GASTROENTEROLOGY ARTICLE OF THE WEEK
March 31, 2005
Charlton M. Nonalcoholic fatty liver disease: A review of current understanding and future impact. Clin Gastroenterol Hepatol 2004;2:1048-1058,
1. Features of the metabolic syndrome include
a. increased hip circumference
b. increased waist circumference
c. hyperlipidemia
d. low HDL
e. elevated fasting glucose
f. hypertension
g. baldness
2. Factors associated with finding more advanced histologic findings on biopsy include
a. age >45 years
b. BMI > 30
c. type 2 DM
d. ALT levels >300
e. ALT to AST ratio >1
3. Effects of increased levels of insulin on hepatic triglyceride metabolism
a. decreased triglyceride synthesis
b. decreased triglyceride hydrolysis
c. decreased apolipoprotein B-100, which decreases triglyceride export
d. increased intrahepatic HDL
True or False
4. The sensitivity of radiologic methods to detect steatosis decreases in patients with <30% steatosis.
5. NASH (as opposed to fatty liver) is not found in patients with persistently normal liver enzymes
6. High insulin levels inhibit hydrolysis of intrahepatic triglycerides
7. The prevalence of the metabolic syndrome in individuals over the age of 60 is 40%
8. Low levels of adiponectin are associated with hepatic insulin resistance.
9. Glycemic control in the absence of weight loss does not improve liver enzymes
10. For weight loss to be effective, patients most lose weight to approximate their ideal body weight.
11. Megamitochondria, a hallmark of NAFLD is probably an expression of oxidative damage to mitochondrial DNA from lipid peroxidation of free fatty acids.
12. Rapid weight loss such as that induced by bariatric surgery is the ideal modality to rapidly improve NAFLD
13. Ursodeoxycholic acid therapy is associated with biochemical and histologic improvement in NAFLD.
14. PPAR-g agonists such as the thiazolidenediones, may be beneficial, but the weight gain induced by these agents may negate benefits from increased insulin sensitivity.