Nonalcoholic Fatty Liver Disease Alone Is a Better Predictor of Metabolic Syndrome and Insulin Resistance than Existing ATP-III Criteria

Objective: Metabolic syndrome (MS) also known as insulin resistance syndrome is a surrogate marker of insulin resistance (IR). Traditionally this is being diagnosed by Adult Treatment Panel III (ATP-III) and International Federation of Diabetes (IDF) criteria. Despite mounting evidence in favor of non-alcoholic fatty liver disease (NAFLD), this has not been yet included as a component of either ATP-III or IDF criteria. We conducted this study to evaluate if NAFLD could be used as a criterion for identifying metabolic syndrome. Methods: Setting: Single center observational study in Gastroenterology OPD at SCB Medical College, Cuttack. Subjects: Consecutive subjects presenting with functional bowel disease were included; these included 68 NAFLD subjects and 200 subjects with normal liver on ultrasonography. Investigations: All 268 subjects were evaluated for the presence of metabolic syndrome by ATP-III and insulin resistance by HOMA IR method. NAFLD subjects were compared with those with metabolic syndrome for presence of insulin resistance Results: Patients with NAFLD had higher HOMA-IR than those with metabolic syndrome (2.34±1.01 vs. 1.79±1.01; p<0.000). Presence of NAFLD can detect insulin resistance with a sensitivity of 78.0% and specificity of 86.3 % with an odds ratio of 25.55 (95%CI: 11.51-56.70) which is better than that of metabolic syndrome diagnosed by ATP-III criteria (sensitivity 71.43%, specificity 70.32%; OR: 5.92, 95%CI: 2.99-11.74). Multivariate logistic regression analysis showed that fatty liver was an independent predictor for insulin resistance and metabolic syndrome. Conclusion: NAFLD alone is a better predictor for insulin resistance than existing ATP-III criteria. Hence NAFLD should be used as a surrogate marker for metabolic syndrome.