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Non‐alcoholic fatty liver disease as an independent manifestation of the metabolic syndrome: Results of a US national survey in three ethnic groups
Author(s) -
Smits Mark M,
Ioannou George N,
Boyko Edward J,
Utzschneider Kristina M
Publication year - 2013
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.12106
Subject(s) - medicine , metabolic syndrome , fatty liver , steatosis , triglyceride , gastroenterology , endocrinology , disease , obesity , cholesterol
Background and Aim The metabolic syndrome ( MetS ) and each of its components are strongly associated with non‐alcoholic fatty liver disease ( NAFLD ). This has led many investigators to suggest that NAFLD is an independent component of the MetS . We formally tested this hypothesis using confirmatory factor analysis, which allows comparison of different models, with or without including NAFLD as a component of the MetS . Methods We analyzed data from 3846 subjects of the T hird N ational H ealth and N utrition E xamination S urvey (1988–1994). NAFLD was defined by increased liver fat measured by ultrasonography. Results MetS by A dult T reatment P anel III criteria was present in 20.5%, and 30.2% had NAFLD , defined as mild, moderate, or severe ultrasonographic steatosis. Using confirmatory factor analysis, a basic model representing the MetS using its currently accepted components (glucose, waist, triglyceride/high‐density lipoprotein ratio, and mean arterial pressure) showed excellent goodness‐of‐fit statistics. Addition of NAFLD to the model as a fifth independent variable decreased model fit, suggesting that NAFLD is not an additional independent component of the MetS . Analysis by ethnicity showed that addition of NAFLD decreased model fit in W hites but resulted in minor improvements in non‐ H ispanic B lacks and M exican A mericans. Conclusions The MetS is strongly associated with NAFLD . However, we found no evidence that NAFLD is an independent component or manifestation of the MetS . Interestingly, ethnic differences might be important in this relationship and require further study.