Liver Fat Is Increased in Type 2 Diabetic Patients and Underestimated by Serum Alanine Aminotransferase Compared With Equally Obese Nondiabetic Subjects

  1. Anna Kotronen, MB12,
  2. Leena Juurinen, MD1,
  3. Antti Hakkarainen, BSC3,
  4. Jukka Westerbacka, MD, PHD1,
  5. Anja Cornér, MD1,
  6. Robert Bergholm, MD, PHD12 and
  7. Hannele Yki-Järvinen, MD, PHD, FRCP1
  1. 1Division of Diabetes, University of Helsinki, Helsinki, Finland
  2. 2Minerva Medical Research Institute, Helsinki, Finland
  3. 3Helsinki Medical Imaging Centre, Hospital District of Helsinki and Uusimaa, Helsinki, Finland
  1. Address correspondence and reprint requests to Anna Kotronen, MB, Division of Diabetes, University of Helsinki, Helsinki, Finland, P.O. Box 700, Room C418B, FIN 00029 HUCH, Helsinki, Finland. E-mail: anna.kotronen{at}


OBJECTIVE—The purpose of this study was to determine whether type 2 diabetic patients have more liver fat than age-, sex-, and BMI-matched nondiabetic subjects and whether liver enzymes (serum alanine aminotransferase [S-ALT] and serum aspartate aminotransferase) are similarly related to liver fat in type 2 diabetic patients and normal subjects.

RESEARCH DESIGN AND METHODS—Seventy type 2 diabetic patients and 70 nondiabetic subjects matched for BMI, age, and sex were studied. Liver fat (1H-magnetic resonance spectroscopy), body composition (magnetic resonance imaging), and biochemical markers of insulin resistance were measured.

RESULTS—The type 2 diabetic patients had, on average, 80% more liver fat and 16% more intra-abdominal fat than the nondiabetic subjects. The difference in liver fat between the two groups remained statistically significant when adjusted for intra-abdominal fat (P < 0.05). At any given BMI or waist circumference, the type 2 diabetic patients had more liver fat than the nondiabetic subjects. The difference in liver fat between the groups rose as a function of BMI and waist circumference. Fasting serum insulin (r = 0.55, P < 0.0001), fasting plasma glucose (r = 0.29, P = 0.0006), A1C (r = 0.34, P < 0.0001), fasting serum triglycerides (r = 0.36, P < 0.0001), and fasting serum HDL cholesterol (r = −0.31, P = 0.0002) correlated with liver fat similarly in both groups. The slopes of the relationships between S-ALT and liver fat were significantly different (P = 0.004). Liver fat content did not differ between the groups at low S-ALT concentrations (10–20 units/l) but was 70–200% higher in type 2 diabetic patients compared with control subjects at S-ALT concentrations of 50–200 units/l.

CONCLUSIONS—Type 2 diabetic patients have 80% more liver fat than age-, weight-, and sex-matched nondiabetic subjects. S-ALT underestimates liver fat in type 2 diabetic patients.


  • Published ahead of print at on 12 October 2007. DOI: 10.2337/dc07-1463.

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

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    • Accepted October 6, 2007.
    • Received July 29, 2007.
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  1. Diabetes Care vol. 31 no. 1 165-169
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