To Study the Role of Serum Follistatin and C - reactive protein in Overweight Individuals with Non-Alcoholic Fatty Liver Disease

Abstract

Background: Non-alcoholic fatty liver disease (NAFLD) is a common hepatic manifestation of metabolic dysfunction, closely linked to obesity, insulin resistance, and chronic low-grade inflammation. Identification of reliable, non-invasive biomarkers for early detection and severity assessment of NAFLD remains clinically important. This study evaluated the role of circulating follistatin, a novel hepatokine, and C-reactive protein (CRP), an established inflammatory marker, in overweight individuals with NAFLD.

Objectives: To assess serum follistatin and CRP levels in overweight individuals with NAFLD and to examine their association with anthropometric parameters, metabolic profile, and ultrasonographic severity of NAFLD.

Methods: In this hospital-based case–control study, 200 overweight adults were enrolled, including 100 ultrasonography-diagnosed NAFLD cases and 100 overweight controls without fatty liver. Anthropometric measurements, liver function tests, lipid profile, serum follistatin (ELISA), and CRP levels were assessed. NAFLD severity was graded using ultrasonography. Statistical analyses included group comparisons, correlation analysis, receiver operating characteristic (ROC) curves, and multivariate logistic regression.

Results: NAFLD cases had significantly higher serum follistatin (404.32 ± 40.35 pg/mL vs 256.43 ± 36.61 pg/mL) and CRP levels (4.98 ± 1.20 mg/L vs 0.97 ± 0.42 mg/L) compared with controls (p < 0.001). Both biomarkers showed a progressive increase across ultrasonographic grades of NAFLD (Grade I–III; p < 0.001). Follistatin and CRP demonstrated strong positive correlations with body mass index, waist circumference, liver enzymes, triglycerides, and LDL cholesterol, and inverse correlations with HDL cholesterol in NAFLD cases. ROC analysis revealed excellent diagnostic performance for NAFLD, and logistic regression identified follistatin and CRP as independent predictors.

Conclusion: Elevated serum follistatin and CRP levels are strongly associated with the presence and severity of NAFLD in overweight individuals. These biomarkers may provide complementary non-invasive tools for NAFLD risk stratification and disease assessment.