Current Science

Open Access Open Access  Restricted Access Subscription Access

Non-Alcoholic Fatty Liver Disease in Asian Indians:Relationship With Insulin Resistance, Diabetes and Cardiovascular Risk


Affiliations
1 Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, B-16, Chirag Enclave, New Delhi 110 048, India
2 Department of Medicine, All India Institute of Medical Sciences, New Delhi 110 029, India
 

Prevalence of non-alcoholic fatty liver disease (NAFLD) varies in India; up to one-third of the urban population is affected by the disease. In Asian Indians, presence of NAFLD is driven by multiple factors – presence of excess abdominal fat (abdominal subcutaneous and intra-abdominal fat) and lifestyle factors (imbalanced diets and physical inactivity), and it is correlated closely with insulin resistance, the metabolic syndrome and dysglycaemia in the background of genetic predisposition (investigated genes in Asian Indians: APOC3, PNPLA-3, PPARγ, SREBP-2, adiponectin, SAMM50, PARVB and PZP). Recent studies also show that presence of NAFLD independently correlates with subclinical inflammation and surrogate markers of atherosclerosis (carotid intima-media thickness, impaired flow-mediated vasodilatation) in Asian Indians. A prediction equation (Indian Fatty Liver Index) which includes simple measures has been developed for Asian Indians. On the other hand, increased (more than 15.6 cm) liver span (surrogate marker of fatty liver), in a preliminary study, predicted diabetes in non-obese Asian Indians. Dietary factors are important for the development of NAFLD, and some evidence indicates that regular use of high monounsaturated fatty acid rich oils, and low amount of saturated fat intake are beneficial.

Keywords

Diabetes, Insulin Resistance, Obesity, Nonalcoholic Fatty Liver Disease.
User
Notifications
Font Size

  • Marchesini, G. et al., Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology, 2003, 37(4), 917–923.

  • Garg, A. and Misra, A., Hepatic steatosis, insulin resistance and adipose tissue disorders. J. Clin. Endocrinol. Metab., 2002, 87(7), 3019–3022.

  • Marchesini, G. et al., Association of non-alcoholic fatty liver disease with insulin resistance. Am. J. Med., 1999, 107, 450–455.

  • Angelico, F. et al., Insulin resistance, the metabolic syndrome, and nonalcoholic fatty liver disease. J. Clin. Endocrinol. Metab., 2005, 90, 1578–1582.

  • Misra, A. et al., Diabetes, cardiovascular disease, and chronic kidney disease in South Asia: current status and future directions. BMJ, 2017, 357, 1420.

  • Misra, A., Anoop, S., Gulati, S., Mani, K., Bhatt, S. P. and Pandey, R. M., Body fat patterning, hepatic fat and pancreatic volume of non-obese Asian Indians with type 2 diabetes in North India: a case-control study. PLoS ONE. 2015, 10(11), e0142749.

  • Nishioji. K. et al., Prevalence of and risk factors for non-alcoholic fatty liver disease in a non-obese Japanese population, 2011–2012. J. Gastroenterol., 2015, 50(1), 95–108.

  • Liu, S. H. et al., Oral contraceptive pill use s associated with reduced odds of nonalcoholic fatty liver disease in menstruating women: results from NHANES III. J. Gastroenterol., 2013, 48(10), 1151–1159.

  • Lazo, M. et al., Prevalence of nonalcoholic fatty liver disease in the United States: the third National Health and Nutrition Examination Survey, 1988–1994. Am. J. Epidemiol., 2013, 178(1), 38–45.

  • Zelber-Sagi, S., Nitzan-Kaluski, D., Halpern, Z. and Oren, R., Prevalence of primary non-alcoholic fatty liver disease in a populationbased study and its association with biochemical and anthropometric measures. Liver Int., 2006, 26(7), 856–863.

  • Fan, J. G. et al., The importance of metabolic factors for the increasing prevalence of fatty liver in Shanghai factory workers. J. Gastroenterol. Hepatol., 2007, 22, 663–668.

  • Hasan, I. et al., Prevalence and risk factors for nonalcoholic fatty liver in Indonesia. J. Gastroenterol. Hepatol., 2002, 17, S154.

  • Mishra, S., Yadav, D., Gupta, M., Mishra, H. and Sharma, P. A., Study of carotid atherosclerosis in patients with non-alcoholic fatty liver disease. Indian J. Clin. Biochem., 2013, 28(1), 79–83.

  • Prashanth, M. et al., Prevalence of nonalcoholic fatty liver disease in patients with type-2 diabetes mellitus. J. Assoc. Phys. India, 2009, 57, 205–210.

  • Mohan, V., Farooq, S., Deepa, M., Ravikumar, R. and Pitchumoni, C. S., Prevalence of non-alcoholic fatty liver disease in urban south Indians in relation to different grades of glucose intolerance and metabolic syndrome. Diabetes Res. Clin. Pract., 2009, 84(1), 84–91; doi:10.1016/j.diabres.2008.11.039.

  • Bajaj, S. et al., A case-control study on insulin resistance, metabolic co-variates and prediction score in non-alcoholic fatty liver disease. Indian J. Med. Res., 2009, 129, 285–292.

  • Amarapurkar, A. and Ghansar, T., Fatty liver: experience from western India. Hepatology, 2007, 6, 37–40.

  • Caprio, S., Definitions and pathophysiology of the metabolic syndrome in obese children and adolescents. Int. J. Obes. (London), 2005, 29, S24–S25.

  • Bellentani, S., Scaglioni, F., Marino, M. and Bedogni, G., Epidemiology of nonalcoholic fatty liver disease. Dig. Dis., 2010, 28, 155–161.

  • Franzese, A. et al., Liver involvement in obese children. Ultrasonography and liver enzyme levels at diagnosis and during followup in an Italian population. Dig. Dis. Sci., 1997, 42, 1428–1432.

  • Tazawa, Y., Noguchi, H., Nishinomiya, F. and Takada, G., Serum alanine aminotransferase activity in obese children. Acta Paediatr., 1997, 86, 238–241.

  • Strauss, R. S., Barlow, S. E. and Dietz, W. H., Prevalence of abnormal serum aminotransferase values in overweight and obese adolescents. J. Pediatr., 2000, 136, 727–733.

  • Parry, I. A., Bhat, R. A. and Khan, I., The prevalence of non-alcoholic fatty liver disease and its association with metabolic syndrome and obesity in pediatric population of north India. J. Metab. Syndr., 2012, 1, 5.

  • Misra, A. and Khurana, L., Obesity and the metabolic syndrome in developing countries. J. Clin. Endocrinol. Metab., 2008, 93, S9–S30.

  • Das, K. et al., Nonobese population in a developing country has a high prevalence of nonalcoholic fatty liver and significant liver disease. Hepatology, 2010, 51, 1593–1602.

  • Nazare, J. A. et al., Ethnic influences on the relations between abdominal subcutaneous and visceral adiposity, liver fat, and cardiometabolic risk profile: the International Study of Prediction of Intra-Abdominal Adiposity and its Relationship with Cardiometabolic Risk/Intra-Abdominal Adiposity. Am. J. Clin. Nutr., 2012, 96(4), 714–726.

  • Bhatt, S. P., Misra, A., Nigam, P., Guleria, R. and Pasha, M. A., Phenotype, body composition, and prediction equations (Indian Fatty Liver Index) for non-alcoholic fatty liver disease in nondiabetic Asian Indians: a case – control study. PLoS ONE, 2015, 10(11), e0142260.

  • Anoop, S., Misra, A., Mani, K., Pandey, R. M., Gulati, S., Bhatt, S. P. and Mahajan, H., Estimation of liver span using MRI for prediction of type 2 diabetes in non-obese Asian Indians. J. Diabetes Sci. Technol., 2017, 11, 446–447.

  • Garg, A. and Misra, A., Hepatic steatosis, insulin resistance and adipose tissue disorders. J. Clin. Endocrinol. Metab., 2002, 87, 3019–3022.

  • Misra, A., Khurana, L., Vikram, N. K., Goel, A. and Wasir, J. S., Metabolic syndrome in children: current issues and South Asian perspective. Nutrition, 2007, 23, 895–910.

  • Mishra, S., Yadav, D., Gupta, M., Mishra, H. and Sharma, P., A study of carotid atherosclerosis in patients with non-alcoholic fatty liver disease. Indian J. Clin. Biochem., 2013, 28(1), 79–83.

  • Petersen, K. F., et al., Increased prevalence of insulin resistance and nonalcoholic fatty liver disease in Asian-Indian men. Proc. Natl. Acad. Sci. USA, 2006, 103, 18273–18277.

  • Sharma, R. et al., Investigation of hepatic gluconeogenesis pathway in non-diabetic Asian Indians with non-alcoholic fatty liver disease using in vivo (31P) phosphorus magnetic resonance spectroscopy. Atherosclerosis, 2009, 203, 291–297.

  • Chambers, J. C. et al., C-reactive protein, insulin resistance, central obesity, and coronary heart disease risk in Indian Asians from the United Kingdom compared with European whites. Circulation, 2001, 104, 145–150.

  • Nigam, P., Bhatt, S. P., Misra, A., Vaidya, M., Dasgupta, J. and Chadha, D. S., Non-alcoholic fatty liver disease is closely associated with sub-clinical inflammation: a case-control study on Asian Indians in North India. PLoS ONE. 2013, 8(1), e49286.

  • Kumar, R. et al., Association of pro-inflammatory cytokines, adipokines and oxidative stress with insulin resistance and non-alcoholic fatty liver disease. Indian J. Med. Res., 2012, 136(2), 229–236.

  • Kuppan, G., Anjana, R. M., Deepa, M., Paramasivam, P., Chandrakumar, S., Kaliyaperumal, V. and Mohan, V., Inflammatory markers in relation to nonalcoholic fatty liver disease in urban South Indians. Diabetes Technol. Ther., 2012, 14(2), 152–158.

  • Thakur, M. L. et al., Nonalcoholic fatty liver disease is associated with subclinical atherosclerosis independent of obesity and metabolic syndrome in Asian Indians. Atherosclerosis, 2012, 223(2), 507–511.

  • Ginde, A. A., Liu, M. C. and Camargo Jr, C. A., Demographic differences and trends of vitamin D insufficiency in the US population, 1988e2004. Arch. Intern. Med., 2009, 169(6), 626e32.

  • Chiu, K. C. et al., Insulin sensitivity is inversely correlated with plasma intact parathyroid hormone level. Metabolism, 2000, 49(11), 1501–1505.

  • Targher, G. et al., Associations between serum 25-hydroxy vitamin D3 concentrations and liver histology in patients with nonalcoholic fatty liver disease. Nutr. Metab. Cardiovasc. Dis., 2007, 17(2), 517–524.

  • Bhatt, S. P., Nigam, P., Misra, A. and Guleria, R., Independent associations of low 25 hydroxy vitamin D and high parathyroid hormonal levels with non alcoholic fatty liver disease in Asian Indians residing in north India. Atherosclerosis, 2013, 230(1), 157–163.

  • Abate, N. et al., Adipose tissue metabolites and insulin resistance in nondiabetic Asian Indian men. J. Clin. Endocrinol. Metab., 2004, 89(6), 2750–2755.

  • Kumar, M. S. et al., Cardiovascular autonomic dysfunction in patients of nonalcoholic fatty liver disease. Int. J. Hepatol., 2016, 2016, 5160754.

  • Petersen, K. F. et al., Apolipoprotein C3 gene variants in nonalcoholic fatty liver disease. N. Engl. J. Med., 2010, 362, 1082–1089.

  • Bhatt, S. P. et al., Genetic variation in the patatin-like phospholipase domain-containing protein-3 gene in Asian Indians with non alcohollic fatty liver disease. Metab. Syndr. Rel. Dis., 2013, 11(5), 329–335.

  • Duseja, A. and Aggarwal, R., APOC3 and PNPLA3 in non-alcoholic fatty liver disease: need to clear the air. J. Gastroenterol. Hepatol., 2012, 27, 951–956.

  • Bhatt, S. P., et al., Association of peroxisome proliferator activated receptor-γ gene in Asian Indians with non alcoholic fatty liver disease. Gene, 2013, 512(1), 143–147.

  • Bhatt, S. P. et al., SREBP-2 1784 G/C genotype is associated with non-alcoholic fatty liver disease in north Indians. Dis. Markers, 2011, 31(6), 371–377.

  • Gupta, A. C. et al., Association of adiponectin gene function polymorphism (-11377G/C and +45T/G) with non alcoholic fatty liver disease. Gene, 2012, 496(1), 63–67.

  • Kanth, V. V., Sasikala, M., Rao, P. N., Steffie Avanthi, U., Rao, K. R. and Nageshwar Reddy, D., Pooled genetic analysis in ultrasound measured non-alcoholic fatty liver disease in Indian subjects: a pilot study. World J. Hepatol., 2014, 6(6), 435–442.

  • Bhat, G., Baba, C. S., Pandey, A., Kumari, N. and Choudhuri, G., Lifestyle modification improves insulin resistance and liver histology in patients with non-alcoholic fatty liver disease. World J. Hepatol., 2012, 4(7), 209–217.

  • Baba Sreenivasa, C., Alexander, G., Kalyani, B., Pandey, R., Rastogi, S., Pandey, A. and Choudhuri, G., Effect of exercise and dietary modification on serum aminotransferase levels in patients with nonalcoholic steatohepatitis. J. Gastroenterol. Hepatol., 2006, 21(1 Pt 1), 191–198.

  • Nigam, P. et al., Effect of a 6-month intervention with cooking oils containing a high concentration of monounsaturated fatty acids (olive and canola oils) compared with refined oil in male Asian Indians with nonalcoholic fatty liver disease. Diabetes Technol. Ther., 2014, 16, 4.

  • Anurag, L., Aniket, S., Shalik, J., Amarja, L., Dhananjay, R. and Sachin, J., Non-alcoholic fatty liver disease prevalence and associated risk factors – a study from rural sector of Maharashtra. Trop. Gastroenterol., 2015, 36(1), 25–30.

  • Praveenraj, P. et al., Prevalence and predictors of non-alcoholic fatty liver disease in morbidly obese south Indian patients undergoing bariatric surgery. Obes. Surg., 2015, 25(11), 2078–2087.

  • Vendhan, R., Amutha, A., Anjana, R. M., Unnikrishnan, R. and Mohan, V., Clinical profile of nonalcoholic fatty liver disease among young patients with type 1 diabetes mellitus seen at a diabetes speciality center in India. Endocr. Pract., 2014, 20(12), 1249–1257.

  • Karoli, R., Fatima, J., Chandra, A., Gupta, U., Islam, F. U. and Singh, G., Prevalence of hepatic steatosis in women with polycystic ovary syndrome. J. Hum. Reprod. Sci., 2013, 6(1), 9–14.

  • Anbalagan, V. P., Venkataraman, V., Vamsi, M., Deepa, M. and Mohan, V., A simple Indian diabetes risk score could help identify nondiabetic individuals at high risk of non-alcoholic fatty liver disease (CURES-117). J. Diabetes Sci. Technol., 2012, 1; 6(6), 1429–1345.

  • Agarwal, A. K., Jain, V., Singla, S., Baruah, B. P., Arya, V., Yadav, R. and Singh, V. P., Prevalence of non-alcoholic fatty liver disease and its correlation with coronary risk factors in patients with type-2 diabetes. J. Assoc. Phys. India, 2011 59, 351–354.

  • Uchil, D., Pipalia, D., Chawla, M., Patel, R., Maniar, S. and Narayani, J. A., Non-alcoholic fatty liver disease (NAFLD) – the hepatic component of metabolic syndrome. J. Assoc. Phys. India, 2009, 57, 201–204.

  • Gupte, P. et al., Non-alcoholic steatohepatitis in type-2 diabetes mellitus. J. Gastroenterol. Hepatol., 2004, 19(8), 854–858.

  • Amarapurkar, D. et al., Prevalence of non-alcoholic fatty liver disease: population based study. Ann Hepatol., 2007, 6(3), 161–163.

  • Madan, K. et al., Non-alcoholic fatty liver disease may not be a severe disease at presentation among Asian Indians. World J. Gastroenterol., 2006, 7, 12(21), 3400–3405.

  • Amarapurkar, D. N. and Patel, N. D., Prevalence of metabolic syndrome in non-diabetic and non-cirrhotic patients with non-alcoholic steatohepatitis. Trop. Gastroenterol., 2004, 25(3), 125–129.

  • Singh, S. P. et al., Prevalence of nonalcoholic fatty liver disease in coastal eastern India: a preliminary ultrasonographic survey. Trop. Gastroenterol., 2004, 25(2), 76–79.


Abstract Views: 253

PDF Views: 68




  • Non-Alcoholic Fatty Liver Disease in Asian Indians:Relationship With Insulin Resistance, Diabetes and Cardiovascular Risk

Abstract Views: 253  |  PDF Views: 68

Authors

Surya Prakash Bhatt
Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, B-16, Chirag Enclave, New Delhi 110 048, India
Anoop Misra
Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, B-16, Chirag Enclave, New Delhi 110 048, India
Naval K. Vikram
Department of Medicine, All India Institute of Medical Sciences, New Delhi 110 029, India

Abstract


Prevalence of non-alcoholic fatty liver disease (NAFLD) varies in India; up to one-third of the urban population is affected by the disease. In Asian Indians, presence of NAFLD is driven by multiple factors – presence of excess abdominal fat (abdominal subcutaneous and intra-abdominal fat) and lifestyle factors (imbalanced diets and physical inactivity), and it is correlated closely with insulin resistance, the metabolic syndrome and dysglycaemia in the background of genetic predisposition (investigated genes in Asian Indians: APOC3, PNPLA-3, PPARγ, SREBP-2, adiponectin, SAMM50, PARVB and PZP). Recent studies also show that presence of NAFLD independently correlates with subclinical inflammation and surrogate markers of atherosclerosis (carotid intima-media thickness, impaired flow-mediated vasodilatation) in Asian Indians. A prediction equation (Indian Fatty Liver Index) which includes simple measures has been developed for Asian Indians. On the other hand, increased (more than 15.6 cm) liver span (surrogate marker of fatty liver), in a preliminary study, predicted diabetes in non-obese Asian Indians. Dietary factors are important for the development of NAFLD, and some evidence indicates that regular use of high monounsaturated fatty acid rich oils, and low amount of saturated fat intake are beneficial.

Keywords


Diabetes, Insulin Resistance, Obesity, Nonalcoholic Fatty Liver Disease.

References





DOI: https://doi.org/10.18520/cs%2Fv113%2Fi07%2F1303-1310