Body Fat Distribution and Risk of Incident and Regressed Nonalcoholic Fatty Liver Disease.

BACKGROUND & AIMS: Some studies have examined correlations between visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) with nonalcoholic fatty liver disease (NAFLD) or between VAT and NAFLD. We investigated the longitudinal association between body fat distribution (VAT vs SAT) and incidence and regression of NAFLD, adjusting for risk factors, in a large population-based cohort. METHODS: We collected data from adults who underwent abdominal ultrasonography (to identify liver fat), abdominal fat computed tomography scan, and blood tests from March 2007 through December 2008. Each patient underwent an anthropometric assessment and completed a questionnaire about their medical history, physical activity, and diet. Our final analysis involved 2017 subjects from the initial cohort who participated in a voluntary follow-up health screen performed in 2011 and 2013. The median follow-up time was 4.43 years. RESULTS: We found 288 incident cases of NAFLD; 159 patients had NAFLD regression during the follow-up period. An increasing area of VAT was associated with higher incidence of NAFLD in the multivariable analysis (highest quintile vs lowest quintile of VAT hazard ratio [HR], 2.23; 95% confidence interval [CI], 1.28-3.89; P for trend = .002; HR, 1.36 [per 1 standard deviation]; 95% CI, 1.16-1.59). An increased area of SAT was significantly associated with regression of NAFLD (highest quintile vs lowest quintile of SAT HR, 2.30; 95% CI, 1.28-4.12; P for trend = .002; HR, 1.36 [per 1 standard deviation]; 95% CI, 1.08-1.72). CONCLUSIONS: In a large cohort study, larger areas of VAT were longitudinally associated with higher risk of incident NAFLD (during a period of approximately 4 years). In contrast, larger areas of SAT were longitudinally associated with regression of NAFLD. These data indicate that certain types of body fat are risk factors for NAFLD, whereas other types could reduce risk for NAFLD.

Hepatic fat, not visceral fat, is associated with gallbladder polyps: a study of 2643 healthy subjects.

BACKGROUND AND AIM: Gallbladder polyps (GBPs) appear to be strongly associated with obesity and metabolic disease. To date, the relationship between GBPs and fatty liver has not been adequately evaluated. The aim of the present study was to investigate whether GBPs are associated with fatty liver, which is an ectopic regional fat deposit, independent of visceral adipose tissue (VAT). METHODS: A cross-sectional study using 2643 health checkup subjects (961 patients with GBP and 1682 age- and sex-matched healthy controls) was conducted. The subjects underwent various laboratory tests, abdominal fat computed tomography (CT), and hepatic ultrasonography. RESULTS: The mean age of the subjects was 51.4 ± 8.3 years, and 74.1% were male. GBPs were significantly associated with fatty liver. Multivariate regression analysis revealed that GBPs were significantly associated with the presence of fatty liver (odds ratio [OR] 1.23, 95% confidence interval [CI]: 1.02-1.48), and adjusting for the homeostatic metabolic assessment index had little effect on this association (OR 1.23, 95% CI: 1.02-1.48). Additionally, GBPs remained significantly associated with the presence of fatty liver after adjustments for CT-measured VAT and subcutaneous adipose tissue (OR 1.24, 95% CI: 1.03-1.50). The degree of fatty liver showed an independent (OR 1.37 95% CI: 1.03-1.80) and dose-dependent relationship (moderate-severe fatty liver: OR 1.55 95% CI: 1.07-2.23, P for trend = 0.014) with large GBPs (≥ 5 mm). CONCLUSION: Fatty liver, an ectopic regional fat deposit, was found to be closely associated with GBPs independent of known metabolic risk factors, insulin resistance, and CT-measured VAT, confirming a relevant clinical relationship between the two diseases.

Carotid intima-media thickness in mainly non-obese women with polycystic ovary syndrome and age-matched controls.

OBJECTIVE: Metabolic disturbances are well-recognized clinical features of polycystic ovary syndrome (PCOS). Carotid intima-media thickness (CIMT) has been widely used as a surrogate marker of atherosclerosis and cardiovascular disease (CVD). CIMT in women with PCOS has been investigated in many studies, but there has been only one report in the Korean population. The aim of the present study was to compare the presence of subclinical atherosclerosis in young untreated Korean women with PCOS and age-matched controls, specifically by measuring their CIMT. METHODS: CIMT was measured by one radiologist in 56 PCOS patients and 56 controls. To compare the CIMT according to PCOS phenotypes, women with PCOS were divided into two subgroups according to the presence of hyperandrogenism. RESULTS: Although PCOS patients were more obese and had higher blood pressure and insulin resistance index than the age-matched controls, the CIMT was not different between the two groups (0.49 ± 0.09 mm in PCOS patients vs. 0.50 ± 0.11 mm in controls, respectively, p = 0.562). When the CIMT in the control group was compared with hyperandrogenic and non-hyperandrogenic PCOS groups, also no significant differences were found. CONCLUSION: Despite the significant differences in some vascular risk factors between women with PCOS and controls, PCOS patients did not have a significantly higher CIMT (even in the hyperandrogenic subgroups). Although our study did not show the increased risk of subclinical atherosclerosis in PCOS patients, the role of CIMT continues to be investigated considering the importance of screening and monitoring CVD risk factors in women with PCOS.

Nonalcoholic fatty liver disease is associated with coronary artery calcification.

UNLABELLED: Nonalcoholic fatty liver disease (NAFLD) is related to risk factors of coronary artery disease, such as dyslipidemia, diabetes, and metabolic syndrome, which are closely linked with visceral adiposity. The aim of this study was to investigate whether NAFLD was associated with coronary artery calcification (CAC), which is used as a surrogate marker for coronary atherosclerosis independent of computed tomography (CT)-measured visceral adiposity. Out of 5,648 subjects who visited one of our health screening centers between 2003 and 2008, we enrolled 4,023 subjects (mean age, 56.9 ± 9.4 years; 60.7% males) without known liver disease or a history of ischemic heart disease. CAC score was evaluated using the Agatston method. On univariate analysis, the presence of CAC (score >0) was significantly associated with age, sex, body mass index, aspartate aminotransferase, alanine aminotransferase, high-density lipoprotein cholesterol, triglycerides, and increased risk of diabetes, hypertension, smoking, and NAFLD. Increasing CAC scores (0, <10, 10-100, ≥ 100) were associated with higher prevalence of NAFLD (odds ratio [OR], 1.84; 95% confidence interval [CI], 1.61-2.10; P<0.001). Multivariable ordinal regression analysis was adjusted for traditional risk factors, and CT-measured visceral adipose tissue area in a subgroup of subjects showed that the increased CAC scores were significantly associated with the presence of NAFLD (OR, 1.28, 95% CI, 1.04-1.59; P = 0.023) independent of visceral adiposity. CONCLUSION: Patients with NAFLD are at increased risk for coronary atherosclerosis independent of classical coronary risk factors, including visceral adiposity. These data suggest that NAFLD might be an independent risk factor for coronary artery disease.

The relation between non-alcoholic fatty liver disease and the risk of coronary heart disease in Koreans.

OBJECTIVES: Non-alcoholic fatty liver disease (NAFLD) is known to be related to factors that predict the development of coronary heart disease (CHD), such as dyslipidemia, central obesity, and metabolic syndrome (MS). The aim of this study was to determine whether individuals with NAFLD have an elevated risk of CHD, as estimated using the Framingham risk score (FRS). METHODS: A total of 21,130 individuals who underwent a voluntary general health examination were recruited. NAFLD was diagnosed among these individuals on the basis of typical sonographic findings and a level of alcohol consumption of <20 g/day. Of the 21,130 individuals, 3,780 were excluded because they had known causes of liver disease (1,690 were alcoholics, 975 had hepatitis B virus, 242 had hepatitis C virus, 91 had other hepatitis history, and 593 were taking medication known to produce fatty liver) or a history of heart disease (189). RESULTS: NAFLD was diagnosed in 5,769 of the 17,350 individuals (33.3%). The 11,581 normal individuals constituted the control group. The 5,769 individuals with NAFLD were split into two groups on the basis of ultrasonographic findings, that is, into a mild NAFLD group (n=3,278) and a moderate-severe NAFLD group (n=2,491). Individuals with NAFLD had an elevated risk of CHD, as estimated using FRS. Multivariable regression analysis, adjusted for confounding factors, showed a strong association between a higher FRS and NAFLD. CONCLUSIONS: Individuals with ultrasonographically detected NAFLD have an elevated 10-year risk of developing CHD as estimated using FRS. Furthermore, NAFLD was found to be independently related to the risk of developing CHD, regardless of classical risk factors and other components of MS.

The image quality and radiation dose of 100-kVp versus 120-kVp ECG-gated 16-slice CT coronary angiography.

OBJECTIVE: This study was conducted to assess the feasibility of performing 100-kVp electrocardiogram (ECG)-gated coronary CT angiography, as compared to 120-kVp ECG-gated coronary CT angiography. MATERIALS AND METHODS: We retrospectively evaluated one hundred eighty five gender- and body mass index-matched 16-slice coronary CT sets of data, which were obtained using either 100 kVp and 620 effective mAs or 120 kVp and 500 effective mAs. The density measurements (image noise, vessel density, signal-to-noise ratio [SNR] and contrast-to-noise ratio [CNR]) and the estimated radiation dose were calculated. As a preference test, two image readers were independently asked to choose one image from each pair of images. The results of both protocols were compared using the paired t-test or the Wilcoxon signed rank test. RESULTS: The 100-kVp images showed significantly more noise and a significantly higher vessel density than did the 120-kVp images. There were no significant differences in the SNR and CNR. The estimated reduction of the radiation dose for the 100-kVp protocol was 24%; 7.8 +/- 0.4 mSV for 100-kVp and 10.1 +/- 1.0 mSV for 120-kVp (p < 0.001). The readers preferred the 100-kVp images for reading (reader 1, p = 0.01; reader 2, p = 0.06), with their preferences being stronger when the subject's body mass index was less than 25. CONCLUSION: Reducing the tube kilovoltage from 120 to 100 kVp allows a significant reduction of the radiation dose without a significant change in the SNR and the CNR.

Cerebral white matter hyperintensity is mainly associated with hypertension among the components of metabolic syndrome in Koreans.

BACKGROUND: Cerebral white matter hyperintensity (WMH) is a common abnormality in brain magnetic resonance imaging (MRI) and is known to be associated with ischaemic stroke. Previous studies revealed that the risk factors for cerebral WMH were age, female gender, hypertension and diabetes. In this study we examined the association between cerebral WMH and metabolic syndrome, a cluster of hypertension, glucose intolerance, abdominal obesity and dyslipidaemia. METHODS AND RESULTS: We reviewed the results of brain MRI of 5498 subjects who underwent routine check-ups including laboratory tests at the Seoul National University Health Care System. Among the subjects who met the inclusion criteria (n = 5104), 1693 (33.2%) had cerebral WMH. They were characterized by old age, female predominance, higher body mass index (BMI), larger waist circumference, higher blood pressure, higher fasting plasma glucose level, and higher haemoglobin A1c (HbA1c). In multivariate analyses, age, female gender and hypertension were the independent risk factors for cerebral WMH. Metabolic syndrome was associated with cerebral WMH after adjusting for age and gender [odds ratio (OR) 1.20, 95% confidence interval (CI) 1.04-1.39, P = 0.014]. Among the components of metabolic syndrome, hypertension was independently associated with cerebral WMH (OR 1.20, 95% CI 1.05-1.38, P = 0.007). CONCLUSION: Age, female gender and hypertension were risk factors for cerebral WMH in the Korean population. Cerebral WMH was also associated with metabolic syndrome; however, metabolic syndrome offered no advantage over hypertension alone in predicting cerebral WMH.

[Nonalcoholic fatty liver disease as a risk factor of cardiovascular disease: relation of non-alcoholic fatty liver disease to carotid atherosclerosis].

BACKGROUND/AIMS: Non-alcoholic fatty liver disease (NAFLD) is closely associated with abdominal obesity, dyslipidemia, hypertension, and Type 2 diabetes, which are all features of the metabolic syndrome. The aim of the present study was to elucidate whether NAFLD is associated with carotid atherosclerosis. METHODS: The study population comprised 659 subjects without hepatitis B and C infections and who did not consume alcohol. Fatty infiltrations of liver were detected by abdominal ultrasonography, and intima-media thickness (IMT) and plaque prevalence were estimated by carotid ultrasonography. RESULTS: The mean values of systolic and diastolic pressures, body mass index (BMI), aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transpeptidase, uric acid, total cholesterol, triglycerides, high density lipoprotein (HDL) cholesterol, fasting glucose, fasting insulin, homeostasis model of assessment (HOMA) index, hemoglobin A1c, and plasminogen activator inhibitor-1 differed significantly between patients with NAFLD (n=314) and normal controls (n=345). The carotid IMT was 0.817+/-0.212 (mean+/-SD) mm in patients with NAFLD and 0.757+/-0.198 mm in normal controls (p<0.001). The prevalence of carotid plaques was higher in patients with NAFLD (26.4%) than in normal controls (15.9%) (p<0.001). This association persisted significantly after adjusting for age, sex, BMI, HOMA index and individual factors of metabolic syndrome by multiple logistic regression analysis. CONCLUSIONS: Patients with NAFLD are at a high risk of carotid atherosclerosis regardless of metabolic syndrome and classical cardiovascular risk factors. Therefore, the detection of NAFLD should alert to the existence of an increased cardiovascular risk. Moreover, NAFLD might be an independent risk factor for cardiovascular disease.

Radiologic and pathologic findings of nonpalpable thyroid carcinomas detected by ultrasonography in a medical screening center.

OBJECTIVE: The purpose of this study was to investigate the ultrasonographic and pathologic findings of nonpalpable thyroid carcinomas and reliable guidelines for fine-needle aspiration (FNA). METHODS: Our study was approved by our Institutional Review Board, and written informed consent was waived. Between April 2004 and June 2006, screening ultrasonography was performed for 16,352 self-referred patients in the health care center. Among 1325 nonpalpable thyroid nodules in 1009 patients, pathologic results of FNA revealed 823 benign, 154 indeterminate, 198 nondiagnostic, and 150 malignant nodules. Fifty-eight malignant thyroid nodules (39 microcarcionomas and 19 carcinomas >1 cm, confirmed by both FNA and thyroidectomy) in 55 patients and 82 benign nodules (confirmed by both FNA and follow-up over 2 years) in 75 patients were included for the analysis. Three radiologists retrospectively analyzed the ultrasonographic features of these nonpalpable thyroid nodules for echogenicity, shape, margin, calcification, degree of cystic changes, and size. We compared the radiologic and pathologic findings between microcarcinomas and carcinomas larger than 1 cm for extra-capsular invasion, lymph node metastasis, bilaterality, and multicentricity using univariate analysis. RESULTS: Marked hypoechogenicity, an irregular shape, a taller-than-wide shape, a well-defined spiculated margin, microcalcification, and an entirely solid nature were significant predictors for malignancy (P < .05), whereas a cutoff value of 1 cm in the longest diameter was not significant (P = .184). However, extracapsular invasion (P = .024) and lymph node metastasis (P = .019) were observed more frequently in carcinomas larger than 1 cm (73.7% and 42.1%, respectively) than in microcarcinomas (38.5% and 12.8%). CONCLUSIONS: Ultrasonographic findings suggesting malignancy should be preferentially considered as indicators for FNA, regardless of size, in nonpalpable thyroid nodules. However, extracapsular invasion and lymph node metastasis are closely related to the size of the thyroid nodule.