title: Relationships between estimates of adiposity, insulin resistance, and nonalcoholic fatty liver disease in a large group of nondiabetic Korean adults.
abstract: OBJECTIVE
  Nonalcoholic fatty liver disease (NAFLD) is emerging as a major health problem in parallel with an increasing prevalence of obesity. Insulin resistance and abdominal and overall adiposity are closely associated with NAFLD; however, the interplay between them in the relationship with NAFLD is unclear, especially in nondiabetic individuals.
  
  
  METHODS
  Abdominal ultrasound, hepatitis serology, and measurements of fasting plasma insulin (FPI), lipid concentrations, overall obesity (BMI), and abdominal obesity (waist circumference) were performed in 56,249 Korean subjects.
  
  
  RESULTS
  After rigorous exclusion criteria, 36,654 nondiabetic subjects (54% male) were enrolled. Subjects were divided into control (no fatty liver on ultrasound, serum alanine aminotransferase [ALT] <30 units/l [men] or <19 units/l [women]), fatty liver with normal ALT (FL-NALT), and fatty liver with a high ALT (FL-HALT) groups. After adjusting for age, BMI, and waist circumference, FPI and ratio of triglycerides to HDL cholesterol (TG/HDL-C ratio) were significantly higher in the FL-NALT than in the control group and even higher in the FL-HALT group. Odds ratios for the presence of FL-HALT with increasing quartiles of FPI and TG/HDL-C ratio were increased five- to sevenfold over those of the control group, independent of age, BMI, and waist circumference.
  
  
  CONCLUSIONS
  In this large population of individuals of Korean ancestry, results indicate that while overall (BMI) and abdominal (waist circumference) overweight/obesity are associated with features of NAFLD, surrogate estimates of insulin resistance, FPI concentration, and TG/HDL-C ratio predict NAFLD independently of age, BMI, and waist circumference.
authors.affiliation: Division of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, Pyung Dong, Jongro-Ku, Seoul, Korea 110-746. kcmd.sung@samsung.com
authors.forename: Ki Chul
authors.initials: KC
authors.lastname: Sung
authors.forename: Marno C
authors.initials: MC
authors.lastname: Ryan
authors.forename: Bum Soo
authors.initials: BS
authors.lastname: Kim
authors.forename: Yong Kyun
authors.initials: YK
authors.lastname: Cho
authors.forename: Byung Ik
authors.initials: BI
authors.lastname: Kim
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Reaven
mesh_terms: D000273:Adipose Tissue / Q000033:anatomy & histology*; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D015992:Body Mass Index; D049628:Body Size; D005234:Fatty Liver / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D007723:Korea / Q000453:epidemiology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000453:epidemiology*
chemical_list: D007328:Insulin; D000410:Alanine Transaminase