Association of the Nonalcoholic Hepatic Steatosis and

Its Degrees With the Values of Liver Enzymes and

Homeostasis Model Assessment-Insulin Resistance
Index

Gina Ariani

Internal Medicine Department

Dr. M. Djamil Hospital, Padang
2017
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Background
Nonalcoholic fatty liver disease (NAFLD) is a
wide variety of factors including:
o Genetic.
o Environmental, and
o Metabolic
Prevalence by ultrasonography (US) in
industrialized countries ranging from 12.2% to
40%.
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Background
An important factor related to the
emergence of nonalcoholic steatohepatitis
(NASH) is the presence of insulin
resistance(IR).
This is defined as a reduced biological
response to the actions of insulin, causing
the fat, muscle and liver tissues to become
unable to metabolize glucose and fatty
acids, being exacerbated by obesity and the
intake of dietary fats.
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Background
Association between IR and deposition of
triglycerid in the liver, the homeostasis
model assessment-IR (HOMA-IR)
The aim of this study was to investigate
the association between the degrees of
hepatic steatosis at abdominal ultrasound
and amounts of aminotransferases (AST
and ALT), GGT and HOMA-IR.
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Material and Methods

A prospective, descriptive survey type, with
analytical and quantitative approach
Analyzed 800 patients who underwent the
examination for various clinical conditions,
excluding those with alcohol consumption > 40
g/day and previous liver diseases, from July 2013
to July 2014.
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Material and Methods

Steatosis classified the degrees based on the
criteria of Saadeh et al (2002) :
o The degree 0 is the normal test.
o the grade 1 is characterized by the display of fine
echoes of the hepatic parenchyma with normal viewing
of the diaphragm and intrahepatics vessels,.
o grade 2 is characterized by diffuse increase in the fine
echoes with impaired view of intrahepatic vessels and
diaphragm, and
o Grade 3 is characterized with a significant increase in
fine echoes and impaired or absent visualization of
intrahepatic vessels.
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Material and Methods

In the statistical analysis, values were expressed
as median, first and third quartiles.
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Result
We diagnosed 233/800 (29.1%) patients by the US
of hepatic steatosis, 153 (65.7%) were female and
80 (34.3%) were male.
Regarding degrees :
o Grade 1 : 119 (51.0%).
o Grade 2 : 94 (40.4%), and
o Grade 3 : 20 (8.6%).
The median age of the patients ; grade 1 was 44.0
years (first quartile and third quartile were 37.0 and
51.0), grade 2 was 47.5 years (40.0 and 53.0) and
grade 3 was 45.5 (36.5 and 54.8), but did not vary
significantly (P > 0.05).
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The prevalence of alcoholic hepatic steatosis

does not vary depending on the region studied
and the diagnostic methods used.
Eastern countries often have a lower prevalence
compared to the West, as the Western lifestyle is,
in itself, an important environmental risk factor.
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Discussion
Currently ultrasound criteria are mainly used to
evaluate the severity of hepatic steatosis.

Bi et al (2014) found that patients with NAFLD

with advanced degrees had significantly increased
aminotransferase values, thus, there was strong
correlation between the levels of these enzymes
and NAFLD.
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ALT levels
increased as the
degree of
advanced
hepatic steatosis

Figure 1. ALT vs. hepatic

steatosis. ALT: alanine
transferase; P: significance.
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Figure 2. AST vs. hepatic Figure 3. GGT vs. hepatic

steatosis. AST: aspartate steatosis. GGT: gamma-glutamyl
aminotransferase; transpeptidase;
P: significance. P: significance.
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AST, GGT, and HOMA-IR

levels increased as the
degree of advanced hepatic
steatosis (Fig. 2, 3, and 4),

Figure 4. HOMA-IR vs. hepatic steatosis.

HOMA-IR: homeostasis
model assessment-insulin resistance; P:
significance.
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The median AST, ALT, GGT and HOMA-IR index showed

statistically significant variation in the degree of hepatic
steatosis (P 0.05), as shown in Table.
The AST showed a greater association with the severity of
steatosis (P = 0.0001) than the ALT (P = 0.001).
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Discussion
Tomizawa et al (2014) AST and ALT were
significantly higher in patients with NAFLD
compared to those without NAFLD (P = 0.0001).
This study, which found a significant association
of AST and ALT levels with increased ultrasound
degrees of hepatic steatosis.
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Discussion
The increase in GGT can be found early in NAFLD;
however, Bi et al (2014) showed that ALT is a
more specific marker than GGT.

The combination of US of the liver and HOMA-IR is

a sensitive and specific method not only to
diagnose steatosis, but also in the prediction of
severity
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Discussion
Damiani et al (2011) have also shown a strong
relationship between IR measured by HOMA-IR and
hepatic fat.
Fedchuk et al (2014) found a median HOMA-IR 3.3
(2.3 - 5.6) between patients with NAFLD.
Thus, the study found that the coexistence of
NAFLD and elevated ALT are associated with IR
and can be useful for early detection of IR.
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Conclusion

ALT, AST, GGT and HOMA-IR are related to the

degrees of hepatic steatosis on ultrasound.
It can help in the selection of patients for liver
histological evaluation.
Thank You