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Abdalla TSA, Giannou AD, Abdalla ASA, Izbicki JR, Dupreé A, Mann O, Wolter S. The Effect of Non-Alcoholic Fatty Liver Disease on Weight Loss and Resolution of Obesity-Related Disorders After Bariatric Surgery. World J Surg 2023; 47:3281-3288. [PMID: 37747548 PMCID: PMC10694115 DOI: 10.1007/s00268-023-07153-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Patients undergoing bariatric surgery have a high incidence of non-alcoholic fatty liver disease (NAFLD). However, the effect of NAFLD or non-alcoholic steatohepatitis (NASH) on the weight loss and resolution of obesity-related disorders is a matter of debate. METHODS In this study, we compare the long-term outcomes after bariatric with the presence of NAFLD in the liver biopsy at the time of surgery. RESULTS The follow-up was available for 226 out of 288 patients. The mean follow-up time was 24.9 (± 13.6) months. The baseline histology showed that 112 patients (38.9%) had no NASH, 70 (24.3%) were borderline, and 106 (36.8%) had NASH. At follow-up, the mean BMI dropped from (52 ± 10.2) to (36.6 ± 8) kg/m 2. Excess weight loss (EWL) was similar in all NAFLD groups. Type 2 diabetes mellitus dropped from 35.7 to 11.4%, hypertension from 65.6 to 36.7%, hyperlipidemia from 62.3 to 33%, and obstructive sleep apnea from 37.5 to 14.9%. Only hyperlipidemia was significantly associated with NASH compared to the groups with no NASH or borderline NASH (p value = 0.002 and p value = 0.04, respectively) during the first two years of follow-up. CONCLUSION The beneficial effects of bariatric surgery are evident across all patients with NAFLD. Patients with NASH have comparable outcomes regarding weight loss and resolution of obesity-related comorbidities.
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Affiliation(s)
- Thaer S A Abdalla
- Department of General, Visceral and Thoracic Surgery, At the University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany.
| | - Anastasios D Giannou
- Department of General, Visceral and Thoracic Surgery, At the University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - Ahmed S A Abdalla
- Department of General, Visceral and Thoracic Surgery, At the University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - Jakob R Izbicki
- Department of General, Visceral and Thoracic Surgery, At the University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - Anna Dupreé
- Department of General, Visceral and Thoracic Surgery, At the University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - Oliver Mann
- Department of General, Visceral and Thoracic Surgery, At the University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - Stefan Wolter
- Department of General, Visceral and Thoracic Surgery, At the University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
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En Li Cho E, Ang CZ, Quek J, Fu CE, Lim LKE, Heng ZEQ, Tan DJH, Lim WH, Yong JN, Zeng R, Chee D, Nah B, Lesmana CRA, Bwa AH, Win KM, Faulkner C, Aboona MB, Lim MC, Syn N, Kulkarni AV, Suzuki H, Takahashi H, Tamaki N, Wijarnpreecha K, Huang DQ, Muthiah M, Ng CH, Loomba R. Global prevalence of non-alcoholic fatty liver disease in type 2 diabetes mellitus: an updated systematic review and meta-analysis. Gut 2023; 72:2138-2148. [PMID: 37491159 DOI: 10.1136/gutjnl-2023-330110] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/20/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease, with type 2 diabetes mellitus (T2DM) as a major predictor. Insulin resistance and chronic inflammation are key pathways in the pathogenesis of T2DM leading to NAFLD and vice versa, with the synergistic effect of NAFLD and T2DM increasing morbidity and mortality risks. This meta-analysis aims to quantify the prevalence of NAFLD and the prevalence of clinically significant and advanced fibrosis in people with T2DM. METHODS MEDLINE and Embase databases were searched from inception until 13 February 2023. The primary outcomes were the prevalence of NAFLD, non-alcoholic steatohepatitis (NASH) and fibrosis in people with T2DM. A generalised linear mixed model with Clopper-Pearson intervals was used for the analysis of proportions with sensitivity analysis conducted to explore heterogeneity between studies. RESULTS 156 studies met the inclusion criteria, and a pooled analysis of 1 832 125 patients determined that the prevalence rates of NAFLD and NASH in T2DM were 65.04% (95% CI 61.79% to 68.15%, I2=99.90%) and 31.55% (95% CI 17.12% to 50.70%, I2=97.70%), respectively. 35.54% (95% CI 19.56% to 55.56%, I2=100.00%) of individuals with T2DM with NAFLD had clinically significant fibrosis (F2-F4), while 14.95% (95% CI 11.03% to 19.95%, I2=99.00%) had advanced fibrosis (F3-F4). CONCLUSION This study determined a high prevalence of NAFLD, NASH and fibrosis in people with T2DM. Increased efforts are required to prevent T2DM to combat the rising burden of NAFLD. PROSPERO REGISTRATION NUMBER CRD42022360251.
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Affiliation(s)
- Elina En Li Cho
- Department of Medicine, National University Hospital, Singapore
| | - Chong Zhe Ang
- Department of Medicine, National University Hospital, Singapore
| | - Jingxuan Quek
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Clarissa Elysia Fu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lincoln Kai En Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Zane En Qi Heng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jie Ning Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Rebecca Zeng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Douglas Chee
- Department of Medicine, National University Hospital, Singapore
| | - Benjamin Nah
- Department of Medicine, National University Hospital, Singapore
| | | | - Aung Hlaing Bwa
- Department of Medical Research, Union of Myanmar, Naypyidaw, Myanmar
| | - Khin Maung Win
- Department of Medical Research, Union of Myanmar, Naypyidaw, Myanmar
| | - Claire Faulkner
- Department of Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Majd B Aboona
- Department of Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Mei Chin Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Diagnostic Imaging, National University Health System, Singapore
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Anand V Kulkarni
- Hepatology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Hiroyuki Suzuki
- Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | | | - Nobuharu Tamaki
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- Department of Medicine, Musashino Red Cross Hospital, Musashino, Japan
| | - Karn Wijarnpreecha
- Division of Gastroenterology and Hepatology, University of Michigan, Michigan, Michigan, USA
| | - Daniel Q Huang
- Department of Medicine, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, National University Health System, Singapore
| | - Mark Muthiah
- Department of Medicine, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, National University Health System, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Rohit Loomba
- Department of Medicine, University of California San Diego, La Jolla, California, USA
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Reinshagen M, Kabisch S, Pfeiffer AF, Spranger J. Liver Fat Scores for Noninvasive Diagnosis and Monitoring of Nonalcoholic Fatty Liver Disease in Epidemiological and Clinical Studies. J Clin Transl Hepatol 2023; 11:1212-1227. [PMID: 37577225 PMCID: PMC10412706 DOI: 10.14218/jcth.2022.00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/16/2022] [Accepted: 03/21/2023] [Indexed: 07/03/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is strongly associated with the metabolic syndrome and type 2 diabetes and independently contributes to long-term complications. Being often asymptomatic but reversible, it would require population-wide screening, but direct diagnostics are either too invasive (liver biopsy), costly (MRI) or depending on the examiner's expertise (ultrasonography). Hepatosteatosis is usually accommodated by features of the metabolic syndrome (e.g. obesity, disturbances in triglyceride and glucose metabolism), and signs of hepatocellular damage, all of which are reflected by biomarkers, which poorly predict NAFLD as single item, but provide a cheap diagnostic alternative when integrated into composite liver fat indices. Fatty liver index, NAFLD LFS, and hepatic steatosis index are common and accurate indices for NAFLD prediction, but show limited accuracy for liver fat quantification. Other indices are rarely used. Hepatic fibrosis scores are commonly used in clinical practice, but their mandatory reflection of fibrotic reorganization, hepatic injury or systemic sequelae reduces sensitivity for the diagnosis of simple steatosis. Diet-induced liver fat changes are poorly reflected by liver fat indices, depending on the intervention and its specific impact of weight loss on NAFLD. This limited validity in longitudinal settings stimulates research for new equations. Adipokines, hepatokines, markers of cellular integrity, genetic variants but also simple and inexpensive routine parameters might be potential components. Currently, liver fat indices lack precision for NAFLD prediction or monitoring in individual patients, but in large cohorts they may substitute nonexistent imaging data and serve as a compound biomarker of metabolic syndrome and its cardiometabolic sequelae.
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Affiliation(s)
- Mona Reinshagen
- Department of Endocrinology and Metabolism, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany
- Deutsches Zentrum für Diabetesforschung e.V., Geschäftsstelle am Helmholtz-Zentrum München, Neuherberg, Germany
| | - Stefan Kabisch
- Department of Endocrinology and Metabolism, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany
- Deutsches Zentrum für Diabetesforschung e.V., Geschäftsstelle am Helmholtz-Zentrum München, Neuherberg, Germany
| | - Andreas F.H. Pfeiffer
- Department of Endocrinology and Metabolism, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany
- Deutsches Zentrum für Diabetesforschung e.V., Geschäftsstelle am Helmholtz-Zentrum München, Neuherberg, Germany
| | - Joachim Spranger
- Department of Endocrinology and Metabolism, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany
- Deutsches Zentrum für Diabetesforschung e.V., Geschäftsstelle am Helmholtz-Zentrum München, Neuherberg, Germany
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Pais R, Cariou B, Noureddin M, Francque S, Schattenberg JM, Abdelmalek MF, Lalazar G, Varma S, Dietrich J, Miller V, Sanyal A, Ratziu V. A proposal from the liver forum for the management of comorbidities in non-alcoholic steatohepatitis therapeutic trials. J Hepatol 2023; 79:829-841. [PMID: 37001695 DOI: 10.1016/j.jhep.2023.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 02/08/2023] [Accepted: 03/13/2023] [Indexed: 06/19/2023]
Abstract
The current document has been developed by the Liver Forum who mandated the NAFLD-Associated Comorbidities Working Group - a multistakeholder group comprised of experts from academic medicine, industry and patient associations - to identify aspects of diverse comorbidities frequently associated with non-alcoholic steatohepatitis (NASH) that can interfere with the conduct of therapeutic trials and, in particular, impact efficacy and safety results. The objective of this paper is to propose guidance for the management of relevant comorbidities in both candidates and actual participants in NASH therapeutic trials. We relied on specific guidelines from scientific societies, when available, but adapted them to the particulars of NASH trials with the aim of addressing multiple interacting requirements such as maintaining patient safety, reaching holistic therapeutic objectives, minimising confounding effects on efficacy and safety of investigational agents and allowing for trial completion. We divided the field of action into: first, analysis and stabilisation of the patient's condition before inclusion in the trial and, second, management of comorbidities during trial conduct. For the former, we discussed the concept of acceptable vs. optimal control of comorbidities, defined metabolic and ponderal stability prior to randomisation and weighed the pros and cons of a run-in period. For the latter, we analysed non-hepatological comorbid conditions for changes or acute events possibly occurring during the trial, including changes in alcohol consumption, in order to detail when specific interventions are necessary and how best to manage concomitant drug intake in line with methodological constraints. These recommendations are intended to act as a guide for clinical trialists and are open to further refinement when additional data become available.
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Affiliation(s)
- Raluca Pais
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Institute of Cardiometabolism and Nutrition, France; Centre de Recherche Saint Antoine, INSERM UMRS_938 Paris, France
| | - Bertrand Cariou
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du Thorax, F-44000 Nantes, France
| | | | - Sven Francque
- Department of Gastroenterology Hepatology, Antwerp University Hospital, Drie Eikenstraat 655, B-2650 Edegem, Belgium; InflaMed Centre of Excellence, Laboratory for Experimental Medicine and Paediatrics, Translational Sciences in Inflammation and Immunology, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, B-2610 Wilrijk, Belgium European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Belgium
| | - Jörn M Schattenberg
- Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Manal F Abdelmalek
- Division of Gastroenterology and Hepatology, Duke University, Durham, NC, USA
| | - Gadi Lalazar
- Liver Unit, Digestive Disease Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Sharat Varma
- Novo Nordisk A/S, Vandtårnsvej 108-110, 2860 Søborg Denmark
| | - Julie Dietrich
- GENFIT, Parc Eurasanté 885, Avenue Eugène Avinée, 59120, Loos, France
| | - Veronica Miller
- Forum for Collaborative Research, University of California Berkeley School of Public Health, Washington D.C., USA
| | - Arun Sanyal
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Vlad Ratziu
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Institute of Cardiometabolism and Nutrition, France; INSERM UMRS 1138 CRC, Paris, France.
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Valadares EC, Gestic MA, Utrini MP, Chaim FDM, Chaim EA, Cazzo E. Is Helicobacter pylori infection associated with non-alcoholic fatty liver disease in individuals undergoing bariatric surgery? Cross-sectional study. SAO PAULO MED J 2023; 141:e2022517. [PMID: 37042863 PMCID: PMC10085533 DOI: 10.1590/1516-3180.2022.0517.r1.14122022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/14/2022] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND A possible direct link between nonalcoholic fatty liver disease (NAFLD) and Helicobacter pylori (H. pylori) infection has recently emerged. OBJECTIVE This study aimed to analyze associations between the presence of histologically demonstrated NAFLD aspects with H. pylori infection in individuals with obesity undergoing bariatric surgery. DESIGN AND SETTING An observational analytical cross-sectional study was conducted based on data collected from the medical records of individuals undergoing bariatric surgery at a tertiary university hospital in 2019. METHODS NAFLD was assessed through histological examination of wedge liver biopsies collected during the proceedings. H. pylori infection was analyzed through the association of the urease test and histological examination performed in biopsies routinely collected during preoperative esophagogastroduodenoscopy. RESULTS Of the 88 participants, 85% were female, and the average age was 39.1 ± 8.4 years. H. pylori infection was present in 61.4% of the patients. The mean body mass index was 36.6 ± 3.4 kg/m2. The most prevalent histopathological aspects of NAFLD were macrovesicular steatosis (92%), hepatocellular ballooning (92%), lobular inflammation (93.2%), portal inflammation (96.6%), and fibrosis (93.2%). No histopathological aspect of NAFLD was found to be significantly associated with H. pylori infection. CONCLUSION In this study population, H. pylori infection was not significantly associated with the histopathological aspects of NAFLD in individuals with obesity undergoing bariatric surgery.
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Affiliation(s)
- Erick Coelho Valadares
- MD. Resident Physician, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
| | - Martinho Antonio Gestic
- MD, MSc. Assistant Physician, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
| | - Murillo Pimentel Utrini
- MD. Assistant Physician, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
| | - Felipe David Mendonça Chaim
- MD, PhD. Assistant Physician, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
| | - Elinton Adami Chaim
- MD, PhD. Full Professor, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
| | - Everton Cazzo
- MD, PhD. Associate Professor, Department of Surgery, School of Medical Sciences, Universidade Estadual Campinas (UNICAMP), Campinas, Brazil
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Lu S, Kuang M, Yue J, Hu C, Sheng G, Zou Y. Utility of traditional and non-traditional lipid indicators in the diagnosis of nonalcoholic fatty liver disease in a Japanese population. Lipids Health Dis 2022; 21:95. [PMID: 36207744 PMCID: PMC9540727 DOI: 10.1186/s12944-022-01712-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/16/2022] [Accepted: 09/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Traditional and non-traditional (TNNT) lipid indicators are known to be closely related to nonalcoholic fatty liver disease (NAFLD). This study's objective was to compare the degree of associations and diagnostic values of TNNT lipid indicators with NAFLD. METHODS Participants were 14,251 Japanese adults who undergoing health checkups, and we measured and calculated 11 lipid indicators, including traditional lipid indicators such as high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG), as well as non-traditional lipid indicators such as TC/HDL-C ratio, LDL-C/HDL-C ratio, TG/HDL-C ratio, non-HDL-C, remnant cholesterol (RC), RC/HDL-C ratio and non-HDL-C/HDL-C ratio. The associations between these lipid indicators and NAFLD were assessed using multivariate logistic regression, and the performance of these lipid indicators in identifying NAFLD was analyzed by receiver operating characteristic (ROC) curves. RESULTS After rigorous adjustment for potential confounders, multivariate logistic regression showed that all TNNT lipid indicators were independently associated with NAFLD, among which the RC/HDL-C ratio and RC had the strongest association with NAFLD. ROC analysis showed that non-traditional lipid indicators were superior to traditional lipid indicators in identifying NAFLD, especially in young adults and females. It is worth mentioning that the RC/HDL-C ratio was the best lipid indicator for identifying NAFLD with an area under the curve (AUC) of 0.82 and an optimal cut-off value of 0.43; in addition, TG/HDL-C ratio also had a high recognition performance for NAFLD. CONCLUSION Overall, in the Japanese population, non-traditional lipid indicators had a higher diagnostic value for NAFLD compared to traditional lipid indicators, and lipid indicators alone had a lower diagnostic value for NAFLD than the ratio of two lipid indicators, with RC/HDL-C and TG/HDL-C being the best lipid indicators for identifying NAFLD.
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Affiliation(s)
- Song Lu
- Medical College of Nanchang University, 330006, Nanchang, Jiangxi Provincial, China.,Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People's Hospital, 330006, Nanchang, Jiangxi Provincial, China
| | - Maobin Kuang
- Medical College of Nanchang University, 330006, Nanchang, Jiangxi Provincial, China.,Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People's Hospital, 330006, Nanchang, Jiangxi Provincial, China
| | - Jinjing Yue
- Department of Obstetrics and Gynaecology, The Third Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, Henan Provincial, China
| | - Chong Hu
- Department of Gastroenterology, Jiangxi Provincial People's Hospital, 330006, Nanchang, Jiangxi Provincial, China
| | - Guotai Sheng
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People's Hospital, 330006, Nanchang, Jiangxi Provincial, China
| | - Yang Zou
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People's Hospital, 330006, Nanchang, Jiangxi Provincial, China.
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The triglycerides and glucose (TyG) index: A new marker associated with nonalcoholic steatohepatitis (NASH) in obese patients. DIABETES & METABOLISM 2022; 48:101345. [PMID: 35339664 DOI: 10.1016/j.diabet.2022.101345] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/11/2022] [Accepted: 03/11/2022] [Indexed: 11/21/2022]
Abstract
AIM Diagnosis of nonalcoholic steatohepatitis (NASH) relies on liver biopsy. Noninvasive tools would be useful to target patients to refer for a biopsy. We aimed to determine the diagnostic value of the triglycerides and glucose (TyG) index, an insulin-resistance indicator, to predict NASH. METHODS Our study included grade II-III obese patients aged 18-65 years undergoing bariatric surgery and included in the COMET (COllection of MEtabolic Tissues) biobank (NCT02861781). Liver biopsies performed during bariatric surgery were collected from the biobank along with blood derivatives. Biopsies were analysed according to the steatosis, activity and fibrosis (SAF) scoring system to diagnose NASH, nonalcoholic fatty liver disease (NAFLD), and fibrosis. Logistic regression models were performed to identify factors predicting NASH, NAFLD, and fibrosis. RESULTS Of 238 analysed subjects (mean age 43±12 years, 33.6% men), 29% had type 2 diabetes. Steatosis was present in 67.2%, while NASH and advanced fibrosis (stage F3) were diagnosed in 18.1% and 2.9% respectively. TyG index was independently associated with NASH (odds ratio (OR): 4.7 [95% confidence interval: 2.3;9.5] P < 0.0001), NAFLD (OR: 2.0 [1.1;3.7] P = 0.03) and stages 2-3 fibrosis (OR: 4.0 [1.5;10.8] P = 0.007). NASH was also predicted by gamma-glutamyl transferase (GGT) with an area under the ROC curve: 0.79 [0.71;0.87 P = 0.04] for GGT and TyG index combined. CONCLUSION In our cohort of severely obese patients, TyG index, when associated with GGT level, exhibited high diagnostic performance to predict NASH. Although validation in larger populations is needed, this result may be of considerable clinical value to predict need for liver biopsy.
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CONCON MM, GESTIC MA, UTRINI MP, CHAIM FDM, CHAIM EA, CAZZO E. SHOULD ROUTINE LIVER BIOPSY BE CONSIDERED IN BARIATRIC SURGICAL PRACTICE? AN ANALYSIS OF THE LIMITATIONS OF NON-INVASIVE NAFLD MARKERS. ARQUIVOS DE GASTROENTEROLOGIA 2022; 59:110-116. [DOI: 10.1590/s0004-2803.202200001-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/13/2021] [Indexed: 11/22/2022]
Abstract
ABSTRACT Background Non-invasive markers are useful and practical tools for assessing non-alcoholic fatty liver disease (NAFLD), but liver biopsy remains the gold-standard method. Liver biopsy can be easily obtained on individuals undergoing bariatric surgery, but there is no ultimate evidence on the relationship between costs, risks and benefits of its systematic performance. Objective To compare the diagnostic accuracy of non-invasive methods with liver biopsy for detection and staging of NAFLD in obese individuals undergoing bariatric surgery. Methods This is a cross-sectional, observational and descriptive study which enrolled individuals who underwent bariatric surgery from 2018 through 2019 at a public tertiary university hospital. Ultrasound scan, hepatic steatosis index, Clinical Non-Alcoholic Steatohepatitis Score (C-NASH), hypertension, alanine aminotransferase (ALT) and insulin resistance (HAIR), aspartate aminotransferase (AST) to Platelet Ratio Index (APRI), NAFLD Fibrosis Score (NFS) and body mass index, AST/ALT ratio, and diabetes (BARD) were the methods compared with the histopathological examination of wedge liver biopsies collected during surgery. Results Of 104 individuals analyzed, 91 (87.5%) were female. The mean age was 34.9±9.7 years. There was no biopsy-related morbidity. The respective overall accuracies of each marker analyzed were: ultrasound scan (79.81% for steatosis), hepatic steatosis index (79.81% for steatosis), HAIR (40.23% for steatohepatitis), C-NASH (22.99% for steatohepatitis), APRI (94.23% for advanced fibrosis), NFS (94.23% for advanced fibrosis), and BARD (16.35% for advanced fibrosis). Discussion Given the high prevalence of liver disease within this population, even the most accurate markers did not present enough discretionary power to detect and/or rule out the NAFLD aspects they were designed to assess in comparison with liver biopsy, which is safe and easy to obtain in these patients. Conclusion Wedge liver biopsy during bariatric surgery helps to diagnose and stage NAFLD, presents low risks and acceptable costs; given the limitations of non-invasive methods, it is justifiable and should be considered in bariatric routine.
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Pentraxin 3 and the TyG Index as Two Novel Markers to Diagnose NAFLD in Children. DISEASE MARKERS 2022; 2021:8833287. [PMID: 35059041 PMCID: PMC8764277 DOI: 10.1155/2021/8833287] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 11/12/2020] [Accepted: 02/20/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND The diagnosis of NAFLD requires a liver biopsy, which is difficult in children. This study explored the diagnostic value of pentraxin 3 (PTX-3) and the triglyceride-glucose (TyG) index for NAFLD in children. METHODS Sixty-eight children with NAFLD were selected as study subjects, and 68 healthy children enrolled during the same period served as controls. The TyG index was calculated, serum PTX-3 expression was detected by enzyme-linked immunosorbent assay, and the correlations between PTX-3 or the TyG index and clinical and biochemical indicators were analyzed. A receiver operating characteristics curve analysis and area under the curve (AUC) were used to evaluate diagnostic accuracy. RESULTS Serum PTX-3 level and the TyG index of the NAFLD patients were significantly higher than those of the healthy controls (P < 0.001), which was closely related with the BMI, ALT, and insulin resistance. The AUC of PTX-3 for diagnosing NAFLD was 0.731 (95% confidence interval [CI] 0.646-0.806), and the AUC of the TyG index for diagnosing NAFLD was 0.765 (95% CI 0.682-0.835). The AUC of PTX-3, the TyG index, and ALT for the combined diagnosis of NAFLD was 0.964 (95% CI 0.916-0.989). CONCLUSION PTX-3 and the TyG index are novel diagnostic biomarkers for NAFLD, as they effectively improved the diagnostic accuracy for NAFLD when combined with ALT.
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Smiderle CA, Coral GP, DE Carli LA, Mattos AAD, Mattos AZD, Tovo CV. PERFORMACE OF TRIGLYCERIDE-GLUCOSE INDEX ON DIAGNOSIS AND STAGING OF NAFLD IN OBESE PATIENTS. ARQUIVOS DE GASTROENTEROLOGIA 2021; 58:139-144. [PMID: 34231659 DOI: 10.1590/s0004-2803.202100000-24] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 11/15/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is the most prevalent liver disease in the world, and its prevalence is increasing alongside obesity. In United States, NAFLD is already the second leading cause of liver transplantation. The spectrum of the disease ranges from simple steatosis, which has a benign course, to steatohepatitis, which may progress to cirrhosis and its complications. The rising of noninvasive methods for diagnosing and staging non-alcoholic steatohepatitis (NASH) and fibrosis decreases the need of liver biopsy, as well as the costs and the occurrence of complications related to it. OBJECTIVE To analyze the performance of the triglyceride-glucose index to evaluate steatosis, NASH and liver fibrosis in obese patients with NAFLD. METHODS This is a retrospective cross-sectional study. Every medical record of patients who were candidates for bariatric surgery at a leading hospital in Southern Brazil were analyzed. The triglyceride-glucose index (TyG Index), a method composed only of two simple laboratory tests (serum triglycerides and fasting glucose levels), was performed prior to surgery. The TyG Index performance regarding the anatomopathological findings was evaluated, and the AUROC curve was calculated to evaluate the best cut-off point for diagnosing steatosis, non-alcoholic steatohepatitis and liver fibrosis grade. Also, the NAFLD fibrosis Score (NFS) was evaluated. RESULTS A total of 423 patients were evaluated. The TyG Index with a cut-off point of 8.76 excluded significant simple steatosis (grade 2-3) in obese patients, with 67.6% sensitivity, 65.1% specificity, 46.3% positive predictive value (PPV), 81.8% negative predictive value (NPV), 65.8% accuracy and 0.66 AUROC (P=0.005). In the evaluation of NASH, the TyG Index with a cut-off point of 8.82 excluded significant NASH (grade 2-3) with 57.3% sensitivity, 58.6% specificity, 33.7% PPV, 78.8% NPV, 58.2% accuracy and 0.58 AUROC (P=0.022). When evaluating liver fibrosis, the TyG Index with a cut-off point of 8.91 showed a sensitivity of 61.8%, a specificity of 62.5%, a PPV of 13.8 and a NPV of 94.4% for exclusion of advanced fibrosis (F3-4), with a 62.4% accuracy and 0.69 AUROC (P<0.001). When analyzing the performance of NFS in the diagnosis of advanced fibrosis, the cut-off point <-1.455 excluded advanced fibrosis with sensitivity of 59.4%, specificity of 51%, PPV of 11%, NPV of 92.4% and accuracy of 51.7%. However, the cut-off point of 0.676 to diagnose advanced fibrosis presented sensitivity of 21.9%, specificity of 83%, PPV of 11.7%, NPV of 91.2% and 77.3% accuracy. The AUROC was 0.54 (P=0.480). CONCLUSION TyG Index did not perform well in the diagnosis of significant steatosis and NASH. However, it was able to exclude advanced fibrosis in obese patients who are candidates for bariatric surgery.
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Affiliation(s)
- Carla Alessandra Smiderle
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Programa de Pós-Graduação em Hepatologia, Porto Alegre, RS, Brasil
| | - Gabriela Perdomo Coral
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Programa de Pós-Graduação em Hepatologia, Porto Alegre, RS, Brasil.,Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Departamento de Gastroenterologia e Hepatologia, Porto Alegre, RS, Brasil
| | - Luiz Alberto DE Carli
- Santa Casa de Misericórdia de Porto Alegre, Departamento de Cirurgia Gastrointestinal, Porto Alegre, RS, Brasil
| | - Angelo Alves de Mattos
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Programa de Pós-Graduação em Hepatologia, Porto Alegre, RS, Brasil.,Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Departamento de Gastroenterologia e Hepatologia, Porto Alegre, RS, Brasil
| | - Angelo Zambam de Mattos
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Programa de Pós-Graduação em Hepatologia, Porto Alegre, RS, Brasil.,Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Departamento de Gastroenterologia e Hepatologia, Porto Alegre, RS, Brasil
| | - Cristiane Valle Tovo
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Programa de Pós-Graduação em Hepatologia, Porto Alegre, RS, Brasil.,Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Departamento de Gastroenterologia e Hepatologia, Porto Alegre, RS, Brasil
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11
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Mitsunaga TM, Jimenez LS, Soares PFDC, Gestic MA, Utrini MP, Chaim FDM, Callejas-Neto F, Chaim EA, Cazzo E. Effect of transient obstructive cholestasis on liver histology: a cross-sectional study. SAO PAULO MED J 2021; 139:351-363. [PMID: 34161522 PMCID: PMC9615596 DOI: 10.1590/1516-3180.2020.0536.r1.1502021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 02/15/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The role of transient obstructive cholestasis on liver histology remains undetermined. OBJECTIVE To investigate whether transient cholestasis impairs liver histology. DESIGN AND SETTING Cross-sectional study at a public university hospital (UNICAMP), Brazil. METHODS 169 individuals undergoing cholecystectomy, with or without cholestasis. were enrolled. Histopathological findings were correlated with clinical and biochemical characteristics. RESULTS Biliary hepatopathy was more frequent in individuals with resolved cholestasis than in those with active obstruction or no jaundice (P < 0.01), as also were fibrosis and ductular proliferation (P = 0.02). Cholestasis was commoner in individuals with resolved obstruction than in those with no history (P < 0.01) or active cholestasis (P < 0.05). Biliary hepatopathy was associated with longer duration of cholestasis (P < 0.001) and higher bilirubin levels (P = 0.02) in individuals with active obstruction; with lower body mass index (P = 0.02) and longer cholestasis (P < 0.001) in individuals with resolved obstruction; and with longer cholestasis (P < 0.001) and longer interval between endoscopic retrograde cholangiopancreatography and surgery (P = 0.03) overall. In individuals with active obstruction, duration of cholestasis (R = 0.7; P < 0.001) and bilirubin levels (R = 0.6; P = 0.004) were independently correlated with cholestasis severity. Duration of cholestasis (R = 0.7; P < 0.001) was independently correlated with ductular proliferation severity. CONCLUSIONS Transient cholestasis was associated with significant histopathological changes, even after its resolution. Longer duration of obstruction correlated with greater severity of histopathological changes, especially cholestasis and ductular proliferation. This emphasizes the need for early treatment of obstructive cholestasis.
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Affiliation(s)
- Thalita Mendes Mitsunaga
- MD. Resident Physician, Department of Surgery, Faculdade de Ciências Médicas da Universidade de Campinas (FCM-UNICAMP), Campinas (SP), Brazil.
| | - Laísa Simakawa Jimenez
- MD. Resident Physician, Department of Surgery, Faculdade de Ciências Médicas da Universidade de Campinas (FCM-UNICAMP), Campinas (SP), Brazil.
| | - Pedro França da Costa Soares
- MD, MSc. Postgraduate Student, Department of Surgery, Faculdade de Ciências Médicas da Universidade de Campinas (FCM-UNICAMP), Campinas (SP), Brazil.
| | - Martinho Antonio Gestic
- MD, MSc. Attending Physician, Department of Surgery, Faculdade de Ciências Médicas da Universidade de Campinas (FCM-UNICAMP), Campinas (SP), Brazil.
| | - Murillo Pimentel Utrini
- MD. Attending Physician, Department of Surgery, Faculdade de Ciências Médicas da Universidade de Campinas (FCM-UNICAMP), Campinas (SP), Brazil.
| | - Felipe David Mendonça Chaim
- MD, PhD. Attending Physician, Department of Surgery, Faculdade de Ciências Médicas da Universidade de Campinas (FCM-UNICAMP), Campinas (SP), Brazil.
| | - Francisco Callejas-Neto
- MD, MSc. Assistant Professor, Department of Surgery, Faculdade de Ciências Médicas da Universidade de Campinas (FCM-UNICAMP), Campinas (SP), Brazil.
| | - Elinton Adami Chaim
- MD, PhD. Full Professor, Department of Surgery, Faculdade de Ciências Médicas da Universidade de Campinas (FCM-UNICAMP), Campinas (SP), Brazil.
| | - Everton Cazzo
- MD, PhD. Adjunct Professor, Department of Surgery, Faculdade de Ciências Médicas da Universidade de Campinas (FCM-UNICAMP), Campinas (SP), Brazil.
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12
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Reis SS, Callejas GH, Marques RA, Gestic MA, Utrini MP, Chaim FDM, Ramos AC, Chaim EA, Cazzo E. Correlation Between Anthropometric Measurements and Non-alcoholic Fatty Liver Disease in Individuals With Obesity Undergoing Bariatric Surgery: Cross-Sectional Study. Obes Surg 2021; 31:3675-3685. [PMID: 33982243 DOI: 10.1007/s11695-021-05470-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/05/2021] [Accepted: 05/05/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND We hypothesize that non-alcoholic fatty liver disease (NAFLD) may be significantly associated with waist circumference (WC), neck circumference (NC), hip circumference (HC), and waist-to-hip ratio (WHR). OBJECTIVES To analyze correlations between anthropometric parameters and the occurrence and intensity of NAFLD aspects assessed by histopathological examination in individuals undergoing bariatric surgery. METHODS This is a cross-sectional study carried out in a tertiary university hospital. Demographic, clinical, anthropometric, laboratory, and histopathological variables were analyzed; uni- and multivariate analyses were performed. Histopathological variables analyzed were findings of liver biopsies collected during surgical procedures. RESULTS Of 119 individuals, 105 (88.2%) were female. The mean age was 38.8 ± 9.3 years and the mean BMI was 37.6 ± 3.1 kg/m2. The prevalence of NAFLD histopathological aspects was: steatosis (76.5%), steatohepatitis (49.6%), and fibrosis (51.3%). WC was significantly higher in individuals with steatosis (103.5 ± 9.9 vs. 99.4 ± 8.4; p = 0.03). Individuals with steatohepatitis presented significantly higher BMI (38.2 ± 3.2 vs. 36.7 ± 2.8; p = 0.01), WC (105.3 ± 10.4 vs. 99.6 ± 8.8; p = 0.002), and WHR (1 ± 0.1 vs. 0.9 ± 0.1; p = 0.02). Age (40.6 ± 9.7 vs. 37 ± 8.5; p = 0.03) and hemoglobin A1c (6.5 ± 0.5 vs. 5.6 ± 0.5; p = 0.004) were significantly higher among individuals with fibrosis. A positive correlation was observed between the steatosis intensity and WHR (R = 0.2; p = 0.04). BMI (R = 0.2; p = 0.02) and glucose (R = 0.2; p = 0.009) were independently correlated with the steatohepatitis intensity. Age (R = 0.3; p = 0.04) was independently correlated with the fibrosis intensity. CONCLUSION There were significant associations between anthropometric parameters and NAFLD aspects. WC and WHR were associated with steatosis; BMI, WC, and WHR were associated with steatohepatitis. WHR independently correlated with steatosis intensity.
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Affiliation(s)
- Silênio Souza Reis
- Special Academic Unit of Health Sciences (UAE-CISAU), Federal University of Jataí (UFJ), Jataí, Brazil
| | - Guilherme Hoverter Callejas
- Department of Surgery-Faculty of Medical Sciences, State University of Campinas (UNICAMP), Rua Alexander Fleming, s/nº, Cidade Universitaria Zeferino Vaz, Campinas, SP, CEP 13085-000, Brazil
| | - Rodolfo Araújo Marques
- Department of Surgery-Faculty of Medical Sciences, State University of Campinas (UNICAMP), Rua Alexander Fleming, s/nº, Cidade Universitaria Zeferino Vaz, Campinas, SP, CEP 13085-000, Brazil
| | - Martinho A Gestic
- Department of Surgery-Faculty of Medical Sciences, State University of Campinas (UNICAMP), Rua Alexander Fleming, s/nº, Cidade Universitaria Zeferino Vaz, Campinas, SP, CEP 13085-000, Brazil
| | - Murillo P Utrini
- Department of Surgery-Faculty of Medical Sciences, State University of Campinas (UNICAMP), Rua Alexander Fleming, s/nº, Cidade Universitaria Zeferino Vaz, Campinas, SP, CEP 13085-000, Brazil
| | - Felipe D M Chaim
- Department of Surgery-Faculty of Medical Sciences, State University of Campinas (UNICAMP), Rua Alexander Fleming, s/nº, Cidade Universitaria Zeferino Vaz, Campinas, SP, CEP 13085-000, Brazil
| | - Almino C Ramos
- Department of Surgery-Faculty of Medical Sciences, State University of Campinas (UNICAMP), Rua Alexander Fleming, s/nº, Cidade Universitaria Zeferino Vaz, Campinas, SP, CEP 13085-000, Brazil
| | - Elinton A Chaim
- Department of Surgery-Faculty of Medical Sciences, State University of Campinas (UNICAMP), Rua Alexander Fleming, s/nº, Cidade Universitaria Zeferino Vaz, Campinas, SP, CEP 13085-000, Brazil
| | - Everton Cazzo
- Department of Surgery-Faculty of Medical Sciences, State University of Campinas (UNICAMP), Rua Alexander Fleming, s/nº, Cidade Universitaria Zeferino Vaz, Campinas, SP, CEP 13085-000, Brazil.
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13
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Zhou R, Lin C, Cheng Y, Zhuo X, Li Q, Xu W, Zhao L, Yang L. Liraglutide Alleviates Hepatic Steatosis and Liver Injury in T2MD Rats via a GLP-1R Dependent AMPK Pathway. Front Pharmacol 2021; 11:600175. [PMID: 33746742 PMCID: PMC7970416 DOI: 10.3389/fphar.2020.600175] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 12/18/2020] [Indexed: 12/11/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD), ranging from non-alcoholic fatty liver to non-alcoholic steatohepatitis, can be prevalent in patients with type 2 diabetes mellitus (T2DM). However, no antidiabetic drug has been approved for the treatment of NAFLD in T2DM patients. Multiple daily injections of basal-bolus insulin are often the final therapeutic option for T2DM. We found that insulin treatment aggravated hepatic steatosis and oxidative stress in Zucker diabetic fatty (ZDF) rats. In addition to glycaemic control, we demonstrated the stimulatory role of liraglutide in relieving hepatic steatosis and liver injury in ZDF rats. Interestingly, liraglutide could also alleviate insulin-aggravated hepatic fatty accumulation. The glucagon-like peptide-1 (GLP-1) agonists liraglutide and Ex-4 activated the expression of peroxisome proliferator-activated receptor alpha (PPARα) via a GLP-1 receptor-dependent 5′ AMP-activated protein kinase pathway. As a nuclear transcription factor, PPARα could mediate the effect of GLP-1 in alleviating hepatic steatosis by differentially regulating the expression of its target genes, including acetyl CoA carboxylase and carnitine palmitoyl transferase la both in vitro and in vivo. Moreover, GLP-1 could relieve liver injury by decreasing oxidative stress stimulated by hepatic steatosis. Insulin might aggravate hepatic steatosis and liver injury by inhibiting GLP-1R expression. The findings indicate the feasibility of liraglutide treatment combined with basal insulin in attenuating hepatic steatosis and liver injury in ZDF rats. This knowledge, and the evidence for the underlying mechanism, provide a theoretical basis for the combination treatment recommended by the latest clinical practice guidelines for T2DM.
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Affiliation(s)
- Rui Zhou
- Department of Nutrition, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Department of Pathology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Department of Pathology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Chuman Lin
- Department of Nutrition, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Department of Endocrinology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yanzhen Cheng
- Department of Endocrinology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoyun Zhuo
- Department of Nutrition, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Department of Endocrinology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Qinghua Li
- Department of Nutrition, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Department of Endocrinology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Wen Xu
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Liang Zhao
- Department of Pathology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Department of Pathology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Li Yang
- Department of Nutrition, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Department of Endocrinology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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14
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Jesus RN, Callejas GH, Concon MM, Braga JGR, Marques RA, Chaim FDM, Gestic MA, Utrini MP, Ramos AC, Chaim EA, Cazzo E. Prevalence and Factors Associated with Hepatic Iron Overload in Obese Individuals Undergoing Bariatric Surgery: a Cross-Sectional Study. Obes Surg 2020; 30:4967-4973. [PMID: 32979184 DOI: 10.1007/s11695-020-05003-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/17/2020] [Accepted: 09/22/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Slight to moderate hepatic iron overload (HIO) can be found in cases of liver disease, including non-alcoholic fatty liver disease (NAFLD), but the mechanism is not completely understood, as well as its relationship with obesity. OBJECTIVE To determine the prevalence of HIO assessed through histopathological examination in obese individuals undergoing bariatric surgery and to identify correlations between this condition and demographic, anthropometric, clinical, laboratory, and NAFLD-related aspects. METHODS This is a cross-sectional study which enrolled individuals undergoing bariatric surgery from January 2018 to February 2019 at a tertiary university hospital. NAFLD and HIO were assessed through histological examination. RESULTS Of 125 individuals, 87.2% were female and the average age was 38.8 ± 9.2 years. The average BMI was 37.2 ± 3.1 kg/m2. NAFLD was present in 66.4% and HIO in 17.6%, with 63.6% of patients with overload classified as mild (grade I) and 22.7% moderate (grade II). HIO was significantly more frequent in males (p = 0.003) and was significantly associated with higher levels of glucose (92.1 ± 28.4 vs. 80.7 ± 39.6; p = 0.02), ferritin (385.5 ± 290.9 vs. 131.6 ± 99.7; p < 0.0001), serum iron (82.4 ± 35.7 vs. 66.6 ± 25.1; p = 0.03), glutamic-oxaloacetic transaminase (27.3 ± 19.5 vs. 20.6 ± 8.8; p = 0.02), and glutamic-pyruvic transaminase (37.6 ± 36.4 vs. 24.6 ± 16.3; p = 0.01). Multivariate analysis showed that HIO intensity was significant and independently associated with ferritin levels (R = 0.19; p = 0.01), serum iron (R = 0.25; p < 0.0001), blood glucose (R = 0.16; p = 0.001), and total cholesterol (R = - 0.17; p < 0.0001). CONCLUSION In obese individuals, HIO presented a high prevalence and was associated with higher levels of ferritin, serum iron, glucose, and transaminases; lower levels of total cholesterol; and male gender.
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Affiliation(s)
- Rafael N Jesus
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n; Cidade Universitaria Zeferino Vaz, Campinas, SP, 13085-000, Brazil
| | - Guilherme H Callejas
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n; Cidade Universitaria Zeferino Vaz, Campinas, SP, 13085-000, Brazil
| | - Matheus M Concon
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n; Cidade Universitaria Zeferino Vaz, Campinas, SP, 13085-000, Brazil
| | - João G R Braga
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n; Cidade Universitaria Zeferino Vaz, Campinas, SP, 13085-000, Brazil
| | - Rodolfo A Marques
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n; Cidade Universitaria Zeferino Vaz, Campinas, SP, 13085-000, Brazil
| | - Felipe D M Chaim
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n; Cidade Universitaria Zeferino Vaz, Campinas, SP, 13085-000, Brazil
| | - Martinho A Gestic
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n; Cidade Universitaria Zeferino Vaz, Campinas, SP, 13085-000, Brazil
| | - Murillo P Utrini
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n; Cidade Universitaria Zeferino Vaz, Campinas, SP, 13085-000, Brazil
| | - Almino C Ramos
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n; Cidade Universitaria Zeferino Vaz, Campinas, SP, 13085-000, Brazil
| | - Elinton A Chaim
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n; Cidade Universitaria Zeferino Vaz, Campinas, SP, 13085-000, Brazil
| | - Everton Cazzo
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n; Cidade Universitaria Zeferino Vaz, Campinas, SP, 13085-000, Brazil.
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15
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Sousa-Filho PHF, Jimenez LS, Callejas GH, Concon MM, Braga JGR, Marques RA, Chaim FDM, Gestic MA, Utrini MP, Ramos AC, Chaim EA, Cazzo E. Bilobar Hepatic Histological Variability in Obese Individuals Undergoing Bariatric Surgery: an Analysis of Paired Wedge Biopsies. Obes Surg 2020; 30:5125-5128. [PMID: 32949000 DOI: 10.1007/s11695-020-04991-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 01/29/2023]
Affiliation(s)
- Pedro H F Sousa-Filho
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n; Cidade Universitaria Zeferino Vaz, Campinas, SP, CEP 13085-000, Brazil
| | - Laísa S Jimenez
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n; Cidade Universitaria Zeferino Vaz, Campinas, SP, CEP 13085-000, Brazil
| | - Guilherme H Callejas
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n; Cidade Universitaria Zeferino Vaz, Campinas, SP, CEP 13085-000, Brazil
| | - Matheus M Concon
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n; Cidade Universitaria Zeferino Vaz, Campinas, SP, CEP 13085-000, Brazil
| | - João G R Braga
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n; Cidade Universitaria Zeferino Vaz, Campinas, SP, CEP 13085-000, Brazil
| | - Rodolfo A Marques
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n; Cidade Universitaria Zeferino Vaz, Campinas, SP, CEP 13085-000, Brazil
| | - Felipe D M Chaim
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n; Cidade Universitaria Zeferino Vaz, Campinas, SP, CEP 13085-000, Brazil
| | - Martinho A Gestic
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n; Cidade Universitaria Zeferino Vaz, Campinas, SP, CEP 13085-000, Brazil
| | - Murillo P Utrini
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n; Cidade Universitaria Zeferino Vaz, Campinas, SP, CEP 13085-000, Brazil
| | - Almino C Ramos
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n; Cidade Universitaria Zeferino Vaz, Campinas, SP, CEP 13085-000, Brazil
| | - Elinton A Chaim
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n; Cidade Universitaria Zeferino Vaz, Campinas, SP, CEP 13085-000, Brazil
| | - Everton Cazzo
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n; Cidade Universitaria Zeferino Vaz, Campinas, SP, CEP 13085-000, Brazil.
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16
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Ge Q, Feng F, Liu L, Chen L, Lv P, Ma S, Chen K, Yao Q. RNA-Seq analysis of the pathogenesis of STZ-induced male diabetic mouse liver. J Diabetes Complications 2020; 34:107444. [PMID: 31757765 DOI: 10.1016/j.jdiacomp.2019.107444] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/31/2019] [Accepted: 09/05/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Diabetes mellitus (DM) is a chronic disease characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The liver is a key organ involved in glucose metabolism, and the major target proteins' changes in the pathogenesis are still unknown. METHODS A diabetic mouse model was induced by intraperitoneal injection of streptozotocin (STZ) solution and the RNA-Seq analysis was used to evaluate the transcription differences in the livers of diabetic mice of this study. And then, the differentially expressed genes were validated between a normal mouse group (n = 6) and a diabetic mouse group (n = 6) using quantitative real-time PCR (qRT-PCR) and Western blotting analysis. In addition, we also constructed protein-protein interacting (PPI) networks of up-regulated and down-regulated genes. RESULTS Transcriptome sequencing analysis revealed 370 up-regulated differentially expressed genes and 281 down-regulated differentially expressed genes in the diabetes model. The gene ontology (GO) analysis and the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis results showed that the differentially expressed genes were mainly involved in immunity, enzyme activity, metabolism, and steroid synthesis. PPI analysis results indicated that the main 15 core differential proteins (Cyp51a1, Acsl4, Ugt1a1, Stat1, Gsta2, Cbr1, Aldh1a1, Fasn, Ces1, Camk2b, Tap1, Egr1, Sqle, Lpin1, Fabp5) were involved in the pathogenesis of diabetes. The qRT-PCR results showed that expression changes of four genes (Acsl4, Stat1, Gsta2, Fabp5) were in different directions from those of RNA-Seq. Western blotting results indicated that Sqle expression change at the protein level was in opposition direction from qRT-PCR, and we speculated that Sqle may be involved in the post-transcriptional modification process. CONCLUSIONS Our data speculated that the pathogenesis of diabetes may be mediated mainly through steroid biosynthesis, metabolic processes, and immune responses. Further researches on these pathways may provide new targets for the prevention and treatment of diabetes.
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Affiliation(s)
- Qi Ge
- School of the Environment and Safety Engineering, Jiangsu University, Zhenjiang, Jiangsu 212013, PR China; Institute of Life Sciences, Jiangsu University, Zhenjiang, Jiangsu 212013, PR China
| | - Fan Feng
- The Fourth Affiliated Hospital of Jiangsu University, 20# Zhengdong Road, Zhenjiang, Jiangsu 212001, PR China
| | - Lanlan Liu
- Institute of Life Sciences, Jiangsu University, Zhenjiang, Jiangsu 212013, PR China
| | - Liang Chen
- Institute of Life Sciences, Jiangsu University, Zhenjiang, Jiangsu 212013, PR China
| | - Peng Lv
- Institute of Life Sciences, Jiangsu University, Zhenjiang, Jiangsu 212013, PR China
| | - Shangshang Ma
- Institute of Life Sciences, Jiangsu University, Zhenjiang, Jiangsu 212013, PR China
| | - Keping Chen
- Institute of Life Sciences, Jiangsu University, Zhenjiang, Jiangsu 212013, PR China.
| | - Qin Yao
- School of the Environment and Safety Engineering, Jiangsu University, Zhenjiang, Jiangsu 212013, PR China; Institute of Life Sciences, Jiangsu University, Zhenjiang, Jiangsu 212013, PR China.
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17
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Zheng S, Tong M, Dong L, Du C, Zheng X, Wang L, Huang P, Liu W, Lin M, Liu C. Lipid accumulation product independently correlate with hepatic steatosis quantified by controlled attenuation parameter in women with polycystic ovary syndrome. Endocr Connect 2020; 9:154-162. [PMID: 31910158 PMCID: PMC6993272 DOI: 10.1530/ec-19-0559] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 01/07/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To explore the independent associations of the new adiposity indices lipid accumulation product (LAP) index, visceral adiposity index (VAI), and product of triglycerides and glucose (TyG) with the risks of hepatic steatosis (HS) in women with polycystic ovary syndrome (PCOS). DESIGN This is a cross-sectional study with 101 women with PCOS undergoing controlled attenuation parameter (CAP) measurement who were recruited from November 2018 to August 2019. Multivariable logistic regression analysis was performed to determine the associations of adiposity indices with HS. RESULT(S) Among the 101 PCOS patients, the prevalence rate of HS was 70.3%. The PCOS patients with HS have higher percentage of overweight/obesity status, higher level of aminotransferase (AST and ALT), homeostasis model assessment of insulin resistance (HOMA-IR), LAP, VAI, TyG, waist circumference (WC), and BMI (P < 0.05). Partial correlation analysis showed LAP, WC and BMI were significantly positively associated with CAP (P < 0.05) after controlling for confounding factors. Besides, BMI, WC, and CAP were gradually elevated with the increase of LAP level. Further, multivariable logistic regression analysis showed adjusted odd ratio (OR) with associated 95% CI (OR (95% CI)) were respectively 1.09 (1.03-1.16) for LAP, 1.14 (1.05-1.23) for WC, 1.28 (1.08-1.51) for BMI, respectively. CONCLUSIONS The present study demonstrates that in women with PCOS, except for the traditional adiposity indices (WC and BMI), LAP is independently correlated with the risk of HS.
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Affiliation(s)
- Silan Zheng
- School of Medicine, Xiamen University, Xiamen, China
| | - Meifeng Tong
- Department of Endocrinology and Diabetes, The First Affiliated Hospital, Xiamen University, Xiamen, China
| | - Lianqin Dong
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Chunmin Du
- School of Medicine, Xiamen University, Xiamen, China
| | - Xin Zheng
- Department of Endocrinology and Diabetes, The First Affiliated Hospital, Xiamen University, Xiamen, China
| | - Liying Wang
- Department of Endocrinology and Diabetes, The First Affiliated Hospital, Xiamen University, Xiamen, China
| | - Peiying Huang
- Department of Endocrinology and Diabetes, The First Affiliated Hospital, Xiamen University, Xiamen, China
| | - Wei Liu
- Department of Endocrinology and Diabetes, The First Affiliated Hospital, Xiamen University, Xiamen, China
| | - Mingzhu Lin
- Department of Endocrinology and Diabetes, The First Affiliated Hospital, Xiamen University, Xiamen, China
| | - Changqin Liu
- Department of Endocrinology and Diabetes, The First Affiliated Hospital, Xiamen University, Xiamen, China
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
- Correspondence should be addressed to C Liu:
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18
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Prevalence and Predictors of Non-Alcoholic Fatty Liver Disease in Obese and Overweight Children in the Northwest of Iran. HEPATITIS MONTHLY 2019. [DOI: 10.5812/hepatmon.92199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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19
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Aizawa M, Inagaki S, Moriyama M, Asano K, Kakehashi M. Modeling the natural history of fatty liver using lifestyle-related risk factors: Effects of body mass index (BMI) on the life-course of fatty liver. PLoS One 2019; 14:e0223683. [PMID: 31634357 PMCID: PMC6802837 DOI: 10.1371/journal.pone.0223683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 09/25/2019] [Indexed: 12/16/2022] Open
Abstract
Background Incident fatty liver increases the risk of non–alcoholic fatty liver disease (NAFLD), which may lead to end-stage liver diseases, and increase the risk of cardiovascular disease and diabetes. For its prevention, modeling the natural history of fatty liver is useful to demonstrate which lifestyle-related risk factors (e.g. body mass index and cholesterol) play the greatest role in the life-course of fatty liver. Methods Model predictors and their predictive algorithms were determined by prospective regression analyses using 5–year data from approximately 2000 Japanese men aged 20–69 years. The participants underwent health examinations and completed questionnaires on their lifestyle behaviors annually from 2012 to 2016. The life–course of fatty liver was simulated based on this participant data using Monte Carlo simulation methods. Sensitivity analyses were performed. The validity of the model was discussed. Results The body mass index (BMI) and low–density/high–density lipoprotein cholesterol (LDL–C/HDL–C) ratio significantly aided in predicting incident fatty liver. When the natural history of fatty liver was simulated using the data of participants aged 30–39 years, the prevalence increased from 20% to 32% at 40–59 years before decreasing to 24% at 70–79 years. When annual updates of BMI and LDL–C/HDL–C ratio decreased/increased by 1%, the peak prevalence of fatty liver (32%) changed by −8.0/10.7% and −1.6/1.4%, respectively. Conclusions We modeled the natural history of fatty liver for adult Japanese men. The model includes BMI and LDL‒C/HDL‒C ratio, which played a significant role in predicting the presence of fatty liver. Specifically, annual changes in BMI of individuals more strongly affected the life‒course of fatty liver than those in the LDL–C/HDL–C ratio. Sustainable BMI control for individuals may be the most effective option for preventing fatty liver in a population.
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Affiliation(s)
- Mika Aizawa
- Department of Health Informatics, Graduate School of Biomedical & Health Sciences, Hiroshima University, Kasumi, Hiroshima, Japan
- * E-mail:
| | - Seiichi Inagaki
- International University of Health and Welfare, Narita, Chiba, Japan
| | - Michiko Moriyama
- Department of Chronic Care and Family Nursing, Graduate School of Biomedical & Health Sciences, Hiroshima University, Kasumi, Hiroshima, Japan
| | - Kenichiro Asano
- Human Resources Department Health Management Promotion Office, Fujikura Ltd. Kiba, Koto Ward, Tokyo, Japan
| | - Masayuki Kakehashi
- Department of Health Informatics, Graduate School of Biomedical & Health Sciences, Hiroshima University, Kasumi, Hiroshima, Japan
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20
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Yu X, Wang L, Zhang W, Ming J, Jia A, Xu S, Li Q, Ji Q. Fasting triglycerides and glucose index is more suitable for the identification of metabolically unhealthy individuals in the Chinese adult population: A nationwide study. J Diabetes Investig 2019; 10:1050-1058. [PMID: 30417578 PMCID: PMC6626942 DOI: 10.1111/jdi.12975] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/29/2018] [Accepted: 11/04/2018] [Indexed: 01/07/2023] Open
Abstract
AIMS/INTRODUCTION Metabolic unhealth can be defined by the components of metabolic syndrome, which is closely connected to insulin resistance. We aimed to determine a simple index to identify metabolic unhealth in the Chinese adult population. MATERIALS AND METHODS A total of 30,291 individuals were screened from the China National Diabetes and Metabolic Disorders Study carried out from June 2007 to May 2008. Metabolic unhealth was defined using components of metabolic syndrome, except waist circumference. We compared the three surrogate indices of insulin resistance: the product of fasting triglycerides and glucose (TyG), triglycerides divided by high-density lipoprotein cholesterol and the metabolic score for insulin resistance for the evaluation of metabolic status. RESULTS All indices had high sensitivity and specificity for the identification of metabolic unhealth, especially the TyG index with an area under the curve of 0.863 for men and 0.867 for women. Participants were divided into subgroups for further analysis. The TyG index also showed high diagnostic values, especially for younger individuals and men with normal waist circumference. Sex-specific cut-offs for three indices were also used to define metabolic unhealth. The TyG index showed the highest agreement with κ values of 0.603 and 0.605 for men and women between the components of metabolic syndrome and three indices. CONCLUSIONS We propose that the TyG index, just read in one blood laboratory test report, is simpler and more suitable for the identification of metabolically unhealthy individuals as well as who have high risk of cardiometabolic diseases of the Chinese adult population.
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Affiliation(s)
- Xinwen Yu
- Department of EndocrinologyXijing HospitalThe Fourth Military Medical UniversityXi'anChina
| | - Li Wang
- Department of EndocrinologyXijing HospitalThe Fourth Military Medical UniversityXi'anChina
| | - Wencheng Zhang
- Department of EndocrinologyXijing HospitalThe Fourth Military Medical UniversityXi'anChina
| | - Jie Ming
- Department of EndocrinologyXijing HospitalThe Fourth Military Medical UniversityXi'anChina
| | - Aihua Jia
- Department of EndocrinologyXijing HospitalThe Fourth Military Medical UniversityXi'anChina
- Department of EndocrinologyThe First Hospital of YulinYulinChina
| | - Shaoyong Xu
- Department of EndocrinologyXiangyang Central Hospital of Hubei University of Arts and ScienceXiangyangChina
- Department of Health StatisticsFaculty of Preventive MedicineThe Fourth Military Medical UniversityXi'anChina
| | - Qiaoyue Li
- Department of EndocrinologyXijing HospitalThe Fourth Military Medical UniversityXi'anChina
| | - Qiuhe Ji
- Department of EndocrinologyXijing HospitalThe Fourth Military Medical UniversityXi'anChina
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21
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Mouzaki M, Trout AT. Virtual Reality: New Insights Regarding the Prevalence of Nonalcoholic Fatty Liver Disease in Children and Adolescents with Obesity Using Magnetic Resonance Imaging. J Pediatr 2019; 207:8-10. [PMID: 30922506 DOI: 10.1016/j.jpeds.2018.12.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 12/06/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Marialena Mouzaki
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
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22
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Tanaka K, Takahashi H, Hyogo H, Ono M, Oza N, Kitajima Y, Kawanaka M, Chayama K, Saibara T, Anzai K, Eguchi Y. Epidemiological survey of hemoglobin A1c and liver fibrosis in a general population with non-alcoholic fatty liver disease. Hepatol Res 2019; 49:296-303. [PMID: 30367534 DOI: 10.1111/hepr.13282] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/10/2018] [Accepted: 10/22/2018] [Indexed: 12/16/2022]
Abstract
AIM The association between glycemia and liver fibrosis was analyzed using hemoglobin A1c (HbA1c) and the Fibrosis-4 (FIB-4) index in a large general population cohort that underwent a health checkup. METHODS A total of 6927 subjects without hepatitis B or C virus infection or habitual alcohol intake were enrolled. Non-alcoholic fatty liver disease (NAFLD) was diagnosed by ultrasonography and potential liver fibrosis (FIB-4 index ≥1.3) in NAFLD was analyzed in relation to HbA1c level. Factors associated with potential liver fibrosis of NAFLD were also analyzed. RESULTS The overall frequency of NAFLD was 27.9% (1935 subjects) and the frequency of NAFLD by HbA1c level (<4.9%, 5.0-5.9%, 6.0-6.9%, 7.0-7.9%, ≥8.0%) was 16%, 27%, 54%, 53%, and 54%, respectively. Among the 1935 NAFLD cases, the frequency of potential liver fibrosis was 25.2% (487 subjects) overall and 19%, 22%, 30%, 52%, and 31%, respectively, by HbA1c category. From multivariate analysis, an HbA1c level ≥6.5% was significantly associated with potential liver fibrosis (P = 0.017, hazard ratio = 1.7). CONCLUSIONS The prevalence of NAFLD and liver fibrosis of NAFLD increased according to glycemia, up to 8.0% HbA1c. Measuring HbA1c and calculating the FIB-4 index in health checkups could help to identify potential cases of liver fibrosis of NAFLD, which should then be further evaluated using other techniques to confirm liver fibrosis.
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Affiliation(s)
- Kenichi Tanaka
- Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga, Japan.,Clinical Gastroenterology, Eguchi Hospital, Saga, Japan
| | - Hirokazu Takahashi
- Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga, Japan.,Clinical Gastroenterology, Eguchi Hospital, Saga, Japan
| | - Hideyuki Hyogo
- Department of Gastroenterology and Hepatology, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Masafumi Ono
- Department of Gastroenterology and Hepatology, Kochi Medical School, Kochi, Japan
| | - Noriko Oza
- Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga, Japan.,Department of Hepatobiliary and Pancreatology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Yoichiro Kitajima
- Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga, Japan.,Clinical Gastroenterology, Eguchi Hospital, Saga, Japan
| | - Miwa Kawanaka
- Department of General Internal Medicine 2, General Medical Center, Kawasaki Medical School, Okayama, Japan
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Toshiji Saibara
- Department of Gastroenterology and Hepatology, Kochi Medical School, Kochi, Japan
| | - Keizo Anzai
- Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga, Japan
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23
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Bettini S, Bordigato E, Milan G, Dal Pra' C, Favaretto F, Belligoli A, Sanna M, Serra R, Foletto M, Prevedello L, Busetto L, Fassina G, Vettor R, Fabris R. SCCA-IgM as a Potential Biomarker of Non-Alcoholic Fatty Liver Disease in Patients with Obesity, Prediabetes and Diabetes Undergoing Sleeve Gastrectomy. Obes Facts 2019; 12:291-306. [PMID: 31104052 PMCID: PMC6696770 DOI: 10.1159/000499717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 03/16/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) has a high prevalence in obesity and its presence should be screened. Laparoscopic sleeve gastrectomy (LSG) is an effective treatment for obesity, but its effects on NAFLD are still to be firmly established. The diagnosis of non-alcoholic steatohepatitis (NASH) is currently performed by liver biopsy, a costly and invasive procedure. Squamous cell carcinoma antigen-IgM (SCCA-IgM) is a biomarker of viral hepatitis to hepatocellular carcinoma development and its role in NAFLD to NASH progression has not yet been investigated. OBJECTIVE The aim of this study was to evaluate SCCA-IgM as a non-invasive biomarker of NAFLD/NASH in patients with different degrees of metabolic-complicated obesity before and after LSG. METHOD Fifty-six patients with obesity were studied before and 12 months after LSG; anthropometric, biochemical, clinical, and imaging data were collected. RESULTS At baseline steatosis was strongly associated with the glycaemic profile (p = 0.016) and was already present in prediabetic patients with obesity (82%). Only 3 patients had an SCCA-IgM level above the normal cut-off. SCCA-IgM titre did not change according to glycaemic profile or steatosis. Metabolic and inflammatory factors and transaminases significantly reduced after LSG-induced weight loss, except for SCCA-IgM. The ALT/AST ratio decreased post-LSG correlated with BMI (r = 0.297, p = 0.031), insulin (r = 0.354, p = 0.014), and triglycerides (r = 0.355, p = 0.009) reduction. CONCLUSIONS Our results confirm the tight link between NAFLD and metabolic complications, suggesting prediabetes as a new risk factor of steatosis. SCCA-IgM does not seem to have a role in the identification and prognosis of NAFLD.
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MESH Headings
- Adult
- Antigens, Neoplasm/blood
- Antigens, Neoplasm/immunology
- Biomarkers/blood
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/surgery
- Female
- Follow-Up Studies
- Gastrectomy/methods
- Gastrectomy/rehabilitation
- Humans
- Immunoglobulin M/blood
- Male
- Middle Aged
- Non-alcoholic Fatty Liver Disease/blood
- Non-alcoholic Fatty Liver Disease/complications
- Non-alcoholic Fatty Liver Disease/diagnosis
- Non-alcoholic Fatty Liver Disease/surgery
- Obesity/blood
- Obesity/complications
- Obesity/diagnosis
- Obesity/surgery
- Obesity, Morbid/blood
- Obesity, Morbid/complications
- Obesity, Morbid/diagnosis
- Obesity, Morbid/surgery
- Prediabetic State/blood
- Prediabetic State/complications
- Prediabetic State/diagnosis
- Prediabetic State/surgery
- Prognosis
- Risk Factors
- Serpins/blood
- Serpins/immunology
- Treatment Outcome
- Weight Loss
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Affiliation(s)
- Silvia Bettini
- Center for the Study and Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy,
- Internal Medicine 3, Department of Medicine, University Hospital of Padua, Padua, Italy,
| | - Emanuel Bordigato
- Center for the Study and Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
- Internal Medicine 3, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Gabriella Milan
- Center for the Study and Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
- Internal Medicine 3, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Chiara Dal Pra'
- Center for the Study and Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
- Internal Medicine 3, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Francesca Favaretto
- Center for the Study and Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
- Internal Medicine 3, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Anna Belligoli
- Center for the Study and Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
- Internal Medicine 3, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Marta Sanna
- Center for the Study and Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
- Internal Medicine 3, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Roberto Serra
- Center for the Study and Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
- Internal Medicine 3, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Mirto Foletto
- Center for the Study and Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
- Internal Medicine 3, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Luca Prevedello
- Center for the Study and Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
- Internal Medicine 3, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Luca Busetto
- Center for the Study and Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
- Internal Medicine 3, Department of Medicine, University Hospital of Padua, Padua, Italy
| | | | - Roberto Vettor
- Center for the Study and Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
- Internal Medicine 3, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Roberto Fabris
- Center for the Study and Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
- Internal Medicine 3, Department of Medicine, University Hospital of Padua, Padua, Italy
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