Medical history and diagnosis

Prior history of CVD, HTN, and diabetes mellitus (DM) was obtained by questionnaires. HTN was defined by systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg, or being on medication for HTN. DM was diagnosed according to criteria of the American Diabetes Association as either fasting glucose ≥126 mg/dL, HbA1C ≥6.5 %, or use of an oral hypoglycemic agent. Abdominal ultrasonography (Logic Q700 MR, GE Healthcare, Tokyo, Japan) with a 3.5-MHz probe was performed for all participants by experienced clinical radiologists, and FL was diagnosed on the basis of standard criteria including hepatorenal echo contrast, liver brightness and vascular blurring. Fatty infiltration was classified as an increase in echogenicity of the liver compared with that of the renal cortex where the diaphragm and intrahepatic vessels appeared healthy [9]. All computed tomography scans (CT scan) were obtained with a Light speed VCT XTe-64 slice MDCT scanner (GE Healthcare) with the same standard scanning protocol using 40*2.5-mm section collimation, 400 ms rotation time, 120 kV tube voltage, and 124 mAS (310 mA*0.4 s) tube current under ECG-gated dose modulation. The quantitative CAC scores were calculated according to the method described by Agatston et al. [10]. MS was defined by the 2009 joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention criteria, with waist circumference thresholds of ≥90 cm for men and ≥80 cm for women that are specific for Asian populations [11]. Same criteria for waist circumference were used for definition of abdominal obesity.