent of age, BMI (P = 0.008), leptin (P < 0.001), T and SHBG. Log(IL-6) was significantly inversely related with log(BT) (P = 0.032) independently of age, VAT, leptin and HOMA-IR.

Conclusions: 17β-oestradiol levels were positively associated with VAT, but not with SAT, while T and BT were negatively and independently associated with IL-6. The significant inverse association between IL-6 and T suggests an important role of low-grade visceral fat inflammation in the central hypogonadism associated with the metabolic syndrome.

MeSH terms

  • Adult
  • Aged
  • Estradiol / blood
  • Humans
  • Inflammation / blood
  • Inflammation / metabolism*
  • Interleukin-6 / blood
  • Intra-Abdominal Fat / metabolism*
  • Male
  • Middle Aged
  • Steroids / blood*
  • Testosterone / blood


  • Interleukin-6
  • Steroids
  • Testosterone
  • Estradiol