Nonalcoholic fatty liver disease (NAFLD) – is one of the most common non-viral and nonalcoholic chronic liver diseases. NAFLD includes a steatosis, steatohepatitis and fibrosis which is often a cause of development of liver cirrhosis. High incidence of NAFLD is being facilitated by increasing of number of people with obesity and diabetes mellitus.

In particular, in patients with a BMI of 35 kg/m2 NAFLD occurs more than in 35% of individuals. NAFLD is combined with pathology of the cardiovascular system, including hypertension and coronary heart disease in 14–20% of cases.

The aim of the study was to assess the impact of BMI on lipid spectrum of the blood, liver transaminases and 13C-Methacetin breath test in patients with hypertension combined with obesity and NAFLD.

The study involved 40 patients with stage II hypertension combined with obesity and NAFLD who were hospitalized with upset of the disease. There were 30 (75,6%) women and 10 (24,4%) men, mean age – 55,4±1,58 years.

All patients were divided into two groups depending on the level of BMI. The first group included 18 (45%) patients with a BMI of 30.0 to 34.9 kg/m2, second group – 22 (55%) patients with a BMI higher than 35 kg/m2. Fatty liver infiltration noted in patients with increasing size of the liver, by diffuse homogeneous enhancement of echogenicity by ultrasound and expanding the portal vein (VP) Patients underwent 13C-Methacetin breath test for determining the functional state of the microsomal enzyme systems hepatocytes.

Third of patients had the following symptoms: fatigue, general weakness, decreased physical and mental performance, discomfort and heaviness in the right upper quadrant, bloating, and nausea. The most common clinical manifestation of fatty liver disease was a hepatomegaly syndrome. All patients have increasing size of the liver during percussion.

Palpation of the liver in 90% of cases detected sharp edge, smooth surface and densely-flexible texture of liver. Signs steatohepatitis verified in 8 (20%) patients, portal vein diameter was over 13 mm.

The levels of hepatic transaminases did not change from normal, but in 12 (30%) cases of ALT and AST was increased. Examination of correlations between anthropometric and clinical and laboratory parameters showed a positive correlation between BMI/ALT (r=0,64), LDL/VP (r=0,31), LDL/AST (r=0,43). However, the results of 13C-Methacetin breath test a marked decrease in the rate of metabolism of the liver with increasing BMI (p<0,05). Increased BMI makes it possible to diagnose NAFLD in 19–35% of cases. USG makes it possible to qualitatively assess the specific changes in the liver – uniform seal structure of parenchyma, change of it echogenicity and to determine the diameter of the portal vein. In 30% of cases of steatosis and steatohepatitis accompanied by increased levels of ALT and AST. The most reliable information concerning abnormal liver function can be obtained using the rate of metabolism, which significantly decreases with increasing body weight.

Thus, in one third of patients with hypertension combined with obesity the fatty liver manifested typical clinical symptoms, a gradual increase in the level of transaminases and in 20% of cases – an increase in the diameter of the portal vein. As a result of 13CMethacetin breath test decreasing of the rate of liver metabolism with increasing BMI has been noted. In patients with steatohepatitis the diameter of the portal vein often increases, as well as the levels of ALT, AST and reduced metabolic rate.

Keywords: nonalcoholic fatty liver disease, hypertension, obesity, 13C-Methacetin breath test

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