Trimethylamine-N-oxide (TMAO) as novel potential biomarker of early predictors of metabolic syndrome

Luigi Barrea, Giuseppe Annunziata, Giovanna Muscogiuri, Carolina Di Somma, Daniela Laudisio, Maria Maisto, Giulia de Alteriis, Gian Carlo Tenore, Annamaria Colao, Silvia Savastano

Research output: Contribution to journalArticlepeer-review


There is a mechanistic link between the gut-derived metabolite trimethylamine-N-oxide (TMAO) and obesity-related diseases, suggesting that the TMAO pathway may also be linked to the pathogenesis of obesity. The Visceral Adiposity Index (VAI), a gender-specific indicator of adipose dysfunction, and the Fatty Liver Index (FLI), a predictor of non-alcoholic fatty liver disease (NAFLD), are early predictors of metabolic syndrome (MetS). In this cross-sectional observational study, we investigated TMAO levels in adults stratified according to Body Mass Index (BMI) and the association of TMAO with VAI and FLI. One hundred and thirty-seven adult subjects (59 males; 21–56 years) were enrolled. TMAO levels were detected using HPLC/MS analysis. Homeostatic Model Assessment of Insulin Resistance (HoMA-IR), VAI and FLI were included as cardio-metabolic indices. TMAO levels increased along with BMI and were positively associated with VAI and FLI, independently, on common potential covariates. The most sensitive and specific cut-offs for circulating levels of TMAO to predict the presence of NAFLD-FLI and MetS were ≥8.02 µM and ≥8.74 µM, respectively. These findings allow us to hypothesize a role of TMAO as an early biomarker of adipose dysfunction and NAFLD-FLI in all borderline conditions in which overt MetS is not present, and suggest that a specific cut-off of TMAO might help in identifying subjects at high risk of NAFLD.

Original languageEnglish
Article number1971
Issue number12
Publication statusPublished - Dec 13 2018


  • Fatty liver index (FLI)
  • Metabolic syndrome (METS)
  • Obesity
  • Trimethylamine N-oxide (TMAO)
  • Visceral adiposity index (VAI)

ASJC Scopus subject areas

  • Food Science
  • Nutrition and Dietetics


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