Non-alcoholic fatty liver disease in asymptomatic young adults: association with HOMA, metabolic syndrome, and atherogenic risk


  • Jorge Teodoro Chávez-Pagola UAEH
  • Araceli Hernández-Zavala IPN
  • Olga Valenzuela-Limon UV
  • Manuel Sánchez-Gutiérrez UAEH
  • Jeannett Alejandra Izquierdo-Vega UAEH





Objective: Non-alcoholic fatty liver disease (NAFLD) represents the most common liver disease worldwide. The Latin American population has the highest obesity rates in the world. The aim was to research the factors associated with NAFLD in young adults. Methods: A cross-sectional study was performed on 171 participants with an average age of 21 years who underwent a physical and laboratory examination, anthropometric evaluation, and abdominal ultrasound. Results: Subjects with NAFLD were significantly overweight, with dyslipidemia, and with atherogenic risk. They had the presence of metabolic syndrome compared to those without NAFLD. Bivariate logistic regression showed that body mass index, atherogenic risk, Homeostatic Model Assessment (HOMA) value, and metabolic syndrome were associated with NAFLD development. Conclusions: The variables of HOMA, metabolic syndrome, and atherogenic risk were most associated as risk predictors of this pathology in young adults.


Maurice, J.; Manousou, P. Non-Alcoholic Fatty Liver Disease. Clin Med (Lond) 2018, 18, 245–250,

Italian Association for the Study of the Liver (AISF) AISF Position Paper on Nonalcoholic Fatty Liver Disease (NAFLD): Updates and Future Directions. Dig Liver Dis 2017, 49, 471–483,

Younossi, Z.M. Non-Alcoholic Fatty Liver Disease - A Global Public Health Perspective. J Hepatol 2019, 70, 531–544,

Ye, Q.; Zou, B.; Yeo, Y.H.; Li, J.; Huang, D.Q.; Wu, Y.; Yang, H.; Liu, C.; Kam, L.Y.; Tan, X.X.E.; et al. Global Prevalence, Incidence, and Out-comes of Non-Obese or Lean Non-Alcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis. Lancet Gastroenterol Hepatol 2020, 5, 739–752,

Day, CP; James, O.F.W. Steatohepatitis: A Tale of Two "Hits"? Gastroenterology 1998, 114, 842–845,

Kawaguchi, T.; Tsutsumi, T.; Nakano, D.; Torimura, T. MAFLD: Renovation of Clinical Practice and Disease Awareness of Fatty Liver. Hepatol Res 2022, 52, 422–432,

Castro-Martínez, M.; Banderas-Lares, D.; Ramírez Martínez, J.; Escobedo de la Peña, J. Prevalencia de Hígado Graso No Alcohólico En Individuos Con Síndrome Metabólico. Cirujía y Cirujanos 2012, 80, 128–132.

Tsai, C.-H.; Li, T.-C.; Lin, C.-C. Metabolic Syndrome as a Risk Factor for Nonalcoholic Fatty Liver Disease. South Med J 2008, 101, 900–905,

Wainwright, P.; Byrne, C.D. Bidirectional Relationships and Disconnects between NAFLD and Features of the Metabolic Syndrome. Int J Mol Sci 2016, 17, 367,

Arshad, T.; Golabi, P.; Henry, L.; Younossi, Z.M. Epidemiology of Non-Alcoholic Fatty Liver Disease in North America. Curr Pharm Des 2020, 26, 993–997,

Pimentel, J.G.; Chávez, V.J.S.; Alonso, C.G.; Lara, A.C.; Pastrana, I.R.M.; Valladares, P.C. Relación de obesidad con esteatosis hepática no alco-hólica en una unidad de medicina familiar. Aten Fam 2018, 26, 8–12,

Méndez-Sánchez, N.; Cerda-Reyes, E.; Higuera-de-la-Tijera, F.; Salas-García, A.K.; Cabrera-Palma, S.; Cabrera-Álvarez, G.; Cortez-Hernández, C.; Pérez-Arredondo, L.A.; Purón-González, E.; Coronado-Alejandro, E.; et al. Dyslipidemia as a Risk Factor for Liver Fibrosis Progression in a Multi-centric Population with Non-Alcoholic Steatohepatitis. F1000Res 2020, 9, 56,

DiBonaventura, M.D.; Meincke, H.; Le Lay, A.; Fournier, J.; Bakker, E.; Ehrenreich, A. Obesity in Mexico: Prevalence, Comorbidities, Associa-tions with Patient Outcomes, and Treatment Experiences. Diabetes Metab Syndr Obes 2017, 11, 1–10,

WHO Consultation on Obesity (1997: Geneva, S.; Diseases, WHOD of N.; World Health Organization. Programme of Nutrition, F. and RH Obesi-ty : Preventing and Managing the Global Epidemic : Report of a WHO Consultation on Obesity, Geneva, 3-5 June 1997. 1998.

Matthews, D.R.; Hosker, J.P.; Rudenski, A.S.; Naylor, B.A.; Treacher, DF; Turner, R.C. Homeostasis Model Assessment: Insulin Resistance and Beta-Cell Function from Fasting Plasma Glucose and Insulin Concentrations in Man. Diabetologia 1985, 28, 412–419,

Alberti, KGMM; Zimmet, P.; Shaw, J. Metabolic Syndrome--a New World-Wide Definition. A Consensus Statement from the International Diabe-tes Federation. Diabet Med 2006, 23, 469–480,

Alberti, KGMM; Eckel, R.H.; Grundy, S.M.; Zimmet, P.Z.; Cleeman, J.I.; Donato, K.A.; Fruchart, J.-C.; James, W.P.T.; Loria, C.M.; Smith, S.C.; et al. Harmonizing the Metabolic Syndrome: A Joint Interim Statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009, 120, 1640–1645,

Charatcharoenwitthaya, P.; Lindor, K.D. Role of Radiologic Modalities in the Management of Non-Alcoholic Steatohepatitis. Clinics in Liver Dis-ease 2007, 11, 37–54,

Kazemi, T.; Hajihosseini, M.; Moossavi, M.; Hemmati, M.; Ziaee, M. Cardiovascular Risk Factors and Atherogenic Indices in an Iranian Population: Birjand East of Iran. Clin Med Insights Cardiol 2018, 12, 1179546818759286,

Shannon, A.; Alkhouri, N.; Carter-Kent, C.; Monti, L.; Devito, R.; Lopez, R.; Feldstein, A.E.; Nobili, V. Ultrasonographic Quantitative Estimation of Hepatic Steatosis in Children With NAFLD. J Pediatr Gastroenterol Nutr 2011, 53, 190–195,

Eslam, M.; Sanyal, AJ; George, J.; International Consensus Panel MAFLD: A Consensus-Driven Proposed Nomenclature for Metabolic Associated Fatty Liver Disease. Gastroenterology 2020, 158, 1999-2014.e1,

Martin-Rodriguez, J.L.; Gonzalez-Cantero, J.; Gonzalez-Cantero, A.; Arrebola, J.P.; Gonzalez-Calvin, J.L. Diagnostic Accuracy of Serum Alanine Aminotransferase as Biomarker for Nonalcoholic Fatty Liver Disease and Insulin Resistance in Healthy Subjects, Using 3T MR Spectroscopy. Medicine (Baltimore) 2017, 96,

Maximos, M.; Bril, F.; Portillo Sanchez, P.; Lomonaco, R.; Orsak, B.; Biernacki, D.; Suman, A.; Weber, M.; Cusi, K. The Role of Liver Fat and In-sulin Resistance as Determinants of Plasma Aminotransferase Elevation in Nonalcoholic Fatty Liver Disease. Hepatology 2015, 61, 153–160,

Kim, D.; Touros, A.; Kim, W.R. Nonalcoholic Fatty Liver Disease and Metabolic Syndrome. Clin Liver Dis 2018, 22, 133–140,

du Plessis, J.; van Pelt, J.; Korf, H.; Mathieu, C.; van der Schueren, B.; Lannoo, M.; Oyen, T.; Topal, B.; Fetter, G.; Nayler, S.; et al. Association of Adipose Tissue Inflammation With Histologic Severity of Nonalcoholic Fatty Liver Disease. Gastroenterology 2015, 149, 635-648.e14,

Li, L.; Liu, D.-W.; Yan, H.-Y.; Wang, Z.-Y.; Zhao, S.-H.; Wang, B. Obesity Is an Independent Risk Factor for Non-Alcoholic Fatty Liver Disease: Evidence from a Meta-Analysis of 21 Cohort Studies. Obes Rev 2016, 17, 510–519,

European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO) EASL-EASD-EASO Clinical Practice Guidelines for the Management of Non-Alcoholic Fatty Liver Disease. J Hepatol 2016, 64, 1388–1402,

Tokushige, K.; Ikejima, K.; Ono, M.; Eguchi, Y.; Kamada, Y.; Itoh, Y.; Akuta, N.; Yoneda, M.; Iwasa, M.; Yoneda, M.; et al. Evidence-Based Clinical Practice Guidelines for Nonalcoholic Fatty Liver Disease/Nonalcoholic Steatohepatitis 2020. J Gastroenterol 2021, 56, 951–963,

Salgado, A.L.F. de A.; Carvalho, L. de; Oliveira, A.C.; Santos, V.N. dos; Vieira, J.G.; Parise, E.R. Insulin Resistance Index (HOMA-IR) in the Differentiation of Patients with Non-Alcoholic Fatty Liver Disease and Healthy Individuals. Arq Gastroenterol 2010, 47, 165–169,

Isokuortti, E.; Zhou, Y.; Peltonen, M.; Bugianesi, E.; Clement, K.; Bonnefont-Rousselot, D.; Lacorte, J.-M.; Gastaldelli, A.; Schuppan, D.; Schattenberg, J.M.; et al. Use of HOMA-IR to Diagnose Non-Alcoholic Fatty Liver Disease: A Population-Based and Inter-Laboratory Study. Di-abetologia 2017, 60, 1873–1882,

Chitturi, S.; Farrell, G.C.; Hashimoto, E.; Saibara, T.; Lau, G.K.K.; Sollano, J.D.; Asia-Pacific Working Party on NAFLD Non-Alcoholic Fatty Liv-er Disease in the Asia-Pacific Region: Definitions and Overview of Proposed Guidelines. J Gastroenterol Hepatol 2007, 22, 778–787,

Adams, L.A.; Sanderson, S.; Lindor, K.D.; Angulo, P. The Histological Course of Nonalcoholic Fatty Liver Disease: A Longitudinal Study of 103 Patients with Sequential Liver Biopsies. J Hepatol 2005, 42, 132–138,

Bayomy, O.; Rao, A.D.; Garg, R.; Vaidya, A.; Kotin, A.R.; Reiber, B.; Nijmeijer, S.; Di Carli, M.F.; Jerosch-Herold, M.; Kwong, R.Y.; et al. Plas-minogen Activator Inhibitor-1 and Pericardial Fat in Individuals with Type 2 Diabetes Mellitus. Metab Syndr Relat Disord 2017, 15, 269–275,

Takeshita, Y.; Takamura, T.; Hamaguchi, E.; Shimizu, A.; Ota, T.; Sakurai, M.; Kaneko, S. Tumor Necrosis Factor-Alpha-Induced Production of Plasminogen Activator Inhibitor 1 and Its Regulation by Pioglitazone and Cerivastatin in a Nonmalignant Human Hepatocyte Cell Line. Metabo-lism 2006, 55, 1464–1472,

Sookoian, S.; Pirola, C.J. Genetic Predisposition in Nonalcoholic Fatty Liver Disease. Clin Mol Hepatol 2017, 23, 1–12,

Zhao, Y.-C.; Zhao, G.-J.; Chen, Z.; She, Z.-G.; Cai, J. Nonalcoholic Fatty Liver Disease: An Emerging Driver of Hypertension - PubMed. Hyper-tension 2020, 2, 275–284,

Isaksen, V.T.; Larsen, M.A.; Goll, R.; Florholmen, J.R.; Paulssen, E.J. Hepatic Steatosis, Detected by Hepatorenal Index in Ultrasonography, as a Predictor of Insulin Resistance in Obese Subjects. BMC Obes 2016, 3,

Hu, P.-F.; Zeng, X.; Zou, Z.-Y.; Tang, W.; Guo, Y.-B.; Yuan, Z.-L.; Shi, P.-M.; Tan, Y.; Song, Y.; Shi, Y.-Q.; et al. The Presence of NAFLD in Nonobese Subjects Increased the Risk of Metabolic Abnormalities than Obese Subjects without NAFLD: A Population-Based Cross-Sectional Study. Hepatobiliary Surg Nutr 2021, 10, 811–824,

View Full Article: