title: The impact of fat distribution on the severity of nonalcoholic fatty liver disease and metabolic syndrome.
abstract: The patterns of fat distribution and their relationship to severity of nonalcoholic fatty liver disease (NAFLD) are unknown. The objectives of this study were to define the fat distribution patterns and their relationship to histological severity and metabolic parameters in subjects with NAFLD. Anthropometric indices and total body fat were measured in 123 subjects. Fat distribution patterns were defined as: general, abdominal, limb, truncal, and dorsocervical lipohypertrophy (DCL) a novel finding in NAFLD. Eighty-one (66%) of the subjects were obese, and 94 (76%) had abdominal obesity. Thirty-five (28.5%) had DCL. Whereas body mass index (BMI) correlated best with the presence of diabetes (r = 0.22, P < 0.05), waist circumference (WC) correlated best with hypertension (r = 0.2, P < 0.05), hypertriglyceridemia (r = 0.37, P < 0.001), and insulin resistance (homeostasis model of assessment for insulin resistance [r = 0.68, P < 0.0001]). None of the patterns of fat distribution were significantly associated with severity of hepatic steatosis. Abdominal obesity (WC) correlated with inflammation (r = 0.2, P < 0.05) only. DCL correlated significantly with the severity of all histological parameters except steatosis. Whereas DCL was the single greatest contributor to the variability in severity of histological parameters, a model combining BMI, WC, and DCL showed the greatest contribution to the variability in severity of individual histological parameters. The addition of steatosis grade to the model significantly increased its contribution to the range of lobular inflammation.
  
  
  CONCLUSIONS
  WC predicts metabolic risk profile with the most significance. However, DCL is most strongly associated with severity of steatohepatitis. WC and BMI added modestly to the contribution of DCL to severity of nonalcoholic steatohepatitis.
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Richmond, VA 23298, USA.
authors.forename: Onpan
authors.initials: O
authors.lastname: Cheung
authors.forename: Ashwani
authors.initials: A
authors.lastname: Kapoor
authors.forename: Puneet
authors.initials: P
authors.lastname: Puri
authors.forename: Sakita
authors.initials: S
authors.lastname: Sistrun
authors.forename: Velimir A
authors.initials: VA
authors.lastname: Luketic
authors.forename: Carol C
authors.initials: CC
authors.lastname: Sargeant
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Contos
authors.forename: Mitchell L
authors.initials: ML
authors.lastname: Shiffman
authors.forename: Richard T
authors.initials: RT
authors.lastname: Stravitz
authors.forename: Richard K
authors.initials: RK
authors.lastname: Sterling
authors.forename: Arun J
authors.initials: AJ
authors.lastname: Sanyal
mesh_terms: D001706:Biopsy; D050218:Body Fat Distribution / Q000009:adverse effects*; D015992:Body Mass Index; D005234:Fatty Liver / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D015228:Hypertriglyceridemia / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D007333:Insulin Resistance / Q000502:physiology; D008099:Liver / Q000473:pathology; D008297:Male; D024821:Metabolic Syndrome / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology*; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D012720:Severity of Illness Index; D049629:Waist-Hip Ratio