STUDY OF FATTY LIVER AND INSULIN RESISTANCE IN NONOBESE ESSENTIAL HYPERTENSIVE PATIENTS
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Aim of work: The aim of this work is to study the prevalence of fatty liver in non-obese essential hypertensive patients, with normal liver enzymes, and clarify its association with insulin resistance. Patients and methods: One hundred non-obese cases (56 males and 44 females) with essential hypertension were selected, as a study group, from those admitted at the Internal Medicine Department of Benha University Hospitals. Their ages ranged from 45 to 68 years old (with a mean age of 51.3+9.2). One hundred healthy subjects (59 males and 41 females) were selected as a control group and matched with the study group regarding age and sex. Diagnosis of essential hypertension was based on systolic blood pressure >140 mmHg and/or diastolic blood pressure >90 mmHg. Results: The prevalence of fatty liver in non obese hypertensive patients was 32% while in the control group was 13% with statistical significant difference in-between them (P<0.05). The mean levels of fasting blood glucose, fasting serum insulin, insulin resistance, as estimated by homeostasis model assessment of insulin resistance (HOMA-IR) and body mass index were significantly higher in the hypertensive patients than in the control group (P<0.05 respectively). Also, the mean levels of the previous parameters were significantly higher in the hypertensive patients with fatty liver than the controls with fatty liver (P<0.05 respectively). Intra-group analysis showed that the mean levels of the previous parameters were significantly higher in the hypertensive patients with fatty liver than those without (P<0.05 respectively). Interestingly, the mean levels of the previous parameters, were also significantly higher in the control group with fatty liver than those without (P<0.05 respectively) except body mass index (P>0.05). Multivariate regression analysis showed that insulin resistance was independently associated with systolic blood pressure, diastolic blood pressure, body mass index, aspartate aminotransferase and alanine aminotransferase (13<0.05 respectively). Conclusion: It is concluded from this study that, the prevalence of non-alcoholic fatty liver in non-obese hypertensive patients with normal liver enzymes is high and appears to be related to increases in insulin resistance and body weight. The association between hypertension and fatty liver is mediated by elevated insulin resistance. There was a strong association between insulin resistance and liver enzymes. Also, this study threw spotlights on the importance of the routine abdominal ultrasonographic examination for the diagnosis fatty liver in non-obese essential hypertensive patients. Recommendation: Further researches are needed to characterize factors that modulate the natural histories of hepatic steatosis and other disorders, such as hypertension, that often develop in the context of insulin resistance and to improve insulin sensitivity through new therapeutic agents in order to prevent the dreaded consequences of the metabolic syndrome, such as cardiovascular disease, cirrhosis, and hepatocellular carcinoma.