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This version published online on June 26, 2007
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2007-0482
A more recent version of this article appeared on September 1, 2007
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Submitted on March 1, 2007
Accepted on June 15, 2007

LIVER FAT IN THE METABOLIC SYNDROME

Anna Kotronen, Jukka Westerbacka, Robert Bergholm, Kirsi H. Pietiläinen, and Hannele Yki-Järvinen*

Department of Medicine, Division of Diabetes, University of Helsinki, Helsinki, Finland; Minerva Medical Research Institute, Helsinki, Finland; The Finnish Twin Cohort Study, Department of Public Health, University of Helsinki, Helsinki, Finland; Obesity Research Unit, Department of Psychiatry, University of Helsinki, Helsinki, Finland

* To whom correspondence should be addressed. E-mail: ykijarvi{at}cc.helsinki.fi.

Background: The liver, once fatty, overproduces components of the metabolic syndrome, such as glucose and lipids. The amount of liver fat in subjects with and without the metabolic syndrome has not been determined. It is unknown which clinically available markers best reflect liver fat content.

Measurements: Components of the metabolic syndrome as defined by IDF and liver fat content by proton magnetic resonance spectroscopy were measured in 271 non-diabetic subjects (162 women, 109 men). In addition, other features of insulin resistance (serum insulin, C-peptide), intra-abdominal and subcutaneous fat by MRI and liver enzymes (S-ALT and S-AST) were measured.

Results: Liver fat was 4-fold higher in subjects with [n=116; median 8.2% (interquartile range 3.2%-18.7%)] than without [n=155; 2.0% (1.0%-5.0%); p<0.0001] the metabolic syndrome. This increase in liver fat remained significant after adjusting for age, gender and BMI. All components of the metabolic syndrome correlated with liver fat content. The best correlate was waist in both women (r=0.59, p<0.0001) and men (r=0.56, p<0.0001). Liver fat correlated significantly with serum ALT (r=0.39, p<0.0001 for women; r=0.44, p<0.0001 for men) and AST (r=0.27, p=0.0005 for women; r=0.31, p=0.0012 for men) concentrations. The best correlates of liver fat were fS-insulin (r=0.61; p<0.0001 for both women and men) and C-peptide (r=0.62; p<0.0001 for both women and men).

Conclusions: Liver fat content is significantly increased in subjects with the metabolic syndrome as compared to those without the syndrome, independently of age, gender and BMI. Of other markers, serum C-peptide is the strongest correlate of liver fat.
Key words: Liver fat • metabolic syndrome • insulin • liver enzymes • C-peptide




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