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(2) In a study of 105 obese patients (BMI over 35), independent predictors of fibrosis were hypertension (140/90 or above), an elevated index of insulin resistance, and a serum ALT level over 40. (18) This physicians population is not uncommon; 26 percent of the American population is considered obese (BMI over 30 kg/[m.sup.3]). (19) Pathogenesis of NAFLD and NASH Insulin physicians Resistance and its Relationship to Fatty Liver Multiple authors have proposed that NASH be included as a clinical feature in the metabolic disorder of insulin resistance. (20-22) Insulin resistance, estimated to occur in approximately 25 physicians percent of the general population, has been associated with hyperinsulinemia, abnormal glucose tolerance, type 2 diabetes mellitus, hypertriglyceridemia, decreased high-density lipoprotein levels, hypertension, abnormal fibrinolysis, increased visceral fat accumulation, hyperuricemia, polycystic ovarian syndrome, and other lipid abnormalities. (23) This constellation of signs and symptoms, particularly hypertension, hypertriglyceridemia, and impaired glucose tolerance, has been designated as metabolic syndrome or syndrome X.
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