Liver fat accumulation within the ‘normal range’ is associated with the presence of metabolic syndrome traits
Liver fat accumulation within the ‘normal range’ is associated with the presence of metabolic syndrome traits
Aims: the primary objective of this cross-sectional study was to re-examine the liver fat thresholds associated with metabolic health and number of metabolic syndrome (MetS) traits.
Methods: in this cross-sectional study, 597 participants (99.7 % white European) underwent assessment of i) cardiometabolic health with individual MetS traits ii) alcohol consumption and iii) steatotic liver disease (SLD), defined by MRI-PDFF or proton spectroscopy (1H-MRS) liver fat ≥5.56 %.
Results: the median (IQR) liver fat was 0.4 % (0.9) in 30 subjects without MetS traits and 6.7 % (15.4) and 16.7 % (20.1) in 117 and 108 subjects with 3 and 5 MetS traits respectively. SLD was associated with each MetS trait (increased blood pressure, central obesity, dysglycaemia, high triglyceride and low HDL-C concentrations; all p < 0.001). There was an increase in liver fat (%) according to increasing number of MetS traits (p < 0.001). There was an increase in every MetS trait with liver fat categories below 5.56 % (i.e. ≥1 % and ≤1.85 %, >1.85 % and <5.56 %).
Conclusions: previously defined normal levels of liver fat are not associated with optimal metabolic health (no MetS traits). Small increments in liver fat, even within a pre-defined normal range, are associated with a progressive increase in the number of MetS traits.
Brown, Emily
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Bilson, Josh
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Goff, Louise M.
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Kemp, Graham J.
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Weickert, Martin O.
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Umpleby, A Margot
e4673c3c-ca62-4eb4-b0cb-064cb8b16ed1
Byrne, Christopher D.
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Cuthbertson, Daniel J.
07358e9f-22b7-4094-b1fb-157b588b260d
14 November 2025
Brown, Emily
7f07228a-be9a-44d8-94f9-7d99159883d4
Bilson, Josh
a99f9320-335c-47c8-bf30-07df48a5467d
Goff, Louise M.
a55fb373-dbb5-4b5d-81db-90b3c430257f
Kemp, Graham J.
e655122f-ff43-49ae-92d3-b569d4cb7707
Weickert, Martin O.
4f93fd7f-884f-4167-9b2b-123767d21206
Umpleby, A Margot
e4673c3c-ca62-4eb4-b0cb-064cb8b16ed1
Byrne, Christopher D.
1370b997-cead-4229-83a7-53301ed2a43c
Cuthbertson, Daniel J.
07358e9f-22b7-4094-b1fb-157b588b260d
Brown, Emily, Bilson, Josh, Alam, Uazman, Goff, Louise M., Kemp, Graham J., Pfeiffer, Andreas F.H., Weickert, Martin O., Umpleby, A Margot, Byrne, Christopher D. and Cuthbertson, Daniel J.
(2025)
Liver fat accumulation within the ‘normal range’ is associated with the presence of metabolic syndrome traits.
Diabetes Research and Clinical Practice, 230.
(doi:10.1016/j.diabres.2025.112997).
Abstract
Aims: the primary objective of this cross-sectional study was to re-examine the liver fat thresholds associated with metabolic health and number of metabolic syndrome (MetS) traits.
Methods: in this cross-sectional study, 597 participants (99.7 % white European) underwent assessment of i) cardiometabolic health with individual MetS traits ii) alcohol consumption and iii) steatotic liver disease (SLD), defined by MRI-PDFF or proton spectroscopy (1H-MRS) liver fat ≥5.56 %.
Results: the median (IQR) liver fat was 0.4 % (0.9) in 30 subjects without MetS traits and 6.7 % (15.4) and 16.7 % (20.1) in 117 and 108 subjects with 3 and 5 MetS traits respectively. SLD was associated with each MetS trait (increased blood pressure, central obesity, dysglycaemia, high triglyceride and low HDL-C concentrations; all p < 0.001). There was an increase in liver fat (%) according to increasing number of MetS traits (p < 0.001). There was an increase in every MetS trait with liver fat categories below 5.56 % (i.e. ≥1 % and ≤1.85 %, >1.85 % and <5.56 %).
Conclusions: previously defined normal levels of liver fat are not associated with optimal metabolic health (no MetS traits). Small increments in liver fat, even within a pre-defined normal range, are associated with a progressive increase in the number of MetS traits.
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Manuscript Diabetes Res Clin Pract_version 3.0 (CLEAN with figures)
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Accepted/In Press date: 9 November 2025
e-pub ahead of print date: 10 November 2025
Published date: 14 November 2025
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Local EPrints ID: 507381
URI: http://eprints.soton.ac.uk/id/eprint/507381
ISSN: 0168-8227
PURE UUID: 8fc99414-411c-451e-8536-a881680d65f2
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Date deposited: 08 Dec 2025 17:39
Last modified: 09 Dec 2025 03:07
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Contributors
Author:
Emily Brown
Author:
Josh Bilson
Author:
Uazman Alam
Author:
Louise M. Goff
Author:
Graham J. Kemp
Author:
Andreas F.H. Pfeiffer
Author:
Martin O. Weickert
Author:
A Margot Umpleby
Author:
Daniel J. Cuthbertson
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