Pediatric Radiology

, Volume 41, Issue 9, pp 1146–1153 | Cite as

Differential effect of gender on hepatic fat

  • Vicente Gilsanz
  • Sandra A. Chung
  • Neil Kaplowitz
Original Article

Abstract

Background

There are discrepant data on whether men or women have a higher risk for hepatic steatosis.

Objective

To examine the influence of gender on hepatic adiposity in teenagers and young adults.

Materials and methods

We measured subcutaneous abdominal fat (SAF), intra-abdominal fat (IAF) and hepatic tissue density (a surrogate measure of hepatic fat) using CT in 505 healthy teenagers and young adults (254 males, 251 females; ages 15–22.9 years).

Results

Overall, compared to men, women had higher values of SAF (P < 0.0001) but similar measures of IAF and liver tissue density (P = 0.09 and 0.92, respectively). However, when compared to overweight/obese men, overweight/obese women had strikingly similar IAF values (P = 0.85) but lower hepatic fat (P = 0.009). Multiple regression analyses indicated that, after adjusting for age and SAF, IAF independently predicted hepatic density in males (P < 0.0001) but not in females (P = 0.36). Hepatic fat increased with body mass in males from lean to overweight and obese (P < 0.0001) but not in females (P > 0.05).

Conclusion

When compared to overweight and obese young women, overweight and obese young men are at greater risk for hepatic steatosis, independent of IAF.

Keywords

Hepatic Fat Intra-abdominal fat Gender difference CT 

Abbreviations

NAFLD

Nonalcoholic fatty liver disease

IAF

Intra-abdominal fat

BMI

Body mass index

WC

Waist circumference

SAF

Subcutaneous abdominal fat

HU

Hounsfield units

Notes

Acknowledgment

This work is supported in part by grants from the National Institutes of Health (1R01 AR052744-01) and from the Department of the Army (DAMD17-01-1-0817).

References

  1. 1.
    Farrell GC, George J, Hall P et al (eds) (2004) Fatty liver disease: NASH and related disorders. Blackwell Science Inc., MaldenGoogle Scholar
  2. 2.
    Byrne CD, Olufadi R, Bruce KD et al (2009) Metabolic disturbances in non-alcoholic fatty liver disease. Clin Sci (Lond) 116:539–564CrossRefGoogle Scholar
  3. 3.
    Neuschwander-Tetri BA, Caldwell SH (2003) Nonalcoholic steatohepatitis: summary of an AASLD Single Topic Conference. Hepatology 37:1202–1219PubMedCrossRefGoogle Scholar
  4. 4.
    Angulo P (2002) Nonalcoholic fatty liver disease. N Engl J Med 346:1221–1231PubMedCrossRefGoogle Scholar
  5. 5.
    Rector RS, Thyfault JP, Wei Y et al (2008) Non-alcoholic fatty liver disease and the metabolic syndrome: an update. World J Gastroenterol 14:185–192PubMedCrossRefGoogle Scholar
  6. 6.
    van der Poorten D, Milner KL, Hui J et al (2008) Visceral fat: a key mediator of steatohepatitis in metabolic liver disease. Hepatology 48:449–457PubMedCrossRefGoogle Scholar
  7. 7.
    Adams LA, Waters OR, Knuiman MW et al (2009) NAFLD as a risk factor for the development of diabetes and the metabolic syndrome: an 11-year follow-up study. Am J Gastroenterol 104:861–867PubMedCrossRefGoogle Scholar
  8. 8.
    Kelley DE, McKolanis TM, Hegazi RA et al (2003) Fatty liver in type 2 diabetes mellitus: relation to regional adiposity, fatty acids, and insulin resistance. Am J Physiol Endocrinol Metab 285:E906–E916PubMedGoogle Scholar
  9. 9.
    Park BJ, Kim YJ, Kim DH et al (2008) Visceral adipose tissue area is an independent risk factor for hepatic steatosis. J Gastroenterol Hepatol 23:900–907PubMedCrossRefGoogle Scholar
  10. 10.
    Thamer C, Machann J, Haap M et al (2004) Intrahepatic lipids are predicted by visceral adipose tissue mass in healthy subjects. Diab Care 27:2726–2729CrossRefGoogle Scholar
  11. 11.
    Van Gaal LF, Mertens IL, De Block CE (2006) Mechanisms linking obesity with cardiovascular disease. Nature 444:875–880PubMedCrossRefGoogle Scholar
  12. 12.
    Picardi A, Vespasiani-Gentilucci U (2008) Association between non-alcoholic fatty liver disease and cardiovascular disease: a first message should pass. Am J Gastroenterol 103:3036–3038PubMedCrossRefGoogle Scholar
  13. 13.
    Pinto HC, Baptista A, Camilo ME et al (1996) Nonalcoholic steatohepatitis. Clinicopathological comparison with alcoholic hepatitis in ambulatory and hospitalized patients. Dig Dis Sci 41:172–179PubMedCrossRefGoogle Scholar
  14. 14.
    Itoh S, Yougel T, Kawagoe K (1987) Comparison between nonalcoholic steatohepatitis and alcoholic hepatitis. Am J Gastroenterol 82:650–654PubMedGoogle Scholar
  15. 15.
    Ludwig J, Viggiano TR, McGill DB et al (1980) Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease. Mayo Clin Proc 55:434–438PubMedGoogle Scholar
  16. 16.
    Adler M, Schaffner F (1979) Fatty liver hepatitis and cirrhosis in obese patients. Am J Med 67:811–816PubMedCrossRefGoogle Scholar
  17. 17.
    Diehl AM, Goodman Z, Ishak KG (1988) Alcohollike liver disease in nonalcoholics. A clinical and histologic comparison with alcohol-induced liver injury. Gastroenterology 95:1056–1062PubMedGoogle Scholar
  18. 18.
    Lee RG (1989) Nonalcoholic steatohepatitis: a study of 49 patients. Hum Pathol 20:594–598PubMedCrossRefGoogle Scholar
  19. 19.
    Powell EE, Cooksley WG, Hanson R et al (1990) The natural history of nonalcoholic steatohepatitis: a follow-up study of 42 patients for up to 21 years. Hepatology 11:74–80PubMedCrossRefGoogle Scholar
  20. 20.
    Angulo P, Keach JC, Batts KP et al (1999) Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis. Hepatology 30:1356–1362PubMedCrossRefGoogle Scholar
  21. 21.
    Lee K, Sung JA, Kim JS et al (2009) The roles of obesity and gender on the relationship between metabolic risk factors and non-alcoholic fatty liver disease in Koreans. Diabetes Metab Res Rev 25:150–155PubMedCrossRefGoogle Scholar
  22. 22.
    Schwimmer JB, McGreal N, Deutsch R et al (2005) Influence of gender, race, and ethnicity on suspected fatty liver in obese adolescents. Pediatrics 115:e561–e565PubMedCrossRefGoogle Scholar
  23. 23.
    Suzuki A, Abdelmalek MF (2009) Nonalcoholic fatty liver disease in women. Womens Health (Lond Engl) 5:191–203Google Scholar
  24. 24.
    Olufadi R, Byrne CD (2008) Clinical and laboratory diagnosis of the metabolic syndrome. J Clin Pathol 61:697–706PubMedCrossRefGoogle Scholar
  25. 25.
    Stefan N, Kantartzis K, Haring HU (2008) Causes and metabolic consequences of fatty liver. Endocr Rev 29:939–960PubMedCrossRefGoogle Scholar
  26. 26.
    Speliotes EK, Massaro JM, Hoffmann U et al (2008) Liver fat is reproducibly measured using computed tomography in the Framingham Heart Study. J Gastroenterol Hepatol 23:894–899PubMedCrossRefGoogle Scholar
  27. 27.
    Cowin GJ, Jonsson JR, Bauer JD et al (2008) Magnetic resonance imaging and spectroscopy for monitoring liver steatosis. J Magn Reson Imaging 28:937–945PubMedCrossRefGoogle Scholar
  28. 28.
    Mehta SR, Thomas EL, Bell JD et al (2008) Non-invasive means of measuring hepatic fat content. World J Gastroenterol 14:3476–3483PubMedCrossRefGoogle Scholar
  29. 29.
    Jensen MD (2008) Role of body fat distribution and the metabolic complications of obesity. J Clin Endocrinol Metab 93:S57–S63PubMedCrossRefGoogle Scholar
  30. 30.
    Erlingsson S, Herard S, Dahlqvist Leinhard O et al (2009) Men develop more intraabdominal obesity and signs of the metabolic syndrome after hyperalimentation than women. Metabolism 58:995–1001PubMedCrossRefGoogle Scholar
  31. 31.
    Leenen R, van der Kooy K, Seidell JC et al (1992) Visceral fat accumulation measured by magnetic resonance imaging in relation to serum lipids in obese men and women. Atherosclerosis 94:171–181PubMedCrossRefGoogle Scholar
  32. 32.
    Despres JP, Couillard C, Gagnon J et al (2000) Race, visceral adipose tissue, plasma lipids, and lipoprotein lipase activity in men and women: the Health, Risk Factors, Exercise Training, and Genetics (HERITAGE) family study. Arterioscler Thromb Vasc Biol 20:1932–1938PubMedCrossRefGoogle Scholar
  33. 33.
    Lemieux S, Despres JP, Moorjani S et al (1994) Are gender differences in cardiovascular disease risk factors explained by the level of visceral adipose tissue? Diabetologia 37:757–764PubMedCrossRefGoogle Scholar
  34. 34.
    Lemieux S, Prud'homme D, Bouchard C et al (1993) Sex differences in the relation of visceral adipose tissue accumulation to total body fatness. Am J Clin Nutr 58:463–467PubMedGoogle Scholar
  35. 35.
    Krotkiewski M, Bjorntorp P, Sjostrom L et al (1983) Impact of obesity on metabolism in men and women. Importance of regional adipose tissue distribution. J Clin Invest 72:1150–1162PubMedCrossRefGoogle Scholar
  36. 36.
    Rattarasarn C, Leelawattana R, Soonthornpun S et al (2004) Gender differences of regional abdominal fat distribution and their relationships with insulin sensitivity in healthy and glucose-intolerant Thais. J Clin Endocrinol Metab 89:6266–6270PubMedCrossRefGoogle Scholar
  37. 37.
    Beasley LE, Koster A, Newman AB et al (2009) Inflammation and race and gender differences in computerized tomography-measured adipose depots. Obesity (Silver Spring) 17:1062–1069CrossRefGoogle Scholar
  38. 38.
    Fox CS, Massaro JM, Hoffmann U et al (2007) Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Circulation 116:39–48PubMedCrossRefGoogle Scholar
  39. 39.
    Bray GA, Jablonski KA, Fujimoto WY et al (2008) Relation of central adiposity and body mass index to the development of diabetes in the diabetes prevention program. Am J Clin Nutr 87:1212–1218PubMedGoogle Scholar
  40. 40.
    Shen W, Punyanitya M, Silva AM et al (2009) Sexual dimorphism of adipose tissue distribution across the lifespan: a cross-sectional whole-body magnetic resonance imaging study. Nutr Metab (Lond) 6:17Google Scholar
  41. 41.
    Onat A, Ugur M, Can G et al (2009) Visceral adipose tissue and body fat mass: predictive values for and role of gender in cardiometabolic risk among Turks. Nutrition 26:382–389PubMedCrossRefGoogle Scholar
  42. 42.
    Ludescher B, Najib A, Baar S et al (2007) Gender specific correlations of adrenal gland size and body fat distribution: a whole body MRI study. Horm Metab Res 39:515–518PubMedCrossRefGoogle Scholar
  43. 43.
    Porter SA, Massaro JM, Hoffmann U et al (2009) Abdominal subcutaneous adipose tissue: a protective fat depot? Diab Care 32:1068–1075CrossRefGoogle Scholar
  44. 44.
    Chung SA, Dorey F, Mittelman S et al (2011) Effect of gender on intra-abdominal fat in teenagers and young adults. Pediatr Radiol (in press)Google Scholar
  45. 45.
    Tanner JM (1978) Physical growth and development. Churchill Livingstone, EdinburghGoogle Scholar
  46. 46.
    Kalender WA (1992) Effective dose values in bone mineral measurements by photon absorptiometry and computed tomography. Osteoporos Int 2:82–87PubMedCrossRefGoogle Scholar
  47. 47.
    Lee S, Janssen I, Ross R (2004) Interindividual variation in abdominal subcutaneous and visceral adipose tissue: influence of measurement site. J Appl Physiol 97:948–954PubMedCrossRefGoogle Scholar
  48. 48.
    Hounsfield GN (1980) Computed medical imaging. Science 210:22–28PubMedCrossRefGoogle Scholar
  49. 49.
    Schneider W, Bortfeld T, Schlegel W (2000) Correlation between CT numbers and tissue parameters needed for Monte Carlo simulations of clinical dose distributions. Phys Med Biol 45:459–478PubMedCrossRefGoogle Scholar
  50. 50.
    Eguchi Y, Eguchi T, Mizuta T et al (2006) Visceral fat accumulation and insulin resistance are important factors in nonalcoholic fatty liver disease. J Gastroenterol 41:462–469PubMedCrossRefGoogle Scholar
  51. 51.
    Denzer C, Thiere D, Muche R et al (2009) Gender-specific prevalences of fatty liver in obese children and adolescents: roles of body fat distribution, sex steroids, and insulin resistance. J Clin Endocrinol Metab 94:3872–3881PubMedCrossRefGoogle Scholar
  52. 52.
    Browning JD, Szczepaniak LS, Dobbins R et al (2004) Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology 40:1387–1395PubMedCrossRefGoogle Scholar
  53. 53.
    Cheung O, Kapoor A, Puri P et al (2007) The impact of fat distribution on the severity of nonalcoholic fatty liver disease and metabolic syndrome. Hepatology 46:1091–1100PubMedCrossRefGoogle Scholar
  54. 54.
    Geer EB, Shen W (2009) Gender differences in insulin resistance, body composition, and energy balance. Gend Med 6(Suppl 1):60–75PubMedCrossRefGoogle Scholar
  55. 55.
    Cooke PS, Naaz A (2004) Role of estrogens in adipocyte development and function. Exp Biol Med (Maywood) 229:1127–1135Google Scholar
  56. 56.
    Ostberg JE, Thomas EL, Hamilton G et al (2005) Excess visceral and hepatic adipose tissue in Turner syndrome determined by magnetic resonance imaging: estrogen deficiency associated with hepatic adipose content. J Clin Endocrinol Metab 90:2631–2635PubMedCrossRefGoogle Scholar
  57. 57.
    Simpson ER, Jones ME (2006) Of mice and men: the many guises of estrogens. Ernst Schering Found Symp Proc 1:45–67PubMedCrossRefGoogle Scholar
  58. 58.
    Brzozowska MM, Ostapowicz G, Weltman MD (2009) An association between non-alcoholic fatty liver disease and polycystic ovarian syndrome. J Gastroenterol Hepatol 24:243–247PubMedCrossRefGoogle Scholar
  59. 59.
    Iwasaki M, Takada Y, Hayashi M et al (2004) Noninvasive evaluation of graft steatosis in living donor liver transplantation. Transplantation 78:1501–1505PubMedCrossRefGoogle Scholar
  60. 60.
    Piekarski J, Goldberg HI, Royal SA et al (1980) Difference between liver and spleen CT numbers in the normal adult: its usefulness in predicting the presence of diffuse liver disease. Radiology 137:727–729PubMedGoogle Scholar
  61. 61.
    Valls C, Iannacconne R, Alba E et al (2006) Fat in the liver: diagnosis and characterization. Eur Radiol 16:2292–2308PubMedCrossRefGoogle Scholar
  62. 62.
    Panicek DM, Giess CS, Schwartz LH (1997) Qualitative assessment of liver for fatty infiltration on contrast-enhanced CT: is muscle a better standard of reference than spleen? J Comput Assist Tomogr 21:699–705PubMedCrossRefGoogle Scholar
  63. 63.
    Birnbaum BA, Hindman N, Lee J et al (2007) Multi-detector row CT attenuation measurements: assessment of intra- and interscanner variability with an anthropomorphic body CT phantom. Radiology 242:109–119PubMedCrossRefGoogle Scholar
  64. 64.
    Kodama Y, Ng CS, Wu TT et al (2007) Comparison of CT methods for determining the fat content of the liver. Am J Roentgenol 188:1307–1312CrossRefGoogle Scholar
  65. 65.
    Mohanty SR, Troy TN, Huo D et al (2009) Influence of ethnicity on histological differences in non-alcoholic fatty liver disease. J Hepatol 50:797–804PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Vicente Gilsanz
    • 1
    • 2
  • Sandra A. Chung
    • 1
  • Neil Kaplowitz
    • 3
  1. 1.Department of Radiology, MS 81Children’s Hospital Los Angeles, USC, Keck School of MedicineLos AngelesUSA
  2. 2.Department of PediatricsChildren’s Hospital Los Angeles, USC, Keck School of MedicineLos AngelesUSA
  3. 3.USC Research Center for Liver DiseaseUSC, Keck School of MedicineLos AngelesUSA

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