Nonalcoholic fatty liver and metabolic syndrome in Italy: results from a multicentric study of the Italian Arteriosclerosis society

Nonalcoholic fatty liver disease (NAFLD) is associated with all the components of metabolic syndrome (MS) and might to be considered an additional component of MS itself. The Italian Society for the Study of Atherosclerosis (SISA) in 2005 started a research project aimed to study the NAFLD, using ultrasound (US), in nondiabetic MS subjects matching at least one of the ATP III criteria for HDL-C or triglycerides [TG]. Prevalence of US-NAFLD and its associated risk factors and prevalence of hypertransaminasemia and its possible determinants were evaluated. NAFLD prevalence was 0.78. Men with steatosis compared to men without steatosis were younger (P <0.05) with higher TG (P <0.03), homeostasis model assessment insulin resistance (HOMA-R) (P <0.003), and visceral fat thickness (VFT) (P <0.0001). Women with steatosis showed higher TG (P <0.05), HOMA-R (P <0.04), VFT (P <0.0001), and lower age (P <0.05). At multivariate analyses, VFT (P <0.0001), HOMA-R (P <0.02), and TG/HDL (P <0.05) were associated with severity of NAFLD. Age (P <0.05), LogTG (P <0.005), and VFT (P <0.01) were associated with higher ALT. The US prevalence of steatosis in this study (0.78) is the highest reported in patients with MS. Considering the exclusion of severe obese and diabetic patients and the recruitment criteria, this finding highlights the prominent role played by the alterations of lipid metabolism in the pathogenesis of NAFLD.