{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:59:35Z","timestamp":1775091575717,"version":"3.50.1"},"reference-count":32,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2022,9,27]],"date-time":"2022-09-27T00:00:00Z","timestamp":1664236800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Biomedicines"],"abstract":"<jats:p>Non-alcoholic fatty liver disease (NAFLD) is associated with several other metabolic disorders, which are typically pro-inflammatory states. Body fat content is an important marker of metabolic health and abdominal fat is associated with harmful cardiometabolic outcomes. We aimed to evaluate the association between the risk of NAFLD (through Fatty Liver Index (FLI), and BMI, AST\/ALT ratio, and presence of diabetes (BARD)), and anthropometric parameters, predictors of metabolic status, in patients with morbid obesity, and to evaluate the association of FLI and BARD scores with pro-inflammatory markers. We have retrospectively studied patients with morbid obesity followed in our center. In total, 2184 participants were included, with an average age of 42.8 \u00b1 10.6 years, 84.5% being females. We report a positive association of FLI with waist circumference (\u03b2 = 0.10 [0.09 to 0.11], p &lt; 0.01) and waist-to-hip ratio (\u03b2 = 8.68 [6.85 to 10.52, p &lt; 0.01]), even after adjusting for age, sex, body mass index, diabetes, and dyslipidemia (p &lt; 0.01 for both adjusted models). The associations of BARD with anthropometric measures were significant only in the non-adjusted model. There was a positive association between both FLI and BARD and C-reactive protein. Our results point towards a positive association between waist-to-hip ratio and the risk of hepatic steatosis, and between pro-inflammatory markers and both hepatic steatosis and fibrosis.<\/jats:p>","DOI":"10.3390\/biomedicines10102416","type":"journal-article","created":{"date-parts":[[2022,9,27]],"date-time":"2022-09-27T21:23:27Z","timestamp":1664313807000},"page":"2416","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Waist-to-Hip Ratio and Inflammatory Parameters Are Associated with Risk of Non-Alcoholic Fatty Liver Disease in Patients with Morbid Obesity"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2929-3751","authenticated-orcid":false,"given":"Marta","family":"Borges-Canha","sequence":"first","affiliation":[{"name":"Servi\u00e7o de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"},{"name":"Departamento de Cirurgia e Fisiologia, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal"}]},{"given":"Jo\u00e3o","family":"Neves","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"},{"name":"Departamento de Cirurgia e Fisiologia, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4073-2495","authenticated-orcid":false,"given":"Maria","family":"Silva","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}]},{"given":"Fernando","family":"Mendon\u00e7a","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4176-3069","authenticated-orcid":false,"given":"Telma","family":"Moreno","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}]},{"given":"Sara","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}]},{"given":"Jo\u00e3o","family":"Correa","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Medicina Interna do Centro Hospitalar Universit\u00e1rio de Cova da Beira, 6200-251 Covilh\u00e3, Portugal"}]},{"given":"Catarina","family":"Vale","sequence":"additional","affiliation":[{"name":"Departamento de Cirurgia e Fisiologia, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal"},{"name":"Servi\u00e7o de Medicina Interna do Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}]},{"given":"Juliana","family":"Gon\u00e7alves","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3925-1750","authenticated-orcid":false,"given":"Helena","family":"Urbano Ferreira","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}]},{"given":"Sara","family":"Gil-Santos","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Endocrinologia do Instituto Portugu\u00eas de Oncologia do Porto, 4200-319 Porto, Portugal"}]},{"given":"Vanessa","family":"Guerreiro","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}]},{"given":"Ana","family":"Sande","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}]},{"given":"Selma","family":"B. Souto","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}]},{"given":"Jorge","family":"Pedro","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}]},{"given":"Paula","family":"Freitas","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"},{"name":"Investiga\u00e7\u00e3o e Inova\u00e7\u00e3o em Sa\u00fade (i3s), Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3156-3741","authenticated-orcid":false,"given":"Davide","family":"Carvalho","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"},{"name":"Investiga\u00e7\u00e3o e Inova\u00e7\u00e3o em Sa\u00fade (i3s), Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal"}]},{"name":"CRIO Group","sequence":"additional","affiliation":[]}],"member":"1968","published-online":{"date-parts":[[2022,9,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/j.cld.2015.10.001","article-title":"Epidemiology of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis in the United States and the Rest of the World","volume":"20","author":"Sayiner","year":"2016","journal-title":"Clin. Liver Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"17932","DOI":"10.3748\/wjg.v20.i47.17932","article-title":"Lean-non-alcoholic fatty liver disease increases risk for metabolic disorders in a normal weight Chinese population","volume":"20","author":"Feng","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"811","DOI":"10.21037\/hbsn-20-263","article-title":"The presence of NAFLD in nonobese subjects increased the risk of metabolic abnormalities than obese subjects without NAFLD: A population-based cross-sectional study","volume":"10","author":"Hu","year":"2021","journal-title":"Hepatobiliary Surg Nutr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1002\/hep.29367","article-title":"The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases","volume":"67","author":"Chalasani","year":"2018","journal-title":"Hepatology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1002\/hep.28431","article-title":"Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes","volume":"64","author":"Younossi","year":"2016","journal-title":"Hepatology"},{"key":"ref_6","first-page":"261","article-title":"Current Modalities of Fibrosis Assessment in Non-alcoholic Fatty Liver Disease","volume":"5","author":"Cheah","year":"2017","journal-title":"J. Clin. Transl. Hepatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1007\/s00125-017-4264-9","article-title":"EASL-EASD-EASO clinical practice guidelines for the management of non-alcoholic fatty liver disease in severely obese people: Do they lead to over-referral?","volume":"60","author":"Blond","year":"2017","journal-title":"Diabetologia"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver, European Association for the Study of Diabete, and European Association for the Study of Obesity (2016). EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J. Hepatol., 64, 1388\u20131402.","DOI":"10.1016\/j.jhep.2015.11.004"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1016\/S2213-8587(18)30288-2","article-title":"Association of BMI with overall and cause-specific mortality: A population-based cohort study of 3.6 million adults in the UK","volume":"6","author":"Bhaskaran","year":"2018","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e218505","DOI":"10.1001\/jamanetworkopen.2021.8505","article-title":"An Empirically Derived Definition of Metabolically Healthy Obesity Based on Risk of Cardiovascular and Total Mortality","volume":"4","author":"Zembic","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e218860","DOI":"10.1001\/jamanetworkopen.2021.8860","article-title":"Metabolically Healthy Obesity Redefined","volume":"4","author":"Rodriguez","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1038\/ejcn.2009.68","article-title":"Body mass index, waist circumference and waist:hip ratio as predictors of cardiovascular risk\u2014A review of the literature","volume":"64","author":"Huxley","year":"2010","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.immuni.2021.12.013","article-title":"Inflammation in obesity, diabetes, and related disorders","volume":"55","author":"Rohm","year":"2022","journal-title":"Immunity"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"101409","DOI":"10.1016\/j.molmet.2021.101409","article-title":"The metabolic syndrome, thiazolidinediones, and implications for intersection of chronic and inflammatory disease","volume":"55","author":"Colca","year":"2022","journal-title":"Mol. Metab."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"American Diabetes Association (2019). 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2019. Diabetes Care, 42, S13\u2013S28.","DOI":"10.2337\/dc19-S002"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3021","DOI":"10.1093\/eurheartj\/ehy339","article-title":"2018 ESC\/ESH Guidelines for the management of arterial hypertension","volume":"39","author":"Williams","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (2001). Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA, 285, 2486\u20132497.","DOI":"10.1001\/jama.285.19.2486"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Bedogni, G., Bellentani, S., Miglioli, L., Masutti, F., Passalacqua, M., Castiglione, A., and Tiribelli, C. (2006). The Fatty Liver Index: A simple and accurate predictor of hepatic steatosis in the general population. BMC Gastroenterol., 6.","DOI":"10.1186\/1471-230X-6-33"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Von-Hafe, M., Borges-Canha, M., Vale, C., Leite, A.R., Sergio Neves, J., Carvalho, D., and Leite-Moreira, A. (2022). Nonalcoholic Fatty Liver Disease and Endocrine Axes-A Scoping Review. Metabolites, 12.","DOI":"10.3390\/metabo12040298"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/S0929-8266(01)00153-7","article-title":"Correlation of abdominal fat accumulation and liver steatosis: Importance of ultrasonographic and anthropometric measurements","volume":"14","author":"Sabir","year":"2001","journal-title":"Eur. J. Ultrasound."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.1016\/j.dld.2019.02.019","article-title":"Different predictors of steatosis and fibrosis severity among lean, overweight and obese patients with nonalcoholic fatty liver disease","volume":"51","author":"Shao","year":"2019","journal-title":"Dig. Liver Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1111\/apt.14112","article-title":"Systematic review with meta-analysis: Risk factors for non-alcoholic fatty liver disease suggest a shared altered metabolic and cardiovascular profile between lean and obese patients","volume":"46","author":"Sookoian","year":"2017","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Sheng, G., Xie, Q., Wang, R., Hu, C., Zhong, M., and Zou, Y. (2021). Waist-to-height ratio and non-alcoholic fatty liver disease in adults. BMC Gastroenterol., 21.","DOI":"10.1186\/s12876-021-01824-3"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1007\/s42000-021-00334-x","article-title":"Association of cardiovascular factors in diabetic patients with non-alcoholic fatty liver disease","volume":"21","author":"Cholongitas","year":"2022","journal-title":"Hormones"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"390","DOI":"10.4103\/jfmpc.jfmpc_887_19","article-title":"Association of high-sensitivity C-reactive protein (hs-CRP) with non-alcoholic fatty liver disease (NAFLD) in Asian Indians: A cross-sectional study","volume":"9","author":"Kumar","year":"2020","journal-title":"J. Fam. Med. Prim. Care"},{"key":"ref_26","first-page":"422","article-title":"High-sensitivity C-reactive protein is a strong predictor of non-alcoholic fatty liver disease","volume":"61","author":"Yeniova","year":"2014","journal-title":"Hepatogastroenterology"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Lee, J., Yoon, K., Ryu, S., Chang, Y., and Kim, H.R. (2017). High-normal levels of hs-CRP predict the development of non-alcoholic fatty liver in healthy men. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0172666"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"107609","DOI":"10.1016\/j.intimp.2021.107609","article-title":"Neutrophil: An emerging player in the occurrence and progression of metabolic associated fatty liver disease","volume":"97","author":"Chen","year":"2021","journal-title":"Int. Immunopharmacol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"751802","DOI":"10.3389\/fendo.2021.751802","article-title":"Role of Neutrophils in the Pathogenesis of Nonalcoholic Steatohepatitis","volume":"12","author":"Hwang","year":"2021","journal-title":"Front. Endocrinol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e24225","DOI":"10.1002\/jcla.24225","article-title":"The association between non-alcoholic fatty liver disease and serum ferritin levels in American adults","volume":"36","author":"Yang","year":"2022","journal-title":"J. Clin. Lab. Anal."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1007\/s10620-009-0771-y","article-title":"Serum ferritin is a clinical biomarker in Japanese patients with nonalcoholic steatohepatitis (NASH) independent of HFE gene mutation","volume":"55","author":"Yoneda","year":"2010","journal-title":"Dig. Dis. Sci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1186\/s12944-017-0613-4","article-title":"Association of serum ferritin with non-alcoholic fatty liver disease: A meta-analysis","volume":"16","author":"Du","year":"2017","journal-title":"Lipids Health Dis."}],"container-title":["Biomedicines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9059\/10\/10\/2416\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:40:22Z","timestamp":1760143222000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9059\/10\/10\/2416"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,27]]},"references-count":32,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["biomedicines10102416"],"URL":"https:\/\/doi.org\/10.3390\/biomedicines10102416","relation":{},"ISSN":["2227-9059"],"issn-type":[{"value":"2227-9059","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,27]]}}}