title: Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome.
abstract: Nonalcoholic fatty liver disease (NAFLD) has been associated with the insulin-resistance syndrome, at present defined as the metabolic syndrome, whose limits were recently set. We assessed the prevalence of the metabolic syndrome in 304 consecutive NAFLD patients without overt diabetes, on the basis of 3 or more criteria out of 5 defined by the U.S. National Institutes of Health (waist circumference, glucose, high-density lipoprotein [HDL]-cholesterol, triglycerides, and arterial pressure). The prevalence of the metabolic syndrome increased with increasing body mass index, from 18% in normal-weight subjects to 67% in obesity. Insulin resistance (Homeostasis Model Assessment method) was significantly associated with the metabolic syndrome (odds ratio [OR], 2.5; 95% CI, 1.5-4.2; P <.001). Liver biopsy was available in 163 cases (54%). A total of 120 patients (73.6%) were classified as having nonalcoholic steatohepatitis (NASH); 88% of them had a metabolic syndrome (vs. 53% of patients with pure fatty liver; P <.0001). Logistic regression analysis confirmed that the presence of metabolic syndrome carried a high risk of NASH among NAFLD subjects (OR, 3.2; 95% CI, 1.2-8.9; P =.026) after correction for sex, age, and body mass. In particular, the syndrome was associated with a high risk of severe fibrosis (OR, 3.5; 95% CI, 1.1-11.2; P =.032). In conclusion, the presence of multiple metabolic disorders is associated with a potentially progressive, severe liver disease. The increasing prevalence of obesity, coupled with diabetes, dyslipidemia, hypertension, and ultimately the metabolic syndrome puts a very large population at risk of forthcoming liver failure in the next decades.
authors.affiliation: Unit of Metabolic Diseases and Department of Internal Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy. marchreg@med.unibo.it
authors.forename: Giulio
authors.initials: G
authors.lastname: Marchesini
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Bugianesi
authors.forename: Gabriele
authors.initials: G
authors.lastname: Forlani
authors.forename: Fernanda
authors.initials: F
authors.lastname: Cerrelli
authors.forename: Marco
authors.initials: M
authors.lastname: Lenzi
authors.forename: Rita
authors.initials: R
authors.lastname: Manini
authors.forename: Stefania
authors.initials: S
authors.lastname: Natale
authors.forename: Ester
authors.initials: E
authors.lastname: Vanni
authors.forename: Nicola
authors.initials: N
authors.lastname: Villanova
authors.forename: Nazario
authors.initials: N
authors.lastname: Melchionda
authors.forename: Mario
authors.initials: M
authors.lastname: Rizzetto
mesh_terms: D000328:Adult; D018450:Disease Progression; D005234:Fatty Liver / Q000150:complications* / Q000503:physiopathology; D005260:Female; D006505:Hepatitis / Q000209:etiology*; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D015995:Prevalence