Association of epicardial fat volume and nonalcoholic fatty liver disease with metabolic syndrome: From the CAESAR study

Background and aims Epicardial adipose tissue or nonalcoholic fatty liver disease (NAFLD) can be one of putative risk factors for metabolic syndrome (MetS). However, there are no data assessing the associations of MetS with epicardial fat and NAFLD. The present study was performed to evaluate the combined effect of epicardial fat volume (EFV) and NAFLD on MetS in Korean adults. Methods and results Computed tomographic EFV and ultrasonographic fatty liver were measured in 1472 individuals (1242 men: mean age, 44 ± 8.6 years) among a total of 2277 individuals enrolled in the CArdiometabolic risk, Epicardial fat, and Subclinical Atherosclerosis Registry (CAESAR). Subjects were divided into 4 groups according to EFV and NAFLD (group I: low EFV and without NAFLD; group II: low EFV and with NAFLD; group III: high EFV and without NAFLD; and group IV: high EFV and with NAFLD). The overall prevalence of MetS was 24.2%. The EFV levels and prevalence of NAFLD in individuals with MetS was significant higher than those without MetS (81.0 cm³ vs 57.3 cm³, P < .001; 75.6% vs 36.5%, P < .001). The multivariate regression analysis including the five components of MetS showed that Group IV had significantly higher odds ratios (ORs) for the presence of MetS compared with Group I (OR [95% CI], 2.10 [1.11–3.98]). In the model, EFV was associated with MetS (2.03 [1.17–3.52]) but NAFLD was not (1.38 [0.88–2.12]). Conclusion This study showed that increased EFV and NAFLD are associated with the presence of MetS. However, EFV was more influenced by MetS than NAFLD despite NAFLD having more unfavorable metabolic and lipid profiles.