Value of cardiovascular disorders’ predictors in patients with abdominal obesity, nonalcoholic fatty liver disease and various metabolic syndrome components

The study of the metabolic status of 102 patients with abdominal obesity (AO) in different stages of nonalcoholic fatty liver disease (NAFLD) was performed to determine the most significant predictors of cardio-vascular disorders. Arterial hypertension or receiving antigipertenziveh funds is the main exclusion criterion. The diagnosis of NAFLD was established based on ultrasound examination of the liver, as well as on FibroMax and SteatoScreen indices (BioPredictive, France). Two groups were identified: amounting to 20 % metabolically healthy phenotype of abdominal obesity (MHPAO) and amounting to 80 % an unhealthy metabolic phenotype of abdominal obesity (UMPAO). Statistically significant differences of severity (p < 0.01) between the patients’ groups were identified for indicators: total cholesterol, triglycerides, HDL, LDL, ratio of accumulation of lipids LAP, an index of visceral obesity VAI, homocysteine. Identifying a visceral adipose dysfunction index VAI demonstrates a 12-fold increase in the likelihood of having MS in patients with abdominal obesity (OR: 12.38; 95% CI: 4.55-33.74; p < 0.0001). The level of VAI at AO for MHPAO patients is 1.57 [±0.8; m ± 99 % CI] relative units, significantly lower compared to patients with UMPAO of 4.02 [±2.1; m ± 99% CI] relative units (p < 0.001). The connection between VAI index with different forms of NAFLD have not been identified. The frequency of MS not accompanied by an increase in blood pressure is higher in patients with fibrosis compared with steatosis ones (OR: 4.01; 95 % CI: 1.14-14.69; p < 0.05). The combination of AO and two or more additional risk factors of MS the chances of detection of increase of the thickness of the intima-media complex of the common carotid artery (IMC) 11.5 times higher than among MHPAO group (OR: 11.5; 95 % CI: 3.16-41.89; p < 0.05). The VAI index demonstrates a high degree of statistical significance of the forecast of increase in the thickness of IMC (OR: 8.16; 95 % CI: 2.85-23.35; p < 0.00001). Among other factors of cardiovascular complications (total cholesterol, hs-CRP, homocysteine, apolipoprotein B to apolipoprotein A ratio), the correlation with the thickness of the IMC increasing have not been identified; probably at the stage of absence of hypertension, these factors are less important. The results allow us to conclude that there is a relationship of abdominal obesity, markers of systemic inflammation with the progression of the NAFLD stages and cardiovascular disorders.

obesity, non-alcoholic fatty liver disease, visceral adiposity index, intima-media complex of common carotid artery

1. Amato M. C., Giordano C., Galia M., Criscimanna A., Vitabile S. et al. Visceral Adiposity Index: a reliable indicator of visceral fat function associated with cardiometabolic risk. 2010 г., 33, стр. 920-922.

2. Amato M. C., Giordano C., Pitrone M., Galluzzo A. Cut-off points of the visceral adiposity index (VAI) identifying a visceral adipose dysfunction associated with cardiometabolic risk in a Caucasian Sicilian. Lipids in Health and Disease. 2011 г., Т. 10, 183, стр. 1-8.

3. Appleton S. L., Seaborn C. J., Visvanathan R. et al. Diabetes and cardiovascular disease outcomes in the metabolically healthy obese phenotype a cohort study. 2013 г., Т. 36, стр. 2388-2394.

4. Cao Y., Li L. Relationship of non-alcoholic steatohepatitis with arterial endothelial function and atherosclerosis. Zhonghua Gan Zang Bing Za Zhi. 2014 г., Т. 22, 3, стр. 205-208.

5. Hosseinpanah F., Barzin M., Mirbolouk M., Abtahi H., Cheraghi L. Lipid accumulation product and incident cardiovascular events in a normal weight population: Tehran Lipid and Glucose Study. 2016 г., 23, стр. 2187-2193.

6. Huang, P.L. A comprehensive definition for metabolic syndrome. Disease Models & Mechanisms. 2009 г., Т. 2, 5-6, стр. 231-237.

7. Kahn, H. The “lipid accumulation product” performs better than the body mass index for recognizing cardiovascular risk: a population-based comparison. 2005 г., 5, стр. 26.

8. Leach N. V., Dronca E., Vesa S. C., Sampelean D. P., Craciun E. C., Lupsor M. et al. Serum homocysteine levels, oxidative stress and cardiovascular risk in non-alcoholic steatohepatitis. Eur J Intern Med. 2014 г., Т. 25, стр. 762-767.

9. Li Y., Liu L., Wang B., Chen D. Letter: is visceral adiposity index a predictor of liver histology in patients with non-alcoholic fatty liver disease? 2013 г., Т. 37, 5, стр. 583.

10. Li Y., Liu L., Wang B., Chen D. Simple steatosis is a more relevant source of serum inflammatory markers than omental adipose tissue. 2014 г., Т. 38, 1, стр. 46-54.

11. Musso G., Cassader M., F. de Michieli, Rosina F., Orlandi F., Gambino R. Nonalcoholic steatohepatitis versus steatosis: adipose tissue insulin resistance and dysfunctional response to fat ingestion predict liver injury and altered glucose and lipoprotein metabolism. 2012 г., Т. 56, 3, стр. 933-942.

12. Petta S., Amato M. C., Di Marco V. et al. Visceral adiposity index is associated with significant fibrosis in patients with non-alcoholic fatty liver disease. 2012 г., Т. 35, 2, стр. 238-247.

13. Vongsuvanh Г., George J., McLeod D., D. van der Poorten. Visceral adiposity index is not a predictor of liver histology in patients with non-alcoholic fatty liver d'isease. 2012 г., Т. 57, 2, стр. 392-398.

14. Ивашкин В. Т., Маевская М. В., Павлов Ч. С. и др. Диагностика и лечение неалкогольной жировой болезни печени. Методические рекомендации для врачей. Москва: б.н., 2015.

15. Комшилова К. А., Трошина Е.А., Бутрова С. А., Богомолов П. О., Князева А. П. Кардиометаболические факторы риска на разных клинико-морфологических стадиях неалкогольной жировой болезни печени у больных абдоминальным ожирением. Ожирение и метаболизм. 2012 г., Т. 3, стр. 20-25.

16. Крысанова В. С., Журавлева М. В., Дралова О. В., Рогачева О. А., Каменева Т. Р. Проблема ожирения и избыточной массы тела в Российской Федерации и ее фармакоэкономическая оценка. Альманах клинической медицины. 2015 г., Спецвыпуск 1 «Проблемы ожирения», стр. 36-41.

17. Рекомендации по ведению больных с метаболическим синдромом (Национальные клинические рекомендации). Разработаны по поручению Минздрава России, утверждены Российским медицинским обществом по артериальной гипертонии и профильной комиссией по кардиологии. 28 112013 г., стр. 1-43.

18. Синдром поликистозных яичников в репродуктивном возрасте (Национальные клинические рекомендации): Министерство здравоохранения РФ Письмо от 10 июня 2015 г. N 15-4/10/2-2814, 2015.

19. Шляхто Е. В., Недогода С. В., Конради А. О., Баранова Е. И., Фомин В. В., Верткин А. Л., Чумакова Г. А. Концепция новых национальных клинических рекомендаций по ожирению. Российский кардиологический журнал. 2016 г., 4, стр. 7-13.