Patients with ultrasound diagnosis of hepatic steatosis are at high metabolic risk

Abstract

Background and aims: Hepatic steatosis is the basis of non-alcoholic fatty liver disease (NALFD). Mere fat accumulation within hepatocytes is considered the mild form of NAFLD, but can progress in some patients to advanced steatohepatitis (NASH), which may lead to fibrosis, cirrhosis or hepatocellular carcinoma. However, even hepatic steatosis alone may be a risk factor for cardiovascular disease (CVD).

Patients and methods: In the present real life study 106 patients from the outpatient clinic of the Department for Gastroenterology and Hepatology with either NAFLD (n = 60) or other typical diagnoses (n = 46) were included. Ultrasound examination identified 77 patients with hepatic steatosis. Liver enzymes, lipid profile, surrogate cell death markers, and adiponectin were determined. Transient elastography (Fibroscan^®) and bioelectrical impedance analysis (BIA) were performed.

Results: Mean patient age was 46 years (23 – 62) for non-NAFLD and 53 years (18 – 71) for the NAFLD group. ALT and AST did not differ significantly between the two groups. Adiponectin and HDL were significantly lower in NAFLD (p < 0.05) and BIA profiles showed higher fat and fat free mass. Non-NAFLD patients with steatosis also exhibited an adverse metabolic profile. Overall steatosis was associated with factors of metabolic syndrome (MS) and CVD. Prevalence of CVD and factors of MS hint to steatosis as an early event for these conditions.

Conclusion: Patients with steatosis are at higher cardiovascular and metabolic risk without differences in transaminases levels compared to those without steatosis. Steatosis diagnosed by ultrasound needs to rise attention for further metabolic alterations including CVD.

Zusammenfassung

Hintergrund und Ziele: Fettakkumulation (Steatose) in der Leberzelle stellt die Grundlage der nicht-alkoholischen Fettlebererkrankung (NAFLE) dar. Die einfache Steatose bei Hepatozyten wird als milde Form der NAFLE betrachtet, kann jedoch zur progressiv-entzündlichen Form, der Steatohepatitis (NASH), übergehen. Die NASH kann über Fibrose weiter zur Zirrhose oder zu einem hepatozellulären Karzinom (HCC) führen. Dennoch stellt bereits die einfache Steatose ein Risiko für Herzkreislauferkrankungen (KHK) dar.

Patienten und Methodik: In der aktuellen Studie wurden 106 Patienten aus einer gastroenterologischen und hepatologischen Ambulanz untersucht, sowohl mit bekannter NAFLE (n = 60) oder anderen typischen Diagnosen (n = 46). Mittels Sonografie wurde bei 77 Patienten eine Steatosis hepatis diagnostiziert. Leberenzyme, Lipidprofil, Surrogatmarker des Zelltodes und Adiponektin wurden bestimmt. Transiente Elastografie (Fibroscan^®) und Bioimpedanzanalyse (BIA) wurden durchgeführt.

Ergebnisse: Das mittlere Alter der Patienten lag bei 46 Jahren (23 – 62; nicht-NAFLE) bzw. bei 53 Jahren (18 – 71; NAFLE). AST und ALT zeigten keine signifikanten Unterschiede zwischen den Gruppen. Adiponektin und HDL waren signifikant niedriger bei NAFLE (p < 0,05) und BIA-Profile zeigten sowohl höhere Fett- als auch fettfreie Masse. Auch nicht-NAFLE Patienten mit Steatose wiesen ein deutlich verändertes metabolisches Profil auf. Insgesamt war Steatose häufiger mit Faktoren des metabolischen Syndroms (MS) und mit KHK assoziiert. Die Prävalenzen der KHK und Faktoren des MS weisen darauf hin, dass Leber-Steatose ein frühes Ereignis bei der Entwicklung dieser Erkrankungen darstellt.

Zusammenfassung: Patienten mit Leber-Steatose haben ein deutlich höheres kardiovaskuläres und metabolisches Risiko, ohne Veränderung der Transaminasen im Vergleich zu Patienten ohne Steatose. sonografisch diagnostizierte Steatose sollte die Aufmerksamkeit für weitere metabolische Veränderungem, inklusive KHK, erhöhen.

Schlüsselwörter

hepatische Steatose - metabolisches Syndrom - kardiovaskuläre Erkrankungen - Leber

Key words

hepatic steatosis - metabolic syndrome - cardiovascular disease - liver

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