European Radiology

, Volume 28, Issue 4, pp 1345–1355 | Cite as

Increased severity of liver fat content and liver fibrosis in non-alcoholic fatty liver disease correlate with epicardial fat volume in type 2 diabetes: A prospective study

  • Sharon S. Brouha
  • Phirum Nguyen
  • Ricki Bettencourt
  • Claude B. Sirlin
  • Rohit Loomba



To determine whether severity of non-alcoholic fatty liver disease (NAFLD) and liver fibrosis quantitatively assessed in individuals with diabetes mellitus (DM)-2 correlate with increased coronary heart disease (CHD) risk using non-invasive markers.


We conducted a single-centre, prospective, cross-sectional study in 100 consecutive diabetic individuals without known CHD recruited between March 2013 and September 2014. History, physical examination, serum markers, cardiac computed tomography (CT), magnetic resonance (MR) imaging-estimated proton density fat fraction (PDFF) and MR elastography (MRE) were obtained for 95 participants. Written informed consent was provided. Institutional review board approved this study. Spearman rank correlation was performed to assess for correlations. Multiple linear regression model determined independent predictors of epicardial adipose tissue (EAT) volume.


A p value < 0.05 determined statistical significance. The EAT volume was higher in the NAFLD group, defined as MR-imaging PDFF ≥ 5 %, compared to the non-NAFLD group (126.5 ml (IQR 80.9) versus 85.4 ml (IQR 44.7), p=0.002). MR imaging-PDFF correlated with EAT (r=0.42, p < 0.0001). MR imaging-PDFF and liver fibrosis were independently associated with EAT.


Higher liver fat content and liver fibrosis may portend worse cardiovascular risk in diabetics.

Key Points

EAT volume is higher in diabetic individuals with NAFLD.

Liver fat content is positively correlated with EAT.

Liver fat content and liver fibrosis were independently associated with EAT.

Higher liver fat content and fibrosis may adversely affect cardiovascular risk.


Non-alcoholic fatty liver disease Liver fibrosis Magnetic resonance imaging Coronary disease Multidetector computed tomography 



Coronary artery calcium


Coronary heart disease


Computed tomography


Diabetes mellitus


Epicardial adipose tissue


Magnetic resonance


Magnetic resonance elastography


Non-alcoholic fatty liver disease


Proton density fat fraction



This study has received funding by the following:

• American Gastroenterological Association (AGA) Foundation—Sucampo—ASP Designated Research Award in Geriatric Gastroenterology

• T. Franklin Williams Scholarship Award

• Atlantic Philanthropies, Inc

• The John A. Hartford Foundation

• The Association of Specialty Professors

• American Gastroenterological Association

• Grant K23-DK090303

• Grant R01-DK106419-01.

• National Institute of Environmental Health Sciences of the National Institutes of Health under Award Number P42ES010337

Compliance with ethical standards


The scientific guarantor of this publication is Rohit Loomba MD MHSc.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in the following:

Doycheva I, Cui J, Nguyen P, et al. Non-invasive screening of diabetics in primary care for NAFLD and advanced fibrosis by MRI and MRE. Aliment Pharmacol Ther. 2016;43(1):83-95.


• Prospective

• Cross-sectional study

• Performed at one institution


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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Sharon S. Brouha
    • 1
  • Phirum Nguyen
    • 2
    • 3
  • Ricki Bettencourt
    • 2
    • 3
    • 4
  • Claude B. Sirlin
    • 3
  • Rohit Loomba
    • 2
    • 3
    • 4
  1. 1.Department of RadiologyUniversity of California at San DiegoSan DiegoUSA
  2. 2.NAFLD Research Center and Division of Gastroenterology, Department of MedicineUniversity of CaliforniaLa JollaUSA
  3. 3.Liver Imaging Group, Department of RadiologyUniversity of CaliforniaLa JollaUSA
  4. 4.Division of Epidemiology, Department of Family Medicine and Public HealthUniversity of CaliforniaLa JollaUSA

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