European Radiology

, Volume 29, Issue 12, pp 6662–6670 | Cite as

Hepatic fat is superior to BMI, visceral and pancreatic fat as a potential risk biomarker for neurodegenerative disease

  • Ebba BellerEmail author
  • Roberto Lorbeer
  • Daniel Keeser
  • Franziska Schoeppe
  • Sabine Sellner
  • Holger Hetterich
  • Fabian Bamberg
  • Christopher L. Schlett
  • Annette Peters
  • Birgit Ertl-Wagner
  • Sophia Stoecklein
Magnetic Resonance



Prior studies relating body mass index (BMI) to brain volumes suggest an overall inverse association. However, BMI might not be an ideal marker, as it disregards different fat compartments, which carry different metabolic risks. Therefore, we analyzed MR-based fat depots and their association with gray matter (GM) volumes of brain structures, which show volumetric changes in neurodegenerative diseases.


Warp-based automated brain segmentation of 3D FLAIR sequences was obtained in a population-based study cohort. Associations of temporal lobe, cingulate gyrus, and hippocampus GM volume with BMI and MR-based quantification of visceral adipose tissue (VAT), as well as hepatic and pancreatic proton density fat fraction (PDFFhepatic and PDFFpanc, respectively), were assessed by linear regression.


In a sample of 152 women (age 56.2 ± 9.0 years) and 199 men (age 56.1 ± 9.1 years), we observed a significant inverse association of PDFFhepatic and cingulate gyrus volume (p < 0.05) as well as of PDFFhepatic and hippocampus volume (p < 0.05), when adjusting for age and sex. This inverse association was further enhanced for cingulate gyrus volume after additionally adjusting for hypertension, smoking, BMI, LDL, and total cholesterol (p < 0.01) and also alcohol (p < 0.01). No significant association was observed between PDFFhepatic and temporal lobe and between temporal lobe, cingulate gyrus, or hippocampus volume and BMI, VAT, and PDFFpanc.


We observed a significant inverse, independent association of cingulate gyrus and hippocampus GM volume with hepatic fat, but not with other obesity measures. Increased hepatic fat could therefore serve as a marker of high-risk fat distribution.

Key Points

• Obesity is associated with neurodegenerative processes.

• In a population-based study cohort, hepatic fat was superior to BMI and visceral and pancreatic fat as a risk biomarker for decreased brain volume of cingulate gyrus and hippocampus.

• Increased hepatic fat could serve as a marker of high-risk fat distribution.


Obesity Magnetic resonance imaging Liver steatosis Cingulate gyrus Hippocampus 



Analyses of functional images


Body mass index


FMRIB’s automated segmentation tool


Fluid attenuation inversion recovery


FMRIB’s linear registration tool


Functional magnetic resonance imaging of the brain


FMRIB’s non-linear image registration tool


Gray matter


Cooperative Health Research in the Region of Augsburg


Nonalcoholic fatty liver disease


Proton density fat fraction


Total brain volume


Volume interpolated body examination


Visceral adipose tissue



This research was funded in-part by the German Research Foundation (DFG, Bonn, Germany; grant-number 245222810).​ The KORA study was initiated and financed by the Helmholtz Zentrum München—German Research Center for Environmental Health, which is funded by the German Federal Ministry of Education and Research (BMBF) and by the State of Bavaria. The KORA-MRI sub-study was supported by an unrestricted research grant from Siemens Healthcare.

Compliance with ethical standards


The scientific guarantor of this publication is Sophia Stoecklein.

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

No complex statistical methods were necessary for this paper.

Informed consent

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

Ethical approval

Institutional Review Board approval was obtained.


• Retrospective

• Diagnostic or prognostic study

• Performed at one institution


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Ebba Beller
    • 1
    • 2
    Email author
  • Roberto Lorbeer
    • 2
  • Daniel Keeser
    • 2
  • Franziska Schoeppe
    • 2
  • Sabine Sellner
    • 2
  • Holger Hetterich
    • 2
  • Fabian Bamberg
    • 3
    • 4
  • Christopher L. Schlett
    • 3
    • 4
  • Annette Peters
    • 5
  • Birgit Ertl-Wagner
    • 2
    • 6
  • Sophia Stoecklein
    • 2
  1. 1.Department of Diagnostic and Interventional RadiologyUniversity HospitalRostockGermany
  2. 2.Department of RadiologyLudwig-Maximilians University MunichMunichGermany
  3. 3.Department of Diagnostic and Interventional Radiology, Medical Center-University of FreiburgFaculty of Medicine, University of FreiburgFreiburgGermany
  4. 4.University Heart Center Freiburg-Bad KrozingenBad KrozingenGermany
  5. 5.Helmholtz Zentrum München, German Research Center for Environmental HealthInstitute of Epidemiology IINeuherbergGermany
  6. 6.Department of Medical Imaging, The Hospital for Sick ChildrenUniversity of TorontoTorontoCanada

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