CLINICAL PROFILE OF PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE AND INSULIN RESISTANCE
DOI:
https://doi.org/10.11603/1811-2471.2024.v.i3.14901Keywords:
non-alcoholic steatohepatitis, liver, albumin, metabolic syndrome, lipid metabolism, lipidogram, steatohepatosis, insulin resistanceAbstract
SUMMARY. Non-alcoholic fatty liver disease (NAFLD) is a significant medical concern that has reached pandemic proportions in the 21st century. While research on NAFLD continues, many aspects of its pathogenesis, diagnosis, and treatment remain unclear. Insulin resistance (IR) is a common comorbidity of NAFLD, grounded in metabolic syndrome, worsening prognosis and accelerating disease progression. The combination of NAFLD and IR is also associated with an increased risk of cardiovascular diseases, underscoring the need to understand the clinical profile of these patients to develop effective treatment and prevention strategies.
The aim – to evaluate the clinical profile changes in patients with non-alcoholic fatty liver disease and insulin resistance.
Material and Methods. The study involved 137 patients, including 86 men and 51 women aged 18 to 70 years. Patients were screened to exclude comorbid conditions such as viral hepatitis, cirrhosis, alcohol abuse, toxic and drug-associated liver diseases, autoimmune diseases, and type 1 or 2 diabetes. NAFLD diagnosis was confirmed using validated tests like Fib-4 and NAFLD Fibrometer, while IR was assessed using the HOMA index. Patients were divided into two groups: Group 1 – patients with comorbid NAFLD and IR (n=76), and Group 2 – patients with isolated NAFLD (n=61). The groups were comparable in terms of the number of patients, age, and gender.
Results. Asthenovegetative syndrome was common in both groups, but more frequent among patients with comorbid NAFLD and IR (90.78 % vs. 70.49 %). Complaints of dyspeptic syndrome, including nausea and bitterness in the mouth, were also more prevalent in this group. Additionally, patients with comorbidities more often reported dry mouth and increased appetite. Laboratory tests, such as ALT, AST, and the De Ritis ratio, were elevated in patients with IR, indicating liver dysfunction. The comorbid group also showed decreased total protein and albumin levels, suggesting impaired liver synthetic function. Glucose levels were higher in the comorbid group and correlated with IR, confirming its role in the pathogenesis of this condition. Leptin levels were also elevated in the comorbid group, potentially serving as a marker for metabolic disturbances and inflammation. Lipid profiles indicated that all parameters were higher in patients with comorbidities, with triglycerides and atherogenic index exceeding normal ranges, indicating impaired liver metabolic function.
Conclusions. Patients with comorbid NAFLD and IR more frequently reported general weakness, fatigue, sleep disturbances, loss of appetite, nausea, and bitterness in the mouth, indicating asthenovegetative and dyspeptic syndromes. The combined disease group exhibited elevated levels of ALT, AST, De Ritis ratio, total bilirubin, and decreased levels of total protein and albumin, indicating liver dysfunction. Leptin levels were significantly higher in the comorbid group and may serve as a marker for disease progression. The lipid profile parameters showed a significant correlation with IR in NAFLD patients, indicating impaired liver metabolic function.
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