Metabolic Characteristics and Associated Factors of Nonalcoholic Fatty Liver Disease Diagnosed at Medical Checkups

Eun Hee Nah; Jae Young Park

doi:10.3343/kjlm.2008.28.3.244

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Nah and Park: Metabolic Characteristics and Associated Factors of Nonalcoholic Fatty Liver Disease Diagnosed at Medical Checkups

Original Article

Korean J Leg Med 2008;28(3):244-250.

Published online: 14 February 2008

DOI: https://doi.org/10.3343/kjlm.2008.28.3.244

Metabolic Characteristics and Associated Factors of Nonalcoholic Fatty Liver Disease Diagnosed at Medical Checkups

Eun Hee Nah, M.D., Jae Young Park, M.T.

Korea Association of Health Promotion, Seoul, Korea

Received 27 November 200711 February 2008 Accepted 16 February 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Nonalcoholic fatty liver disease (NAFLD) has been reported to be related with metabolic disorder and frequently accompanied by abnormal liver function. This study was performed to investigate the metabolic characteristics of NAFLD and its associated factors.

Methods

We analysed 7,150 subjects diagnosed with NAFLD (n=2,381) or normal liver (n=4,769) and classified them into four groups based on ultrasonography and ALT levels as follows: 1) Control (normal liver and ALT), 2) increased ALT (normal liver with increased ALT), 3) NAFLD I (fatty liver with normal ALT), and 4) NAFLD II (fatty liver with increased ALT). Age, blood pressure, body mass index (BMI), fasting glucose, blood lipids, and high sensitivity C-reactive protein (hsCRP) were compared, and the incidence of metabolic syndrome was also determined in each group.

Results

The diastolic blood pressure, BMI, fasting glucose, total cholesterol, triglyceride, hsCRP, and the incidence of metabolic syndrome, were the highest in the NAFLD II group, followed by the NAFLD I group, the increased ALT group, and the control group in descending order. Meanwhile, HDL cholesterol (HDL-C) was the lowest in the NAFLD II group. Male sex, age, systolic blood pressure, BMI, fasting glucose, triglyceride, LDL cholesterol (LDL-C), and hsCRP were associated with NAFLD (P<0.001). An increased level of ALT in NAFLD was significantly related with male sex, increased BMI, fasting glucose, triglyceride, and LDL-C, younger age and decreased HDL-C (P< 0.001).

Conclusions

NAFLD was related with metabolic syndrome and the risk factors of cardiovascular disease in Koreans. The correlation was more prominent in NAFLD with increased ALT. Thus, a more intensive management is required for the individuals in the NAFLD with increased ALT.

Keywords: Nonalcoholic fatty liver disease, ALT, Cardiovascular risk factors, Metabolic syndrome

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Fig. 1.

Prevalence of metabolic syndrome in the four groups. P<0.001 is for χ² test among 4 groups.

Abbreviations: See Table 1.

Table 1.

Clinical and metabolic characteristics of study groups

	Control (N=4,635)	Increased ALT (N=134)	NAFLD I (N=1,916)	NAFLD II (N=465)	P value^∗
Sex					<0.001
Male	1,043 (45.8%)	62 (2.7%)	855 (37.5%)^†	319 (14.0%)^‡
Female	3,592 (73.7%)	72 (1.5%)	1,061 (21.8%)^†	146 (3.0%)^‡
Age (yr)	44.7±12.3	44.8±12.9	52.5 ± 11.6^†	45.9 ± 12.1^‡	<0.001
Systolic BP (mmHg)	110.0±16.2	113.1±14.9	119.3 ± 16.9^†	120.0±16.4	<0.001
Diastolic BP (mmHg)	68.2±9.2	69.2±8.3	73.3±9.5^†	74.9±9.7^‡	<0.001
BMI	22.6±2.8	24.0±2.6	25.8±2.8^†	27.1 ±3.1^‡	<0.001
FBS (mg/dL)	90.0±14.3	93.9±14.5	99.5 ±23.5^†	102.8±28.0^‡	<0.001
T-Cholesterol (mg/dL)	176.6±31.6	181.1±36.6	192.7±33.3^†	197.3±34.7	<0.001
TG (mg/dL)	86.6±51.7	110.4±65.5	142.7±85.4^†	173.9 ± 106.6^‡	<0.001
HDL-C (mg/dL)	55.3±9.6	53.8±10.2	51.3±8.8^†	49.4±7.5^‡	<0.001
LDL-C (mg/dL)	109.5±28.5	112.9±34.2	124.4±30.8^†	129.6±32.4^‡	<0.001
hsCRP (mg/dL)	0.11±0.29	0.35±1.04	0.19±0.56^†	0.27 ± 1.18^‡	<0.001
Lp(a) (mg/dL)	15.6±17.5	13.5±16.5	14.9±17.4	11.6 ± 13.5^†	<0.001
ALT (IU/L)	16.8±6.4	57.1±23.3	23.2±7.6^†	62.1±24.6^‡	<0.001

^∗ P value derived from one-way ANOVA that used to evaluate differences in the 4 groups;

^† P<0.001 from the posthoc comparisons (Dunnett t) of the investigated variables between control and NAFLD I;

^‡ P<0.05 from the posthoc comparisons (Scheffe, Bonferroni) of the investigated variables between NAFLD I and NAFLD II

Abbreviations: Control, normal sonogram and ALT; Increased ALT, normal sonogram and increased ALT; NAFLD I, fatty liver and normal ALT; NAFLD II, fatty liver and increased ALT; BP, blood pressure; BMI, body mass index; FBS, fasting blood glucose; T-cholesterol, total cholesterol; TG, triglyceride; hsCRP, high sensitivity C-reactive protein; Lp(a), lipoprotein(a).

Table 2.

Multivariate analysis of risk factors for NAFLD versus control

Variables	OR (95% CI)	P value
Sex (Male vs female)	2.419 (2.121-2.758)	<0.001
Age (yr)
20 to 39	1
40 to 64	1.360 (1.164-1.590)	<0.001
≥65	1.520 (1.195-1.933)	<0.001
Systolic BP
<130 mmHg	1
≥130 mmHg	1.251 (1.071-1.460)	<0.001
BMI
<23	1
23 to <25	3.460 (2.903-4.123)	<0.001
25 to <30	9.197 (7.778-10.874)	<0.001
≥30	16.382 (11.648-23.039)	<0.001
FBS (mg/dL)
<100	1
100 to <126	2.299 (1.945-2.717)	<0.001
≥126	3.916 (2.799-5.478)	<0.001
TG (mg/dL)
<150	1
≥150	3.578 (3.068-4.174)	<0.001
LDL-C (mg/dL)
≤100	1
100 to <130	1.467 (1.250-1.722)	<0.001
≥130	2.321 (1.963-2.744)	<0.001
hsCRP (mg/dL)
≤0.3	1
0.3 to 1.0	1.511 (1.173-1.947)	0.001
1.0 to 3.0	1.885 (1.136-3.128)	0.014
>3.0	4.269 (1.498-12.165)	0.007

Abbreviations: OR, odds ratio; CI, confidence interval. For the others See Table 1.

Table 3.

The association with an increased ALT activity in NAFLD by multiple logistic regression analysis

Variables	OR (95% CI)	P value
Sex (Male vs female)	2.403 (1.890-3.054)	<0.001
BMI
<23	1
23 to <25	1.516 (0.922-2.493)	0.101
25 to <30	2.583 (1.640-4.070)	<0.001
≥30	4.951 (2.880-8.512)	<0.001
FBS (mg/dL)
<100	1
100 to <126	1.545 (1.196-1.997)	0.001
≥126	2.456 (1.664-3.625)	<0.001
TG (mg/dL)	1.654 (1.323-2.069)	<0.001
HDL-C (mg/dL)	0.618 (0.383-0.996)	0.048
LDL-C (mg/dL)
≤100	1
100 to <130	1.064 (0.774-1.462)	0.702
≥130	1.644 (1.207-2.241)	0.002
Age (yr)
20 to 39	1
40 to 64	0.396 (0.306-0.513)	<0.001
≥65	0.172 (0.110-0.271)	<0.001

Abbreviations: See Table 1 and 2.

Table 4.

Prevalence of the components of metabolic syndrome in the four groups

	Control (N=4,635)	Increased ALT (N=134)	NAFLD I (N=1,916)	NAFLD II (N=465)	P value^∗
Obesity	879 (19.0%)	44 (32.8%)	1,146 (59.8%)	360 (77.4%)	<0.001
Raised TG	405 (8.7%)	27 (20.1%)	662 (34.6%)	224 (48.2%)	<0.001
Reduced HDL-C	148 (3.2%)	9 (6.7%)	124 (6.5%)	26 (5.6%)	<0.001
Raised BP	650 (14.0%)	19 (14.2%)	592 (30.9%)	148 (31.8%)	<0.001
Raised FBS	476 (10.3%)	24 (17.9%)	611 (31.9%)	187 (40.2%)	<0.001

P values were determined by using χ² test.

Abbreviations: See Table 1

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