Prevalence Of Obesity And Hyperlipidemia In Adults With Liver Steatosis

Prevalencija gojaznosti i hiperlipidemije u odraslih osoba sa steotozom jetre

To the Editor:  Non - alcohol induced fatty liver is widely believed to be a benign condition with a little or no risk of disease progression ( 1 ). Excessive accumulation of triglycerides with the liver may result from defects in any of the events in the sequence from fatty acid entry to lipoprotein synthesis ( 2 ). As usual the liver function tests are normal or show mild elevation of alkaline phosphatase or aminotransferases ( 3 ).  Imaging techniques such as CT, ultrasound ( US ), and NMR may each yield alterations suggesting increased fat in the liver. However hepatosteatosis is a case that is frequently found during abdominal ultrasonographic examinations imposing differential diagnostic difficulties. In this study we explored and assessed parameters of obesity and lipids in patients with US diagnosed fatty liver

Twenty-nine healthy adults enrolled this study. Their average age was 44+ 4 years. Woman to man ratio was 10 / 19.  All were found to have hepatosteatosis by US. Estimate of weight, height and BMI were computed. Weight ( kg ) / height ( m2 ) formula is used for BMI. Triglycerides ( TG ), total cholesterol ( T ( TCh ), and SGPT measurement were performed by autoanalyser. Toshiba SS 270A color Doppler US scans were made in all cases. Three grades of liver texture have been defined in US for classification of fatty infiltration.

Average findings belong to patients with hepatosteatosis are summarized at the Table.
                                         Age                       : 44.4+ 4 years
                                         BMI                      : 31+ 6
                                         Triglyceride         : 230 + 178 mg/dl
                                         Total cholesterol : 198 +  54   mg/dl
                                         SGPT                   :  35+ 22 U/dl

Hepatosteatosis was staged as: grade I ( 12 cases, 41% ), grade II ( 11 cases, 38%), and grade III ( 6 cases, 20% ). Four patients ( 13.7% ) had two times increased values of SGPT. Two of them had hepatosteatosis grade III, one grade II, and one grade I. TG were higher than normal in 41.3% cases ( normal value 200 MG/DL ). Total cholesterol radio of 34.4% was higher than normal ( normal value 200 mg/dl ). The ratio of combined hyperlipidamia was 22.6%. In the statistical analysis a positive correlation was found: between hepatic steatosis grade and BMI ( p=0.004, r=0.678 ) and liver steatosis and weight  ( p=0.004, r=67.23 ). No correlation was found between steatosis and height. In the variance analysis between liver statosis grade, tryglicerides, and cholesterol values, no difference was noticed between the groups ( > 0.05 ).

Address correspondence to:
Dr Nevin Yilmaz
Harran Universitesi Tip Fakultesi
Ic Hastaliklari A.B.D.
63100 Saniliurfa, Turkey
FAX: + 90 ( 414 ) 315 11 81
E-mail: [email protected]
 

Heptosteatosis is frequent findings in people between 40 - 50 years and do no necessarily imply clinical and biochemical evidence of liver disease ( 4 ).  On the other hand in these cases Adler found frequently increased GGT ( 3 ). In our study 13% of cases had increased SGPT.  Tacikowski in his group of patients with and without features of liver steatosis did not find any difference in relation with concentration of TG and high-density lipoprotein fraction.  But in patients with US features of liver steatosis, the mean serum TG concentration was almost twice higher than in the group without steatosis ( 5 ). Tominaga showed that in his study fatty liver may develop very early in the life and that there is no direct relationship with degree of obesity ( 6 ).

In our study we found a meaningful correlation between weight and liver steatosis grade. We therefore concluded that obesity had an influence on liver steatosis aetiology and on the other hand, while there wad an increase in lipid level it had no correlation with liver steatosis.

References:

1.Teli MR, James OF, Burt AD, Bennett MK, Day CP. The natural history of nonalcoholic fatty liver. A follow up study. Hepatology 1995; 22: 1714 - 9.

2.Cotran RS, Kumar V, Robbins S. Pathological basis of disease. Philadelphia: WB Sounders; 1989.

3.Adler M, Schhaffner F. Fatty liver hepatitis and cirrhosis in obese patients. AJM 1979; 67: 811 - 6.

4.Dainless I, Lentz J. Fatty liver hepatitis ( steatohepatitis ) and obesity. Hepatology 1990; 12: 1106 - 10.

5.Tacikowski T, Milewski B, Dzieniszewski J, et al. Liver steatosis assessed by ultrasonographic examination in patients with hyper-lipoproteinemia. Wiadomosei Lllekarskie 1994; 731 - 7.

6.Tominaga K, Kurata JH, Chen YK, Fujimato E, et al. Prevalence of fatty liver in Japanese and relationship to obesity. Dig Dis 1995; 2002 - 9.
 

Nevin Yilmaz MD., Yasar Nazligul, MD.
Department of Internal Medicine, Harran University, Faculty of Medicine, Sanliurfa, Turkey
Huseyin Vural, MD.
Department of Biochemistry, Harran University, Faculty of Medicine, Sanliurfa, Turkey
Mustafa Karaoglanoglu, MD.
Department of Radiology, Harran University, Faculty of Medicine, Sanliurfa, Turkey
Munire Gundogan, MD.
Department of Radiology, University Hospital, Istanbul, Turkey