Insulin resistance and metabolic syndrome in patients with NAFLD but without diabetes: effect of a 6 month regime intervention.
OBJECTIVE
Non-alcoholic fatty liver disease (NAFLD) and the metabolic syndrome are two intertwined diseases sharing the same factor in their pathogenesis; insulin resistance. The aim of the study was to establish a link between glucose tolerance and NAFLD.


METHODS
Fifty-two non-diabetic NAFLD patients were included in the study. Inclusion criteria were elevated alanine aminotransferase (ALT), hyperechogenic liver detected at ultrasonography, and exclusion of other causes of liver disease. Hepatobiliary ultrasonography and laboratory tests including biochemical and metabolic profiles were performed; HOMA insulin resistance was calculated.


RESULTS
The mean age was 43 years, and 61% were male. More than a two fold increase in alanine aminotransferase levels was seen in 37% of the patients. Serum levels of aspartate aminotransferase, gamma-glutamyl transferase, alkaline phosphatase (ALP) were elevated in 36%, 46%, and 30% of patients respectively. Low HDL-C levels were found in 46% and high LDL-C levels in 25%. Other results of note were elevated lipoprotein-a levels in 40%, impaired fasting glucose in 23%, impaired glucose tolerance in 26%, elevated fasting c-peptide levels in 61%, and elevated fasting serum insulin levels in 11% of patients. In 30% of patients, body mass index was over 30 kg/m2 and 78% had a waist-hip ratio more than 0.9. HOMA insulin resistance was significantly related with elevated ALP levels and hepatomegaly. Following a 6 months treatment with a standard diet, liver enzymes and metabolic parameters both improved. Only 7 patients had persistently high liver enzymes.


CONCLUSIONS
Basal insulin levels and the oral glucose tolerance test should be an integral part of the evaluation of patients with NAFLD. The association between NAFLD and metabolic syndrome as well as the benefits of dieting on preventing progression of NAFLD should be stressed.
Cankurtaran
M
M
Hacettepe University, Medical Faculty, Department of Internal Medicine, Sihhiye, Ankara, 06100, Turkey.
Tayfur
O
O
Yavuz
B B
BB
Geyik
S
S
Akhan
O
O
Arslan
S
S
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000469:Alkaline Phosphatase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D002096:C-Peptide / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D005215:Fasting / Q000097:blood; D005234:Fatty Liver / Q000097:blood* / Q000178:diet therapy; D005260:Female; D005500:Follow-Up Studies; D005951:Glucose Tolerance Test; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology*; D017270:Lipoprotein(a) / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood* / Q000178:diet therapy; D008875:Middle Aged; D011446:Prospective Studies; D049629:Waist-Hip Ratio; D005723:gamma-Glutamyltransferase / Q000097:blood
D001786:Blood Glucose; D002096:C-Peptide; D008076:Cholesterol, HDL; D007328:Insulin; D017270:Lipoprotein(a); D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase