Visceral adipose tissue and inflammation correlate with elevated liver tests in a cohort of overweight and obese patients

Objective: To study the relationship between elevated liver tests and high sensitive C-reactive protein (hs-CRP), as potential markers of liver inflammation and non-alcoholic steatohepatitis (NASH), with anthropometric and laboratory parameters in overweight patients, especially the relationship with visceral adipose tissue (VAT). Methods: Patients presenting to the obesity clinic were prospectively included. Detailed anthropometry, computed tomography (CT)-measured VAT, liver tests (aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT)) and hs-CRP were assessed, along with an extended series of biochemical parameters. Results: All 480 patients (gender distribution male (M)/female (F) (10/90%)) with complete data were included. Mean age was 39 +/- 13 years, mean BMI 34.5 +/- 6.0 kgm(-2). In 37.3% of the patients one or more of the liver tests were elevated. VAT was positively related to AST (r 0.18, P < 0.001), ALT (r 0.29, Po0.001), ALP (r 0.16, Po0.01) and GGT (r 0.39, Po0.001). Comparing subjects with high (VATX113cm 2) vs low (VATo113cm 2) VAT levels, significant differences were noted for AST (26 +/- 12 vs 24 +/- 12Ul(-1), P 0.003), ALT (37 +/- 21 vs 31 +/- 21Ul(-1), Po0.001), ALP (76 +/- 20 vs 71 +/- 18Ul (-1), P 0.008), GGT (33 +/- 20 vs 25 +/- 15Ul(-1), Po0.001) and hs-CRP (0.62 +/- 0.43 vs 0.52 +/- 0.48mgdl(-1), Po0.001). After correction for BMI the difference in AST and ALP between the high vs low VAT group disappeared. The differences for ALT and GGT remained significant (P 0.008 and Po0.001 respectively). After correction for hs-CRP the four different liver tests remained significantly higher in the high VAT group. A stepwise multiple regression analysis revealed that every single liver test has his own most important determinant; VAT and hs-CRP for AST, insulin resistance calculated with homeostasis model assessment (HOMA-IR) and hs-CRP for ALT and ALP, and triglycerides and VAT for GGT. Conclusion: In overweight and obese patients, liver tests, especially ALT and GGT, are associated with visceral fat mass. After correction for BMI and hs-CRP, ALT and GGT are significantly higher in patients with increased VAT, thereby supporting evidence for a potential key role of VAT in the pathogenesis of non-alcoholic fatty liver disease (NAFLD). International Journal of Obesity (2010) 34, 899-907; doi: 10.1038/ijo. 2010.4; published online 9 February 2010