Abstract

Background: The metabolic syndrome is a constellation of clinical and metabolic abnormalities including abdominal obesity, hypertension, dyslipidernia and impaired fasting glucose/or impaired glucose tolerance. The accumulation of excessive fat in the liver is a manifestation of lipotoxicity to the liver. Initially this is characterized by only steatosis. but later on free fatty acids induce inflammatory reactions called as steatohepatits. The long-term consequences of non alcoholic steatohepatitis (NASH) include cirrhosis of the liver and hepatocellular carcinoma.

In this study we studied the hepatic manifestations of metabolic syndrome.

Methods: The study was carried out in the Post-graduate Department of Medicine, S.N. Medical College, Agra in the period of may 2007 to September 2009. The material of the study included 30 cases of metabolic syndrome selected from the medicine outdoor clinic (including diabetic clinic) and medicine indoor wards as well as from GI clinic. Data were collected regarding antropometric and clinical parameters. Symptoms and signs related to liver involvement were assessed. Laboratory parameters and imaging study were done to look for hepatic involvement and also to exclude other causes of hepatic involvement. In selected cases liver biopsy was done.

Results: Study group consisted of 12 male (40%) and 18 (60%) female patients. Most of the patients (60%) of metabolic syndrome were asymptomatic. Fatigue/malaise was present in 11 (36.7%) of patients, anorexia in 8 (26.7%) and right upper quadrant discomfort in 6 (20%) of patients. Hepatomegaly was present in 7 (23.3%) patients. Ascites was present in 4 (13.3%) patients, Icterus was present in 3 (10%) patients while 2 (6.7%) of patients have hemetemesis/malena.10 out of 30 patients (33.3%) have increased hepatic echogenicity on USG abdomen while 20 (66.7%) patients have normal sonographic study liver of Histopathological evaluation of liver was done in 7 male and 7 female patients.3 out of 14 patients (21.4%) have normal histopathology of liver, while 4 patients (28.6%) have grade-I changes, 4 patients (28.6%) have grade-II and only one patient (7.1) have grade III histopathological changes in liver. 2(14.3%) patients showed grade IV histopathological changes. These changes were statistically significant (P. value<0.05).

Conclusion: Most of the patients of metabolic syndrome (60%) had no symptoms or signs of liver disease. Persistent fatigue/malaise (36.7%) and anorexia (26.7%) were most common symptoms observed. Hepatomegaly was   prevalent in 23.3% of the cases.There was poor correlation between abnormal liver function tests and ultrasonographic abnormalities of liver. Only 53.3% patients of metabolic syndrome with abnormal liver function tests were found to have abnormal ultrasonographic findings. Positive correlation between duration of diabetes mellitus, obesity, hepatomegaly, liver function tests and ultrasonographic findings were observed.