an increase in fat accumulation in the liver and hepatic insulin resistance is independent of obesity and body fat distribution . this increase in liver fat associated with insulin resistance is called nonalcoholic fatty liver disease ( nafld ) . nafld is defined as excess fat in the liver ( 5 - 10% fat histologically ) which is not brought about by excess alcohol use ( over 20 g / day ) , effects of other toxins , autoimmune , viral , or other causes of steatosis . nafld is common in the obese and is associated with hyperinsulinemia , dyslipidemia , and hypertension . together , these abnormalities comprise insulin resistance syndrome ( metabolic syndrome ) and predicts the development of type 2 diabetes . however , biopsies are invasive , induce pain , and require 6 h or more of bed rest . as a substitute for biopsy ; imaging techniques including ultrasonography ( us ) , computed tomography ( ct ) , and magnetic resonance ( mr ) are now widely used . of these ct attenuation values of the liver were strongly correlated with histological evidence of hepatic steatosis . hepatic attenuation was a reliable indicator of fatty liver if it was considerably lower than splenic attenuation . therefore , ct can be used as a noninvasive test to confirm the presence of hepatic steatosis . to determine correlation between liver fat content with dyslipidemia and insulin resistance a total of 33 subjects were selected between february 2013 till june 2013 from obesity clinic who visited with self - perception of obesity . information including age , sex , height , body weight ( wt ) , body mass index ( bmi ) , waist - hip ratio ( whr ) , history of alcohol intake , systolic and diastolic blood pressure , triglyceride level ( tg ) , high density lipoprotein ( hdl ) , low density lipoprotein ( ldl ) , fasting plasma sugar , fasting plasma insulin , and 2 h oral glucose tolerance test ( ogtt ) was collected for each patient . any patient with a history of significant alcohol consumption , bile duct dilatation , hepatic mass , hepatitis , liver cirrhosis , or history of hepatic surgery was excluded . the attenuation of the liver and the spleen were measured using ct scans taken without intravenous contrast agent administration ( ge brightspeed elite select 16 slice ) . the examination was done with a tube voltage of 120 kvp and a tube current of 50 ma . five regions of interests ( rois ) were identified in the liver , avoiding vessels , bile ducts , calcifications , and artifacts ; four rois were identified in the spleen in the same manner . the highest and lowest values were excluded when calculating the mean attenuation values of the liver and spleen . as such , three liver values and two spleen values were used to calculate the mean values . liver and spleen attenuation measurements were taken with three rois from the liver and two rois from the spleen . hepatic attenuation indices ( hais ) were measured as follows : ( 1 ) hepatic parenchymal attenuation ( ctlp ) ; ( 2 ) liver to spleen attenuation ratio ( lsratio ) ; and ( 3 ) difference between hepatic and splenic attenuation ( lsdif ) . statistical analysis was performed with statistical packages for social sciences ( spss ) statistical software ( version 17.0 for windows ) . we used a bivariate correlation method to assess the relationship between the three hais and bmi , whr , tg , ldl , hdl , fasting plasma sugar , homeostasis model of assessment - insulin resistance ( homa ir ) , and 2 h ogtt . the mean  standard deviation ( sd ) of ctlp , lsratio , and the lsdif value were 53.979  14.452 ( ranging 22.5 - 74.6 ) , 0.998  0.265 ( ranging 0.527 - 1.549 ) , and  0.558  13.742 ( ranging  28.6 to 24.3 ) , respectively . the mean values  sd of bmi , whr , tg , ldl , hdl , fasting plasma sugar , fasting plasma insulin , homa ir , and 2 hour ogtt were 27.697  4.391 ( ranging 22.290 - 37.756 ) , 1.06  0.11 ( ranging 0.88 - 1.24 ) , 173.73  52.257 ( ranging 58 - 342 ) , 158.024  42.125 ( ranging 66.0 - 242.0 ) , 47.13  8.152 ( ranging 32 - 65 ) , 92.906  19.874 ( ranging 69.8 - 152.6 ) , 102.34  46.75 ( ranging 28.80 - 186.30 ) , 3.79  2.23 ( ranging 0.9 - 8.2 ) , and 141.673  34.723 ( ranging 96.4 - 246.8 ) , respectively . as shown in [ table 1 ] there was statistically significant negative correlation between ctlp , lsratio , and lsdif with other features of metabolic syndrome correlation between hepatic attenuation indices and other features of metabolic syndrome a hepatic attenuation value ( ctlp ) that is significantly lower than the splenic attenuation value is a reliable indicator for the presence of fatty liver . ctlp and ls ratio both demonstrate strong inverse correlations with degree of histologic steatosis . in our study , we have observed that lsratio and lsdif were more correlated to various features of metabolic syndrome than ctlp . as obesity is associated with fatty infiltration of liver , so patients with nafld need to be aware that nafld is associated with increased risk of developing type 2 dm and is associated with poor glycemic control , dyslipidemia , and increased risk of cvd .
total 33 obese patients were studied to determine correlation in between liver fat content with dyslipidemia and insulin resistance . 
 liver and spleen attenuation measurements were taken with three regions of interests ( rois ) from the liver and two rois from the spleen . 
 hepatic attenuation indices were measured as follows : ( 1 ) hepatic parenchymal attenuation ( ctlp ) ; ( 2 ) liver to spleen attenuation ratio ( lsratio ) ; and ( 3 ) difference between hepatic and splenic attenuation ( lsdif ) . 
 bivariate correlation analysis showed moderate but statistically significant negative correlation between ctlp , lsratio , and lsdif with body mass index , triglyceride , fasting plasma sugar , fasting plasma insulin , homeostasis model assessment - insulin resistance ( homa ir ) , 2 h oral glucose tolerance test ( ogtt ) , and statistically significant positive correlation with high density lipoprotein . 
 nonalcoholic fatty liver disease ( nafld ) is closely associated with features of the metabolic syndrome . 
 the amount of intrahepatic fat closely correlates with the number of metabolic syndrome features . 
 the values of ctlp , lsratio , and lsdif demonstrate strong inverse correlations with degree of steatosis .