Liver cells play a major role in the regulation of lipid metabolism. They are the principal
location for lipoprotein and cholesterol synthesis. In healthy individuals an equilibrium is
preserved between utilization, biosynthesis and transfer of lipid fractions. Many diseases
that affect the parenchyma of liver can lead to changes in the structure of lipoprotein and
transport through blood.
Non - alcoholic fatty liver disease (NAFLD) is an abnormal accumulation of fat in the liver
in the absence of secondary causes of fatty liver, such as significant alcohol use, viral
hepatitis or medications that induce fatty liver [3]. NAFLD is the most common liver disorder
worldwide and is present in approximately 25%of the world's population.
People with NAFLD often have no symptoms and NAFLD is often only detectable during routine
blood tests or unrelated abdominal imaging or liver biopsy.in some cases NAFLD can cause
symptoms such as fatigue, malaise and dull right upper quadrant abdominal discomfort [5]. Non
- alcoholic steatohepatitis can severely impair liver functions leading to cirrhosis, liver
failure and hepatocellular carcinoma.
Grading of NAFLD on ultrasound: when the echogenicity is only marginally increases, it is
grade 1, when the echogenic liver obscures the echogenic walls of portal vein branches, it is
grade 2, and when the echogenic liver obscures the diaphragmatic outlines, it is grade 3
fatty infiltrations.
Liver biopsy is a sensitive method for diagnosis of NAFLD. However, liver biopsy is painful
and invasive procedure with rare, but potentially life-threatening complications like
bleeding and is prone to sampling error.
Circulating serum biomarkers of liver fibrosis can give moderate estimates in the diagnosis
of liver fibrosis and cirrhosis. The ratio of AST to platelets known as AST /Platelets ratio
index (APRI Score) and Fibrotest are recommended as the preferred non invasive tests for
cirrhosis by the Asian -Pacific Association for Study of the Liver (APASL).Several other
scores such as FIB -4 score and NAFLD fibrosis score can also reflect the burden of fibrosis
in the liver.
Dyslipidemia: hypertriglyceridemia, low HDL-C level and high LDL-C level is the most frequent
type of lipid abnormality in NAFLD. Previous studies demonstrated that decreased HDL-C levels
were associated with occurrence of NAFLD.