Usefullness of a combined evaluation of the serum adiponectin level and insulin growth factor 1 to predict the early stage of nonalcoholic steatohepatitis

Abstract

on-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in Western industrialised countries and affects around 25% of the European population. The prevalence of NAFLD is increasing in parallel with the global increase in obesity and type 2 diabetes mellitus (T2DM). NAFLD is histologically further divided into nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). NAFL is defined as the presence of hepatic steatosis with no evidence of hepatocellular injury in the form of ballooning of the hepatocytes. NASH is defined as the presence of hepatic steatosis and inflammation with hepatocyte injury (ballooning) with or without fibrosis. All patients of NAFLD irrespective of the liver enzyme elevation should undergo a detailed physical examination and anthropometry including, height, weight, BMI, waist circumference, and waist–hip ratio for the assessment of overweight and central and overall obesity. These patients should be further evaluated with full liver function tests (LFTs) and for the presence of other components of metabolic syndrome namely hypertension, IGT, serum triglycerides, and HDL. In addition, all patients should also be screened for viral markers including hepatitis B surface antigen (HBsAg) and antibodies to hepatitis C virus (anti-HCV). Further work-up should include also autoimmune markers, celiac disease work-up, serum iron profile, and serum ceruloplasmin should be done only in patients with elevated liver enzymes depending on the age of the patient. In response to inflammatory cytokines and liver injury, collagen deposition occurs in the liver causing fibrosis. Noninvasive tests for fibrosis may decrease the need for liver biopsy in patients with nonalcoholic fatty liver disease. A commercially available combination of serologic markers of fibrosis has a sensitivity of 47% and specificity of 90% for detecting advanced fibrosis.