1% were diagnosed with NASH-induced www.selleckchem.com/products/VX-809.html cirrhosis (Fig. 5). According to that survey, the proportion of NASH cirrhosis is 1.4% in males and 3.4% in females, and there is a significant gender difference (P < 0.005). In that study, obese subjects were few and, at that time, the concept of NASH was not yet commonly accepted by many Japanese doctors. Furthermore, many cases of advanced stage NASH show no fatty deposit, so-called

“burn-out NASH”, resulting in the diagnosis of cryptogenic liver cirrhosis. Therefore, the actual incidence of NASH-related cirrhosis might be higher than was reported. Patients with metabolic syndrome are increasing in number in Japan (Figs. 4,6). Visceral fat accumulation and insulin resistance learn more are usual in these patients. The enhanced insulin resistance caused by the excessive accumulation of body fat (especially visceral fat) is considered to be important in the pathogenesis of fatty liver. The diagnostic criteria for metabolic syndrome established by the Japanese Society of Internal Medicine are as follows:6 an umbilical abdominal circumference (men: 85 cm or more; women: 90 cm or more) which reflects

visceral fat accumulation (a visceral fat area of 100 cm2 or more), and any two of the following four criteria: (i) elevated serum triglyceride level; (ii) reduced HDL cholesterol; (iii) elevated blood pressure; and (iv) elevated fasting plasma glucose. According to the National Health and Nutrition Examination Survey conducted in Japan in 2008, the prevalence of patients afflicted by metabolic syndrome was

25.3% among men and 10.6% among women, whereas patients with pre-metabolic syndrome (patients with an abdominal circumference of ≥85 cm in men and 90 cm in women, and who fulfill one other criterion) accounted for 21.9% of the men and 8.3% of the women. Therefore, approximately half of Japanese men and about 20% of Japanese women might have metabolic syndrome or be predisposed to metabolic syndrome.7 The criteria for metabolic syndrome are useful for the screening of NAFLD. The previous report by Ishibashi et al. stated that abdominal circumference was well 上海皓元 correlated with NAFLD in men, but not in women.8 Waist circumference has been reported to be smaller in men than women and there has been considerable debate regarding whether this criterion is appropriate or not.9 There is the possibility that the amount of visceral fat might be underestimated and that the estimate may detect fewer than the actual number of women with NAFLD. In women, caution is required when the abdominal circumference is used instead of the visceral fat area. Epidemiologically, it is clear that the risk of cardiovascular diseases is increased markedly in people with multiple risk factors for life-style related diseases. In addition, Hamaguchi et al.