title: The metabolic syndrome as a predictor of nonalcoholic fatty liver disease.
abstract: BACKGROUND
  The frequent association of nonalcoholic fatty liver disease with components of the metabolic syndrome such as obesity, hyperglycemia, dyslipidemia, and hypertension is well known. However, no prospective study has examined the role of the metabolic syndrome in the development of this disease.
  
  
  OBJECTIVE
  To characterize the longitudinal relationship between the metabolic syndrome and nonalcoholic fatty liver disease.
  
  
  METHODS
  A prospective observational study.
  
  
  METHODS
  A medical health checkup program in a general hospital.
  
  
  METHODS
  4401 apparently healthy Japanese men and women, 21 to 80 years of age, with a mean body mass index (BMI) of 22.6 kg/m2 (SD, 3.0).
  
  
  METHODS
  Alcohol intake was assessed by using a questionnaire. Biochemical tests for liver and metabolic function and abdominal ultrasonography were done. Modified criteria of the National Cholesterol Education Program Adult Treatment Panel III were used to characterize the metabolic syndrome.
  
  
  RESULTS
  At baseline, 812 of 4401 (18%) participants had nonalcoholic fatty liver disease. During the mean follow-up period of 414 days (SD, 128), the authors observed 308 new cases (10%) of nonalcoholic fatty liver disease among 3147 participants who were disease-free at baseline and who completed a second examination. Regression of nonalcoholic fatty liver disease was found in 113 (16%) of 704 participants who had the disease at baseline and who completed a second examination. Men and women who met the criteria for the metabolic syndrome at baseline were more likely to develop the disease during follow-up (adjusted odds ratio, 4.00 [95% CI, 2.63 to 6.08] and 11.20 [CI, 4.85 to 25.87], respectively). Nonalcoholic fatty liver disease was less likely to regress in those participants with the metabolic syndrome at baseline.
  
  
  CONCLUSIONS
  Ultrasonography may lead to an incorrect diagnosis of nonalcoholic fatty liver disease in 10% to 30% of cases and cannot distinguish steatohepatitis from simple steatosis. Self-reported alcohol intake may cause bias. Because all of the participants were Japanese, generalizability to non-Japanese populations is uncertain.
  
  
  CONCLUSIONS
  The metabolic syndrome is a strong predictor of nonalcoholic fatty liver disease.
authors.affiliation: Department of Gastroenterology, Asahi University, Murakami Memorial Hospital, Gifu, Japan. seele@mbox.kyoto-inet.or.jp
authors.forename: Masahide
authors.initials: M
authors.lastname: Hamaguchi
authors.forename: Takao
authors.initials: T
authors.lastname: Kojima
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Takeda
authors.forename: Takayuki
authors.initials: T
authors.lastname: Nakagawa
authors.forename: Hiroya
authors.initials: H
authors.lastname: Taniguchi
authors.forename: Kota
authors.initials: K
authors.lastname: Fujii
authors.forename: Tatsushi
authors.initials: T
authors.lastname: Omatsu
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Nakajima
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sarui
authors.forename: Makoto
authors.initials: M
authors.lastname: Shimazaki
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kato
authors.forename: Junichi
authors.initials: J
authors.lastname: Okuda
authors.forename: Kazunori
authors.initials: K
authors.lastname: Ida
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking; D005234:Fatty Liver / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications*; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014463:Ultrasonography