The Finnish Diabetes Risk Score (FINDRISC) as a screening tool for hepatic steatosis

INTRODUCTION. Hepatic steatosis due to non-alcoholic fatty liver disease is associated with obesity, dyslipidemia, insulin resistance, and type 2 diabetes. The Finnish Diabetes Risk Score (FINDRISC) is a prognostic screening tool to detect people at risk for type 2 diabetes without the use of any blood test. The objective of this study was to evaluate whether FINDRISC can also be used to screen for the presence of hepatic steatosis. PATIENTS AND METHODS. Steatosis was determined by ultrasound. The study sample consisted of 821 non-diabetic subjects without previous hepatic disease; 81% were men (mean age 45 ± 9 years) and 19% women (mean age 41 ± 10 years). RESULTS. Steatosis was present in 44% of men and 10% of women. The odds ratio for one unit increase in the FINDRISC associated with the risk of steatosis was 1.30 (95% CI 1.25-1.35), similar for men and women. The area under the receiver operating characteristics curve for steatosis was 0.80 (95% CI 0.77-0.83); 0.80 in men (95% CI 0.77-0.83) and 0.83 (95% CI 0.73-0.93) in women. CONCLUSIONS. Our data suggest that the FINDRISC could be a useful primary screening tool for the presence of steatosis.

Mean platelet volume and its relationship with carotid atherosclerosis in subjects with non-alcoholic fatty liver disease

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is linked to an increased risk of cardiovascular disease. Mean platelet volume (MPV), a determinant of platelet activation, is an emerging risk factor for atherothrombosis.

AIMS

The aim of this study was to investigate the levels of MPV in subjects with NAFLD having no confounding factors for atherosclerosis such as obesity, diabetes mellitus, and hypertension. In addition, the possible relationship between MPV and carotid artery intima media thickness (CIMT), a well known marker of subclinical atherosclerosis, was also studied.

METHODS

MPV and CIMT levels were measured in 60 biopsy-proven NAFLD subjects and 54 healthy controls. Age and sex were similar between two groups.

RESULTS

Body mass index and waist circumference levels were higher in the NAFLD group when compared to the controls. There were no differences between the two groups regarding LDL cholesterol levels, whereas HDL cholesterol levels were lower in the NAFLD group. MPV and CIMT levels were not different between the two groups. According to the correlation analyses, CIMT levels were positively correlated to age in patients with NAFLD. However, no significant correlation was found between MPV and CIMT levels.

CONCLUSIONS

The results of this study do not show any difference in MPV levels between subjects with NAFLD and controls. These finding suggests that in the absence of other metabolic risk factors, MPV might not be involved in the mechanism(s) of increased cardiovascular risk in NAFLD.

Development of apolipoprotein B antisense molecules as a therapy for hyperlipidemia

As new studies demonstrate that lower levels of low-density lipoprotein cholesterol (LDL-C) reduce cardiovascular disease, and as goals for LDL-C in high-risk individuals are reduced further and further, reaching those goals becomes more difficult for a significant percentage of the population. New therapeutic approaches to lower LDL-C would, therefore, be advantageous, particularly in those who are most likely to suffer cardiovascular disease-associated morbidity and mortality. Mouse and human genetic models suggest that decreasing hepatic apolipoprotein B (apoB) production may be a therapeutic approach for the treatment of dyslipidemia. Because antisense oligonucleotides naturally distribute to the liver and can specifically inhibit synthesis of proteins from their messenger RNAs, antisense oligonucleotides represent a potential approach for decreasing the biosynthesis of apoB, and thereby, the production of both very low density lipoprotein (VLDL) and LDL. Newly developed apoB antisense approaches have produced results in animal models and humans, providing proof of concept regarding reductions in LDL-C concentrations. Surprisingly, despite prior experience with inhibitors of microsomal triglyceride transfer protein, which also inhibits the secretion of VLDL, apoB antisense-mediated reduction in VLDL secretion does not appear to cause marked steatosis. The mechanisms whereby two different approaches for inhibiting apoB and triglyceride secretion have different effects on hepatic triglycerides are currently being examined.

Psoriasis and non-alcoholic fatty liver disease

Several recent studies have found an increased prevalence of non-alcoholic fatty liver disease within psoriasis patients. The exact pathophysiological mechanisms behind these observations are unclear, but are likely related to the high prevalence of obesity and metabolic syndrome within this patient population. Chronic inflammation, mediated by either proinflammatory adipokines or skin-derived cytokines, may contribute to fatty liver disease development by increasing insulin resistance which in turn promotes hepatic lipid accumulation. These same adipokines in addition to hepatic cytokines may act on the skin to influence psoriasis disease severity.

Liver enzymes, nonalcoholic fatty liver disease, and incident cardiovascular disease: a narrative review and clinical perspective of prospective data

In recent years, a strong link has been established between nonalcoholic fatty liver disease (NAFLD) and the pathogenesis of type 2 diabetes mellitus. The potential role of NAFLD in cardiovascular disease (CVD) has also attracted interest. Published studies have tended to use biochemical and imaging surrogate markers of NAFLD, such as elevated gamma glutamyl transpeptidase (GGT) and alanine aminotransferase (ALT) and fatty liver on ultrasound, when investigating associations with incident CVD events. Positive associations between both baseline GGT and temporal change in GGT, as well as cardiovascular events and cardiovascular mortality independent of alcohol intake, have been reported in several prospective studies. However, adjustment for confounders is often incomplete, and there is scant evidence of improvement in cardiovascular risk prediction beyond established risk scores when incorporating such data. There also appears to be a strong and underrecognized age interaction, with associations between GGT and incident coronary heart disease (CHD) being strong in young individuals but relatively weak in the elderly. By contrast, ALT appears to be only weakly associated with incident CHD and may exhibit a U-shaped association with total mortality. Finally, although some studies have linked imaging-defined and biopsy-confirmed NAFLD with CVD risk, the evidence is inconsistent, with few incident events and/or insufficient potential confounders.

CONCLUSION

A diagnosis of NAFLD is insufficient to consider patients as being at high risk for CVD. The presence of NAFLD should be a clear indication for diabetes screening, but cardiovascular risk screening should be performed with the use of existing risk calculators and should be guided by established cardiovascular risk factors.

Liver immunolocalization and plasma levels of MMP-9 in non-alcoholic steatohepatitis (NASH) and hepatitis C infection

Non-alcoholic steatohepatitis (NASH) is a progressive fibrotic disease. Many issues related to the pathogenesis of this disease remain unresolved. Because of NASH association with the activation of liver fibrogenesis, we examined the plasma levels and liver immunolocalization of matrix metalloprotease-9 (MMP-9), a molecule involved in the remodelling processes of fibrogenesis. In addition, patients with chronic hepatitis C (HCV) were analyzed. Plasma concentrations of MMP-9 were determined by ELISA from peripheral blood and immunohistochemistry of the same protein was carried out in formalin-fixed and paraffin wax-embedded liver specimens. The mean value of circulating concentrations of MMP-9 in healthy controls was 39.7 ng/ml (SD: +/-4.6). In NASH and HCV-infected patients, MMP-9 concentrations were higher: 69.0 ng/ml (SD: +/-14.5) and 61.7 ng/ml (SD: +/-11.0), respectively. In NASH livers, MMP-9 was mainly immunolocalized on neutrophils, whereas in HVC-infected livers it was mainly localized over biliary canaliculi, bile ducts and hepatocyte cytoplasm. The different MMP-9 immunolocalization patterns in the examined diseases suggest the presence of a different pathophysiological involvement of this protease in the fibrogenesis underlying these diseases.

Steatosis and steatohepatitis in postmortem material from Northwestern Greece

AIM: To determine the prevalence of steatosis and steatohepatitis in a series of autopsies in Northwestern Greece.

METHODS: Liver biopsy material from a total of 600 autopsies performed over a period of 2 years (2006-2008) to define the cause of death was subjected to histological examination. Patient demographic data were also collected. Tissue sections were stained with different dyes for the evaluation of liver architecture, degree of fibrosis and other pathological conditions when necessary.

RESULTS: Satisfactory tissue samples for histological evaluation were available in 498 cases (341 male, 157 female) with a mean age of 64.51 ± 17.78 years. In total, 144 (28.9%) had normal liver histology, 156 (31.3%) had evidence of steatosis, and 198 (39.8%) had typical histological findings of steatohepatitis. The most common causes of death were ischemic heart disease with or without myocardial infarction (43.4%), and traffic accidents (13.4%).

CONCLUSION: A high prevalence of steatosis and steatohepatitis was detected in postmortem biopsies from Northwestern Greece. Since both diseases can have serious clinical consequences, they should be considered as an important threat to the health of the general population in Greece.

Effect of dietary monosodium glutamate on HFCS-induced hepatic steatosis: expression profiles in the liver and visceral fat

It has previously been shown that patients with nonalcoholic fatty liver disease (NAFLD) exhibit alterations in both hepatic and adipose tissue metabolism, and the dietary factors that contribute to the pathogenesis of NAFLD are likely to be multifactorial. Using C57BL/6J mice, we examined whether chronic exposure to low-dose dietary monosodium glutamate (MSG), high-fructose corn syrup (HFCS), or a combination of the two, vs. control would affect metabolism and hepatic and visceral fat gene expression in adult male progeny. A maternal diet containing 20% HFCS and/or dietary MSG (97.2 +/- 6.3 mg/kg body weight (bw), provided in the drinking water) was offered ad libitum from 3 weeks before mating, and continued throughout gestation and weaning until the progeny reached 32 weeks of age. Liver and abdominal fat gene expression was compared with control animals fed isocaloric standard chow under identical conditions. HFCS induced hepatic steatosis and increased the expression of genes involved in carbohydrate and lipid metabolism. Conversely, dietary MSG elevated serum free fatty acids (FFAs), triglycerides (TGs), high-density lipoprotein-cholesterol (HDL-C), and insulin, together with the expression of hepatic genes involved in lipid metabolism and bile synthesis. The HFCS+MSG combination elevated hepatic TGs, serum FFAs, and TG levels. In visceral white adipose tissue, both MSG and HFCS diets increased the expression of transcription factor Srebf2 and decreased expression of Ppargc1a, while downregulating the expression of mitochondrial respiratory chain components. MSG increased the expression of several genes implicated in adipocytes differentiation. We hypothesize that HFCS may promote hepatic steatosis, whereas dietary MSG induces dyslipidemia and markers of insulin resistance.

Oxidative stress and regulation of anti-oxidant enzymes in cytochrome P4502E1 transgenic mouse model of non-alcoholic fatty liver

BACKGROUND AND AIM

Reactive oxygen species produced by cytochrome P4502E1 (CYP2E1) are believed to play a role in pathophysiology of non-alcoholic fatty liver disease (NAFLD). However, little is known about the expression, protein content and activity of anti-oxidant enzymes and the role of inducible nitric oxide synthase (iNOS), a source of reactive nitrogen species, in NAFLD. In the present study, we evaluate gene expression, protein content and activity of anti-oxidant enzymes, and iNOS, in a CYP2E1 overexpressing model of non-alcoholic fatty liver (NAFL).

METHODS

Non-transgenic (nTg) and CYP2E1 transgenic (Tg) mice were fed rodent chow for 8 months. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), liver triglycerides, malondialdehyde and protein carbonyls were measured. Gene expression of NF-E2-related factor (Nrf2), superoxide dismutase-1, -2 (SOD-1,2), catalase (CAT), glutathione peroxidase (GPx), heme oxygenase-1 (HO-1) and iNOS were determined. Protein content, activity and nitrosylation of the enzymes were also measured.

RESULTS

Tg mice had greater CYP2E1 activity and histological liver injury. MDA and protein carbonyls were increased, indicating insufficient anti-oxidant response. Gene expression of Nrf2, CAT, GPx, HO-1 and iNOS were significantly increased. Protein content and enzyme activities of most anti-oxidant enzymes were not correspondingly increased. iNOS activity and nitrosylation of CAT and SOD was greater in Tg mice liver.

CONCLUSION

Hepatocyte-specific CYP2E1 overexpression results in increased oxidative stress and nitrosative stress. Several anti-oxidant enzymes are upregulated. Failure of corresponding increase in total protein and activity of anti-oxidant enzymes suggests modification/degradation, possibly by nitrosylation, due to increased iNOS activity in a CYP2E1 overexpressing NAFL mouse model.

Advances in the treatment of nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the Western world, and its prevalence is predicted to rise in the future in parallel with rising levels of obesity and type 2 diabetes mellitus. It is commonly associated with insulin resistance. Many patients have coexisting obesity, hypertension, dyslipidaemia or hyperglycaemia, and are at increased risk of developing cardiovascular disease. Although patients with simple steatosis have a good prognosis, a significant percentage will develop nonalcoholic steatohepatitis which may progress to cirrhosis, end-stage liver failure and hepatocellular carcinoma. Despite promising results from several pilot studies and small to medium randomized controlled trials, there is currently no pharmacological agent that is licensed for the treatment of NAFLD. At present the mainstay of treatment for all patients is lifestyle modification using a combination of diet, exercise and behavioural therapy. With recent advances in the understanding of the pathogenesis of NAFLD, the goal of treatment has shifted from simply trying to clear fat from the liver and prevent progressive liver damage to addressing and treating the metabolic risk factors for the condition. To reduce liver-related and cardiovascular morbidity and mortality, all patients with NAFLD should be invited to enrol in adequately powered, randomized controlled studies testing novel therapies, many of which are targeted at reducing insulin resistance or preventing progressive liver disease. Coexisting obesity, hypertension, dyslipidaemia or hyperglycaemia should be treated aggressively. Orlistat, bariatric surgery, angiotensin receptor blockers, statins, fibrates, metformin and thiazolidinediones should all be considered, but treatments should be carefully tailored to meet the specific requirements of each patient. The efficacy and safety of any new treatment, as well as its cost-effectiveness, will need to be carefully evaluated before it can be advocated for widespread clinical use.

Assessment of liver steatosis in chicken by using acoustic radiation force impulse imaging: preliminary results

OBJECTIVE

To evaluate acoustic radiation force impulse (ARFI) imaging as a non-invasive tool for quantification of the grades of liver steatosis in chickens.

METHODS

We used two different diets: a standard diet (SD group) and a hyperlipidaemic diet (HD group). The ARFI technique was performed in all the animals in the right hepatic lobe and shear wave velocity (SWV) was measured and expressed in metres per second (m/s). Plasma lipid levels were analysed. Steatosis was quantified by using semiquantitative analysis. Statistical analysis was used and Pearson's correlation coefficient was calculated.

RESULTS

Mean SWV was 0.94 ± 0.16 m/s (range 0.8-1.3 m/s) in the SD group and 1.91 ± 0.25 m/s (range 1.3-2.2 m/s) in the HD group (p < 0.001). The lowest SWVs (≤1.3 m/s) corresponded to the chickens in the SD group, with 100% of the animals returning a score of 0, whereas the range of SWV in the HD group chickens was between 1.6 and 2.2 m/s. A substantial correlation was observed between SWVs with histological semiquantitative analysis of steatosis (r = 0.85, p < 0.001).

CONCLUSION

ARFI imaging is a non-invasive diagnostic tool that allows discrimination between the grades of liver steatosis in chickens.

Regulation of hepatic gene expression by saturated fatty acids

Diets rich in saturated fatty acids have long been associated with increased plasma cholesterol concentrations and hence increased risk of cardiovascular disease. More recently, they have also been suggested to promote the development of non-alcoholic fatty liver disease. While there is now considerable evidence to suggest that polyunsaturated fatty acids exert many of their effects through regulating the activity of transcription factors, including peroxisome proliferator activated receptors, sterol regulatory binding proteins (SREBPs) and liver X receptor, our understanding of how saturated fatty acids act is still limited. Here we review the potential mechanisms whereby saturated fatty acids modulate hepatic lipid metabolism thereby impacting on the synthesis, storage and secretion of lipids. Evidence is presented that their effects are, at least partly, mediated through modulation of the activity of the SREBP family of transcription factors.

Levels of soluble CD40 ligand and P-Selectin in nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is linked to an increased risk of cardiovascular disease. We aimed to research whether the levels of soluble P-selectin (sP-selectin) and soluble CD40 ligand (sCD40L), markers of endothelial function, are altered in subjects with NAFLD having no confounding factors for atherosclerosis. sCD40L, sP-selectin, and high-sensitivity C-reactive protein (hsCRP) levels, and homeostasis model assessment of insulin resistance (HOMA-IR) indexes were measured in 50 NAFLD subjects and 30 healthy controls. sCD40L, sP-selectin, and hsCRP levels were not significantly different between two groups (P = 0.48, 0.51, and 0.34, respectively). Body mass index, waist circumference, and insulin levels and HOMA indexes were significantly higher in subjects with NAFLD (all P < 0.001). The present data show that sCD40L and sP-selectin may not contribute to the accelerated atherogenesis associated with this clinically relevant condition.

Inflammatory mediators of hepatic steatosis

Nonalcoholic fatty liver disease (NAFLD) is rapidly becoming a world-wide public health problem. NAFLD represents a spectrum of disease ranging from "simple steatosis", which is considered relatively benign, to nonalcoholic steatohepatitis and to NAFLD-associated cirrhosis and end-stage liver disease. The etiology of NAFLD and its progression is complex and remains incompletely understood. The progression of the disease involves many factors. Apart from the two hits, the accumulation of TG and the development of fibrosis and necroinflammatory processes, exit numerous molecules associated with these two hits. Among them we can highlight the pro-inflammatory molecules and adiponectins. This review focuses on the growing evidence from both experimental and human studies suggesting a central role of cytokines in the pathogenesis of NAFLD. We review the role of cytokines as key regulators of insulin sensitivity and hepatic lipid overloading, liver injury and inflammation, and fibrosis with an emphasis on potential therapeutic implications.

Ad36 adipogenic adenovirus in human non-alcoholic fatty liver disease

AIMS

Infection with specific pathogens may lead to increased adiposity. The human adenovirus 36 (Ad36) is a relatively new factor in promoting adipogenesis. It seems to improve the metabolic profile, expanding adipose tissue and enhancing insulin sensitivity in animal models. The aim of this study was to investigate whether any association or predictor effect of Ad36 seropositivity is present in non-alcoholic fatty liver disease (NAFLD), a condition associated with obesity and insulin resistance (IR).

METHODS

Sixty-five NAFLD patients and 114 controls were investigated. Ultrasound bright liver score (BLS), body composition, IR evaluated by homeostasis model assessment of insulin resistance index (HOMA or HOMA-IR) and serum neutralization assay for antibodies to Ad36 were assessed.

RESULTS

Ad36-seropositive patients have a lower risk of bright liver [OR 0.505 (95% confidence interval (CI) 0.265-0.962)]; greater IR leads to a higher risk of bright liver [OR 9.673 (95% CI 4.443-21.058)]. Among NAFLD, Ad36-seropositive vs. Ad36-seronegative patients did not show a significant IR difference. Ad36-seropositive NAFLD patients, with the same levels of HOMA and BLS, had greater body mass index and body fat mass, in comparison with seronegative NAFLD patients. By a multiple linear regression model, BLS was explained by HOMA (beta 0.513; P<0.0001), high density lipoprotein cholesterol (beta-0.219, P<0.006) and Ad36 seropositivity (beta-0.202, P<0.005); Ad36 seropositivity did not explain HOMA in the other multiple logistic regression model.

CONCLUSIONS

Ad36 seropositivity is not associated with a significant difference of IR in NAFLD patients, but is associated with a greater adiposity. Ad36 seropositivity is associated with a lower occurrence of NAFLD and bright liver, which, conceivably, is not directly mediated by IR.

Lack of interleukin-6/glycoprotein 130/signal transducers and activators of transcription-3 signaling in hepatocytes predisposes to liver steatosis and injury in mice

A deregulated cytokine balance is involved in triggering the sequence from steatosis to nonalcoholic steatohepatitis, ultimately leading to liver fibrosis and cancer. To better define the role of proinflammatory interleukin-6 (IL-6)-type cytokines in hepatocytes we investigated the role of IL-6 and its shared receptor, glycoprotein 130 (gp130), in a mouse model of steatohepatitis. IL-6(-/-) mice were fed a choline-deficient, ethionine-supplemented (CDE) diet. Conditional gp130 knockout and knockin mice were used to achieve hepatocyte-specific deletion of gp130 (gp130(Deltahepa)), gp130-dependent rat sarcoma (Ras)-(gp130(DeltahepaRas)), and signal transducers and activators of transcription (STAT)-(gp130(DeltahepaSTAT)) activation. CDE-treated IL-6(-/-) mice showed a significant hepatic steatosis at 2 weeks after feeding. The mice rapidly developed elevated fasting blood glucose, insulin serum levels, and transaminases. To better define IL-6-dependent intracellular pathways, specifically in hepatocytes, we next treated gp130(Deltahepa) mice with a CDE diet. These animals also developed a marked steatosis with hyperglycemia and displayed elevated insulin serum levels. Additionally, gp130(Deltahepa) animals showed an imbalanced inflammatory response with increased hepatic tumor necrosis factor-alpha and decreased adiponectin messenger RNA levels. Dissecting the hepatocyte-specific gp130-dependent pathways revealed a similar disease phenotype in gp130(DeltahepaSTAT) mice, whereas gp130(DeltahepaRas) animals were protected. In CDE-treated mice lack of gp130-STAT3 signaling was associated with immune-cell-infiltration, jun kinase-activation, a blunted acute-phase-response, and elevated transaminases. Furthermore, gp130(Deltahepa) and gp130(DeltahepaSTAT) mice showed beginning signs of liver fibrosis compared to gp130(DeltahepaRas) mice and controls.

CONCLUSION

During CDE treatment mice lacking IL-6 and gp130-STAT signaling in hepatocytes are prone to hepatic metabolic changes and inflammation. This ultimately leads to progressive steatohepatitis with signs of liver remodeling. Thus, the presented model allows one to further dissect the role of IL-6/gp130-type signaling in hepatocytes during fatty liver degeneration to define new therapeutic targets in metabolic liver diseases.

The medical risks of obesity

Obesity is at epidemic proportions in the United States and in other developed and developing countries. The prevalence of obesity is increasing not only in adults, but especially among children and adolescents. In the United States in 2003 to 2004, 17.1% of children and adolescents were overweight, and 32.2% of adults were obese. Obesity is a significant risk factor for and contributor to increased morbidity and mortality, most importantly from cardiovascular disease (CVD) and diabetes, but also from cancer and chronic diseases, including osteoarthritis, liver and kidney disease, sleep apnea, and depression. The prevalence of obesity has increased steadily over the past 5 decades, and obesity may have a significant impact on quality-adjusted life years. Obesity is also strongly associated with an increased risk of all-cause mortality as well as cardiovascular and cancer mortality. Despite the substantial effects of obesity, weight loss can result in a significant reduction in risk for the majority of these comorbid conditions. Those comorbidities most closely linked to obesity must be identified to increase awareness of potential adverse outcomes. This will allow health care professionals to identify and implement appropriate interventions to reduce patient risk and mortality. A systematic search strategy was used to identify published literature between 1995 and 2008 that reported data from prospective longitudinal studies of obesity and comorbid medical conditions. This article will review evidence for significant associations of obesity with comorbidities to provide information useful for optimal patient management.

Effect of 6-month nutritional intervention on non-alcoholic fatty liver disease

OBJECTIVE

We evaluated the effect of diet therapy as exclusive treatment on insulin resistance, biochemical parameters of metabolic syndrome, and degree of hepatic steatosis in patients with non-alcoholic fatty liver disease.

METHODS

Thirty-one patients with non-alcoholic fatty liver disease received a diet with a reduction of 500 to 1000 cal/d, containing 15% protein, 55% carbohydrates, and 30% fat, for 6 mo. At entry and 6 mo after dietary instructions, degrees of hepatic steatosis and visceral obesity were assessed by computed tomography; serum aspartate aminotransferase, alanine aminotransferase, γ-glutamyl transferase, glucose, triacylglycerols, and high-density lipoprotein cholesterol were measured by automated methods. Body mass index, waist circumference, waist-to-hip ratio, and food intake (7-d diary) were also evaluated. At the end of follow-up, the patients were classified as adherent or non-adherent to treatment according to a weight loss of more or less than 5% of initial body weight, respectively.

RESULTS

Seventeen patients were classified as adherent (group 1) and 14 as non-adherent (group 2). Group 2 only presented a significant reduction in body mass index and waist circumference. In contrast, in group 1, in addition to significant improvement of all anthropometric parameters, a significant reduction was observed in alanine aminotransferase and γ-glutamyl transferase levels, homeostasis model assessment for insulin resistance, visceral fat and tomographic liver density, together with an increase in serum high-density lipoprotein cholesterol levels. These patients presented a significant decrease in total energy intake and in total and saturated fats.

CONCLUSION

Nutritional intervention as exclusive treatment, with a loss of at least 5% of initial weight, is effective in the treatment of non-alcoholic fatty liver disease.

Maternal high-fat feeding primes steatohepatitis in adult mice offspring, involving mitochondrial dysfunction and altered lipogenesis gene expression

Nonalcoholic fatty liver disease (NAFLD) describes an increasingly prevalent spectrum of liver disorders associated with obesity and metabolic syndrome. It is uncertain why steatosis occurs in some individuals, whereas nonalcoholic steatohepatitis (NASH) occurs in others. We have generated a novel mouse model to test our hypothesis: that maternal fat intake contributes to the development of NAFLD in adult offspring. Female mice were fed either a high-fat (HF) or control chow (C) diet before and during gestation and lactation. Resulting offspring were fed either a C or a HF diet after weaning, to generate four offspring groups; HF/HF, HF/C, C/HF, C/C. At 15 weeks of age, liver histology was normal in both the C/C and HF/C offspring. Kleiner scoring showed that although the C/HF offspring developed nonalcoholic fatty liver, the HF/HF offspring developed NASH. At 30 weeks, histological analysis and Kleiner scoring showed that both the HF/C and C/HF groups had NAFLD, whereas the HF/HF had a more severe form of NASH. Therefore, exposure to a HF diet in utero and during lactation contributes toward NAFLD progression. We investigated the mechanisms by which this developmental priming is mediated. At 15 weeks of age, hepatic mitochondrial electron transport chain (ETC) enzyme complex activity (I, II/III, and IV) was reduced in both groups of offspring from HF-fed mothers (HF/C and HF/HF). In addition, measurement of hepatic gene expression indicated that lipogenesis, oxidative stress, and inflammatory pathways were up-regulated in the 15-week-old HF/C and HF/HF offspring.

CONCLUSION

Maternal fat intake contributes toward the NAFLD progression in adult offspring, which is mediated through impaired hepatic mitochondrial metabolism and up-regulated hepatic lipogenesis.

Therapeutic effects of diet change on nonalcoholic fatty liver disease

AIM: To investigate the therapeutic effects of diet change on nonalcoholic fatty liver disease (NAFLD) and explore potential mechanisms involved.

METHODS: Eighty Sprague-Dawley male rats were randomly and equally divided into five groups: two normal control groups (NG8 and NG12 groups; fed a normal diet for 8 and 12 weeks, respectively), two high-fat diet groups (HG8 and HG12 groups; fed a high-fat diet for 8 and 12 weeks, respectively), and one diet change group (DG group; fed a high-fat diet for 8 weeks and a normal diet for another 4 weeks). The glucose infusion rate (GIR) was detected by the euglycemic hyperinsulinemic clamp test. The levels of ALT, AST, TG, TC, FFAs, FBS, FIns, TNF-α, SOD and MDA in the serum or liver were tested using a biochemistry automatic analyzer or by radioimmunoassay (RIA). The expression of c-Jun N-terminal protein kinase 1 (JNK1), insulin receptor substrate-1 (IRS-1) and phospho-IRS-1 Ser307 (p-IRS-1Ser307) was detected by Western blot.

RESULTS: Compared with the two matched NG groups, the body weight, liver index, the levels of ALT, AST, TG, TC, FFAs, FIns and TNF-α in the serum and TG, TC, FFAs and MDA in the liver increased (all P < 0.05 or 0.01), the level of SOD in the liver and GIR decreased (t = 4.88 and 7.92, respectively; both P < 0.05), and the expression of JNK1 protein and p-IRS-1Ser307 in the liver was upregulated in the two HG groups (t = 4.39, 5.81; 4.60, and 6.48, respectively). Significant differences were also noted in the above parameters between the HG8 and HG12 groups (all P < 0.05 or 0.01). A positive correlation was found between the expression intensity of JNK1 and insulin resistance (IR). The fatty degeneration of hepatocytes was aggravated in the HG groups with the prolongation of feeding time. In the DG group, all the above parameters were improved but did not return to normal levels as those in the NG groups (all P < 0.05).

CONCLUSION: A rat model of NAFLD and a rat model of NASH are established by feeding rats a high-fat diet for 8 weeks and 12 weeks, respectively. Diet change can improve NAFLD induced by a high fat diet.

Modulation of glycosphingolipid metabolism significantly improves hepatic insulin sensitivity and reverses hepatic steatosis in mice

Nonalcoholic fatty liver disease (NAFLD) is associated with obesity, insulin resistance, and type 2 diabetes. The hyperinsulinemia that occurs as a consequence of insulin resistance is thought to be an important contributor to the development of fatty liver. We have shown that the iminosugar N-(5'-adamantane-1'-yl-methoxy)-pentyl-1-deoxynojirimycin (AMP-DNM), an inhibitor of the enzyme glucosylceramide synthase, is a potent enhancer of insulin signaling in rodent models for insulin resistance and type 2 diabetes. The present study was designed to assess the impact of AMP-DNM on insulin levels, liver triglyceride synthesis, and gene expression profile. Treatment of ob/ob mice with AMP-DNM restored insulin signaling in the liver, corrected blood glucose values to levels found in lean mice, and decreased insulin concentration. The expression of sterol regulatory element-binding protein 1c target genes involved in fatty acid synthesis normalized. AMP-DNM treatment significantly reduced liver to body weight ratio and reversed hepatic steatosis, comprising fat as well as inflammatory markers. In addition, AMP-DNM treatment corrected to a large extent the gene expression profile of ob/ob mice livers toward the profile of lean mice.

CONCLUSION

Pharmacological lowering of glycosphingolipids with the iminosugar AMP-DNM is a promising approach to restore insulin signaling and improve glucose homeostasis as well as hepatic steatosis.

Serum concentrations of human angiopoietin-like protein 3 in patients with nonalcoholic fatty liver disease: association with insulin resistance

OBJECTIVE

Insulin resistance is considered a key feature of nonalcoholic fatty liver disease (NAFLD). In this setting, experimental studies have suggested a potential role of angiopoietin-like (ANGPTL) proteins in the pathogenesis of hepatic steatosis and the metabolic syndrome. In this study, we sought to investigate the plasma levels of ANGPTL protein 3 (ANGPTL3)--a liver-derived protein that modulates plasma triglyceride clearance--in patients with definite nonalcoholic steatohepatitis (NASH, n=40), borderline NASH (n=8), simple fatty liver (n=9), and healthy controls without evidence of liver disease (n=14).

METHODS

Levels of ANGPTL3 were measured by enzyme-linked immunosorbent assay and compared in the four study groups. Moreover, concentrations of ANGPTL3 were assessed in relation to the general characteristics of the study participants and the results of liver biopsy.

RESULTS

Levels of ANGPTL3 were significantly higher in patients with definite NASH (389+/-110 ng/ml, P<0.05) and borderline NASH (433+/-70 ng/ml, P<0.05) compared with controls (291+/-78 ng/ml). No significant differences were found in patients with simple fatty liver (321+/-119 ng/ml) as compared with controls. In correlation analyses of the entire study cohort, ANGPTL3 was significantly and positively associated with homeostatic model assessment for insulin resistance (r=0.28, P<0.05) but not with histological staging and pathological characteristics of NAFLD.

CONCLUSION

Although subject to future confirmation, our data suggest that ANGPTL3 levels are elevated in the more severe forms of NAFLD and could be associated with insulin resistance in this setting.

Overexpression of liver-specific cytochrome P4502E1 impairs hepatic insulin signaling in a transgenic mouse model of nonalcoholic fatty liver disease

OBJECTIVE

Cytochrome P4502E1 (CYP2E1) expression in the liver is increased in nonalcoholic fatty liver disease. The aim of this study was to determine whether CYP2E1 overexpression in the liver interferes with insulin signaling pathways in a mouse model of nonalcoholic fatty liver disease.

METHODS

Male mice containing the human CYP2E1 transgene under control of the mouse albumin enhancer-promoter (Tg) and control, nontransgenic mice were fed a diet containing 20% calories from fat for 8 months ad libitum.

MEASUREMENTS

Liver injury was measured by histology and alanine aminotransferase. Malondialdehyde and protein carbonyls were measured as markers of oxidative stress. Total and phosphorylated proteins involved in the insulin signaling cascade were measured by western blotting.

RESULTS

Tg mice had higher fasting insulin, and greater hepatic fat accumulation and histological liver injury. Malondialdehyde and protein carbonyls were increased in Tg mice liver indicating increased oxidative stress. Tyrosine phosphorylation of insulin receptor substrates 1 and 2, and serine phosphorylation of PKB/Akt, were significantly decreased in Tg mice. Serine phosphorylation of glycogen synthase kinase 3alpha was decreased in Tg mice and liver glycogen content was decreased correspondingly. Serine phosphorylation of the transcription factor Fox01a was decreased, and expression of the enzyme phosphoenolcarboxykinase was increased in Tg mice.

CONCLUSION

Hepatocyte-specific overexpression of CYP2E1 increased hepatic oxidative stress in the liver, fasting insulin, and histological liver damage. CYP2E1 overexpression reduced hepatic insulin signaling and reduced glycogen storage and increased glucose synthesis. Overall, this study suggests an association of hepatic CYP2E1 with increased oxidative stress, increased systemic insulin resistance, decreased insulin signaling in the liver and increased hepatic fat accumulation.

Direct comparison among oral hypoglycemic agents and their association with insulin resistance evaluated by euglycemic hyperinsulinemic clamp: the 60's study

The aim of the study was to compare the long-term effect of 4 antidiabetic treatment protocols on insulin resistance evaluated by euglycemic hyperinsulinemic clamp in type 2 diabetes mellitus patients. Two hundred seventy-one type 2 diabetes mellitus patients with poor glycemic control and who were overweight were enrolled in this study. Patients were randomized and titrated to take pioglitazone, metformin, pioglitazone + metformin, or glimepiride + metformin for 15 months. They underwent a euglycemic hyperinsulinemic clamp at baseline, after 3 months, and after 15 months. Anthropometric and metabolic measurements were assessed at baseline, after 3 months, and after 15 months. There was a decrease in glycated hemoglobin in all groups, but glycated hemoglobin value was lower in the group treated with pioglitazone + metformin compared with the groups treated with metformin alone and with pioglitazone alone. There was a decrease in fasting plasma glucose and postprandial plasma glucose values in all groups, but values obtained with pioglitazone + metformin were lower compared with values in the groups treated with metformin alone and with pioglitazone alone. Fasting plasma insulin and postprandial plasma insulin values were higher in the group treated with glimepiride + metformin compared with the other groups. After 15 months, glucose infusion rate and total glucose requirement values observed in the groups treated with pioglitazone alone and with pioglitazone + metformin were higher compared with the values in the group treated with metformin alone and with glimepiride + metformin; furthermore, values obtained in the group treated with pioglitazone + metformin were higher than the value obtained with pioglitazone alone. Pioglitazone-metformin-based therapeutic control is associated with the most quantitatively relevant improvement in insulin resistance-related parameters, whereas the sulfonylurea-metformin-including protocol has less relevant effects.

Adipose tissue: a motor for the inflammation associated with obesity

Obesity is a worldwide epidemic that continues to grow at an alarming rate. This condition increases the morbidity and mortality associated with both acute and chronic diseases. Some of the deleterious consequences of obesity have been attributed to its induction of a low-grade chronic inflammatory state that arises from the production and secretion of inflammatory mediators from the expanded pool of activated adipocytes. This review focuses on the mechanisms that underlie the proposed link between obesity and inflammation, and it addresses how obesity-induced inflammation may account for increased morbidity and mortality that is associated with a diverse group of diseases.

Metadoxine, an ion-pair of pyridoxine and L-2-pyrrolidone-5-carboxylate, blocks adipocyte differentiation in association with inhibition of the PKA-CREB pathway

Adipogenesis is orchestrated by the expression of master adipogenic regulators. In particular, phosphorylation of cAMP response element binding protein (CREB) by protein kinase A promotes CREB nuclear translocation, thereby inducing expression of the adipogenic regulators and resulting in adipogenic maturation. Although metadoxine, an ion-pair of pyridoxine and l-2-pyrrolidone-5-carboxylate, has been shown to inhibit lipid accumulation in the liver, its effect on adipocyte differentiation has never been explored. This study investigated the effects of metadoxine on the differentiation of 3T3-L1 preadipocytes and the molecular mechanism. Metadoxine treatment did not inhibit mitotic clonal expansion, but inhibited late-stage cell differentiation, suggesting that metadoxine may block the differentiation step of preadipocytes. Metadoxine inhibited CREB phosphorylation and binding to the cAMP response element, thereby repressing CCAAT/enhancer-binding protein beta during hormone-induced adipogenesis. Overall, metadoxine inhibits adipogenic differentiation in association with the inhibition of CREB/cAMP response element-dependent CCAAT/enhancer-binding protein beta induction in the protein kinase A-CREB pathway.

Non-alcoholic fatty liver disease is associated with cardiovascular disease risk markers

Recognition of the link between non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease (CVD) has boosted research in this area. The main objective of this paper is to review the literature on NAFLD in the context of CVD, focussing on underlying mechanisms and treatment. Besides excessive fatty acid influx, etiologic factors may include components of the metabolic syndrome, cytokines and mitochondrial dysfunction. NAFLD is associated with both hepatic and systemic insulin resistance. In the case of NAFLD, the liver overproduces several atherogenic factors, notably inflammatory cytokines, glucose, lipoproteins and coagulation factors, and factors increasing blood pressure. Intervention studies on diet and laparoscopic surgery revealed improvements of hepatic fat content and CVD risk profile. Pharmacological approaches with potential benefit have been developed as well, but effects are often confounded by weight change. NAFLD is associated with an increased CVD risk profile (and hepatic risk). In order to improve CVD risk profile, prevention and treatment of NAFLD seem advisable. However, well-designed intervention studies, randomized clinical trials and long-term follow-up studies are scarce.

Maternal diets deficient in folic acid and related methyl donors modify mechanisms associated with lipid metabolism in the fetal liver of the rat

Previously we have examined the effects of diets deficient in folic acid ( - F) or folate deficient with low methionine and choline ( - F LM LC) on the relative abundance of soluble proteins in the liver of the pregnant rat. In the present study we report the corresponding changes in the fetal liver at day 21 of gestation. The abundance of eighteen proteins increased when dams were fed the - F diet. When dams were fed the - F LM LC diet, thirty-three proteins increased and eight decreased. Many of the differentially abundant proteins in the fetal liver could be classified into the same functional groups as those previously identified in the maternal liver, namely protein synthesis, metabolism, lipid metabolism and proteins associated with the cytoskeleton and endoplasmic reticulum. The pattern was consistent with reduced cell proliferation in the - F LM LC group but not in the - F group. Metabolic enzymes associated with lipid metabolism changed in both the - F and - F LM LC groups. The mRNA for carnitine palmitoyl transferase were up-regulated and CD36 (fatty acid translocase) down-regulated in the - F group, suggesting increased mitochondrial oxidation of fatty acids as an indirect response to altered maternal lipid metabolism. In the - F LM LC group the mRNA for acetyl CoA carboxylase was down-regulated, suggesting reduced fatty acid synthesis. The mRNA for transcriptional regulators including PPARalpha and sterol response element-binding protein-1c were unchanged. These results suggest that an adequate supply of folic acid and the related methyl donors may benefit fetal development directly by improving lipid metabolism in fetal as well as maternal tissues.

Non-alcoholic fatty liver disease (NAFLD), insulin resistance and lipid profile in antiepileptic drug treatment

PURPOSE

Patients undergoing long-term treatment with valproic acid (VPA) are prone to develop different features of the metabolic syndrome (MS). The aim of the present study was to evaluate the occurrence of non-alcoholic fatty liver disease (NAFLD), insulin resistance (IR) and a pro-atherogenic lipid profile in patients undergoing VPA, carbamazepine (CBZ) and lamotrigine (LTG) monotherapy compared to healthy controls.

METHODS

Abdominal ultrasound as well as measurement of serum fasting insulin and glucose, serum lipids and liver function parameters were performed in VPA (n=23), CBZ (n=22) and LTG (n=23) treated non-diabetic and non-obese epileptic patients compared to healthy controls (n=16).

RESULTS

Ultrasound measurement demonstrated characteristics of fatty liver disease in 60.9% of VPA, in 22.7% of CBZ, in 8.7% of LTG treated patients and in 12.5% of the healthy controls, with highest level of steatosis seen in VPA treated patients. In addition, patients on VPA monotherapy showed a higher body-mass index (BMI) when compared to LTG treated patients and controls (p<or=0.049). Total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and gamma-glutamyltransferase (gammaGT) were greatest in the CBZ group (p<or=0.043). Interestingly, serum fasting glucose, serum fasting insulin as well as the HOMA-IR did not differ significantly between groups.

CONCLUSION

In conclusion, VPA (and moderately CBZ) therapy is related to increased risk for ultrasonographic signs of fatty liver disease, emphasizing the importance of regular ultrasound measurements as well as monitoring of serum lipids and BMI during enzyme-modulating AED treatment.

Efficacy and safety of ezetimibe/simvastatin combination therapy in patients with type 2 diabetes and nonalcoholic fatty liver disease

A nem alkoholos zsírmáj gyakran fordul elő a metabolikus szindrómához tartozó 2-es típusú diabetesben, dyslipidaemiában és obesitasban. Célkitűzés: Az ezetimib/simvastatin 10/20 mg kombinált kezelés hatékonyságának és biztonságosságának meghatározása 2-es típusú diabeteses és nem alkoholos zsírmájú betegek esetében. Módszer: Tizenkilenc 2-es típusú diabeteses és nem alkoholos zsírmájú beteget vizsgáltunk, akiket 2005 és 2008 között diagnosztizáltak és kezeltek a Budaörsi Egészségügyi Központban. Hat hónappal az ezetimib/simvastatin (10/20 mg naponta) kombinált kezelést követően minden betegnél megfigyeltük a szérum-alanin-aminotranszferáz- (ALT-), aszpartát-aminotranszferáz- (AST-), koleszterin-, LDL-koleszterin-, HDL-koleszterin- és trigliceridszint változását. Eredmények: Hat hónappal az ezetimib/simvastatin adását követően szignifikánsan csökkent az ALT (63,78±5,12 vs. 32,57±3,92 U/L; p < 0,0001), az AST (50,79±3,66 vs. 23,68±3,42 U/L; p < 0,0001), a koleszterin (6,26±0,46 vs. 4,02±0,31 mmol/L; p < 0,0001) és az LDL-koleszterin (4,24±0,37 vs. 2,22±0,1 mmol/L; p < 0,0001) koncentrációja. A kombinált kezelés szignifikánsan csökkentette a triglicerid szintjét (2,62±0,48 vs. 1,33±0,20 mmol/L; p < 0,0001) és növelte a HDL-koleszterin (1,02±0,12 vs. 1,18±0,07 mmol/L; p < 0,0001) koncentrációját. Következtetések: Vizsgálatunk eredményei azt mutatják, hogy az ezetimib/simvastatin kombinált kezelés biztonságos és hatékony 2-es típusú diabeteses, nem alkoholos zsírmájú betegek esetében.

Predictors of development of diabetes in patients with chronic heart failure in the Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity (CHARM) program

OBJECTIVE

The purpose of this study was to identify predictors of incident diabetes during follow-up of nondiabetic patients with chronic heart failure (CHF) in the Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity (CHARM) program.

RESEARCH DESIGN AND METHODS

A total of 1,620 nondiabetic patients had full baseline datasets. We compared baseline demographic, medication, and laboratory data for patients who did or did not develop diabetes and conducted logistic regression and receiver operator characteristic curve analyses.

RESULTS

Over a median period of 2.8 years, 126 of the 1,620 patients (7.8%) developed diabetes. In multiple logistic regression analysis, the following baseline characteristics were independently associated with incident diabetes in decreasing order of significance by stepwise selection: higher A1C (odds ratio [OR] 1.78 per 1 SD increase; P < 0.0001), higher BMI (OR 1.64 per 1 SD increase; P < 0.0001), lipid-lowering therapy (OR 2.05; P = 0.0005), lower serum creatinine concentration (OR 0.68 per 1 SD increase; P = 0.0018), diuretic therapy (OR 4.81; P = 0.003), digoxin therapy (OR 1.65; P = 0.022), higher serum alanine aminotransferase concentration (OR 1.15 per 1 SD increase; P = 0.027), and lower age (OR 0.81 per 1 SD increase; P = 0.048). Using receiver operating characteristic curve analysis, A1C and BMI yielded areas under the curve of 0.723 and 0.712, respectively, increasing to 0.788 when combined. Addition of other variables independently associated with diabetes risk minimally improved prediction of diabetes.

CONCLUSIONS

In nondiabetic patients with CHF in CHARM, A1C and BMI were the strongest predictors of the development of diabetes. Other minor predictors in part reflected CHF severity or drug-associated diabetes risk. Identifying patients with CHF at risk of diabetes through simple criteria appears possible and could enable targeted preventative measures.

Successful use of extended criteria donor grafts with low to moderate steatosis in patients with model for end-stage liver disease scores below 27

Liver transplantation may be performed using extended criteria donor grafts (ECDg). The characteristics of ECDg include age >60 years, long intensive care unit (ICU) stay, history of malignancy or steatosis. Grafts are often discarded due to steatosis, which can be macrovesicular (MaS) or microvesicular (MiS). MaS is the variety most frequently involved with unfavorable outcomes due to primary nonfunction (PNF) or primary dysfunction (PDF). As of January 2000, all livers referred to our institution were considered potentially transplantable. Steatosis was defined as the presence of fat droplets in more than 5% of hepatocytes. We observed 35 steatotic grafts. Grafts were stratified according to MaS and MiS as follows: low steatosis (5%-15%), mild steatosis (16%-30%), moderate steatosis (31%-60%), or severe steatosis (>60%). Fifteen grafts with moderate (n = 2) or severe (n = 13) MaS were discarded. Twenty grafts were harvested: 18 of them were transplanted at our institution, the remaining 2, discarded by our donor team, were transplanted by other Italian centers. Low MaS was detected in 10 grafts (50%), mild MaS in 4 (20%), and moderate MaS in 2 (10%). Low MiS was detected in 8 grafts (40%), mild MiS in 5 (25%), and moderate MiS in 1 (5%). Steatotic grafts were transplanted only into recipients with model for end-stage liver disease (MELD) scores <27. The 6-month graft survival was 80%; the PNF rate was 10%; and the PDF rate was 15%. The careful use of ECDg with low to moderate steatosis is possible if particular care is taken to avoid additional risk factors related to the recipient.

Preventive effect of pioglitazone against nonalcoholic fatty liver disease in Sprague-Dawley rats and its mechanism

AIM: To explore the prevention effect and mechanism of pioglitazone (PIO) on nonalcoholic fatty liver disease (NAFLD) in rats.

METHODS: Seventy two Sprague-Dawley rats were randomly divided into three groups: normal diet group (NG), high fat diet group (HG) and PIO group (PIOG), with 24 rats in every group. PIOG were fed with high fat diet and PIO for eight weeks. IR was tested by euglycemic-hyperinsulinemic clamp; TG, ALT, AST, FFAs, FINS and TNF-α were tested by biochemistry automatic analyzer or RIA; mRNA expression of peroxisome proliferator-activated receptor (PPARγ) was detected using RT-PCR. The expression of PPARγ and c-Jun amino-terminal kinase 1 (JNK1) were detected by Western blot.

RESULTS: The glucose infusion rate (GIR) decreased and JNK1 increased in HG rats in a time-dependent manner from 1st to 8th week (P < 0.05). Compared with NG, at the end of 8th week, the hepatic steatosis was significant in HG group. The weight, liver index, serum levels of TG, ALT, AST, FFAs, FINS and TNF-α increased, while IR was aggravated. Meanwhile, the JNK1 protein expression in liver tissue was up-regulated, while expression of PPARγ was decreased (TG: 1.23 ± 0.08 vs 0.62 ± 0.12; ALT: 92.80 ± 7.09 vs 51.34 ± 8.12; AST: 153.22 ± 20.65 vs 119.26 ± 13.61; FFAs: 511.94 ± 24.88 vs 335.31 ± 15.71; FINS: 41.23 ± 1.84 vs 22.65 ± 2.25; TNF-α: 1.02 ± 0.12 vs 0.34 ± 0.07, all P < 0.05). In PIOG, all the indexes were improved, but didn't completely return to the same as those of NG group.

CONCLUSION: PIO could prevent NAFLD induced by a high-fat diet and other IR-related diseases.

Decreased plasma levels of soluble receptor for advanced glycation endproducts (sRAGE) in patients with nonalcoholic fatty liver disease

OBJECTIVES

Levels of soluble receptor for advanced glycation endproducts (sRAGE) have been linked to several components of the metabolic syndrome. We tested the hypothesis that plasma levels of sRAGE may be associated with non-alcoholic fatty liver disease.

DESIGN AND METHODS

We enrolled subjects with definite nonalcoholic steatohepatitis (NASH, n=40), borderline NASH (n=8), simple fatty liver (n=9) and healthy controls (n=14). Plasma levels of sRAGE were measured by ELISA.

RESULTS

Concentrations of sRAGE were significantly lower in patients with definite NASH (1080+/-392 pg/mL, P<0.01) and borderline NASH (1050+/-278 pg/mL, P<0.05) compared to controls (1480+/-387 pg/mL). Levels of sRAGE were significantly and inversely correlated with ALT (r=-0.30, P<0.05) and AST (r=-0.23, P<0.05).

CONCLUSION

Plasma levels of sRAGE are significantly reduced in definite and borderline NASH.

Effects of n-3 polyunsaturated fatty acids from seal oils on nonalcoholic fatty liver disease associated with hyperlipidemia

AIM: To investigate the efficacy and safety of n-3 polyunsaturated fatty acids (PUFA) from seal oils for patients with nonalcoholic fatty liver disease (NAFLD) associated with hyperlipidemia.

METHODS: One hundred and forty-four patients with NAFLD associated with hyperlipidemia were included in the 24-wk, randomized, controlled trial. The patients were randomized into two groups. Group A (n = 72) received recommended diet and 2 g n-3 PUFA from seal oils, three times a day. Group B (n = 72) received recommended diet and 2 g placebo, three times a day. Primary endpoints were fatty liver assessed by symptom scores, liver alanine aminotransferase (ALT) and serum lipid levels after 8, 12, 16, and 24 wk. Hepatic fat infiltration was detected by ultrasonography at weeks 12 and 24 after treatment.

RESULTS: A total of 134 patients (66 in group A, 68 in group B) were included in the study except for 10 patients who were excluded from the study. After 24 wk of treatment, no change was observed in body weight, fasting blood glucose (FBG), renal function and blood cells of these patients. Total symptom scores, ALT and triglyceride (TG) levels decreased more significantly in group A than in group B (P < 0.05). As expected, there was a tendency toward improvement in aspartate aminotransferase (AST), γ-glutamyltranspeptidase (GGT), and total cholesterol (TCHO) and high-density lipoprotein (HDL) cholesterol levels (P < 0.05) after administration in the two groups. However, no significant differences were found between the two groups. The values of low-density lipoprotein (LDL) were significantly improved in group A (P < 0.05), but no significant change was found in group B at different time points and after a 24-wk treatment. After treatment, complete fatty liver regression was observed in 19.70% (13/66) of the patients, and an overall reduction was found in 53.03% (35/66) of the patients in group A. In contrast, in group B, only five patients (7.35%, 5/68) achieved complete fatty liver regression (P = 0.04), whereas 24 patients (35.29%, 24/68) had a certain improvement in fatty liver (P = 0.04). No serious adverse events occurred in all the patients who completed the treatment.

CONCLUSION: Our results indicate that n-3 PUFA from seal oils is safe and efficacious for patients with NAFLD associated with hyperlipidemia and can improve their total symptom scores, ALT, serum lipid levels and normalization of ultrasonographic evidence. Further study is needed to confirm these results.