Abstract
Background
There are discrepant data on whether men or women have a higher risk for hepatic steatosis.
Objective
To examine the influence of gender on hepatic adiposity in teenagers and young adults.
Materials and methods
We measured subcutaneous abdominal fat (SAF), intra-abdominal fat (IAF) and hepatic tissue density (a surrogate measure of hepatic fat) using CT in 505 healthy teenagers and young adults (254 males, 251 females; ages 15–22.9 years).
Results
Overall, compared to men, women had higher values of SAF (P < 0.0001) but similar measures of IAF and liver tissue density (P = 0.09 and 0.92, respectively). However, when compared to overweight/obese men, overweight/obese women had strikingly similar IAF values (P = 0.85) but lower hepatic fat (P = 0.009). Multiple regression analyses indicated that, after adjusting for age and SAF, IAF independently predicted hepatic density in males (P < 0.0001) but not in females (P = 0.36). Hepatic fat increased with body mass in males from lean to overweight and obese (P < 0.0001) but not in females (P > 0.05).
Conclusion
When compared to overweight and obese young women, overweight and obese young men are at greater risk for hepatic steatosis, independent of IAF.
Similar content being viewed by others
Abbreviations
- NAFLD:
-
Nonalcoholic fatty liver disease
- IAF:
-
Intra-abdominal fat
- BMI:
-
Body mass index
- WC:
-
Waist circumference
- SAF:
-
Subcutaneous abdominal fat
- HU:
-
Hounsfield units
References
Farrell GC, George J, Hall P et al (eds) (2004) Fatty liver disease: NASH and related disorders. Blackwell Science Inc., Malden
Byrne CD, Olufadi R, Bruce KD et al (2009) Metabolic disturbances in non-alcoholic fatty liver disease. Clin Sci (Lond) 116:539–564
Neuschwander-Tetri BA, Caldwell SH (2003) Nonalcoholic steatohepatitis: summary of an AASLD Single Topic Conference. Hepatology 37:1202–1219
Angulo P (2002) Nonalcoholic fatty liver disease. N Engl J Med 346:1221–1231
Rector RS, Thyfault JP, Wei Y et al (2008) Non-alcoholic fatty liver disease and the metabolic syndrome: an update. World J Gastroenterol 14:185–192
van der Poorten D, Milner KL, Hui J et al (2008) Visceral fat: a key mediator of steatohepatitis in metabolic liver disease. Hepatology 48:449–457
Adams LA, Waters OR, Knuiman MW et al (2009) NAFLD as a risk factor for the development of diabetes and the metabolic syndrome: an 11-year follow-up study. Am J Gastroenterol 104:861–867
Kelley DE, McKolanis TM, Hegazi RA et al (2003) Fatty liver in type 2 diabetes mellitus: relation to regional adiposity, fatty acids, and insulin resistance. Am J Physiol Endocrinol Metab 285:E906–E916
Park BJ, Kim YJ, Kim DH et al (2008) Visceral adipose tissue area is an independent risk factor for hepatic steatosis. J Gastroenterol Hepatol 23:900–907
Thamer C, Machann J, Haap M et al (2004) Intrahepatic lipids are predicted by visceral adipose tissue mass in healthy subjects. Diab Care 27:2726–2729
Van Gaal LF, Mertens IL, De Block CE (2006) Mechanisms linking obesity with cardiovascular disease. Nature 444:875–880
Picardi A, Vespasiani-Gentilucci U (2008) Association between non-alcoholic fatty liver disease and cardiovascular disease: a first message should pass. Am J Gastroenterol 103:3036–3038
Pinto HC, Baptista A, Camilo ME et al (1996) Nonalcoholic steatohepatitis. Clinicopathological comparison with alcoholic hepatitis in ambulatory and hospitalized patients. Dig Dis Sci 41:172–179
Itoh S, Yougel T, Kawagoe K (1987) Comparison between nonalcoholic steatohepatitis and alcoholic hepatitis. Am J Gastroenterol 82:650–654
Ludwig J, Viggiano TR, McGill DB et al (1980) Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease. Mayo Clin Proc 55:434–438
Adler M, Schaffner F (1979) Fatty liver hepatitis and cirrhosis in obese patients. Am J Med 67:811–816
Diehl AM, Goodman Z, Ishak KG (1988) Alcohollike liver disease in nonalcoholics. A clinical and histologic comparison with alcohol-induced liver injury. Gastroenterology 95:1056–1062
Lee RG (1989) Nonalcoholic steatohepatitis: a study of 49 patients. Hum Pathol 20:594–598
Powell EE, Cooksley WG, Hanson R et al (1990) The natural history of nonalcoholic steatohepatitis: a follow-up study of 42 patients for up to 21 years. Hepatology 11:74–80
Angulo P, Keach JC, Batts KP et al (1999) Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis. Hepatology 30:1356–1362
Lee K, Sung JA, Kim JS et al (2009) The roles of obesity and gender on the relationship between metabolic risk factors and non-alcoholic fatty liver disease in Koreans. Diabetes Metab Res Rev 25:150–155
Schwimmer JB, McGreal N, Deutsch R et al (2005) Influence of gender, race, and ethnicity on suspected fatty liver in obese adolescents. Pediatrics 115:e561–e565
Suzuki A, Abdelmalek MF (2009) Nonalcoholic fatty liver disease in women. Womens Health (Lond Engl) 5:191–203
Olufadi R, Byrne CD (2008) Clinical and laboratory diagnosis of the metabolic syndrome. J Clin Pathol 61:697–706
Stefan N, Kantartzis K, Haring HU (2008) Causes and metabolic consequences of fatty liver. Endocr Rev 29:939–960
Speliotes EK, Massaro JM, Hoffmann U et al (2008) Liver fat is reproducibly measured using computed tomography in the Framingham Heart Study. J Gastroenterol Hepatol 23:894–899
Cowin GJ, Jonsson JR, Bauer JD et al (2008) Magnetic resonance imaging and spectroscopy for monitoring liver steatosis. J Magn Reson Imaging 28:937–945
Mehta SR, Thomas EL, Bell JD et al (2008) Non-invasive means of measuring hepatic fat content. World J Gastroenterol 14:3476–3483
Jensen MD (2008) Role of body fat distribution and the metabolic complications of obesity. J Clin Endocrinol Metab 93:S57–S63
Erlingsson S, Herard S, Dahlqvist Leinhard O et al (2009) Men develop more intraabdominal obesity and signs of the metabolic syndrome after hyperalimentation than women. Metabolism 58:995–1001
Leenen R, van der Kooy K, Seidell JC et al (1992) Visceral fat accumulation measured by magnetic resonance imaging in relation to serum lipids in obese men and women. Atherosclerosis 94:171–181
Despres JP, Couillard C, Gagnon J et al (2000) Race, visceral adipose tissue, plasma lipids, and lipoprotein lipase activity in men and women: the Health, Risk Factors, Exercise Training, and Genetics (HERITAGE) family study. Arterioscler Thromb Vasc Biol 20:1932–1938
Lemieux S, Despres JP, Moorjani S et al (1994) Are gender differences in cardiovascular disease risk factors explained by the level of visceral adipose tissue? Diabetologia 37:757–764
Lemieux S, Prud'homme D, Bouchard C et al (1993) Sex differences in the relation of visceral adipose tissue accumulation to total body fatness. Am J Clin Nutr 58:463–467
Krotkiewski M, Bjorntorp P, Sjostrom L et al (1983) Impact of obesity on metabolism in men and women. Importance of regional adipose tissue distribution. J Clin Invest 72:1150–1162
Rattarasarn C, Leelawattana R, Soonthornpun S et al (2004) Gender differences of regional abdominal fat distribution and their relationships with insulin sensitivity in healthy and glucose-intolerant Thais. J Clin Endocrinol Metab 89:6266–6270
Beasley LE, Koster A, Newman AB et al (2009) Inflammation and race and gender differences in computerized tomography-measured adipose depots. Obesity (Silver Spring) 17:1062–1069
Fox CS, Massaro JM, Hoffmann U et al (2007) Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Circulation 116:39–48
Bray GA, Jablonski KA, Fujimoto WY et al (2008) Relation of central adiposity and body mass index to the development of diabetes in the diabetes prevention program. Am J Clin Nutr 87:1212–1218
Shen W, Punyanitya M, Silva AM et al (2009) Sexual dimorphism of adipose tissue distribution across the lifespan: a cross-sectional whole-body magnetic resonance imaging study. Nutr Metab (Lond) 6:17
Onat A, Ugur M, Can G et al (2009) Visceral adipose tissue and body fat mass: predictive values for and role of gender in cardiometabolic risk among Turks. Nutrition 26:382–389
Ludescher B, Najib A, Baar S et al (2007) Gender specific correlations of adrenal gland size and body fat distribution: a whole body MRI study. Horm Metab Res 39:515–518
Porter SA, Massaro JM, Hoffmann U et al (2009) Abdominal subcutaneous adipose tissue: a protective fat depot? Diab Care 32:1068–1075
Chung SA, Dorey F, Mittelman S et al (2011) Effect of gender on intra-abdominal fat in teenagers and young adults. Pediatr Radiol (in press)
Tanner JM (1978) Physical growth and development. Churchill Livingstone, Edinburgh
Kalender WA (1992) Effective dose values in bone mineral measurements by photon absorptiometry and computed tomography. Osteoporos Int 2:82–87
Lee S, Janssen I, Ross R (2004) Interindividual variation in abdominal subcutaneous and visceral adipose tissue: influence of measurement site. J Appl Physiol 97:948–954
Hounsfield GN (1980) Computed medical imaging. Science 210:22–28
Schneider W, Bortfeld T, Schlegel W (2000) Correlation between CT numbers and tissue parameters needed for Monte Carlo simulations of clinical dose distributions. Phys Med Biol 45:459–478
Eguchi Y, Eguchi T, Mizuta T et al (2006) Visceral fat accumulation and insulin resistance are important factors in nonalcoholic fatty liver disease. J Gastroenterol 41:462–469
Denzer C, Thiere D, Muche R et al (2009) Gender-specific prevalences of fatty liver in obese children and adolescents: roles of body fat distribution, sex steroids, and insulin resistance. J Clin Endocrinol Metab 94:3872–3881
Browning JD, Szczepaniak LS, Dobbins R et al (2004) Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology 40:1387–1395
Cheung O, Kapoor A, Puri P et al (2007) The impact of fat distribution on the severity of nonalcoholic fatty liver disease and metabolic syndrome. Hepatology 46:1091–1100
Geer EB, Shen W (2009) Gender differences in insulin resistance, body composition, and energy balance. Gend Med 6(Suppl 1):60–75
Cooke PS, Naaz A (2004) Role of estrogens in adipocyte development and function. Exp Biol Med (Maywood) 229:1127–1135
Ostberg JE, Thomas EL, Hamilton G et al (2005) Excess visceral and hepatic adipose tissue in Turner syndrome determined by magnetic resonance imaging: estrogen deficiency associated with hepatic adipose content. J Clin Endocrinol Metab 90:2631–2635
Simpson ER, Jones ME (2006) Of mice and men: the many guises of estrogens. Ernst Schering Found Symp Proc 1:45–67
Brzozowska MM, Ostapowicz G, Weltman MD (2009) An association between non-alcoholic fatty liver disease and polycystic ovarian syndrome. J Gastroenterol Hepatol 24:243–247
Iwasaki M, Takada Y, Hayashi M et al (2004) Noninvasive evaluation of graft steatosis in living donor liver transplantation. Transplantation 78:1501–1505
Piekarski J, Goldberg HI, Royal SA et al (1980) Difference between liver and spleen CT numbers in the normal adult: its usefulness in predicting the presence of diffuse liver disease. Radiology 137:727–729
Valls C, Iannacconne R, Alba E et al (2006) Fat in the liver: diagnosis and characterization. Eur Radiol 16:2292–2308
Panicek DM, Giess CS, Schwartz LH (1997) Qualitative assessment of liver for fatty infiltration on contrast-enhanced CT: is muscle a better standard of reference than spleen? J Comput Assist Tomogr 21:699–705
Birnbaum BA, Hindman N, Lee J et al (2007) Multi-detector row CT attenuation measurements: assessment of intra- and interscanner variability with an anthropomorphic body CT phantom. Radiology 242:109–119
Kodama Y, Ng CS, Wu TT et al (2007) Comparison of CT methods for determining the fat content of the liver. Am J Roentgenol 188:1307–1312
Mohanty SR, Troy TN, Huo D et al (2009) Influence of ethnicity on histological differences in non-alcoholic fatty liver disease. J Hepatol 50:797–804
Acknowledgment
This work is supported in part by grants from the National Institutes of Health (1R01 AR052744-01) and from the Department of the Army (DAMD17-01-1-0817).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gilsanz, V., Chung, S.A. & Kaplowitz, N. Differential effect of gender on hepatic fat. Pediatr Radiol 41, 1146–1153 (2011). https://doi.org/10.1007/s00247-011-2021-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00247-011-2021-7