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Nonalcoholic fatty liver disease, adiponectin and insulin resistance in dipper and nondipper essential hypertensive patients

Fallo, Francescoa; Pozza, Anna Dallaa; Sonino, Nicolettab; Federspil, Giovannia; Ermani, Marioc; Baroselli, Sarad; Catena, Cristianad; Soardo, Giorgiod; Carretta, Renzoe; Belgrado, Darioe; Fabris, Brunoe; Sechi, Leonardo Ad

doi: 10.1097/HJH.0b013e32830dfe4b
Original papers: Insuline resistance and diabetes

Objective The pathogenesis of nonalcoholic fatty liver disease (NAFLD) is multifactorial, and the presence of insulin resistance is recognized as the pathophysiological hallmark of this condition. Arterial hypertension is referred as an insulin-resistant state, and insulin resistance may substantially contribute to the cardiovascular risk in this disorder. We examined the inter-relationship between insulin sensitivity, adiponectin levels, and NAFLD in hypertensive patients with different circadian blood pressure profiles.

Methods Eighty never-treated patients with essential hypertension were selected for having a nocturnal decrement of blood pressure that was at least 10% (dippers, n = 47) or less than 10% (nondippers, n = 33) of daytime values. No patient had diabetes mellitus, obesity, hyperlipidemia, or other risk factors for hepatic disease. The two groups were similar as to sex, age, and BMI. Abdominal fat distribution and NAFLD were assessed by ultrasonography.

Results Hepatic steatosis was detected in 57.5% of all patients. Nondippers showed a higher prevalence of NAFLD than dippers (81.8 vs. 40.4%, P < 0.005). Insulin and the homeostasis model of assessment index were higher (P < 0.001) and adiponectin was lower (P < 0.001) in nondippers than in dippers, whereas no difference was found in regional fat, liver enzymes, and other metabolic parameters. At multivariate analysis, factors independently associated with nondipping were insulin (P < 0.05) and adiponectin (P < 0.01) with the homeostasis model of assessment index being of borderline significance.

Conclusion In the absence of major risk factors for the development of NAFLD, a high prevalence of liver steatosis was associated with insulin resistance and low adiponectin levels in essential hypertensive patients with a nondipping profile.

aDepartment of Medical and Surgical Sciences, Italy

bDepartment of Statistical Sciences, Italy

cDepartment of Neurosciences, Biostatistical Section, University of Padova, Padua, Italy

dClinica Medica, Department of Experimental and Clinical Pathology and Medicine, University of Udine, Udine, Italy

eDepartment of Clinical Medicine and Neurology, University of Trieste, Trieste, Italy

Received 16 January, 2008

Revised 16 May, 2008

Accepted 24 June, 2008

Correspondence to Francesco Fallo, MD, Department of Medical and Surgical Sciences, Clinica Medica 3, University of Padova, Via Ospedale 105, 35128 Padua, Italy Tel: +39 049 8218747; fax: +39 049 8213332; e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.