As expected, most individuals with fatty liver are overweight or obese (the latter defined by body mass index (BMI) ≥ 25 kg/m2). Small changes in weight (2–3 kg) can increase the risk of fatty liver. Even more alarmingly, this may occur within the “normal” range. In a South Korean study, a weight gain of > 2.3 kg was associated with hepatic steatosis even in individuals within the non-obese range (BMI 18.5–22.9 kg/m2).19 It is difficult to interpret this

study without details of body fat distribution because central (truncal, visceral) obesity is a better measure of insulin resistance and learn more is even more closely associated with NAFLD than an increased BMI.20–22 On the other hand, persons with a pronounced subcutaneous fat distribution and peripheral adiposity (typically in the thigh region) are less likely to have significant hepatic steatosis. Cross-sectional and longitudinal Asian studies reaffirm the strong links of fatty liver with insulin resistance and the metabolic syndrome (MetS).23 The latter was present in ∼ 70% of Chinese patients with NAFLD whereas the figures for the general population are ∼ 7% (MetS).24 Similar patterns were found in India, Korea, Taiwan, Sri Lanka, and other Asian countries.14,17,25–28 There is a bidirectional relationship between

NAFLD and MetS-related disorders. Thus, individuals with MetS-related conditions have a higher future risk of NAFLD and in turn, fatty liver confers an increased future risk of MCE公司 developing these disorders. In a prospective study of 4401 Japanese subjects undergoing routine health evaluation, MetS increased AP24534 chemical structure 4-fold and 11-fold the risk of incident fatty liver in men and women, respectively.29 Further, regression in hepatic steatosis occurred in 16%, but this was less likely to occur among those with MetS at baseline. For individuals with NAFLD, what is the future risk of developing metabolic disorders? The best estimates that are available were derived from

a Chinese study and place the odds of developing type 2 diabetes, hypertriglyceridemia, obesity and hypertension at 4.6. 3.3, 3.4 and 2.9, respectively.30 For other regions, individual and other ethnic influences underpinning the MetS should be taken into account. The prevalence of fatty liver increases in parallel with progressive degrees of abnormal glucose tolerance. In a study of 541 subjects from Chennai, India, the prevalence of fatty liver in persons with normal glucose tolerance, prediabetes (impaired glucose tolerance and impaired fasting glucose) and diabetes was 23%, 33% and 55%, respectively.14 Type 2 diabetes is an important predictor of advanced hepatic fibrosis1 and therefore subjects with type 2 diabetes should be carefully evaluated for signs of advanced liver disease. Detecting diabetes early could also pave the way for early therapeutic intervention.