Has natural selection in human populations produced two types of metabolic syndrome (with and without fatty liver)?
I have to admit, with as familiar as I am with metabolic syndrome, the concept that there may be three main clinical manifestations is new to me, but makes sense. We know that there are certain cells that make up the main contributors to insulin resistance and glucose metabolism: muscles, adipose tissue and liver. I’ve always viewed the effects as identical, but this author is suggesting that we may get 3 separate clinical pictures depending upon which tissue is most affected. Thinking about this and applying it to patients in my office, it makes much sense. I have very insulin resistant patients with very low body fat. I have patients that seem to have elevated liver enzymes long before anything else appears. And I have patients that look relatively lean but have a high body fat.
All these pictures would suggest different tissues being affected and may lead to different emphasis on treatments. Interestingly, the main drugs available today to treat insulin resistance in diabetics acts ONLY in the liver and would probably be minimally effective in the other two clinical scenarios presented here.