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Studies have pointed to insulin resistance as pathogenic factor in fatty liver; the role of beta-cell function, even if generally accepted, is unexplored. This study was undertaken to test whether fasting indexes of beta-cell function were related to the intra-hepatic fat (IHF) content in non-diabetic humans. IHF content was measured by means of ¹H-Magnetic Resonance Spectroscopy (MRS), and insulin sensitivity and beta-cell function were estimated based on fasting plasma glucose, insulin and C-peptide in 31 patients with fatty liver and 62 individuals with matched anthropometric features (age: 36±8 vs. 36±7 years, BMI: 27.4±3.8 vs. 26.7±3.2 kg/m²). Patients with fatty liver had higher fasting glucose (P<0.05), insulin (P<0.01), c-peptide (P<0.005) and insulin resistance (HOMA2-%S: 56±24% vs. 77±38%; P=0.008). Fasting insulin secretion (383±168 vs. 284±107 pmol/L; P=0.007) and the beta-cell insulin sensitivity (HOMA2-%B: 171 ± 41% vs. 152±43%; P=0.04) were also increased in patients with fatty liver. A subgroup analysis, performed matching also for HOMA2-%S (including only those <70%; n=25 and n=30 in subjects with and without fatty liver: 47±12% vs. 49±12; P=0.56), confirmed increased insulin secretion (408±178 vs. 266±107 pmol/L; P=0.002) and HOMA2-%B (174±62% ys. 136±56%; P=0.02) in the individuals with fatty liver. In univariate analysis including the entire population fasting insulin explained 14% of the IHF content variability (P<0.000); in multivariate analysis the inclusion of fasting C-peptide increased it more than two-fold (to 32%; P<0.000); inclusion of age, sex, BMI and glucose in this model was not useful. Logistic regression showed that the insulin*C-peptide product was associated with the likelihood of having fatty liver (P<0.001). In conclusion, nondiabetic individuals with fatty liver are characterized not only by reduced insulin sensitivity but also by features of enhanced fasting beta-cell function, which is an independent meaningful factor. [ABSTRACT FROM AUTHOR]