Contribution of body fat distribution instead of generalized obesity to development in nonalcoholic fatty liver disease (NAFLD) has gained much interest. It is well known that visceral adipose tissue plays an important role in developing NAFLD, whereas studies regarding the role of subcutaneous adipose tissue and the ratio of visceral fat to subcutaneous fat are few and inconsistent. The aim of this study was to investigate the association between visceral fat thickness (VFT), subcutaneous fat thickness (SFT), and visceral-to-subcutaneous fat thickness ratio (VSR) and presence of NAFLD in patients with type 2 diabetes (T2DM).


This cross-sectional study was performed with data obtained from 480 T2DM patients (mean age of 56 years, mean DM duration of 8.1 years) admitted to a University hospital of Korea. NAFLD was defined as fatty liver by ultrasonography (US) and VFT and SFT were measured by US.


Prevalence of NAFLD was significantly increased across tertile of VFT, SFT, and VSR (P<0.001, P=0.003, and P=0.016, respectively). Increasing VFT tertiles predicted NAFLD even after adjustment of covariates including body mass index and insulin resistance comparing with the first tertile (Odds ratio, 95% CI, 3.59 [1.46 to 8.87] for second tertile and 6.43 [1.85 to 22.4] for third tertile). SFT tertiles were not significantly associated with presence of NAFLD after multivariable adjustment (2.16 [0.88 to 5.31] for second tertile and 1.19 [0.36-4.0] for third tertile, P=0.14). Multivariable-adjusted odds ratios for NAFLD, determined by comparing the second and third tertiles with the first tertile of VSR were 1.12 (0.28-4.45) and 0.42 (0.16-1.11), respectively.


Only VFT appeared to significantly predict the presence of NAFLD in Korean patients with T2DM. Future large prospective studies are required to confirm the role of the VFT, SFT, and VSR as various body fat distribution markers for NAFLD in diverse population.