Visceral fat and insulin resistance as predictors of non-alcoholic steatohepatitis.
OBJECTIVE
To examine whether visceral fat is associated with non-alcoholic steatohepatitis (NASH), to assess for parameters associated with visceral adiposity and to investigate for factors associated with fibrotic severity in NASH.


METHODS
Thirty NASH and 30 control subjects underwent biochemical tests, anthropometric assessment, bioelectrical impedance, dual energy X-ray absorptiometry and abdominal fat study by CT scan. Liver biopsies were graded according to the Brunt criteria.


RESULTS
NASH subjects had elevated blood pressure, body mass index, waist circumference and waist-to-hip ratio. A greater number of diabetes mellitus, impaired glucose tolerance test and HOMA-IR > 3.5 were found in NASH patients. HOMA-IR > 2.8 (OR 20.98, 95% CI 3.22-136.62; P < 0.001) and visceral fat area > 158 cm(2) (OR 18.55, 95% CI 1.60-214.67; P = 0.019) were independent predictors for NASH. Advanced stage of NASH was found in 15 (50%) patients. HOMA-IR > 3.5 (OR 23.12, 95% CI 2.00-266.23; P = 0.012) and grading of portal inflammation (OR 7.15, 95% CI 1.63-31.20; P = 0.009) were determined as independent risk factors for advanced stage of NASH.


CONCLUSIONS
Obesity (especially central obesity) and metabolic syndrome are common in Thai NASH. Insulin resistance and elevated visceral fat are risk factors for the presence of NASH. The advanced stage of the disease is related to insulin resistance.
Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. teasb@mahidol.ac.th
Abhasnee
A
Sobhonslidsuk
Sutipong
S
Jongjirasiri
Ammarin
A
Thakkinstian
Naruemon
N
Wisedopas
Pongamorn
P
Bunnag
Gobchai
G
Puavilai
D001824:Body Constitution; D018450:Disease Progression; D005234:Fatty Liver / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D050152:Intra-Abdominal Fat / Q000473:pathology*; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D012307:Risk Factors