Ectopic fat accumulation in the liver causes liver damage including fibrosis and cirrhosis, which may ultimately lead to liver failure. In this cross-sectional analysis, we seek to identify sex-specific predictors of elevated liver fat in apparently healthy adults participating in the Fels Longitudinal Study.


The sample consists of 339 non-Hispanic white adult participants (153 males, 186 females) ranging in age from 18 to 90 years (mean 46.5 years). Participants who were assessed between 2010 and 2015 for liver fat content by MRI and had available anthropometric, body composition and cardiometabolic risk factor data were included. Participants who were diabetic and/or reported above moderate consumption of alcohol were excluded. We used sex-stratified forward stepwise logistic regression to construct best-fit models predicting elevated liver fat (defined as liver fat content > 5.56%).


Trunk depth (p<0.001), triglycerides (p<0.001), and aspartate aminotransferase to alanine aminotransferase ratio (AST:ALT) (p<0.05) were positively associated with elevated liver fat in males (model R2 = 0.43). In females, positive significant predictors included: abdominal visceral adipose tissue (p<0.01), triglycerides (p<0.01), HOMA insulin resistance index score (p<0.01), and AST (p<0.05) (model R2 = 0.43).


We found that different sets of variables predict elevated liver fat content in men and women. These variables include measures of central adiposity, indicators of insulin resistance and liver enzyme levels.