Nonalcoholic Fatty Liver Disease Is Associated with Type 2 Diabetes Mellitus Only in Individuals with Visceral Obesity
Authors: FUKUMOTO SHINYA , EMOTO MASANORI , MOTOYAMA KOKA , MORIOKA TOMOAKI , SHOJI TETSUO , HIRATA KAZUTO , INABA MASAAKI 
Published: June 2018

Nonalcoholic fatty liver disease (NAFLD) is considered to be a risk factor for the onset of type 2 diabetes mellitus (T2D), but no studies have considered the role of visceral fat (VF), which is strongly linked to both NAFLD and T2D, as a potential confounder. Therefore, it is not fully understood how NAFLD and T2D are associated. We previously reported that the risk of T2D onset and NAFLD were associated via VF accumulation. In this study, we further investigated the association between liver fat accumulation or NAFLD and T2D comorbidity, focusing on the presence or absence of visceral obesity (VO). The subjects were 367 individuals (179 men, 48.8%; mean age, 56.3 years), who received health check-ups at our medical examination center, MedCity21. In all subjects, quantitative live fat accumulation was evaluated by controlled attenuation parameter (CAP) value using Fibroscan®, and VF area at umbilical level (VFA) by abdominal CT scan as an index of VF accumulation. Those who habitually drank &gt; 30 g/day of alcohol and those with confirmed liver diseases were excluded. CAP value ≥ 236 dB/m was defined as NAFLD, and VFA &gt; 100 cm2 as VO. The association of CAP values or existence of NAFLD with T2D comorbidity was examined in the subgroups with and without VO (n = 101 and n = 266, respectively) by multivariate logistic analysis, with other factors adjusted. NAFLD was found 33.8% of subjects in non-VO group and 75.2% in VO group, respectively. In non-VO group, neither CAP value nor NAFLD showed significant association with T2D. In contrast, in VO group, the odds of T2D comorbidity were higher by 12.7% for each 10 dB/m higher CAP value, and NAFLD raised the odds of T2D comorbidity 5.2 times compared to non-NAFLD. These findings suggest that liver fat accumulation is associated with T2D via interaction with VF accumulation.
In conclusion, both liver fat accumulation and NAFLD are associated with T2D comorbidity only in individuals with VO.

Disclosure
S. Fukumoto: Speaker's Bureau; Self; Astellas Pharma US, Inc.. Research Support; Self; Chugai Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Corporation. Speaker's Bureau; Self; Novo Nordisk Inc., Sanofi K.K.. Research Support; Self; Takeda Pharmaceuticals U.S.A., Inc., Taisho Toyama Pharmaceutical Co., Ltd. M. Emoto: Speaker's Bureau; Self; Eli Lilly and Company, Boehringer Ingelheim Pharmaceuticals, Inc., Sumitomo Dainippon Pharma Co., Ltd.. Research Support; Self; Astellas Pharma Inc, Ono Pharmaceutical Co., Ltd., Kissei Pharmaceutical Co., Ltd., Kowa Pharmaceutical Company Ltd., Taisho Toyama Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Corporation. K. Motoyama: None. T. Morioka: Consultant; Self; Ono Pharmaceutical Co., Ltd.. Research Support; Self; Novartis Pharma K.K., MSD K.K., Eli Lilly and Company, Sanofi K.K., Mitsubishi Tanabe Pharma Corporation. Speaker's Bureau; Self; Takeda Pharmaceuticals U.S.A., Inc., Novo Nordisk Inc., Kowa Pharmaceuticals America, Inc., Astellas Pharma US, Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Sumitomo Dainippon Pharma Co., Ltd. T. Shoji: Speaker's Bureau; Self; Astellas Pharma Inc, Bayer Yakuhin Ltd. Research Support; Self; Bayer Yakuhin Ltd. Speaker's Bureau; Self; Kowa Pharamaceutical Co Ltd, Daiichi Sankyo Company, Limited, MSD K.K., Chugai Pharmaceutical Co., Ltd.. Research Support; Self; Chugai Pharmaceutical Co., Ltd.. Speaker's Bureau; Self; Kyowa Hakko Kirin Co., Ltd., Kissei Pharmaceutical Co., Ltd. K. Hirata: Speaker's Bureau; Self; AstraZeneca, Astellas Pharma Inc., Eisai Co., Ltd., KYORIN Pharmaceutical Co.,Ltd., Daiichi Sankyo Company, Limited, Sumitomo Dainippon Pharma Co., Ltd., TAIHO PHARMACEUTICAL Co.,Ltd., Chugai Pharmaceutical Co., Ltd., TEIJIN HOME HEALTHCARE LIMITED, Eli Lilly Japan K.K, Nippon Shinyaku Co., Ltd., Nippon Boehringer Ingelheim Co. Ltd., Novartis Pharma K.K., Pfizer Japan Inc.. Research Support; Self; KYORIN Pharmaceutical Co.,Ltd., Daiichi Sankyo Company, Limited, Chugai Pharmaceutical Co., Ltd., Nippon Boehringer Ingelheim Co. Ltd., Novartis Pharma K.K., MSD K.K.. Other Relationship; Self; AstraZeneca, GlaxoSmithKline K.K., Chugai Pharmaceutical Co., Ltd., Nippon Boehringer Ingelheim Co. Ltd., Novartis Pharma K.K., Santen Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Eli Lilly Japan K.K. M. Inaba: None.