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Relationships Between Estimates of Adiposity, Insulin Resistance and Nonalcoholic Fatty Liver Disease in a Large Group of Nondiabetic Korean Adults

¹ Division of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
² Division of Medicine, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA, 94305 USA

kcmd.sung{at}samsung.com

ABSTRACT

Background:Nonalcoholic fatty liver disease (NAFLD) is emerging as a major health problem in parallel with an increasing prevalence of obesity. Insulin resistance, abdominal and overall adiposity are closely associated with NAFLD; however the interplay between these in the relationship with NAFLD is unclear, especially in nondiabetic individuals.

Methods:Measurements were made in 56,249 Korean subjects of abdominal ultrasound, fasting plasma insulin (FPI) and lipid concentrations, hepatitis serology, overall obesity (body mass index, BMI), and abdominal obesity (waist circumference, WC).

Results:After rigorous exclusion criteria, 36,654 nondiabetic subjects (54% men) were enrolled. Subjects were divided into controls (no fatty liver on ultrasound, serum ALT<30U/L(men) or <19U/L (women)), fatty liver with normal ALT ("FL-NALT") and fatty liver with a high ALT ("FL-HALT"). After adjusting for age, BMI and WC, FPI concentrations and the concentration ratio of triglyceride/high -density lipoprotein cholesterol (TG/HDL-C) were still significantly higher in the FL-NALT group, and higher again 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 5-7 fold over controls, independent of age, BMI and WC.

Conclusions:In this large population of individuals of Korean ancestry, results indicate that whilst overall (BMI) and abdominal (WC) 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 WC.

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