Relation of nonalcoholic fatty liver disease to the metabolic syndrome: the Multi-Ethnic Study of Atherosclerosis

J Cardiovasc Comput Tomogr. Sep-Oct 2013;7(5):311-8. doi: 10.1016/j.jcct.2013.08.011. Epub 2013 Sep 26.


Background: An overlap exists between risk factors for metabolic syndrome (MetS) and nonalcoholic fatty liver disease (NAFLD).

Objectives: We studied the association of MetS and its components with NAFLD in a multi-ethnic population.

Methods: Cross-sectional study was designed, including 6814 participants from the Multi-Ethnic Study of Atherosclerosis. Liver fat content was measured with cardiac CT scans by using liver-to-spleen ratio of <1.0 and liver attenuation < 40 HU. Participants with heavy alcohol intake (>14 drinks/week for men and >7 drinks/week for women), self-reported history of cirrhosis, and missing information were excluded. A total of 4140 participants met the criteria for inclusion in the study.

Results: The odds ratios (ORs) for presence of NAFLD were highest for persons with diabetes (OR, 4.16; 95% CI, 3.24-5.33), followed by presence of MetS (OR, 3.97; 95% CI, 3.26-4.83). Among components of MetS central obesity was associated with higher odds for presence (OR, 3.41; 95% CI, 2.77-4.20) and severity (OR, 5.58; 95% CI, 3.86-8.06) of NAFLD . The ORs for moderate-to-severe NAFLD were higher for presence of MetS (OR, 5.92; 95% CI, 4.29-8.19)] by using <40 HU as the cutoff. However, odds of NAFLD increased significantly for combination of MetS components: 9.49 (95% CI, 5.67-15.90) and 24.05 (95% CI, 12.73-45.45) for presence of 3 and 5 MetS components, respectively.

Conclusion: Components of MetS are associated with increased odds for presence and severity of NAFLD and increased risk with increasing number of MetS components in a multi-ethnic population of middle-to-old age persons.

Keywords: Fatty liver; MESA; Metabolic syndrome.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adiposity
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Chi-Square Distribution
  • Cross-Sectional Studies
  • Diabetes Mellitus / ethnology
  • Fatty Liver / diagnosis
  • Fatty Liver / ethnology*
  • Female
  • Humans
  • Liver / diagnostic imaging
  • Logistic Models
  • Male
  • Metabolic Syndrome / diagnostic imaging
  • Metabolic Syndrome / ethnology*
  • Middle Aged
  • Multidetector Computed Tomography
  • Non-alcoholic Fatty Liver Disease
  • Obesity, Abdominal / ethnology
  • Odds Ratio
  • Prevalence
  • Prospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Spleen / diagnostic imaging
  • United States / epidemiology