title: Nonalcoholic fatty liver disease (NAFLD) without insulin resistance: Is it different?
abstract: OBJECTIVE
  Nonalcoholic fatty liver disease (NAFLD) is considered the hepatic manifestation of insulin resistance [IR]. However, a significant proportion of NAFLD patients are devoid of IR. Is NAFLD sans IR a different entity? The aim of the study was to compare the anthropometric, metabolic, biochemical, ultrasonography, and histological profile of NAFLD patients with and without IR.
  
  
  METHODS
  Retrospective analyses of 336 NAFLD patients diagnosed during the last two years was done. Patients without IR were compared with those with IR.
  
  
  RESULTS
  Out of 336 patients, 153 [45.53%] were without IR. Although age, gender, BMI and transaminase levels were comparable, significantly higher proportion of patients in non-IR group were non-obese [43.14% vs. 25/14%; P=0.0005], and had mild fatty change on ultrasonography; [78.43% vs. 67.21%; P=0.022]. Higher proportion of them had elevated transaminases; [67.97% vs. 56.83%; P=0.036]. Serum triglyceride [178.52±78.78 vs. 204.86±94.72 mg/dl; P=0.02], FBG [85.39±13.80 vs. 98.93±31.56 mg/dl; P=0.00], PGBG [123.76±36.77 vs. 148.07±64.67m g/dl; P=0.00], and serum insulin [6.33±2.18 vs. 15.39±12.56 μIU/ml; P=0.00] were significantly lower in patients without IR. Although there was no difference in histology, interestingly fibrosis was seen in one third of patients despite absence of IR.
  
  
  CONCLUSIONS
  Nearly half of our NAFLD population was without IR; one third of them had significant fibrosis. NAFLD is probably a heterogeneous disease and IR is not the sole factor responsible for NAFLD; further studies are needed to find out other possible etiological factors.
authors.affiliation: Department of Gastroenterology, S.C.B. Medical College, 753007 Cuttack, India. Electronic address: scb_gastro_dept@hotmail.com.
authors.forename: Shivaram Prasad
authors.initials: SP
authors.lastname: Singh
authors.affiliation: Department of Gastroenterology, S.C.B. Medical College, 753007 Cuttack, India.
authors.forename: Bijay
authors.initials: B
authors.lastname: Misra
authors.affiliation: Department of Gastroenterology, S.C.B. Medical College, 753007 Cuttack, India.
authors.forename: Sanjib Kumar
authors.initials: SK
authors.lastname: Kar
authors.affiliation: Department of Gastroenterology, S.C.B. Medical College, 753007 Cuttack, India.
authors.forename: Manas Kumar
authors.initials: MK
authors.lastname: Panigrahi
authors.affiliation: Department of Gastroenterology, S.C.B. Medical College, 753007 Cuttack, India.
authors.forename: Debasis
authors.initials: D
authors.lastname: Misra
authors.affiliation: Department of Pathology, S.C.B. Medical College, 753007 Cuttack, India.
authors.forename: Pallavi
authors.initials: P
authors.lastname: Bhuyan
authors.affiliation: Department of Pathology, S.C.B. Medical College, 753007 Cuttack, India.
authors.forename: Kaumudee
authors.initials: K
authors.lastname: Pattnaik
authors.affiliation: Department of Radiology, Beam Diagnostics Centre, Bajrakabati Road, 753001 Cuttack, India.
authors.forename: Chudamani
authors.initials: C
authors.lastname: Meher
authors.affiliation: Department of Radiology, Beam Diagnostics Centre, Bajrakabati Road, 753001 Cuttack, India.
authors.forename: Omprakash
authors.initials: O
authors.lastname: Agrawal
authors.affiliation: Department of Oncopathology, A.H. Regional Cancer Center, 753001 Cuttack, India.
authors.forename: Niranjan
authors.initials: N
authors.lastname: Rout
authors.affiliation: Department of Biochemistry, S.C.B. Medical College, 753007 Cuttack, India.
authors.forename: Manorama
authors.initials: M
authors.lastname: Swain
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis; D002769:Cholelithiasis / Q000000981:diagnostic imaging; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006529:Hepatomegaly / Q000000981:diagnostic imaging; D006801:Humans; D007194:India / Q000453:epidemiology; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000097:blood* / Q000000981:diagnostic imaging / Q000453:epidemiology*; D009765:Obesity / Q000453:epidemiology; D012189:Retrospective Studies; D000637:Transaminases / Q000097:blood; D014280:Triglycerides / Q000097:blood; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007328:Insulin; D014280:Triglycerides; D000637:Transaminases