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Duseja A, Singh SP, Saraswat VA, Acharya SK, Chawla YK, Chowdhury S, Dhiman RK, Jayakumar RV, Madan K, Misra SP, Mishra H, Modi SK, Muruganathan A, Saboo B, Sahay R, Upadhyay R. Non-alcoholic Fatty Liver Disease and Metabolic Syndrome-Position Paper of the Indian National Association for the Study of the Liver, Endocrine Society of India, Indian College of Cardiology and Indian Society of Gastroenterology. J Clin Exp Hepatol 2015; 5:51-68. [PMID: 25941433 PMCID: PMC4415196 DOI: 10.1016/j.jceh.2015.02.006] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 02/27/2015] [Indexed: 02/07/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is closely associated with metabolic syndrome. Prevalence of metabolic risk factors including diabetes mellitus, obesity, etc. is rapidly increasing in India putting this population at risk for NAFLD. Patients with NAFLD are at increased risk for liver-related morbidity and mortality and also cardiovascular disease risk and increased incidence of diabetes mellitus on long-term follow-up. Management of patients with NAFLD may require a multi-disciplinary approach involving not only the hepatologists but also the internists, cardiologists, and endocrinologists. This position paper which is a combined effort of the Indian National Association for Study of the Liver (INASL), Endocrine Society of India (ESI), Indian College of Cardiology (ICC) and the Indian Society of Gastroenterology (ISG) defines the spectrum of NAFLD and the association of NAFLD with insulin resistance and metabolic syndrome besides suggesting preferred approaches for the diagnosis and management of patients with NAFLD in the Indian context.
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Key Words
- ALT, Alanine Aminotransferase
- APO C3, Apolipoprotein C3
- ARFI, Acoustic Radiation Forced Impulse
- AST, Aspartate Aminotransferase
- ATPIII, Adult Treatment Panel III
- BMI, Body mass index
- CAD, Coronary artery disease
- CC, Cryptogenic Cirrhosis
- CIMT, Carotid Intima Media Thickness
- CK 18, Cytokeratin 18
- CT, Computed Tomography
- DM, Diabetes Mellitus
- EBP, Enhancer-Binding Protein
- EMA, Anti-Endomysial antibodies
- FFA, Free Fatty Acids
- FMD, Flow-Mediated Vasodilatation
- FPG, Fasting Plasma Glucose
- GTT, Glucose Tolerance Test
- HCC, Hepatocellular Carcinoma
- HOMA-IR, Homeostasis Model Assessment for Insulin Resistance
- HTG, Hepatic triglyceride
- HTN, Hypertension
- IFG, Impaired Fasting Glucose
- IGT, Impaired Glucose Tolerance
- IKK-β, Inhibitor of nuclear factor kappa-B kinase beta
- IR, Insulin resistance
- IRS-1, Insulin Receptor Substrate-1
- ITT, Insulin Tolerance Test
- LFTs, Liver Function Tests
- MRE, Magnetic Resonance Elastography
- MS, Metabolic syndrome
- NAFLD
- NAFLD, Non-alcoholic fatty liver disease
- NASH
- NASH, Non-Alcoholic Steatohepatitis
- NF-κβ, Nuclear Factor Kappa Β
- PCOS, Polycystic Ovarian Syndrome
- PPG, Post-Prandial Glucose
- PROCAM, Prospective Cardiovascular Munster study
- SREBP, Sterol-Regulatory Element-Binding Protein
- T2DM, Type 2 Diabetes Mellitus
- TE, Transient elastography
- TG, Triglycerides
- TTG, Anti-tissue transglutaminase
- VHCC, Virus-related HCC
- VLDL, Very Low Density Lipoprotein
- WHO, World Health Organization
- cryptogenic cirrhosis
- insulin resistance
- nonalcoholic steatohepatitis
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Affiliation(s)
- Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shivaram P. Singh
- Department of Gastroenterology, SCB Medical College, Cuttack, Odisha, India
- Address for correspondence: Shivaram P. Singh, Professor and Head, Department of Gastroenterology, SCB Medical College, Cuttack 753007, Odisha, India. Tel.: +91 671 2433865.
| | - Vivek A. Saraswat
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Subrat K. Acharya
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Yogesh K. Chawla
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhankar Chowdhury
- Department of Endocrinology, Institute of Postgraduate Medical Education & Research and SSKM Hospital, Kolkata, West Bengal, India
| | - Radha K. Dhiman
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Kaushal Madan
- Medanta Institute of Digestive and Hepatobiliary Sciences, Medanta—The Medicity, Gurgaon, Haryana, India
| | - Sri P. Misra
- Department of Gastroenterology, MotiLal Nehru Medical College, Allahabad, Uttar Pradesh, India
| | - Hrudananda Mishra
- Department of Cardiology, SCB Medical College, Cuttack, Odisha, India
| | - Sunil K. Modi
- Department of Cardiology, Indraprastha Apollo Hospital, New Delhi, India
| | - Arumugam Muruganathan
- The Tamil Nadu Dr. M.G.R. Medical University & AG Hospital, Tirupur, Tamil Nadu, India
| | - Banshi Saboo
- Department of Endocrinology, Diabetes Care & Hormone Clinic, Ahmedabad, Gujarat, India
| | - Rakesh Sahay
- Osmania Medical College & Osmania General Hospital, Hyderabad, Andhra Pradesh & MediCiti Hospital, Hyderabad, Andhra Pradesh, India
| | - Rajesh Upadhyay
- Department of Gastroenterology, Max Super Speciality Hospital, Shalimar Bagh, New Delhi, India
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Obesity and dyslipidemia in South Asians. Nutrients 2013; 5:2708-33. [PMID: 23863826 PMCID: PMC3738996 DOI: 10.3390/nu5072708] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 05/22/2013] [Accepted: 05/28/2013] [Indexed: 12/11/2022] Open
Abstract
Obesity and dyslipidemia are emerging as major public health challenges in South Asian countries. The prevalence of obesity is more in urban areas than rural, and women are more affected than men. Further, obesity in childhood and adolescents is rising rapidly. Obesity in South Asians has characteristic features: high prevalence of abdominal obesity, with more intra-abdominal and truncal subcutaneous adiposity than white Caucasians. In addition, there is greater accumulation of fat at “ectopic” sites, namely the liver and skeletal muscles. All these features lead to higher magnitude of insulin resistance, and its concomitant metabolic disorders (the metabolic syndrome) including atherogenic dyslipidemia. Because of the occurrence of type 2 diabetes, dyslipidemia and other cardiovascular morbidities at a lower range of body mass index (BMI) and waist circumference (WC), it is proposed that cut-offs for both measures of obesity should be lower (BMI 23–24.9 kg/m2 for overweight and ≥25 kg/m2 for obesity, WC ≥80 cm for women and ≥90 cm for men for abdominal obesity) for South Asians, and a consensus guideline for these revised measures has been developed for Asian Indians. Increasing obesity and dyslipidemia in South Asians is primarily driven by nutrition, lifestyle and demographic transitions, increasingly faulty diets and physical inactivity, in the background of genetic predisposition. Dietary guidelines for prevention of obesity and diabetes, and physical activity guidelines for Asian Indians are now available. Intervention programs with emphasis on improving knowledge, attitude and practices regarding healthy nutrition, physical activity and stress management need to be implemented. Evidence for successful intervention program for prevention of childhood obesity and for prevention of diabetes is available for Asian Indians, and could be applied to all South Asian countries with similar cultural and lifestyle profiles. Finally, more research on pathophysiology, guidelines for cut-offs, and culturally-specific lifestyle management of obesity, dyslipidemia and the metabolic syndrome are needed for South Asians.
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Misra A, Khurana L. The Metabolic Syndrome in South Asians: Epidemiology, Determinants, and Prevention. Metab Syndr Relat Disord 2009; 7:497-514. [DOI: 10.1089/met.2009.0024] [Citation(s) in RCA: 228] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Anoop Misra
- Department of Diabetes and Metabolic Diseases, Fortis Hospital, Vasant Kunj, Delhi, India
- Center for Diabetes, Obesity, and Cholesterol Disorders (C-DOC), Diabetes Foundation (India), SDA, New Delhi, India
| | - Lokesh Khurana
- Center for Diabetes, Obesity, and Cholesterol Disorders (C-DOC), Diabetes Foundation (India), SDA, New Delhi, India
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Sharma R, Vikram NK, Misra A. Comparison of short insulin tolerance test with HOMA Method for assessment of insulin sensitivity in Asian Indians in north India. Diabetes Res Clin Pract 2008; 82:e9-12. [PMID: 18706731 DOI: 10.1016/j.diabres.2008.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Revised: 06/20/2008] [Accepted: 07/01/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cost-effective method to assess insulin resistance is needed for Asian Indians. METHODS We compared HOMA with SITT methods in 40 subjects. RESULTS Values obtained from both methods did not show any correlation. CONCLUSIONS Both methods should be evaluated against hyperinsulinemic clamp to determine suitability in Asian Indians.
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Affiliation(s)
- Rajeev Sharma
- Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi 110029, India
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