a Department of Biochemistry , Georgetown University Medical Center , Washington, DC , USA.
b Integrative Health Technologies , San Antonio , Texas , USA.
J Am Coll Nutr. 2018 Aug;37(6):457-465. doi: 10.1080/07315724.2018.1443292. Epub 2018 Apr 13.
Nonalcoholic fatty liver disease (NAFLD) is considered by some to be the hepatic manifestation of the metabolic syndrome (MS). However, others believe NAFLD is a distinct entity that actually initiates MS. Whichever is true, a definite linkage exists between both is generally accepted based upon the frequency of common occurrence and realization that insulin resistance (IR) is and realization that. The objective is to better understand the relationship between NAFLD and MS. Specifically, is there any concrete evidence that development of NAFLD precedes MS or vice versa? Another goal was to better comprehend capabilities of circulating aminotransferases (aspartate aminotransferase [AST] and alanine aminotransferase [ALT]) and their ratio used commonly for diagnosis of NAFLD.
Data from 288 participants with fasting blood glucose (FBG) levels below the diabetic level (<125 mg/dL) and AST and ALT values in the normal range (<40 U/L) were examined. Correlations between ALT and AST and their ratio as independent variables with a variety of metabolic parameter were evaluated and compared.
Like FBG, many significant positive correlations among glucose-insulin indices, body composition, blood pressure, dyslipidemias, and inflammation were discovered using ALT, and less so with AST, as the independent variable. In some cases, even stronger correlations in a negative direction with IR and MS were found with the ratio AST/ALT. Corroboration occurred when values in the lowest and highest quartiles of ALT and AST/ALT readings showed appropriate statistically significant differences.
The findings here suggest that both NAFLD and the MS very early in development have a common inciting mechanism(s)-most likely IR. Accordingly, the early concurrent temporal results are consistent with the concept that NAFLD is a hepatic manifestation of the IR associated with the MS. They do not exclude the possibility that once some liver functional adjustments take place, several aspects of the MS are bolstered further, perhaps via intensified heightening of IR.
非酒精性脂肪性肝病（NAFLD）被一些人认为是代谢综合征（MS）的肝脏表现。然而，也有人认为 NAFLD 是一种独特的实体，实际上是 MS 的起源。无论哪种情况属实，一般都认为两者之间存在明确的联系，这是基于常见的同时发生的频率和对胰岛素抵抗（IR）的认识。目的是更好地理解 NAFLD 和 MS 之间的关系。具体来说，是否有任何具体证据表明 NAFLD 的发展先于 MS 或反之亦然？另一个目标是更好地理解循环氨基转移酶（天冬氨酸氨基转移酶[AST]和丙氨酸氨基转移酶[ALT]）及其比值用于诊断 NAFLD 的能力。
检查了 288 名空腹血糖（FBG）水平低于糖尿病水平（<125mg/dL）且 AST 和 ALT 值在正常范围内（<40U/L）的参与者的数据。评估并比较了 ALT 和 AST 及其比值作为独立变量与各种代谢参数之间的相关性。
与 FBG 一样，使用 ALT 作为独立变量，发现许多葡萄糖-胰岛素指数、身体成分、血压、血脂异常和炎症之间存在显著的正相关，而使用 AST 则相关性较少。在某些情况下，即使是 AST/ALT 的负相关与 IR 和 MS 也存在更强的相关性。当 ALT 和 AST/ALT 读数的最低和最高四分位数的值显示出适当的统计学显著差异时，就会得到证实。
这些发现表明，NAFLD 和 MS 在早期发展中都有一个共同的启动机制（很可能是 IR）。因此，早期同时发生的结果与以下概念一致，即 NAFLD 是与 MS 相关的 IR 引起的肝脏表现。它们并不排除这样一种可能性，即一旦发生一些肝脏功能调整，MS 的几个方面可能会进一步得到加强，也许是通过加剧 IR。
