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Nutrición Hospitalaria

On-line version ISSN 1699-5198Print version ISSN 0212-1611

Nutr. Hosp. vol.31 n.6 Madrid Jun. 2015 

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.




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.


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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