Journal of Gastroenterology

, Volume 41, Issue 5, pp 462–469

Visceral fat accumulation and insulin resistance are important factors in nonalcoholic fatty liver disease

  • Yuichiro Eguchi
  • Takahisa Eguchi
  • Toshihiko Mizuta
  • Yasushi Ide
  • Tsutomu Yasutake
  • Ryuichi Iwakiri
  • Akitaka Hisatomi
  • Iwata Ozaki
  • Kyousuke Yamamoto
  • Yoichiro Kitajima
  • Yasunori Kawaguchi
  • Shigetaka Kuroki
  • Naofumi Ono
Article

Abstract

Background

Nonalcoholic fatty liver diseases are often associated with obesity, insulin resistance, and excessive visceral fat accumulation. The aims of this study were (1) to evaluate the relationship between the severity of fatty liver and visceral fat accumulation in nonalcoholic fatty liver diseases, and (2) to investigate the relationships of fatty liver with biochemical data and insulin resistance.

Methods

One hundred twenty-nine subjects (63 women) with fatty liver diagnosed by ultrasonography were enrolled. Subjects positive for hepatitis B virus, hepatitis C virus, or autoimmune antibodies and those whose alcohol intake was over 20 g/day were excluded. The visceral fat area at the umbilical level and the liver–spleen ratio were evaluated by computed tomography.

Results

The severity of fatty liver evaluated by ultrasonography showed a significant positive relationship with the visceral fat area and waist circumstance (fatty liver severity: mild, 92.0 ± 30.9 cm2; moderate, 122.1 ± 32.6 cm2; severe, 161.0 ± 48.4 cm2; P < 0.0001). The visceral fat area and liver–spleen ratio were negatively correlated (r = −0.605, P < 0.0001). The severity of fatty liver showed strong positive relationships with serum aspartate aminotransferase, alanine aminotransferase, fasting plasma glucose, fasting plasma insulin, and insulin resistance. The severity of fatty liver was positively related to the visceral fat area in 49 nonobese subjects (body mass index <25).

Conclusions

The severity of fatty liver was positively correlated with visceral fat accumulation and insulin resistance in both obese and nonobese subjects, suggesting that hepatic fat infiltration in nonalcoholic fatty liver disease may be influenced by visceral fat accumulation regardless of body mass index.

Key words

nonalcoholic fatty liver disease insulin resistance visceral fat metabolic syndrome ultrasonography 

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References

  1. 1.
    Kojima, S, Watanabe, N, Numata, M, Ogawa, T, Matsuzaki, S 2003Increase in the prevalence of fatty liver in Japan over the past 12 years: analysis of clinical backgroundJ Gastroenterol3895461PubMedCrossRefGoogle Scholar
  2. 2.
    Charlton, M 2004Fatty liver disease: a review of current understanding and future impactClin Gastroenterol Hepatol2104858PubMedCrossRefGoogle Scholar
  3. 3.
    Ludwig, J, Viggiano, TR, Mcgill, DB, Oh, BJ 1980Steatohepatitis: Mayo Clinic experiences with a hitherto unnamed diseaseMayo Clin Proc554348PubMedGoogle Scholar
  4. 4.
    Day, CP, James, OW 1998Steatohepatitis: A tale of two “hits”?Gastroenterology1148425PubMedCrossRefGoogle Scholar
  5. 5.
    Carr, DB, Utzschneider, KM, Hull, RL, Kodama, K, Retzlaff, BM, Brunzell, JD,  et al. 2004Intra-abdominal fat is a major determinant of the National Cholesterol Education Program Adult Treatment Panel III criteria for the metabolic syndromeDiabetes53208794PubMedGoogle Scholar
  6. 6.
    Borst, SE 2004The role of TNF-alpha in insulin resistanceEndocrine2317782PubMedCrossRefGoogle Scholar
  7. 7.
    Tremblay, AJ, Despres, JP, Piche, ME, Nadeau, A, Bergeron, J, Almeras, N,  et al. 2004Associations between the fatty acid content of triglyceride, visceral adipose tissue accumulation, and components of the insulin resistance syndromeMetabolism533107PubMedCrossRefGoogle Scholar
  8. 8.
    Rebuffe-Scrive, M, Anderson, B, Olbe, L, Bjorntorp, P 1990Metabolism of adipose tissue in intraabdominal depots in severely obese men and womenMetabolism3910215PubMedCrossRefGoogle Scholar
  9. 9.
    Lonnqvist, F, Thome, A, Nilsell, K, Hoffstedt, J, Arner, P 1995A pathogenic role of visceral fat beta 3-adrenoceptors in obesityJ Clin Invest95110916PubMedCrossRefGoogle Scholar
  10. 10.
    Yoshizumi, T, Nakamura, T, Yamane, M, Islam, AH, Menju, M, Yamasaki, K,  et al. 1999Abdominal fat: standardized technique for measurement at CTRadiology2112836PubMedGoogle Scholar
  11. 11.
    Nagaretani, H, Nakamura, T, Funahashi, T, Kotani, K, Miyanaga, M, Tokunaga, K,  et al. 2001Visceral fat is a major contributor for multiple risk factor clustering in Japanese men with impaired glucose toleranceDiabetes Care24212733PubMedGoogle Scholar
  12. 12.
    Ratziu, V, Giral, P, Charlotte, F, Bruckert, E, Thibault, V, Theodorou, I,  et al. 2000Liver fibrosis in overweight patientsGastroenterology118111723PubMedCrossRefGoogle Scholar
  13. 13.
    Stranges, S, Dorn, JM, Muti, P, Freudenheim, JL, Farinaro, E, Russell, M,  et al. 2004Body fat distribution, relative weight, and liver enzyme levels: a population-based studyHepatology3975463PubMedCrossRefGoogle Scholar
  14. 14.
    Chitturi, S, Abeygunasekera, S, Farrell, GC, Holmes-Walker, J, Hui, JM, Fung, C,  et al. 2002NASH and insulin resistance: insulin hypersecretion and specific association with the insulin resistance syndromeHepatology353739PubMedCrossRefGoogle Scholar
  15. 15.
    Saadeh, S, Younossi, ZM, Remer, EM, Gramlich, T, Ong, JP, Hurley, M,  et al. 2002The utility of radiological imaging in fatty liver diseaseGastroenterology12374550PubMedCrossRefGoogle Scholar
  16. 16.
    Celle, G, Savarino, V, Picciotto, A, Magnolia, MR, Scalabrini, P, Dodero, M 1988Is hepatic ultrasonography a valid alternative tool to liver biopsy? Report on 507 cases studied with both techniquesDig Dis Sci3346771PubMedCrossRefGoogle Scholar
  17. 17.
    Alberti, KG, Zimmet, PZ 1998Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultationDiabet Med1553953PubMedCrossRefGoogle Scholar
  18. 18.
    Haffner, SM, Kennedy, E, Gonzalez, C, Stern, MP, Miettinen, H 1996A prospective analysis of the HOMA model. The Mexico City Diabetes StudyDiabetes Care19113841PubMedGoogle Scholar
  19. 19.
    Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001;285:2486–97Google Scholar
  20. 20.
    The Examination Committee of Criteria for “Obesity Disease” in Japan, Japan Society for the Study of Obesity2002New criteria for “Obesity Disease” in JapanCirc J6698792CrossRefGoogle Scholar
  21. 21.
    Zhu, SK, Wang, ZM, Heshka, S, Heo, M, Faith, MS, Heymsfield, SB 2002Waist circumference and obesity associated risk factors among whites in the third National Health and Nutrition Examination Survey: clinical action thresholdsAm J Clin Nutr767439PubMedGoogle Scholar
  22. 22.
    Trayhurn, P, Wood, IS 2004Adipokines: inflammation and the pleiotropic role of white adipose tissueBr J Nutr9234755PubMedCrossRefGoogle Scholar
  23. 23.
    Czaja, MJ 2004Liver injury in the setting of steatosis: crosstalk between adipokine and cytokineHepatology401922PubMedCrossRefGoogle Scholar
  24. 24.
    Hui, JM, Hodge, A, Farrell, GC, Kench, JG, Kriketos, A, George, J 2004Beyond insulin resistance in NASH: TNF-alpha or adiponectin?Hepatology404654PubMedCrossRefGoogle Scholar
  25. 25.
    Limanond, P, Raman, SS, Lassman, C, Sayre, J, Ghobrial, RM, Busuttil, RW,  et al. 2004Macrovesicular hepatic steatosis in living related liver donors: correlation between CT and histologic findingsRadiology23027680PubMedGoogle Scholar
  26. 26.
    Berrington de Gonzalez, A, Darby, S 2004Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countriesLancet36334551PubMedCrossRefGoogle Scholar
  27. 27.
    WHO/IASO/IOTF2000The Asia-Pacific perspective: redefining obesity and its treatmentHealth Communications Australia Pty LtdSydneyGoogle Scholar
  28. 28.
    Stranges, S, Dorn, JM, Muti, P, Freudenheim, JL, Farinaro, E, Russell, M,  et al. 2004Body fat distribution, relative weight, and liver enzyme levels: a population-based studyHepatology3975463PubMedCrossRefGoogle Scholar
  29. 29.
    Rinella, ME, Alonso, E, Rao, S, Whitington, P, Fryer, J, Abecassis, M,  et al. 2001Body mass index as a predictor of hepatic steatosis in living liver donorsLiver Transpl740914PubMedCrossRefGoogle Scholar
  30. 30.
    Shiwaku, K, Anuurad, E, Enkhmaa, B, Nogi, A, Kitajima, K, Shimono, K,  et al. 2004Overweight Japanese with body mass index of 23.0–24.9 have high risks for obesity-associated disorders: a comparison of Japanese and MongoliansInt J Obes Relat Metab Disord281528PubMedCrossRefGoogle Scholar
  31. 31.
    Omagari, K, Kadokawa, Y, Masuda, J, Egawa, I, Sawa, T, Hazama, H,  et al. 2002Fatty liver in non-alcoholic non-overweight Japanese adults: incidence and clinical characteristicsJ Gastroenterol Hepatol171098105PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 2006

Authors and Affiliations

  • Yuichiro Eguchi
    • 1
    • 2
  • Takahisa Eguchi
    • 2
  • Toshihiko Mizuta
    • 1
  • Yasushi Ide
    • 1
    • 2
  • Tsutomu Yasutake
    • 1
  • Ryuichi Iwakiri
    • 1
  • Akitaka Hisatomi
    • 1
  • Iwata Ozaki
    • 1
  • Kyousuke Yamamoto
    • 1
  • Yoichiro Kitajima
    • 2
  • Yasunori Kawaguchi
    • 2
  • Shigetaka Kuroki
    • 2
  • Naofumi Ono
    • 2
  1. 1.Department of Internal MedicineSaga Medical SchoolSagaJapan
  2. 2.Eguchi HospitalSagaJapan

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