Serum IGF-1, HOMA-IR and Estimated Glomerular Filtration Rate in Obese Patients with Different Stages of Hepatic Steatosis

Background: Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver injury in many countries around the world. The histological changes range over a wide spectrum, extending from simple steatosis, which is generally progressive, to non alcoholic steatohepatitis (NASH) which may progress to liver fibrosis, liver cirrhosis, liver cell failure, and sometimes even hepatocellular carcinoma. Liver biopsy is recommended as a gold standard method for the diagnosis and staging of steatosis and fibrosis in patients with NAFLD. low IGF-I level are a consequence of the presence of both NASH/advanced fibrosis in adult patients proved by liver biopsy which is a features of abdominal obesity and insulin resistance (HOMA-IR) and all contribute to the reduced eGFR. Objectives: Assessing the link between HOMA-IR, IGF-I level and eGFR in obese patient with different grades of severity of hepatic steatosis proved by liver biopsy. Methods: 54 overweight and obese patients preliminary diagnosed to have NAFLD by liver ultrasound ± elevated liver enzymes and documented by liver biopsy, and 20 age , and sex matched normal Body mass index (BMI), healthy participants as a control group, had been recruited in the current study. Diabetic patients and patients with elevated serum creatinine were excluded from the study. The patients subjected to full medical history, anthropometric measurement, biochemical studies (liver enzymes, HCV antibody, HBVs antigen, total lipid profile, serum creatinine, estimated glomerular filtration rate “eGFR”, fasting blood sugar, fasting insulin level to calculate Homeostatic model assessment of insulin resistance “HOMA-IR”, and IGF-I). Abdominal ultrasound (US), and liver biopsy for histological examination and NAS score to identify NASH patients, were conducted for each participant. According to NAS score, patients were divided into 3 subgroups; NASH, border-line NASH, and non-NASH (simple steatosis). Healthy control participants were not scheduled for liver biopsy for ethical consideration. Results: According to the biopsy results; 7 patients had simple steatosis “not NASH”, 26 patients; border line NASH, and 21 patients had NASH. BMI, and waist circumference were significantly higher in patients than control participant” p < 0.001”, and the highest measurements were in NASH patients. ALT, GGT were significantly higher in NAFLD patients in general and in NASH patient subgroup. HOMA-IR reached 3.57 ± 1.57 compared to 1.87 ± 0.43 in control, and reached 3.94 ± 1.61 in NASH patients compared to 3.20 ± 1.22 in simple steatosis. IGF-I; was highly significantly lower in NAFLD patients compared to healthy control participants (58.15 ± 20.26 & 130.0 ± 19.44 ng/ml respectively), and was higher 66.81 ± 21.56 ng/ml in non-NASH compared to NASH patients 56.92 ± 19.80 ng/ml. eGFR was highly significantly lower in NAFLD patients 60.68 ± 10.17ml/min compared to healthy control 95.81 ± 170 Serum IGF-1, HOMA-IR and Estimated Glomerular Filtration Rate in Obese Patients with Different Stages of Hepatic Steatosis Citation: Mona Abd-Elmonem hegazy. , et al. “Serum IGF-1, HOMA-IR and Estimated Glomerular Filtration Rate in Obese Patients with Different Stages of Hepatic Steatosis”. EC Gastroenterology and Digestive System 1.5 (2017): 169-178. 17.70 ml/min, with” p < 0.001”, to reach below 60ml/min in NASH subgroup 58.03 ± 9.01ml/min resulting in” p value of 0.004” when compared to patients with border line and non-NASH. Conclusion: There was a definitive association between low IGF-1, high level of HOMA-IR, and reduced eGFR with the incidence of NAFLD with different grades of severity. In NAFLD patients’ eGFR was lower than 90ml/min, and lower than 60ml/min in NASH and border line NASH patients