ORIGINAL / Síndrome metabólico

 

Predictive factors of non-alcoholic steatohepatitis: relationship with metabolic syndrome

Factores predictivos de esteatohepatitis no alcohólica: papel del síndrome metabólico

 

 

Rocío Aller¹, Olatz Izaola¹, Lourdes Ruiz-Rebollo¹, David Pacheco² and Daniel A. de Luis²

¹Svo. Gastroenterology. Hospital Clínico Universitario. University of Valladolid, Valladolid.
²Center of Investigation of Endocrinology and Nutrition, Medicine School and Dept of Endocrinology and Nutrition. Hospital Clínico Universitario. University of Valladolid (Valladolid), Spain.

 

 

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ABSTRACT

Non-alcoholic fatty liver disease (NAFLD) has been proposed as the hepatic manifestation of the metabolic syndrom (Ms), with insulin resistance (IR) as the common pathophysiological mechanism.
Methods: we included 145 patients with NAFLD proven liver biopsy. NAS-score was employed to grading NAFLD. We determined anthropometric measurements, basal blood pression (BP), biochemical measurements including high lipoprotein cholesterol (HDL-Chol), low-density lipoprotein cholesterol (LDL-Chol), triglycerides and leptin levels, homeostasis model assessment index (HOMA.IR), and abdominal ultrasound scan (US) was performed. Diagnosis of Ms was performed based on ATP III criteria.
Results: average age was 43.6 + 11.2 years old and the mean body mass index (BMI) was 39 } 10.7 kg/m². Sex distribution was: females 66 and males 79. Forty patients (27.5%) presented a NAS score > = 5. Waist circumference (p = 0.007), systolic and diastolic BP (p = 0.002 and p = 0.003 respectively), (HOMA-IR) (p>0.0001), body mass index BMI (p = 0.04), Ms (p = 0.04) and US-NAFLD were significantly associated with NAS-score > = 5. Independent factors associated to NAS-score > = 5 were Ms and BMI > 30. Leptin levels were higher in patients with advanced fibrosis (. F2) compared to patients with mild fibrosis (F0-F1) (75.5 + 50.2 ng/ml vs - 39.7 + 38.4 ng/ml respectively; p = 0.002).
Conclusion: presence of Ms and obesity (BMI >30) are the principal independent factors associated to NASH (NAS score > = 5). Leptin levels and BMI are higher in patients with advanced fibrosis.

Key words: Non alcoholic steatohepatitis. Metabolic syndrome. Adipokines. Body mass index.

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RESUMEN

La esteatohepatitis no alcoholica (EHNA) se ha propuesto como la manifestacion hepatica del sindrome metabolico (SM), con la resistencia a la insulina (IR) como mecanismo fisiopatologico comun.
Metodos: se incluyeron 145 pacientes con biopsia hepatica con enfermedad por higado graso no alcoholica. NAS-score se utilizo para graduar la EHNA. Se realizaron las siguientes determinaciones; antropometria, presion arterial basal (BP), LDL colesterol, HDL colesterol, trigliceridos, leptina, resistencia a la insulina (HOMA- IR) y ecografia abdominal. El diagnostico de sindrome metabolico se realizo en base a los criterios del ATP III.
Resultados: la edad fue 43,6 + 11,2 anos y la media de indice de masa corporal (IMC) 39 + 10.7 kg/ m² (66 mujeres y 79 varones). Cuarenta pacientes (27,5%) presentaron una puntuacion NAS> = 5. La circunferencia de la cintura (p = 0,007), la presion arterial sistolica y diastolica (p = 0,002 y p = 0,003, respectivamente, la resistencia a la insulina (HOMA-IR) (p >0,0001), IMC (p = 0,04), el SM (p = 0,04) y los datos ecograficos se asociaron significativamente con NAS-score > = 5. Los factores independientes asociados a NAS-score > = 5 fueron el SM y el IMC > 30. Los niveles de leptina fueron mayores en pacientes con fibrosis avanzada (. F2) en comparacion con los pacientes con fibrosis leve (F0-F1) (75,5 + 50,2 ng / ml frente a 39,7 + 38,4 ng / ml, respectivamente; p = 0.002).
Conclusion: la presencia de SM y obesidad (IMC> 30) son los principales factores independientes asociados a la EHNA (puntuacion NAS> = 5). Los niveles de leptina y el IMC son mayores en los pacientes con fibrosis avanzada.

Palabras clave: Esteatohepatitis no alcohólica. Síndrome metabólico. Adipokinas. índice de masa corporal.

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http://scielo.isciii.es/pdf/nh/v31n6/21originalsindromemetabolico01.pdf