Vahide Betül CANITEZ, İbrahim GUNEY, Edip ERKUŞ

Metabolik Sendromlu Olmayan Hastalarda Non-Alkolik Yağlı Karaciğer Hastalığı

Amaç: Non-alkolik yağlı karaciğer hastalığı (NAYKH) en yaygın kronik karaciğer hastalığı türüdür ve metabolik sendromun (MetS) hepatik kanıtıdır. Ancak NAYKH’li hastalar her zaman MetS’ye sahip değildir ve MetS’li tüm hastalar her zaman NAYKH’ye sahip değildir. Çalışmamızda MetS olmayan hastalarda NAYKH ile ilişkili faktörleri araştırmayı amaçladık. Gereç ve Yöntemler: Çalışmamız şehir merkezimizde rastgele seçilen 10 Aile Sağlığı Merkezi’nden (ASM) en az 400 gönüllü ile yapılmıştır. Bireylerden tam kan sayımı, biyokimyasal testler ve hepatobiliyer ultrasonografi (hUSG) yapıldı. Vücut kitle indeksi (BMI), homeostaz Modeli İnsülin Direnci Değerlendirmesi (HOMA-IR), fibrozis-4 (FIB-4) ve BARD skorları hesaplandı. Bulgular: Çalışmada karaciğer yağlanması prevalansı hUSG ile 33,8 % olarak tespit edildi. Karaciğer yağlanması olanlarda (n = 67) evre 1, 2 ve 3 yağlı karaciğer sıklığı sırasıyla 71,6 %, 25,4 % ve 3,0 % olarak bulundu. Tek değişkenli analizde; yağlı karaciğeri olan ve olmayan bireyler arasında yaş, vücut kitle indeksi, bel çevresi, diyastolik kan basıncı, hemoglobin, AST / ALT oranı, ALT, GGT ve trigliserit düzeyleri parametreleri açısından istatistiksel olarak anlamlı farklılıklar vardı. Çok değişkenli lojistik regresyon analizinde, BMI (OR: 1,311, p

Non-Alcoholic Fatty Liver Disease in Patients with Non-Metabolic Syndrome

Aim: Non-alcoholic fatty liver disease (NAFLD) is the most common type of chronic liver diseases and it is the hepatic evidence of metabolic syndrome (MetS). But patients with NAFLD have not always MetS, and all patients with MetS have not always NAFLD. In our study, we aimed to investigate the factors related to NAFLD in patients with non-MetS. Material and Methods: Our study was made at least 400 volunteers from 10 randomly selected Family Health Centers (FHCs) in our city center. Complete blood counts, biochemical tests and hepatobiliary ultrasonography (hUSG) were performed from the individuals. Body mass index (BMI), homeostasis Model Assessment of insulin Resistance (HOMA-IR), fibrosis-4 (FIB-4) and BARD scores were calculated. Results: The prevalence of fatty liver was detected as 33.8% with hUSG. The frequencies of stage 1, 2 and 3 fatty liver were found to be 71.6%, 25.4% and 3.0%, respectively, in those with fatty liver (n=67). In univariate analysis; there were statistically significant differences between those with and without fatty liver individuals for the parameters of age, BMI, waist circumference, diastolic blood pressure, hemoglobin, AST/ALT ratio, ALT, GGT and triglyceride levels. In multivariate logistic regression analysis, BMI (OR: 1.311, p

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1. Preiss D, Sattar N. Non-alcoholic fatty liver disease: An overview of prevalence, diagnosis, pathogenesis and treatment considerations. Clin Sci (Lond) 2008;115:141-150.
2. Shukla V, Fatima J, Chaudhary S, Ali M, Mishra I. A study of endothelial dysfunction in patients of non-alcoholic fatty liver disease. J Assoc Physicians India 2017;65(9):18-22.
3. Miyaoka Y, Jin D , Tashiro K, Masubuchi S, Ozeki M, Hirokawa F, Hayashi M, Takai S, Uchiyama K. A novel hamster nonalcoholic steatohepatitis model induced by a high-fat and high-cholesterol diet. Exp Anim 2018;67(2):239-247.
4. Neuschwander-Tetri BA. Non-alcoholic fatty liver disease. BMC Med 2017;15(1):45.
5. Streba LA, Vere CC, Rogoveanu I, Streba CT. Nonalcoholic fatty liver disease, metabolic risk factors, and hepatocellular carcinoma: An open question. World J Gastroenterol 2015; 21(14):4103-4110.
6. Vanni E, Bugianesi E, Kotronen A, De Minicis S, Yki-Järvinen H, Svegliati-Baroni G. From the metabolic syndrome to NAFLD or vice versa? Dig Liver Dis 2010;42:320-330.
7. Green RM. NASH-hepatic metabolism and not simply the metabolic syndrome. Hepatology 2003;38:14-17.
8. Cobbina E, Akhlaghi F. Non-alcoholic fatty liver disease (NAFLD) - pathogenesis, classification, and effect on drug metabolizing enzymes and transporters. Drug Metab Rev 2017;49(2): 197-211.
9. Lomonaco R, Ortiz-Lopez C, Orsak B, Webb A, Hardies J, Celia Darland, Finch J, Gastaldelli A, Harrison S, Tio F, Cusi K. Effect of adipose tissue insulin resistance on metabolic parameters and liver histology in obese patients with nonalcoholic fatty liver disease. Hepatology 2012;55(5):1389-1397.
10. Mykkanen L, Zaccaro DJ, Wagenknecht LE, Robbins DC, Gabriel M, Haffner SM. Microalbuminuria is associated with insulin resistance in nondiabetic subjects: The insulin resistance atherosclerosis study. Diabetes 1998;47(5):793-800.
11. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: Insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28(7): 412-419.
12. Sterling RK, Lissen E, Clumeck N, Sola R, Correa MC, Montaner J, Sulkowski MS, Torriani FJ, Dieterich DT, Thomas DL, Messinger D, Nelson M, APRICOT Clinical Investigators. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology 2006. 43(6): 1317-1325.
13. Harrison SA, D Oliver D, H LArnold HL, Gogia S, Neuschwander- Tetri BA. Development and validation of a simple NAFLD clinical scoring system for identifying patients without advanced disease. Gut 2008;57(10): 1441-1447.
14. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith Jr SC, Spertus JA, Costa F, American Heart Association; National Heart, Lung, and Blood Institute. Diagnosis and management of the metabolic syndrome: An American Heart Association/ National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005;112(17): 2735-2752.
15. Salva-Pastor N, Chávez-Tapia NC, Misael Uribe M, Nuño- Lámbarri N. The diagnostic and initial approach of the patient with non-alcoholic fatty liver disease: Role of the primary care provider. Gasroenterol Hepatol Bed Bench 2019;12(4):267- 277.
16. Monn K, Leem JM, Bae SS, Lee KM, Kim SH, Chae HB, Park SM, Youn SJ. The prevalence of metabolic syndrome in patients with nonalcoholic fatty liver disease. Korean J Hepatol 2004;10;197-206.
17. Kang H, Greenson JK, Omo JT, Chao C, Peterman D, Anderson L, Foess-Wood L, Sherbondy MA, Conjeevaram HS. Metabolic syndrome is associated with greater histologic severity, higher carbohydrate, and lower fat diet in patients with NAFLD. Am J Gastroenterol 2006; 101:2247-2253.
18. Younossi Z, Gramlich T, Matteoni CA, Boparai N, McCullough AJ. Nonalcoholic fatty liver disease in patients with type 2 diabetes. Clin Gastroenterol Hepatol 2004;2(3):262-265.
19. Amarapurkar D, Kamani P, Patel N, Gupte P, Kumar P, Agal S, Baijal R, Lala S, Chaudhary D, Deshpande A. Prevalence of nonalcoholic fatty liver disease: Population based study. Ann Hepatol 2007;6:161-163.
20. Yang S, Kwak S, Lee JH, Kang S, Lee SP. Nonalcoholic fatty liver disease is an early predictor of metabolic diseases in a metabolically healthy population. Plos One 2019;14(11): e0224626.
21. Makker J, Tariq H , Bella JN, Kumar K, Chime C, Patel H, Kamal MU, Shaikh D, Vootla V, Bajantri B, Gomceli U, Alshelleh M, Peralta R, Zhang A, Chilimuri S. Preclinical cardiac disease in nonalcoholic fatty liver disease with and wtihout metabolic syndrome. Am J Cardiovasc Dis 2019;9(5):65-77.
22. Yilmaz Y, Senates E, Ayyildiz T, Colak Y, Tuncer İ, Kurdas Ovunc AO, Dolar E, Kalayci C. Characterization of nonalcoholic fatty liver disease unrelated to the metabolic syndrome. Eur j Clin Invest 2012;42 (4):411-418.
23. Marchesini G, Bugianesi E, Forlani G, Cerrelli F, Lenzi M, Manini R, Natale S, Vanni E, Villanova N, Melchionda N, Rizzetto M. Nonalcoholic fatty liver disease, steatohepatitis, and the metabolic syndrome. Hepatology 2003;37:917-923.
24. Trak-Smayra V, Dargere D, Noun R, Albuquerque M, Yaghi C, Gannagé-Yared MH, Bedossa P, Paradis V. Serum proteomic profiling of obese patients: Correlation with liver pathology and evoluation after bariatric surgery. Gut 2009;58:825-832.
25. Xu L, Xu CF, Yu CH, Miao M, Li YM. Haemoglobin and non- alcoholic fatty liver disease: Further evidence from a population- based study. Gut 2009;58:1706-1707.
26. Brunt EM, Tiniakos DG. Histopathology of nonalcoholic fatty liver disease. World J Gastroenterol 2010;16(42): 5286-5296.