Fatty Liver, and Not Visceral Fat, Is More Associated with Liver Fibrosis and Diabetes in Non-Obese Japanese Individuals: A Cross-Sectional Study

Noriyo Urata,Miwa Kawanaka,Hirofumi Kawamoto,Noriaki Manabe,Takako Sasai,Katsunori Ishii,Ken Haruma,Tomoari Kamada,Ken Nishino,Tomohiro Tanikawa,Jun Nakamura,Mitsuhiko Suehiro

doi:10.3390/life10090175

Abstract

Asians are known to be more likely than Westerners to develop fatty liver and lifestyle-related diseases in spite of their weight. However, the relationship between fat accumulation and lifestyle-related diseases in non-obese Asians is unknown. Therefore, this study aimed to analyze visceral fat and hepatic fat in participants with a normal body mass index (BMI) and examine their characteristics during a medical checkup. This cross-sectional study was conducted on 663 of 1142 patients who underwent abdominal ultrasonography and who had an alcohol intake (converted to ethanol) of <30 g/day for males and <20 g/day for females and a BMI of <25 kg/m2 during a health checkup. Participants were classified into four groups: group A, visceral fat accumulation (VFA) (−) and fatty liver (FL) (−) (n = 549); group B, VFA (+) and FL (−) (n = 32); group C, VFA (−) and FL (+) (n = 58); and group D, VFA (+) and FL (+) (n = 24). The frequencies of lifestyle-related disease complications, liver function tests, and liver fibrosis were evaluated among the four groups. Compared with group A (control), groups B, C, and D had a higher number of males, BMI, abdominal circumference, ALT, AST, γ-GTP, triglyceride, uric acid, fasting blood sugar levels, and incidence of hyperlipidemia. Groups C and D had higher ALT, HbA1c, cholinesterase, and triglyceride levels, FIB4 index, and the number of patients with diabetes mellitus (DM) than groups A and B; however, there was no difference between groups A and B. FL is a risk factor of DM and liver fibrosis in non-obese Japanese individuals; however, VFA only is not a risk factor of DM and liver fibrosis.

Highlights

Nonalcoholic fatty liver disease (NAFLD) is a common chronic liver disease worldwide [1].The development of fatty liver disease has been known to be associated with weight gain, hypertension, Life 2020, 10, 175; doi:10.3390/life10090175 www.mdpi.com/journal/lifeLife 2020, 10, 175 hypertriglyceridemia, and obesity [2,3,4]
We investigated clinically whether there was a difference in lifestyle-related diseases, blood test values, and liver fibrosis progression depending on the FL and visceral fat accumulation (VFA) sites
Individuals with a body mass index (BMI) of

Summary

Introduction

Nonalcoholic fatty liver disease (NAFLD) is a common chronic liver disease worldwide [1].The development of fatty liver disease has been known to be associated with weight gain, hypertension, Life 2020, 10, 175; doi:10.3390/life10090175 www.mdpi.com/journal/lifeLife 2020, 10, 175 hypertriglyceridemia, and obesity [2,3,4]. Nonalcoholic fatty liver disease (NAFLD) is a common chronic liver disease worldwide [1]. The development of fatty liver disease has been known to be associated with weight gain, hypertension, Life 2020, 10, 175; doi:10.3390/life10090175 www.mdpi.com/journal/life. NAFLD was diagnosed by excluding other chronic liver diseases, including “excessive” alcohol consumption. A positive criterion has been proposed for metabolic dysfunction-associated fatty liver disease (MAFLD). The criteria are based on evidence of hepatic steatosis in addition to one of these criteria: overweight/obesity, type 2 diabetes mellitus (DM), or evidence of metabolic dysregulation [5]. In NAFLD, the body mass index (BMI; kg/m2 ) of Asians is not very high as compared with that of Westerners with NAFLD. The so-called lean NAFLD (BMI, Caucasians ≤ 25 kg/m2 ; Asian ≤ 23 kg/m2 )

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