Digestive Diseases and Sciences

, Volume 40, Issue 9, pp 2002–2009 | Cite as

Prevalence of fatty liver in Japanese children and relationship to obesity

An epidemiological ultrasonographic survey
  • Kunihiko Tominaga
  • John H. Kurata
  • Yang K. Chen
  • Edward Fujimoto
  • Shouhei Miyagawa
  • Ichiro Abe
  • Yoshimasa Kusano
Growth, Development, and Nutrition


The prevalence of fatty liver in children is unknown and its relationship to obesity is poorly defined. The present study of 810 northern Japanese children (4–12 years old) determined the prevalence of fatty liver in the pediatric population and its relationship to obesity. Diagnosis of fatty liver was based on established real-time ultrasonographic criteria. The overall prevalence of fatty liver was 2.6% and was higher for boys (3.4%) than for girls (1.8%), although not statistically significant (P=0.15). Fatty liver was found in children as young as 6 years of age. There was no significant association between the prevalence of fatty liver and height (physical growth). There was a strong positive correlation between fatty liver prevalence and established obesity indices: Rohrer's index-χ2 linear trend =59.2,P<0.0001; body mass index-χ2 linear trend =91.6,P<0.0001; and age-gender-adjusted Japanese standard index of weight for height-χ2 linear trend =93.2,P<0.0001. However, direct measurement of abdominal subcutaneous fat thickness by ultrasonography was the best predictor of fatty liver: χ2 linear trend =159,P<0.0001. These results indicate that fatty liver may develop very early in life, and there is a direct relationship between degree of obesity and fatty liver in children.

Key Words

fatty liver obesity children ultrasonography obesity index abdominal subcutaneous fat thickness 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Anderson T, Gluud C: Liver morphology in morbid obesity: A literature study. Int J Obes 8:97–106, 1984PubMedGoogle Scholar
  2. 2.
    Zelman S, Kan T: The liver in obesity. Arch Intern Med 90:141–156, 1952Google Scholar
  3. 3.
    Hornboll P, Olsen TS: Fatty changes in the liver: The relation to age, overweight and diabetes mellitus. Acta Pathol Microbiol Immunol Scand 90:199–205, 1982Google Scholar
  4. 4.
    Hodgson M, van Tiel DH, Goodman-Klein B: Obesity and hepatotoxins as risk factors for fatty liver disease. Br J Ind Med 48:690–695, 1991PubMedGoogle Scholar
  5. 5.
    Berkowitz D: Metabolic changes associated with obesity before and after weight reduction. JAMA 187:399–403, 1964PubMedGoogle Scholar
  6. 6.
    Nomura F, Ohnishi K, Ochiai T, Okuda K: Obesity-related nonalcoholic fatty liver: CT features and follow-up studies after low-calorie diet. Radiology 162:845–847, 1987PubMedGoogle Scholar
  7. 7.
    Murata M, Yamazaki K, Itani A, Inaba M: Age-gender-height adjusted Japanese standardized weight: Based on 5–17 year old child population. Shoni Hoken Kenkyu 39:93–96, 1980 (in Japanese)Google Scholar
  8. 8.
    Murata M, Kusunoki T, Okuni M, Takano A, Takaishi M, Imamura E: Age-gender-height adjusted Japanese standardized weight for height in Japanese infant aged 1–6 years. Shoni Hoken Kenkyu 46:52–57, 1987 (in Japanese)Google Scholar
  9. 9.
    Tokunaga K, Matsuzawa Y, Ishikawa K, Tarui S: A novel technique for the determination of body fat by computed tomography. Int J Obes 7:437–445, 1983PubMedGoogle Scholar
  10. 10.
    Borkan GA, Hults DE: Relationships between computed tomorgraphy tissue areas, thickness and total body composition. Ann Hum Biol 10:537–545, 1983PubMedGoogle Scholar
  11. 11.
    Weits T, Van Der Beek EJ, Wedel M, Terhaarromeny BM: Computed tomography measurement of abdominal fat deposition in relation to anthropometry. Int J Obes 12:217–225, 1988PubMedGoogle Scholar
  12. 12.
    Yajima Y, Ohta K, Narui T, Abe R, Suzuki H, Ohtsuki M: Ultrasonographical diagnosis of fatty liver: Significance of the liver-kidney contrast. Tohoku J Exp Med 139:43–50, 1983PubMedGoogle Scholar
  13. 13.
    Saverymuttu SH, Joseph AEA, Maxwell JD: Ultrasound scanning in the detection of hepatic fibrosis and steatosis. Br Med J 292:13–15, 1986Google Scholar
  14. 14.
    Nomura H, Kashiwagi S, Hayashi J, Kajiyama W, Ikematsu H, Noguchi A, Tani S, Goto M: Prevalence of gallstone disease in a general population of Okinawa, Japan. Am J Epidemiol 128:598–605, 1986Google Scholar
  15. 15.
    Debongnie JC, Pauls C, Fievez M, Wibin E: Prospective evaluation of the diagnostic accuracy of liver ultrasonography. Gut 22:130–135, 1981PubMedGoogle Scholar
  16. 16.
    Kramer MS, Feinstein AR: Clinical biostatistics: LIV. The biostatistics of concordance. Clin Pharmacol Ther 29:111–123, 1981PubMedGoogle Scholar
  17. 17.
    Cicchetti DV, Fleiss JL: Comparison of the null distributions of weighted kappa and the C ordinal statistic. Appl Psychol Meas 1:195–201, 1978Google Scholar
  18. 18.
    Cochran WG: Some methods for strengthening the common chi-square tests: The regression test based on χ2. Biometrics 10:417–451, 1954Google Scholar
  19. 19.
    Shirai K, Shinomiya M, Saito Y, Umezono T, Takahash K, Yoshida S: Incidence of childhood obesity over the last 10 years in Japan.In World Data Book of Obesity. S Baba, P Zimmet (eds). New York: Elsevier Science Publishers, 1990, pp 65–70Google Scholar
  20. 20.
    Tiwary CM, Holguin AH: Prevalence of Obesity among children of military dependents at two major medical centers. Am J Public Health 82:354–357, 1992PubMedGoogle Scholar
  21. 21.
    Gortmaker SL, Dietz WH, Sobol AM, Wehler CA: Increasing pediatric obesity in the United States. Am J Dis Child 141:535–540, 1987PubMedGoogle Scholar
  22. 22.
    Kolata G: Obese children: A growing problem. Science 232:20–21, 1986PubMedGoogle Scholar
  23. 23.
    Pi-Sunyer FX: Medical hazards of obesity. Ann Intern Med 119:655–660, 1993PubMedGoogle Scholar
  24. 24.
    Charney E, Goodman HC, McBridge M, Lyon B, Pratt R: Childhood antecedents of adult obesity: Do chubby infants become obese adults? N Engl J Med 295:6–9, 1976PubMedGoogle Scholar
  25. 25.
    Mossberg HO: 40-year follow-up of overweight children. Lancet 2:491–493, 1989PubMedGoogle Scholar
  26. 26.
    Brook CGD: Evidence for a sensitive period in adipose-cell replication in man. Lancet 23:624–627, 1972Google Scholar
  27. 27.
    Holzbach RT: Nonalcoholic fatty liver: Structural and clinical implications. Cleveland Clin J Med 55:136–144, 1988Google Scholar
  28. 28.
    Kinugasa A, Tsunamoto K, Furukawa N, Sawada T, Kusunoki T, Shimada N: Fatty liver and its fibrous changes found in simple obesity of children. J Pediatr Gastroenterol Nutr 3:408–414, 1984PubMedGoogle Scholar
  29. 29.
    Yajima Y, Miyazaki Y, Onodera H, et al: Epidemiology of fatty liver. Jpn J Enterogastrol 83:2139–2144, 1986 (in Japanese with English abstract)Google Scholar
  30. 30.
    Liu T, Lu S, Su W, Chang W, et al: Prediction of fatty liver from serum triglyceride levels and body weight indexes. Kaohsiung J Med Sci 6:289–294, 1990Google Scholar
  31. 31.
    Endo H, Uemasu F, Nozue T, Saeki A, Yamamoto I, Takagi Y, Kobayashi A: Relationship between fat distribution and fatty liver in obese children. Proceedings of the 12th Congress of Japanese Society for the Study of Obesity, 1991, pp 298–299 (in Japanese)Google Scholar
  32. 32.
    Welin L, Svärdsudd K, Wilhelmsen L, Larsson B, Tibblin G: Analysis of risk factors for stroke in a cohort of men born in 1931. N Engl J Med 317:521–526, 1987PubMedGoogle Scholar
  33. 33.
    Larsson B: Obesity, fat distribution and cardiovascular disease. Int J Obes 15:53–57, 1991PubMedGoogle Scholar
  34. 34.
    Donahue RP, Abbott RD, Bloom E, Reed DW, Yano K: Central obesity and coronary heart disease in men. Lancet 2:1215, 1987Google Scholar
  35. 35.
    Ohlsson LO, Larsson B, Svärdsudd K, Welin L, Eriksson H, Wilhelmsen L, Björntorp P, Tibblin G: The influence of body fat distribution on the incidence of diabetes mellitus: 13.5 years follow-up of the participants in the study of men born in 1913. Diabetes 34:1055–1058, 1985PubMedGoogle Scholar
  36. 36.
    Freedman DS, Srinivasan SR, Burke GL, Shear CL, Smoak CG, Harsha DW, Webber LS, Berenson GS: Relation of body fat distribution to hyperinsulinemia in children and adolescents: The Bogalusa heart study. Am J Clin Nutr 46:403–410, 1987PubMedGoogle Scholar
  37. 37.
    Drash A: Relationship between diabetes mellitus and obesity in the child. Metabolism 22:337–344, 1973PubMedGoogle Scholar
  38. 38.
    Tokunaga K, Ishikawa K, Sudo H, Matsuzawa Y, Yamamoto A, Tarui S: Serum lipoprotein profile in Japanese obese children. Int J Obes 6:399–404, 1982PubMedGoogle Scholar
  39. 39.
    Rames LK, Clarke WR, Connor WE, Reiter MA, Lauer RM: Normal blood pressure and the evaluation of sustained blood pressure evaluation in childhood: The Muscatine study. Pediatrics 61:245–251, 1978PubMedGoogle Scholar
  40. 40.
    Saito Y, Yagyuk K, Hattori Y, Ohno K, et al: A study on fatty liver in health examination participants. Jpn J Hyg 44:953–961, 1989 (in Japanese with English abstract)Google Scholar
  41. 41.
    Nomura H, Kawagishi S, Hayashi J, Kaiyama W, Tani S, Goto M: Prevalence of fatty liver in a general population of Okinawa, Japan. Jpn J Med 27:142–149, 1988Google Scholar
  42. 42.
    Enzi G, Biondetti PR, Flore D, Semisa M, Zurlo F: Subcutaneous and visceral fat distribution according to sex, age, and overweight, evaluated by computed tomography. Am J Clin Nutr 44:739–746, 1986PubMedGoogle Scholar
  43. 43.
    Kral JG, Schaffner F, Pierson RN, Wang J: Body fat topography as an independent predictor of fatty liver. Metabolism 42:548–551, 1993PubMedGoogle Scholar
  44. 44.
    Matsuzawa Y, Fujioka S, Tokunaga K, Tarui S: Classification of obesity with respect to morbidity. Asian Med J 32:435–441, 1989Google Scholar

Copyright information

© Plenum Publishing Corporation 1995

Authors and Affiliations

  • Kunihiko Tominaga
    • 1
    • 2
  • John H. Kurata
    • 1
    • 2
  • Yang K. Chen
    • 1
    • 2
  • Edward Fujimoto
    • 1
    • 2
  • Shouhei Miyagawa
    • 1
    • 2
  • Ichiro Abe
    • 1
    • 2
  • Yoshimasa Kusano
    • 1
    • 2
  1. 1.Loma Linda University School of Public Health and Division of GastroenterologyLoma Linda
  2. 2.Department of Health EducationTokyo Adventist HospitalTokyoJapan

Personalised recommendations