Prevalence of metabolic syndrome in nonalcoholic fatty liver disease with high transaminase levels

SUMMARY` PREVALENCE OF METABOLIC SYNDROME INNONALCOHOLIC FATTY LIVER DISEASE WITH HIGHTRANSAMINASE LEVELS?It is known that nonalcoholic fatty liver disease (NAFLD) the underlyingcause of the most of the cryptogenic cirrhosis and on its base hepatocelularcarcinoma can develop. Today NAFLD is accepted as the component or hepaticmanifestation of the metabolic syndrome (MS). Thus, the existance of themetabolic syndrome is getting important while evaluating following NAFLDpatients. In this single centered prospective study MS scannig was performedamong the patients diagnosed as NAFLD and the prevalence of the metabolicsyndrome is detected.Study was held at Afyon Kocatepe University Medical Faculty Hospital, inInternal Medicine Department between December 2005 and May 2006. 35patients (9 female,26 male) having a continuous elevation of liver enzymes atleast for 6 months and bright liver on US and in whom no other cause of liverdisease detected were included in the study from the patients admitting to internalmedicine department. The diagnosis of NAFLD is established clinnically and byusing laboratory and imaging methods after ruling out other common ethiologiesMetabolic syndrome scanning was performed among the patients chosenaccording to inclusion and exclusion criteria by using WHO and NCEP ATP IIIcriteria.Metabolic syndrome was detected in 68.6% and 57.1% of patients accordingto the WHO and NCEP ATP III criteria respectively . While esablishing thediagnosis of metabolic syndrome, there was no significant difference between thetwo classification systems (p=0.344). MS was detected in 88.8% of women (n=8)57and in 46.1% of men (n=12) using NCEP ATP III criteria and the difference wassignificant (p=0.048). Positive significant correlation was detected betweendegrees of hepatosteatosis on US and fasting insulin levels, HOMA IR values. Itwas seen that as the severity of hepatosteatosis had progressed, the correlation hadstrengthened. Positive correlation was detected between the severity ofhepatosteatosis and BMI, waist circumference and insulin resistance.The presence of subjects with high transaminase levels but no metabolicsyndrome in predominance of male sex suggests that steatosis itself may startliver damage before the metabolic syndrom criteria are fullfilled. The reason forthis may be the absence of protective effects of estrogen against hepatosteatosis.Because of this reason it is considered that some factors causing liver damagedirectly other than insulin resistance should be present in patients having NAFLDwith high transaminase levels including the nonobese ones.In conclusion, as our data show, NAFLD and metabolic syndrome has aclose relation. Since there is no significant difference between the prevalences ofMS, we think that in daily practice NCEP ATP III criteria may be used moreeasily and efficiently. Metabolic syndrome should be searched in the patientshaving NAFLD and new studies should be performed to reveal theethiopathogenesis of NAFLD patients that do not have metabolic syndrome.Studies searching in details for the different factors that cause this in NAFLDpatients with high transaminase levels who do not have MS are needed.58