Waist-to-calf circumstance ratio is an independent predictor of hepatic steatosis and fibrosis in patients with type 2 diabetes

Eun Yeong Choe, Yong Ho Lee, Young Ju Choi, Byung Wook Huh, byungwan lee, Soo Kyung Kim, Eun Seok Kang, Bong Soo Cha, Eunjig Lee, Kap Bum Huh, Zobair M. Younossi

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Abstract

Background and Aim: Although a combination of central obesity and decreased skeletal muscle mass has been associated with various cardiometabolic disorders, its influence on the presence of non-alcoholic fatty liver disease (NAFLD) in type 2 diabetes (T2D) is unclear. We investigated whether waist-to-calf circumference ratio (WCR) predicts NAFLD or hepatic fibrosis in T2D. Methods: Patients with T2D (n = 5507) were enrolled in this study. Hepatic steatosis was diagnosed using abdominal ultrasound and predicting score. NAFLD was defined as ‘hepatic steatosis absent other causes of chronic liver disease,’ such as virus or alcoholism. Degree of hepatic fibrosis was calculated using non-invasive serum biomarker-based models. Insulin resistance was assessed by short insulin tolerance test. Results: The prevalence of NAFLD and obesity (BMI ≥ 25 kg/m2, Asian definition) were 46.4% and 38.9%, respectively. NAFLD prevalence was higher with increasing WCR tertiles: lowest tertile (36% in men, 28% in women) versus highest tertile (53.8% in men, 58.2% in women, both P < 0.001 after stratification by insulin resistance status. Increasing WCR tertiles were independently associated with presence of NAFLD: odds ratio (OR) = 1.43, 95% confidence interval (CI) = 1.22–1.68 and OR = 1.56, 95% CI = 1.31–1.86, in the middle and highest tertiles, respectively. Furthermore, patients with NAFLD and the highest WCR tertile had significant fibrosis (OR = 8.62, 95% CI = 1.39–53.36, P = 0.021). Also, WCR was correlated with risk of sarcopenia (OR = 3.18, 95% CI = 2.50–4.05, P < 0.001, highest tertile). Conclusions: Higher WCR is associated with increased risk of NAFLD and hepatic fibrosis independent of insulin resistance. This suggests that WCR may be a useful index to predict high risk of hepatic steatosis in T2D.

Original languageEnglish
Pages (from-to)1082-1091
Number of pages10
JournalJournal of Gastroenterology and Hepatology (Australia)
Volume33
Issue number5
DOIs
Publication statusPublished - 2018 May 1

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Type 2 Diabetes Mellitus
Fibrosis
Liver
Odds Ratio
Confidence Intervals
Insulin Resistance
Sarcopenia
Abdominal Obesity
Non-alcoholic Fatty Liver Disease
Alcoholism
Liver Diseases
Skeletal Muscle
Chronic Disease
Obesity
Biomarkers
Insulin
Viruses
Serum

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

Cite this

Choe, Eun Yeong ; Lee, Yong Ho ; Choi, Young Ju ; Huh, Byung Wook ; lee, byungwan ; Kim, Soo Kyung ; Kang, Eun Seok ; Cha, Bong Soo ; Lee, Eunjig ; Huh, Kap Bum ; Younossi, Zobair M. / Waist-to-calf circumstance ratio is an independent predictor of hepatic steatosis and fibrosis in patients with type 2 diabetes. In: Journal of Gastroenterology and Hepatology (Australia). 2018 ; Vol. 33, No. 5. pp. 1082-1091.
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abstract = "Background and Aim: Although a combination of central obesity and decreased skeletal muscle mass has been associated with various cardiometabolic disorders, its influence on the presence of non-alcoholic fatty liver disease (NAFLD) in type 2 diabetes (T2D) is unclear. We investigated whether waist-to-calf circumference ratio (WCR) predicts NAFLD or hepatic fibrosis in T2D. Methods: Patients with T2D (n = 5507) were enrolled in this study. Hepatic steatosis was diagnosed using abdominal ultrasound and predicting score. NAFLD was defined as ‘hepatic steatosis absent other causes of chronic liver disease,’ such as virus or alcoholism. Degree of hepatic fibrosis was calculated using non-invasive serum biomarker-based models. Insulin resistance was assessed by short insulin tolerance test. Results: The prevalence of NAFLD and obesity (BMI ≥ 25 kg/m2, Asian definition) were 46.4{\%} and 38.9{\%}, respectively. NAFLD prevalence was higher with increasing WCR tertiles: lowest tertile (36{\%} in men, 28{\%} in women) versus highest tertile (53.8{\%} in men, 58.2{\%} in women, both P < 0.001 after stratification by insulin resistance status. Increasing WCR tertiles were independently associated with presence of NAFLD: odds ratio (OR) = 1.43, 95{\%} confidence interval (CI) = 1.22–1.68 and OR = 1.56, 95{\%} CI = 1.31–1.86, in the middle and highest tertiles, respectively. Furthermore, patients with NAFLD and the highest WCR tertile had significant fibrosis (OR = 8.62, 95{\%} CI = 1.39–53.36, P = 0.021). Also, WCR was correlated with risk of sarcopenia (OR = 3.18, 95{\%} CI = 2.50–4.05, P < 0.001, highest tertile). Conclusions: Higher WCR is associated with increased risk of NAFLD and hepatic fibrosis independent of insulin resistance. This suggests that WCR may be a useful index to predict high risk of hepatic steatosis in T2D.",
author = "Choe, {Eun Yeong} and Lee, {Yong Ho} and Choi, {Young Ju} and Huh, {Byung Wook} and byungwan lee and Kim, {Soo Kyung} and Kang, {Eun Seok} and Cha, {Bong Soo} and Eunjig Lee and Huh, {Kap Bum} and Younossi, {Zobair M.}",
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Waist-to-calf circumstance ratio is an independent predictor of hepatic steatosis and fibrosis in patients with type 2 diabetes. / Choe, Eun Yeong; Lee, Yong Ho; Choi, Young Ju; Huh, Byung Wook; lee, byungwan; Kim, Soo Kyung; Kang, Eun Seok; Cha, Bong Soo; Lee, Eunjig; Huh, Kap Bum; Younossi, Zobair M.

In: Journal of Gastroenterology and Hepatology (Australia), Vol. 33, No. 5, 01.05.2018, p. 1082-1091.

Research output: Contribution to journalArticle

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T1 - Waist-to-calf circumstance ratio is an independent predictor of hepatic steatosis and fibrosis in patients with type 2 diabetes

AU - Choe, Eun Yeong

AU - Lee, Yong Ho

AU - Choi, Young Ju

AU - Huh, Byung Wook

AU - lee, byungwan

AU - Kim, Soo Kyung

AU - Kang, Eun Seok

AU - Cha, Bong Soo

AU - Lee, Eunjig

AU - Huh, Kap Bum

AU - Younossi, Zobair M.

PY - 2018/5/1

Y1 - 2018/5/1

N2 - Background and Aim: Although a combination of central obesity and decreased skeletal muscle mass has been associated with various cardiometabolic disorders, its influence on the presence of non-alcoholic fatty liver disease (NAFLD) in type 2 diabetes (T2D) is unclear. We investigated whether waist-to-calf circumference ratio (WCR) predicts NAFLD or hepatic fibrosis in T2D. Methods: Patients with T2D (n = 5507) were enrolled in this study. Hepatic steatosis was diagnosed using abdominal ultrasound and predicting score. NAFLD was defined as ‘hepatic steatosis absent other causes of chronic liver disease,’ such as virus or alcoholism. Degree of hepatic fibrosis was calculated using non-invasive serum biomarker-based models. Insulin resistance was assessed by short insulin tolerance test. Results: The prevalence of NAFLD and obesity (BMI ≥ 25 kg/m2, Asian definition) were 46.4% and 38.9%, respectively. NAFLD prevalence was higher with increasing WCR tertiles: lowest tertile (36% in men, 28% in women) versus highest tertile (53.8% in men, 58.2% in women, both P < 0.001 after stratification by insulin resistance status. Increasing WCR tertiles were independently associated with presence of NAFLD: odds ratio (OR) = 1.43, 95% confidence interval (CI) = 1.22–1.68 and OR = 1.56, 95% CI = 1.31–1.86, in the middle and highest tertiles, respectively. Furthermore, patients with NAFLD and the highest WCR tertile had significant fibrosis (OR = 8.62, 95% CI = 1.39–53.36, P = 0.021). Also, WCR was correlated with risk of sarcopenia (OR = 3.18, 95% CI = 2.50–4.05, P < 0.001, highest tertile). Conclusions: Higher WCR is associated with increased risk of NAFLD and hepatic fibrosis independent of insulin resistance. This suggests that WCR may be a useful index to predict high risk of hepatic steatosis in T2D.

AB - Background and Aim: Although a combination of central obesity and decreased skeletal muscle mass has been associated with various cardiometabolic disorders, its influence on the presence of non-alcoholic fatty liver disease (NAFLD) in type 2 diabetes (T2D) is unclear. We investigated whether waist-to-calf circumference ratio (WCR) predicts NAFLD or hepatic fibrosis in T2D. Methods: Patients with T2D (n = 5507) were enrolled in this study. Hepatic steatosis was diagnosed using abdominal ultrasound and predicting score. NAFLD was defined as ‘hepatic steatosis absent other causes of chronic liver disease,’ such as virus or alcoholism. Degree of hepatic fibrosis was calculated using non-invasive serum biomarker-based models. Insulin resistance was assessed by short insulin tolerance test. Results: The prevalence of NAFLD and obesity (BMI ≥ 25 kg/m2, Asian definition) were 46.4% and 38.9%, respectively. NAFLD prevalence was higher with increasing WCR tertiles: lowest tertile (36% in men, 28% in women) versus highest tertile (53.8% in men, 58.2% in women, both P < 0.001 after stratification by insulin resistance status. Increasing WCR tertiles were independently associated with presence of NAFLD: odds ratio (OR) = 1.43, 95% confidence interval (CI) = 1.22–1.68 and OR = 1.56, 95% CI = 1.31–1.86, in the middle and highest tertiles, respectively. Furthermore, patients with NAFLD and the highest WCR tertile had significant fibrosis (OR = 8.62, 95% CI = 1.39–53.36, P = 0.021). Also, WCR was correlated with risk of sarcopenia (OR = 3.18, 95% CI = 2.50–4.05, P < 0.001, highest tertile). Conclusions: Higher WCR is associated with increased risk of NAFLD and hepatic fibrosis independent of insulin resistance. This suggests that WCR may be a useful index to predict high risk of hepatic steatosis in T2D.

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