Prevalence of non-alcoholic fatty liver disease at obesity and its interrelation with cardio-vascular disease and 2nd type diabetes mellitus risk factors
Abstract
Aim of investigation. To estimate prevalence of non-alcoholic fatty liver disease (NAFLD) in patients with obesity and to determine its interrelation with cardiometabolic risk factors of cardio-vascular diseases (CVD) and diabetes mellitus of the 2nd type (type 2 DM).
Material and methods. Retrospective analysis of case records of 560 obese patients aged 18 to 55 years was carried out. At the investigation past history, anthropometric data, level of blood pressure were analyzed, blood lipid spectrum, activity of ALT, AST, markers of viral hepatites – HbsAg, HCV-at (to rule out viral etiology of liver disease), fasting and at 120-th minute of the standard glucose tolerance test blood glucose and immunoreactive insulin were determined. Insulin resistance was estimated by HOMA-IR score. Metabolic syndrome was verified by IDF (2005) criteria. Liver US was carried out to diagnose NAFLD.
Results. During investigation NAFLD was revealed in 77,7% of patients. At multi-factor analysis of variance interrelation of NAFLD with CVD and type 2 DM risk factors, such as systemic hypertension, dyslipidemia, disorders of carbohydrate metabolism and insulin resistance was confirmed.
Conclusions. Study results determine necessity of more careful investigation of patients with obesity and NAFLD for early diagnostics and treatment of cardiometabolic risk factors of cardio-vascular diseases and type 2 DM.
About the Authors
G. A. MelnichenkoRussian Federation
A. Yu. Yeliseyeva
Russian Federation
M. V. Mayevskaya
Russian Federation
References
1. Богомолов П.О., Шульпекова Ю.О. Неалкогольная жировая болезнь печени: стеатоз и неалкогольный стеатогепатит // Клин. перспективы гастроэнтерол. гепатол. – 2004. – № 3. – С. 20–26.
2. Буеверов А.О., Маевская М.В., Широкова Е.Н. Неалкогольный стеатогепатит / Под ред. В.Т. Ивашкина. – М., 2005. – С. 16.
3. Бутрова С.А. Метаболический синдром: патогенез, клиника, диагностика, подходы к лечению // Рус. мед. журн. – 2001. – № 9. – С. 56–60.
4. Ивашкин В.Т., Маевская М.В. Липотоксичность и метаболические нарушения при ожирении // Рос. журн. гастроэнтерол. гепатол. колопроктол. – 2010. – Т. 20, № 1. – С. 4–13.
5. Корнеева О.Н. Клинические варианты метаболического синдрома: Дис. ... канд. мед. наук. – М., 2007. – 103 с.
6. Корнеева О.Н., Драпкина О.М., Буеверов А.О., Ивашкин В.Т. Неалкогольная жировая болезнь печени как проявление метаболического синдрома // Клин. перспективы гастроэнтерол. гепатол. – 2005. – № 4. – С. 24–27.
7. Митьков В.В., Сандриков В.А. Клиническое руководство по ультразвуковой диагностике. – 2007. – Т. 5. – 360 с.
8. Никитин И.Г. Скрининговая программа по выявлению распространенности неалкогольной жировой болезни печени и определению факторов риска развития заболевания // Рос. мед. вести. – 2010. – Т. 4, № 1. – С. 41–46.
9. Adams LA, Lymp JF, St. Sauver J, et al. The natural history of nonalcoholic fatty liver disease: a populationbased cohort study. Gastroenterology. 2005; 129: 113–21.
10. Alba LM, Lindor K. Review article: Non-alcoholic fatty liver disease. Aliment Pharmacol Ther. 2003; 17(8): Р. 977–86.
11. Angulo P. Nonalcoholic fatty liver disease. N Engl J Med. 2002; 346: 1221–31.
12. Bellentani S, Saccoccio G, Masutti F, et al. Prevalence of and risk factors for hepatic steatosis in Northern Italy. Ann Intern Med. 2000; 132: 112–7.
13. Brea A, Mosquera D, Martin E, et al. Nonalcoholic fatty liver disease is associated with carotid atherosclerosis: A case-control study. Arterioscler Thromb Vasc Biol. 2005; 25: 1045–50.
14. Charlton M. Nonalcoholic fatty liver disease: a review of current understanding and future impact. Clin Gastroenterol Hepatol. 2004; 2: 1048–58.
15. Clark JM, Brancati FL, Diehl AM. The prevalence and etiology of elevated aminotransferase levels in the United States. Am J Gastroenterol. 2003; 98: 960–7.
16. Cortez-Pinto H, Camilo ME, Baptista A, et al. Nonalcoholic fatty liver: another feature of the metabolic syndrome? Clin Nutr. 1999; 18(6): 353–8.
17. Day CP. Pathogenesis of steatohepatitis. Best Pract Res Clin Gastroenterol. 2002; 16: 663–78.
18. De Alwis NM, Day CP. Nonalcoholic fatty liver disease: the mist gradually clears. J Hepatol. 2008; 48 (suppl. 1): 104–12.
19. Diehl AM. Nonalcoholic steatosis and steatohepatitis: nonalcoholic fatty liver disease abnormalities in macrophage function and cytokines. Am J Physiol. 2002; 282 (1):1–5.
20. Dixon JB. Nonsalcoholic fatty liver disease: predictors of nonalcoholic steatohepapitis and liver fibrosis in the severely obese. Gastroenterology. 2001: 91–100.
21. Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001; 285:2486–97.
22. Galassi A, Reynolds K, He J. Metabolic syndrome and risk of cardiovascular disease: A meta-analysis. Am J Med. 2006; 119:812–9.
23. Hamaguchi M, Kojima T, Takeda N, et al. The metabolic syndrome as a predictor of nonalgoholic fatty liver disease. Ann Intern Med. 2005; 143:722–8.
24. Joseph AE, Saverymuttu SH, al-Sam S, et al. Comparison of liver histology with ultrosonography in assessing diffuse parenchymal liver disease. Clin Radiol. 1991; 43: 26–31.
25. Knobler H. Fatty liver – an additional and treatable feature of the insulin resistance syndrome. QJM. 1999; 92:73–9.
26. Laakso M. How good a marker is insulin level of insulin resistance? Am J Epidemiol. 1993; 137:959–65.
27. Lee RG. Nonalcoholic steatohepatitis: a study of 49 patients. Hum Pathol. 1989; 20:594–8.
28. Ludwig J, et al. Nonalcoholic steatohepatitis. J Gastroenterol Hepatol. 1997; 12:398–403.
29. Luyckx FH, Scheen AJ, Lefebvre PJ. Nonalcoholic steatohepatitis. Lancet. 1999; 354 (9186):1298–9.
30. Marchesini G, Brizi M, Morselli-Labate AM, et al. Association of nonalcoholic fatty liver disease with insulin resistance. Am J Med. 1999; 107 (5):450–5.
31. Marchesini G, Bugianesi E, Forlani G, et al. Nonalcoholic fatty liver, steatohepatitis and the metabolic syndrome. Hepatology. 2003; 37:217–31.
32. Matteoni CA, Younossi ZM, Gramlich T, et al. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology. 1999; 116:1413–9.
33. Misra Vijay Laxmi, Khashab Mouen, Chalasani Naga. Nonalcoholic fatty liver disease and cardiovascular risk. Curr Gastroenterol Rep. 2009; 11:50–5.
34. Mottin CC, Moretto M, Padoin AV, et al. The role of ultrasound in the diagnosis of hepatic steatosis in morbidly obese patients. Obes Surg. 2004; 14:635–7.
35. Ruhl CE, Everhart JE. Determinants of the association of overweight with elevated serum alanine aminotransferase activity in the United States. Gastroenterology. 2003; 124. 71–9.
36. Sanyal AJ, Campbell-Sargent C, Mirshahi F, et al. Nonalcoholic steatohepatitis: association of insulin resistance and mitochondrial abnormalities. Gastroenterology. 2001; 120:1183–92.
37. Scheen AJ, Luyckx FH. Nonalcoholic steatohepatitis and insulin resistance: interface between gastroenterologists and endocrinologists. Acta Clin Belg. 2003; 58 (2):81–91.
38. Schwimmer JB, Pardee PE, Lavine JE, et al. Cardiovascular risk factors and the metabolic syndrome in pediatric nonalcoholic fatty liver disease. Circulation 2008; 118:277–83.
39. Targher G, Bertolini L, Padovani R, et al. Prevalence of nonalcoholic fatty liver disease and its association with cardiovascular disease among type 2 diabetic patients. Diabetes Care. 2007; 30:1212–8.
40. Vuppalanchi R, Chalasani N. Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: Selected practical issues in their evalution and management. Hepatology. 2009; 49:306–17.
41. Wanless IR, Lentz JS. Fatty liver hepatitis (steatohepatitis) and obesity: an autopsy study with analysis of risk factors. Hepatology. 1990; 12(5):1106–10.
Review
For citations:
Melnichenko G.A., Yeliseyeva A.Yu., Mayevskaya M.V. Prevalence of non-alcoholic fatty liver disease at obesity and its interrelation with cardio-vascular disease and 2nd type diabetes mellitus risk factors. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2012;22(2):45-53. (In Russ.)