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

  1. Ki Chul Sung, MD12,
  2. Marno C. Ryan, MD2,
  3. Bum Soo Kim, MD1,
  4. Yong Kyun Cho, MD1,
  5. Byung Ik Kim, MD1 and
  6. Gerald M. Reaven, MD2
  1. 1Division of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
  2. 2Division of Medicine, Stanford University Medical Center, Stanford, California
  1. Address correspondence and reprint requests to Ki Chul Sung, MD, Kangbuk Samsung Hospital, Sungkyunkwan University, Pyung Dong, Jongro-Ku, Seoul, Korea 110-746. E-mail: kcmd.sung{at}


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

RESEARCH DESIGN AND METHODS—Abdominal ultrasound, hepatitis serology, and measurements of fasting plasma insulin (FPI), lipid concentrations, overall obesity (BMI), and abdominal obesity (waist circumference) were performed in 56,249 Korean subjects.

RESULTS—After rigorous exclusion criteria, 36,654 nondiabetic subjects (54% male) were enrolled. Subjects were divided into control (no fatty liver on ultrasound, serum alanine aminotransferase [ALT] <30 units/l [men] or <19 units/l [women]), fatty liver with normal ALT (FL-NALT), and fatty liver with a high ALT (FL-HALT) groups. After adjusting for age, BMI, and waist circumference, FPI and ratio of triglycerides to HDL cholesterol (TG/HDL-C ratio) were significantly higher in the FL-NALT than in the control group and even higher 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 five- to sevenfold over those of the control group, independent of age, BMI, and waist circumference.

CONCLUSIONS—In this large population of individuals of Korean ancestry, results indicate that while overall (BMI) and abdominal (waist circumference) 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 waist circumference.


  • Published ahead of print at on 7 May 2007. DOI: 10.2337/dc07-0512.

    K.C.S. and M.C.R. contributed equally to this article.

    A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Accepted April 26, 2007.
    • Received March 14, 2007.
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  1. Diabetes Care vol. 30 no. 8 2113-2118
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