508 Indian Journal of Medical Sciences, Vol. 64, No. 11, November 2010 CRYPTOGENIC CIRRHOSIS: METABOLIC LIVER DISEASE DUE TO INSULIN RESISTANCE BINAY K. DE, SIDDHARTHA MANI, SANJAY K. MANDAL, SOUMYA S. MONDAL, RAJA BHATTACHARYA, APURBA B. PRAMANIK, DEBJOY SAU, KAUSHIK BHATTACHARJEE, SWARNALI JOARDAR 1 ABSTRACT OBJECTIVE: Etiopathogenesis of cryptogenic cirrhosis (CC) is not yet well established. Up to 20% of non-alcoholic fatty liver disease (NAFLD) may progress to cirrhosis, mostly termed as cryptogenic. Insulin resistance and altered metabolic parameters form a major pathogenic link between NAFLD and CC. CC may thus be actually a metabolic liver disease. MATERIALS AND METHODS: Thirty-four patients of CC and 32 patients having cirrhosis due to chronic hepatitis B (Hep B) were assessed in a cross-sectional study in a tertiary hospital for insulin resistance, % β-cell activity, obesity indices, plasma glucose, lipid profiles, and many other parameters. RESULTS: CC patients had higher homeostasis model assessment (HOMA)-IR compared to Hep B group (P = 0.000016). A positive correlation between IR values and Child–Pugh score among CC patients was found (“r” = 0.87; P < 0.00001). Out of 34 CC patients, 15 (44.1%) had obesity contrary to 6 (18.8%) in the control group (P = 0.0022). Differences were observed in subcutaneous fat (P = 0.0022), intra-abdominal fat (P = 0.0055), waist circumference (P = 0.014), and percentage body fat (P = 0.047) between the two groups. Significant differences were observed in the levels of triglyceride, total cholesterol, and very low density lipoprotein (VLDL). CONCLUSION: Most of the CC patients showed significantly higher prevalence of HOMA-IR, obesity indices, and various parameters of “lipotoxicity” and metabolic syndrome, suggesting that CC may be the long- term consequence of a type of “metabolic liver disease.” Further studies are required to evaluate the role of therapeutic interventions to enhance insulin sensitivity in such patients. Key words: Cryptogenic cirrhosis, insulin resistance, metabolic syndrome ORIGINAL ARTICLE Access this article online Quick Response Code: Website: www.indianjmedsci.org DOI: 10.4103/0019-5359.102124 PMID: ***************************** Departments of Medicine, 1 Pediatric Medicine, Medical College, Kolkata, India Address for correspondence: Prof. Binay K. De, 64/4A/1A, Dr. S. C. Banerjee Road, Kolkata-700010, India. E-mail: binaykde@hotmail.com INTRODUCTION Till today, even with advanced diagnostic tools, we are unable to diagnose the etiology of cirrhosis in 5–31% cases, [1,2] which are designated as cryptogenic cirrhosis (CC). Several explanations, e.g. unknown viral