Non-alcoholic Fatty Liver Disease (NAFLD) and its association with metabolic syndrome and cardiovascular diseases
Abstract
Non Alcoholic Fatty Liver Disease is also becoming public health impotance nowadays. So this study was aimed to determine the association of Non Alcoholic Fatty Liver Disease with metabolic syndrome and Cardio-Vascular disease along with assessment of degree of severity of NAFLD with respect to number of components of metabolic syndrome. This study includes a total of 222 subjects were enrolled as per the inclusion/exclusion criteria, out of which 110 cases who had NAFLD with hepatic steatosis on ultrasonography and 112 subjects who did not have NAFLD were considered control. These cases and controls were interrogated and investigated further. Observations were recorded and association of Non Alcoholic Fatty Liver Disease with metabolic syndrome and CardioVascular disease along with assessment of degree of severity of NAFLD with respect to number of components of metabolic syndrome. Statistical methods used were unpaired student’s t-test for continuous variables, Fischer’s and chi-sq test for categorical variables using bivariate analysis by Graph Pad Instat Version 3.10. Risk was assessed in terms of Odd's Ratio. The patients with MS and NAFLD had a higher proportion of CVD compared with those who did not have NAFLD (29.1 vs 18.1 %). This study concludes that NAFLD is significantly associated with MS; most significant with WC, followed by TG and FBS and thus can be considered as hepatic component of MS. This needs more research with large multi-centric prospective studies to evaluate NAFLD as an independent risk factor for CVD.
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Introduction
Non - alcoholic fatty liver disease (NAFLD) is the most common cause of abnormal liver function tests among adults 1-4 . NAFLD refers to a wide spectrum of hepatic disorders in clinical practice ranging from simple fatty liver to non - alcoholic steatohepatitis (NASH) to cirrhosis. The definition of nonalcoholic fatty liver disease (NAFLD) requires that (a) there is evidence of hepatic steatosis, either by imaging or by histology and (b) there are no causes for secondary hepatic fat accumulation such as significant alcohol consumption, use of steatogenic medication or hereditary disorders 5 . Approximately 20 to 30% of adults in the general population in Western countries have non-alcoholic fatty liver disease, and its prevalence increases to 70 to 90% among persons who are obese or have diabetes; such patients are also at increased risk for the development of advanced fibrosis and cirrhosis 1, 6-8 . Obesity is a common and well documented risk factor for NAFLD. Both excessive BMI and visceral obesity are recognized risk factors for NAFLD. The metabolic syndrome, as well as each of its five components, is strong risk factors for the presence of NAFLD 9-12. This has led investigators to suggest that NAFLD is a component of the Metabolic Syndrome 13, 14 . ATP III introduced the metabolic syndrome into its clinical guidelines in the effort to achieve CVD risk reduction beyond LDL-lowering therapy. People with NAFLD harbour the same cardiovascular risk factors (hypertension, dyslipidemia, obesity, physical inactivity, insulin resistance, endothelial dysfunction, and inflammation) as metabolic syndrome that places them at higher risk of cardiovascular events.
There is paucity of Indian studies on prevalence of NAFLD and its relationship to metabolic syndrome in the normal population. With the presence of metabolic syndrome in epidemic proportions in the Indian population it is fair to say that there may be an underlying silent epidemic of NAFLD but its prevalence, rate of progression, impact on quality of life as well as life expectancy needs to be explored further. Similarly, there are strong suggestions linking cardiovascular disease to NAFLD as that to the metabolic syndrome but limited conclusive data are available at present. So this present study is conducted with the primary objective of this study was to determine the association of NAFLD with metabolic syndrome and thus with CVD in the Indian population, by using clinical and laboratory data and simple cost effective, non invasive method; ultrasonogram of the liver. A secondary objective of this study is to determine an association between NAFLD and CVD independent of the metabolic syndrome.
Conclusion
This study conclude that NAFLD is associated with MS and thus can be considered as hepatic component of MS. Amongst the various cardiometabolic factors association was most significant with WC, followed by TG and FBS. Degree of severity of NAFLD does not correlate with the increasing components of metabolic syndrome. Only presence of NAFLD on ultrasonogram has its own importance. Presence of NAFLD may predict higher CVD risk irrespective of presence or absence of MS. This needs more research with large multi-centric prospective studies to evaluate NAFLD as an independent risk factor for CVD. Waist circumference as an anthropometric measurement of body fat distribution is simple and non-invasive tool for prediction of NAFLD in metabolic syndrome.