Skip to main content
SpringerLink
Log in

Ultrasonographic evaluation of liver volume and the metabolic syndrome in obese women

  • Original Articles
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

Non-alcoholic fatty liver disease is a common finding in obese subjects, and increasing evidence has been provided suggesting that it represents the hepatic component of the metabolic syndrome. The aim of this study was to evaluate whether the extent of liver enlargement is related to the severity of the metabolic syndrome in obese women. The relationship between ultrasound-measured hepatic left lobe volume (HLLV) and various features of the metabolic syndrome was evaluated in 85 obese women. The mean±SD value of HLLV in obese women was 431±214 ml (range 46–1019 ml) while it was 187±31 ml (range 143–258 ml) in lean subjects. In a multiple logistic regression analysis, ultrasound-measured intra-abdominal fat was the only anthropometric measure independently associated with HLLV. A strong positive association was found between HLLV and serum liver enzymes, triglycerides, glucose, insulin, uric acid, C reactive protein, systolic and diastolic blood pressure, while a negative correlation was observed between HLLV and HDL cholesterol. The values of HLLV corresponding to the cut-off values of various risk factors for the diagnosis of the metabolic syndrome were calculated, yielding a mean value of 465 ml. In conclusion, ultrasound measurement of HLLV represents a simple, reliable and low-cost tool for the evaluation of liver involvement in the metabolic syndrome. The strong association between liver enlargement and various cardiovascular risk factors associated with insulin resistance supports the role of liver steatosis as an important link among the many facets of the metabolic syndrome in human obesity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Reaven GM. Role of insulin resistance in human disease. Diabetes 1988, 37: 1595–607.

    Article  PubMed  CAS  Google Scholar 

  2. Isomaa B. A major health hazard: the metabolic syndrome. Life Sci 2003, 73: 2395–411.

    Article  PubMed  CAS  Google Scholar 

  3. Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet 2005, 365: 1415–28.

    Article  PubMed  CAS  Google Scholar 

  4. Wajchenberg BL. Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. Endocr Rev 2000, 21: 697–738.

    Article  PubMed  CAS  Google Scholar 

  5. Kahn R, Buse J, Ferrannini E, Stern M. The metabolic syndrome: time for a critical appraisal: Joint statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2005, 28: 2289–304.

    Article  PubMed  Google Scholar 

  6. Natali A, Ferrannini E. Hypertension, insulin resistance, and the metabolic syndrome. Endocrinol Metab Clin North Am 2004, 33: 417–29.

    Article  PubMed  CAS  Google Scholar 

  7. Dandona P, Aljada A, Chaudhuri A, Mohanty P, Garg R. Metabolic syndrome: a comprehensive perspective based on interactions between obesity, diabetes, and inflammation. Circulation 2005, 111: 1448–54.

    Article  PubMed  Google Scholar 

  8. Marceau P, Biron S, Hould FS, et al. Liver pathology and the metabolic syndrome X in severe obesity. J Clin Endocrinol Metab 1999, 84: 1513–7.

    Article  PubMed  CAS  Google Scholar 

  9. Marchesini G, Brizi M, Bianchi G, et al. Nonalcoholic fatty liver disease: a feature of the metabolic syndrome. Diabetes 2001, 50: 1844–50.

    Article  PubMed  CAS  Google Scholar 

  10. Bloomgarden ZT. Second World Congress on the Insulin Resistance Syndrome: insulin resistance syndrome and nonalcoholic fatty liver disease. Diabetes Care 2005, 28: 1518–23.

    Article  PubMed  Google Scholar 

  11. Seppala-Lindroos A, Vehkavaara S, Hakkinen AM, et al. Fat accumulation in the liver is associated with defects in insulin suppression of glucose production and serum free fatty acids independent of obesity in normal men. J Clin Endocrinol Metab 2002, 87: 3023–8.

    Article  PubMed  CAS  Google Scholar 

  12. Venturi C, Zoppini G, Zamboni C, Muggeo M. Insulin sensitivity and hepatic steatosis in obese subjects with normal glucose tolerance. Nutr Metab Cardiovasc Dis 2004, 14: 200–4.

    Article  PubMed  CAS  Google Scholar 

  13. Yki-Jarvinen H, Westerbacka J. The fatty liver and insulin resistance. Curr Mol Med 2005, 5: 287–95.

    Article  PubMed  CAS  Google Scholar 

  14. Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology 1999, 116: 1413–9.

    Article  PubMed  CAS  Google Scholar 

  15. Kleiner DE, Brunt EM, Van Natta M, et al. Nonalcoholic Steatohepatitis Clinical Research Network Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 2005, 41: 1313–21.

    Article  PubMed  Google Scholar 

  16. Matthews DR, Hosker J P, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985, 28: 412–9.

    Article  PubMed  CAS  Google Scholar 

  17. Ribeiro-Filho FF, Faria AN, Azjen S, Zanella MT, Ferreira SR. Methods of estimation of visceral fat: advantages of ultrasonography. Obes Res 2003, 11: 1488–94.

    Article  PubMed  Google Scholar 

  18. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001, 285: 2486–97.

    Article  Google Scholar 

  19. International Diabetes Federation (IDF) Worldwide Definition of the Metabolic Syndrome 2005 available on line: www.idf.org

  20. Angulo P. Nonalcoholic fatty liver disease. N Engl J Med 2002, 346: 1221–31.

    Article  PubMed  CAS  Google Scholar 

  21. Bellentani S, Saccoccio G, Masutti F, et al. Prevalence of and risk factors for hepatic steatosis in Northern Italy. Ann Intern Med 2000, 132: 112–7.

    Article  PubMed  CAS  Google Scholar 

  22. Schaffner F, Thaler H. Nonalcoholic fatty liver disease. Prog Liver Dis 19868: 283–9

  23. Knobler H, Schattner A, Zhornicki T, et al. Fatty liver: an additional and treatable feature of the insulin resistance syndrome. QJM 1999, 92: 73–9.

    Article  PubMed  CAS  Google Scholar 

  24. Adams LA, Lymp JF, St Sauver J, et al. The natural history of nonalcoholic fatty liver disease: a population-based cohort study. Gastroenterology 2005, 129: 113–21.

    Article  PubMed  Google Scholar 

  25. Grundy SM. Metabolic syndrome: part II. Endocrinol Metab Clin North Am 2004, 33: xi–xiii.

    Article  PubMed  Google Scholar 

  26. Pouliot MC, Despres JP, Lemieux S, et al. Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. Am J Cardiol 1994, 73: 460–8.

    Article  PubMed  CAS  Google Scholar 

  27. Fritschy P, Robotti G, Schneekloth G, Vock P. Measurement of liver volume by ultrasound and computed tomography. J Clin Ultrasound 1983, 11: 299–303.

    Article  PubMed  CAS  Google Scholar 

  28. Busetto L, Tregnaghi A, De Marchi F, et al. Liver volume and visceral obesity in women with hepatic steatosis undergoing gastric banding. Obes Res 2002, 10: 408–11.

    Article  PubMed  Google Scholar 

  29. Fishbein M, Castro F, Cheruku S, et al. Hepatic MRI for fat quantitation: its relationship to fat morphology, diagnosis, and ultrasound. J Clin Gastroenterol 2005, 39: 619–25.

    Article  PubMed  Google Scholar 

  30. Joseph AE, Saverymuttu SH, al-Sam S, Cook MG, Maxwell JD. Comparison of liver histology with ultrasonography in assessing diffuse parenchymal liver disease. Clin Radiol 1991, 43: 26–31.

    Article  PubMed  CAS  Google Scholar 

  31. Mathiesen UL, Franzen LE, Aselius H, et al. Increased liver echogenicity at ultrasound examination reflects degree of steatosis but not of fibrosis in asymptomatic patients with mild/moderate abnormalities of liver transaminases. Dig Liver Dis 2002, 34: 516–22.

    Article  PubMed  CAS  Google Scholar 

  32. Hatsuno T, Kaneko T, Ito S, Nakao A. Sonographic measurement of the volume of the left lateral segment of the liver. J Clin Ultrasound 2002, 30: 117–22.

    Article  PubMed  Google Scholar 

  33. Thomas EL, Hamilton G, Patel N, et al. Hepatic triglyceride content and its relation to body adiposity: a magnetic resonance imaging and proton magnetic resonance spectroscopy study. Gut 2005, 54: 122–7.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  34. Donnelly KL, Smith CI, Schwarzenberg SJ, Jessurun J, Boldt MD, Parks EJ. Sources of fatty acids stored in liver and secreted via lipoproteins in patients with nonalcoholic fatty liver disease. J Clin Invest 2005, 115: 1343–51.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  35. Westerbacka J, Lammi K, Hakkinen AM, et al. Dietary fat content modifies liver fat in overweight nondiabetic subjects. J Clin Endocrinol Metab 2005, 90: 2804–9.

    Article  PubMed  CAS  Google Scholar 

  36. Angelico F, Del Ben M, Conti R, et al. Insulin resistance, the metabolic syndrome, and nonalcoholic fatty liver disease. J Clin Endocrinol Metab 2005, 90: 1578–82.

    Article  PubMed  CAS  Google Scholar 

  37. Kunde SS, Lazenby AJ, Clements RH, Abrams GA. Spectrum of NAFLD and diagnostic implications of the proposed new normal range for serum ALT in obese women. Hepatology 2005, 42: 650–6.

    Article  PubMed  Google Scholar 

  38. Marchesini G, Avagnina S, Barantani EG, et al. Aminotransferase and gammaglutamyltranspeptidase levels in obesity are associated with insulin resistance and the metabolic syndrome. J Endocrinol Invest 2005, 28: 333–9.

    Article  PubMed  CAS  Google Scholar 

  39. Nannipieri M, Gonzales C, Baldi S, et al. Liver enzymes, the metabolic syndrome, and incident diabetes: the Mexico City diabetes study. Diabetes Care 2005, 28: 1757–62.

    Article  PubMed  CAS  Google Scholar 

  40. Johnson RJ, Feig DI, Herrera-Acosta J, Kang DH. Resurrection of uric acid as a causal risk factor in essential hypertension. Hypertension 2005, 45: 18–20.

    Article  PubMed  CAS  Google Scholar 

  41. Devaraj S, Rosenson RS, Jialal I. Metabolic syndrome: an appraisal of the pro-inflammatory and procoagulant status. Endocrinol Metab Clin North Am 2004, 33: 431–53.

    Article  PubMed  CAS  Google Scholar 

  42. Visser M, Bouter LM, McQuillan GM, Wener MH, Harris TB. Elevated C-reactive protein levels in overweight and obese adults. JAMA 1999, 282: 2131–5.

    Article  PubMed  CAS  Google Scholar 

  43. Park SH, Kim BI, Yun JW, et al. Insulin resistance and C-reactive protein as independent risk factors for non-alcoholic fatty liver disease in non-obese Asian men. J Gastroenterol Hepatol 2004, 19: 694–8.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Endocrinology and Metabolic Diseases, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy

    F. Santini MD, M. Giannetti, P. Fierabracci, G. Scartabelli, A. Marsili, R. Valeriano, A. Pucci, P. Vitti & A. Pinchera

  2. Department of Radiology, University Hospital of Pisa, Pisa, Italy

    S. Mazzeo & V. Zampa

  3. Department of Surgery, University Hospital of Pisa, Pisa, Italy

    M. Anselmino

Authors
  1. F. Santini MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Giannetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Mazzeo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Fierabracci
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Scartabelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Marsili
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R. Valeriano
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. Pucci
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. M. Anselmino
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. V. Zampa
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. P. Vitti
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. A. Pinchera
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F. Santini MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Santini, F., Giannetti, M., Mazzeo, S. et al. Ultrasonographic evaluation of liver volume and the metabolic syndrome in obese women. J Endocrinol Invest 30, 104–110 (2007). https://doi.org/10.1007/BF03347407

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03347407

Keywords

Search

Navigation