Glucose metabolism and insulin resistance in nonalcoholic fatty liver disease

VIII. NG L ZCE ÖZET (ABSTRACT)INTRODUCTION AND OBJECTIVES: Non-alcoholic fatty liver disease (NAFLD) is adisease process of the liver that may progress from simple fatty accumulation tofibrosis. The process is called non-alcoholic steatohepatitis (NASH) wheninflammation and/or fibrosis accompany fatty accumulation in the liver. The fact thatNAFLD is seen in the patients with diabetes mellitus, hyperlipidemia and obesityunder which insulin resistance lies and that such cases increased steadily has led toincreased interest to this condition. Among multiple factors in its etiology, the mostimportant one is insulin resistance.The present study aimed to evaluate disorders of glucose metabolism and investigateinsulin resistance and to compare the groups of steatosis and elevated liver enzymeinduced steatosis for the presence of insulin resistance in the patients in our regionwith fatty liver disease.MATERIALS AND METHODS: The study included the patients 18 to 65 years oldwho were diagnosed as having fatty liver on routine abdominal ultrasound andcomputerized tomography (CT) examinations. The diagnosis was made upondetermining fatty accumulation in the liver and exclusion of other hepatic diseases.Those patients in whom no abnormality was found in hepatic function tests inlaboratory investigations were taken as the cases with steatosis and those in whomabnormal liver function tests were found as the cases with elevated liver enzymeinduced steatosis.FINDINGS: The present study included a total of 66 patients of whom 40 hadsteatosis and 26 had elevated liver enzyme induced steatosis after they had givenwritten informed consent. When the patients were compared for parameters ofglucose metabolism, insulin levels were similar in both groups, although it was higherin the elevated liver enzyme induced steatosis group. The difference was significant.The patients were also compared for insulin resistance. Insulin resistance was higherin the elevated liver enzyme induced steatosis group.CONCLUSIONS AND RECOMMENDATIONS: The present study investigated therelationship between glucose metabolism and insulin resistance in the population ofthe patients with non-alcoholic fatty liver disease, namely in those patients withsteatosis or elevated liver enzyme induced steatosis. We concluded that the patientswith elevated liver enzyme induced steatosis had more insulin resistance. Suchpatients should be considered meticulously for exercise, weight loss and medicationsto reduce insulin resistance. It is also believed that insulin resistance may play a rolein progression from steatosis to NASH.Key Words: Non-alcoholic fatty liver disease (NAFLD), Non-alcoholic steatohepatitis,Insülin Resistance