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Multifocal fatty liver disease, insulin resistance and carotid atherosclerosis: exploring the interrelated relationship

Amr Shaaban Hanafy
Amr Shaaban Hanafy
, 
Sherief Abd-Elsalam
Sherief Abd-Elsalam
, 
Ayman F. Ahmed
Ayman F. Ahmed
 and 
Mohammed M. Dawoud
Mohammed M. Dawoud
   | Jan 31, 2019
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Article Category: original-paper
Published Online: Jan 31, 2019
Page range: 302 - 309
Received: Jul 24, 2018
Accepted: Dec 31, 2018
DOI: https://doi.org/10.15557/jou.2018.0044
Keywords
© 2018 Amr Shaaban Hanafy et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1.

Ultrasonography shows focal fatty sparing as a hypoechoic lesion in a steatotic liver
Ultrasonography shows focal fatty sparing as a hypoechoic lesion in a steatotic liver

Fig. 2.

Multiple focal hepatic lesions, the largest in segment IV measures about 34 x 28 mm. No enhancement in all phases of the examination, high signal intensity onT1WI, low signal intensity in the fat suppression sequence, and high signal intensity during in-phase study with a drop of signal intensity in out-of-phase study. A. Pre-contrast; B. T1W1; C. Fat suppression; D. Arterial phase; E. Venous phase; F. Delayed phase; G. DWI – diffusion weighted images; H. In-phase study; I. Out-of-phase study
Multiple focal hepatic lesions, the largest in segment IV measures about 34 x 28 mm. No enhancement in all phases of the examination, high signal intensity onT1WI, low signal intensity in the fat suppression sequence, and high signal intensity during in-phase study with a drop of signal intensity in out-of-phase study. A. Pre-contrast; B. T1W1; C. Fat suppression; D. Arterial phase; E. Venous phase; F. Delayed phase; G. DWI – diffusion weighted images; H. In-phase study; I. Out-of-phase study

Fig. 3.

ROC curve of the cutoff value of LSM associated with histological severity of focal fatty liver (A) and insulin resistance (B)
ROC curve of the cutoff value of LSM associated with histological severity of focal fatty liver (A) and insulin resistance (B)

The mean values of the metabolic variables among the studied groups

Variable Diffuse fatty liver (n = 100 Focal fatty liver (n = 96) Healthy controls (n = 100) p
FBS (mg/dl) 93.5 ± 5.3 105 ± 20 82 ± 6 0.034
Insulin 6.1 ± 0.7 9.3 ± 1.8 5.1 ± 0.3 0.001
HbA1c% 5.2 ± 0.37 6.7 ± 0.9 4.4 ± 0.37 0.03
HOMA-IR 1.4 ± 0.2 2.64 ± 0.6 1.3 ± 0.3 0.04
Ferritin (ng/dl) 326 ± 18.7 352.3 ± 81.1 183 ± 13 0.005
Uric acid (mg/dl) 6.5 ± 0.4 6.8 ± 1.6 4.2 ± 0.6 0.04
TGs mg/dl 143.7 ± 21.3 173 ± 10.8 122 ± 9 0.02
LDL mg/dl 157 ± 12.1 220.3 ± 13.3 99.2 ± 8.9 0.003
HDL (mg/dl) 37.3 ± 4.9 35.7 ± 3.2 44.3 ± 6.2 0.3
VLDL (mg/dl) 27.8 ± 6.9 34.7 ± 4.3 23.7 ± 5.6 0.02
Total cholesterol 220.4 ± 18.5 292.6 ± 12.4 173.6 ± 11.5 0.032
TC/HDL ratio 5.72 ± 1.9 7.8 ± 1.4 3.7 ± 0.9 0.001
LDL/HDL ratio 4.33 ± 2.6 5.9 ± 2.4 2.39 ± 0.7 0.02

Baseline laboratory, metabolic and Fibroscan values of patient subgroups

Variable Diffuse fatty liver Focal fatty liver Healthy controls p
N 100 96 100 0.6*
Sex (M/F) 80/20 70/26 83/17 0.23*
Age 36.7 ± 1.8 37.6 ± 2.7 36 ± 0.2 0.17
BMI (kg/m2) 28.3 ± 1.4 28.9 ± 2.6 24.3 ± 1.1 0.03
AST (IU/l) 32.7 ± 4.6 77.5 ± 28.4 26 ± 3 0.036
ALT (IU/l) 37.3 ± 4 88.2 ± 33.7 27 ± 5 0.003
GGT (IU/l) 30.2 ± 4.6 57.8 ± 20 23 ± 5 0.03
Albumin (g/dl) 4.3 ± 0.5 4.4 ± 0.2 4.5 ± 0.4 0.1
Total bilirubin (mg/dl) 1 ± 0.1 1.12 ± 0.1 0.9 ± 0.1 0.2
HsCRP (mg/l) 2.3 ± 0.85 4.8 ± 1.1 0.66 ± 0.35 0.001
NLR 1.6 ± 0.1 2.7 ± 0.7 1.56 ± 0.4 0.04
FibroScan (kPa) 9.6 ± 0.9 9.8 ± 1.2 3.6 ± 1.2(10 patients) 0.01
CIMT (mm) 1.02 ± 0.1 1.16 ± 0.2 0.88 ± 0.05 0.023
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