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Prevalence of Risk Factors for Non Alcoholic Fatty Liver Disease in Cryptogenic Cirrhosis: A Case Control Study
Anando Sengupta1, Sushil Kumar Sharma1, Vibhu Vibhas Mittal1, Hridesh Sant2, Phani K Gumma1, Premashis Kar1
1Department of Gastroenterology and Hepatology, 2Department of Radiology, Max Super Speciality Hospital, Vaishali, Ghaziabad, UP-201012, India. 

Corresponding Author
Dr. Premashis Kar


Background: Non-alcoholic fatty liver disease (NAFLD) can progress silently to cirrhosis with loss of classical histological features, thus masquerading as cryptogenic cirrhosis (CC). NAFLD has been deemed to be the commonest etiology of CC. 
Aim: The objective of the study was to compare the prevalence of risk factors for NAFLD in patients of CC and cirrhosis due to other etiologies. 
Methods: In this case-control study, cases (CC) and controls (cirrhosis due to known causes excluding NASH) comprised of 50 patients each. Comparison of risk factors of NAFLD (obesity, diabetes, dyslipidemia, hypertension, metabolic syndrome in past 10 years) and metabolic biomarkers (Adiponectin, HOMA-IR) was done between cases and controls.
Results: The average age (61.70 ± 11.24 yrs vs 54.16 ± 12.30 yrs;p=0.002) and proportion of females (48% vs 14%;p<0.001) in CC was significantly higher than controls. The prevalence of obesity (82% vs 38%;p<0.001), diabetes (72% vs 20%;p<0.001), dyslipidemia (16% vs 4%;p=0.046) and metabolic syndrome (66% vs 16%;p<0.001) were higher in CC than in controls. Insulin resistance (HOMA-IR) was higher in CC (2.72 ± 2.26) compared to controls (1.48 ± 1.28)(p=0.003). Fasting adiponectin level was lower in CC group (11.80 ± 11.18 µg/ml) than controls (18.06 ± 15.72 µg/ml)(p=0.024). On multivariable logistic regression analysis, previously reported obesity and higher HbA1c were independently associated with CC.
Conclusions: The prevalence of obesity, diabetes, dyslipidemia and metabolic syndrome is significantly higher in CC than cirrhosis due to other etiologies. Insulin resistance is higher and serum adiponectin levels are lower in CC. All these findings suggest that NAFLD may be an important etiology of cryptogenic cirrhosis.