Alterations in lipid, carbohydrate and iron metabolism in patients with non-alcoholic steatohepatitis (NASH) and metabolic syndrome

BackgroundNASH (non-alcoholic steatohepatitis) is considered the hepatic manifestation of the metabolic syndrome (MS). We aimed to analyze lipid, carbohydrate, and iron metabolism in NASH.Patients, methods37 patients with MS (17 M/20 F, 51 +/− 15 years), elevated transaminases; 25 patients had histologically proven NASH (NAS score ≥ 5), 12 patients had toxic background (nonNASH). 37 age, sex, BMI-matched healthy controls.Lipid variables, LDL-subfractions, iron, ferritin, transferrin (T), transferrin saturation (TS), and hepcidin (H) were measured in patients/controls. Oral glucose tolerance tests were performed.ResultsNASH patients with steatosis gr. 2 and 3 (> 33% hepatic fat) had higher sd-LDL (mg/dl) concentrations than patients with steatosis gr. 1 (< 33%) (p = 0.002), nonNASH patients (p = 0.03) and controls (p = 0.001). Sd absolute (mg/dl) correlated directly with the steatosis grade only in patients with NASH and steatosis > 33% (p = 0.04).NASH-patients showed higher insulin, C-peptide and IRI values than nonNASH patients (p = 0.034; 0.032; 0.04).H was increased in patients versus controls (p < 0.001). H correlated with ferritin in MS-patients (p = 0.01), correlated directly with sd-LDL (mg/dl) (p = 0.017) and IRI (p < 0.001) and indirectly with HDL (p = 0.05) in NASH. No associations between hepatic inflammation/iron content on liver biopsy and variables of lipid metabolism were found but hepcidin correlated with hepatic inflammation in all patients and with NAS scores in NASH.ConclusionsNASH-patients show insulin resistance and increased sd-LDL subfractions, suggesting an atherogenic profile. The correlation of H with sd-LDL and IRI, without relation to hepatic iron content suggests a putative link between inflammation, carbohydrate and lipid metabolism in NASH.