Nonalcoholic steatohepatitis associated with metabolic syndrome: relationship to insulin resistance and liver histology.
BACKGROUND
Nonalcoholic steatohepatitis (NASH) is a hepatic manifestation of metabolic syndrome. We aimed to assess the relationship of metabolic syndrome-associated NASH and insulin resistance (IR), and to define the correlation of chemicometabolic components with different degree of liver histology in NASH subjects.


METHODS
Ninety-four subjects with NASH (mean age, 38±14 y; 77% male) were enrolled. IR was calculated using a homeostasis model assessment of insulin resistance (HOMA-IR). Clinical characteristics including IR and accompanying metabolic risk components in NASH subjects were compared with those of 52 diabetics and 21 healthy controls. The relationship between IR and chemicometabolic variables was analyzed according to different clustering of metabolic risk components and the histologic activity.


RESULTS
NASH subjects had a stronger association with metabolic syndrome than healthy controls. HOMA-IR was significantly higher in NASH subjects than in healthy controls (4.4±2.5 vs. 1.7±0.6; P<0.001) but not than in diabetics. NASH subjects with metabolic syndrome were more likely to have higher HOMA-IR compared with that of NASH subjects without metabolic syndrome (5.0±2.9 vs. 3.6±1.7; P=0.032). HOMA-IR showed a positive correlation with body mass index (r=0.428, P=0.015) and serum fasting blood sugar (r=0.365, P=0.037). Serum aspartate aminotransferase/alanine aminotransferase ratio (P=0.029) and high-density lipoprotein cholesterol level (P=0.034) were significantly affected according to the degree of fibrotic activity in 41 histology-proven NASH subjects.


CONCLUSIONS
NASH subjects showed increased IR with a significant association of metabolic syndrome. The severity of hepatic fibrosis revealed a strong correlation with serum aspartate aminotransferase/alanine aminotransferase ratio and high-density lipoprotein cholesterol level.
Division of Hepatology, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, South Korea.
Kyong Yeun
KY
Jung
Sun Young
SY
Cho
Hyung Joon
HJ
Kim
Suk Bae
SB
Kim
Il Han
IH
Song
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D001786:Blood Glucose / Q000032:analysis; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008099:Liver / Q000201:enzymology / Q000473:pathology*; D008103:Liver Cirrhosis / Q000097:blood / Q000209:etiology* / Q000473:pathology; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000150:complications* / Q000473:pathology; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000097:blood / Q000209:etiology* / Q000473:pathology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult
D015415:Biomarkers; D001786:Blood Glucose; D007328:Insulin; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase