Сучасні можливості діагностики віcцерального ожиріння та його практичне значення

Abstract

Objective — to evaluate the ultrasound parameters of visceral adipose tissue in an amount of different localization in patients with non-alcoholic fatty liver disease (NAFLD) and in healthy individuals and also their association with metabolic risk factors and liver fibrosis.Materials and methods. To implement the set goal 45 people (25 men and 20 wo­­men) with overweight and obese (body mass index (BMI) (Quetelet index) — 23 — 24.9 kg/ m2 and ≥ 25.0 kg/ m2), aged from 18 to 65 years were examined, the average age of the patients was (M ± σ) 46.18 ± 13.26 years. 40 surveyed patients out of 45 had other components of metabolic syndrome. The control group included 20 conditionally healthy volunteers (10 males and 10 females) with normal body weight and overweight (BMI — 23.2 — 24.9 kg/ m2). Liver steatometry and elastometry conducted with the Soneus P7 system. The determination of visceral adipose tissue (VAT) was performed by ultrasound using a number of conventional techniques and some of their modifications. All ultrasonographic procedures were performed by the same examiner using a 3.5 MHz frequency. We estimated the VАT thickness as distance between the anterior aortic wall and the posterior surface of the rectus abdominis muscles (white line) at a level of 5 cm below the xiphoid from the sprout. Two US measurements of intra-abdominal («visceral») and fat were taken. The thickness of the subcutaneous SАT was measured at the same level. US-determined subcutaneous fat was defined as the distance between the skin and external surface of the rectus abdominis muscle. The ratio of the thickness of the VАT and subcutaneous adipose tissue was calculated. The amount of epicardial adipose tissue (EAT) was also measured by ultrasound.Results and discussion. Significant reliable correlations were established between the values of the thickness of the VАT, and the level of glucose (r = 0.54; p = 0.0018), the level of insulin (r = –0.68; p = 0.039), and the level of high-density lipoprotein cholesterol (r = –0.84; p = 0.046), the insulin resistance index HOMA-IR (r = –0.66; p = 0.042). The rates of VAT increased in patients with NAFLD with significant fibrosis compared to NAFLD without significant fibrosis (р < 0,001) and in the control group (р < 0,001) after adjusting the age, gender, BMI, diabetes, arterial hypertension and the number of platelet. In our study, EAT was positively correlated only with waist circumference (r = 0.196; p = 0.006), and no association with BMI was found (r = 0.104; p = 0.144). No significant differences in mean BMI were found in groups with different EATs (p = 0.083).Conclusions. Ultrasonic examination of visceral fat deposits is a good alternative to more complex and expensive visual methods. The main result of this study is the independent association of the VAT zone with significant fibrosis in patients with NAFLD. VAT showed a statistically significant correlation with the severity of NAFLD status. Our study demonstrates that VAT is an independent predictor of significant fibrosis in patients with NAFLD and plays an important role in the formation of carbohydrate and lipid metabolism disorders.