The Impact of NAFLD and Waist Circumference Changes on Diabetes Development in Prediabetes Subjects

Global epidemiology of type 2 diabetes in patients with NAFLD or MAFLD: a systematic review and meta-analysis

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) and metabolic-associated fatty liver disease (MAFLD) shares common pathophysiological mechanisms with type 2 diabetes, making them significant risk factors for type 2 diabetes. The present study aimed to assess the epidemiological feature of type 2 diabetes in patients with NAFLD or MAFLD at global levels.

METHODS

Published studies were searched for terms that included type 2 diabetes, and NAFLD or MAFLD using PubMed, EMBASE, MEDLINE, and Web of Science databases from their inception to December 2022. The pooled global and regional prevalence and incidence density of type 2 diabetes in patients with NAFLD or MAFLD were evaluated using random-effects meta-analysis. Potential sources of heterogeneity were investigated using stratified meta-analysis and meta-regression.

RESULTS

A total of 395 studies (6,878,568 participants with NAFLD; 1,172,637 participants with MAFLD) from 40 countries or areas were included in the meta-analysis. The pooled prevalence of type 2 diabetes among NAFLD or MAFLD patients was 28.3% (95% confidence interval 25.2-31.6%) and 26.2% (23.9-28.6%) globally. The incidence density of type 2 diabetes in NAFLD or MAFLD patients was 24.6 per 1000-person year (20.7 to 29.2) and 26.9 per 1000-person year (7.3 to 44.4), respectively.

CONCLUSIONS

The present study describes the global prevalence and incidence of type 2 diabetes in patients with NAFLD or MAFLD. The study findings serve as a valuable resource to assess the global clinical and economic impact of type 2 diabetes in patients with NAFLD or MAFLD.

Clinical Classification of Obesity and Implications for Metabolic Dysfunction-Associated Fatty Liver Disease and Treatment

Obesity,and metabolic dysfunction-associated fatty liver disease (MAFLD) have reached epidemic proportions globally. Obesity and MAFLD frequently coexist and act synergistically to increase the risk of adverse clinical outcomes (both hepatic and extrahepatic). Type 2 diabetes mellitus (T2DM) is the most important risk factor for rapid progression of steatohepatitis and advanced fibrosis. Conversely, the later stages of MAFLD are associated with an increased risk of T2DM incident. According to the proposed criteria, MAFLD is diagnosed in patients with liver steatosis and in at least one in three: overweight or obese, T2DM, or signs of metabolic dysregulation if they are of normal weight. However, the clinical classification and correlation between obesity and MAFLD is more complex than expected. In addition, treatment for obesity and MAFLD are associated with a reduced risk of T2DM, suggesting that liver-based treatments could reduce the risk of developing T2DM. This review describes the clinical classification of obesity and MAFLD, discusses the clinical features of various types of obesity and MAFLD, emphasizes the role of visceral obesity and insulin resistance (IR) in the development of MAFLD,and summarizes the existing treatments for obesity and MAFLD that reduce the risk of developing T2DM.

Non-Alcoholic Fatty Liver Disease or Type 2 Diabetes Mellitus—The Chicken or the Egg Dilemma

In clinical practice, we often deal with patients who suffer from non-alcoholic fatty liver disease (NAFLD) concurrent with type 2 diabetes mellitus (T2DM). The etiopathogenesis of NAFLD is mainly connected with insulin resistance (IR) and obesity. Similarly, the latter patients are in the process of developing T2DM. However, the mechanisms of NAFLD and T2DM coexistence have not been fully elucidated. Considering that both diseases and their complications are of epidemic proportions and significantly affect the length and quality of life, we aimed to answer which of these diseases appears first and thereby highlight the need for their diagnosis and treatment. To address this question, we present and discuss the epidemiological data, diagnoses, complications and pathomechanisms of these two coexisting metabolic diseases. This question is difficult to answer due to the lack of a uniform procedure for NAFLD diagnosis and the asymptomatic nature of both diseases, especially at their beginning stages. To conclude, most researchers suggest that NAFLD appears as the first disease and starts the sequence of circumstances leading ultimately to the development of T2DM. However, there are also data suggesting that T2DM develops before NAFLD. Despite the fact that we cannot definitively answer this question, it is very important to bring the attention of clinicians and researchers to the coexistence of NAFLD and T2DM in order to prevent their consequences.

Effect of changes in anthropometric measurements on the remission and progression of prediabetes: A community-based cohort study

AIMS

We assessed the impact of changes in body mass index (BMI), body fat percentage (BF%), and waist circumference (WC) on prediabetes among middle-aged and elderly Chinese adults.

SUBJECTS, MATERIALS AND METHODS

2.5-year changes in BMI, BF%, and WC were calculated by subtracting baseline levels from follow-up, based on a cohort of 3,632 participants with prediabetes, and outcomes were defined as remission to normal glucose regulation (NGR), persistence in prediabetes, and progression to newly diagnosed diabetes mellitus (NDM).

RESULTS

Among participants with prediabetes, 16.9% returned to NGR and 24.6% progressed to NDM. Changes in BMI, BF%, but not WC were associated with remission and progression of prediabetes (risk ratio per standard deviation increase of BMI: 0.86 [0.79-0.93] and 1.15 [1.08-1.23]; BF%: 0.91 [0.84-0.98] and 1.11 [1.03-1.19]). Among participants with combined impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), only BF% change was significantly associated with remission of prediabetes.

CONCLUSION

Short-term management of BMI and BF% should be emphasized to promote the remission and prevent the progression of prediabetes. Moreover, it is of particular clinical importance to monitor BF% among people with combined IFG and IGT.

Racial/ethnic and gender disparity in the severity of NAFLD among people with diabetes or prediabetes

Aim: Non-alcoholic fatty liver disease (NAFLD) exhibits a racial disparity. We examined the prevalence and the association between race, gender, and NAFLD among prediabetes and diabetes populations among adults in the United States. Methods: We analyzed data for 3,190 individuals ≥18 years old from the National Health and Nutrition Examination Survey (NHANES) 2017-2018. NAFLD was diagnosed by FibroScan^® using controlled attenuation parameter (CAP) values: S0 (none) < 238, S1 (mild) = 238-259, S2 (moderate) = 260-290, S3 (severe) > 290. Data were analyzed using Chi-square test and multinomial logistic regression, adjusting for confounding variables and considering the design and sample weights. Results: Of the 3,190 subjects, the prevalence of NAFLD was 82.6%, 56.4%, and 30.5% (p < 0.0001) among diabetes, prediabetes and normoglycemia populations respectively. Mexican American males with prediabetes or diabetes had the highest prevalence of severe NAFLD relative to other racial/ethnic groups (p < 0.05). In the adjusted model, among the total, prediabetes, and diabetes populations, a one unit increase in HbA1c was associated with higher odds of severe NAFLD [adjusted odds ratio (AOR) = 1.8, 95% confidence level (CI) = 1.4-2.3, p < 0.0001; AOR = 2.2, 95% CI = 1.1-4.4, p = 0.033; and AOR = 1.5, 95% CI = 1.1-1.9, p = 0.003 respectively]. Conclusion: We found that prediabetes and diabetes populations had a high prevalence and higher odds of NAFLD relative to the normoglycemic population and HbA1c is an independent predictor of NAFLD severity in prediabetes and diabetes populations. Healthcare providers should screen prediabetes and diabetes populations for early detection of NAFLD and initiate treatments including lifestyle modification to prevent the progression to non-alcoholic steatohepatitis or liver cancer.

Correlation between Component Factors of Non-Alcoholic Fatty Liver Disease and Metabolic Syndrome in Nurses: An Observational and Cross-Sectional Study

This study aimed to understand the correlation between non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome in nurses. Questionnaires were used to eliminate individuals with a daily drinking habit, hepatitis B or C, or incomplete data. A total of 706 valid samples were obtained. The prevalence of NAFLD among nurses was 36.8%. Nurses with a greater age (OR = 1.08, 95% CI: 1.01-1.16), obese BMI (OR = 23.30, 95% CI: 8.88-61.10), overweight BMI (OR = 3.89, 95% CI: 2.15-7.04), waist circumference exceeding the standard (OR = 2.10, 95% CI: 1.14-3.87), fasting blood glucose 100-125 mg/dL (OR = 4.09, 95% CI: 1.19-14.03), and overly low HDL-C (OR = 2.01, 95% CI: 1.05-3.85) were at greater risk of NAFLD. Furthermore, male nurses (OR = 6.42, 95% CI: 1.07-38.70), nurses with triglycerides over 150 mg/dL (OR = 4.80; 95% CI: 1.05-21.95), and nurses with HDL-C lower than the standard (OR = 5.63, 95% CI: 1.35-23.49) were at greater risk of moderate/severe NAFLD. Among younger nurses, those of greater age, male nurses, obese and overweight nurses, and those with a waist circumference exceeding the standard, 100-125 mg/dL, overly low HDL-C, and triglycerides over 150 mg/dL should consider the possibility that they have NAFLD.

Gender-Based Association of Coronary Artery Calcification and Framingham Risk Score With Non-alcoholic Fatty Liver Disease and Abdominal Obesity in Taiwanese Adults, a Cross-Sectional Study

Background

It is not certain whether non-alcoholic fatty liver disease (NAFLD) or abdominal obesity (AO) has stronger associations with atherosclerosis and coronary artery disease (CAD) risk across different genders. The purpose of this study was to determine the gender-based association of NAFLD and AO with subclinical atherosclerosis represented by coronary artery calcification (CAC) and CAD risk by Framingham risk score (FRS).

Methods

A total of 1,655 participants in a health-screening program (mean age: 49.44 years; males: 70.33%) were enrolled for analysis. Fatty liver and coronary artery calcium score (CACS) were measured via ultrasonography (US) and multi-detector computed tomography (MDCT). The presence of CAC was defined as having a CACS > 0, intermediate to high CAD risk was defined as FRS ≥ 10%, while the presence of AO was defined as having a waist circumference (WC) of ≥90 cm for men and ≥80 cm for women. Participants were categorized into four groups depending on the presence or absence of NAFLD and/or AO.

Results

The percentage of subjects with CACS > 0 was highest in the AO-only group (overall: 42.6%; men: 48.4%; women: 35.8%); and FRS ≥ 10% was highest in the group with both abnormalities (overall: 50.3%%; men: 57.3%; women: 32.4%). After adjustment factors, the odds ratio (OR) for CAC and FRS was the highest in the group with both abnormalities [men: 1.61 (1.13–2.30) for CACS > 0 and 5.86 (3.37–10.20) for FRS ≥ 10%; women: 2.17 (1.13–4.16) for CACS > 0 and 6.31 (2.08–19.10) for FRS ≥ 10%]. In men, the OR of NAFLD was higher than that of AO [1.37 (1.03–1.83) vs. 1.35 (1.02–1.79) for CACS > 0, 3.26 (2.13–4.98) vs. 2.97 (1.91–4.62) for FRS ≥ 10%]. However, women with AO consistently showed increased OR for CACS > 0 [1.87 (1.11–3.16)] and FRS ≥ 10% [4.77 (2.01–11.34)].

Conclusion

The degree of association of NAFLD and AO with CAC and FRS depends on the gender. NAFLD is more closely associated with CACS > 0 and FRS ≥ 10% in men and AO in women, respectively. NAFLD and AO could be considered independent determinants of CAC and FRS by gender.

Pericardial fat, thoracic peri-aortic adipose tissue, and systemic inflammatory marker in nonalcoholic fatty liver and abdominal obesity phenotype

Researchers have conducted many studies about the relationships between peri-cardiovascular fat, nonalcoholic fatty liver disease (NAFLD), waist circumference, and cardiovascular disease (CVD). Nevertheless, the relationship between NAFLD and pericardial fat (PCF)/thoracic peri-aortic adipose tissue (TAT) phenotypes was still unknown. This study aimed to explore whether PCF/TAT was associated with NAFLD/abdominal obesity (AO) phenotypes in different high-sensitivity C-reactive protein (hs-CRP) levels. We consecutively studied 1655 individuals (mean age, 49.44 ± 9.76 years) who underwent a health-screening program. We showed a significant association between PCF/TAT and NAFLD/AO phenotypes in the cross-sectional study. We observed that the highest risk occurred in both abnormalities' groups, and the second highest risk occurred in the AO-only group. Subjects with AO had a significantly increased risk of PCF or TAT compared to those with NAFLD. Notably, the magnitude of the associations between PCF/TAT and NAFLD/AO varied by the level of systemic inflammatory marker (hs-CRP level). We suggested that people with AO and NAFLD must be more careful about changes in PCF and TAT. Regular measurement of waist circumference (or AO) can be a more accessible way to monitor peri-cardiovascular fat (PCF and TAT), which may serve as a novel and rapid way to screen CVD in the future.

MAFLD/NAFLD Biopsy-Free Scoring Systems for Hepatic Steatosis, NASH, and Fibrosis Diagnosis

Metabolic dysfunction-associated fatty liver disease (MAFLD), formerly known as nonalcoholic fatty liver disease, is the most prevalent liver disorder worldwide. Historically, its diagnosis required biopsy, even though the procedure has a variable degree of error. Therefore, new non-invasive strategies are needed. Consequently, this article presents a thorough review of biopsy-free scoring systems proposed for the diagnosis of MAFLD. Similarly, it compares the severity of the disease, ranging from hepatic steatosis (HS) and nonalcoholic steatohepatitis (NASH) to fibrosis, by contrasting the corresponding serum markers, clinical associations, and performance metrics of these biopsy-free scoring systems. In this regard, defining MAFLD in conjunction with non-invasive tests can accurately identify patients with fatty liver at risk of fibrosis and its complications. Nonetheless, several biopsy-free scoring systems have been assessed only in certain cohorts; thus, further validation studies in different populations are required, with adjustment for variables, such as body mass index (BMI), clinical settings, concomitant diseases, and ethnic backgrounds. Hence, comprehensive studies on the effects of age, morbid obesity, and prevalence of MAFLD and advanced fibrosis in the target population are required. Nevertheless, the current clinical practice is urged to incorporate biopsy-free scoring systems that demonstrate adequate performance metrics for the accurate detection of patients with MAFLD and underlying conditions or those with contraindications of biopsy.

Metabolic-Associated Fatty Liver Disease (MAFLD), Diabetes, and Cardiovascular Disease: Associations with Fructose Metabolism and Gut Microbiota

Non-alcoholic fatty liver disease (NAFLD) is an increasingly common condition associated with type 2 diabetes (T2DM) and cardiovascular disease (CVD). Since systemic metabolic dysfunction underlies NAFLD, the current nomenclature has been revised, and the term metabolic-associated fatty liver disease (MAFLD) has been proposed. The new definition emphasizes the bidirectional relationships and increases awareness in looking for fatty liver disease among patients with T2DM and CVD or its risk factors, as well as looking for these diseases among patients with NAFLD. The most recommended treatment method of NAFLD is lifestyle changes, including dietary fructose limitation, although other treatment methods of NAFLD have recently emerged and are being studied. Given the focus on the liver-gut axis targeting, bacteria may also be a future aim of NAFLD treatment given the microbiome signatures discriminating healthy individuals from those with NAFLD. In this review article, we will provide an overview of the associations of fructose consumption, gut microbiota, diabetes, and CVD in patients with NAFLD.

Aqueous Metabolite Trends for the Progression of Nonalcoholic Fatty Liver Disease in Female Bariatric Surgery Patients by Targeted 1H-NMR Metabolomics

Determining biomarkers and better characterizing the biochemical progression of nonalcoholic fatty liver disease (NAFLD) remains a clinical challenge. A targeted ¹H-NMR study of serum, combined with clinical variables, detected and localized biomarkers to stages of NAFLD in morbidly obese females. Pre-surgery serum samples from 100 middle-aged, morbidly obese female subjects, grouped on gold-standard liver wedge biopsies (non-NAFLD; steatosis; and fibrosis) were collected, extracted, and analyzed in aqueous (D₂O) buffer (¹H, 600 MHz). Profiled concentrations were subjected to exploratory statistical analysis. Metabolites varying significantly between the non-NAFLD and steatosis groups included the ketone bodies 3-hydroxybutyrate (↓; p = 0.035) and acetone (↓; p = 0.012), and also alanine (↑; p = 0.004) and a putative pyruvate signal (↑; p = 0.003). In contrast, the steatosis and fibrosis groups were characterized by 2-hydroxyisovalerate (↑; p = 0.023), betaine (↓; p = 0.008), hypoxanthine (↓; p = 0.003), taurine (↓; p = 0.001), 2-hydroxybutyrate (↑; p = 0.045), 3-hydroxyisobutyrate (↑; p = 0.046), and increasing medium chain fatty acids. Exploratory classification models with and without clinical variables exhibited overall success rates ca. 75–85%. In the study conditions, inhibition of fatty acid oxidation and disruption of the hepatic urea cycle are supported as early features of NAFLD that continue in fibrosis. In fibrosis, markers support inflammation, hepatocyte damage, and decreased liver function. Complementarity of NMR concentrations and clinical information in classification models is shown. A broader hypothesis that standard-of-care sera can yield metabolomic information is supported.

The complex link between NAFLD and type 2 diabetes mellitus - mechanisms and treatments

Nonalcoholic fatty liver disease (NAFLD) has reached epidemic proportions worldwide. NAFLD and type 2 diabetes mellitus (T2DM) are known to frequently coexist and act synergistically to increase the risk of adverse (hepatic and extra-hepatic) clinical outcomes. T2DM is also one of the strongest risk factors for the faster progression of NAFLD to nonalcoholic steatohepatitis, advanced fibrosis or cirrhosis. However, the link between NAFLD and T2DM is more complex than previously believed. Strong evidence indicates that NAFLD is associated with an approximate twofold higher risk of developing T2DM, irrespective of obesity and other common metabolic risk factors. This risk parallels the severity of NAFLD, such that patients with more advanced stages of liver fibrosis are at increased risk of incident T2DM. In addition, the improvement or resolution of NAFLD (on ultrasonography) is associated with a reduction of T2DM risk, adding weight to causality and suggesting that liver-focused treatments might reduce the risk of developing T2DM. This Review describes the evidence of an association and causal link between NAFLD and T2DM, discusses the putative pathophysiological mechanisms linking NAFLD to T2DM and summarizes the current pharmacological treatments for NAFLD or T2DM that might benefit or adversely affect the risk of T2DM or NAFLD progression.

HbA1C as a Biomarker of Non-alcoholic Fatty Liver Disease: Comparison with Anthropometric Parameters

BACKGROUND AND AIMS

Multiple non-invasive methods including radiological, anthropometric and biochemical markers have been reported with variable performance. The present study assessed glycosylated hemoglobin (HbA_1C) as a biomarker to predict non-alcoholic fatty liver disease (NAFLD) and its severity, compared with body mass index (BMI), waist to hip ratio (WHR) and waist circumference (WC).

METHODS

This case control study included 450 individuals, including 150 cases and 300 age- and gender-matched controls recruited from the Dow Radiology Institute on the basis of radiological findings of fatty infiltration on abdominal ultrasound through convenient sampling. BMI, WHR and WC were measured according to standard protocols. HbA_1C was determined by turbidimetric inhibition immunoassay.

RESULTS

Among the cases and controls, 66% and 32% had HbA_1C levels higher than 5.7% respectively. HbA_1C and BMI were significantly associated with NAFLD [crude odds ratio (cOR)=4.12, 2.88, 2.25 (overweight) and 4.32 (obese)]. WC was found to be significantly associated with NAFLD for both genders (cOR in males=5.50 and females=5.79, p<0.01). After adjustment for other parameters, HbA_1C and WC were found to be significantly associated with NAFLD (aOR=3.40, p<0.001) along with WC in males (aOR=2.91, p<0.05) and in females (aOR=4.28, p<0.05). A significant rise in severity of hepatic steatosis was noted with increases in HbA_1C, BMI and WC. HbA_1C possessed a positive predictive value of 76% for the study population [0.76, confidence interval (CI): 0.715-0.809], 70.6% for males (0.706, CI: 0.629-0.783) and 80% for females (0.80, CI: 0.741-0.858).

CONCLUSIONS

Higher than normal HbA_1C and WC measurements possess a more than 70% potential to predict NAFLD. It is the single risk factor that is strongly associated with NAFLD after adjustment for indices of body measurements. HbA_1C may be presented as a potential biomarker for NAFLD in examination with other anthropometric measures in the adult population.

Human and molecular genetics shed lights on fatty liver disease and diabetes conundrum

The causal role of abdominal overweight/obesity, insulin resistance and type 2 diabetes (T2D) on the risk of fatty liver disease (FLD) has robustly been proven. A consensus of experts has recently proposed the novel definition of 'metabolic dysfunction-associated fatty liver disease, MAFLD' instead of 'nonalcoholic fatty liver disease, NAFLD', emphasizing the central role of dysmetabolism in the disease pathogenesis. Conversely, a direct and independent contribution of FLD per se on risk of developing T2D is still a controversial topic. When dealing with FLD as a potential risk factor for T2D, it is straightforward to think of hepatic insulin resistance as the most relevant underlying mechanism. Emerging evidence supports genetic determinants of FLD (eg PNPLA3, TM6SF2, MBOAT7, GCKR, HSD17B13) as determinants of insulin resistance and T2D. However, recent studies highlighted that the key molecular mechanism of dysmetabolism is not fat accumulation per se but the degree of hepatic fibrosis (excess liver fat content-lipotoxicity), leading to reduced insulin clearance, insulin resistance and T2D. A consequence of these findings is that drugs that will ameliorate liver fat accumulation and fibrosis in principle may also exert a beneficial effect on insulin resistance and risk of T2D in individuals with FLD. Finally, initial findings show that these genetic factors might be directly implicated in modulating pancreatic beta-cell function, although future studies are needed to fully understand this relationship.

Association between Adiponectin Gene Polymorphism and Environmental Risk Factors of Type 2 Diabetes Mellitus among the Chinese Population in Hohhot

Objective

The aim of this study was to investigate the association between adiponectin gene polymorphisms rs10937273, rs1501299, rs182052, rs2241767, and rs266729 and environmental risk factors of type 2 diabetes mellitus (T2DM) in Hohhot. The study explored different models of gene-environment interactions, aimed at providing approaches for the prevention and control of T2DM in combination with the characteristics of the local population.

Methods

A case-control study was conducted including 406 Chinese participants, comprising 203 cases and 203 controls from various hospitals. Adiponectin (ADIPOQ) gene polymorphisms rs10937273, rs1501299, rs182052, rs2241767, and rs266729 were detected using an improved multiple ligation detection reaction technique. Generalized multifactor dimensionality reduction (GMDR) and logistic regression were conducted to analyze the associations between adiponectin gene polymorphisms and T2DM, as well as the interactions between adiponectin gene polymorphisms and environmental factors.

Results

ADIPOQ gene polymorphisms rs10937273, rs1501299, rs182052, rs2241767, and rs266729 were associated with type 2 diabetes. Based on the haplotype of the five adiponectin gene single-nucleotide polymorphism (SNP) loci, we found that G-G-A-A-C was a susceptible haplotype of T2DM (P < 0.05). Interaction analyses demonstrated associations between rs1501299 and central obesity (consistency = 80%, P = 0.011) and between rs266729 and rs182052 and central obesity (consistency = 70%, P = 0.011).

Conclusions

Our findings indicate that there is an interaction between the ADIPOQ gene and central obesity, which provides new insights into the prevention and treatment of T2DM.

Estimated Cardiorespiratory Fitness Attenuates the Impacts of Sarcopenia and Obesity on Non-Alcoholic Fatty Liver in Korean Adults

This population-based, cross-sectional study examined the preventive role of non-exercise-based estimation of cardiorespiratory fitness (eCRF) against the impacts of sarcopenia and obesity on the non-alcoholic fatty liver (NAFL) in Korean adults. Data were obtained from the 2008–2011 Korea National Health and Nutrition Examination Surveys IV and V (n = 14,015 Koreans aged ≥ 18 years, 64% women). eCRF was calculated with the age- and sex-specific algorithms, and classified as lower (lowest 25%), middle (middle 50%) and upper (highest 25%). Individuals were classified as optimal (i.e., the absence of both sarcopenia and obesity), sarcopenia (i.e., the presence of sarcopenia), obesity (i.e., the presence of obesity) or sarcopenic obesity (i.e., the coexistence of sarcopenia and obesity). Limited to the sarcopenia phenotype, the adjusted odds ratio (OR) of NAFL was 2.2 (95% confidence interval, CI, 1.5–3.1) for the lower eCRF, 1.6 (95% CI, 1.3–2.1) for the middle eCRF and 2.1 (95% CI, 1.4–3.1) for the upper eCRF, compared to the optimal phenotype. Limited to the obesity phenotype, the adjusted OR of NAFL was 2.9 (95% CI, 2.0–4.2) for the lower eCRF, 3.5 (95% CI, 2.7–4.6) for the middle eCRF and 1.8 (95% CI, 1.2–2.8) for the upper eCRF, compared to the optimal phenotype. Limited to the sarcopenic obesity phenotype, the adjusted OR of NAFL was 5.9 (95% CI, 4.3–8.2) for the lower eCRF, 4.2 (95% CI, 3.2–5.5) for the middle eCRF and 2.5 (95% CI, 1.5–4.1) for the upper eCRF, compared to the optimal phenotype. The current findings suggest that high eCRF attenuates the individual and synergistic impacts of sarcopenia and obesity on NAFL in Korean adults.

Obesity Fact Sheet in Korea, 2018: Data Focusing on Waist Circumference and Obesity-Related Comorbidities

Background

The global prevalence of obesity has increased steadily in recent years. Waist circumference (WC) reflects body composition better than body mass index. The Korean Society for the Study of Obesity released the 2018 Obesity Fact Sheet to address the incidence of obesity-related comorbidities according to WC levels.

Methods

Data from the Korean National Health Insurance Service health examination database from 2009 to 2016 were analyzed. Abdominal obesity was defined as a WC ≥90 cm in men and ≥85 cm in women. Incidence rates of comorbidities and all-cause mortality rates were calculated after standardizing by age and sex based on the 2010 census.

Results

From 2009 to 2015, the incidence rates of type 2 diabetes mellitus, hypertension, myocardial infarction, and ischemic stroke increased both in men and women. Individuals with the lowest WC levels had the highest all-cause mortality rates followed by those with the highest WC levels in men, women, and the total population. The incidence rates of total cancer increased as WC levels escalated between 2009 and 2016. In men, the incidence rates of colorectal, prostate, and liver cancers increased as WC levels increased. The incidence rates of thyroid, colorectal, and stomach cancers increased as WC levels rose in women. In addition, medical expenses continuously increased as WC increased in both men and women.

Conclusion

Based on the 2018 Obesity Fact Sheet, strategies for reducing the abdominal obesity and related comorbidities and medical expenses are a public health priority.