Nonalcoholic Fatty Liver, Steatohepatitis, and the Metabolic Syndrome

Nonalcoholic Fatty Liver, Steatohepatitis, and the Metabolic Syndrome,Giulio Marchesini,Elisabetta Bugianesi,Gabriele Forlani,Fernanda Cerrelli,Marco

Nonalcoholic Fatty Liver, Steatohepatitis, and the Metabolic Syndrome   (Citations: 235)
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Nonalcoholic fatty liver disease (NAFLD) has been associated with the insulin-resistance syndrome, at present defined as the metabolic syndrome, whose limits were recently set. We assessed the prevalence of the metabolic syndrome in 304 consecutive NAFLD patients withoutovertdiabetes,onthebasisof3ormorecriteriaoutof5definedbytheU.S.National Institutes of Health (waist circumference, glucose, high-density lipoprotein (HDL)-choles- terol, triglycerides, and arterial pressure). The prevalence of the metabolic syndrome in- creased with increasing body mass index, from 18% in normal-weight subjects to 67% in obesity. Insulin resistance (Homeostasis Model Assessment method) was significantly asso- ciated with the metabolic syndrome (odds ratio (OR), 2.5; 95% CI, 1.5-4.2;P<.001). Liver biopsy was available in 163 cases (54%). A total of 120 patients (73.6%) were classified as having nonalcoholic steatohepatitis (NASH); 88% of them had a metabolic syndrome (vs. 53% of patients with pure fatty liver;P<.0001). Logistic regression analysis confirmed that the presence of metabolic syndrome carried a high risk of NASH among NAFLD subjects (OR, 3.2; 95% CI, 1.2-8.9;P!.026) after correction for sex, age, and body mass. In particular, the syndrome was associated with a high risk of severe fibrosis (OR, 3.5; 95% CI, 1.1-11.2;P!.032).Inconclusion,thepresenceofmultiplemetabolicdisordersisassociated with a potentially progressive, severe liver disease. The increasing prevalence of obesity, coupled with diabetes, dyslipidemia, hypertension, and ultimately the metabolic syndrome puts a very large population at risk of forthcoming liver failure in the next decades. (HEPATOLOGY2003;37:917-923.)
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