Keywords
Hígado Graso
Cirrosis Hepática
Resistencia a la insulina
Síndrome X Metabólico Gastroenterology
Fatty liver
Liver cirrhosis
Insulin resistance
Metabolic Syndrome X
How to Cite
Abstract
Introduction: Non-Alcoholic Fatty Liver Disease or fatty liver is a term that comprises many clinical-pathological conditions. The global prevalence ranges around 20 to 30% in adults and up to 75% in obese patients, being more frequent in women. Most patients are diagnosed between the age of 40 and 50. Fatty liver is directly associated with dyslipidemia and insulin resistance. Objective: To determine the occurrence of insulin resistance and its association to non-alcoholic fat. Methodology: The medical records of patients with a diagnosis of fatty liver who visited the outpatient hepatology department at the University Clinic in Colombia and one of the author’s hepatology services between January 1st and May 31st, 2014 were reviewed. Results: The medical records of 162 patients diagnosed with fatty liver were reviewed. There were 51.2% males and 48.8% females, average age of 48.5 years at the time of consultation. The most common risk factor was dyslipidemia with 39.5%, followed by obesity, high blood pressure, diabetes mellitus and coronary disease. 55.5% of the patients had a HOMA index > 3. Conclusions: Dyslipidemia continues to be the most important risk factor for the development of fatty liver. The insulin resistance index is strongly associated with non-alcoholic fatty liver disease and we suggest using dyslipidemia for early detection of fatty liver in patients with one or more risk factors for metabolic syndrome.
References
Luisa Fernanda Santos, Geovanny Hernández, Adriana Varón Puerta, Óscar Beltrán, Rafael Claudino Botero, Gilberto Mejía, Enfermedad hepática por infiltración grasa no alcohólica. La nueva pandemia del milenio, Rev Col Gastroenterol / 25 (4) 2010.
Ludwig J, Viaggiano TR, McGill DB, Oh BJ. Non-alcoholic steatohepatitis: Mayo clinic experience with a hitherto unnamed disease. Mayo Clin Proc 1980; 55: 434-8.
Santiago Sánchez Pardo, Leonardo Rojas Díaz, Sandra Huertas Pacheco, Jhon E. Prieto Ortiz, características clínicas de los pacientes con diagnóstico de hígado graso de la clínica universitaria Colombia, periodo 2010-2013, Rev.Medica.Sanitas 16 (4): 170-179, 2013.
Naga Chalasani, Zobair Younossi, Joel E. Lavine, Anna Mae Diehl, Elizabeth M. Brunt, Kenneth Cusi, The Diagnosis and Management of NonAlcoholic Fatty Liver Disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association, HEPATOLOGY, Vol. 55, No. 6, 2012. https://doi.org/10.1002/hep.25762
Ekstedt M, Franzen LE, Mathiesen UL, et al. Long-term follow-up of patients with NAFLD and elevated liver enzymes. Hepatology 2006; 44:865-873. https://doi.org/10.1002/hep.21327
N. Mavrogiannaki and I. N. Migdalis, Nonalcoholic Fatty Liver Disease, Diabetes Mellitus and Cardiovascular Disease: Newer Data, International Journal of Endocrinology, Volume 2013. https://doi.org/10.1155/2013/450639
Ahmed MH, Barakat S, Almobarak AO. Nonalco- holic fatty liver disease and cardiovascular disease: has the time come for cardiologists to be hepatologists? J Obes. 2012; 2012:483135. https://doi.org/10.1155/2012/483135
Villanova, N.; Moscatiello, S.; Ramilli, S.; Bugianesi, E.; Magalotti, D.; Vanni, E.; Zoli, M.; Marchesini, G. Endothelial dysfunction and cardiovascular risk profile in nonalcoholic fatty liver disease. Hepatology 2005, 42, 473-480. https://doi.org/10.1002/hep.20781
Vlad Ratziu, Stefano Bellentani, Helena Cortez-Pinto, Chris Day, Giulio Marchesini, A position statement on NAFLD/NASH based on the EASL 2009 special conference, Journal of Hepatology 2010 vol. 53 j 372-384. https://doi.org/10.1016/j.jhep.2010.04.008
McCallough A. The clinical features, diagnosis and natural history of nonalcoholic fatty liver disease. Clin Liver Dis. 2004 ;8(3):521-33. https://doi.org/10.1016/j.cld.2004.04.004
Caldwell SH, Crespo DM. The spectrum expanded: cryptogenic cirrhosis and the natural history of non-alcoholic fatty liver disease. J Hepatol 2004; 40:578. https://doi.org/10.1016/j.jhep.2004.02.013
Williams CD, Stengel J, Asike MI, et al. Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middleaged population utilizing ultrasound and liver biopsy: a prospective study. Gastroenterology 2011; 140:124. https://doi.org/10.1053/j.gastro.2010.09.038
Katherine JP Schwenger and Johane P Allard, Clinical approaches to non-alcoholic fatty liver disease, World J Gastroenterol. 2014 February 21; 20(7): 1712-1723. https://doi.org/10.3748/wjg.v20.i7.1712
Barbara Fruci, Stefania Giuliano, Angela Mazza, Roberta Malaguarnera and Antonino Belfiore, Nonalcoholic Fatty Liver: A Possible New Target for Type 2 Diabetes Prevention and Treatment, Int. J. Mol. Sci. 2013, 14, 22933-22966. https://doi.org/10.3390/ijms141122933
Xu H, Barnes GT, Yang Q, Tan G, Yang D, Chou CJ, Sole J, Nichols A, Ross JS, Tartaglia LA, Chen H: Chronic inflammation in fat plays a crucial role in the development of obesity-related insulin resistance. J Clin Invest 2003, 112:1821-1830. https://doi.org/10.1172/JCI200319451
Seppala-Lindroos, A.; Vehkavaara, S.; Hakkinen, A.M.; Goto, T.; Westerbacka, J.; Sovijarvi, A.; Halavaara, J.; Yki-Jarvinen, H. Fat accumulation in the liver is associated with defects in insulin suppression of glucose production and serum free fatty acids independent of obesity in normal men. J. Clin. Endocrinol. Metab. 2002, 87, 3023-3028. https://doi.org/10.1210/jcem.87.7.8638
Bugianesi, E.; Gastaldelli, A.; Vanni, E.; Gambino, R.; Cassader, M.; Baldi, S.; Ponti, V.; Pagano, G.; Ferrannini, E.; Rizzetto, M. Insulin resistance in non-diabetic patients with non-alcoholic fatty liver disease: Sites and mechanisms. Diabetologia 2005, 48, 634-642. https://doi.org/10.1007/s00125-005-1682-x
Gaggini Melania, Morelli Mariangela, Buzzigoli Emma , DeFronzo A Ralph, Bugianesi Elisabetta, Gastaldelli Amalia, Non-Alcoholic Fatty Liver Disease (NAFLD) and Its Connection with Insulin Resistance, Dyslipidemia, Atherosclerosis and Coronary Heart Disease, Nutrients 2013, 5, 1544-1560. https://doi.org/10.3390/nu5051544
Thomas Galbo, Gerald I. Shulman, Lipid-induced hepatic insulin resistance, AGING, 2013, (5);8. Ed. https://doi.org/10.18632/aging.100585
Hebbard, L.; George, J. Animal models of nonalcoholic fatty liver disease. Nat. Rev. Gastroenterol. Hepatol. 2011, 8, 35-44. https://doi.org/10.1038/nrgastro.2010.191
Ota, T.; Takamura, T.; Kurita, S.; Matsuzawa, N.; Kita, Y.; Uno, M.; Akahori, H.; Misu, H.; Sakurai, M.; Zen, Y.; et al. Insulin resistance accelerates a dietary rat model of nonalcoholic steatohepatitis. Gastroenterology 2007, 132, 282-293. https://doi.org/10.1053/j.gastro.2006.10.014
Nagle, C.A.; Klett, E.L.; Coleman, R.A. Hepatic triacylglycerol accumulation and insulin resistance. J. Lipid Res. 2009, 50, S74-S79. https://doi.org/10.1194/jlr.R800053-JLR200
Fabbrini E, Sullivan S, Klein S. Obesity and nonalcoholic fatty liver disease: biochemical, metabolic, and clinical implications. Hepatology 2010; 51: 679-689. https://doi.org/10.1002/hep.23280
Galbo T. et al. Proc Natl Acad Sci. 2013.
K.Cusi, "the role of adipose tissue and lipotoxicity in the pathogenesis of type 2 diabetes", Current Diabetes Reports. 2010 (10); 306-315. https://doi.org/10.1007/s11892-010-0122-6
Francis M Finucane, Stephen J Sharp, Mensud Hatunic, Alison Sleigh, Ema De Lucia Rolf, Avan Aihie Sayer, Liver fat accumulation is associated with reduced hepatic insulin extraction and beta cell dysfunction in healthy older individuals, Diabetology & Metabolic Syndrome 2014, 6:43. https://doi.org/10.1186/1758-5996-6-43
Elaine Hui, Aimin Xu, Hong Bo Yang, Karen S L Lam, Obesity as the common soil of non-alcoholic fatty liver disease and diabetes: Role of adipokines, Journal of Diabetes Investigation 2013 (4); 5. https://doi.org/10.1111/jdi.12093
Wiesenthal SR, Sandhu H, McCall RH, Tchipashvili V, Yoshii H, Polonsky K, Shi ZQ, Lewis GF, Mari A, Giacca A: Free fatty acids impair hepatic insulin extraction in vivo. Diabetes 1999, 48:766-774. https://doi.org/10.2337/diabetes.48.4.766
Marra F, Bertolani C. Adipokines in liver diseases. Hepatology. 2009;50:957-969. https://doi.org/10.1002/hep.23046
Bernsmeier C, Meyer-Gerspach AC, Blaser LS, Jeker L, Steinert RE, et al. (2014) Glucose-Induced Glucagon-Like Peptide 1 Secretion Is Deficient in Patients with Non-Alcoholic Fatty Liver Disease. PLoS ONE 9(1): e87488. https://doi.org/10.1371/journal.pone.0087488
Zeynel Abidin Ozturk, Abdurrahman Kadayifci, Insulin sensitizers for the treatment of non-alcoholic fatty liver disease, World J Hepatol 2014 April 27; 6(4): 199-206. https://doi.org/10.4254/wjh.v6.i4.199
Al-Jiffri O, Al-Sharif FM, Abd El-Kader SM, Ashmawy EM, Weight reduction improves markers of hepatic function and insulin resistance in type-2 diabetic patients with non-alcoholic fatty liver, African Health Sciences, 2013; (13); 3. https://doi.org/10.4314/ahs.v13i3.21
Jun DW The Role of Diet in Non-alcoholic Fatty Liver Disease. Korean J Gastroenterol. 2013 May 25; 61(5):243-51. https://doi.org/10.4166/kjg.2013.61.5.243
William Sánchez, Quindo Santana, José Buelvas, Rafael Camargo, Relación entre insulinemia e hígado graso en pacientes con índice de masa corporal normal, sin antecedentes de consumo de alcohol crónico ni diabetes mellitus, Acta Medica Colombiana, 2011. (36); 73-77." https://doi.org/10.36104/amc.2012.1487