Nonalcoholic fatty liver disease is associated with insulin resistance in a young Hispanic population
Introduction
Nonalcoholic fatty liver disease (NAFLD) is characterized by the accumulation of hepatic fat in patients without history of excessive alcohol consumption (Browning et al., 2004). This condition may progress to nonalcoholic steatohepatitis (NASH), liver cirrhosis and hepatocellular carcinoma (Angulo, 2005). A close association between NAFLD and insulin resistance (IR) has been reported (Marchesini et al., 2001a, Targher et al., 2007, Utzschneider and Kahn, 2006). Moreover, the prevalence of metabolic syndrome (MS) in NAFLD is very high, and it has been suggested that IR could be not only a mere occasional finding, but also a pathogenic factor responsible for both MS and hepatic steatosis (Bugianesi et al., 2004).
A higher prevalence of hepatic steatosis has been described in Hispanic populations compared to Caucasic populations, and it has been proposed that this difference is caused by a higher prevalence of obesity and IR in these ethnic groups (Browning et al., 2004). Previously, our group reported that Colombian population had also a greater propensity to develop IR and MS at relatively lower levels of abdominal obesity (Garcia et al., 2006, Garcia et al., 2007), which could be related to epigenetic adaptations forced by the abrupt urbanization process, the sedentary lifestyle and the consumption of high fat and calorie foods (Lopez-Jaramillo et al., 2008). It has been hypothesized that in this population, fetal programming in response to maternal malnutrition results in the development of fetus with an increased tendency to develop IR, with deficient hepatic, renal, cardiac and pancreatic anatomical structures, which might explain the increased risk for certain chronic diseases, including type 2 diabetes mellitus, renal and cardiac failure and cirrhosis observed in developing countries (Lopez-Jaramillo, 2009). In light of these observations, the aim of the present study was to determine whether NAFLD was associated with MS and IR markers in a young Hispanic population.
Section snippets
Study population
A cross-sectional study was performed in 263 officers (age range 29–54 years) from the Colombian Air Force personnel, who attended an annual medical examination in 2006. The study was approved by the Ethics Committee of the Nueva Granada Military University. Subjects who presented acute or chronic inflammatory diseases and/or cancer were excluded.
Procedures
A verbal interview aimed to determine cardiovascular risk factors and medication use was performed in all participants. All anthropometric measures
Results
The anthropometric and biochemical characteristics of the 263 male individuals included are described in Table 1. None of the subjects had a history of alcohol consumption exceeding 14 drinks per week. NAFLD was detected by ultrasound examination in 70 subjects (26.6%). Only 34 of these individuals had complete MS criteria. Patients with NAFLD had a higher body mass index, waist perimeter, diastolic blood pressure, triglycerides, fasting plasma insulin, post-glucose load levels, uric acid,
Discussion
In the present study individuals with NAFLD had higher prevalence of MS criteria (48.6% vs. 14%) compared to normal subjects. In addition, high density lipoprotein cholesterol levels, subcutaneous fat and visceral fat were identified as significant predictors of NAFLD in our population. Previously it had been postulated that NAFLD represented the hepatic component of MS (Sobhonsldsuk et al., 2007, Angulo, 2005). Most cases of NAFLD have been associated with obesity (40–100%) and hyperlipidemia
Conclusion
In conclusion, our results demonstrated that NAFLD is associated with IR in a young male Hispanic population. The strong association of IR with NAFLD is particularly relevant in epidemiological terms. Because of the association of MS with a more severe grading of liver histology in NAFLD, our results underline the increased risk of forthcoming liver failure in the next decades for Hispanic population. Further studies are required to establish the genetic and epigenetic mechanisms that grant our
Conflict of interest statement
The authors declare that there are no conflicts of interest.
Acknowledgments
We would like to express our gratitude to Jean Noel Guillemot for reviewing syntax and style.
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2022, The Lancet Gastroenterology and HepatologyCitation Excerpt :We could not verify this claim in our study because neither of the two publications from South America met our inclusion criteria. The report from Columbia only studied men aged 29–54 years enlisted in the Colombian Air Force,51 and the report from Brazil only recruited participants aged 55 years or older.52 Considering the high prevalence of overweight and obesity in most countries in South America (eg, Brazil [56·6%] and Argentina [62·7%]),50 as well as a rising prevalence of type 2 diabetes in the region,53 prevalence of NAFLD is also likely to be high.
Latin American Association for the study of the liver (ALEH) practice guidance for the diagnosis and treatment of non-alcoholic fatty liver disease
2020, Annals of HepatologyCitation Excerpt :However, only two South American studies were included in this meta-analysis. Both studies included subjects undergoing health screenings: the first was a Brazilian study that enrolled middle-aged patients [7], detecting NAFLD in 35.2% of them, whereas the second study was performed in Colombia, including 263 young males [8]: NAFLD was found in 26.6% of them and was associated with higher insulin levels. Only a few more Latin American studies assessing the prevalence of NAFLD have been published [9].