medigraphic.com
Órgano Oficial de la Asociación Mexicana de Hepatología

2016, Number 5

<< Back Next >>

Ann Hepatol 2016; 15 (5)

The product of triglycerides and glucose as biomarker for screening simple steatosis and NASH in asymptomatic women

Simental-Mendía LE, Simental-Mendía E, Rodríguez-Hernández H, Rodríguez-Morán M, Guerrero-Romero F

Language: English
References: 49
Page: 715-720
PDF size: 145.54 Kb.


ABSTRACT

Introduction and aim. Given that early identification of non-alcoholic fatty liver disease (NAFLD) is an important issue for primary prevention of hepatic disease, the objectives of this study were to evaluate the efficacy of the product of triglyceride and glucose levels (TyG) for screening simple steatosis and non-alcoholic steatohepatitis (NASH) in asymptomatic women, and to compare its efficacy vs. other biomarkers for recognizing NAFLD. Material and methods. Asymptomatic women aged 20 to 65 years were enrolled into a cross-sectional study. The optimal values of TyG, for screening simple steatosis and NASH were established on a Receiver Operating Characteristic scatter plot; the sensitivity, specificity, and likelihood ratios of TyG index were estimated versus liver biopsy. According sensitivity and specificity, the efficacy of TyG was compared versus the well-known clinical biomarkers for recognizing NAFLD. Results. A total of 50 asymptomatic women were enrolled. The best cutoff point of TyG for screening simple steatosis was 4.58 (sensitivity 0.94, specificity 0.69); in addition, the best cutoff point of TyG index for screening NASH was 4.59 (sensitivity 0.87, specificity 0.69). The positive and negative likelihood ratios were 3.03 and 0.08 for simple steatosis, and 2.80 and 0.18 for NASH. As compared versus SteatoTest, NashTest, Fatty liver index, and Algorithm, the TyG showed to be the best test for screening. Conclusions. TyG has high sensitivity and low negative likelihood ratio; as compared with other clinical biomarkers, the TyG showed to be the best test for screening simple steatosis and NASH.


REFERENCES

  1. Clark JM, Diehl AM. Hepatic steatosis and type 2 diabetes mellitus. Curr Diab Rep 2002; 2: 210-5.

  2. Bedogni G, Miglioli L, Masutti F, Tiribelli C, Marchesini G, Bellentani S. Prevalence of and risk factors for nonalcoholic fatty liver disease: the Dionysos nutrition and liver study. Hepatology 2005; 42: 44-52.

  3. Browning JD, Szczepaniak LS, Dobbins R, Nuremberg P, Horton JD, Cohen JC, Grundy SM, et al. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology 2004; 40: 1387-95.

  4. Vernon G, Baranova A, Younossi ZM. Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther 2011; 34: 274-85.

  5. Machado M, Marques-Vidal P, Cortez-Pinto H. Hepatic histology in obese patients undergoing bariatric surgery. J Hepatol 2006; 45: 600-6.

  6. Bugianesi E, Marchesini G, Gentilcore E, Cua IH, Vanni E, Rizzetto M, George J. Fibrosis in genotype 3 chronic hepatitis C and nonalcoholic fatty liver disease: Role of insulin resistance and hepatic steatosis. Hepatology 2006; 44: 1648-55.

  7. Petta S, Muratore C, Craxì A. Non-alcoholic fatty liver disease pathogenesis: the present and the future. Dig Liver Dis 2009; 41: 615-25.

  8. van der Poorten D, Milner KL, Hui J, Hodge A, Trenell MI, Kench JG, London R, et al. Visceral fat: a key mediator of steatohepatitis in metabolic liver disease. Hepatology 2008; 48: 449-57.

  9. Schwenger KJ, Allard JP. Clinical approaches to non-alcoholic fatty liver disease. World J Gastroenterol 2014; 20: 1712-23. Doi: 10.3748/wjg.v20.i7.1712.

  10. Yan E, Durazo F, Tong M, Hong K. Nonalcoholic fatty liver disease: pathogenesis, identification, progression, and management. Nutr Rev 2007; 65: 376-84.

  11. Angulo P. Nonalcoholic fatty liver disease. N Engl J Med 2002; 346: 1221-31 [PMID: 11961152 DOI: 10.1056/NEJMra011775]

  12. Chalasani N, Younossi Z, Lavine JE, Diehl AM, Brunt EM, Cusi K, Charlton M, et al. The diagnosis and Management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology 2012; 55: 2005-23 [PMID: 22488764 DOI: 10.1002/hep.25762]

  13. Saadeh S, Younossi ZM, Remer EM, Gramlich T, Ong JP, Hurley M, Mullen KD, et al. The utility of radiological imaging in nonalcoholic fatty liver disease. Gastroenterology 2002; 123: 745-50.

  14. Strauss S, Gavish E, Gottlieb P, Katsnelson L. Interobserver and intraobserver variability in the sonographic assessment of fatty liver. AJR 2007; 189: W320-3.

  15. Simental-Mendía LE, Rodríguez-Hernández H, Rodríguez- Morán M, Guerrero-Romero F. The alanine aminotransferase to triglycerides ratio as a marker to identify nonalcoholic fatty liver disease. Eur J Gastroenterol Hepatol 2012; 24: 1173-7. Doi: 10.1097/MEG.0b013e3283564ee5.

  16. Guerrero-Romero F, Simental-Mendía LE, González-Ortiz M, Martínez-Abundis E, Ramos-Zavala MG, Hernández- González SO, Jacques-Camarena O, et al. The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp. J Clin Endocrinol Metab 2010; 95: 3347-51.

  17. Gastaldelli A, Folli F, DeFronzo RA. The Product of Triglycerides and Glucose as index of insulin resistance. Validation in the SAM study. J Clin Endocrinol Metab 2010; 95: 3351.

  18. Lee SH, Kwon HS, Park YM, Ha HS, Jeong SH, Yang HK, Lee JH, et al. Predicting the Development of Diabetes Using the Product of Triglycerides and Glucose. The Chungju Metabolic Disease Cohort (CMC) Study. PLoS One 2014; 9: e90430.

  19. Lee SH, Han K, Yang HK, Kim MK, Yoon KH, Kwon HS, Park YM. Identifying subgroups of obesity using the product of triglycerides and glucose: the Korea National Health and Nutrition Examination Survey, 2008-2010. Clin Endocrinol (Oxf) 2015; 82: 213-20.

  20. Du T, Yuan G, Zhang M, Zhou X, Sun X, Yu X. Clinical usefulness of lipid ratios, visceral adiposity indicators, and the triglycerides and glucose index as risk markers of insulin resistance. Cardiovasc Diabetol 2014; 13: 146.

  21. Espinel-Bermúdez MC, Robles-Cervantes JA, Del Sagrario Villarreal-Hernández L, Villaseñor-Romero JP, Hernández- González SO, González-Ortiz M, Martínez-Abundis E, et al. Insulin resistance in adult primary care patients with a surrogate index, Guadalajara, Mexico, 2012. J Investig Med 2015; 63: 247-50.

  22. Unger G, Benozzi SF, Perruzza F, Pennacchiotti GL. Triglycerides and glucose index: a useful indicator of insulin resistance. Endocrinol Nutr 2014; 61: 533-40.

  23. Lucatello F, Vigna L, Carugno M, Tirelli AS, Bertazzi PA, Riboldi L. Comparison of indexes for assessing insulin resistance for the health surveillance among workers. G Ital Med Lav Ergon 2012; 34 (3 Suppl.): 748-9.

  24. Vasques AC, Novaes FS, de Oliveira M da S, Souza JR, Yamanaka A, Pareja JC, Tambascia MA, et al. TyG index performs better than HOMA in a Brazilian population: a hyperglycemic clamp validated study. Diabetes Res Clin Pract 2011: 93: e98-e100.

  25. Gonzalez-Ortiz M, Martinez-Abundis E. Comparison of several formulas to assess insulin action in the fasting state with the hyperglycemic-hyperinsulinemic clamp technique in healthy individuals. Rev Invest Clin 2003; 55: 419-22.

  26. Chalasani N, Younossi Z, Lavine JE, Diehl AM, Brunt EM, Cusi K, Charlton M, et al.; American Gastroenterological Association; American Association for the Study of Liver Diseases; American College of Gastroenterology. The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology. Gastroenterology 2012; 142: 1592-609.

  27. Simental-Mendía LE, Rodríguez-Morán M, Guerrero-Romero F. The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects. Metab Syndr Relat Disord 2008; 6: 299-304. Doi: 10.1089/met.2008.0034.

  28. Poynard T, Ratziu V, Naveau S, Thabut D, Charlotte F, Messous D, Capron D, et al. The diagnostic value of biomarkers (SteatoTest) for the prediction of liver steatosis. Comp Hepatol 2005; 4: 10.

  29. Poynard T, Ratziu V, Charlotte F, Messous D, Munteanu M, Imbert-Bismut F, Massard J, et al. Diagnostic value of biochemical markers (NashTest) for the prediction of non alcoholo steato hepatitis in patients with non-alcoholic fatty liver disease. BMC Gastroenterol 2006; 6: 34.

  30. Bedogni G, Bellentani S, Miglioli L, Masutti F, Passalacqua M, Castiglione A, Tiribelli C. The Fatty Liver Index: a simple and accurate predictor of hepatic steatosis in the general population. BMC Gastroenterol 2006; 6: 33.

  31. Lin YC, Chou SC, Huang PT, Chiou HY. Risk factors and predictors of non-alcoholic fatty liver disease in Taiwan. Ann Hepatol 2011; 10: 125-32.

  32. Rodriguez-Hernandez H, Cervantes-Huerta M, Gonzalez JL, Marquez-Ramirez MD, Rodriguez-Moran M, Guerrero-Romero F. Nonalcoholic fatty liver disease in asymptomatic obese women. Ann Hepatol 2010; 9: 144-9.

  33. Kramer MS. Clinical Epidemiology and Biostatistics. A Primer for investigators and Decision-Makers. Berlin: Springer-Verlag Press: 1998; p. 201-10.

  34. Altman DG, Bland JM. Diagnostic tests. 1: Sensitivity and specificity. BMJ 1994; 308: 1552.

  35. Chitturi S, Abeygunasekera S, Farrell GC, Holmes-Walker J, Hui JM, Fung C, Karim R, et al. NASH and insulin resistance: insulin hypersecretion and specific association with the insulin resistance syndrome. Hepatology 2002; 35: 373-9.

  36. Chalasani N, Deeg MA, Persohn S, Crabb DW. Metabolic and anthropometric evaluation of insulin resistance in nondiabetic patients with nonalcoholic steatohepatitis. Am J Gastroenterol 2003; 98: 1849-55.

  37. Musso G, Gambino R, De Michieli F, Cassader M, Rizzetto M, Durazzo M, Faga E, et al. Dietary habits and their relations to insulin resistance and postprandial lipemia in nonalcoholic steatohepatitis. Hepatology 2003; 37: 909-16.

  38. Cassader M, Gambino R, Musso G, Depetris N, Mecca F, Cavallo-Perin P, Pacini G, et al. Postprandial triglyceride- rich lipoprotein metabolism and insulin sensitivity in nonalcoholic steatohepatitis patients. Lipids 2001; 36: 1117-24.

  39. Willner IR, Waters B, Patil SR, Reuben A, Morelli J, Riely CA. Ninety patients with nonalcoholic steatohepatitis: insulin resistance, familial tendency, and severity of disease. Am J Gastroenterol 2001; 96: 2957-61.

  40. Tiikkainen M, Tamminen M, Hakkinen AM, Bergholm R, Vehkavaara S, Halavaara J, Teramo K, et al. Liver-fat accumulation and insulin resistance in obese women with previous gestational diabetes. Obes Res 2002; 10: 859-67.

  41. Sanyal AJ, Campbell-Sargent C, Mirshahi F, Rizzo WB, Contos MJ, Sterling RK, Luketic VA, et al. Nonalcoholic steatohepatitis: association of insulin resistance and mitochondrial abnormalities. Gastroenterology 2001; 120: 1183-92.

  42. Marchesini G, Brizi M, Bianchi G, Tomassetti S, Bugianesi E, Lenzi M, McCullough AJ, et al. Nonalcoholic fatty liver disease: a feature of the metabolic syndrome. Diabetes 2001; 50: 1844-50.

  43. Bugianesi E, Gastaldelli A, Vanni E, Gambino R, Cassader M, Baldi S, Ponti V, et al. Insulin resistance in non-diabetic patients with non-alcoholic fatty liver disease: sites and mechanisms. Diabetologia 2005; 48: 634-42.

  44. Seppala-Lindroos A, Vehkavaara S, Hakkinen AM, Goto T, Westerbacka J, Sovijarvi A, Halavaara J, et al. Fat accumulation in the liver is associated with defects in insulin suppression of glucose production and serum free fatty acids independent of obesity in normal men. J Clin Endocrinol Metab 2002; 87: 3023-8.

  45. Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999-2000. JAMA 2002; 288: 1723-7

  46. Moran JR, Ghishan FK, Halter SA, Greene HL. Steatohepatitis in obese children: a cause of chronic liver dysfunction. Am J Gastroenterol 1983; 78: 374-7.

  47. Baldridge AD, Perez-Atayde AR, Graeme-Cook F, Higgins L, Lavine JE. Idiopathic steatohepatitis in childhood: a multicenter retrospective study. J Pediatr 1995; 127: 700-4.

  48. Utzschneider KM, Kahn SE. Review: The role of insulin resistance in nonalcoholic fatty liver disease. J Clin Endocrinol Metab 2006; 91: 4753-61.

  49. Fedchuk L, Nascimbeni F, Pais R, Charlotte F, Housset C, Ratziu V; LIDO Study Group. Performance and limitations of steatosis biomarkers in patients with nonalcoholic fatty liver disease. Aliment Pharmacol Ther 2014; 40: 1209-22.




2020     |     www.medigraphic.com