The severity of ultrasonographic findings in nonalcoholic fatty liver disease reflects the metabolic syndrome and visceral fat accumulation

Am J Gastroenterol. 2007 Dec;102(12):2708-15. doi: 10.1111/j.1572-0241.2007.01526.x. Epub 2007 Sep 25.


Background: Nonalcoholic fatty liver disease (NAFLD) is closely associated with the metabolic syndrome.

Aim: We evaluated the association among the metabolic syndrome, visceral fat accumulation, and the severity of fatty liver with a new scoring system of ultrasonographic findings in apparently healthy Japanese adults.

Methods: Subjects consisted of 94 patients who received liver biopsy and 4,826 participants who were selected from the general population. Two hepatologists scored the ultrasonographic findings from 0 to 6 points. We calculated Cohen's kappa of within-observer reliability and between-observer reliability. We evaluated the predictive value of the score by the area under a conventional receiver operating characteristic curve (AUC).

Results: Within-observer reliability was 0.95 (95% CI 0.93-0.97, P<0.001) and between-observer reliability was 0.95 (95% CI 0.93-0.97, P<0.001). The AUC to diagnose NAFLD was 0.980. The sensitivity was 91.7% (95% CI 87.0-95.1, P<0.001) and the specificity was 100% (95% CI 95.4-100.0, P<0.001). The AUC to diagnose visceral obesity was 0.821. The sensitivity was 68.3% (95% CI 51.9-81.9, P=0.028) and the specificity was 95.1% (95% CI 86.3-99.0, P<0.001). Adjusted odds ratio of the score for the metabolic syndrome was 1.37 (95% CI 1.26-1.49, P<0.001).

Conclusions: The scoring system with abdominal ultrasonography could provide accurate information about hepatic steatosis, visceral obesity, and the metabolic syndrome in apparently healthy people who do not consume alcohol.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Area Under Curve
  • Biopsy
  • Cross-Sectional Studies
  • Fatty Liver / diagnostic imaging*
  • Fatty Liver / epidemiology
  • Fatty Liver / etiology
  • Female
  • Humans
  • Intra-Abdominal Fat / diagnostic imaging*
  • Japan / epidemiology
  • Logistic Models
  • Male
  • Metabolic Syndrome / complications
  • Metabolic Syndrome / diagnostic imaging*
  • Metabolic Syndrome / epidemiology
  • Middle Aged
  • Severity of Illness Index
  • Ultrasonography