{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T09:19:59Z","timestamp":1762507199609,"version":"3.37.3"},"reference-count":50,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2018,2,6]],"date-time":"2018-02-06T00:00:00Z","timestamp":1517875200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100007687","name":"Korean Diabetes Association","doi-asserted-by":"publisher","award":["Y.L., 2015"],"award-info":[{"award-number":["Y.L., 2015"]}],"id":[{"id":"10.13039\/100007687","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Gastro and Hepatol"],"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Aim<\/jats:title><jats:p>Although a combination of central obesity and decreased skeletal muscle mass has been associated with various cardiometabolic disorders, its influence on the presence of non\u2010alcoholic fatty liver disease (NAFLD) in type 2 diabetes (T2D) is unclear. We investigated whether waist\u2010to\u2010calf circumference ratio (WCR) predicts NAFLD or hepatic fibrosis in T2D.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with T2D (<jats:italic>n<\/jats:italic>\u00a0=\u00a05507) were enrolled in this study. Hepatic steatosis was diagnosed using abdominal ultrasound and predicting score. NAFLD was defined as \u2018hepatic steatosis absent other causes of chronic liver disease,\u2019 such as virus or alcoholism. Degree of hepatic fibrosis was calculated using non\u2010invasive serum biomarker\u2010based models. Insulin resistance was assessed by short insulin tolerance test.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The prevalence of NAFLD and obesity (BMI\u00a0\u2265\u00a025\u00a0kg\/m<jats:sup>2<\/jats:sup>, Asian definition) were 46.4% and 38.9%, respectively. NAFLD prevalence was higher with increasing WCR tertiles: lowest tertile (36% in men, 28% in women) <jats:italic>versus<\/jats:italic> highest tertile (53.8% in men, 58.2% in women, both <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001 after stratification by insulin resistance status. Increasing WCR tertiles were independently associated with presence of NAFLD: odds ratio (OR)\u00a0=\u00a01.43, 95% confidence interval (CI)\u00a0=\u00a01.22\u20131.68 and OR\u00a0=\u00a01.56, 95% CI\u00a0=\u00a01.31\u20131.86, in the middle and highest tertiles, respectively. Furthermore, patients with NAFLD and the highest WCR tertile had significant fibrosis (OR\u00a0=\u00a08.62, 95% CI\u00a0=\u00a01.39\u201353.36, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.021). Also, WCR was correlated with risk of sarcopenia (OR\u00a0=\u00a03.18, 95% CI\u00a0=\u00a02.50\u20134.05, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001, highest tertile).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Higher WCR is associated with increased risk of NAFLD and hepatic fibrosis independent of insulin resistance. This suggests that WCR may be a useful index to predict high risk of hepatic steatosis in T2D.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jgh.14011","type":"journal-article","created":{"date-parts":[[2017,10,9]],"date-time":"2017-10-09T03:22:38Z","timestamp":1507519358000},"page":"1082-1091","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Waist\u2010to\u2010calf circumstance ratio is an independent predictor of hepatic steatosis and fibrosis in patients with type 2 diabetes"],"prefix":"10.1111","volume":"33","author":[{"given":"Eun Yeong","family":"Choe","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Yonsei University College of Medicine  Seoul Korea"},{"name":"Korean Association of Health Promotion  Incheon Korea"},{"name":"Graduate school Yonsei University College of Medicine  Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6219-4942","authenticated-orcid":false,"given":"Yong\u2010ho","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Yonsei University College of Medicine  Seoul Korea"},{"name":"Graduate school Yonsei University College of Medicine  Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Young Ju","family":"Choi","sequence":"additional","affiliation":[{"name":"Huh's Diabetes Center and the 21st Century Diabetes and Vascular Research Institute  Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Byung Wook","family":"Huh","sequence":"additional","affiliation":[{"name":"Huh's Diabetes Center and the 21st Century Diabetes and Vascular Research Institute  Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Byung\u2010Wan","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Yonsei University College of Medicine  Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soo\u2010Kyung","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, CHA Bundang Medical Center CHA University  Seongnam Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eun Seok","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Yonsei University College of Medicine  Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bong\u2010Soo","family":"Cha","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Yonsei University College of Medicine  Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eun Jig","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Yonsei University College of Medicine  Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kap Bum","family":"Huh","sequence":"additional","affiliation":[{"name":"Huh's Diabetes Center and the 21st Century Diabetes and Vascular Research Institute  Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zobair M","family":"Younossi","sequence":"additional","affiliation":[{"name":"Center for Liver Diseases, Department of Medicine Inova Fairfax Hospital  Falls Church Virginia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,2,6]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc10-0107"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2009.171520"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12603-009-0084-z"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.20734"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21496"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.5370"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2009.171447"},{"key":"e_1_2_5_9_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.b3292","article-title":"Thigh circumference and risk of heart disease and premature death: prospective cohort study","volume":"339","author":"Heitmann BL","year":"2009","journal-title":"BMJ"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/77.5.1192"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.108.520106"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.archger.2011.05.015"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc09-2310"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc11-0743"},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1532-5415.2003.51362.x"},{"key":"e_1_2_5_16_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra011775"},{"key":"e_1_2_5_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.22603"},{"key":"e_1_2_5_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.23280"},{"key":"e_1_2_5_19_1","article-title":"Non\u2010laboratory\u2010based self\u2010assessment screening score for non\u2010alcoholic fatty liver disease: development, validation and comparison with other scores","volume":"9","author":"Lee YH","year":"2014","journal-title":"PLoS One"},{"key":"e_1_2_5_20_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v20.i39.14185"},{"key":"e_1_2_5_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.13264"},{"key":"e_1_2_5_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2016.05.013"},{"key":"e_1_2_5_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2014.09.020"},{"key":"e_1_2_5_24_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v20.i7.1724"},{"key":"e_1_2_5_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.28376"},{"key":"e_1_2_5_26_1","first-page":"S11","article-title":"Natural history of nonalcoholic steatohepatitis","volume":"40","author":"Liou I","year":"2006","journal-title":"J. Clin. Gastroenterol."},{"key":"e_1_2_5_27_1","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/S2213-8587(14)70055-5","article-title":"Sarcopenia: a fate worth challenging","volume":"2","author":"The Lancet Diabetes E","year":"2014","journal-title":"Lancet Diabetes Endocrinol."},{"key":"e_1_2_5_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.26716"},{"key":"e_1_2_5_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2015.02.051"},{"key":"e_1_2_5_30_1","doi-asserted-by":"publisher","DOI":"10.4093\/dmj.2011.35.6.561"},{"key":"e_1_2_5_31_1","doi-asserted-by":"publisher","DOI":"10.1053\/gast.2002.35354"},{"key":"e_1_2_5_32_1","doi-asserted-by":"publisher","DOI":"10.1586\/17474124.2015.1007955"},{"key":"e_1_2_5_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2017.04.003"},{"key":"e_1_2_5_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1478-3231.2009.02192.x"},{"key":"e_1_2_5_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21178"},{"key":"e_1_2_5_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2008.07.010"},{"key":"e_1_2_5_37_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.1992.tb01813.x"},{"key":"e_1_2_5_38_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1096-9136(199605)13:5<429::AID-DIA98>3.0.CO;2-K"},{"key":"e_1_2_5_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(14)70034-8"},{"key":"e_1_2_5_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2015.08.010"},{"key":"e_1_2_5_41_1","doi-asserted-by":"publisher","DOI":"10.3803\/EnM.2015.30.2.142"},{"key":"e_1_2_5_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2015.07.024"},{"key":"e_1_2_5_43_1","article-title":"Visceral obesity predicts significant fibrosis in patients with nonalcoholic fatty liver disease","volume":"94","author":"Yu SJ","year":"2015","journal-title":"Medicine (Baltimore)"},{"key":"e_1_2_5_44_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrgastro.2013.34"},{"key":"e_1_2_5_45_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1440-1746.2003.02989.x"},{"key":"e_1_2_5_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)67663-5"},{"key":"e_1_2_5_47_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0801891"},{"key":"e_1_2_5_48_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwr048"},{"key":"e_1_2_5_49_1","doi-asserted-by":"publisher","DOI":"10.1111\/jdi.12421"},{"key":"e_1_2_5_50_1","doi-asserted-by":"publisher","DOI":"10.1186\/1475-2840-11-62"},{"key":"e_1_2_5_51_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-016-4285-0"}],"container-title":["Journal of Gastroenterology and Hepatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fjgh.14011","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jgh.14011","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,24]],"date-time":"2023-09-24T13:03:51Z","timestamp":1695560631000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jgh.14011"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,2,6]]},"references-count":50,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2018,5]]}},"alternative-id":["10.1111\/jgh.14011"],"URL":"https:\/\/doi.org\/10.1111\/jgh.14011","archive":["Portico"],"relation":{},"ISSN":["0815-9319","1440-1746"],"issn-type":[{"type":"print","value":"0815-9319"},{"type":"electronic","value":"1440-1746"}],"subject":[],"published":{"date-parts":[[2018,2,6]]},"assertion":[{"value":"2017-04-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-09-27","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-02-06","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}