Nutrient intake in Italian obese patients: relationships with insulin resistance and markers of non-alcoholic fatty liver disease.
OBJECTIVE
We investigated the prevalence of insulin resistance, elevated liver enzymes, and Non-Alcoholic Fatty Liver Disease Fibrosis Score (NFS) in obese and severely obese patients. Relations between inadequate nutrient intakes and the markers of metabolic and hepatic disorders were evaluated.


METHODS
From January to September 2009, 63 consecutive obese patients (21 men and 42 women, 19-68 y old) were admitted to the study. According to the World Health Organization obesity classification, patients were categorized into three subgroups (classes I, II, and III). NFS scores lower than -1.455 were defined as NFS(-); higher scores were positive (NFS(+)). Insulin resistance (IR) was assessed by the homeostasis model assessment. Nutrient intakes and their potential role as risk factors for IR and liver damage were determined.


RESULTS
Body mass index ranged from 30.9 to 73.7 kg/m(2) and most patients (54%) were in class III (body mass index ≥40 kg/m(2)). Homeostasis model assessment of IR (>2.5) was recorded in 63.5%. The prevalence of NFS(+) was significantly higher in class III than in classes II and I. Excessive nutrient and energy intake prevalence showed significant differences for protein, fat, and carbohydrate among the obesity classes. Animal protein (odds ratio 3.43, 95% confidence interval 1.15-10.20) and carbohydrate (odds ratio 3.83, 95% confidence interval 1.33-10.94) intakes were the risk factors for IR and NFS(+).


CONCLUSIONS
Non-normal alanine aminotransferase and γ-glutamyltranspeptidase values were observed in less than one-third of patients, whereas NFS(+) and IR were significantly prevalent, suggesting a close relation between the progression of liver fibrosis and metabolic derangement. An excessive intake of animal protein is associated with an increased risk of IR. Carbohydrate intake, albeit at the highest limit of the recommended dietary allowance range, is associated with an increased risk of liver fibrosis.
Postgraduate School of Gastroenterology, Department of Clinical and Experimental Medicine, University of Ferrara, Ferrara, Italy. giorgio.ricci@unife.it
Giorgio
G
Ricci
Edgardo
E
Canducci
Veronica
V
Pasini
Angelo
A
Rossi
Gianluca
G
Bersani
Enrico
E
Ricci
Vittorio
V
Alvisi
D000328:Adult; D000368:Aged; D050110:Bariatric Surgery; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D004032:Diet; D004040:Dietary Carbohydrates / Q000008:administration & dosage / Q000009:adverse effects; D004044:Dietary Proteins / Q000008:administration & dosage / Q000009:adverse effects; D005234:Fatty Liver / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007333:Insulin Resistance; D007558:Italy / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008460:Meat / Q000009:adverse effects; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000503:physiopathology* / Q000601:surgery; D009767:Obesity, Morbid / Q000097:blood / Q000503:physiopathology; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult
D015415:Biomarkers; D004040:Dietary Carbohydrates; D004044:Dietary Proteins