Insulin Resistance in Nonalcoholic Fatty Liver Disease: Experience from Bangladesh

Abstract

Background: Insulin resistance (IR) has largely been hypothesized as central in multifactorial pathogenesis of nonalcoholic fatty liver disease (NAFLD). This study was aimed to explore the association of IR with NAFLD and nonalcoholic steatohepatitis (NASH).Methods: We enrolled 219 patients of NAFLD with sonographic evidence of fatty changes in liver excluding patients with alcohol intake and other causes of fatty change during June 2012 to July 2014.Liver biopsy was done for 110 patients with elevated ALT of >30 U/L for male and >18 U/L for female. We have measured IR by homeostatic model assessment of insulin resistance (HOMA-IR).Results: Age of the study population was 40.6 ± 10.0 years, male and female was 83 (37.9%) and 136 (62.1%), ALT was 42.0 (16-861) U/L, AST was 32 (16-608) U/L and GGT was 39 (10-243) U/L. According to Asian criteria 54 (25.9%) were non-obese, 139 (64.1%) had metabolic syndrome, 163 (74.8%) were hypertriglyceridemic, 200 (91.3%) had low HDL and 170 (77.4%) had high waist. Hypertensive and diabetic were 58 (26.7%) and 57 (26.1%) respectively. IR was 1.9±1.3 with the range of 0.4 to 9.3 and only 87 (39.7%) were above normal. Of the 110 biopsied, 65 (59.1%) had NASH. Normal and raised IR was associated with 32 (50.8%) and 33 (70.2%) NASH respectively (p < 0.05). Correlation between IR and steatosis, ballooning and fibrosis was not significant except lobular inflammation. IR was similar in NASH (2.2 ±1.6) and non NASH (1.9±1.6).Conclusion: Large proportion of NAFLD patients had normal IR. IR had inconsistent association with histological activity.Bangladesh Crit Care J September 2016; 4 (2): 86-91

Correlation of blood glucose, serum chemerin and insulin resistance with NAFLD in patients with type 2 diabetes mellitus

“…The close association between NAFLD and type 2 diabetes mellitus lies in that they have a common pathogenesis, insulin resistance ( 17 ). NAFLD can reduce the inhibitory effect of insulin in the body on endogenous glucose production, and reduce the body's insulin sensitivity, making it difficult to control blood glucose in patients with type 2 diabetes mellitus ( 18 ). In a study involving 2,839 patients with type 2 diabetes mellitus, the level of glycosylated hemoglobin in patients complicated by NAFLD was significantly increased compared with that in patients with simple diabetes mellitus, and the proportion of patients using insulin was also significantly increased ( 19 ).…”

Nonalcoholic Fatty Liver Disease: A New Frontier for Hepatology in Bangladesh and a Call for Action to Combat

“…31 Although IR has the central role in the pathogenesis of NAFLD, a subgroup of NAFLD of Bangladeshi population are not associated with IR, where genetic polymorphism and dietary habit may be responsible for it. 32 The most alarming feature is that there is a high prevalence of NASH of about 40% among the NAFLD patients 14,25,27 These NASH patients are the future patients of cirrhosis and hepatocellular carcinoma.…”

Study of Cellular Senescence and Vitamin D Deficiency in Nonalcoholic Fatty Liver Disease and The Potential Protective Effect of Vitamin D Supplementation

“…17 NAFLD is associated with reduced body sensitivity to insulin, making it hard for such patients to regulate their blood glucose. 18 The main metabolic disorder that leads to lipid accumulation could be attributed to IR state. This could predispose to disturbed hepatic synthesis, secretion and degradation of lipid.…”