title: Hepatic steatosis in overweight/obese females: new screening method for those at risk.
abstract: OBJECTIVE
  To identify which parameters could help to distinguish the "metabolically benign obesity", which is not accompanied by insulin resistance (IR) and early atherosclerosis.
  
  
  METHODS
  Eighty two of 124 overweight/obese females formed the study population, which was divided into two groups (52 and 30 subjects, respectively) with and without IR according to a HO meostatic Metabolic Assessment (HOMA) cut-off of 2, and were studied in a cross-sectional manner. The main outcome measures were waist circumference, serum uric acid, high-density lipoprotein-cholesterol and triglycerides, alanine aminotransferase, blood pressure and the two imaging parameters, hepatic steatosis and longitudinal diameter of the spleen, which were measured in relation to the presence/absence of IR.
  
  
  RESULTS
  A variable grade of visceral obesity was observed in all subjects with the exception of three. Obesity of a severe grade was represented more in the group of IR individuals (P = 0.01). Hepatic steatosis, revealed at ultrasound, was more pronounced in IR than in non-IR subjects (P = 0.005). The two groups also demonstrated a clear difference in longitudinal spleen diameter and blood pressure, with raised and significant values in the IR group. Metabolic syndrome was frequent in the IR group, and was not modified when adjusted for menopause (P = 0.001). At linear regression, the beta values of waist circumference and body mass index predicting HOMA were 0.295, P = 0.007 and 0.41, P = 0.0001, respectively. Measures of spleen longitudinal diameter were well predicted by body mass index (BMI) values, beta = 0.35, P = 0.01, and by HOMA, beta = 0.41, P = 0.0001. Blood pressure was predicted by HOMA values, beta = 0.39, P = 0.0001). HOMA and hepatic steatosis were highly associated (rho = 0.34, P = 0.002). Interestingly, IR patients were almost twice as likely to have hepatic steatosis as non-IR patients. Among the MS criteria, blood pressure was very accurate in identifying the presence of IR (AUROC for systolic blood pressure 0.66, cut-off 125 mm of Hg, sensibility 64%, specificity 75%; AUROC for diastolic blood pressure 0.70, cut-off 85 mm of Hg, sensibility 54.5%, specificity 75%).
  
  
  CONCLUSIONS
  As health care costs are skyrocketing, reliable and mainly inexpensive tools are advisable to better define subjects who really need to lose weight.
authors: Department of Clinical and Experimental Medicine, Section of Hepatology in Internal Medicine, Federico II University Medical School of Naples, Naples, Italy. tarantin@unina.it
authors: Giovanni
authors: G
authors: Tarantino
authors: Genoveffa
authors: G
authors: Pizza
authors: Annamaria
authors: A
authors: Colao
authors: Fabrizio
authors: F
authors: Pasanisi
authors: Paolo
authors: P
authors: Conca
authors: Patrizia
authors: P
authors: Colicchio
authors: Carmine
authors: C
authors: Finelli
authors: Franco
authors: F
authors: Contaldo
authors: Carolina
authors: C
authors: Di Somma
authors: Silvia
authors: S
authors: Savastano
mesh_terms: D000293:Adolescent; D000328:Adult; D050197:Atherosclerosis / Q000209:etiology; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D001835:Body Weight; D005234:Fatty Liver / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology; D008297:Male; D008403:Mass Screening / Q000379:methods*; D024821:Metabolic Syndrome / Q000209:etiology; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D050177:Overweight / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D013154:Spleen / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D014463:Ultrasonography; D055815:Young Adult