C-reactive protein mediates the association of liver fat and carotid intima–media thickness in healthy men and men with the metabolic syndrome and/or uncomplicated type 2 diabetes

We investigated whether the relation between liver fat and subclinical atherosclerosis is mediated by low-grade systemic inflammation in type 2 diabetes (T2DM) and the metabolic syndrome (MetS).In 16 T2DM, 36 MetS, and 21 age-matched healthy men, liver fat was quantified by 1H-MRS. Carotid intima–media thickness (cIMT) was measured by ultrasound. Differences between controls, MetS and T2DM or between high versus low liver fat content were calculated. Furthermore, the association of liver fat content, cIMT and CRP was assessed.Liver fat percentage was highest in T2DM, as compared to MetS and controls [17.5% (8.0–27.6), 8.2% (4.2–14.2) and 5.3% (2.3–7.4), respectively; P < 0.001]. Subjects with high-liver fat content had increased cIMT and CRP (all P < 0.02). Liver fat content was positively associated with cIMT (r = 0.37; P = 0.003). The association of liver fat content and cIMT disappeared after adjustment for CRP.The association between liver fat content and subclinical atherosclerosis seems mediated by low-grade inflammation, possibly due to increased hepatic production. Lowering of liver fat content may decrease CVD risk by concomitantly reducing the pro-inflammatory state in high-risk populations.