A case-control study on insulin resistance, metabolic co-variates & prediction score in non-alcoholic fatty liver disease.

Background & objectives: Asian Indians have a high prevalence of insulin resistance and the metabolic syndrome. Currently, non-alcoholic fatty liver disease (NAFLD) is considered to be an integral part of the metabolic syndrome with insulin resistance as a central pathogenic factor. We studied anthropometric parameters, insulin resistance and metabolic co-variates in subjects with NAFLD as compared to those without NAFLD, and also developed a prediction score for NAFLD. Methods: Thirty nine subjects with NAFLD and 82 controls were selected for the study after ultrasonography of 121 consecutive apparently healthy subjects. Anthropometric profile [body mass index (BMI), waist circumference (WC) etc,], lipid profile, hepatic aminotransferases, fasting blood glucose (FBG), insulin were recorded and value of homeostasis model assessment of insulin resistance (HOMA-IR) was analysed. Step-wise logistic regression analysis and area under the receiver operator curve (aROC) were analysed to arrive at a prediction score. Results: Overall, prevalence of NAFLD was 32.2 per cent and prevalence of metabolic syndrome was seen in 41 per cent among cases and 19.5 per cent in controls (P<0.01). Subjects with NAFLD had significantly higher values of BMI, WC, hip circumference, FBG, fasting insulin, total cholesterol and serum triglycerides. Step-wise logistic regression analysis showed odds ratio (OR) and 95 per cent confidence interval (CI) for BMI [ 4.3 (1.6, 11.3)], FBG [5.5 (1.5, 19.8)] and fasting insulin [ 2.4 (1.0, 5.8)] as independent predictors of NAFLD. The prediction score for NAFLD was; 1 (fasting insulin) +1.6 (BMI) + 1.9 (FBG) (sensitivity of 84.6%, specificity of 51.2% and aROC 76%). Interpretation & conclusion: In this study, presence of NAFLD indicated close relationship with multiple features of metabolic syndrome. The prediction score developed could be used as a screening tool to predict NAFLD among Asian Indians in north India.

Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for asian indians and recommendations for physical activity, medical and surgical management.

Asian Indians exhibit unique features of obesity; excess body fat, abdominal adiposity, increased subcutaneous and intra-abdominal fat, and deposition of fat in ectopic sites (liver, muscle, etc.). Obesity is a major driver for the widely prevalent metabolic syndrome and type 2 diabetes mellitus (T2DM) in Asian Indians in India and those residing in other countries. Based on percentage body fat and morbidity data, limits of normal BMI are narrower and lower in Asian Indians than in white Caucasians. In this consensus statement, we present revised guidelines for diagnosis of obesity, abdominal obesity, the metabolic syndrome, physical activity, and drug therapy and bariatric surgery for obesity in Asian Indians after consultations with experts from various regions of India belonging to the following medical disciplines; internal medicine, metabolic diseases, endocrinology, nutrition, cardiology, exercise physiology, sports medicine and bariatric surgery, and representing reputed medical institutions, hospitals, government funded research institutions, and policy making bodies. It is estimated that by application of these guidelines, additional 10-15% of Indian population would be labeled as overweight/obese and would require appropriate management. Application of these guidelines on countrywide basis is also likely to have a deceleration effect on the escalating problem of T2DM and cardiovascular disease. These guidelines could be revised in future as appropriate, after another large and countrywide consensus process. Till that time, these should be used by clinicians, researchers and policymakers dealing with obesity and related diseases. ©

Comparison of definitions of the metabolic syndrome in adult Asian Indians.

OBJECTIVE: The optimum definition of the metabolic syndrome (MS) is not known. We compared international definitions of MS [recently proposed modified definition of National Cholesterol Education Programme, Adult Treatment Panel III (NCEP, ATP III) and International Diabetes Federation (IDF)] with two proposed candidate definitions in adult Asian Indians. DESIGN: Data from three previous cross-sectional studies carried out in North India were analyzed. SUBJECTS: The study included 2050 adult (mean age: 40 +/- 18 years) Asian Indian subjects residing two metropolitan cities. MEASUREMENTS: Candidate definitions of MS were proposed by modifying the NCEP, ATP III and IDF definitions by including the following modified variables into two combinations (MS-ATP1 and MS-IDF1); waist circumference cut-off points as >90 cm in males and >80 cm in females, body mass index (BMI) cut-off point as >23 kg/m2, impaired fasting glucose (IFG) cut-off point >100 mg/dl and waist circumference as an obligatory criterion. RESULTS: Maximum overall and gender-specific prevalence of the MS (49.2% overall; 41.4% in males; 55.3% in females) was observed using the definition which included modified cut-off points of WC (non-obligatory), BMI, and IFG (>100 mg/dl) in addition to other defining parameters. Compared to other definitions this proposed candidate definition maximally detected presence of MS in subjects with IFG and T2DM [Percentage prevalence: 78.1% (73.0-82.7) and 91.1% (84.2-95.6)]. Even in subjects without abdominal obesity, a high prevalence of other abnormal defining parameters of the metabolic syndrome; hypertension (> or = 130 or > or = 85 mmHg), 35.7%; BMI >23 kg/m2, 15.3%; hypertriglyceridemia (>150 mg/dl), 20.2% and low levels of HDL-C (<40 in males; <50 mg/dl in females), 55% were seen. Further, 10.5% of subjects who did not have abdominal obesity had presence of at least 3 risk variables of the metabolic syndrome. These data indicate that by making abdominal obesity a mandatory criterion would lead to missing of some cases of the metabolic syndrome. CONCLUSION: By including BMI and making waist circumference as a non-obligatory criterion, more cases of the metabolic syndrome is detected. For Asian Indians, making waist circumference as mandatory variable in the definition of the metabolic syndrome would lead to non-inclusion of nearly 11% cases who would otherwise be diagnosed as metabolic syndrome according to modified NCEP, ATP III definition.