Waist Circumference Correlates and Hepatic Fat Accumulation

  • Yuichiro Eguchi
  • Toshihiko Mizuta
  • Iwata Ozaki
  • Dita Salova
  • Masato Yoneda
  • Koji Fujita
  • Hideyuki Hyogo
  • Hideki Fujii
  • Masafumi Ono
  • Yasuaki Suzuki
  • Takaaki Ohtake
  • Yoshio Sumida
  • Kazuma Fujimoto


Nonalcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease and is a major public health problem worldwide. It has been suggested that simple fatty liver, the most common type of NAFLD, is a reversible condition in which large vacuoles containing triglycerides accumulate in hepatocytes. Simple fatty liver is often a precursor to non-alcoholic steatohepatitis, which can progress to liver cirrhosis and hepatocellular carcinoma. NAFLD is considered one of the phenotypes of metabolic syndrome, which is characterized by obesity, type 2 diabetes mellitus, hyperlipidemia and hypertension. Obesity, particularly abdominal obesity, is a major risk factor for NAFLD. Several recent studies have revealed a relationship between excessive visceral fat accumulation and the severity of hepatic fat accumulation. On the other hand, in the current definitions of metabolic syndrome, waist circumference measurement has been proposed as a simple and useful estimate of abdominal obesity, taking into account sex differences in waist circumference. Recent studies have also reported that waist circumference could be a marker for hepatic fat accumulation. In this chapter, we first discuss the relationship between waist circumference, hepatic fat accumulation and liver function. Finally, we discuss the sex and age-group differences in these relationships, based on recent findings.


Waist Circumference Abdominal Obesity Nonalcoholic Fatty Liver Disease Measure Waist Circumference Umbilical Level 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Alanine aminotransferase


Body mass index


Confidence interval


Computed tomography


Homeostasis model assessment-insulin resistance


Japan Study Group for NAFLD

L/S ratio

Liver/spleen attenuation ratio


Magnetic resonance spectroscopy


Nonalcoholic fatty liver disease


Non-alcoholic steatohepatitis


Odds ratio


Standard deviation


Waist circumference



The authors would like to thank all the medical staff at Eguchi Hospital and Professor Kyuichi Tanikawa (International Institute for Liver Research) for excellent advice.


  1. Bugianesi E, Pagotto U, Manini R, Vanni E, Gastaldelli A, de Iasio R, Gentilcore E, Natale S, Cassader M, Rizzetto M, Pasquali R, Marchesini G. Plasma adiponectin in nonalcoholic fatty liver is related to hepatic insulin resistance and hepatic fat content, not to liver disease severity. J Clin Endocrinol Metab. 2005;90:3498–504.PubMedCrossRefGoogle Scholar
  2. Church TS, Kuk JL, Ross R, Priest EL, Biltoft E, Blair SN. Association of cardiorespiratory fitness, body mass index, and waist circumference to nonalcoholic fatty liver disease. Gastroenterology 2006;130:2023–30.PubMedCrossRefGoogle Scholar
  3. Day CP, James OF. Steatohepatitis: a tale of two “hits”?. Gastroenterology 1998;114:842–5.PubMedCrossRefGoogle Scholar
  4. Eguchi Y, Eguchi T, Mizuta T, Ide Y, Yasutake T, Iwakiri R, Hisatomi A, Ozaki I, Yamamoto K, Kitajima Y, Kawaguchi Y, Kuroki S, Ono N. Visceral fat accumulation and insulin resistance are important factors in nonalcoholic fatty liver disease. J Gastroenterol. 2006;41:462–9.PubMedCrossRefGoogle Scholar
  5. Fabbrini E, Magkos F, Mohammed BS, Pietka T, Abumrad NA, Patterson BW, Okunade A, Klein S. Intrahepatic fat, not visceral fat, is linked with metabolic complications of obesity. Proc Natl Acad Sci USA 2009;106:15430–5.PubMedCrossRefGoogle Scholar
  6. Hsiao TJ, Chen JC, Wang JD. Insulin resistance and ferritin as major determinants of nonalcoholic fatty liver disease in apparently healthy obese patients. Int J Obes Relat Metab Disord 2004;28:167–72.PubMedCrossRefGoogle Scholar
  7. Hu FB. Obesity Epidemiology. New York: Oxford University Press (2008). Obesity Epidemiology. p. 53–83.CrossRefGoogle Scholar
  8. Huang MA, Greenson JK, Chao C, Anderson L, Peterman D, Jacobson J, Emick D, Lok AS, Conjeevaram HS. One-year intense nutritional counseling results in histological improvement in patients with non-alcoholic steatohepatitis: a pilot study. Am J Gastroenterol 2005;100:1072–81.PubMedCrossRefGoogle Scholar
  9. Ishibashi E, Eguchi Y, Eguchi T, Matsunobu A, Oza N, Nakashita S, Kitajima Y, Kuroki S, Ozaki I, Kawaguchi Y, Ide Y, Yasutake T, Iwakiri R, Mizuta T, Ono N, Fujimoto K. Waist circumference correlates with hepatic fat accumulation in male Japanese patients with non-alcoholic fatty liver disease, but not in females. J Gastroenterol Hepatol 2008;23:908–13.PubMedCrossRefGoogle Scholar
  10. Jakobsen M, Berentzen T, Sørensen TI, Overvad K. Abdominal obesity and fatty liver. Epidemiol Rev 2007;29:77–87.PubMedCrossRefGoogle Scholar
  11. Kogiso T, Moriyoshi Y, Nagahara H. Clinical significance of fatty liver associated with metabolic syndrome. Hepatol Res 2007;37:711–21.PubMedCrossRefGoogle Scholar
  12. Kogiso T, Moriyoshi Y, Shimizu S, Nagahara H, Shiratori K. High-sensitivity C-reactive protein as a serum predictor of nonalcoholic fatty liver disease based on the Akaike Information Criterion scoring system in the general Japanese population. J Gastroenterol 2009;44:313–21.PubMedCrossRefGoogle Scholar
  13. Kotronen A, Westerbacka J, Bergholm R, Pietiläinen KH, Yki-Järvinen H. Liver fat in the metabolic syndrome. J Clin Endocrinol Metab 2007;92:3490–7.PubMedCrossRefGoogle Scholar
  14. Leite NC, Salles GF, Araujo AL, Villela-Nogueira CA, Cardoso CR. Prevalence and associated factors of non-alcoholic fatty liver disease in patients with type-2 diabetes mellitus. Liver Int 2009;29:113–9.PubMedCrossRefGoogle Scholar
  15. Ludwig J, Viggiano TR, McGill DB, Oh BJ. Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease. Mayo Clin Proc 1980;55:434–8.PubMedGoogle Scholar
  16. Marchesini G, Bugianesi E, Forlani G, Cerrelli F, Lenzi M, Manini R, Natale S, Vanni E, Villanova N, Melchionda N, Rizzetto M. Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology 2003;37:917–23.PubMedCrossRefGoogle Scholar
  17. Nielsen S, Guo Z, Johnson CM, Hensrud DD, Jensen MD. Splanchnic lipolysis in human obesity. J Clin Invest 2004;113:1582–8.PubMedGoogle Scholar
  18. Oh SY, Cho YK, Kang MS, Yoo TW, Park JH, Kim HJ, Park DI, Sohn CI, Jeon WK, Kim BI, Son BH, Shin JH. The association between increased alanine aminotransferase activity and metabolic factors in nonalcoholic fatty liver disease. Metabolism 2006;55:1604–9.PubMedCrossRefGoogle Scholar
  19. Park SH, Kim BI, Kim SH, Kim HJ, Park DI, Cho YK, Sung IK, Sohn CI, Kim H, Keum DK, Kim HD, Park JH, Kang JH, Jeon WK. Body fat distribution and insulin resistance: beyond obesity in nonalcoholic fatty liver disease among overweight men. J Am Coll Nutr 2007;26:321–6.PubMedGoogle Scholar
  20. Sabir N, Sermez Y, Kazil S, Zencir M. Correlation of abdominal fat accumulation and liver steatosis: importance of ultrasonographic and anthropometric measurements. Eur J Ultrasound 2001;14:121–8.PubMedCrossRefGoogle Scholar
  21. Savvidou S, Hytiroglou P, Orfanou-Koumerkeridou H, Panderis A, Frantzoulis P, Goulis J. Low serum adiponectin levels are predictive of advanced hepatic fibrosis in patients with NAFLD. J Clin Gastroenterol 2009;43:765–72.PubMedCrossRefGoogle Scholar
  22. Shen L, Fan JG, Shao Y, Zeng MD, Wang JR, Luo GH, Li JQ, Chen SY. Prevalence of nonalcoholic fatty liver among administrative officers in Shanghai: an epidemiological survey. World J Gastroenterol 2003;9:1106–10.PubMedGoogle Scholar
  23. Stranges S, Trevisan M, Dorn JM, Dmochowski J, Donahue RP. Body fat distribution, liver enzymes, and risk of hypertension: evidence from the Western New York Study. Hypertension 2005;46:1186–93.PubMedCrossRefGoogle Scholar
  24. Sung KC, Ryan MC, Kim BS, Cho YK, Kim BI, Reaven GM. Diabetes Care. 2007;30:2113–8.PubMedCrossRefGoogle Scholar
  25. Targher G, Bertolini L, Scala L, Zoppini G, Zenari L, Falezza G. Diabet Med. 2005;22:1354–8.PubMedCrossRefGoogle Scholar
  26. Wasada T, Kasahara T, Wada J, Jimba S, Fujimaki R, Nakagami T, Iwamoto Y. Metabolism. 2008;57:980–5.PubMedCrossRefGoogle Scholar
  27. Zelber Sagi SS, Nitzan KD, Halpern Z, Oren R. Liver Int. 2006;26:856–63.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Yuichiro Eguchi
    • 1
  • Toshihiko Mizuta
  • Iwata Ozaki
  • Dita Salova
  • Masato Yoneda
  • Koji Fujita
  • Hideyuki Hyogo
  • Hideki Fujii
  • Masafumi Ono
  • Yasuaki Suzuki
  • Takaaki Ohtake
  • Yoshio Sumida
  • Kazuma Fujimoto
  1. 1.Department of Internal MedicineSaga Medical SchoolSagaJapan

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