ANTHROPOMETRIC AND BIOCHEMICAL CHARACTERISTICS OF ADULT PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE
Objective: The objective of this study was to analyze the distribution of non-alcoholic fatty liver disease (NAFLD) with reference to age, gender, and socioeconomic status, to look for clinical features, anthropometric measurements, and biochemical parameters in patients of NAFLD, and to analyze statistically significant differences in biochemical parameters of lean, overweight, and obese NAFLD patients, in a medical college hospital of Durgapur.
Methods: This was a prospective, cross-sectional hospital-based study carried out over 2 months. Patients diagnosed as NAFLD based on clinical findings and ultrasonography (USG) were evaluated. Patients were classified on the basis of body mass index (BMI) and their fibrosis score calculated.
Results: The authors report several interesting findings that warrant further exploration. In this study, average age was 42 years and there was a male preponderance. 31.25% among patients who had undergone USG evaluation were diagnosed as NAFLD. Glucose, glycosylated hemoglobin, thyroid-stimulating hormone (TSH), BMI, and lipid profile were significantly different in controls and cases. In NAFLD patient group, 48% were lean, 40% overweight, and 12% obese. Lean patients had significantly different alanine transaminase/aspartate transaminase, TSH, and fibrosis score compared to overweight and obese patients.
Conclusion: Authors stress on the importance of early identification of patients and stratifying them using less invasive, highly accurate, and affordable screening tools such as USG, biochemical tests, and fibrosis scores. More large-scale prospective studies can validate our observations, help physicians in early identification of patients who may benefit from therapeutic interventions, and even help them formulate more effective treatment algorithms.
2. Kalra S, Vithalani M, Gulati G, Kulkarni CM, Kadam Y, Pallivathukkal J, et al. Study of prevalence of nonalcoholic fatty liver disease (NAFLD) in type 2 diabetes patients in India (SPRINT). J Assoc Physicians India 2013;61:448-53.
3. Barros F, SetÃºbal S, Martinho JM, Ferraz L, GaudÃªncio A. Correlation of non-alcoholic fatty liver disease and features of metabolic syndrome in morbidly obese patients in the preoperative assessment for bariatric surgery. Arq Bras Cir Dig 2016;29:260-3.
4. Vernon G, Baranova A, Younossi ZM. Systematic review: The epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther 2011;34:274-85.
5. World Health Organization. Obesity: Preventing and Managing the Global Epidemic Report of a WHO Consultation (WHO Technical Report Series 894); 2000. p. 9.
6. Farrell GC, Chitturi S, Lau GK, Sollano JD, Asia-Pacific Working Party on NAFLD. Guidelines for the assessment and management of non-alcoholic fatty liver disease in the Asia-pacific region: Executive summary. J Gastroenterol Hepatol 2007;22:775-7.
7. Treeprasertsuk S, BjÃ¶rnsson E, Enders F, Suwanwalaikorn S, Lindor KD. NAFLD fibrosis score: A prognostic predictor for mortality and liver complications among NAFLD patients. World J Gastroenterol 2013;19:1219-29.
8. Mahaling DU, Basavaraj MM, Bika AJ. Comparison of lipid profile in different grades of non-alcoholic fatty liver disease diagnosed on ultrasound. Asian Pac J Trop Biomed 2013;3:907-12.
9. Abangah G, Yousefi A, Asadollahi R, Veisani Y, Rahimifar P, Alizadeh S, et al. Correlation of body mass index and serum parameters with ultrasonographic grade of fatty change in non-alcoholic fatty liver disease. Iran Red Crescent Med J 2014;16:e12669.
10. Agarwal R, Mishra S, Dixit VK, Rai S. Non alcoholic fatty liver disease and metabolic syndrome. Indian J Prev Soc Med 2011;42:2-3.
11. Singh SP, Singh A, Misra D, Misra B, Pati GK, Panigrahi MK, et al. Risk factors associated with non-alcoholic fatty liver disease in Indians: A case-control study. J Clin Exp Hepatol 2015;5:295-302.
12. Nigam P, Bhatt SP, Misra A, Vaidya M, Dasgupta J, Chadha DS, et al. Non-alcoholic fatty liver disease is closely associated with sub-clinical inflammation: A case-control study on Asian Indians in north India. PLoS One 2013;8:e49286.
13. Mohan V, Farooq S, Deepa M, Ravikumar R, Pitchumoni CS. Prevalence of non-alcoholic fatty liver disease in urban south Indians in relation to different grades of glucose intolerance and metabolic syndrome. Diabetes Res Clin Pract 2009;84:84-91.
14. Kumar R, Mohan S. Non-alcoholic fatty liver disease in lean subjects: Characteristics and implications. J Clin Transl Hepatol 2017;5:216-23.
15. Mofrad P, Contos MJ, Haque M, Sargeant C, Fisher RA, Luketic VA, et al. Clinical and histologic spectrum of nonalcoholic fatty liver disease associated with normal ALT values. Hepatology 2003;37:1286-92.
16. Ghamar-Chehreh ME, Khedmat H, Amini M, Taheri S. Predictive factors for ultrasonographic grading of nonalcoholic fatty liver disease. Hepat Mon 2012;12:e6860.
17. 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.
18. Bellentani S, Tiribelli C, Saccoccio G, Sodde M, Fratti N, De Martin C, et al. Prevalence of chronic liver disease in the general population of northern Italy: The dionysos study. Hepatology 1994;20:1442-9.
19. Yano E, Tagawa K, Yamaoka K, Mori M. Test validity of periodic liver function tests in a population of Japanese male bank employees. J Clin Epidemiol 2001;54:945-51.
20. Su CC, Wang K, Hsia TL, Chen CS, Tung TH. Association of nonalcoholic fatty liver disease with abnormal aminotransferase and postprandial hyperglycemia. J Clin Gastroenterol 2006;40:551-4.
21. Ma H, Xu C, Xu L, Yu C, Miao M, Li Y, et al. Independent association of hbA1c and nonalcoholic fatty liver disease in an elderly Chinese population. BMC Gastroenterol 2013;13:3.
22. Naderian M, Kolahdoozan S, Sharifi AS, Garmaroudi G, Yaseri M, Poustchi H, et al. Assessment of lean patients with non-alcoholic fatty liver disease in a middle income country; prevalence and its association with metabolic disorders: A cross-sectional study. Arch Iran Med 2017;20:211-7.
23. Feng R, Luo C, Li C, Du S, Okekunle AP, Li Y, et al. Free fatty acids profile among lean, overweight and obese non-alcoholic fatty liver disease patients: A case control study. Lipids Health Dis 2017;16:165.
24. Machado MV, Cortez-Pinto H. Non-alcoholic fatty liver disease: What the clinician needs to know. World J Gastroenterol 2014;20:12956-80.
25. Patell R, Dosi R, Joshi H, Sheth S, Shah P, Jasdanwala S, et al. Non-alcoholic fatty liver disease (NAFLD) in obesity. J Clin Diagn Res 2014;8:62-6.
26. Eshraghian A, Hamidian Jahromi A. Non-alcoholic fatty liver disease and thyroid dysfunction: A systematic review. World J Gastroenterol 2014;20:8102-9.
27. Chung GE, Kim D, Kim W, Yim JY, Park MJ, Kim YJ, et al. Non-alcoholic fatty liver disease across the spectrum of hypothyroidism. J Hepatol 2012;57:150-6.
28. Oswal A, Yeo G. Leptin and the control of body weight: A review of its diverse central targets, signaling mechanisms, and role in the pathogenesis of obesity. Obesity (Silver Spring) 2010;18:221-9.
29. Hulbert AJ. Thyroid hormones and their effects: A new perspective. Biol Rev Camb Philos Soc 2000;75:519-631.
30. Grover GJ, MellstrÃ¶m K, Ye L, Malm J, Li YL, Bladh LG, et al. Selective thyroid hormone receptor-beta activation: A strategy for reduction of weight, cholesterol, and lipoprotein (a) with reduced cardiovascular liability. Proc Natl Acad Sci U S A 2003;100:10067-72.
31. Erion MD, Cable EE, Ito BR, Jiang H, Fujitaki JM, Finn PD, et al. Targeting thyroid hormone receptor-beta agonists to the liver reduces cholesterol and triglycerides and improves the therapeutic index. Proc Natl Acad Sci U S A 2007;104:15490-5.
32. Khandelwal VK, Singh P, Ravingerova T, Chaudhary M. Evaluation of Ezenus in an experimental model of diet-induced alcoholic and non-alcoholic fatty liver condition in rats. Int J Pharm Pharm Sci 2016;7:247-52.
33. Ahmed HH, Salem AM, Mohamed MR, Shahat AA, Khalil WK, Mohamed SH. Experimental evidences for the promising therapeutic role of Vitis vinifera seed extract against nonalcoholic steatohepatitis. Int J Pharm Pharm Sci 2015:7:417-24.
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.