Endothelial dysfunction in Turkish patients with non-alcoholic fatty liver disease.

摘要

We read with great interest the recent article by Senturk et al., in which the authors reported on endothelial dysfunction, measured as flow-mediated vasodilation (FMD) in patients with non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH).These authors found a lower FMD in patients with NASH compared with healthy controls but no difference in FMD in patients with NAFLD compared with controls. Thesefindings are in contrast with the report by Villanova et al., in which FMD was already impaired in patients with NALFD. Senturk et al. attributed this difference to the severity of metabolic syndrome components in the patients who were studied in both reports. It would have been of great value if the authors had applied multivariableregression models to adjust for differences in metabolic syndrome components and insulin resistance as both FMD and NAFLD/NASH are associated with insulin resistance and (some) components of the metabolic syndrome, especially body mass index and waistcircumference. The difference of FMD across the three groups may have been confounded by these variables. Previously, we reported an association of alanine aminotransferase, which is used as a marker of hepatic steatosis, and FMD. The association in our report was independent of insulin sensitivity and body mass index, and we believe that adjustment for. possible confounding variables may provide more insight into the mechanism underlying the relation of NAFLD and NASH with endothelial dysfunction.