Evaluation of adinopectin and insulin resistance in chronic hepatitis C and non alcoholic fatty liver disease

Non alcoholic fatty liver disease (NAFLD) is a chronic liver disease characterized with diffuse fat infiltration, lobular inflammation and presinusoidal fibrosis. It?s high prevalance, progression to cirrhosis and hepatic insufficiency makes NAFLD an important health problem. In recent years, it is postulated that insulin resistance may be the major pathophysiological factor for development of steatosis in NAFLD as well as in chronic hepatitis C (CHC). Insulin resistance syndrome (IRS) is characterized with hypertension, abdominal obesity, impaired glucose intolerance, dislipidemia and thus increased cardiovascular morbidity. It is assumed that the changes in the levels of adipocytokines such as adiponectin synthesized by fat tissue may play an important role in this syndrome and progression of cardiovascular disease. Adinopectin is a protein which is thought to effect the modulation of carbohydrate and lipid metabolism in insulin sensitive tissues and it?s plasma levels decrease significantly in insulin resistance. The objective of this study is to evaluate adiponectin and its association to insulin resistance and cardiovascular risk factors in NAFLD and CHC.23 NAFLD, 18 CHC patients and 21 healthy controls were included in the study. Following the measurement of abdominal circumference and calculation of BMI, the analysis of lipid parameters, homocystein, hs-CRP and ferritin was performed in all groups. Insulin resistance was evaluated by calculating HOMA-IR index. Serum adinopectin levels were determined with ELİSA method. Kruskall-Wallis and Mann-Whitney U test was applied for statistical evaluation of the difference between the groups. Correlation analysis was done by Spearman rank correlation test. p< 0.05 was considered as significant.NAFLD patients had higher levels of TA (p=0,000), abdominal circumference (p=0,010), homocystein (p= 0,019), HOMA-IR (p=0,000) and lower levels of adiponectin (p=0,001) compared to controls. CHC patients had higher levels of TA (p=0,000), HOMA-IR (p=0,001) and lower levels of total cholesterol (p=0,037) and Apo B ((p=0,035) compared to controls. In CHC group, although adinopectin levels were lower than the control group the difference was not significant. Comparing NAFLD and CHC groups, no significant difference was observed regarding adiponectin ve HOMA-IR. In NAFLD group hs-CRP (p=0.000), total cholesterol (p=0,047), triglyceride (p=0,006) levels were higher and HDL2-K (p=0,004) levels were lower compared to CHC group.Insulin resistance was observed both in NAFLD and CHC patients although more profound in NAFLD. Significantly low levels of adiponectin in NAFLD patients support the association between hepatic steatosis and adiponectin. Further studies are necessary to elucidate the possible pathophysiological role of adiponectin and its relationship to insulin resistance in NAFLD.Key words: NAFLD, CHC, adiponectin, insulin resistance.