Rationale and Objectives Fatty liver disease is a common clinical entity in hepatology practice. This study evaluates the prevalence and reproducibility of computed tomography (CT) measures for diagnosis of fatty liver and compares commonly used CT criteria for the diagnosis of liver fat. Materials and Methods The study includes 6,814 asymptomatic participants from a population based sample. The ratio of liver-to-spleen (L/S) Hounsfield units (HU) <1.0 and liver attenuation <40HU were utilized for diagnosing and assessing the severity of liver fat content. Participants with heavy alcohol intake (>7 drinks/week for women and >14 drinks/week for men) were excluded. Final analysis was performed on participants where images of both liver and spleen were available on the scans. Results The overall prevalence of fatty liver (4,175 patients) was 17.2% (using L/S ratio <1.0), with 6.3% (with <40HU cutoff) of the population having moderate to severe steatosis (>30% liver fat content). The prevalence was high in participants with dyslipidemia (70.4%), hypertension (56.8%) and obesity (53%). Diabetic patients had 24.1% prevalence of fatty liver. The prevalence provided by L/S ratio <1.0 (17.2%) was comparable to prevalence provided by <51 HU (17.3%), whereas prevalence obtained by <40HU (6.3%) cutoff corresponded to L/S ratio of <0.8 (6.5%). The measurements of liver and spleen HU attenuations were highly reproducible (0.96, 0.99 and 0.99, 0.99 for intra- and inter-reader variability, respectively) in a sample of 100 scans. Conclusion Fatty liver can be reliably diagnosed using non-enhanced CT scans.

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Background Circulating sex hormone levels are associated with glucose metabolism and adiposity, but their association with ectopic fat deposition in the liver is not well understood. Methods We studied the association of the circulating levels of bioavailable testosterone (Bio-T), estradiol (E2), dehydroepiandrosterone (DHEA) and sex hormone binding globulin (SHBG) with fatty liver, defined as attenuation ≤ 40 Hounsfield Units by magnetic resonance imaging in 2835 postmenopausal women and 2899 men in the Multiethnic Study of Atherosclerosis baseline examination. Results In women, there was a significantly greater odds ratio of fatty liver prevalence in the highest tertile versus the lowest tertile of Bio-T (1.73, 95% CI 1.05 – 2.87) and E2 (2.42, 95% CI 1.37 – 4.29) adjusting for age, race/ethnicity, body mass index, hypertension, total and high density lipoprotein cholesterol, smoking, insulin sensitivity and hormone replacement therapy use. In men, there was a significantly greater odds ratio of fatty liver prevalence in the highest tertile versus the lowest tertile of E2 (1.96, 95% CI 1.21 – 3.18), but a significantly lower odds ratio for the highest versus lowest tertiles of SHBG (0.50, 95% CI 0.30 – 0.84). Other associations of hormones with fatty liver were not statistically significant. Conclusions A more androgenic internal mileu is associated with fatty liver in postmenopausal women. In men, lower levels of SHBG are associated with fatty liver. Higher levels of E2 are associated with fatty liver in both sexes. This pattern is consistent with the sex-specific associations of sex hormones with other cardiometabolic risk factors.