Patterns of Dyslipidemia among Patients with Non-Alcoholic Fatty Liver Disease: Dyslipidemia among Patients with NAFLD

Kaleem Ullah Shaikh; Shahid Kareem; Abeer Sarfaraz; Muhammad Wasiq Anwar; Nida Batool; Saadia Abu Bakar

doi:10.54393/pjhs.v6i4.2530

Authors

Kaleem Ullah Shaikh Department of Cardiology, Liaquat National Hospital, Karachi, Pakistan
Shahid Kareem Department of Gastroenterology, Liaquat National Hospital, Karachi, Pakistan
Abeer Sarfaraz Department of Cardiology, Liaquat National Hospital, Karachi, Pakistan
Muhammad Wasiq Anwar Department of Cardiology, Liaquat National Hospital, Karachi, Pakistan
Nida Batool Department of Cardiology, Liaquat National Hospital, Karachi, Pakistan
Saadia Abu Bakar Department of Cardiology, Liaquat National Hospital, Karachi, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i4.2530

Keywords:

Dyslipidemia, NAFLD, Fibro Scan

Abstract

Non-alcoholic fatty liver disease (NAFLD) affects a significant proportion and is frequently associated with dyslipidemia and metabolic disorders. Objective: To explore the patterns of dyslipidemia among patients with NAFLD and their association with disease severity. Methods: A cross-sectional study was conducted at the Department of Cardiology, Liaquat National Hospital, Karachi. All participants diagnosed with NAFLD were included, and NAFLD severity was assessed using Fibro Scan, categorizing patients into no significant fibrosis, mild fibrosis, significant fibrosis, and advanced fibrosis. Dyslipidemia patterns were evaluated based on lipid profiles. Results: The cohort (n=300) had a mean age of 51.44 years, with a majority being female (60.3%) and over 45 years old (71.3%). NAFLD severity was distributed as follows: 33% mild fibrosis, 32% no significant fibrosis, 29.3% significant fibrosis, and 5.7% advanced fibrosis. As NAFLD severity increased, waist circumference, liver enzyme levels (AST and ALT), and lipid markers (TC, LDL-C, TG) increased, while HDL-C decreased. Advanced cases showed higher hemoglobin A1c levels and increased hepatic steatosis and CAP values. Dyslipidemia associated with metabolic syndrome (24%), low HDL-C (61.3%), and hypertriglyceridemia (2%) were observed, with combined and general hyperlipidemia affecting 3.7% and 1.3% of participants, respectively. The patterns of dyslipidemia varied with severity; normolipidemia was common in cases with no significant fibrosis, combined hyperlipidemia was seen in significant fibrosis, and hyperlipidemia was exclusive to advanced NAFLD. Conclusion: It was concluded that the study found significant associations between NAFLD severity and dyslipidemia patterns.

References

Powell EE, Wong VW, Rinella M. Non-Alcoholic Fatty Liver Disease. The Lancet. 2021 Jun; 397(10290): 2212-24. doi: 10.1016/S0140-6736(20)32511-3. DOI: https://doi.org/10.1016/S0140-6736(20)32511-3

Angulo P. Nonalcoholic Fatty Liver Disease. New England Journal of Medicine. 2002 Apr; 346(16): 1221-31. doi: 10.1056/NEJMra011775. DOI: https://doi.org/10.1056/NEJMra011775

Muzurović E, Mikhailidis DP, Mantzoros C. Non-Alcoholic Fatty Liver Disease, Insulin Resistance, Metabolic Syndrome and Their Association with Vascular Risk. Metabolism. 2021 Jun; 119: 154770. doi: 10.1016/j.metabol.2021.154770. DOI: https://doi.org/10.1016/j.metabol.2021.154770

Rosato V, Masarone M, Dallio M, Federico A, Aglitti A, Persico M. NAFLD and Extra-Hepatic Comorbidities: Current Evidence on a Multi-Organ Metabolic Syndrome. International Journal of Environmental Research and Public Health. 2019 Sep; 16(18): 3415.doi: 10.3390/ijerph16183415. DOI: https://doi.org/10.3390/ijerph16183415

Dallio M, Sangineto M, Romeo M, Cipullo M, Coppola A, Mammone S et al. The Influence of Acute Lifestyle Changes on NAFLD Evolution in a Multi-centre Cohort: A Matter of Body Composition. Nutrition and Diabetes. 2024 May; 14(1): 33. doi: 10.1038/s41387-024-00294-2. DOI: https://doi.org/10.1038/s41387-024-00294-2

Almeda-Valdes P, Altamirano-Barrera A, Méndez-Sánchez N. Insights in Non-Alcoholic Fatty Liver Disease Pathophysiology with Lipidomic Analyses. Annals of Hepatology. 2015 Jul; 14(4): 567-9. doi: 10.1016/S1665-2681(19)31182-2. DOI: https://doi.org/10.1016/S1665-2681(19)31182-2

Jiménez-Cortegana C, García-Galey A, Tami M, Del Pino P, Carmona I, López S et al. Role of Leptin in Non-Alcoholic Fatty Liver Disease. Biomedicines. 2021 Jun; 9(7): 762. doi: 10.3390/biomedicines9070762. DOI: https://doi.org/10.3390/biomedicines9070762

Khan MA, Adeel M, Ur A, Rehman SJ, Ghafoor A, Haleem AM et al. Evaluating the Derangement of LFTS Concerning Statin Use and Probable Liver Injury Among Non-Cardiac Patients, in the Light of R Ratio. International Journal of Endorsing Health Science Research. 2023 Oct; 11(4):192-198. doi: 10.29052/IJEHSR.v11.i4.2023.192-198. DOI: https://doi.org/10.29052/IJEHSR.v11.i4.2023.192-198

Musso G, Cassader M, Cohney S, Pinach S, Saba F, Gambino R. Emerging Liver–Kidney Interactions in Nonalcoholic Fatty Liver Disease. Trends in Molecular Medicine. 2015 Oct; 21(10): 645-62. doi: 10.1016/j.molmed.2015.08.005. DOI: https://doi.org/10.1016/j.molmed.2015.08.005

Kikkawa K, Nakajima K, Shimomura Y, Tokita Y, Machida T, Sumino H et al. Small Dense LDL Cholesterol Measured by Homogeneous Assay in Japanese Healthy Controls, Metabolic Syndrome and Diabetes Patients with or without A Fatty Liver. Clinica Chimica Acta. 2015 Jan; 438: 70-9. doi: 10.1016/j.cca.2014.07.017. DOI: https://doi.org/10.1016/j.cca.2014.07.017

Sonmez A, Nikolic D, Dogru T, Ercin CN, Genc H, Cesur M et al. Low- and High-Density Lipoprotein Subclasses in Subjects with Nonalcoholic Fatty Liver Disease. Journal of Clinical Lipidology. 2015 Jul; 9(4): 576-82. doi: 10.1016/j.jacl.2015.03.010. DOI: https://doi.org/10.1016/j.jacl.2015.03.010

Scoditti E, Sabatini S, Carli F, Gastaldelli A. Hepatic Glucose Metabolism in the Steatotic Liver. Nature Reviews Gastroenterology and Hepatology. 2024 May; 21(5): 319-34. doi: 10.1038/s41575-023-00888-8. DOI: https://doi.org/10.1038/s41575-023-00888-8

Rehan R, Perveen K, Imtiaz F, Mubeen S. Hepatic Steatosis: Can Herbs Cure This. International Journal of Endorsing Health Science Research. 2018; 6(1): 8-15. doi: 10.29052/IJEHSR.v6.i1.2018.08-15. DOI: https://doi.org/10.29052/IJEHSR.v6.i1.2018.08-15

Kasper P, Martin A, Lang S, Kuetting F, Goeser T, Demir M, Steffen HM. NAFLD and Cardiovascular Diseases: A Clinical Review. Clinical Research in Cardiology. 2021 Jul; 110: 921-37. doi: 10.1007/s00392-020-01709-7. DOI: https://doi.org/10.1007/s00392-020-01709-7

Stepanova M and Younossi ZM. Independent Association Between Nonalcoholic Fatty Liver Disease and Cardiovascular Disease in the US Population. Clinical Gastroenterology and Hepatology. 2012 Jun; 10(6): 646-50. doi: 10.1016/j.cgh.2011.12.039 DOI: https://doi.org/10.1016/j.cgh.2011.12.039

Marí M, Caballero F, Colell A, Morales A, Caballeria J, Fernandez A et al. Mitochondrial Free Cholesterol Loading Sensitizes to TNF-And Fas-Mediated Steatohepatitis. Cell Metabolism. 2006 Sep; 4(3): 185-98. doi: 10.1016/j.cmet.2006.07.006. DOI: https://doi.org/10.1016/j.cmet.2006.07.006

Tziomalos K, Athyros VG, Paschos P, Karagiannis A. Nonalcoholic Fatty Liver Disease and Statins. Metabolism. 2015 Oct; 64(10): 1215-23. doi: 10.1016/j.metabol.2015.07.003. DOI: https://doi.org/10.1016/j.metabol.2015.07.003

Demir M, Bornstein SR, Mantzoros CS, Perakakis N. Liver Fat as Risk Factor of Hepatic and Cardio-metabolic Diseases. Obesity Reviews. 2023 Oct; 24(10): e13612. doi: 10.1111/obr.13612. DOI: https://doi.org/10.1111/obr.13612

Bhala N, Ibrahim Kamal Jouness R, Bugianesi E. Epidemiology and Natural History of Patients with NAFLD. Current Pharmaceutical Design. 2013 Sep; 19(29): 5169-76. doi: 10.2174/13816128113199990336. DOI: https://doi.org/10.2174/13816128113199990336

Abbas Z and Zaheer R. Non-Alcoholic Fatty Liver Disease: A Real Threat in Pakistan. The Journal of the Pakistan Medical Association. 2020 Dec; 70(12 (B)): 2437-40. doi: 10.5455/JPMA.95891. DOI: https://doi.org/10.5455/JPMA.95891

Sen A, Kumar J, Misra RP, Uddin M, Shukla PC. Lipid Profile of Patients Having Non-Alcoholic Fatty Liver Disease as Per Ultrasound Findings in North Indian Population: A Retrospective Observational Study. Journal of Medical and Allied Sciences. 2013 Aug; 3(2): 59.

Bhusal KR, Simkhada R, Nepal P. Lipid Profile in Different Grades of Ultrasonic Non-Alcoholic Fatty Liver Disease. Journal of College of Medical Sciences-Nepal. 2017 Jul; 13(2): 258-61. doi: 10.3126/jcmsn.v13i2.17773. DOI: https://doi.org/10.3126/jcmsn.v13i2.17773

Marušić M, Paić M, Knobloch M, Liberati Pršo AM. NAFLD, Insulin Resistance, and Diabetes Mellitus Type 2. Canadian Journal of Gastroenterology and Hepatology. 2021; 2021(1): 6613827. doi: 10.1155/2021/6613827. DOI: https://doi.org/10.1155/2021/6613827

Mantovani A, Petracca G, Beatrice G, Tilg H, Byrne CD, Targher G. Non-Alcoholic Fatty Liver Disease and Risk of Incident Diabetes Mellitus: An Updated Meta-Analysis of 501 022 Adult Individuals. Gut. 2021 May; 70(5): 962-9. doi: 10.1136/gutjnl-2020-322572. DOI: https://doi.org/10.1136/gutjnl-2020-322572

Taipale T, Seppälä I, Raitoharju E, Mononen N, Lyytikäinen LP, Illig T et al. Fatty Liver Is Associated with Blood Pathways of Inflammatory Response, Immune System Activation and Prothrombotic State in Young Finns Study. Scientific Reports. 2018 Jul; 8(1): 10358. doi: 10.1038/s41598-018-28563-y. DOI: https://doi.org/10.1038/s41598-018-28563-y

Lonardo A, Nascimbeni F, Ballestri S, Fairweather D, Win S, Than TA et al. Sex Differences in Nonalcoholic Fatty Liver Disease: State of the Art and Identification of Research Gaps. Hepatology. 2019 Oct; 70(4): 1457-69. doi: 10.1002/hep.30626. DOI: https://doi.org/10.1002/hep.30626

Fotakis C, Kalafati IP, Amanatidou AI, Andreou V, Matzapetakis M, Kafyra M et al. Serum Metabolomic Profiling Unveils Distinct Sex-Related Metabolic Patterns in NAFLD. Frontiers in Endocrinology. 2023 Oct; 14: 1230457. doi: 10.3389/fendo.2023.1230457. DOI: https://doi.org/10.3389/fendo.2023.1230457

Morán-Costoya A, Proenza AM, Gianotti M, Lladó I, Valle A. Sex differences in NAFLD: Estrogen Influence on the Liver-Adipose Tissue Crosstalk. Antioxidants and Redox Signalling. 2021; 35(9): 753-774. 2021. doi: 10.1089/ars.2021.0044. DOI: https://doi.org/10.1089/ars.2021.0044

Khurram M and Ashraf MM. A Clinical and Biochemical Profile of Biopsy-Proven Non-Alcoholic Fatty Liver Disease Subjects. Journal of College of Physicians and Surgeons Pakistan. 2007 Sep; 17(9): 531-4.