Determination of the prevalance of metabolic syndrome and insulin resistance among adults with ultrasound diagnosed nonalcoholic fatty liver disease and without known systemic disease

ABSTRACTDETERMINATION OF THE PREVALANCE OF METABOLIC SYNDROME ANDINSULIN RESISTANCE AMONG ADULTS WITH ULTRASOUND DIAGNOSEDNONALCOHOLIC FATTY LIVER DISEASE AND WITHOUT KNOWN SYSTEMICDISEASEMetabolic syndrome that is frequently associated with nonalcoholic fatty liver disease(NAFLD) is characrerized by insulin resistance, abdominal obesity, dyslipidemia, hypertensionand hyperglycemia. The aim of this study is to determine the prevalance of metabolicsyndrome components, such as, insulin resistance, type 2 diabetes and impaired glucosetolerance, among subjects without any known systemic disease and diagnosed as NAFLDduring routine examinations.From January 2006 to March 2007, in Çukurova University School of MedicineInternal Medicine Department, 230 adult subjects with ultrasound diagnosed fatty liver diseasewere included. Cases who have history of drug or alcohol use and viral or autoimmune liverdiseases were excluded. Anthropometric measures were taken for all subjects who were thencategorized according to body-mass index (BMI).Oral glucose tolerance test was applied.Fasting glucose, insulin, c-peptid and transaminase levels were measured. Homeostasis ModelAssesment-Insulin Resistance (HOMA) index was calculated accordingly. Cut off level forinsulin resistance was accepted as 2.7. National Cholesterol Eduction Program AdultTreatment Panel III criteria were applied for metabolic syndrome.141 of patients (61.3%) were female. Mean age was 50.3±10(18-95) years. Mean body-mass index was 30.5±10.6 (18-50). Mean waist circumference was 104.8±10 (74-140). Meanfasting glucose level was 101.39±27.9(69-364). Mean HOMA index was 3.3±2.6 (0.5-26.5)78 of patients (33.9%) were diagnosed as impaired fasting glycemia while 65 (28.3%)and 51 (22.1%) of them were diagnosed as impaired glucose tolerance and type 2 diabetes,respectively.Prevalance of metabolic syndrome in NAFLD was 56.5% being significantly associatedwith body-mass index. Metabolic syndrome was detected in 73.2% of patients whom HOMAindex was 2.7. In NAFLD, insulin resistance was increased, independent of body mass index.In NAFLD, metabolic syndrome isn?t associated with significant change intransaminase levels, while AST and GGT are well associated with type 2 diabetes.In conclusion, the prevalance of metabolic syndrome, insulin resistance and type 2diabetes is increased in NAFLD. In these patients, early diagnosis and treatment of thesecomorbidities is very important due to the increased risk of cardiovascular disease.Key Words: Nonacoholic fatty liver disease, metabolic syndrome, insulin resistance, HOMA.