Data di Pubblicazione:
2009
Abstract:
NAFLD, the hepatic expression of the metabolic syndrome.
Insulin resistance is the underlying metabolic condition favouring
the occurrence of NAFLD, a spectrum of liver conditions
ranging from fatty liver, to steatohepatitis, fibrosis and cirrhosis.
Waist circumference (WC), the simplest and most widely used
surrogate marker of visceral adiposity is a clinical correlate of
insulin resistance. In a small series of patients with NAFLD, it
has recently been reported that metabolic and histological characteristics
were similar in patients with or without diabetes and
obesity. Aim To evaluate the clinical presentation and liver histological
findings in patients with NAFLD according to the presence
of visceral obesity estimated by WC. Methods We
merged the databases of consecutive patients with liver biopsyconfirmed
NAFLD observed in four Liver Units (427 cases) who
underwent liver biopsy between January 2003 and June 2008.
Patients were divided in two groups according to their WC
(group A≥94 and ≥ 80 cm, group B < 94 cm and < 80 cm, in
men and in women respectively). Patients in group A (273
cases) were significantly older (45 ± 10 vs 39 ± 11 years,
p=0.01), had higher triglycerides (158 ± 80 vs 134 ±88
mg/dl, p=0.03), HOMA-IR (5 ± 4 vs 3.4 ± 2, p= 0.007), and
a higher prevalence of females (22% vs 6%, p=0.001), diabetes
or impaired glucose tolerance (27% vs 15%, p=0.01),
arterial hypertension (44% vs 22%, p=0.001), metabolic syndrome
(35% vs 8%, p=0.001) and NASH (47% vs 36%,
p=0.03), with no significant differences in the prevalence of
severe fibrosis (≥2) (31% and 27%) between groups. Serum ferritin,
fasting glucose, diabetes and ALT were significantly associated
with fibrosis ≥ 2 in the overall series and in the two
groups evaluated separately. At multivariate logistic regression
analysis in the overall series of patients and in the two groups
analysed separately, ALT (p=0.02)and diabetes (p=0.0001)
remained independently associated with fibrosis ≥ 2. Conclusion
Patients with NAFLD and normal waist circumference,
despite a milder metabolic involvement, may have NASH and
are at high risk of developing severe liver fibrosis. These findings
suggest that visceral obesity does not influence the severity
of liver damage in patients with NAFLD, whereas diabetes
is a risk factor, independent of obesity.
Tipologia CRIS:
04E-Meeting abstract in rivista
Elenco autori:
A.L. Fracanzani; L. Valenti; E. Bugianesi; E. Vanni; L. Miele; C. Bertelli; E. Fatta; A. Grieco; G. Marchesini; S. Fargion
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