Predictors of non-alcoholic fatty liver in a group of non-obese and non-diabetic Iranian adults

  • Mohsen Maddah
  • Nazli Ahani
  • Haji Hossaini
  • Majid Karandish
Original Article


Non-alcoholic fatty liver disease (NAFLD) is not uncommon in non-obese people. We examined the independent predictors of NAFLD in a group of non-obese and non-diabetic men and women in Rasht, Iran. Sixty-one adults aged 38.4 ± 8.4 years (32 men and 29 women) with body mass index (BMI) <30 kg/m2 and non-diabetic with clinical features of NAFLD who visited our center between 2007 and 2009 were compared to 147 non-obese, non-diabetic and normal liver subjects (40 men and 107 women) aged 40.8 ± 9.1. Data on blood lipids, anthropometry, fasting blood glucose, exercise, and educational levels were gathered using a questionnaire. Logistic regression analysis revealed that weight gain during adulthood [OR = 1.90 (95% CI = 1.03–1.84), P < 0.04] and high serum triglyceride levels [OR = 1.19 (95% CI = 1.09–1.28), P < 0.0001] were independent predictors of NAFLD in this group of non-obese subjects. BMI, educational levels, gender, and habitual physical activity were not independently related to NAFLD in this study. These data suggest that weight gain after 20 years of age rather than BMI and high levels of triglyceride may serve as screening tool for NAFLD in clinical practice in this population. In nutritional management of these apparently normal weight subjects with NAFLD modest weight loss is necessary.


NAFLD Weight gain Triglyceride Iran 



We thank our patients for their participation in this study. We also thank the personnel of Razi Laboratory for their technical assistance. This work was financially supported by Ahvaz University of Medical Sciences.

Conflict of interest



  1. 1.
    Clark JM (2006) The epidemiology of nonalcoholic fatty liver disease in adults. J Clin Gastroenterol 40:S5–S10Google Scholar
  2. 2.
    Moore JB (2010) Non-alcoholic fatty liver disease: the hepatic consequence of obesity and the metabolic syndrome. Proc Nutr Soc 69:211–220CrossRefGoogle Scholar
  3. 3.
    Loria P, Lonardo A, Carulli L, Verrone M, Ricchi M, Lombardini S et al (2005) The metabolic syndrome and non-alcoholic fatty liver disease. Aliment Pharmacol Ther 22:31–36CrossRefGoogle Scholar
  4. 4.
    Kim J, Jo I (2010) Relationship between body mass index and alanine aminotransferase concentration in non-diabetic Korean adults. Eur J Clin Nutr 64:169–175CrossRefGoogle Scholar
  5. 5.
    Jamali R, Khonsari MR, Merat SH, Khoshnia M, Jafari E, Kalhori BA et al (2008) Persistent alanine aminotransferase elevation among the general Iranian population: prevalence and causes. World J Gastroenterol 14:2867–2871CrossRefGoogle Scholar
  6. 6.
    Ghassemi H, Harrison G, Mohammad K (2002) An accelerated nutrition transition in Iran. Public Health Nutr 5:149–155CrossRefGoogle Scholar
  7. 7.
    Janghorbani M, Amini M, Willet WC, Goya MM, Delavari A, Alikhani S et al (2007) First nationwide survey of prevalence of overweight, underweight, and abdominal obesity in Iranian adults. Obesity 15:2797–2808CrossRefGoogle Scholar
  8. 8.
    Bahrami H, Sadatsafavi M, Pourshams A, Kamangar F, Nouraei M, Semnani S et al (2006) Obesity and hypertension in an Iranian cohort study; Iranian women experience higher rates of obesity and hypertension than American women. BMC Public Health 20:158CrossRefGoogle Scholar
  9. 9.
    Kelishadi R, Alikhani S, Delavari A, Alaedini F, Safaie A, Hojatzadeh E (2008) Obesity and associated lifestyle behaviours in Iran: findings from the first national non-communicable disease risk factor surveillance survey. Public Health Nutr 11:249–251CrossRefGoogle Scholar
  10. 10.
    Dudeja V, Misra A, Pandey RM, Devina G, Kumar G, Vikram NK (2001) BMI does not accurately predict overweight in Asian Indians in northern India. Br J Nutr 50:590–593Google Scholar
  11. 11.
    Lonardo A, Lombardini S, Ricchi M, Scaglioni F, Loria P (2005) Hepatic steatosis and insulin resistance. Aliment Pharmacol Ther 22:64–70CrossRefGoogle Scholar
  12. 12.
    Wanless IR, Lentz JS (1990) Fatty liver hepatitis (steatohepatitis) and obesity: an autopsy study with analysis of risk factors. Hepatology 11:74–90CrossRefGoogle Scholar
  13. 13.
    Ruhl CE, Everhart JE (2003) Determinants of the association of overweight with elevated serum alanine aminotransferase activity in the United States. Gasteroenterololgy 124:71–79CrossRefGoogle Scholar
  14. 14.
    Marchesini G, Bugianesi F, Forlani G et al (2003) Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology 37:917–923CrossRefGoogle Scholar
  15. 15.
    Chow WC, Tai ES, Lian SC, Tan CK, Sun I, Ng HS (2007) Significant non-alcoholic fatty liver disease is found in non-diabetic, pre-obese Chinese in Singapore. Singapore Med J 48:752–757Google Scholar
  16. 16.
    Bugianesi E, Gastaldelli A, Vanni E, Gambino R, Cassader M, Baldi S et al (2005) Insulin resistance in non-diabetic patients with non-alcoholic fatty liver disease: sites and mechanisms. Diabetologia 48:634–642CrossRefGoogle Scholar
  17. 17.
    Kim HJ, Kim H, Lee KE, Kim DJ, Kim SK, Ahn CW et al (2004) Metabolic significance of non-alcoholic fatty liver disease in non-obese, non-diabetic adults. Arch Intern Med 164:2169–2175CrossRefGoogle Scholar
  18. 18.
    Park SH, Kim BI, Yun JW, Kim JW, Park DI, Cho YK et al (2004) Insulin resistance and C-reactive protein as independent risk factors for non-alcoholic fatty liver disease in non-obese Asian men. J Gasteroenterol Hepatol 19:694–698CrossRefGoogle Scholar
  19. 19.
    Eguchi Y, Eguchi T, Mizuta T, Ide Y, Yasutake T, Iwakiri R et al (2006) Visceral fat accumulation and insulin resistance are important factors in nonalcoholic fatty liver disease. J Gastroenterol 15:775–782Google Scholar
  20. 20.
    Liu Q, Bengmark S, Qu S (2010) The role of hepatic fat accumulation in pathogenesis of non-alcoholic fatty liver disease. Lipids Health Dis 9:42–49CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.RashtIran
  2. 2.Nutrition Research CenterAhvaz Jundishapour University of Medical SciencesAhvazIran
  3. 3.Department of BiologyPayam e Noor UniversityTehranIran

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