Relationships between estimates of adiposity, insulin resistance, and nonalcoholic fatty liver disease in a large group of nondiabetic Korean adults.
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.
Sung
Ki Chul
KC
Division of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, Pyung Dong, Jongro-Ku, Seoul, Korea 110-746. kcmd.sung@samsung.com
Ryan
Marno C
MC
Kim
Bum Soo
BS
Cho
Yong Kyun
YK
Kim
Byung Ik
BI
Reaven
Gerald M
GM
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*
D007328:Insulin; D000410:Alanine Transaminase