Association of Non-alcoholic Fatty Liver Disease with Metabolic Syndrome Independently of Central Obesity and Insulin Resistance

Abstract

Non-alcoholic fatty liver disease (NAFLD) is an emerging chronic liver disease that may lead to liver cirrhosis and hepatocellular carcinoma. We aimed to determine the association between the prevalence of metabolic syndrome (MetS) and NAFLD severity using semi-quantitative ultrasonography (US). A total of 614 participants were recruited from the community. NAFLD was evaluated according to the ultrasonographic Fatty Liver Indicator (US-FLI), which is a semi-quantitative liver ultrasound score. Insulin resistance was estimated with the homeostasis model assessment index for insulin resistance (HOMA-IR). NAFLD and MetS were found in 53.7 and 17.3% of the participants, respectively. Linear relationships were found between the severity of NAFLD and waist circumference, fasting glucose, HOMA-IR, triglycerides, HDL-C and blood pressure. After adjusting for confounding factors, i.e., body mass index and HOMA-IR, the odds ratios for MetS were 3.64 (95% confidence interval (CI): 1.5-8.83) for those with mild NAFLD and 9.4 (95% CI: 3.54-24.98) for those with moderate-to-severe NAFLD compared to those without NAFLD. The combination of the HOMA-IR and US-FLI scores better differentiated MetS than the HOMA-IR alone. In addition to obesity, the severity of NAFLD and the HOMA-IR both play important roles in MetS. Whether NAFLD is a component of MetS warrants further research.

Figure 1

Comparisons of the (A) waist circumference (WC), (B) fasting plasma glucose (FPG), (C) HOMA-IR, (D) triglycerides (TG), (E) high-density lipoprotein cholesterol (HDL-C) and (F) mean blood pressure (MBP) parameters according to the ultrasonographic Fatty Liver Indicator (US-FLI) quartiles (i.e., the severity of NAFLD). The means ± SE were calculated with the least squared (LS) method using a multiple regression model after adjustments for age, gender, education level, betel nut chewing, alcohol consumption, smoking, menopause, coffee intake, hours of sleep, and hours of exercise per week. The LS means of (A–F) exhibited linear relationships with the severity of NAFLD (P for trend = 0.0001 for WC, P for trend = 0.0068 for fasting glucose, P for trend = 0.0167 for HOMA-IR, and P for trend <0.0001 for triglycerides, HDL-C, and MBP). Q1: US-FLI: 0–1; Q2: US-FLI: 2–3; Q3: US-FLI: 4–5; Q4: US-FLI ≥6.