Triglyceride levels but not adipokine concentrations as metabolic determinants of advanced non-alcoholic fatty liver disease

Only a fraction of patients with fatty liver infiltration develop advanced liver disease. The aim of the study was to examine metabolic determinants of non-alcoholic fatty liver disease (NAFLD) in obese patients. At the time of obesity surgery, 142 consecutive patients from an obesity surgery population underwent liver biopsy. Liver histology was scored using the NAFLD activity score, and patients were divided into four groups: simple steatosis, NAFLD, borderline non-alcoholic steatohepatitis (NASH), and definitive NASH. The prevalence of type 2 diabetes and metabolic syndrome did not differ among the four histological groups. Triglyceride (TG) and alanine transaminase (ALT) levels were strongly associated with advanced stages of NAFLD and NASH. TG levels >150 mg/dL increased 3.4-fold the likelihood of NASH, whereas HDL-C levels were not predictive for NAFLD. Concentrations of TNF-alpha, leptin, and retinol-binding protein 4 did not identify NASH, but adiponectin tended to be lower in NASH versus no NAFLD. In conclusion, both TG and ALT levels are associated with NASH in obese patients. These findings highlight the importance of fatty acid metabolism to NASH development in severely obese subjects.

Abstract

Keywords:
Adiponectin – HDL cholesterol – Leptin – Metabolic syndrome – NAFLD – Obesity – Triglycerides – Type 2 diabetes