Indian patients with nonalcoholic fatty liver disease presenting with raised transaminases are different at presentation

Duseja, Ajay

doi:10.3748/wjg.v13.i4.649

Cited by 29 publications

(54 citation statements)

References 10 publications

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“…NAFLD series of Madan et al 8 and Duseja et al 9 Similarly, the mean BMI too in our NAFLD patients (26.25 kg/m 2 ) was comparable to the BMI reported in earlier studies from India 3,4 and was significantly higher than that of controls. Most studies from India had reported male gender, higher BMI, insulin resistance and MS as risk factors associated with NAFLD, which was also evident in our study.…”

Section: Singh Et Al Risk Factors Associated With Non-alcoholic Fattysupporting

confidence: 87%

“…[8][9][10] The observed differences in Indian NAFLD patients include a lower frequency of MS, 9,11 lesser degree of adiposity and histological milder disease at presentation. 8 A study that compared Indians with matched Caucasians, Hispanics, Blacks and Eastern Asians showed 2-to 3-fold increase in insulin resistance, and 2-fold increase in hepatic triglyceride content in the Indian subgroup.…”

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confidence: 99%

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Risk Factors Associated With Non-Alcoholic Fatty Liver Disease in Indians: A Case–Control Study

Singh

Misra

et al. 2015

Journal of Clinical and Experimental Hepatology

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Background/Aims: NAFLD has today emerged as the leading cause of liver disorder. There is scanty data on risk factors associated with NAFLD emanating from India. The present study was conducted to identify the risk factors associated with NAFLD. Methods: 464 consecutive NAFLD patients and 181 control patients were subjected to detailed questionnaire regarding their lifestyle and dietary risk factors. Anthropometric measurements were obtained and biochemical assays were done. Comparison of different variables was made between NAFLD patients and controls using principal component analysis (PCA). Results: NAFLD patients had higher BMI [26.25 AE 3.80 vs 21.46 AE 3.08 kg/m 2 , P = 0.000], waist-hip ratio [0.96 AE 0.12 vs 0.90 AE 0.08, P = 0.000] and waist-height ratio [0.57 AE 0.09 vs 0.50 AE 0.06, P = 0.000] compared to controls. Fasting blood sugar [101.88 AE 31.57 vs 90.87 AE 10.74 mg/dl] and triglyceride levels [196.16 AE 102.66 vs 133.20 AE 58.37 mg/dl] were significantly higher in NAFLD group. HOMA-IR was also higher in NAFLD group [2.53 AE 2.57 vs 1.16 AE 0.58, P = 0.000]. Majority (90.2%) of NAFLD patients were sedentary. Family history of metabolic syndrome (MS) was positively correlated with NAFLD. Dietary risk factors associated with NAFLD were non-vegetarian diet [35% vs 23%, P = 0.002], fried food [35% vs 9%, P = 0.000], spicy foods [51% vs 15%, P = 0.001] and tea [55% vs 39%, P = 0.001]. Diabetes, hypertension, snoring and sleep apnoea syndrome were common factors in NAFLD. On multivariate PCA, waist/height ratio and BMI were significantly higher in the NAFLD patients. Conclusion: The risk factors associated with NAFLD are sedentary lifestyle, obesity family history of MS, consumption of meat/fish, spicy foods, fried foods and tea. Other risk factors associated with NAFLD included snoring and MS. ( J CLIN EXP HEPATOL 2015;5:295-302) N on-alcoholic fatty liver disease (NAFLD) is a distinct clinico-pathologic entity characterized histologically by a spectrum ranging from simple steatosis to steatohepatitis (NASH), cirrhosis and even hepatocellular carcinoma (HCC). 1,2 NAFLD (steatosis of the liver) is highly prevalent in Western countries. 1 With the introduction of westernized lifestyle and the increasing frequency of obesity in the Asia-Pacific region, the prevalence of NAFLD has increased over the past two decades.Studies from different regions of India have shown that NAFLD is very common in Indians. [3][4][5] Risk factors implicated in the development of NAFLD are obesity and metabolic syndrome (MS). 6,7 However, it is obvious that NAFLD is multifactorial and identifying the various risk factors associated with NAFLD in our population could help us to intervene in order to prevent its progression to more severe forms of the disease.The few studies identifying the risk factors associated with NAFLD have emanated from the West, where the profiles of NAFLD patients appear to be different. [8][9][10] The observed differences in Indian NAFLD patients include a lower frequency of MS, 9,11 lesser degree ...

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Section: Singh Et Al Risk Factors Associated With Non-alcoholic Fattysupporting

confidence: 87%

mentioning

confidence: 99%

Risk Factors Associated With Non-Alcoholic Fatty Liver Disease in Indians: A Case–Control Study

Singh

Misra

et al. 2015

Journal of Clinical and Experimental Hepatology

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“…70 Insulin resistance is seen in about 63% of NAFLD cases in the USA 71 ; 83-98% of our patients had evidence of IR tested by both insulin tolerance test (ITT) and HOMA-IR. 53,54,59 Data from Delhi are similar and show the prevalence of IR to be 80% in patients with NAFLD. 72 It was shown in a multiethnic trial from Italy that nonobese Indian men have a higher prevalence of IR compared with Eastern Asians, Caucasians, and Hispanics, and that this higher IR was associated with higher intrahepatic TG and serum IL-6 levels.…”

Section: Insulin Resistancementioning

confidence: 66%

“…53,54 Other centers from India have also reported low prevalence of DM at presentation in patients with NAFLD ranging from 4% to 10%. 4,[72][73][74] Similarly, only 15% of Chinese patients with NAFLD have diabetes at presentation.…”

Section: Diabetes Mellitusmentioning

confidence: 99%

“…8 We found overweight and obesity in 64% and 12% of patients with NAFLD 59 using the international criteria but our figures got reversed to 20% (overweight) and 68% (obesity) when we used the Asia-Pacific criteria 60 for overweight and obesity in our later studies, involving more than 100 patients. 53,54 Even at lower BMI, the Asians have been found to have a high percentage of body fat compared with white Caucasians and Blacks. At a given percentage of body fat, the BMI values of the Asians including Asian Indians was 3 Kg/m 2 lower than that in white Caucasians.…”

Section: Overweight/obesitymentioning

confidence: 99%

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Non-alcoholic Fatty Liver Disease: East Versus West

Agrawal

Duseja

2012

Journal of Clinical and Experimental Hepatology

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Non-alcoholic fatty liver disease (NAFLD) is an important cause of liver disease worldwide with prevalence ranging from 10% to 30% in various countries. It has become an important cause of unexplained rise in transaminases, cryptogenic cirrhosis, and cryptogenic hepatocellular carcinoma. Pathogenesis is related to obesity, insulin resistance, oxidative stress, lipotoxicity, and resultant inflammation in the liver progressing to fibrosis. Pharmacological treatment in patients with NAFLD is still evolving and the treatment of these patients rests upon lifestyle modification with diet and exercise being the cornerstones of therapy. While there are many similarities between patients with NAFLD from Asia and the West, there are certain features which make the patients with NAFLD from Asia stand apart. This review highlights the data on NAFLD from Asia comparing it with the data from the West. ( J CLIN EXP HEPATOL 2012;2:122-134)

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Nonalcoholic fatty liver in a developing country is responsible for significant liver disease

et al. 2010

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We read with great interest the article by Cavazza et al., 1 who demonstrated that an advanced histological stage was the only risk factor associated with the development of hepatocellular carcinoma (HCC) in patients with primary biliary cirrhosis (PBC) from two European centers. Similar results were described in a Japanese multicenter study by Shibuya et al. 2 Although these studies suggest screening for HCC in patients with advanced-stage PBC, it is still uncertain whether there is a significantly increased risk of HCC development in patients with stage IV PBC cirrhosis versus patients with cirrhosis of other etiologies. We assessed in a single-center study the incidence of HCC in North American patients with stage IV PBC or autoimmune hepatitis (AIH) cirrhosis and compared it to the incidence of HCC in patients with hepatitis C virus (HCV) cirrhosis. Three hundred fifteen patients with HCV cirrhosis, 49 patients with AIH cirrhosis, and 52 patients with stage IV PBC were evaluated at the Cleveland Clinic between 2001 and 2007. Stage IV PBC cirrhosis was diagnosed when patients had positive serological and histological findings of cirrhosis or biochemical and radiological evidence of portal hypertension. Cirrhosis due to AIH was defined by positive serological and histological findings of cirrhosis or biochemical and radiological evidence of portal hypertension. HCC-free survival was analyzed from the moment of the diagnosis of cirrhosis in HCV, AIH, and PBC patients until death or transplantation. During a median follow-up of 3.6 years (with 25th and 75th percentiles of 1.8 and 6.3, respectively), 64 of 315 patients (20.3%) with HCV cirrhosis, 2 of 49 patients (4.1%) with AIH cirrhosis, and 4 of 52 patients (7.7%) with PBC cirrhosis developed HCC. The annual cumulative incidence of HCC was 1.1% in patients with AIH cirrhosis, 1.5% in patients with PBC cirrhosis, and 4.0% in patients with HCV cirrhosis (Fig. 1). This study has shown that although patients with stage IV PBC cirrhosis develop liver cancer, the risk is significantly lower in comparison with the risk for patients with HCV cirrhosis. The results of our study are discordant with a previously reported Spanish series in which the risks of HCC were similar in patients with late-stage PBC and in patients with HCV cirrhosis. 3 We agree with Cavazza et al. 1 that the low prevalence of PBC and the possible influence of geography on disease progression are confounding factors that may explain the divergent results in the literature. Future multicenter studies in North America with a longer follow-up period are necessary to validate these findings and better estimate the risk of HCC in PBC patients at an advanced histological stage.

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Indian patients with nonalcoholic fatty liver disease presenting with raised transaminases are different at presentation

Cited by 29 publications

References 10 publications

Risk Factors Associated With Non-Alcoholic Fatty Liver Disease in Indians: A Case–Control Study

Risk Factors Associated With Non-Alcoholic Fatty Liver Disease in Indians: A Case–Control Study

Non-alcoholic Fatty Liver Disease: East Versus West

Nonalcoholic fatty liver in a developing country is responsible for significant liver disease

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