Clinical profile of patients with non-alcoholic fatty liver disease and its association with metabolic syndrome
Keywords:Clinical profile, Metabolic syndrome, Non-alcoholic fatty liver disease
Background: Non-alcoholic fatty liver disease (NAFLD) is the accumulation of lipid, primarily in the form of triacylglycerols in individuals who do not consume significant amounts of alcohol and other known causes of steatosis, such as certain drugs and toxins, have been excluded. The rising incidence of obesity is associated with health complications. The non-alcoholic fatty liver disease is increasingly being recognized as a major cause of liver-related morbidity and mortality among 15-40% of the general population. Currently, a liver biopsy is the gold standard method for diagnosing NAFLD. Ultrasonography is relatively inexpensive and widely available in clinical settings. NAFLD is considered to be an integral part of the metabolic syndrome. The present study is designed to study the clinical profile of patients with NAFLD with varying degrees of severity as diagnosed by Ultrasonography and evaluate the relationship between the non-alcoholic fatty liver disease and the metabolic syndrome along with its individual components, as defined by the modified NCEP ATP III criteria.
Methods: A cross-sectional study was conducted by Department of Medicine, NKPSIMS and LMH, Nagpur. A total of 100 cases during the study period of February 2015 to January 2016 were included and investigated for metabolic syndrome according to the NCEP ATP 3 Criteria.
Results: Total of 100 cases ultrasonographically diagnosed as NAFLD were included in the study and showed 49%, 38% and 13% of cases had grade I, II, and III fatty liver respectively. On physical examination mean BMI was 27.6±4.39 kg/m2. Mean diastolic blood pressure was 92.87±6.25 and mean systolic blood pressure (mm Hg) 132.0±18.17. Out of the 100, patients with NAFLD with metabolic syndrome were 57% and without metabolic syndrome were 43%. The correlation was significant for fasting plasma glucose, diastolic blood pressure, triglycerides, high-density lipoprotein and waist circumference (p<0.05).
Conclusions: From the study, it can be concluded that symptoms and signs of NAFLD are non-specific and occur later in the course of the disease hence the physician should have a high index of suspicion in order to detect NAFLD early in the course of the disease. Early detection would help not only in modifying the disease course and delaying its complications.
McCullough AJ. The clinical features, diagnosis and natural history of the non-alcoholic fatty liver disease. Clin Liver Dis. 2004;8:521-33.
Pi-Sunyer FX. The obesity epidemic: pathophysiology and consequences of obesity. Obes Res 2002;10(suppl 2):97S-104S.
Haynes P, Liangpunsakul S, Chalasani N. Nonalcoholic fatty liver disease in individuals with severe obesity. Clin Liver Dis. 2004;8:535-47.
Angulo P. Nonalcoholic fatty liver disease. N Engl J Med. 2002;346:1221- 31.
Farrell GC, Larter CZ. Nonalcoholic Fatty Liver Disease: from Steatosis to cirrhosis. Hepatol. 2006;43:S00-S112.
Lazo M, Clark JM. The epidemiology of nonalcoholic fatty liver disease: A global perspective. Semin Liver Dis. 2008;28:39-50.
Duseja A. Nonalcoholic fatty liver disease in India - a lot done, yet more required. Indian J Gastroenterol. 2010;29:217-25.
Gupte P, Amarapurkar D, Agal S, Baijal R, Kulshrestha P, Pramanik S, et al. Non-alcoholic steatohepatitis in type 2 diabetes mellitus. J Gastroenterol Hepatol. 2004;19:854-8.
Sanyal AJ. AGA technical review on the nonalcoholic fatty liver disease. Gastroenterol. 2002;123:1705-25.
Neuschwander-Tetri BA, Caldwell SH. Nonalcoholic steatohepatitis: summary of an AASLD single topic conference. Hepatol. 2003;37:1202-19.
Cairns SR, Peters TJ. Biochemical analysis of hepatic lipid in alcoholic and diabetic and control subjects. Clin Sci (Lond). 1983;65:645-52.
Machado MV, Cortez-Pinto H. Non-invasive diagnosis of non-alcoholic fatty liver disease. A critical appraisal. J Hepatol. 2013;58:1007-19.
Prashanth M, Ganesh HK, Vima MV, John M, Bandgar T, Joshi SR, et al. Prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus. J Assoc Physicians Ind. 2009;57:205-10.
Duseja A, Das A, Kumar K, Dhiman RK, Chawla Y, Das R, et al. Clinicopathological profile of Indian patients with nonalcoholic fatty liver disease (nafld) is different from the West. J Gastroenterol Hepatol. 2006;21:A465.
Agrawal R, Mishra S, Dixit VK, Rai S. Association of non-alcoholic fatty liver disorder with obesity. Indian J Prev Soc Med. 2008;39:13-16.
Misra A, Chowbey P, Makkar BM, Vikram NK, Wasir JS, Chadha D, et al. Consensus Group. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians Ind. 2009;57:163-70.
Gaharwar R, Trikha S, Margekar SL, Jatav OP, Ganga PD. Study of clinical profile of patients with non-alcoholic fatty liver disease and its association with metabolic syndrome. J Assoc Phy Ind. 2015;63:12-16.
Deb A, Chattopadhyay A, Hassan K, Bhattacharya J, Basu M. Clinical profile of patients with non-alcoholic fatty liver disease and its association with metabolic syndrome: a cross-sectional study. IOSR J Dent Med Sci (IOSR-JDMS). 2015;14(12):11-15.
Singh SP, Kar SK, Panigrahi MK, Misra B, Pattnaik K, Bhuyan P, et al. Profile of patients with incidentally detected non-alcoholic fatty liver disease (IDNAFLD) in coastal Eastern India. Tropical Gastroenterol. 2013;34(3):144-52.
Kwon YM, Oh SW, Hwang SS, Lee C, Kwon H, Chung GE. Association of non-alcoholic fatty liver disease with components of metabolic syndrome according to body mass index in Korean adults. Am J Gastroenterol. 2012;107(12):1852-8.
Yang KC, Hung HF, Lu CW, Chang HH, Lee LT, Huang KC. Association of non-alcoholic fatty liver disease with metabolic syndrome independently of central obesity and insulin resistance. Scientific Reports. 2016;6.
Vendhan R, Amutha A, Anjana RM, Unnikrishnan R, Mohan V. Clinical profile of nonalcoholic Fatty liver disease among young patients with type 1 diabetes mellitus seen at a diabetes specialty center in India. Endocr Pract. 2014;20(12):1249-57.
Andrade GC, Fujise LH, Santana JE Filho, Oliveira F, Silva RC. Non-alcoholic fatty liver disease (NAFLD) in different populations: a clinical and epidemiological study - sample of São José do Rio Preto. Rev Assoc Med Bras. 2016;62(3):218-26.
Younossi ZM, Otgonsuren M, Venkatesan C, Mishra A. In patients with the non-alcoholic fatty liver disease, metabolically abnormal individuals are at a higher risk for mortality while metabolically normal individuals are not. Metabol. 2013;62(3):352-60.