Metabolic Changes Underlying Interactions Between Obesity and Non‐Alcoholic Fatty Liver Disease in South Asian Adults

Abstract

Non‐alcoholic fatty liver disease (NAFLD) is often referred to as the hepatic manifestation of the metabolic syndrome, which is characterized by at least three of the following: hypertension, hyperglycemia, abdominal obesity, elevated plasma triglycerides and reduced plasma high‐density lipoproteins. While hepatic steatosis has been well studied in animal models, the relationship between body weight, hepatic steatosis and insulin resistance is not well characterized in humans. Moreover, not all human subjects with obesity develop metabolic complications. In addition, it is unclear why South Asian adults develop insulin resistance and diabetes even at lower levels of adiposity and body mass index compared to their Western counterparts. To address this question, we used a convenient sample of Sri Lankan adult females (n = 30) who underwent routine abdominal surgery at the Teaching Hospital of Peradeniya. Anthropometric data, adipose tissue specimens and fasted serum samples were collected for analyses of glucose, lipid and inflammatory markers. Histological sections of adipose tissue were obtained from omental fat (OF) and anterior abdominal wall fat (AF), and adipocyte cross‐sectional area was measured using the ImageJ software. Further, the presence of hepatic steatosis was assessed using ultrasound scanning by a radiologist. Participants with higher grade of fatty liver had a significantly higher body mass index (BMI), fasting blood glucose and aspartate aminotransferase levels. Additionally, participants with higher grade of fatty liver also had significantly higher serum levels of non‐HDL cholesterol and the pro‐inflammatory adipokine, resistin. Interestingly, there were no significant differences in serum adiponectin levels between the groups. Individuals with fatty liver also had a higher mean adipocyte area in both OF and AF, indicating a higher degree of adipocyte hypertrophy associated with fatty liver. Currently, the measurements of additional biomarkers of inflammation and insulin resistance are underway. These findings indicate distinct metabolic differences between South Asian adults with varying degrees of fatty liver, and may help in establishing effective treatment strategies for obesity‐associated NAFLD.Support or Funding InformationFunded by an International Research/Development Seed grant from the Office of International Affairs and the Office of the Vice President for Research at Texas Tech university (TTU), and an International Research Seed Grant from The College of Human Sciences at TTU, and by the International Research Center, University of Peradeniya.