Abstract :
Background: Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver injury. Insulin resistance is central to the pathogenesis of NAFLD, and recent data indicate that non-alcoholic steatohepatitis (NASH) should be considered the hepatic manifestation of the insulin resistance syndrome.
Objective: The aim of this study was to find out if insulin resistance level can predict liver histology in NAFLD and NASH patients.
Method: One-hundred-sixty-four patients with a presumptive diagnosis of presumed NAFLD were enrolled in the study. The diagnosis of presumed NAFLD was made if liver ultrasonographic findings were compatible with hepatic steatosis and other causes of hepatitis were excluded. A presumed NAFLD patient with persistent increase of aminotransferase level of at least 1.5 times the upper normal limit for two consecutive times in 3 months, and with adequate control of the underlying disease and the body weight would be subjected to liver biopsy. Body mass index (BMI), waist circumference, fasting blood sugar, liver function test, lipid profile, insulin level, ferritin and hs-CRP were measured.
Result: Of 164 patients, 103 (63.0%) patients fulfilled the criteria for liver biopsy. Eighty-five patients(85/103; 82.5%) had insulin resistance (HOMA-IR ≥2). Only 30 patients (29.1%) gave informed consent for liver biopsy. Twenty-three patients (76.7%) had histology compatible with nonalcoholic steatohepatitis (NASH), and 7(23.3%) patients had histology compatible with fatty liver. Six patients (85.7%) in fatty liver group and 22 patients(95.7%) in NASH group had insulin resistance. HOMA-IR of NASH patients was 4.0 ± 1.5 and of fatty liver patients was 3.9 ± 1.4, (p = 0.917).
Conclusion: HOMA-IR was not difference statistically between NASH patients and fatty liver patients.
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file/Thai-Journal-of-gastroenterology-vol-12-no-1-1328346.pdf