Korean J Fam Pract. 2017; 7(3): 424-430  https://doi.org/10.21215/kjfp.2017.7.3.424
Association of the Serum Homocysteine Levels and Nonalcoholic Fatty Liver Disease
Ji-Hyun Kim1, Chang-Ho Youn1,*, Hae-Jin Ko1, A-Sol Kim1, Hyo-Min Kim2, Hyun-Sook Kim1, Min-Sun Kim1
1Department of Family Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine; 2Department of Family Medicine, Kyungpook National University Medical Center, Daegu, Korea
Chang-Ho Youn
Tel: +82-53-200-5791, Fax: +82-53-200-5480
E-mail: ychfm@knu.ac.kr
Received: May 19, 2016; Revised: July 28, 2016; Accepted: September 17, 2016; Published online: June 20, 2017.
© The Korean Academy of Family Medicine. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Studies of serum homocysteine levels in patients with non-alcoholic fatty liver disease (NAFLD) have resulted in inconsistent results. Our aim was to determine the association of serum homocysteine levels with NAFLD.
Methods: The study subjects include 4,134 healthy women who visited Kyungpook National University Hospital for health check-ups from January 2013 to February 2014. Patients whose daily alcohol consumption was >20 g or who had liver disease from a different cause were excluded. NAFLD was defined as the presence of a bright liver on ultrasound imaging not caused by other liver disease. Participants were divided into four quartiles (Q1, Q2, Q3, and Q4) according to their serum homocysteine levels (≤6.2 μmol/L, 6.3–7.5 μmol/L, 7.6–9.1 μmol/L, and ≥9.2 μmol/L), and the incidence of NAFLD was assessed.
Results: Elevated serum homocysteine levels were associated with an increased incidence of NAFLD (P<0.001, P for trend <0.001). The odds ratio (OR) of NAFLD was 1.246 (95% confidence interval [CI]=1.035–1.502, P=0.020) among the Q3 participants and 1.590 (95% CI=1.325–1.908, P<0.001) among the Q4 participants, compared to that among Q1 participants. After adjusting for various covariates, the odds ratios of Q3 and Q4, compared to that of Q1, were significant (OR=1.314, 95% CI=1.077–1.605, P=0.007 in Q3; OR=1.478, 95% CI=1.214–1.798, P<0.001 in Q4).
Conclusion: Serum homocysteine level had a statistically significant positive correlation with the incidence of NAFLD. NAFLD is highly affected by obesity and further studies to investigate serum homocysteine as a marker of NAFLD among non-obese patients are needed.
Keywords: Female; Non-Alcoholic Fatty Liver Disease; Homocysteine; Obesity
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