Metabolic disorders in patients with nonalcoholic fatty liver disease

Article by Doctor Mai Vien Phuong - Department of Medical Examination & Internal Medicine - Vinmec Central Park International General Hospital

The presence of nonalcoholic fatty liver (NAFLD) is associated with an increased incidence of type 2 diabetes and metabolic syndrome (independent of demographic and lifestyle parameters). .

Regarding the non-obese population, 2 independent studies in China confirmed that obese patients with chronic nonalcoholic fatty liver disease were associated with increased blood pressure and metabolic syndrome more than others. In contrast - the China-specific study also reported that obese nonalcoholic fatty liver patients, hypertension and diabetes had arterial stiffness, fasting blood glucose levels, total cholesterol, LDL -C, Triglycerides and insulin resistance were higher than other non-obese subjects.
Furthermore, a cohort study in India also showed that nonalcoholic fatty liver patients were at higher risk for metabolic disorders regardless of the presence of obesity. Obese nonalcoholic fatty liver disease is more often glucose intolerant and has higher blood lipid levels than non-obese controls.
Consistent with the above studies, Oral et al also reported that obese nonalcoholic fatty liver patients from Turkey were generally glucose intolerant, had higher triglyceride and total cholesterol levels compared with the group. non-obesity. Similar findings were reported in another Turkish study, where lean nonalcoholic fatty liver patients had lower rates of hypertension and metabolic syndrome as well as insulin resistance.

Regarding the metabolic outcomes in obese and non-obese/thin NAFLD patients, a study of 669 NAFLD patients in Italy demonstrated that lean NAFLD patients had a higher frequency of hypertension. lower rates of type 2 diabetes and lower metabolic syndrome than overweight and obese NAFLD patients.
However, this result was not confirmed in a study by Shao et al in obese and non-obese Chinese NAFLD patients. The authors found that the second group had lower fasting blood sugar, total cholesterol and serum triglyceride levels, and a lower prevalence of hypertension.
Furthermore, Li et al demonstrated that the proportion of Chinese patients with increased fasting blood glucose and serum triglyceride levels was higher in the obese group than in the non-obese NAFLD patients. In addition, 2 studies from China showed a higher prevalence of metabolic syndrome and hypertension in obese subjects than in non-obese patients with NAFLD.
In the Indian population, Kumar et al reported that among lean NAFLD patients there was lower serum insulin levels and insulin resistance, as well as a higher incidence of type 2 diabetes and syndromic disease. lower metabolism than obese patients.

In studies conducted in Japan, Yoshitaka et al reported lower fasting blood pressure and blood sugar and higher serum high-density lipoprotein (HDL-C) cholesterol levels in lean subjects compared with patients NAFLD obesity.
While Honda et al also reported that fasting blood glucose, insulin, triglycerides and insulin resistance were increased in Japanese obese NAFLD patients compared with non-obese NAFLD patients.
In a sample study in Hong Kong, Wei et al. reported that non-obese NAFLD patients had a lower IR than obese NAFLD patients. Furthermore, the incidence of metabolic syndrome and hypertension has been increased in obese patients.
A study conducted in Bangladesh also showed no obesity (BMI in NAFLD patients had lower total cholesterol, fasting blood glucose, insulin resistance and HDL-C levels than in obese NAFLD patients. enlarged.

Contrary to these findings, 1 study from Korea reported a higher prevalence of metabolic syndrome components in non-obese fatty liver patients compared with obese NALFD patients. Even after adjusting for confounding factors.
Possibly unrecorded differences in diet, physical activity and smoking status between the 2 groups. Lee et al. also reported that non-obese NAFLD patients had lower rates of metabolic syndrome and hypertension as well as lower serum HDL-C levels than obese NAFLD patients. However, this study was hospital-based and not community-based.
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References
Chrysavgis L, Ztriva E, Protopapas A, Tziomalos K, Cholongitas E. Nonalcoholic fatty liver disease in lean subjects: Prognosis, outcomes and management. World J Gastroenterol 2020; 26(42): 6514-6528 [PMID: 33268944 DOI: 10.3748/wjg.v26.i42.6514]