Predictive value of the adiponectin to leptin ratio for diagnosis of steatohepatitis in patients with nonalcoholic fatty liver disease

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Abstract

Background

Differentiation between nonalcoholic steatohepatitis (NASH) and simple steatosis (SS) is critical for proper management. The adiponectin to leptin ratio (A/L) might be of value for the diagnosis of NASH.

Aim

The aim of this study was to assess the serum levels of adiponectin and leptin and to determine their ratio (A/L) for the diagnosis of steatohepatitis in patients with nonalcoholic fatty liver disease (NAFLD).

Materials and methods

A total of 46 patients with biopsy-proven NAFLD (25 with NASH and 21 with SS) and 22 controls with matched age, sex, and BMI were included in this study. In all participants, the fasting serum insulin, glucose, liver transaminases, triglycerides, cholesterol, leptin, and adiponectin levels were measured and the Homeostasis Model Assessment (HOMA) index was determined.

Results

The leptin levels were significantly higher in patients with NASH and in those with SS compared with controls (P1<0.0001). The adiponectin levels were significantly lower in NASH patients compared with controls (P1<0.001). No significant difference in adiponectin levels was found between patients with NASH and those with SS (P>0.05), and there was no difference between those with SS and controls (P>0.05). The mean A/L ratio was significantly lower in NASH patients compared with those with SS and controls (P<0.001 and P<0.0001, respectively). The area under the receiver-operating characteristic curve for the A/L ratio to distinguish between patients with NASH and those with SS was 0.85. At a cutoff value of 0.71, the sensitivity was 80%, specificity was 77%, positive predictive value was 78%, negative predictive value was 79%, and accuracy was79%. In multivariate analysis, both an A/L ratio less than 0.71 and a HOMA index greater than 3 were independently associated with NASH. The leptin levels positively correlated with the HOMA index (r=0.51 and P<0.003) and BMI (r=0.32 and P<0.02). The A/L ratio negatively correlated with the HOMA index (r=−0.6 and P<0.001) and BMI (r=−0.4 and P<0.002). In univariate analysis, fibrosis was significantly associated with age, BMI, hyperglycemia, and serum leptin levels. In the multivariate analysis, age and BMI were independent factors associated with fibrosis.

Conclusion

The A/L ratio has a good predictive value for the diagnosis of NASH and could be utilized as a noninvasive test for the assessment of liver injury in patients with NAFLD.

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