title: Risk of nonalcoholic steatohepatitis and fibrosis in patients with nonalcoholic fatty liver disease and low visceral adiposity.
abstract: OBJECTIVE
  Increased visceral adiposity is considered the hallmark of the metabolic syndrome, whose hepatic manifestation is nonalcoholic fatty liver disease (NAFLD), although a subset of patients does not have visceral obesity. Our study aimed to compare metabolic alterations and liver damage in patients with NAFLD with and without visceral obesity.
  
  
  METHODS
  Four hundred and thirty one consecutive patients with liver biopsy-confirmed NAFLD were divided in three groups according to waist circumference, the simplest surrogate marker of visceral obesity. One hundred and thirty three patients (31%) had a waist circumference ≤94 (males) and ≤80 cm (females) (group A), 157 (36%) between 94 and 102, and 80 and 88 (B), and the remaining 141 (33%) had values higher than 102 and 88 cm (C).
  
  
  RESULTS
  Significant trends for older age, higher prevalence of female gender, lower HDL, higher triglycerides, altered glucose metabolism, hypertension, and metabolic syndrome were observed with increasing visceral adiposity. In contrast, non-alcoholic steatohepatitis (NASH) detected in 55% and 72% of patients with normal and increased waist circumference, respectively, and the presence of fibrosis ≥2 were not associated with visceral adiposity. Alanine aminotransferase (ALT), ferritin, HOMA-IR >4, and severe steatosis were independently associated with NASH, whereas ferritin and impaired glucose tolerance were associated with fibrosis ≥2.
  
  
  CONCLUSIONS
  Patients with normal waist circumference, despite milder metabolic alterations, may have NASH and are at risk of developing fibrosis, suggesting that once NAFLD is present, visceral obesity is not a major determinant of liver damage severity.
authors.affiliation: Dipartimento di Medicina Interna, Centro Studi Malattie Metaboliche del Fegato, Università degli Studi di Milano, Ospedale Maggiore Policlinico, IRCCS, Fondazione Ca' Granda, Milano, Italy.
authors.forename: Anna Ludovica
authors.initials: AL
authors.lastname: Fracanzani
authors.forename: Luca
authors.initials: L
authors.lastname: Valenti
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Bugianesi
authors.forename: Ester
authors.initials: E
authors.lastname: Vanni
authors.forename: Antonio
authors.initials: A
authors.lastname: Grieco
authors.forename: Luca
authors.initials: L
authors.lastname: Miele
authors.forename: Dario
authors.initials: D
authors.lastname: Consonni
authors.forename: Erika
authors.initials: E
authors.lastname: Fatta
authors.forename: Rosa
authors.initials: R
authors.lastname: Lombardi
authors.forename: Giulio
authors.initials: G
authors.lastname: Marchesini
authors.forename: Silvia
authors.initials: S
authors.lastname: Fargion
mesh_terms: D050154:Adiposity; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D005234:Fatty Liver / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D050152:Intra-Abdominal Fat / Q000473:pathology; D008055:Lipids / Q000097:blood; D008103:Liver Cirrhosis / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D056128:Obesity, Abdominal / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D012307:Risk Factors; D055105:Waist Circumference
chemical_list: D008055:Lipids; D000410:Alanine Transaminase