Insulin Resistance and Non-Alcoholic Fatty Liver Disease in Premenopausal Women with Metabolic Syndrome

 

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Abstract

It is suggested that estrogen protects premenopausal women against non-alcoholic fatty liver disease. From another perspective, the relation between metabolic syndrome (MetS) and non-alcoholic fatty liver disease (NAFLD) is bidirectional. Role of insulin resistance (IR) in NAFLD continues to be a matter of debate. The present study aimed to assess the relation between IR and NAFLD in premenopausal women with MetS. The study included 51 premenopausal women with MetS. In addition, there were 40 age-matched healthy controls. All participants were subjected to careful history taking and thorough clinical examination. Performed laboratory investigations included fasting blood glucose, fasting insulin, lipid profile, and liver functions. Calculation of IR was achieved by the Homeostasis Model Assessment (HOMA-IR). NAFLD was graded into three grades according to findings of abdominal ultrasound. Patients had significantly higher BMI, SBP, DBP, FBG, fasting insulin, HOMA-IR, total cholesterol, triglycerides, and LDL levels when compared with controls. They also had significantly lower HDL levels in comparison to controls. Moreover, they have more advanced grades of NAFLD in contrast to controls. Comparison between patients with various grades of NAFLD regarding the clinical data revealed significant increase of fasting insulin and HOMA-IR levels with advancing NAFLD grade. Using multivariate regression analysis, HOMA-IR was an independent predictor of advanced NAFLD grade. In conclusion, the present study documented a combined inter-relation between MetS, IR, and NAFLD in premenopausal women with MetS. IR is correlated with NAFLD grade.

Publication History

Received: 14 July 2020

Accepted: 17 December 2020

Article published online:
29 January 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

• References

• 1 Alberti KG, Eckel RH, Grundy SM. et al. Harmonizing the metabolic syndrome: A joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009; 120: 1640-1645
  CrossrefPubMedGoogle Scholar
• 2 Eckel RH, Alberti KG, Grundy SM. et al. The metabolic syndrome. Lancet 2010; 375 (9710) 181-183
  CrossrefPubMedGoogle Scholar
• 3 Saklayen MG. The Global Epidemic of the Metabolic Syndrome. Curr Hypertens Rep 2018; 20: 12
  CrossrefPubMedGoogle Scholar
• 4 Parker VE, Semple RK. Genetics in endocrinology: Genetic forms of severe insulin resistance: What endocrinologists should know. Eur J Endocrinol 2013; 169: R71-R80
  CrossrefPubMedGoogle Scholar
• 5 Takatori S, Zamami Y, Hashikawa-Hobara N. et al. Insulin resistance-induced hypertension and a role of perivascular CGRPergic nerves. Curr Protein Pept Sci 2013; 14: 275-281
  CrossrefPubMedGoogle Scholar
• 6 Buzzetti E, Pinzani M, Tsochatzis EA. The multiple-hit pathogenesis of non-alcoholic fatty liver disease (NAFLD). Metabolism 2016; 65: 1038-1048
  CrossrefPubMedGoogle Scholar
• 7 Wainwright P, Byrne CD. Bidirectional relationships and disconnects between NAFLD and features of the metabolic syndrome. Int J Mol Sci 2016; 17: 367
  CrossrefPubMedGoogle Scholar
• 8 Alam S, Mustafa G, Alam M. et al. Insulin resistance in development and progression of nonalcoholic fatty liver disease. World J Gastrointest Pathophysiol 2016; 7: 211-217
  CrossrefPubMedGoogle Scholar
• 9 Stefan N, Häring HU, Cusi K. Non-alcoholic fatty liver disease: Causes, diagnosis, cardiometabolic consequences, and treatment strategies. Lancet Diabetes Endocrinol 2019; 7: 313-324
  CrossrefPubMedGoogle Scholar
• 10 Vryonidou A, Paschou SA, Muscogiuri G. et al. Mechanisms in endocrinology: Metabolic syndrome through the female life cycle. Eur J Endocrinol 2015; 173: R153-R163
  CrossrefPubMedGoogle Scholar
• 11 Chedraui P, Perez-Lopez FR. Metabolic syndrome during female midlife: What are the risks?. Climacteric 2019; 22: 127-132
  CrossrefPubMedGoogle Scholar
• 12 Lonardo A, Nascimbeni F, Ballestri S. et al. Sex differences in nonalcoholic fatty liver disease: State of the art and identification of research gaps. Hepatology 2019; 70: 1457-1469
  CrossrefPubMedGoogle Scholar
• 13 Alberti KG, Zimmet P, Shaw J. Metabolic syndrome–a new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabet Med 2006; 23: 469-480
  CrossrefPubMedGoogle Scholar
• 14 Levy JC, Matthews DR, Hermans MP. Correct homeostasis model assessment (HOMA) evaluation uses the computer program. Diabetes Care 1998; 21: 2191-2192
  CrossrefPubMedGoogle Scholar
• 15 Kakrani AL, Sharma ZD, Thind SS. et al. Correlation of NAFLD fibrosis score and BARD score with ultrasonographic evidence of nonalcoholic fatty liver disease in overweight patients: A prospective study. Int J Med Public Health 2013; 3: 111-114
  CrossrefPubMedGoogle Scholar
• 16 Petrovic G, Bjelakovic G, Benedeto-Stojanov D. et al. Obesity and metabolic syndrome as risk factors for the development of non-alcoholic fatty liver disease as diagnosed by ultrasound. Vojnosanit Pregl 2016; 73: 910-920
  CrossrefPubMedGoogle Scholar
• 17 Yang KC, Hung HF, Lu CW. et al. Association of non-alcoholic fatty liver disease with metabolic syndrome independently of central obesity and insulin resistance. Sci Rep 2016; 627034
  PubMedGoogle Scholar
• 18 Cuenza LR, Razon TLJ, Dayrit JC. Correlation between severity of ultrasonographic nonalcoholic fatty liver disease and cardiometabolic risk among Filipino wellness patients. J Cardiovasc Thorac Res 2017; 9: 85-89
  CrossrefPubMedGoogle Scholar
• 19 Pardhe BD, Shakya S, Bhetwal A. et al. Metabolic syndrome and biochemical changes among non-alcoholic fatty liver disease patients attending a tertiary care hospital of Nepal. BMC Gastroenterol 2018; 18: 109
  CrossrefPubMedGoogle Scholar
• 20 Finck BN, Hall AM. Does diacylglycerol accumulation in fatty liver disease cause hepatic insulin resistance?. Biomed Res Int 2015; 2015104132
  PubMedGoogle Scholar
• 21 Meex RCR, Watt MJ. Hepatokines: Linking nonalcoholic fatty liver disease and insulin resistance. Nat Rev Endocrinol 2017; 13: 509-520
  CrossrefPubMedGoogle Scholar
• 22 Stefan N, Häring HU. Circulating fetuin-A and free fatty acids interact to predict insulin resistance in humans. Nat Med 2013; 19: 394-395
  CrossrefPubMedGoogle Scholar
• 23 Stefan N, Häring HU. The role of hepatokines in metabolism. Nat Rev Endocrinol 2013; 9: 144-152
  CrossrefPubMedGoogle Scholar
• 24 Zhang Y, Zhang T, Zhang C. et al. Identification of reciprocal causality between non-alcoholic fatty liver disease and metabolic syndrome by a simplified Bayesian network in a Chinese population. BMJ Open 2015; 5: e008204
  CrossrefPubMedGoogle Scholar
• 25 Asrih M, Jornayvaz FR. Metabolic syndrome and nonalcoholic fatty liver disease: Is insulin resistance the link?. Mol Cell Endocrinol 2015; 418 Pt 155-165
  CrossrefPubMedGoogle Scholar
• 26 Stefan N. Causes, consequences, and treatment of metabolically unhealthy fat distribution. Lancet Diabetes Endocrinol 2020; 8: 616-627
  CrossrefPubMedGoogle Scholar