2012, Number 4
<< Back Next >>
Ann Hepatol 2012; 11 (4)
Correlation of adipose tissue with liver histology in Asian Indian patients with nonalcoholic fatty liver disease (NAFLD)
Choudhary NS, Duseja A, Kalra N, Das A, Dhiman RK, Chawla YK
Language: English
References: 40
Page: 478-486
PDF size: 127.75 Kb.
ABSTRACT
Background. There is sparse literature on the association of adipose tissue with liver histology in patients with nonalcoholic fatty liver disease (NAFLD).
Aim. To study the correlation of visceral adipose tissue
(VAT), subcutaneous adipose tissue (SAT) and total adipose tissue (TAT) with liver histology in Indian patients with NAFLD.
Material and methods. A single slice CT scan at the level of L4-L5 vertebrae was done to assess the abdominal VAT and SAT volumes in 21 patients with histological diagnosis of NAFLD. Adult treatment panel III criteria with modified abnormal waist were used to define metabolic syndrome (MS). Histological grading was done according to the NAFLD activity score (NAS).
Results. Twenty-one patients with NAFLD [13 males, median age: 35 years, median BMI: 25.97 kg/m
2] were included prospectively. Even though overweight/obese patients had severe liver disease, there was no difference in the volume of VAT adjusted for BMI between 6 (28.5%) lean and 15 (71.5%) overweight/obese patients. Patients with NASH and borderline NASH were older, obese with higher VAT and SAT volumes than no-NASH group. SAT volume (SATV) correlated significantly with hepatic steatosis but none of the adipose tissue volumes had any correlation with other histological variables. Both SATV and TAT volume (TATV) correlated significantly with severity of liver disease as determined by NAS score whereas presence of MS or insulin resistance had no correlation with histological severity.
Conclusion. Both subcutaneous and total adipose tissue volume are related to the disease severity as determined by NAFLD activity score in Indian patients with NAFLD.
REFERENCES
Farrell GC, Larter CZ. Nonalcoholic fatty liver disease, from steatosis to cirrhosis. Hepatology 2006; 43: 99-112.
Vuppalanchi R, Chalasani N. Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: selected practical issues in their evaluation and management. Hepatology 2009; 49: 306-17.
Duseja A, Nanda M, Das A, Das R, Bhansali A, Chawla Y. Prevalence of obesity, diabetes mellitus and hyperlipidemia in patients with cryptogenic liver cirrhosis. Trop Gastroenterol 2004; 25: 15-7.
Duseja A, Sharma B, Kumar A, Kapil S, Das A, Dhiman RK, Chawla YK. Nonalcoholic fatty liver in a developing country is responsible for significant liver disease. Hepatology 2010; 52: 2248-9.
Musso G, Gambino R, Cassader M. Non-alcoholic fatty liver disease from pathogenesis to management: an update. Obes Rev 2010; 11: 430-45.
Amarapurkar D, Kumani P, Patel N, Gupte P, Kumar P, Agal S, Baijal R, et al. Prevalence of nonalcoholic fatty liver disease, population based study. Ann Hepatol 2007; 6: 161-3.
Singh SP, Nayak S, Swain H, Rout N, Mallik RN, Agrawal O, Meher C, et al. Prevalence of nonalcoholic fatty liver disease in coastal eastern India: a preliminary ultrasonographic survey. Trop Gastroenterol 2004; 25: 76-9.
Singh DK, Sakhuja P, Malhotra V, Gondal R, Sarin SK. Independent predictors of steatohepatitis and fibrosis in Asian Indian patients with non-alcoholic steatohepatitis. Dig Dis Sci 2008; 53: 1967-76.
Madan K, Batra Y, Gupta SD, Chander B, Rajan KD, Tewatia MS, Panda SK, et al. Non-alcoholic fatty liver disease may not be a severe disease at presentation among Asian Indians. World J Gastroenterol 2006; 12: 3400-5.
Duseja A, Das A, Das R, Dhiman RK, Chawla Y, Bhansali A, Kalra N. The clinicopathological profile of Indian patients with nonalcoholic fatty liver disease is different from that in west. Dig Dis Sci 2007; 52: 2368-74.
Larter CZ, Chitturi S, Heydet D, Farrell GC. A fresh look at NASH pathogenesis. Part 1: The metabolic movers. J Gastroenterol Hepatol 2010; 25: 672-90.
Duseja A, Murlidharan R, Bhansali A, Sharma S, Das A, Das R, Chawla Y. Assessment of insulin resistance and effect of metformin in nonalcoholic steatohepatitis—a preliminary report. Indian J Gastroenterol 2004; 23: 12-5.
Dowman JK, Tomlinson JW, Newsome PN. Pathogenesis of non-alcoholic fatty liver disease. Q J Med 2010; 103: 71-83.
Wajchenberg BL. Subcutaneous and visceral adipose tissue: their relation to metabolic syndrome. Endocr Rev 2000; 21: 697-738.
Polyzos SA, Kountouras J, Zavos C, Tsiaousi E. The role of adiponectin in the pathogenesis and treatment of non-alcoholic fatty liver disease. Diabetes Obes Metab 2010; 12: 365-83.
Marra F, Bertolani C. Adipokines in liver diseases. Hepatology 2009; 50: 957-69.
Van der Poorten D, Milner KL, Hui J, Hodge A, Trenell MMI, Kench JG, London R, et al. Visceral fat: a key mediator of steatohepatitis in metabolic liver disease. Hepatology 2008; 48: 449-57.
Ayonrinde OT, Olynyk JK, Beilin LJ, Mori TA, Pennell CE, de Klerk N, Oddy WH, et al. Gender specific differences in adipose distribution and adipocytokines influence adolescent nonalcoholic fatty liver disease. Hepatology 2011; 53: 800-9.
Steering Committee of the Western Pacific Region of the World Health Organization, International Association for the Study of Obesity, International Study Task Force The Asia-Pacific perspective; redefining obesity and its treatment. Australia: Health Communications; 2000, p. 8-56.
Dhiman RK, Duseja A, Chawla Y. Asians need different criteria for defining overweight and obesity. Arch Intern Med 2005; 165: 1069-70.
World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: Diagnosis and classification of diabetes mellitus. Geneva: World Health Organization; 1999, p. 31-3.
Expert Panel on Detection, Evaluation and Treatment of High Cholesterol in Adults Executive summary of the third report of 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: 2486-97.
Duseja A, Thumburu KK, Das A, Dhiman RK, Chawla YK, Bhadada S, Bhansali A. Insulin tolerance test is comparable to homeostasis model assessment for insulin resistance in patients with nonalcoholic fatty liver disease. Indian J Gastroenterol 2007; 26: 170-3.
Chitturi S, Abeygunasekera S, Farrell GC, Holmes-Walker J, Hui JM, Fung C, et al. NASH and insulin resistance: Insulin hypersecretion and specific association with the insulin resistance syndrome. Hepatology 2002; 35: 373-9.
Yoshijumi T, Nakamura T, Yamane M, Islam AH, Menju M, Yamasaki K, Arai T, et al. Abdominal fat: standardized technique for measurement at CT. Radiology 1999; 211: 283-6.
Kleiner DE, Brunt EM, Van Natta M, Behling C, Contos MJ, Cummings OW, Ferrell LD, et al; Nonalcoholic Steatohepatitis Clinical Research Network. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 2005; 41: 1313-21.
Kabir M, Catalano KJ, Ananthnarayan S, Kim SP, Van Citters GW, Dea MK, Bergman RN. Molecular evidence supporting the portal theory: a causative link between visceral adiposity and hepatic insulin resistance. Am J Physiol Endocrinol Metab 2005; 288: E454-E461.
Park BJ, Kim YJ, Kim DH, Kim W, Jung YJ, Yoon JH, Kim CY, et al. Visceral adipose tissue area is an independent risk factor for hepatic steatosis. J Gastroenterol Hepatol 2008; 23: 900-7.
Klein S. The case of visceral fat: argument for the defense. J Clin Invest 2004; 113: 1530-2.
Abate N, Garg A, Peshock RM, Stray-Gundersen J, Grundy SM. Relationships of generalized and regional adiposity to insulin sensitivity in men. J Clin Invest 1995; 96: 88-98.
Demerath EW, Sun SS, Rogers N, Lee M, Reed D, Choh AC, Couch W, et al. Anatomical patterning of visceral adipose tissue: race, sex, and age variation. Obesity 2007; 15: 2984-93.
Pascot A, Lemieux S, Lemieux I, Prud’homme D, Tremblay A, Bouchard C, Nadeau A, et al. Age related increase in visceral adipose tissue and body fat and the metabolic risk profile of premenopausal women. Diabetes Care 1999; 22: 1471-8.
Lara-Castro C, Weinsier RL, Hunter GR, Desmond R. Visceral adipose tissue in women: longitudinal study of the effects of fat gain, time, and race. Obes Res 2002; 10: 868-74.
Eguchi Y, Mizuta T, Sumida Y, Ishibashi E, Kitajima Y, Isoda H, Horie H, et al. The pathological role of visceral fat accumulation in steatosis, inflammation, and progression of nonalcoholic fatty liver disease. J Gastroenterol 2011; 46: 70-8.
Das K, Das K, Mukherjee PS, Ghosh A, Ghosh S, Mridha AR, Dhibar T, et al. Nonobese population in a developing country has a high prevalence of nonalcoholic fatty liver and significant liver disease. Hepatology 2010; 51: 1593-602.
Porter SA, Massaro JM, Hoffmann U, Vasan RS, O’Donnel CJ, Fox CS. Abdominal subcutaneous adipose tissue: a protective fat depot? Diabetes Care 2009; 32: 1068-75.
Liu J, Fox CS, Hickson DA, May WD, Hairston KG, Carr JJ, Taylor HA. Impact of abdominal visceral and subcutaneous adipose tissue on cardiometabolic risk factors: the Jackson heart study. J Clin Endocrinol Metab 2010; 95: 5419-26.
Goel K, Misra A, Vikram NK, Poddar P, Gupta N. Subcutaneous abdominal adipose tissue is associated with the metabolic syndrome in Asian Indians independent of intra-abdominal and total body fat. Heart 2010; 96: 579-83.
Nagaretani H, Nakamura T, Funahashi T, Kotani K, Miyanaga M, Tokunaga K, Takahashi M, et al. Visceral fat is a major contributor for multiple risk factor clustering in Japanese men with impaired glucose tolerance. Diabetes Care 2001; 24: 2127-33.
Lirussi F, Vitturi N, Azzalini L, Orando S, Orlando R, Plebani M, Realdi G. Perihepatic adipose tissue thickness: a new non-invasive marker of NAFLD? J Gastrointestin Liver Dis 2009; 18: 61-6.