Background & Aims: The aim of this study was to investigate the relationship between regional fat distribution, especially leg fat to total fat ratio (LF/TF ratio), and the presence of non-alcoholic fatty liver disease (NAFLD) using nationally representative data in Korea.


This was a cross-sectional study performed in 14,502 subjects using the Korea National Health and Nutrition Examination Survey 2008-2011. Total fat mass, leg fat mass, and appendicular skeletal muscle mass were measured by dual-energy X-ray absorptiometry. Validated NAFLD prediction models such as the comprehensive NAFLD score, NAFLD liver fat score, and hepatic steatosis index were used. The degree of liver fibrosis was assessed by NAFLD fibrosis score, Fibrosis-4, and Forns index


The LF/TF ratio showed a negative relationship with several metabolic factors, including body mass index, waist circumference, systolic/diastolic blood pressure, fasting blood glucose, atherogenic lipid profiles, and liver enzyme levels. When the LF/TF ratio and indices of hepatic steatosis were stratified by quartiles, the LF/TF ratio showed a negative correlation with scores predicting NAFLD. The LF/TF ratio showed better accuracy in predicting NAFLD than total fat mass or leg fat mass alone. After adjusting for various traditional and lifestyle factors, the LF/TF ratio remained a risk factor for NAFLD. Furthermore, among NAFLD subjects, the LF/TF ratio showed a negative relationship with hepatic fibrosis.


A lower LF/TF ratio is independently associated with a higher risk of hepatic steatosis and advanced hepatic fibrosis and might be a useful anthropometric parameter to predict NAFLD or hepatic fibrosis.