Obesity and metabolic syndrome as risk factors for the development of non-alcoholic fatty liver disease as diagnosed by ultrasound
Authors: Petrovic Gordana , Bjelakovic Goran , Benedeto-Stojanov Daniela , Nagorni Aleksandar , Brzacki Vesna , Markovic-Zivkovic Bojana 
Published: May 2016

Introduction/ aim. Non-alcoholic fatty liver disease (NAFLD) is a chronic
liver disease of a broad histological spectrum, characterized by the
accumulation of triglycerides in more than 5% of hepatocytes in the absence
of consuming alcohol in quantities harmful to the liver. The aim of our study
was to determine the importance of anthropometric and laboratory parameters
as well as metabolic syndrome (MS) for the diagnosis of NAFLD and to estimate
their influence on the degree of liver steatosis as evaluated by ultrasound
(US). Methods. The study included 86 participants, 55 of whom had fatty liver
diagnosed by ultrasound and they comprised the study group. The control group
consisted of 31 control subjects. During the course of hospitalization at the
Clinic of Gastroenterology and Hepatology, Clinical Centre Nis, the patients
had their anamnesis taken, and anthropometric measurements as well as
biochemical blood analyses and abdominal ultrasound were performed. Results.
The patients with NAFLD had statistically higher values of body mass index
(BMI), waist circumference (WC), systolic (SBP) and diastolic blood pressure
(DBP), levels of alanin and aspartate aminotransferase (ALT, AST),
gamma-glutamyl transpeptidase (GGT) (p<0.001), low-density lipoprotein
cholesterole (LDL), total bilirubin (TBIL) (p<0.05), total cholesterol
(p<0.01), triglycerides (TGL), urates, C-reactive protein (CRP), ferritin,
fibrinogenes, fasting blood glucose (FBG), insulin and Homeostasis Model
Assessment (HOMA-IR) (p<0.001), whereas the levels of high-density
lipoprotein cholesterol (HDL) were higher in the control group (p<0.05). In
the NAFLD group, there were statistically significantly more patients with
hypertension (72.73% vs. 12.90%, p<0.001) and type 2 diabetes mellitus (DM)
(47.27%). Metabolic syndrome was determined in 48 (87.27%) patients of the
study group. An equal number of patients, 16 of them (29.09%), had 3, 4 and 5
components of MS. In the NAFLD group there were 17 overweight (30.91%) (BMI
from 25 kg/m2 to 29.9 kg/m2) and 38 (69.09%) obese patients. (BMI ? 30.0
kg/m2). The largest number of patients in the obesity group, 22 (40.00%) of
them, had the first degree obesity (BMI from 30 kg/m2 to 34.99 kg/m2). The
largest number of the NAFLD group patients - 23 (41.82%), had an ultrasound
finding of grade 3 fatty liver, 20 patients (36.36%) had grade 2 and 12
(21.82%) grade 1 fatty liver. Kruskal-Wallis test and ANOVA analysis showed
statistically significant differences between groups with different US grade
for insulin, LDL-cholesterol, WC, BMI (p<0.05), as well as HOMA-IR and body
weight (BW) (p<0.01). Metabolic syndrome was statistically more present in
patients with US finding grades 2 and 3 (p<0.01) in relation to grade 1 US
finding, as well as obesity, hypertension and DM type 2 (p<0.05). Conclusion.
The results of our study have confirmed that a high percentage of patients
with high risk factors (DM, MS, dyslipidemia, hypertension) have NAFLD.