Journals / Turkish Journal of Health Science and Life / 2026 / Cilt: 8 Sayı: 2

Exploring The Impact of Dietary and Metabolic Risk Factors on Non-Alcoholic Fatty Liver Disease (NAFLD) : A Cross-Sectional Study

Diyet ve Metabolik Risk Faktörlerinin Non-Alkolik Yağlı Karaciğer Hastalığı (NAFLD) Üzerindeki Etkisinin İncelenmesi: Kesitsel Bir Çalışma

İzel Aycan Orakçı(MEHMET AKİF ERSOY ÜNİVERSİTESİ, BUCAK SAĞLIK YÜKSEKOKULU)0000-0003-1199-3194
İlyas Tuncer(İSTANBUL MEDENİYET ÜNİVERSİTESİ, TIP FAKÜLTESİ)0000-0001-8866-9734
Fatma Esra Güneş(ISTANBUL MEDENIYET UNIVERSITY)0000-0003-1693-6375
Pages
29–44
Publication Date
2025-08-30
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Early monitoring of central adiposity, insulin resistance, and hepatic enzymes may improve risk stratification and support timely interventions.

📌 3 Key Takeaways

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Objective & Hypothesis:Objectives: This study aimed to investigate the associations between the severity of non-alcoholic fatty liver disease (NAFLD) and a range of dietary, anthropometric, and biochemical parameters in adults with clinically diagnosed NAFLD.
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Key Findings & Data:Materials and Methods: A total of 114 adult NAFLD patients were included in this cross-sectional study.
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Conclusion & Impact:Early monitoring of central adiposity, insulin resistance, and hepatic enzymes may improve risk stratification and support timely interventions.
🔬Design:Modeling & Simulation
📍Scope:Comprehensive Sample
⚙️Variables:Antropometrik ölçümler · Diyet alımı · Hepatik enzimler

Abstract

Objectives: This study aimed to investigate the associations between the severity of non-alcoholic fatty liver disease (NAFLD) and a range of dietary, anthropometric, and biochemical parameters in adults with clinically diagnosed NAFLD. Materials and Methods: A total of 114 adult NAFLD patients were included in this cross-sectional study. Dietary intake was assessed using three 24-hour recalls. Participants were stratified by steatosis grade (Grade 1–3) based on ultrasonographic evaluation. Anthropometric measurements and biochemical markers were analyzed across groups. Ordinal logistic regression and ANOVA were used to evaluate group differences and associations. Results: Dietary cholesterol intake was significantly higher in the moderate steatosis group (p=0.026). Waist circumference, body fat percentage, and muscle mass were significantly associated with steatosis severity. Hovewer, no significant differences were observed among steatosis grades in energy, macronutrients, fiber, or polyunsaturated fatty acids (PUFA) intake. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), fasting glucose, and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) levels were elevated in more advanced steatosis groups (p<0.05), while lipid parameters such as low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol and triglycerides (TG) showed no significant differences. Conclusion: Findings suggest that metabolic and anthropometric parameters—rather than general dietary intake—are more strongly associated with the severity of NAFLD. Early monitoring of central adiposity, insulin resistance, and hepatic enzymes may improve risk stratification and support timely interventions.

Özet

Amaç: Bu çalışma, klinik olarak tanısı konmuş non-alkolik yağlı karaciğer hastası (NAFLD) erişkin bireylerde hastalığın şiddeti ile çeşitli beslenme, antropometrik ve biyokimyasal parametreler arasındaki ilişkileri incelemeyi amaçlamıştır. Gereç ve Yöntem: Kesitsel olarak tasarlanan bu çalışmaya toplam 114 yetişkin NAFLD hastası dahil edilmiştir. Diyet alımı, üç adet 24 saatlik besin tüketim kaydı ile değerlendirilmiştir. Katılımcılar, ultrasonografik değerlendirme temel alınarak karaciğer yağlanma derecelerine göre (Derece 1–3) sınıflandırılmıştır. Antropometrik ölçümler ve biyokimyasal belirteçler gruplar arasında analiz edilmiştir. Grup farklılıklarını ve ilişkileri değerlendirmek için sırasal lojistik regresyon ve ANOVA testleri kullanılmıştır. Bulgular: Diyetle alınan kolesterol miktarı, orta dereceli steatoz grubunda anlamlı olarak daha yüksek bulunmuştur (p=0.026). Bel çevresi, vücut yağ yüzdesi ve kas kütlesi, steatoz şiddeti ile anlamlı düzeyde ilişkili bulunmuştur. Ancak enerji, makro besin öğeleri, diyet lifi ve çoklu doymamış yağ asitleri (PUFA) alımında steatoz dereceleri arasında anlamlı bir fark gözlenmemiştir. Serum aminotransferaz (ALT), aspartat aminotransferaz (AST), açlık glukozu ve İnsülin Direncinin Homeostatik Modeli Değerlendirmesi (HOMA-IR) düzeyleri, daha ileri düzeydeki steatoz gruplarında yükselmiş olarak saptanmıştır (p<0.05). Buna karşılık düşük yoğunluklu lipoprotein (LDL), yüksek yoğunluklu lipoprotein (HDL) kolesterol ve trigliserid (TG) gibi lipid parametreleri arasında anlamlı bir fark bulunmamıştır. Sonuç: Elde edilen bulgular, genel diyet alımından ziyade metabolik ve antropometrik parametrelerin NAFLD şiddetiyle daha güçlü ilişki gösterdiğini ortaya koymaktadır. Santral obezite, insülin direnci ve karaciğer enzimlerinin erken dönemde izlenmesi, risk sınıflandırmasını iyileştirebilir ve zamanında müdahaleleri destekleyebilir.

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Cite This Article

Orakçı, İ. A., Tuncer, İ., Güneş, F. E. (2025). Exploring The Impact of Dietary and Metabolic Risk Factors on Non-Alcoholic Fatty Liver Disease (NAFLD) : A Cross-Sectional Study. Turkish Journal of Health Science and Life, Cilt: 8 Sayı: 2, 29–44. https://doi.org/10.56150/tjhsl.1677733

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References (71)

  1. Le M.H., Yeo Y.H., Li X., Li J., Zou B., Wu Y., Ye Q., Huang D.Q., Zhao C., Zhang J., Liu C., Chang N., Xing F., Yan S., Wan Z.H., Tang N.S.Y., Mayumi M., Liu X., Liu C., Rui F., Yang H., Yang Y., Jin R., Le R.H.X., Xu Y., Le D.M., Barnett S., Stave C.D., Cheung R., Zhu Q., Nguyen M.H., 2019 Global NAFLD Prevalence: A Systematic Review and Meta-analysis, Clin Gastroenterol Hepatol 20(12), (2022), 2809-2817.e28. https://doi.org/10.1016/j.cgh.2021.12.002
  2. Teng M.L., Ng C.H., Huang D.Q., Chan K.E., Tan D.J., Lim W.H., Yang J.D., Tan E., Muthiah M.D., Global incidence and prevalence of nonalcoholic fatty liver disease, Clin Mol Hepatol 29(Suppl), (2023), S32-s42. https://doi.org/10.3350/cmh.2022.0365
  3. Younossi Z.M., Golabi P., Paik J.M., Henry A., Van Dongen C., Henry L., The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review, Hepatology 77(4), (2023), 1335-1347. https://doi.org/10.1097/hep.0000000000000004
  4. EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease, J Hepatol 64(6), (2016), 1388-402. https://doi.org/10.1016/j.jhep.2015.11.004
  5. Chalasani N., Younossi Z., Lavine J.E., Charlton M., Cusi K., Rinella M., Harrison S.A., Brunt E.M., Sanyal A.J., The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases, Hepatology 67(1), (2018), 328-357. https://doi.org/10.1002/hep.29367
  6. Arab J.P., Arrese M., Trauner M., Recent Insights into the Pathogenesis of Nonalcoholic Fatty Liver Disease, Annu Rev Pathol 13 (2018), 321-350. https://doi.org/10.1146/annurev-pathol-020117-043617
  7. Ullah R., Rauf N., Nabi G., Ullah H., Shen Y., Zhou Y.D., Fu J., Role of Nutrition in the Pathogenesis and Prevention of Non-alcoholic Fatty Liver Disease: Recent Updates, Int J Biol Sci 15(2), (2019), 265-276. https://doi.org/10.7150/ijbs.30121
  8. Fan J.G., Cao H.X., Role of diet and nutritional management in non-alcoholic fatty liver disease, J Gastroenterol Hepatol 28 Suppl 4 (2013), 81-7. https://doi.org/10.1111/jgh.12244
  9. Musso G., Gambino R., De Michieli F., Cassader M., Rizzetto M., Durazzo M., Fagà E., Silli B., Pagano G., Dietary habits and their relations to insulin resistance and postprandial lipemia in nonalcoholic steatohepatitis, Hepatology 37(4), (2003), 909-16. https://doi.org/10.1053/jhep.2003.50132
  10. Pafili K., Roden M., Nonalcoholic fatty liver disease (NAFLD) from pathogenesis to treatment concepts in humans, Mol Metab 50 (2021), 101122. https://doi.org/10.1016/j.molmet.2020.101122
  11. Toshimitsu K., Matsuura B., Ohkubo I., Niiya T., Furukawa S., Hiasa Y., Kawamura M., Ebihara K., Onji M., Dietary habits and nutrient intake in non-alcoholic steatohepatitis, Nutrition 23(1), (2007), 46-52. https://doi.org/10.1016/j.nut.2006.09.004
  12. Vancells Lujan P., Viñas Esmel E., Sacanella Meseguer E., Overview of Non-Alcoholic Fatty Liver Disease (NAFLD) and the Role of Sugary Food Consumption and Other Dietary Components in Its Development, Nutrients 13(5), (2021). https://doi.org/10.3390/nu13051442
  13. Yki-Järvinen H., Non-alcoholic fatty liver disease as a cause and a consequence of metabolic syndrome, Lancet Diabetes Endocrinol 2(11), (2014), 901-10. https://doi.org/10.1016/s2213-8587(14)70032-4
  14. Almeida N.S., Rocha R., Cotrim H.P., Daltro C., Anthropometric indicators of visceral adiposity as predictors of non-alcoholic fatty liver disease: A review, World J Hepatol 10(10), (2018), 695-701. https://doi.org/10.4254/wjh.v10.i10.695
  15. Radmehr M., Homayounfar R., Djazayery A., The relationship between anthropometric indices and non-alcoholic fatty liver disease in adults: a cross-sectional study, Front Nutr 11 (2024), 1494497. https://doi.org/10.3389/fnut.2024.1494497
  16. Sultana F., Shanchay S., Ahmed F., Association of Anthropometric Measurement With Ultrasound- Diagnosed Non Alcoholic Fatty Liver Disease In Dhaka Medical College Hospital, Journal of Medicine 22 (2021), 27-32. https://doi.org/10.3329/jom.v22i1.51388
  17. Modak D., Investigating the Biochemical Parameters Derangement and Physical Examination Findings in Patients with Non-Alcoholic Fatty Liver Disease, Journal of Medical Science And clinical Research 08 (2020). https://doi.org/10.18535/jmscr/v8i7.36
  18. Warkade V., To Study the Biochemical Parameters in Non-Alcoholic Fatty Liver Disease Patients, Journal of Medical Science And clinical Research 6 (2018). https://doi.org/10.18535/jmscr/v6i6.04
  19. Ballestri S., Lonardo A., Romagnoli D., Carulli L., Losi L., Day C.P., Loria P., Ultrasonographic fatty liver indicator, a novel score which rules out NASH and is correlated with metabolic parameters in NAFLD, Liver Int 32(8), (2012), 1242-52. https://doi.org/10.1111/j.1478-3231.2012.02804.x
  20. Paige J.S., Bernstein G.S., Heba E., Costa E.A.C., Fereirra M., Wolfson T., Gamst A.C., Valasek M.A., Lin G.Y., Han A., Erdman J.W., Jr., O'Brien W.D., Jr., Andre M.P., Loomba R., Sirlin C.B., A Pilot Comparative Study of Quantitative Ultrasound, Conventional Ultrasound, and MRI for Predicting Histology-Determined Steatosis Grade in Adult Nonalcoholic Fatty Liver Disease, AJR Am J Roentgenol 208(5), (2017), W168-w177. https://doi.org/10.2214/ajr.16.16726
  21. Canbolat E., Possible Role of Phase Angle From Bioelectric Impedance Analysis Parameters As Diagnostic Criteria (Biyoelektrik İmpedans Analizi Parametrelerinden Faz Açısının, Tanısal Kriter Olarak Olası Rolü), 7 (2018), 58-65.
  22. World Health O., (2011): Waist circumference and waist–hip ratio: Report of a WHO expert consultation, Geneva, 8–11 December 2008, World Health Organization
  23. Amato M.C., Giordano C., Galia M., Criscimanna A., Vitabile S., Midiri M., Galluzzo A., Visceral Adiposity Index: a reliable indicator of visceral fat function associated with cardiometabolic risk, Diabetes Care 33(4), (2010), 920-2. https://doi.org/10.2337/dc09-1825
  24. Rakıcıoğlu N., Acar Tek N., Ayaz A., Pekcan G., (2012): Food and photo catalog: Portion sizes and amounts (3rd ed.), Ata Ofset Matbaacılık ER, Ankara.
  25. Caturano A., Acierno C., Nevola R., Pafundi P.C., Galiero R., Rinaldi L., Salvatore T., Adinolfi L.E., Sasso F.C., Non-Alcoholic Fatty Liver Disease: From Pathogenesis to Clinical Impact, Processes, 2021.
  26. Di Francia R., Rinaldi L., Cillo M., Varriale E., Facchini G., D'Aniello C., Marotta G., Berretta M., Antioxidant diet and genotyping as tools for the prevention of liver disease, Eur Rev Med Pharmacol Sci 20(24), (2016), 5155-5163.
  27. Moore J.B., Gunn P.J., Fielding B.A., The role of dietary sugars and de novo lipogenesis in non-alcoholic fatty liver disease, Nutrients 6(12), (2014), 5679-703. https://doi.org/10.3390/nu6125679
  28. Worm N., Beyond Body Weight-Loss: Dietary Strategies Targeting Intrahepatic Fat in NAFLD, Nutrients 12(5), (2020). https://doi.org/10.3390/nu12051316
  29. Anstee Q.M., Targher G., Day C.P., Progression of NAFLD to diabetes mellitus, cardiovascular disease or cirrhosis, Nat Rev Gastroenterol Hepatol 10(6), (2013), 330-44. https://doi.org/10.1038/nrgastro.2013.41
  30. Kong L., Lu Y., Zhang S., Nan Y., Qiao L., Role of nutrition, gene polymorphism, and gut microbiota in non-alcoholic fatty liver disease, Discov Med 24(131), (2017), 95-106.
  31. Neuschwander-Tetri B.A., Clark J.M., Bass N.M., Van Natta M.L., Unalp-Arida A., Tonascia J., Zein C.O., Brunt E.M., Kleiner D.E., McCullough A.J., Sanyal A.J., Diehl A.M., Lavine J.E., Chalasani N., Kowdley K.V., Clinical, laboratory and histological associations in adults with nonalcoholic fatty liver disease, Hepatology 52(3), (2010), 913-24. https://doi.org/10.1002/hep.23784
  32. Wehmeyer M.H., Zyriax B.C., Jagemann B., Roth E., Windler E., Schulze Zur Wiesch J., Lohse A.W., Kluwe J., Nonalcoholic fatty liver disease is associated with excessive calorie intake rather than a distinctive dietary pattern, Medicine (Baltimore) 95(23), (2016), e3887. https://doi.org/10.1097/md.0000000000003887
  33. Jump D.B., Tripathy S., Depner C.M., Fatty acid-regulated transcription factors in the liver, Annu Rev Nutr 33 (2013), 249-69. https://doi.org/10.1146/annurev-nutr-071812-161139
  34. Scorletti E., Byrne C.D., Omega-3 fatty acids, hepatic lipid metabolism, and nonalcoholic fatty liver disease, Annu Rev Nutr 33 (2013), 231-48. https://doi.org/10.1146/annurev-nutr-071812-161230
  35. Xie Y., Tian H., Xiang B., Li D., Liu J., Cai Z., Liu Y., Xiang H., Total polyunsaturated fatty acid intake and the risk of non-alcoholic fatty liver disease in Chinese Han adults: a secondary analysis based on a case-control study, BMC Gastroenterol 21(1), (2021), 451. https://doi.org/10.1186/s12876-021-02039-2
  36. Enjoji M., Nakamuta M., Is the control of dietary cholesterol intake sufficiently effective to ameliorate nonalcoholic fatty liver disease?, World J Gastroenterol 16(7), (2010), 800-3. https://doi.org/10.3748/wjg.v16.i7.800
  37. Gao X., Lin X., Xin Y., Zhu X., Li X., Chen M., Huang Z., Guo H., Dietary cholesterol drives the development of nonalcoholic steatohepatitis by altering gut microbiota mediated bile acid metabolism in high-fat diet fed mice, J Nutr Biochem 117 (2023), 109347. https://doi.org/10.1016/j.jnutbio.2023.109347
  38. Mendez M.A., Wynter S., Wilks R., Forrester T., Under- and overreporting of energy is related to obesity, lifestyle factors and food group intakes in Jamaican adults, Public Health Nutr 7(1), (2004), 9-19. https://doi.org/10.1079/phn2003508
  39. Lee J.H., Jeon S., Lee H.S., Kwon Y.J., Association between waist circumference trajectories and incident non-alcoholic fatty liver disease, Obes Res Clin Pract 17(5), (2023), 398-404. https://doi.org/10.1016/j.orcp.2023.09.005
  40. Ju D.Y., Choe Y.G., Cho Y.K., Shin D.S., Yoo S.H., Yim S.H., Lee J.Y., Park J.H., Kim H.J., Park D.I., Sohn C.I., Jeon W.K., Kim B.I., The influence of waist circumference on insulin resistance and nonalcoholic fatty liver disease in apparently healthy Korean adults, Clin Mol Hepatol 19(2), (2013), 140-7. https://doi.org/10.3350/cmh.2013.19.2.140
  41. Yun K.E., Nam G.E., Lim J., Park H.S., Chang Y., Jung H.S., Kim C.W., Ko B.J., Chung E.C., Shin H., Ryu S., Waist Gain Is Associated with a Higher Incidence of Nonalcoholic Fatty Liver Disease in Korean Adults: A Cohort Study, PLoS One 11(7), (2016), e0158710. https://doi.org/10.1371/journal.pone.0158710
  42. Loomis A.K., Kabadi S., Preiss D., Hyde C., Bonato V., St Louis M., Desai J., Gill J.M., Welsh P., Waterworth D., Sattar N., Body Mass Index and Risk of Nonalcoholic Fatty Liver Disease: Two Electronic Health Record Prospective Studies, J Clin Endocrinol Metab 101(3), (2016), 945-52. https://doi.org/10.1210/jc.2015-3444
  43. Fan L., Zhao S., Shi H., Zhang S., Role of BMI in the relationship between dietary inflammatory index and non-alcoholic fatty liver disease: an intermediary analysis, Scand J Gastroenterol 58(10), (2023), 1159-1165. https://doi.org/10.1080/00365521.2023.2213791
  44. Fan J.G., Zhou Q., Wo Q.H., [Effect of body weight mass and its change on the incidence of nonalcoholic fatty liver disease], Zhonghua Gan Zang Bing Za Zhi 18(9), (2010), 676-9. https://doi.org/10.3760/cma.j.issn.1007-3418.2010.09.008
  45. Xie W., Hong Y., Chen X., Wang S., Zhang F., Chi X., Waist-to-hip ratio and nonalcoholic fatty liver disease: a clinical observational and Mendelian randomization analysis, Front Nutr 11 (2024), 1426749. https://doi.org/10.3389/fnut.2024.1426749
  46. Wu S., He Y., Li J., Wang S., Causal effect of waist-to-hip ratio on non-alcoholic fatty liver disease: a mendelian randomization study, Front Genet 15 (2024), 1414835. https://doi.org/10.3389/fgene.2024.1414835
  47. Kim G., Lee S.E., Lee Y.B., Jun J.E., Ahn J., Bae J.C., Jin S.M., Hur K.Y., Jee J.H., Lee M.K., Kim J.H., Relationship Between Relative Skeletal Muscle Mass and Nonalcoholic Fatty Liver Disease: A 7-Year Longitudinal Study, Hepatology 68(5), (2018), 1755-1768. https://doi.org/10.1002/hep.30049
  48. Bansal S., Vachher M., Arora T., Kumar B., Burman A., Visceral fat: A key mediator of NAFLD development and progression, Human Nutrition & Metabolism 33 (2023), 200210. https://doi.org/https://doi.org/10.1016/j.hnm.2023.200210
  49. Ko Y.H., Wong T.C., Hsu Y.Y., Kuo K.L., Yang S.H., The Correlation Between Body Fat, Visceral Fat, and Nonalcoholic Fatty Liver Disease, Metab Syndr Relat Disord 15(6), (2017), 304-311. https://doi.org/10.1089/met.2017.0001
  50. Díez-Vallejo J., Comas-Fuentes A., Asymptomatic hypertransaminasemia in patients in primary care, Rev Esp Enferm Dig 103(10), (2011), 530-5. https://doi.org/10.4321/s1130-01082011001000005
  51. Maharjan P., Khanal P., Parajuli N., Joshi G., Parajuli H., Khanal S., Bhatta B., Pandeya D., Biochemical changes in Non-alcoholic fatty liver disease (NAFLD): A study in Nepalese Population, Annals of Clinical Chemistry and Laboratory Medicine 2 (2016), 6. https://doi.org/10.3126/acclm.v2i2.15597
  52. Mansour-Ghanaei R., Mansour-Ghanaei F., Naghipour M., Joukar F., Biochemical markers and lipid profile in nonalcoholic fatty liver disease patients in the PERSIAN Guilan cohort study (PGCS), Iran, J Family Med Prim Care 8(3), (2019), 923-928. https://doi.org/10.4103/jfmpc.jfmpc_243_18
  53. Shousha W., ElNahass Y., Darwish M., Mahmoud A., Mogawer S., Biochemical Parameters in Obese Egyptian Patients as a Non-Invasive Marker for Disease Screening in Early Diagnosis of Non-Alcoholic Fatty Liver Disease, Open Access Macedonian Journal of Medical Sciences 8 (2020), 105-112. https://doi.org/10.3889/oamjms.2020.4001
  54. Khodadoostan M., Shariatifar B., Motamedi N., Abdolahi H., Comparison of liver enzymes level and sonographic findings value with liver biopsy findings in nonalcoholic fatty liver disease patients, Adv Biomed Res 5 (2016), 40. https://doi.org/10.4103/2277-9175.178785
  55. Lomonaco R., Sunny N.E., Bril F., Cusi K., Nonalcoholic fatty liver disease: current issues and novel treatment approaches, Drugs 73(1), (2013), 1-14. https://doi.org/10.1007/s40265-012-0004-0
  56. Guidorizzi de Siqueira A.C., Cotrim H.P., Rocha R., Carvalho F.M., de Freitas L.A., Barreto D., Gouveia L., Landeiro L., Non-alcoholic fatty liver disease and insulin resistance: importance of risk factors and histological spectrum, Eur J Gastroenterol Hepatol 17(8), (2005), 837-41. https://doi.org/10.1097/00042737-200508000-00010
  57. Pirgon Ö., Bilgin H., Çekmez F., Kurku H., Dündar B.N., Association between insulin resistance and oxidative stress parameters in obese adolescents with non-alcoholic fatty liver disease, J Clin Res Pediatr Endocrinol 5(1), (2013), 33-9. https://doi.org/10.4274/Jcrpe.825
  58. Suresh S., Rajanbabu B., Veetil V.M., Hussain A., Veetil J.N., A study on the altered glycemic and lipid parameters and prevalence of insulin resistance in nonalcoholic fatty liver disease, J Family Med Prim Care 7(1), (2018), 93-97. https://doi.org/10.4103/jfmpc.jfmpc_352_16
  59. Mehta M., Shah J., Joshi U., Understanding Insulin Resistance in NAFLD: A Systematic Review and Meta-Analysis Focused on HOMA-IR in South Asians, Cureus 16(10), (2024), e70768. https://doi.org/10.7759/cureus.70768
  60. Chatrath H., Vuppalanchi R., Chalasani N., Dyslipidemia in patients with nonalcoholic fatty liver disease, Semin Liver Dis 32(1), (2012), 22-9. https://doi.org/10.1055/s-0032-1306423
  61. Zhang Q.Q., Lu L.G., Nonalcoholic Fatty Liver Disease: Dyslipidemia, Risk for Cardiovascular Complications, and Treatment Strategy, J Clin Transl Hepatol 3(1), (2015), 78-84. https://doi.org/10.14218/jcth.2014.00037
  62. Huang H., Wang J., Wu L., Ruan J., Hou L., Shen C., Xu C., Remnant cholesterol and severity of nonalcoholic fatty liver disease, Diabetol Metab Syndr 15(1), (2023), 238. https://doi.org/10.1186/s13098-023-01220-9
  63. Cuenza L.R., Razon T.L.J., Dayrit J.C., Correlation between severity of ultrasonographic nonalcoholic fatty liver disease and cardiometabolic risk among Filipino wellness patients, J Cardiovasc Thorac Res 9(2), (2017), 85- 89. https://doi.org/10.15171/jcvtr.2017.14
  64. Mahaling D.U., Basavaraj M.M., Bika A.J., Comparison of lipid profile in different grades of non-alcoholic fatty liver disease diagnosed on ultrasound, Asian Pacific Journal of Tropical Biomedicine 3(11), (2013), 907-912. https://doi.org/https://doi.org/10.1016/S2221-1691(13)60177-X
  65. Gaggini, M., Morelli, M., Buzzigoli, E., DeFronzo, R. A., Bugianesi, E., & Gastaldelli, A. (2013). Non-alcoholic fatty liver disease (NAFLD) and its connection with insulin resistance, dyslipidemia, atherosclerosis and coronary heart disease. Nutrients, 5(5), 1544–1560. https://doi.org/10.3390/nu5051544
  66. Nagral A., Bangar M., Menezes S., Bhatia S., Butt N., Ghosh J., Manchanayake J.H., Mahtab M.A., Singh S.P., Gender Differences in Nonalcoholic Fatty Liver Disease, Euroasian J Hepatogastroenterol 12(Suppl 1), (2022), S19-s25. https://doi.org/10.5005/jp-journals-10018-1370
  67. Pan J.J., Fallon M.B., Gender and racial differences in nonalcoholic fatty liver disease, World J Hepatol 6(5), (2014), 274-83. https://doi.org/10.4254/wjh.v6.i5.274
  68. Ballestri S., Nascimbeni F., Baldelli E., Marrazzo A., Romagnoli D., Lonardo A., NAFLD as a Sexual Dimorphic Disease: Role of Gender and Reproductive Status in the Development and Progression of Nonalcoholic Fatty Liver Disease and Inherent Cardiovascular Risk, Adv Ther 34(6), (2017), 1291-1326. https://doi.org/10.1007/s12325-017-0556-1
  69. Hörist-Kollmann S., Strametz-Juranek J., Female Dietary Patterns and the Pathogenesis of NAFLD, Gender and the Genome 2(2), (2018), 49-55. https://doi.org/10.1177/2470289718787091
  70. Gutierrez-Grobe Y., Ponciano-Rodríguez G., Ramos M.H., Uribe M., Méndez-Sánchez N., Prevalence of non alcoholic fatty liver disease in premenopausal, posmenopausal and polycystic ovary syndrome women. The role of estrogens, Ann Hepatol 9(4), (2010), 402-9.
  71. Halaoui A.F., Ali A.H., Habib S.G., Kanso M., Daniel F., Mukherji D.M., Khalife M.J., Jaafar R.F., Faraj W., Gender differences in liver fibrosis among patients younger than 50 years: A retrospective cohort study, Clin Res Hepatol Gastroenterol 44(5), (2020), 733-738. https://doi.org/10.1016/j.clinre.2020.01.001