Distinguishing nonalcoholic steatohepatitis from fatty liver: serum-free fatty acids, insulin resistance, and serum lipoproteins

Liver Int. 2006 Jun;26(5):566-71. doi: 10.1111/j.1478-3231.2006.01256.x.


Objectives: The prognosis of nonalcoholic fatty liver disease is determined by liver biopsy; steatohepatitis can be progressive whereas fatty liver is benign. Insulin resistance and increased hepatic-free fatty acids are central to the pathophysiology of this disorder. Our objective was to assess whether serum-free fatty acids, lipoproteins, and insulin resistance are increased in steatohepatitis compared with fatty liver and healthy controls, and thus may be potential noninvasive markers for liver disease severity.

Methods: Fifteen subjects with biopsy proven nonalcoholic steatohepatitis, 15 with histological fatty liver, and 15 healthy controls were enrolled. Fasting serum glucose and insulin levels, serum-free fatty acids, HDL, LDL, and cholesterol were collected from each subject. Insulin resistance was calculated using the homeostasis assessment model.

Results: Insulin resistance, LDL, and cholesterol-to-HDL ratio values were significantly higher in steatohepatitis, whereas HDL was significantly lower compared with both fatty liver and controls. Free fatty acids were similar in all groups.

Conclusions: Along with insulin resistance, serum LDL, and cholesterol-to-HDL ratio values increase with worsening severity of liver histology, and serum HDL values decline. Free fatty acids, however, do not vary between groups.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Biopsy
  • Case-Control Studies
  • Cholesterol / blood
  • Diagnosis, Differential
  • Fatty Acids / analysis*
  • Fatty Liver / diagnosis*
  • Female
  • Hepatitis / diagnosis*
  • Humans
  • Insulin Resistance*
  • Lipoproteins / blood*
  • Lipoproteins, HDL / blood
  • Lipoproteins, LDL / blood
  • Male
  • Middle Aged
  • Severity of Illness Index


  • Fatty Acids
  • Lipoproteins
  • Lipoproteins, HDL
  • Lipoproteins, LDL
  • Cholesterol