Cryptogenic cirrhosis: metabolic liver disease due to insulin resistance.
OBJECTIVE
Etiopathogenesis of cryptogenic cirrhosis (CC) is not yet well established. Up to 20% of non-alcoholic fatty liver disease (NAFLD) may progress to cirrhosis, mostly termed as cryptogenic. Insulin resistance and altered metabolic parameters form a major pathogenic link between NAFLD and CC. CC may thus be actually a metabolic liver disease.


METHODS
Thirty-four patients of CC and 32 patients having cirrhosis due to chronic hepatitis B (Hep B) were assessed in a cross-sectional study in a tertiary hospital for insulin resistance, % β-cell activity, obesity indices, plasma glucose, lipid profiles, and many other parameters.


RESULTS
CC patients had higher homeostasis model assessment (HOMA)-IR compared to Hep B group (P = 0.000016). A positive correlation between IR values and Child-Pugh score among CC patients was found ("r" = 0.87; P < 0.00001). Out of 34 CC patients, 15 (44.1%) had obesity contrary to 6 (18.8%) in the control group (P = 0.0022). Differences were observed in subcutaneous fat (P = 0.0022), intra-abdominal fat (P = 0.0055), waist circumference (P = 0.014), and percentage body fat (P = 0.047) between the two groups. Significant differences were observed in the levels of triglyceride, total cholesterol, and very low density lipoprotein (VLDL).


CONCLUSIONS
Most of the CC patients showed significantly higher prevalence of HOMA-IR, obesity indices, and various parameters of "lipotoxicity" and metabolic syndrome, suggesting that CC may be the long-term consequence of a type of "metabolic liver disease." Further studies are required to evaluate the role of therapeutic interventions to enhance insulin sensitivity in such patients.
Department of Medicine, Medical College, Kolkata, India. binaykde@hotmail.com
Binay K
BK
De
Siddhartha
S
Mani
Sanjay K
SK
Mandal
Soumya S
SS
Mondal
Raja
R
Bhattacharya
Apurba B
AB
Pramanik
Debjoy
D
Sau
Kaushik
K
Bhattacharjee
Swarnali
S
Joardar
D001837:Body Weights and Measures / Q000379:methods / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications; D006706:Homeostasis; D006801:Humans; D007328:Insulin / Q000378:metabolism*; D007333:Insulin Resistance; D050356:Lipid Metabolism; D008099:Liver / Q000378:metabolism / Q000473:pathology; D008103:Liver Cirrhosis / Q000151:congenital* / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000378:metabolism / Q000503:physiopathology; D008875:Middle Aged; D012307:Risk Factors; D013223:Statistics as Topic; D013995:Time
D007328:Insulin