J Korean Med Sci.  2008 Oct;23(5):789-795. 10.3346/jkms.2008.23.5.789.

Impact of Visceral Fat on the Metabolic Syndrome and Nonalcoholic Fatty Liver Disease

• Jeong SK
• Kim YK
• Park JW
• Shin YJ
• Kim DS

• KMID: 1783062
• DOI: http://doi.org/10.3346/jkms.2008.23.5.789

Abstract

Visceral fat has been reported to be associated with nonalcoholic fatty liver disease (NAFLD) and the metabolic syndrome (MetS). We assessed the prevalence of both NAFLD and the MetS, measured visceral fat thickness VFT), and estimated the physical activity indexes of 224 relatively healthy hospital workers. We also investigated the associations between both VFT and physical activity index and each of NAFLD and the MetS. The MetS was diagnosed according to the guidelines outlined by the Adult Treatment Panel III, and NAFLD was diagnosed by ultrasonography. Subjects with hepatitis B and C infections and those reporting moderate alcohol consumption were excluded from the study. The prevalence of the MetS was 11.6% and that of NAFLD was 41.5%. Many subjects with the MetS had NAFLD (73.1%), and some subjects with NAFLD (20.4%) also had several components of the MetS (p=0.001). VFT was significantly increased by both the addition of components of the MetS and the severity of NAFLD (p<0.001). In addition, VFT was independently associated with NAFLD (odds ratio [OR], 1.10; 95% confidence interval [CI], 1.02-1.19) in subjects with more than 2 components of the MetS. In contrast, habitual physical activity was reversely associated with NAFLD (OR, 0.29; 95% CI, 0.10-0.87). In conclusion, an increased visceral fat content and reduced physical activity could be not only biological markers but also therapeutic targets in the treatment of NAFLD and the MetS.

Keyword

Nonalcoholic Fatty Liver Disease; Metabolic Syndrome; Intra-Abdominal Fat; Work Index

MeSH Terms

Adult
Alcohol Drinking
Blood Pressure
Comorbidity
Fatty Liver/*physiopathology
Female
Humans
Hyperinsulinism/complications
*Intra-Abdominal Fat
Male
Metabolic Syndrome X/*physiopathology
Middle Aged
Multivariate Analysis
Odds Ratio

Figure

• 

  Fig. 1 Distribution of visceral fat thickness according to the grade of NAFLD in subjects with more than 2 components of the metabolic syndrome. Visceral fat thickness was significantly increased with the severity of NAFLD (p<0.001). The interaction terms between gender and the severity of NAFLD were not significant (p=0.303).

Reference

1. 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. 285:2486–2497.

2. Laaksonen DE, Lakka HM, Niskanen LK, Kaplan GA, Salonen JT, Lakka TA. Metabolic syndrome and development of diabetes mellitus: application and validation of recently suggested definitions of the metabolic syndrome in a prospective cohort study. Am J Epidemiol. 2002. 156:1070–1077.

3. Onat A, Ceyhan K, Basar O, Erer B, Toprak S, Sansoy V. Metabolic syndrome: major impact on coronary risk in a population with low cholesterol levels--a prospective and cross-sectional evaluation. Atherosclerosis. 2002. 165:285–292.

4. Isomaa B, Almgren P, Tuomi T, Forsen B, Lahti K, Nissen M, Taskinen MR, Groop L. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care. 2001. 24:683–689.

5. Jeong SK, Nam HS, Rhee JA, Shin JH, Kim JM, Cho KH. Metabolic syndrome and ALT: a community study in adult Koreans. Int J Obes Relat Metab Disord. 2004. 28:1033–1038.

6. 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. 37:917–923.

7. Targher G, Bertolini L, Scala L, Zoppini G, Zenari L, Falezza G. Nonalcoholic hepatic steatosis and its relation to increased plasma biomarkers of inflammation and endothelial dysfunction in non-diabetic men. Role of visceral adipose tissue. Diabet Med. 2005. 22:1354–1358.

8. Ford ES, Kohl HW 3rd, Mokdad AH, Ajani UA. Sedentary behavior, physical activity, and the metabolic syndrome among U.S. adults. Obes Res. 2005. 13:608–614.

9. O'Leary VB, Marchetti CM, Krishnan RK, Stetzer BP, Gonzalez F, Kirwan JP. Exercise-induced reversal of insulin resistance in obese elderly is associated with reduced visceral fat. J Appl Physiol. 2006. 100:1584–1589.

10. Baecke JA, Burema J, Frijters JE. A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr. 1982. 36:936–942.

11. Lee CW, Lee SH, Lee MS, Suh SK, Yoon NK, Ahn EJ. Measurement properties of Baecke's habitual physical activity questionnaire and related variables. J Korean Pub Health Asso. 1992. 18:38–53.

12. Durnin JV, Womersley J. Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 years. Br J Nutr. 1974. 32:77–97.

13. Andrade S, Lan SJ, Engelson ES, Agin D, Wang J, Heymsfield SB, Kotler DP. Use of a Durnin-Womersley formula to estimate change in subcutaneous fat content in HIV-infected subjects. Am J Clin Nutr. 2002. 75:587–592.

14. Lee WG, Kwak YS, Lee DH, Hwang YS, Lee KN. Laboratory inspection and accreditation in Korea II: analysis of the first round inspection. Korean J Lab Med. 2003. 23:363–369.

15. Quinn SF, Gosink BB. Characteristic sonographic signs of hepatic fatty infiltration. AJR Am J Roentgenol. 1985. 145:753–755.

16. Sanyal AJ. AGA technical review on nonalcoholic fatty liver disease. Gastroenterology. 2002. 123:1705–1725.

17. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC Jr, Spertus JA, Costa F. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005. 112:2735–2752.

18. Bedogni G, Bellentani S. Fatty liver: how frequent is it and why? Ann Hepatol. 2004. 3:63–65.

19. Roskams T, Yang SQ, Koteish A, Durnez A, DeVos R, Huang X, Achten R, Verslype C, Diehl AM. Oxidative stress and oval cell accumulation in mice and humans with alcoholic and nonalcoholic fatty liver disease. Am J Pathol. 2003. 163:1301–1311.

20. Banfi C, Mussoni L, Ris P, Cattaneo MG, Vicentini L, Battaini F, Galli C, Tremoli E. Very low density lipoprotein-mediated signal transduction and plasminogen activator inhibitor type 1 in cultured HepG2 cells. Circ Res. 1999. 85:208–217.

21. Samuel VT, Liu ZX, Qu X, Elder BD, Bilz S, Befroy D, Romanelli AJ, Shulman GI. Mechanism of hepatic insulin resistance in nonalcoholic fatty liver disease. J Biol Chem. 2004. 279:32345–32353.

22. Barzilai N, She L, Liu BQ, Vuguin P, Cohen P, Wang J, Rossetti L. Surgical removal of visceral fat reverses hepatic insulin resistance. Diabetes. 1999. 48:94–98.

23. Furukawa S, Fujita T, Shimabukuro M, Iwaki M, Yamada Y, Nakajima Y, Nakayama O, Makishima M, Matsuda M, Shimomura I. Increased oxidative stress in obesity and its impact on metabolic syndrome. J Clin Invest. 2004. 114:1752–1761.

24. Bedogni G, Miglioli L, Masutti F, Tiribelli C, Marchesini G, Bellentani S. Prevalence of and risk factors for nonalcoholic fatty liver disease: the Dionysos nutrition and liver study. Hepatology. 2005. 42:44–52.

25. Jeong SK, Seo MW, Kim YH, Kweon SS, Nam HS. Does waist indicate dyslipidemia better than BMI in Korean adult population? J Korean Med Sci. 2005. 20:7–12.

26. Kim DS, Jeong SK, Kim HR, Kim DS, Chae SW, Chae HJ. Effects of triglyceride on ER stress and insulin resistance. Biochem Biophys Res Commun. 2007. 363:140–145.

27. Kim SY, Shim KW, Lee HS, Lee SH, Kim HL, Oh YA. The association between nonalcoholic fatty liver disease with metabolic syndrome. J Korean Acad Fam Med. 2007. 28:667–674.

28. Bellentani S, Saccoccio G, Masutti F, Croce LS, Brandi G, Sasso F, Cristanini G, Tiribelli C. Prevalence of and risk factors for hepatic steatosis in Northern Italy. Ann Intern Med. 2000. 132:112–117.

29. Hamaguchi M, Kojima T, Takeda N, Nakagawa T, Taniguchi H, Fujii K, Omatsu T, Nakajima T, Sarui H, Shimazaki M, Kato T, Okuda J, Ida K. The metabolic syndrome as a predictor of nonalcoholic fatty liver disease. Ann Intern Med. 2005. 143:722–728.

30. Woo J, Leung SS, Ho SC, Sham A, Lam TH, Janus ED. Influence of educational level and marital status on dietary intake, obesity and other cardiovascular risk factors in a Hong Kong Chinese population. Eur J Clin Nutr. 1999. 53:461–467.

31. Yajima Y, Ohta K, Narui T, Abe R, Suzuki H, Ohtsuki M. Ultrasonographical diagnosis of fatty liver: significance of the liver-kidney contrast. Tohoku J Exp Med. 1983. 139:43–50.

32. Saadeh S, Younossi ZM, Remer EM, Gramlich T, Ong JP, Hurley M, Mullen KD, Cooper JN, Sheridan MJ. The utility of radiological imaging in nonalcoholic fatty liver disease. Gastroenterology. 2002. 123:745–750.