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Correlation between insulin resistance and liver histology in patients with nonalcoholic steatohepatitis with and without obesity

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Abstract

Introduction

Insulin resistance (IR) plays a central role in pathogenesis of nonalcoholic steatohepatitis (NASH). The aim of this study was to correlate histopathological grading and IR in overweight/obese patients with NASH as compared with lean NASH.

Methods

Patients with NASH who underwent liver biopsy between January 2012 and December 2012 were included. Anthropometric, clinical, and biochemical features, necro-inflammatory grades, and fibrosis stage on liver biopsies were scored according to Brunt and non-alcoholic fatty liver disease (NAFLD) activity score (NAS).

Results

Of 42 patients, 33 (78.6%) had body mass index (BMI) ≥ 23 kg/m2 (overweight/obese) while 9 had BMI < 23 kg/m2 (lean). Mean fasting blood sugar (FBS) and HbA1c levels in overweight/obese patients with NASH were higher than in lean NASH (p < 0.05). The median homeostatic model assessment–estimated insulin resistance (HOMA-IR) among NASH patients with BMI ≥ 23 kg/m2 was higher than among those with BMI < 23 kg/m2 (3.02 [0.34–17.22] vs. 2 [0.52–5.26]; p = 0.045). However, fasting insulin levels were comparable among lean and overweight/obese patients with NASH. Metabolic syndrome could be predicted with 75% sensitivity and 85.3% specificity at a HOMA-IR cutoff value of 3.9. No significant difference was observed with regard to HOMA-IR levels with Brunt grades, Brunt staging, Brunt grades 1 and 2, Brunt scores < 2 and > 2, and NAS scores, and NAS scores < 4 and > 4.

Conclusions

Although IR was significantly higher in overweight/obese patients with NASH as compared with that in lean patients with NASH, there was no difference in the correlation of HOMA-IR with histology between these groups.

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Acknowledgments

We acknowledge the assistance of Dr. B.N. Girish, Associate Professor, Department of Physiology, Amrita Institute of Medical Sciences, Kochi.

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Authors and Affiliations

  1. Department of Gastroenterology, Amrita Institute of Medical Sciences, Kochi, Amrita Vishwa Vidyapeetham, AIMS Ponekkara P.O., Kochi, 682 041, India

    Mathew Vadukoot Lazar, Harikumar R. Nair, Ismail Siyad & Rajesh Gopalakrishna

  2. Department of Pathology, Amrita Institute of Medical Sciences, Kochi, Amrita Vishwa Vidyapeetham, AIMS Ponekkara P.O., Kochi, 682 041, India

    Malini Eapen

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  1. Mathew Vadukoot Lazar
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  2. Malini Eapen
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Correspondence to Rajesh Gopalakrishna.

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MVL, ME, HRN, IS, and RG declare that they have no conflict of interest.

Ethics statement

Written informed consent was obtained from all the study subjects. The study protocol conforms to the ethical guidelines of the “World Medical Association (WMA) Declaration of Helsinki Ethical Principles for Medical Research Involving Human Subjects” adopted by the 18th WMA General Assembly, Helsinki, Finland, June 1964, as revised in Tokyo 2004. The study was approved by the institutional ethical review committee.

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Annual meeting of the Indian National Association for Study of the Liver (INASL, 2016)

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Lazar, M.V., Eapen, M., Nair, H.R. et al. Correlation between insulin resistance and liver histology in patients with nonalcoholic steatohepatitis with and without obesity. Indian J Gastroenterol 39, 42–49 (2020). https://doi.org/10.1007/s12664-020-01024-z

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  • DOI: https://doi.org/10.1007/s12664-020-01024-z

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