Association Between Different Parameters of Adipose Distribution and Transient Elastography-Assessed Hepatic Steatosis in American Adults with Diabetes, Prediabetes and Normal Glucose Tolerance

Figures & data

Figure 1 Regional body composition measurement and regions of interest (ROI) in the android and gynoid by dual-energy X-ray absorptiometry (DXA).

Table 1 Characteristics of the Study Population by CAP

		Without Hepatic Steatosis (n=1405)	With Hepatic Steatosis (n=1581)	p
Sex (male, %)		630 (44.8)	834 (52.8)	<0.001
Age (years)		35.2±12.4	41.6±11.9	<0.001
Race (%)	White	440 (31.3)	473 (29.9)	<0.001
	Black	355 (25.3)	309 (19.5)
	Hispanic	283 (20.1)	453 (28.7)
	Asian	235 (16.7)	253 (16.0)
	Other	92 (6.5)	93 (5.9)
BMI (kg/m^2)		25.8±5.8	32.9±7.3	<0.001
WC (cm)		88.3±14.2	107.0±16.1	<0.001
Excessive drinking (%)		307 (21.9)	398 (25.2)	0.033
SBP (mmHg)		116±15	124±17	<0.001
HbA1c (%)		5.4±0.5	5.9±1.2	<0.001
Scr (µmol/L)		75.2±27.7	75.6±42.1	0.791
AST (U/L)		18 (16, 22)	20 (16, 25)	<0.001
ALT (U/L)		15 (12, 22)	22 (15, 33)	<0.001
TG (mmol/L)		1.20±0.87	1.99±1.75	<0.001
TC (mmol/L)		4.67±0.97	5.01±1.01	<0.001
Visceral adipose tissue area (cm^2)		68.0±40.7	125.9±52.3	<0.001
Visceral adipose tissue mass (g)		327.9±196.1	606.9±252.2	<0.001
Visceral adipose tissue volume (cm^3)		354.5±212.0	656.1±272.7	<0.001
Total abdominal fat volume (L)		1.72±0.90	2.77±1.00	<0.001
Total percent fat (%)		30.7±8.8	35.7±7.7	<0.001
Trunk percent fat (%)		28.4±8.9	35.7±7.3	<0.001
Android percent fat (%)		30.9±9.2	38.7±7.2	<0.001
Android to gynoid ratio		0.91±0.17	1.09±0.17	<0.001

Abbreviations: BMI, body mass index; WC, waist circumference; CAP, controlled attenuation parameter; TG, triglycerides; TC, total cholesterol; SBP, systolic blood pressure; HbA1c, glycosylated hemoglobin; ALT, alanine aminotransferase; AST, aspartate aminotransferase; Scr, serum creatinine.

Figure 2 Proportion of different grades of hepatic steatosis in diabetes-specific groups. S0: normal, fatty infiltration<5%; S1: mild, 5%~33%; S2: moderate, 33%~66%; S3: severe, ≥66%.

Figure 3 Association between different parameters of adipose distribution and CAP, stratified by NGT, prediabetes and diabetes, with LOWESS smooth for trend.

Table 2 Interaction Between Adiposity Measures and Glycemic Status on Presence of Hepatic Steatosis in the Overall Group

	NGT	Prediabetes		Diabetes
	N=1438	N=755		N=229
	OR (95% CI)	OR (95% CI)	p	OR (95% CI)	p
Total abdominal fat volume (0.1 L)	1.00 (Ref.)	1.02 (0.99, 1.05)	0.191	0.96 (0.92, 1.00)	0.054
Visceral adipose tissue volume (0.1 L)	1.00 (Ref.)	0.99 (0.89, 1.11)	0.867	0.85 (0.72, 1.00)	0.045
Total percent fat (%)	1.00 (Ref.)	1.02 (0.99, 1.05)	0.204	0.99 (0.93, 1.06)	0.846
Trunk percent fat (%)	1.00 (Ref.)	1.02 (0.99, 1.05)	0.151	1.01 (0.95, 1.07)	0.804
Android percent fat (%)	1.00 (Ref.)	1.02 (0.99, 1.05)	0.138	0.98 (0.93, 1.04)	0.534
Android to gynoid ratio (×10)	1.00 (Ref.)	0.96 (0.84.1.10)	0.590	0.88 (0.70, 1.10)	0.252

Notes: All models were adjusted for age, sex, race, excessive drinking, WC, TG, TC and SBP. P values <0.0083 were considered study-wide significant after Bonferroni correction.

Abbreviations: OR, odds ratio; CI, confidence interval.

Table 3 Association of Prevalence of Fatty Liver Disease with Different Parameters of Adipose Distribution, Sorted by Glycemic Status

		NGT		Prediabetes		Diabetes
		N=1438		N=755		N=229
		OR (95% CI)	p	OR (95% CI)	p	OR (95% CI)	p
Total abdominal fat volume (0.1 L)	Model 1	1.12 (1.10, 1.14)	<0.001	1.12 (1.10, 1.14)	<0.001	1.06 (1.02, 1.10)	0.002
	Model 2	1.14 (1.13, 1.16)	<0.001	1.15 (1.12, 1.17)	<0.001	1.08 (1.04, 1.12)	<0.001
	Model 3	1.08 (1.03, 1.13)	0.001	1.06 (1.00, 1.13)	0.053	1.04 (0.93, 1.16)	0.460
Visceral adipose tissue volume (0.1 L)	Model 1	1.80 (1.68, 1.92)	<0.001	1.67 (1.53, 1.81)	<0.001	1.31 (1.15, 1.51)	<0.001
	Model 2	1.80 (1.67, 1.94)	<0.001	1.71 (1.56, 1.87)	<0.001	1.30 (1.12, 1.49)	<0.001
	Model 3	1.24 (1.12, 1.38)	<0.001	1.19 (1.05, 1.36)	0.009	1.13 (0.93, 1.39)	0.225
Total percent fat (%)	Model 1	1.07 (1.05, 1.08)	<0.001	1.07 (1.05, 1.09)	<0.001	1.02 (0.97, 1.07)	0.405
	Model 2	1.17 (1.14, 1.20)	<0.001	1.18 (1.14, 1.23)	<0.001	1.06 (0.98, 1.15)	0.125
	Model 3	1.00 (0.96, 1.04)	0.872	1.00 (0.95, 1.06)	0.962	0.91 (0.80, 1.05)	0.205
Trunk percent fat (%)	Model 1	1.10 (1.08, 1.11)	<0.001	1.11 (1.09, 1.14)	<0.001	1.07 (1.02, 1.13)	0.004
	Model 2	1.17 (1.15, 1.20)	<0.001	1.21 (1.17, 1.25)	<0.001	1.12 (1.05, 1.19)	0.001
	Model 3	1.06 (1.02, 1.09)	0.001	1.08 (1.03, 1.14)	0.003	1.02 (0.91, 1.14)	0.747
Android percent fat (%)	Model 1	1.11 (1.09, 1.12)	<0.001	1.12 (1.10, 1.15)	<0.001	1.07 (1.02, 1.12)	0.006
	Model 2	1.15 (1.13, 1.17)	<0.001	1.17 (1.14, 1.20)	<0.001	1.09 (1.03, 1.15)	0.002
	Model 3	1.04 (1.01, 1.07)	0.004	1.06 (1.01, 1.10)	0.011	1.02 (0.94, 1.11)	0.573
Android to gynoid ratio (×10)	Model 1	1.85 (1.71, 1.99)	<0.001	1.67 (1.51, 1.85)	<0.001	1.43 (1.17, 1.75)	<0.001
	Model 2	1.94 (1.77, 2.12)	<0.001	1.97 (1.74, 2.24)	<0.001	1.66 (1.29, 2.13)	<0.001
	Model 3	1.28 (1.15, 1.44)	<0.001	1.28 (1.09, 1.49)	0.002	1.62 (1.16, 2.25)	0.004

Notes: Model 1 was unadjusted (univariate); Model 2 was adjusted for age, sex and race; Model 3 was adjusted for model 2 adjustments plus excessive drinking, WC, HbA1c, TG, TC and SBP. P values <0.0083 were considered study-wide significant after Bonferroni correction.

Abbreviations: OR, odds ratio; CI, confidence interval.

Figure 4 Forest plots of OR and 95% CI of different parameters on hepatic steatosis, stratified by NGT, prediabetes and diabetes.