title: Body Fat Distribution and Risk of Incident and Regressed Nonalcoholic Fatty Liver Disease.
abstract: OBJECTIVE
  Some studies have examined correlations between visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) with nonalcoholic fatty liver disease (NAFLD) or between VAT and NAFLD. We investigated the longitudinal association between body fat distribution (VAT vs SAT) and incidence and regression of NAFLD, adjusting for risk factors, in a large population-based cohort.
  
  
  METHODS
  We collected data from adults who underwent abdominal ultrasonography (to identify liver fat), abdominal fat computed tomography scan, and blood tests from March 2007 through December 2008. Each patient underwent an anthropometric assessment and completed a questionnaire about their medical history, physical activity, and diet. Our final analysis involved 2017 subjects from the initial cohort who participated in a voluntary follow-up health screen performed in 2011 and 2013. The median follow-up time was 4.43 years.
  
  
  RESULTS
  We found 288 incident cases of NAFLD; 159 patients had NAFLD regression during the follow-up period. An increasing area of VAT was associated with higher incidence of NAFLD in the multivariable analysis (highest quintile vs lowest quintile of VAT hazard ratio [HR], 2.23; 95% confidence interval [CI], 1.28-3.89; P for trend = .002; HR, 1.36 [per 1 standard deviation]; 95% CI, 1.16-1.59). An increased area of SAT was significantly associated with regression of NAFLD (highest quintile vs lowest quintile of SAT HR, 2.30; 95% CI, 1.28-4.12; P for trend = .002; HR, 1.36 [per 1 standard deviation]; 95% CI, 1.08-1.72).
  
  
  CONCLUSIONS
  In a large cohort study, larger areas of VAT were longitudinally associated with higher risk of incident NAFLD (during a period of approximately 4 years). In contrast, larger areas of SAT were longitudinally associated with regression of NAFLD. These data indicate that certain types of body fat are risk factors for NAFLD, whereas other types could reduce risk for NAFLD.
authors.affiliation: Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea; Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California. Electronic address: messmd@chol.com.
authors.forename: Donghee
authors.initials: D
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea.
authors.forename: Goh Eun
authors.initials: GE
authors.lastname: Chung
authors.affiliation: Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea.
authors.forename: Min-Sun
authors.initials: MS
authors.lastname: Kwak
authors.affiliation: Department of Radiology, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea.
authors.forename: Hyo Bin
authors.initials: HB
authors.lastname: Seo
authors.affiliation: Department of Radiology, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea.
authors.forename: Jin Hwa
authors.initials: JH
authors.lastname: Kang
authors.affiliation: Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Won
authors.initials: W
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Yoon Jun
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Jung-Hwan
authors.initials: JH
authors.lastname: Yoon
authors.affiliation: Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hyo-Suk
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Chung Yong
authors.initials: CY
authors.lastname: Kim
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000886:Anthropometry; D001774:Blood Chemical Analysis; D050218:Body Fat Distribution; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000453:epidemiology*; D011860:Radiography, Abdominal; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D055815:Young Adult
keywords: BMI; Marker; NASH; Prognosis; Steatosis