THE ROLE OF INSULIN RESISTANCE IN HYPERTENSIVE PATIENTS WITH FATTY LIVER AND NORMAL LIVER FUNCTIONS
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BACKGROUND: The conditions associated with fatty Liver disease presenting with normal liver enzymes and the mechanism in its development remain to be fully investigated. AIMS: The aim of this work was to test the hypothesis that fatty Liver with normal Liver enzymes occurs most frequently in arterial hypertensive patients and to establish whether this is associated with insulin resistance. PATIENTS: Fifty five non-obese, non-diabetic, non-alcoholic patients with arterial hypertensive and normal liver enzymes and 55 sex and age matched healthy subjects (control group) were enrolled into the study. METHODS: Plasma metabolic parameters, body mass index, and the presence of fatty liver were investigated. Insulin resistance was estimated from plasma insulin and glucose. Stepwise logistic regression and multivariate regression analysts were used on the combined sample to identify variables independently associated with fatty liver and insulin resistance. RESULTS: Hypertensive patients had a significantly higher prevalence of fatty liver (30.9% v 12.7%; p>0.041), higher insulin resistance (mean 2.27(SD 1.81) v 1.56(0.70); p = 0.022), and slightly higher body mass index (24.9 (3.0) v 24.0 (2.2); p = 0.043) than controls. Multivariate logistic regression identified insulin resistance (odds ratio 1.66(95% confidence interval (Cl) 1.03-2.52)) and body mass index (OR 1.22 (95% C/ 1.00- 1.49)) as factors independently associated with fatty liver. Multivariate regression analysis showed insulin resistance to be predicted by alanine transaminase (p=0.002), presence of arterial hypertension (p=0.029), body mass index (p=0.048). and CONCLUSION: The higher prevalence of non-alcoholic fatty liver in nonobese hypertensive patients with normal liver enzymes appears to be related to increases in insulin resistance and body weight. .