International Journal of Medicine Research

Authors
Dr. Priyank Jain, Dr. Rohit Parate, Dr. TN Dubey, Dr. RK Jain

Abstract
Background: Non-alcoholic fatty liver disease (NAFLD) is a clinicopathologic entity increasingly recognized as a major health burden in developing countries. It includes a spectrum of liver damage ranging from simple steatosis to nonalcoholic steatohepatitis (NASH), advanced fibrosis, and rarely, progression to cirrhosis. Various study in past have tried to establish association between serological markers and NFALD, but have not been proven to be effective in determining the further prognosis of disease. Aims and Objective: To determine the prevalence of non alcoholic fatty liver disease (NAFLD) in metabolic syndrome (MS) and to establish a correlation between various serological and sociodemographic parameters in MS and NFALD grades and to establish a correlation of NAFLD and BMI to determine the presence of Lean NASH. Materials and methods: Hundred patients with MS were studied at the Department of Medicine, Gandhi Medical College and associated Hamidiya Hospital, Bhopal from November 2015 to August 2017. Detailed history, sociodemographic profile and serum markers including haemoglobin, lipid profile, ALT, AST, fasting blood sugar, serum uric acid, hs CRP, fasting insulin level were estimated in each patient. Diagnosis of NAFLD was made using ultrasonography and patients were grouped in to Grade 1 (mild steatosis), Grade 2 (moderate steatosis) and Grade 3 (severe steatosis). All the groups were compared with serologic markers and waist circumference to identify the presence of NAFLD in Lean (Lean NASH). Results: Prevalence of NFALD in study cohort was 64% and significantly higher in patients with age group >55 (p=0.011) years. NFALD was significantly higher in patients with WHR between 0.9-1.1 (p=0.049), WC ≥90 cm (p=0.046), SBP of ≥130 mmHg (p=0.046), DBP ≥80 mmHg (p=0.043), who were smokers (p=0.044), presence of type 2 diabetes mellitus (T2DM) (p=0.023), FBG >110 mg/dL (p=0.042), increasing SGPT (p=0.026), total cholesterol ≥200 mg/dL (p=0.042), triglyecrides ≥150 mg/dL (p=0.040), LDL >130 mg/dL (p=0.027), HDL <30 mg/dL (p=0.023), fasting insulin >25 units (p=0.001) and uric acid level of ≥5.5 Units (p=0.033). In patients with lean NASH, most of them had WC >90 cm (p=0.0012), TG >150 mg/dL (p<0.049), LDL >130 mg/dL (p=0.032), HDL level <40 (p=0.048), fasting insulin level of >25 units (p=0.086) and Hb >10 (p=0.002) which were comparable to levels in overweight and obese. Conclusion: Prevalence of NFALD was high among the MS patients. Most of them had direct association with WC, abdominal obesity, WHR, fasting blood sugar, TG, LDL, TC, ALT, serum uric acid, h SCRP and fasting insulin and inverse correlation with HDL. We also found significant NAFLD amongst the patients of MS and Normal BMI (Lean NASH).