Turkiye Klinikleri Journal of Medical Sciences

.: REVIEW
Relationship of Liver Enzymes to Homeostatic Model Assessment Insulin Resistance in Non-Alcoholic Fatty Liver Disease Patients: A Meta-Analysis and Systematic Review
Non Alkolik Yağlı Karaciğer Hastalarında Karaciğer Enzimleri ile İnsülin Direnci Homeostatik Model Değerlendirmesi İlişkisi: Bir Meta-Analiz ve Sistematik Derleme
Putu Ijiya DANTA AWATARAa , Levrita Nindya POETRIb , Jonny Karunia FAJARc , Syifa MUSTIKAd
aMalang General Hospital, Malang, Indonesia
bArmy Hospital Doctor Soepraoen, Malang, Indonesia
cDepartment of Internal Medicine, University of Brawijaya Faculty of Medicine, Malang, Indonesia
dDepartment of Gastroenterohepatology, Doctor Saiful Anwar General Hospital, Malang, Indonesia
Turkiye Klinikleri J Med Sci. 2023;43(3):323-32
doi: 10.5336/medsci.2023-97079
Article Language: EN
Full Text
ABSTRACT
 Studies have assessed that the liver enzymes were proven having the association with insulin resistance (IR) in patients with liver disease; however, there were conflicting findings across the reports. The purpose of this study was to assess the association between liver enzymes and Homeostatic Model Assessment Insulin Resistance (HOMA-IR) in patients with non-alcoholic fatty liver disease (NAFLD). We conducted a meta-analysis between April 2022 and August 2022. Data were obtained from articles in PubMed, ScienceDirect, Cochrane Library, and Taylor & Francis. Using a Z test, the liver enzymes and the HOMA-IR among patients with NALD were compared. We included 683 patients with elevated liver enzymes and 3.579 patients with normal liver enzymes, retrieved from five papers. HOMA-IR score appeared higher in patients with NAFLD with elevated alanine aminotransferase (ALT) than in patients with normal ALT [ALT, mean difference (MD): 1.02; 95% confidence interval (CI): 0.49, 1.54]. Conversely, the aspartate aminotransferase (AST), alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT) had no crucial impact in affectting the HOMA-IR when compared between patients with NAFLD and control [(AST, MD: 0.81; 95% CI: 0.21, 1.40), (GGT, MD: 0.77; 95% CI: 0.20, 1.34), and (ALP, MD: 0.90; 95% CI: 0.22, 1.57)]. IR assessed using HOMAIR has a significant association with abnormal liver enzymes in patients with NAFLD.

Keywords: Non-alcoholic fatty liver disease; homeostatic model assessment insulin resistance; liver enzymes
ÖZET
 Karaciğer hastalarında karaciğer enzimlerinin insülin direnci [insulin resistance (IR)] ile ilişkili olduğunun kanıtladığı, çalışmalarla değerlendirilmiştir. Ancak raporlar arasında birbiriyle çelişen bulgular mevcuttur. Bu çalışmanın amacı, non alkolik yağlı karaciğer hastalığı [non-alcoholic fatty liver disease (NAFLD)] hastalarında karaciğer enzimleriyle insülin direnci homeostatik model değerlendirmesi [homeostatic model assessment insulin resistance (HOMA-IR)] ilişkisini değerlendirmektir. Nisan 2022 ve Ağustos 2022 arasında bir meta-analiz gerçekleştirilmiştir. Veriler PubMed, ScienceDirect, Cochrane Library ve Taylor & Francis'de bulunan makalelerden elde edilmiştir. Z-testi kullanılarak NAFLD hastaları arasında karaciğer enzimleri ve HOMA-IR karşılaştırılmıştır. Beş makaleden elde edilen yüksek karaciğer enzimli 683 hasta ve normal karaciğer enzimli 3579 hasta çalışmaya dahil edilmiştir. HOMA-IR skoru, alanin aminotransferaz (ALT) değeri yüksek olan NAFLD hastalarında, ALT değeri normal olan hastalara kıyasla daha yüksek bulunmuştur [ALT, ortalama fark (OF): 1.02; 95% güven aralığı (GA) : 0.49, 1.54]. Buna karşılık, aspartat aminotransferaz (AST), alkalin fosfataz (ALP) ve gama-glutamil transferaz (GGT) NAFLD hastaları ve kontrol karşılaştırıldığında HOMA-IR'ı etkilemede önemli bir etkiye sahip değildi [(AST, OF: 0.81; 95% GA: 0.21, 1.40), (GGT, OF: 0.77; 95% GA: 0.20, 1.34), and (ALP, OF: 0.90; 95% GA: 0.22, 1.57)]. HOMAIR kullanılarak değerlendirilen IR, NAFLD hastalarında anormal karaciğer enzimleri ile anlamlı bir ilişkiye sahiptir.

Anahtar Kelimeler: Non alkolik yağlı karaciğer hastalığı; insülin direnci homeostatik model değerlendirmesi; karaciğer enzimleri
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4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com