Non-alcoholic fatty liver disease and metabolic syndrome in Brazilian middle-aged and older adults
Keywords:
Fatty liver, Aged, Middle aged, Metabolic syndrome X, BrazilAbstract
CONTEXT AND OBJECTIVES: Non-alcoholic fatty liver disease (NAFLD) is a complex clinicopathological entity characterized by diffuse or focal fat accumulation in the hepatic parenchyma of patients who deny abusive alcohol consumption. This study aimed to assess idiopathic NAFLD in community-dwelling, middle-aged and older adults living in the Brazilian Federal District. Associations between NAFLD and components of metabolic syndrome and the whole syndrome were investigated. DESIGN AND SETTINGS: This was a cross-sectional study on 139 subjects aged 55 years or older. METHODS: NAFLD was diagnosed by means of clinical procedures, to exclude subjects with signs of liver disorders, abusive alcohol consumption and infl uence from hepatotoxic drugs. Phenotypes were graded based on ultrasound examination. Metabolic syndrome was defi ned using the NCEP ATP III criteria. Laboratory tests were performed to assist clinical examinations and defi ne the syndrome. RESULTS: NAFLD was present in 35.2% of the subjects. Taken together, the two most intense phenotypes correlated with increased serum fasting glucose, triglyceride and VLDL cholesterol levels. Metabolic syndrome was diagnosed in 25.9% of the sample. In addition to associating NAFLD with specifi c traits of metabolic syndrome, non-parametric analysis confi rmed the existence of a relationship (p < 0.05) between the steatotic manifestation and the syndromic condition. CONCLUSION: Compared with the literature, this study reveals greater frequency of idiopathic NAFLD among Brazilian middle-aged and older adults than is described elsewhere. The fi ndings also suggest that impaired glycemic metabolism coupled with increased fat delivery and/or sustained endogenous biosynthesis is the most likely physiopathogenic mechanisms underlying the onset of NAFLD in this population.
Downloads
References
Akbar DH, Kawther AH. Non-alcoholic fatty liver disease and metabolic syndrome: what we know and what we don’t know. Med Sci Monit. 2006;12(1):RA23-6.
Day CP, James OF. Hepatic steatosis: innocent bystander or guilty party? Hepatology. 1998;27(6):1463-6.
Younossi ZM. Nonalcoholic fatty liver disease. Curr Gastroen- terol Rep. 1999;1(1):57-62.
Bellentani S, Tiribelli C, Saccoccio G, et al. Prevalence of chronic liver disease in the general population of northern Italy: the Dionysos Study. Hepatology. 1994;20(6):1442-9.
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report on the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001;285(19):2486-97.
Osawa H, Mori Y. Sonographic diagnosis of fatty liver using a histogram technique that compares liver and renal cortical echo amplitudes. J Clin Ultrasound. 1996;24(1):25-9.
Park SH, Jeon WK, Kim SH, et al. Prevalence and risk factors of non-alcoholic fatty liver disease among Korean adults. J Gastroenterol Hepatol. 2006;21(1 Pt 1):138-43.
Mulhall BP, Ong JP, Younossi ZM. Non-alcoholic fatty liver disease: an overview. J Gastroenterol Hepatol. 2002;17(11):1136-43.
Nomura H, Kashiwagi S, Hayashi J, Kajiyama W, Tani S, Goto M. Prevalence of fatty liver in a general population of Okinawa, Japan. Jpn J Med. 1988;27(2):142-9.
Bellentani S, Saccoccio G, Masutti F, et al. Prevalence of and risk factors for hepatic steatosis in Northern Italy. Ann Intern Med. 2000;132(2):112-7.
Falck-Ytter Y, Younossi ZM, Marchesini G, McCullough AJ. Clinical features and natural history of nonalcoholic steatosis syndromes. Semin Liver Dis. 2001;21(1):17-26.
Ruhl CE, Everhart JE. Epidemiology of nonalcoholic fatty liver. Clin Liver Dis. 2004;8(3):501-19, vii.
Marchesini G, Bugianesi E, Forlani G, et al. Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology. 2003;37(4):917-23.
Angulo P, Alba LM, Petrovic LM, Adams LA, Lindor KD, Jensen MD. Leptin, insulin resistance, and liver fibrosis in human nonalcoholic fatty liver disease. J Hepatol. 2004;41(6):943-9.
Angulo P, Lindor KD. Non-alcoholic fatty liver disease. J Gastroenterol Hepatol. 2002;17 Suppl:S186-90.
Kim HJ, Kim HJ, Lee KE, et al. Metabolic significance of nonalcoholic fatty liver disease in nonobese, nondiabetic adults. Arch Intern Med. 2004;164(19):2169-75.
Sabir N, Sermez Y, Kazil S, Zencir M. Correlation of abdominal fat accumulation and liver steatosis: importance of ultrasono- graphic and anthropometric measurements. Eur J Ultrasound. 2001;14(2-3):121-8.
Bacon BR, Farahvash MJ, Janney CG, Neuschwander-Tetri BA. Nonalcoholic steatohepatitis: an expanded clinical entity. Gastroenterology. 1994;107(4):1103-9.
Bashist B, Hecht HL, Harley WD. Computed tomographic demonstration of rapid changes in fatty infiltration of the liver. Radiology. 1982;142(3):691-2.
Chaimowicz F. A saúde dos idosos brasileiros às vésperas do século XXI: problemas, projeções e alternativas. [Health of Brazilian elderly population on the eve of the 21st century: current problems, forecasts and alternatives]. Rev Saúde Pública = J Public Health. 1997;31(2):184-200.
Nóbrega OT, Melo GF, Karnikowski MGO. Pattern of drugs prescribed for community-residing middle-aged and older adults from the outskirts of Brasília. Rev Bras Ciênc Farm 2005;41(2):271-7.
Forattini OP. Qualidade de vida e meio urbano. A cidade de São Paulo, Brasil. [Quality of life and urban environment. São Paulo city, Brazil]. Rev Saúde Pública = J Public Health. 1991;25(2):75-86.
