Obesity-independent association of human adenovirus Ad37 seropositivity with nonalcoholic fatty liver disease

J Clin Gastroenterol. 2012 Jul;46(6):e46-54. doi: 10.1097/MCG.0b013e31824b225c.


Objective: Adenoviruses Ad36 and Ad37 increase adiposity in animals and are associated with obesity in humans; effects on the liver have been reported. The association of Adenovirus Ad36 seropositivity (Ad36+) with obesity but not with the severity of nonalcoholic fatty liver disease (NAFLD) has been previously shown. We investigate whether nondiabetic Ad37+ patients show a different prevalence of NAFLD and ultrasound Bright Liver score.

Patients: A total of 268 adult nondiabetic patients (146 men, 122 women) were included after lifestyle counseling including a personalized Mediterranean diet, increase in physical activity, and smoking withdrawal. After an Ad37+/Ad36+ assay, overweight obesity, insulin resistance, C-reactive protein, and bright liver prevalence and severity were compared according to Ad37+.

Results: Sixty-five of 268 patients were Ad37+ and 82/268 patients were both Ad37 seronegative (Ad37-) and Ad36-. The prevalence of obesity, defined as body mass index≥30, was not significantly different in Ad37+ (11/65; 16.9%) vs. Ad37- (15/82; 18.2%) patients; Bright Liver was present in 22/65 (33.8%) Ad37+ patients vs. 13/82 (15.8%) Ad37- patients (P<0.019). By odds ratio (OR), a consistent risk for NAFLD was associated with Ad37+, greater insulin resistance, and C-reactive protein. By a predictive multiple linear regression model, 40.0% of variance toward NAFLD and 50.4% toward the severity of Bright Liver score was explained significantly and independently by Ad37+ and by body mass index.

Conclusions: Ad37+ status in nondiabetic patients on an appropriate diet is significantly associated with NAFLD; because fatty liver improves even without weight loss by a "healthy" diet, and not only by lower food caloric intake, Ad37+ may be an adjunctive hallmark of an unfavorable clinical-metabolic profile, if not a causative factor of NAFLD.

MeSH terms

  • Adenovirus Infections, Human / complications*
  • Adenovirus Infections, Human / virology
  • Adenoviruses, Human / isolation & purification
  • Adult
  • Body Mass Index
  • C-Reactive Protein / metabolism
  • Diet, Mediterranean
  • Fatty Liver / etiology
  • Fatty Liver / physiopathology*
  • Fatty Liver / virology
  • Female
  • Humans
  • Insulin Resistance
  • Life Style*
  • Linear Models
  • Male
  • Middle Aged
  • Motor Activity
  • Non-alcoholic Fatty Liver Disease
  • Obesity / epidemiology*
  • Obesity / virology
  • Prevalence
  • Severity of Illness Index
  • Smoking Cessation


  • C-Reactive Protein