Hepatology highlights

Non-Alcoholic Fatty Liver Disease (NAFLD) is considered by many to be the hepatic manifestation of metabolic syndrome, the constellation of obesity, impaired glucose tolerance, dyslipidemia and hypertension that has been associated with a higher prevalence of NAFLD and Non-Alcoholic Steatohepatitis (NASH).1 Most patients with NAFLD are asymptomatic, with many of them suspected to have fatty liver disease because of elevated liver function tests or abnormal imaging studies, found during evaluation of other medical complains or routine tests. This study validated the triglyceride and glucose (TyG) index as a screening tool for NAFLD and NASH in asymptomatic women. The TyG index has been found to be comparable or better than scores like triglycerides/ HDL cholesterol ratio and the HOMA score as a screening marker of insulin resistance.2,3 50 asymptomatic women aged 20 to 65 years with no clinical evidence of chronic liver disease were enrolled. Laboratory data included liver enzymes, fasting glucose, cholesterol and triglycerides. Liver biopsy was performed and results were classified as normal, simple steatosis or NASH. TyG was calculated as Ln (TG [mg/dL] x glucose [mg/dL]/2). Women with simple steatosis and NASH presented the highest percentage of obesity and TyG index, whereas women with NASH had higher cholesterol and triglycerides levels than women with normal liver (P < 0.05). The optimal values of TyG index for screening of steatosis and NASH was established on a receiver operating characteristic (ROC) curve, with an index of 4.58 having a sensitivity of 0.94 and specificity of 0.69 for NAFLD, and an index of 4.59 having a sensitivity of 0.87 and specificity 0.69 for NASH. In recent years, NAFLD has become a worldwide epidemic and a public health concern;4 however, NAFLD remains unrecognized and the diagnosis delayed. Liver biopsy remains the gold standard to diagnose NAFLD and advanced fibrosis. Nonetheless, liver biopsy is an invasive procedure with potential risk for complications. This study validates results of others that suggest that TyG index can be a useful non-invasive screening biomarker for NAFLD.5