Identification of individuals with non-alcoholic fatty liver disease by the diagnostic criteria for the metabolic syndrome

Abstract

Aim: To clarify the efficiency of the criterion of metabolic syndrome to detecting non-alcoholic fatty liver disease (NAFLD).

Methods: Authors performed a cross-sectional study involving participants of a medical health checkup program including abdominal ultrasonography. This study involved 11 714 apparently healthy Japanese men and women, 18 to 83 years of age. NAFLD was defined by abdominal ultrasonography without an alcohol intake of more than 20 g/d, known liver disease, or current use of medication. The revised criteria of the National Cholesterol Education Program Adult Treatment Panel III were used to characterize the metabolic syndrome.

Results: NAFLD was detected in 32.2% (95% CI: 31.0%-33.5%) of men (n = 1874 of 5811) and in 8.7% (95% CI: 8.0%-9.5%) of women (n = 514 of 5903). Among obese people, the prevalence of NAFLD was as high as 67.3% (95% CI: 64.8%-69.7%) in men and 45.8% (95% CI: 41.7%-50.0%) in women. Although NAFLD was thought of as being the liver phenotype of metabolic syndrome, the prevalence of the metabolic syndrome among subjects with NAFLD was low both in men and women. 66.8% of men and 70.4% of women with NAFLD were not diagnosed with the metabolic syndrome. 48.2% of men with NAFLD and 49.8% of women with NAFLD weren't overweight [body mass index (BMI) ≥ 25 kg/m(2)]. In the same way, 68.6% of men with NAFLD and 37.9% of women with NAFLD weren't satisfied with abdominal classification (≥ 90 cm for men and ≥ 80 cm for women). Next, authors defined it as positive at screening for NAFLD when participants satisfied at least one criterion of metabolic syndrome. The sensitivity of the definition "at least 1 criterion" was as good as 84.8% in men and 86.6% in women. Separating subjects by BMI, the sensitivity was higher in obese men and women than in non-obese men and women (92.3% vs 76.8% in men, 96.1% vs 77.0% in women, respectively).

Conclusion: Authors could determine NAFLD effectively in epidemiological study by modifying the usage of the criteria for metabolic syndrome.

Keywords: Metabolic syndrome; Methodology; Nonalcoholic fatty liver; Population based study.

Figure 1

We separated the subjects by quartile according to their body mass index or abdominal circumference. A: The bar indicated the prevalence (%) of individuals with NAFLD; B: Individuals who meet two or more of the MS criteria other than waist circumference according to BMI or waist circumference quartiles. 2 MS criteria means individuals who meets two or more of the MS criteria other than waist circumference. NAFLD: Nonalcoholic fatty liver disease; BMI: Body mass index; MS: Metabolic syndrome.

Figure 2

This figure indicates the prevalence of non-alcoholic fatty liver disease and alcoholic fatty liver disease with or without patients being overweight (BMI ≥ 25 kg/m²) or having elevated abdominal circumferences (≥ 90 cm for men and ≥ 80 cm for women). Data was expressed as prevalence (%). NAFLD accompanied with being overweight occurred in 51.8% of NAFLD men (970/1874) and 50.2% of NAFLD women (258/514). NAFLD accompanied by elevated abdominal circumference occurred in 31.4% of NAFLD men (588/1874) and 62.1% of women (319/514). NAFLD: Non-alcoholic fatty liver disease; BMI: Body mass index.

Figure 3

The prevalence of subjects with or without the metabolic syndrome among 1874 men and 514 women with non-alcoholic fatty liver disease. Data was expressed as prevalence (%). The metabolic syndrome (MS) was diagnosed using revised IDF. Among men with NAFLD, 66.8% and 79.0% were not diagnosed with the MS defined by revised NCEP-ATPIII definition and revised IDF definition, respectively. In women, 70.4% and 67.5%, respectively, were not diagnosed with the MS by revised NCEP-ATPIII definition and revised IDF definition. IDF: International Diabetes Federation; NCEP-ATPIII: National Cholesterol Education Program Adult Treatment Panel III; NAFLD: Non-alcoholic fatty liver disease.