1
|
Yadav M, Verma S, Tiwari P, Mugale MN. Unraveling the mechanisms of hepatogenous diabetes and its therapeutic perspectives. Life Sci 2024; 353:122934. [PMID: 39089644 DOI: 10.1016/j.lfs.2024.122934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/26/2024] [Accepted: 07/25/2024] [Indexed: 08/04/2024]
Abstract
The review focused mainly on the pathogenesis of hepatogenous diabetes (HD) in liver cirrhosis (LC). This review reveals parallels between the mechanisms of metabolic dysfunction observed in LC and type II diabetes (T2DM), suggesting a shared pathway leading to HD. It underscores the role of insulin in HD pathogenesis, highlighting key factors such as insulin signaling, glucose metabolism, insulin resistance (IR), and the influence of adipocytes. Furthermore, the impact of adipose tissue accumulation, fatty acid metabolism, and pro-inflammatory cytokines like Tumor necrosis factor-α (TNF-α) on IR are discussed in the context of HD. Altered signaling pathways, disruptions in the endocrine system, liver inflammation, changes in muscle mass and composition, and modifications to the gut microbiota collectively contribute to the complex interplay linking cirrhosis and HD. This study highlights how important it is to identify and treat this complex condition in cirrhotic patients by thoroughly analyzing the link between cirrhosis, IR, and HD. It also emphasizes the vitality of targeted interventions. Cellular and molecular investigations into IR have revealed potential therapeutic targets for managing and preventing HD.
Collapse
Affiliation(s)
- Manisha Yadav
- Division of Toxicology and Experimental Medicine, CSIR-Central Drug Research Institute (CSIR-CDRI), Lucknow 226031, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Smriti Verma
- Division of Toxicology and Experimental Medicine, CSIR-Central Drug Research Institute (CSIR-CDRI), Lucknow 226031, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Purnima Tiwari
- Division of Toxicology and Experimental Medicine, CSIR-Central Drug Research Institute (CSIR-CDRI), Lucknow 226031, India
| | - Madhav Nilakanth Mugale
- Division of Toxicology and Experimental Medicine, CSIR-Central Drug Research Institute (CSIR-CDRI), Lucknow 226031, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India.
| |
Collapse
|
2
|
Wei T, Jin Q. Research trends and hotspots in exercise interventions for liver cirrhosis: A bibliometric analysis via CiteSpace. Medicine (Baltimore) 2024; 103:e38831. [PMID: 38996156 PMCID: PMC11245219 DOI: 10.1097/md.0000000000038831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 06/14/2024] [Indexed: 07/14/2024] Open
Abstract
Cirrhosis is a chronic liver disease with severe consequences for a patient's health and survival. Exercise is an essential therapeutic strategy for both cirrhosis prevention and treatment. On the other hand, information regarding the present status of exercise-related research in cirrhosis is limited. Therefore, this study seeks to close the information gap in the scientific literature by using bibliometric techniques to analyze the trends, focal points, and cutting-edge research areas on exercise and cirrhosis. On September 22, 2023, research articles and reviews on exercise intervention for cirrhosis were obtained and downloaded from the Web of Science Core Collection (WoSCC). Subsequently, we employed CiteSpace (version 6.1.R6) to conduct bibliometric and knowledge graph analyses. 588 papers in 301 scholarly journals were written by 673 authors from 460 institutions spread over 63 countries and regions. The most productive nation among them is the United States. Not only is Zobair M. Younossi 1 of the most prolific writers, but he also receives the most co-citations. Most articles were published by the University of Michigan in the US, with the University of Alberta in Canada coming in second. Meanwhile, the WORLD JOURNAL OF GASTROENTEROLOGY has the most published articles, whereas HEPATOLOGY has the greatest number of co-citations. Apart from the theme words, the most frequently utilized keywords were "quality of life," "insulin resistance," and "mortality." Future research may concentrate on "obesity," "sarcopenia," and "Mediterranean diet," according to the analysis of keyword emergence. CiteSpace is used in this work to visually represent the topic of exercise intervention in cirrhosis, offering valuable information to researchers regarding the field's current status and possible future direction.
Collapse
Affiliation(s)
- Tao Wei
- Department of Physical Education, Yangzhou University, Yangzhou, Jiangsu, China
| | - Qiguan Jin
- Department of Physical Education, Yangzhou University, Yangzhou, Jiangsu, China
| |
Collapse
|
3
|
Trinh B, Rasmussen Rinnov A, Winning Iepsen U, Winding Munch G, Munch Winding K, Lauridsen C, Gluud LL, van Hall G, Ellingsgaard H. Glucose turnover at whole-body and skeletal muscle level in response to parenteral nutrition in male patients with alcoholic liver cirrhosis. Clin Nutr ESPEN 2024; 60:240-246. [PMID: 38479917 DOI: 10.1016/j.clnesp.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/21/2024] [Accepted: 02/09/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND & AIMS Cirrhosis is associated with insulin resistance and impaired glucose tolerance, which may be caused by impairments at different tissue levels (liver, skeletal muscle, and/or beta cell). METHODS Here, glucose kinetics at whole-body and skeletal muscle level in patients with cirrhosis (Child-Pugh A and B) were studied during parenteral nutrition using the isotope dilution technique and arteriovenous balance approach across the leg. As opposed to the euglycemic hyperinsulinemic clamp or glucose tolerance tests applied in previous studies, this approach provides a nutrient composition more similar to a normal meal while circumventing any possible portal-systemic shunting, impaired hepatic uptake and incretin effect. RESULTS We confirmed the presence of hepatic and peripheral insulin resistance in our patient population. Endogenous glucose production was less suppressed in response to parenteral nutrition. However, glucose uptake in skeletal muscle was increased. CONCLUSION Our results suggests that in our study participants with cirrhosis, the hepatic and peripheral insulin resistance is compensated for by increased insulin secretion and thus, increased glucose uptake in muscle. Hereby, glucose homeostasis is maintained.
Collapse
Affiliation(s)
- Beckey Trinh
- The Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Denmark.
| | - Anders Rasmussen Rinnov
- The Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Denmark
| | - Ulrik Winning Iepsen
- The Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Denmark; Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital - Hvidovre Hospital, Copenhagen, Denmark
| | - Gregers Winding Munch
- The Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Denmark
| | - Kamilla Munch Winding
- The Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Denmark
| | - Carsten Lauridsen
- Department of Diagnostic Radiology, Copenhagen University Hospital - Rigshospitalet, Denmark; Department of Technology, Copenhagen University College, Denmark
| | - Lise Lotte Gluud
- Gastrounit, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Gerrit van Hall
- Clinical Metabolomics Core Facility, Clinical Biochemistry, Copenhagen University Hospital, Department of Biomedical Sciences, Health & Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Helga Ellingsgaard
- The Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Denmark
| |
Collapse
|
4
|
Liu Y, Hu H, Li C, Zhang Y, Li M, Lu T, Wu Y, Yang Y, Li Y, Yang F, Shi X, Lin S. Impacts of the development of acute-on-chronic liver failure and bacterial infections on β-cell function and glucose homeostasis in patients with liver cirrhosis. Dig Liver Dis 2024; 56:648-655. [PMID: 37758609 DOI: 10.1016/j.dld.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 09/04/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND The pathogenesis involved in glucose metabolism disorders (GMDs) in patients with liver cirrhosis remains unclear. AIMS We investigated the effects of acute-on-chronic liver failure (ACLF) development and bacterial infections (BIs) on pancreatic β-cell function and glucose homeostasis in individuals with liver cirrhosis. METHODS A retrospective analysis was conducted on 327 patients experiencing acute deterioration of liver cirrhosis. Oral glucose tolerance tests (OGTTs) and OGTT-based β-cell function indices were employed to assess β-cell function and glucose homeostasis. Univariate and multivariate logistic regression analyses were employed to identify GMD-associated risk factors. RESULTS Both the development of ACLF and BIs significantly increased the prevalence of GMDs. Both ACLF and BIs markedly elevated the homeostasis model of assessment 2-insulin resistance (HOMA2-IR). ACLF significantly impaired glucose-stimulated insulin secretion, as evidenced by reduced insulinogenic index (IGI). Patients with GMDs exhibited significantly lower IGI levels than those without GMDs. Independent risk factors associated with GMDs were prothrombin activity (odds ratio [OR]=0.981, 95% confidence interval [CI]: 0.960-0.995), HOMA2-IR (OR=1.749, 95% CI: 1.130-2.707), and IGI (OR=0.963, 95% CI: 0.947-0.978). CONCLUSIONS In liver cirrhosis, the onset of ACLF impairs glucose-stimulated insulin secretion from β-cells. Both liver impairment and BIs contribute to increased insulin resistance, ultimately disturbing glucose homeostasis.
Collapse
Affiliation(s)
- Yujuan Liu
- Suzhou Medical College of Soochow University, Suzhou 215325, China; Department of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, Guizhou, 563003, China
| | - Han Hu
- Department of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, Guizhou, 563003, China
| | - Chuan Li
- Department of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, Guizhou, 563003, China
| | - Yin Zhang
- Department of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, Guizhou, 563003, China
| | - Meichuan Li
- Department of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, Guizhou, 563003, China
| | - Tao Lu
- Department of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, Guizhou, 563003, China
| | - Yunchong Wu
- Department of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, Guizhou, 563003, China
| | - Yanyan Yang
- Department of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, Guizhou, 563003, China
| | - Ying Li
- Department of Infectious Diseases, Second Affiliated Hospital of Zunyi Medical University, Guizhou, 563000, China
| | - Fangwan Yang
- Department of Infectious Diseases, Second Affiliated Hospital of Zunyi Medical University, Guizhou, 563000, China
| | - Xiuquan Shi
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Guizhou, 563006, China
| | - Shide Lin
- Suzhou Medical College of Soochow University, Suzhou 215325, China; Department of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, Guizhou, 563003, China; College of Laboratory Medicine, Zunyi Medical University, Guizhou, 563003, China.
| |
Collapse
|
5
|
Peschel G, Grimm J, Müller M, Höring M, Krautbauer S, Weigand K, Liebisch G, Buechler C. Sex-specific changes in triglyceride profiles in liver cirrhosis and hepatitis C virus infection. Lipids Health Dis 2022; 21:106. [PMID: 36280840 PMCID: PMC9590217 DOI: 10.1186/s12944-022-01715-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/11/2022] [Indexed: 12/05/2022] Open
Abstract
Background Hepatitis C virus (HCV) infection is associated with serum lipid abnormalities, which partly normalize following direct-acting antiviral (DAA) therapy. Here, associations of serum triglycerides (TGs) with viral genotype and markers of liver disease severity were evaluated in patients with chronic HCV. Methods The study included the serum of 177 patients with chronic HCV. TGs were quantified by flow injection analysis Fourier transform mass spectrometry. Laboratory values and noninvasive scores for liver fibrosis assessment were determined. The nonparametric Kruskal‒Wallis test, one-way ANOVA, multiple linear regression and Student’s t test were used as appropriate. P values were adjusted for multiple comparisons. Results HCV-infected women had lower serum TGs than men, and thus, a sex-specific analysis was performed. None of the 46 TG species analyzed differed in the serum of female patients with and without liver cirrhosis. In contrast, in the serum of male patients with liver cirrhosis, TGs with 53, 56 and 58 carbon atoms and three to eight double bonds were diminished. These polyunsaturated TGs were also low in males with a high fibrosis-4 score. TGs with 7 or 8 double bonds negatively correlated with the model of end-stage liver disease score in males. In addition, TGs with 49, 51 and 53 carbon atoms were reduced in male patients infected with genotype 3a in comparison to genotype 1a. TGs with 56 carbon atoms were lower in genotype 3a-infected males than in genotype 1b-infected males. TGs did not differ in females by genotype. Genotype 3-related changes disappeared at the end of therapy with DAAs. Overall, the levels of serum TGs did not change during DAA therapy in either sex. Consequently, the serum TGs of males with liver cirrhosis were lower than those of males without cirrhosis at the end of therapy. Such a difference was not apparent in females. Conclusions The decline in TGs observed only in male patients with liver cirrhosis and male patients infected with genotype 3 illustrates sex-specific changes in lipid metabolism in chronic HCV. Supplementary Information The online version contains supplementary material available at 10.1186/s12944-022-01715-w.
Collapse
Affiliation(s)
- Georg Peschel
- grid.411941.80000 0000 9194 7179Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany ,Department of Internal Medicine, Klinikum Fürstenfeldbruck, 82256 Fürstenfeldbruck, Germany
| | - Jonathan Grimm
- grid.411941.80000 0000 9194 7179Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Martina Müller
- grid.411941.80000 0000 9194 7179Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Marcus Höring
- grid.411941.80000 0000 9194 7179Institute of Clinical Chemistry and Laboratory Medicine, Regensburg University Hospital, 93053 Regensburg, Germany
| | - Sabrina Krautbauer
- grid.411941.80000 0000 9194 7179Institute of Clinical Chemistry and Laboratory Medicine, Regensburg University Hospital, 93053 Regensburg, Germany
| | - Kilian Weigand
- grid.411941.80000 0000 9194 7179Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany ,grid.502406.50000 0004 0559 328XDepartment of Gastroenterology, Gemeinschaftsklinikum Mittelrhein, 56073 Koblenz, Germany
| | - Gerhard Liebisch
- grid.411941.80000 0000 9194 7179Institute of Clinical Chemistry and Laboratory Medicine, Regensburg University Hospital, 93053 Regensburg, Germany
| | - Christa Buechler
- grid.411941.80000 0000 9194 7179Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany
| |
Collapse
|
6
|
Bae JC, Beste LA, Utzschneider KM. The Impact of Insulin Resistance on Hepatic Fibrosis among United States Adults with Non-Alcoholic Fatty Liver Disease: NHANES 2017 to 2018. Endocrinol Metab (Seoul) 2022; 37:455-465. [PMID: 35726152 PMCID: PMC9262684 DOI: 10.3803/enm.2022.1434] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/03/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGRUOUND We aimed to investigate the association of hepatic steatosis with liver fibrosis and to assess the interactive effects of hepatic steatosis and insulin resistance on liver fibrosis in a nationally representative sample of United States adults. METHODS We conducted a cross-sectional analysis using data from National Health and Nutrition Examination Survey 2017 to 2018, which for the first time included transient elastography to assess liver stiffness and hepatic steatosis. We evaluated the association between hepatic steatosis (using controlled attenuation parameter [CAP]) and clinically significant liver fibrosis (defined as liver stiffness ≥7.5 kPa) using logistic regression with an interaction term for hepatic steatosis and insulin resistance (defined as homeostatic model assessment of insulin resistance ≥3.0). RESULTS Among adults undergoing transient elastography (n=2,023), 45.9% had moderate or greater hepatic steatosis and 11.3% had clinically significant liver fibrosis. After adjustment for demographic and metabolic factors, the odds of significant liver fibrosis increased as CAP score rose (odds ratio, 1.35 per standard deviation increment; 95% confidence interval, 1.11 to 1.64). We detected a significant interaction effect between CAP score and insulin resistance on the probability of significant liver fibrosis (P=0.016 for interaction). The probability of significant liver fibrosis increased in the presence of insulin resistance with increasing CAP score, while those without insulin resistance had low probability of significant liver fibrosis, even with high CAP scores. CONCLUSION Individuals with hepatic steatosis had higher odds of fibrosis when insulin resistance was present. Our findings emphasize the importance of the metabolic aspects of the disease on fibrosis risk and suggest a need to better identify patients with metabolic associated fatty liver disease.
Collapse
Affiliation(s)
- Ji Cheol Bae
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Lauren A. Beste
- General Medicine Service, Veterans Affairs Puget Sound Health Care System, University of Washington, Seattle, WA, USA
| | - Kristina M. Utzschneider
- Division of Endocrinology, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, WA, USA
- Corresponding author: Kristina M. Utzschneider Division of Endocrinology, Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA 98108, USA Tel: +1-206-277-3568, Fax: +1-206-764-2689, E-mail:
| |
Collapse
|
7
|
Abstract
Background/Objectives Cirrhosis of liver is associated with loss of liver function, portal hypertension, and pancreatic β-cell dysfunction leading to hepatogenous diabetes (HD). Often HD is an underestimated and understudied problem, particularly in the Indian subcontinent, where the prevalence of both Chronic liver disease (CLD) and diabetes is high. Hence this study was planned to highlight the prevalence of HD and its association with the severity of cirrhosis. Methods A total of 121 cirrhotic patients without a history of diabetes were included in this prospective cross-sectional study. Seventy five g oral glucose tolerance test (OGTT) was done in all patients. Fasting serum insulin levels were done to calculate insulin resistance (IR) using homeostatic model assessment-insulin resistance (HOMA-IR). Upper gastrointestinal endoscopy was done to detect varices. Patients were divided into HD group and non-HD group for comparison of results. Results HD was seen in 52 (42.98%) patients; among them, 63.4% did not show evidence of HD by fasting plasma glucose (FPG) levels. Impaired glucose tolerance (IGT) was seen in 58 (47.93%) patients. Compared with the non-HD group, the HD group had significantly higher model for end-stage liver disease (MELD) score (P = 0.038), HOMA-IR (P < 0.001), incidence of large varices (P < 0.001) and variceal bleeding (P < 0.001). A statistically significant association was noted between HD and Hepatocellular carcinoma (HCC) (P < 0.001). Conclusion Patients with cirrhosis had a high prevalence of IGT, IR, and HD. The presence of HD is well associated with the severity of cirrhosis in the form of higher MELD score (>15), CTP score (>10), higher bilirubin levels, large varices, bleeding varices, and HCC. FPG levels and glycated hemoglobin (HbA1c) cannot be relied upon, and OGTT aids in the unmasking of HD in these patients.
Collapse
Key Words
- 120-min PG, 120 min plasma glucose
- AASLD, American association for the study of liver diseases
- ADA, American diabetic association
- CLD, chronic liver disease
- CTP score, Child-Turcotte-Pugh score
- DM, diabetes mellitus
- FPG, fasting plasma glucose
- HCC, hepatocellular carcinoma
- HD, hepatogenous diabetes
- HOMA-IR, homeostatic model assessment-insulin resistance
- HVPG, hepatic venous pressure gradient
- HbA1c, glycated hemoglobin
- IGF, insulin-like growth factor
- IGT, impaired glucose tolerance
- IR, insulin resistance
- MELD score, model for end-stage liver disease
- OGTT, oral glucose tolerance test
- SPSS, statistical software for social sciences
- T2DM, type 2 diabetes mellitus
- chronic liver disease
- hepatogenous diabetes
- impaired glucose tolerance
- insulin resistance
- variceal bleeding
Collapse
|
8
|
Lim AKH, Crnobrnja L, Metlapalli M, Jiang C, Wang RSH, Pham JH, Abasszade JH. Observational study of the relative efficacy of insulin-glucose treatment for hyperkalaemia in patients with liver cirrhosis. BMJ Open 2021; 11:e051201. [PMID: 34686554 PMCID: PMC8543643 DOI: 10.1136/bmjopen-2021-051201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 10/06/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To determine if liver cirrhosis is associated with reduced efficacy of insulin-glucose treatment in moderate to severe hyperkalaemia. DESIGN Retrospective, cohort study. SETTING Two secondary and one tertiary care hospital at a large metropolitan healthcare network in Melbourne, Australia. PARTICIPANTS This study included 463 adults with a mean age of 68.7±15.8 years, comprising 79 patients with cirrhosis and 384 without cirrhosis as controls, who received standard insulin-glucose treatment for a serum potassium ≥6.0 mmol/L from October 2016 to March 2020. Patients were excluded if they received an insulin infusion, or if there was inadequate follow-up data for at least 6 hours after IDT due to death, lost to follow-up or inadequate biochemistry monitoring. The mean Model for End-stage Liver Disease score in patients with cirrhosis was 22.2±7.5, and the distribution of the Child-Pugh score for cirrhosis was: class A (24%), class B (46%), class C (30%). OUTCOME MEASURES The primary outcome was the degree of potassium lowering and the secondary outcome was the proportion of patients who achieved normokalaemia, within 6 hours of treatment. RESULTS The mean pretreatment potassium for the cohort was 6.57±0.52 mmol/L. After insulin-glucose treatment, mean potassium lowering was 0.84±0.58 mmol/L in patients with cirrhosis compared with 1.33±0.75 mmol/L for controls (p<0.001). The proportion of patients achieving normokalaemia was 33% for patients with cirrhosis, compared with 53% for controls (p=0.001). By multivariable regression, on average, liver cirrhosis was associated with a reduced potassium lowering effect of 0.42 mmol/L (95% CI 0.22 to 0.63 mmol/L, p<0.001) from insulin-glucose treatment, after adjusting for age, serum creatinine, cancer, pretreatment potassium level, β-blocker use and cotreatments (sodium polystyrene sulfonate, salbutamol, sodium bicarbonate). CONCLUSIONS Our observational data suggest reduced efficacy of insulin-glucose treatment for hyperkalaemia in patients with cirrhosis.
Collapse
Affiliation(s)
- Andy K H Lim
- Department of Medicine, Monash University School of Clinical Sciences at Monash Health, Clayton, Victoria, Australia
- General Medicine, Monash Health, Clayton, Victoria, Australia
| | | | | | - Cathy Jiang
- General Medicine, Monash Health, Clayton, Victoria, Australia
| | - Rene S H Wang
- General Medicine, Monash Health, Clayton, Victoria, Australia
| | - Jeanette H Pham
- General Medicine, Monash Health, Clayton, Victoria, Australia
| | | |
Collapse
|
9
|
Vargas-Mendoza N, García-Machorro J, Angeles-Valencia M, Martínez-Archundia M, Madrigal-Santillán EO, Morales-González Á, Anguiano-Robledo L, Morales-González JA. Liver disorders in COVID-19, nutritional approaches and the use of phytochemicals. World J Gastroenterol 2021; 27:5630-5665. [PMID: 34629792 PMCID: PMC8473593 DOI: 10.3748/wjg.v27.i34.5630] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/19/2021] [Accepted: 07/19/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), has affected millions of people globally. It was declared a pandemic by the World Health Organization in March 2020. The hyperinflammatory response to the entry of SARS-CoV-2 into the host through angiotensin-converting enzyme 2 is the result of a "cytokine storm" and the high oxidative stress responsible for the associated symptomatology. Not only respiratory symptoms are reported, but gastrointestinal symptoms (diarrhea, vomiting, and nausea) and liver abnormalities (high levels of aspartate aminotransferase, alanine aminotransferase transaminases, and bilirubin) are observed in at least 30% of patients. Reduced food intake and a delay in medical services may lead to malnutrition, which increases mortality and poor outcomes. This review provides some strategies to identify malnutrition and establishes nutritional approaches for the management of COVID-19 and liver injury, taking energy and nutrient requirements and their impact on the immune response into account. The roles of certain phytochemicals in the prevention of the disease or as promising target drugs in the treatment of this disease are also considered.
Collapse
Affiliation(s)
- Nancy Vargas-Mendoza
- Laboratorio de Medicina de Conservacion, Instituto Politécnico Nacional, México 11340, Mexico
| | - Jazmín García-Machorro
- Laboratorio de Medicina de Conservacion, Instituto Politécnico Nacional, México 11340, Mexico
| | | | - Marlet Martínez-Archundia
- Laboratorio de Diseño y Desarrollo de Nuevos Fármacos e Innovación Biotécnológica, Instituto Politécnico Nacional, México 11340, Mexico
| | | | | | | | - José A Morales-González
- Laboratorio Medicina de Conservación, Escuela Superior de Medicina, Instituto Politécnico Nacional, México 11340, Mexico
| |
Collapse
|
10
|
Rodríguez-Escaja C, Á Navascués C, González-Diéguez L, Cadahía V, Varela M, de Jorge MÁ, Castaño-García A, Rodríguez M. Diabetes is not associated with an increased risk of hepatocellular carcinoma in patients with alcoholic or hepatitis C virus cirrhosis. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 113:505-511. [PMID: 33244982 DOI: 10.17235/reed.2020.6953/2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS diabetes has been reported as a risk factor for hepatocellular carcinoma (HCC) in population-based studies but there are controversial data in patients with cirrhosis. Metformin could have a protective role in HCC development. The aim of this study was to determine the influence of diabetes on the risk of developing HCC in patients with alcohol- and hepatitis C virus (HCV)-related cirrhosis. METHODS a cohort of 982 Caucasian patients were analyzed with alcoholic or HCV cirrhosis, included from 1992 to 2014 in a HCC surveillance program and prospectively followed. The influence of diabetes on the development of HCC was analyzed by Kaplan Meier analysis and adjusted with a Cox regression for relevant co-factors. RESULTS after a median follow-up of 49.5 (24.0-96.0) months, 156 patients (15.8 %) developed HCC. There were no differences in the cumulative incidences of HCC after 20 years between diabetic and non-diabetic patients in the global (53.5 % vs 45.4 %; p = 0.26), alcoholic (50.4 % vs 45.4 %; p = 0.21) or HCV (60 % vs 43.1 %; p = 0.57) cirrhosis series. Diabetes did not constitute a risk factor after adjusting for other potential co-factors, neither in the whole series (hazard ratio [HR]: 1.12, 95 % CI: 0.78-1.51; p = 0.26), alcoholic (HR: 1.160, 95 % CI: 0.74-1.82; p = 0.50) or HCV cirrhosis cohort (HR: 1.17, 95 % CI: 0.63-2.19; p = 0.60). These figures did not change after excluding patients treated with metformin. CONCLUSIONS in Caucasian patients with alcoholic or HCV cirrhosis, diabetes is not a risk factor for developing HCC. This lack of an association does not seem to be a consequence of the protective effect of metformin.
Collapse
Affiliation(s)
- Carlos Rodríguez-Escaja
- Liver Unit. Division of Gastroenterology and Hepat, Hospital Universitario Central de Asturias, España
| | - Carmen Á Navascués
- Liver Unit. Division of Gastroenterology and Hepat, Hospital Universitario Central de Asturias, España
| | - Luisa González-Diéguez
- Liver Unit. Division of Gastroenterology and Hepat, Hospital Universitario Central de Asturias, España
| | - Valle Cadahía
- Liver Unit. Division of Gastroenterology and Hepat, Hospital Universitario Central de Asturias, España
| | - María Varela
- Liver Unit. Division of Gastroenterology and Hepat, Hospital Universitario Central de Asturias, España
| | - Miguel Ángel de Jorge
- Liver Unit. Division of Gastroenterology and Hepat, Hospital Universitario Central de Asturias, España
| | - Andrés Castaño-García
- Liver Unit. Division of Gastroenterology and Hepat, Hospital Universitario Central de Asturias, España
| | - Manuel Rodríguez
- Liver Unit. Division of Gastroenterology and Hepat, Hospital Universitario Central de Asturias, España
| |
Collapse
|
11
|
Armandi A, Rosso C, Caviglia GP, Bugianesi E. Insulin Resistance across the Spectrum of Nonalcoholic Fatty Liver Disease. Metabolites 2021; 11:155. [PMID: 33800465 PMCID: PMC8000048 DOI: 10.3390/metabo11030155] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/01/2021] [Accepted: 03/01/2021] [Indexed: 02/07/2023] Open
Abstract
Insulin resistance (IR) is defined as a lower-than-expected response to insulin action from target tissues, leading to the development of type 2 diabetes through the impairment of both glucose and lipid metabolism. IR is a common condition in subjects with nonalcoholic fatty liver disease (NAFLD) and is considered one of the main factors involved in the pathogenesis of nonalcoholic steatohepatitis (NASH) and in the progression of liver disease. The liver, the adipose tissue and the skeletal muscle are major contributors for the development and worsening of IR. In this review, we discuss the sites and mechanisms of insulin action and the IR-related impairment along the spectrum of NAFLD, from simple steatosis to progressive NASH and cirrhosis.
Collapse
Affiliation(s)
| | | | | | - Elisabetta Bugianesi
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (A.A.); (C.R.); (G.P.C.)
| |
Collapse
|
12
|
Yip TCF, Wong GLH, Tse YK, Yuen BWY, Luk HWS, Lam MHB, Li MKK, Loo CK, Tsang OTY, Tsang SWC, Chan HLY, Wing YK, Wong VWS. High incidence of hepatocellular carcinoma and cirrhotic complications in patients with psychiatric illness: a territory-wide cohort study. BMC Gastroenterol 2020; 20:128. [PMID: 32349708 PMCID: PMC7189713 DOI: 10.1186/s12876-020-01277-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 04/15/2020] [Indexed: 12/17/2022] Open
Abstract
Background Because of high-risk behaviours, sedentary lifestyle and side effects of medications, psychiatric patients are at risk of viral hepatitis, alcohol-related liver disease and non-alcoholic fatty liver disease. We aimed to study the incidence of hepatocellular carcinoma (HCC) and cirrhotic complications in psychiatric patients. Methods We identified consecutive adult patients in all public hospitals and clinics in Hong Kong with psychiatric diagnoses between year 2003 and 2007 using the Clinical Data Analysis and Reporting System, which represents in-patient and out-patient data of approximately 80% of the 7.4-million local population. The patients were followed for liver-related events (HCC and cirrhotic complications) and deaths until December 2017. Age- and sex-standardized incidence ratio (SIR) of HCC in psychiatric patients to the general population was estimated by Poisson model. Results We included 105,763 psychiatric patients without prior liver-related events in the final analysis. During a median (interquartile range) follow-up of 12.4 (11.0–13.7) years, 1461 (1.4%) patients developed liver-related events; 472 (0.4%) patients developed HCC. Compared with the general population, psychiatric patients had increased incidence of HCC (SIR 1.42, 95% confidence interval [CI] 1.28–1.57, P < 0.001). The SIR was highest in patients with drug-induced (SIR 3.18, 95% CI 2.41–4.11, P < 0.001) and alcohol-induced mental disorders (SIR 2.98, 95% CI 2.30–3.81, P < 0.001), but was also increased in patients with psychotic disorders (SIR 1.39, 95% CI 1.16–1.65, P < 0.001) and mood disorders (SIR 1.16, 95% CI 1.00–1.34, P = 0.047). Liver disease was the fifth most common cause of death in this population, accounting for 595 of 10,614 (5.6%) deaths. Importantly, 569 (38.9%) patients were not known to have liver diseases at the time of liver-related events. The median age at HCC diagnosis (61 [range 26–83] years) was older and the median overall survival (8.0 [95% CI 5.0–10.9] months) after HCC diagnosis was shorter in this cohort of psychiatric patients than other reports from Hong Kong. Conclusions HCC, cirrhotic complications, and liver-related deaths are common in psychiatric patients, but liver diseases are often undiagnosed. More efforts are needed to identify liver diseases in the psychiatric population so that treatments and screening for HCC and varices can be provided to patients in need.
Collapse
Affiliation(s)
- Terry Cheuk-Fung Yip
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, China.,State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Grace Lai-Hung Wong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, China.,State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Yee-Kit Tse
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, China.,State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Becky Wing-Yan Yuen
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, China.,State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Hester Wing-Sum Luk
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Marco Ho-Bun Lam
- Department of Psychiatry, Shatin Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Ching Kong Loo
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong, China
| | - Owen Tak-Yin Tsang
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China
| | | | - Henry Lik-Yuen Chan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, China.,State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Yun-Kwok Wing
- Department of Psychiatry, Shatin Hospital, The Chinese University of Hong Kong, Hong Kong, China.
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, China. .,State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.
| |
Collapse
|
13
|
Košuta I, Mrzljak A, Kolarić B, Vučić Lovrenčić M. Leptin as a Key Player in Insulin Resistance of Liver Cirrhosis? A Cross-Sectional Study in Liver Transplant Candidates. J Clin Med 2020; 9:E560. [PMID: 32092909 PMCID: PMC7073684 DOI: 10.3390/jcm9020560] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/11/2020] [Accepted: 02/17/2020] [Indexed: 02/07/2023] Open
Abstract
Insulin resistance is associated with increased risk of death and liver transplantation in the cirrhotic population, independent of disease aetiology. However, factors accounting for insulin resistance in the context of cirrhosis are incompletely understood. This study aimed to investigate the association between adiponectin and leptin with insulin resistance in cirrhotic patients and to assess the influence of disease severity on insulin resistance and metabolic status. This cross-sectional study included 126 non-diabetic cirrhotic transplant candidates. The homeostasis model assessment 2 model was used to determine the insulin resistance index, and fasting adiponectin, leptin, insulin, c-peptide, glucose, HbA1c, and lipid profiles were analysed. Insulin resistance was detected in 83% of subjects and associated with increased leptin, fasting plasma glucose and body mass index, and lower triglyceride levels. Logistic regression analysis identified leptin and triglycerides as independent predictors of insulin resistance (OR 1.247, 95% CI 1.076-1.447, p = 0.003; OR 0.357, 95% CI 0.137-0.917, p = 0.032.). Leptin levels remained unchanged, whereas adiponectin levels increased (p < 0.001) with disease progression, and inversely correlated with HbA1c (ρ = -0.349, p < 0.001). Our results indicate that leptin resistance, as indicated by elevated leptin levels, can be regarded as a contributing factor to insulin resistance in cirrhotic patients, whereas triglycerides elicited a weak protective effect. Progressively increasing adiponectin levels elicited a positive effect on glucose homeostasis, but not insulin sensitivity across disease stages.
Collapse
Affiliation(s)
- Iva Košuta
- Department of Gastroenterology, Merkur University Hospital, Zajčeva 19, 10000 Zagreb, Croatia;
| | - Anna Mrzljak
- Department of Gastroenterology, Merkur University Hospital, Zajčeva 19, 10000 Zagreb, Croatia;
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
| | - Branko Kolarić
- Department of Epidemiology, Andrija Štampar Teaching Institute of Public Health, Mirogojska cesta 16, 10000 Zagreb, Croatia;
- Faculty of Medicine, University of Rijeka, Ul. Braće Branchetta 20/1, 51000 Rijeka, Croatia
| | - Marijana Vučić Lovrenčić
- Department of Clinical Chemistry and Laboratory Medicine, Merkur University Hospital, Zajčeva 19, 10000 Zagreb, Croatia;
| |
Collapse
|
14
|
Xu C, Chen J, Zhang PA. Relationship Between Diabetes Mellitus and Cirrhosis Risk in Chronic Hepatitis B Patients in Wuhan, China. Med Sci Monit 2019; 25:8112-8119. [PMID: 31661471 PMCID: PMC6839395 DOI: 10.12659/msm.917000] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background The objective of our research was to assess the possible link between diabetes mellitus (DM) and liver cirrhosis in chronic hepatitis B (CHB) patients in Wuhan, China. Material/Methods Individuals with a diagnosis of both liver cirrhosis and chronic HBV infection (n=257), and CHB-only patients (n=514) were matched 1: 2 by age and sex. Demographic, lifestyle, laboratory, and clinical characteristics were reviewed. Univariate and the multiple logistic regression analysis were conducted to investigate the association between DM and HBV-related liver cirrhosis. Results The prevalence of DM was higher among CHB patients with liver cirrhosis than in those without liver cirrhosis (22.2% vs. 12.8%, P=0.001), yielding an adjusted odds ratio (AOR) of 2.317 and a 95% confidence interval (CI) of 1.528–3.513. Among them, 87.7% of liver cirrhosis patients were diagnosed with DM before liver cirrhosis diagnosis, yielding an AOR (95% CI) of 2.386 (1.533–3.714). In comparison to patients with a DM duration of 2–5 years, the AOR (95% CI) for those with a DM duration >5 years was 2.073 (0.701–6.132). In DM treatment, the AOR (95% CI) for those treated with insulin was 4.746 (1.329–16.949). Conclusions DM was associated with cirrhosis risk in CHB patients in Wuhan, China.
Collapse
Affiliation(s)
- Chu Xu
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, Hubei, China (mainland)
| | - Juanjuan Chen
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, Hubei, China (mainland)
| | - Ping-An Zhang
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, Hubei, China (mainland)
| |
Collapse
|
15
|
Wen F, Zhuge W, Wang J, Lu X, You R, Liu L, Zhuge Q, Ding S. Oridonin prevents insulin resistance-mediated cognitive disorder through PTEN/Akt pathway and autophagy in minimal hepatic encephalopathy. J Cell Mol Med 2019; 24:61-78. [PMID: 31568638 PMCID: PMC6933371 DOI: 10.1111/jcmm.14546] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/21/2019] [Accepted: 06/11/2019] [Indexed: 12/13/2022] Open
Abstract
Minimal hepatic encephalopathy (MHE) was characterized for cognitive dysfunction. Insulin resistance (IR) has been identified to be correlated with the pathogenesis of MHE. Oridonin (Ori) is an active terpenoid, which has been reported to rescue synaptic loss and restore insulin sensitivity. In this study, we found that intraperitoneal injection of Ori rescued IR, reduced the autophagosome formation and synaptic loss and improved cognitive dysfunction in MHE rats. Moreover, in insulin‐resistant PC12 cells and N2a cells, we found that Ori blocked IR‐induced synaptic deficits via the down‐regulation of PTEN, the phosphorylation of Akt and the inhibition of autophagy. Taken together, these results suggested that Ori displays therapeutic efficacy towards memory deficits via improvement of IR in MHE and represents a novel bioactive therapeutic agent for treating MHE.
Collapse
Affiliation(s)
- Fangfang Wen
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disease Research, Department of Surgery Laboratory, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Weishan Zhuge
- Gastrointestinal Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jian Wang
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disease Research, Department of Surgery Laboratory, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaoai Lu
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disease Research, Department of Surgery Laboratory, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ruimin You
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disease Research, Department of Surgery Laboratory, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Leping Liu
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disease Research, Department of Surgery Laboratory, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qichuan Zhuge
- Neurosurgery Department, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Saidan Ding
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disease Research, Department of Surgery Laboratory, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| |
Collapse
|
16
|
Plauth M, Bernal W, Dasarathy S, Merli M, Plank LD, Schütz T, Bischoff SC. ESPEN guideline on clinical nutrition in liver disease. Clin Nutr 2019; 38:485-521. [PMID: 30712783 DOI: 10.1016/j.clnu.2018.12.022] [Citation(s) in RCA: 332] [Impact Index Per Article: 66.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 12/18/2018] [Indexed: 02/06/2023]
Abstract
This update of evidence-based guidelines (GL) aims to translate current evidence and expert opinion into recommendations for multidisciplinary teams responsible for the optimal nutritional and metabolic management of adult patients with liver disease. The GL was commissioned and financially supported by ESPEN. Members of the guideline group were selected by ESPEN. We searched for meta-analyses, systematic reviews and single clinical trials based on clinical questions according to the PICO format. The evidence was evaluated and used to develop clinical recommendations implementing the SIGN method. A total of 85 recommendations were made for the nutritional and metabolic management of patients with acute liver failure, severe alcoholic steatohepatitis, non-alcoholic fatty liver disease, liver cirrhosis, liver surgery and transplantation as well as nutrition associated liver injury distinct from fatty liver disease. The recommendations are preceded by statements covering current knowledge of the underlying pathophysiology and pathobiochemistry as well as pertinent methods for the assessment of nutritional status and body composition.
Collapse
Affiliation(s)
- Mathias Plauth
- Department of Internal Medicine, Municipal Hospital of Dessau, Dessau, Germany.
| | - William Bernal
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Srinivasan Dasarathy
- Division of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - Manuela Merli
- Gastroenterology and Hepatology Unit, Sapienza University of Rome, Rome, Italy
| | - Lindsay D Plank
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Tatjana Schütz
- IFB Adiposity Diseases, Leipzig University Medical Centre, Leipzig, Germany
| | - Stephan C Bischoff
- Department for Clinical Nutrition, University of Hohenheim, Stuttgart, Germany
| |
Collapse
|
17
|
Abstract
Liver cirrhosis is associated with significant nutritional risks that often result in serious hepatic complications and poor survival rates. Diet is an important but underutilized aspect in the treatment modality of cirrhosis. Therefore, the aims of this review are to ascertain nutritional risks associated with its pathophysiology and to summarize existing evidence that support dietary recommendations for managing this patient population. Alterations in substrate utilization for energy production is a main feature of liver cirrhosis, resulting in increased catabolism of protein stores and a predisposition toward protein-energy malnutrition, even in the early stages of the disease. The body of evidence suggests that a high energy and protein (>1.2 g/kg body weight/d) diet consumed frequently and late in the evening is effective in improving nutritional status of these patients and has been associated with improved hospitalization and mortality rates. The use of branched-chain amino acid supplementation shows promise in reducing cirrhosis-related complications but are currently limited by adverse gastrointestinal symptoms and poor palatability. Furthermore exploration of dietary manipulation of branched-chain amino acid warrants further examination. Evidence is also accumulating that protein intake should not be restricted in patients with hepatic encephalopathy with earlier studies of protein restriction neglecting to account for the relative increase in fermentable fiber which would reduce the absorption of ammonia into the portal system in a way similar to supplementation with lactulose. Finally, a major finding of this review is the need to improve the quality and quantity of dietary intervention studies for patients with liver cirrhosis, particularly with the use of partial or whole dietary sources. In conclusion, dietary management of cirrhosis is not a one-size fits all approach but should be implemented earlier on in the treatment algorithm to improve the clinical prognosis of cirrhosis.
Collapse
|
18
|
Ramos-Prol A, Hervás-Marín D, García-Castell A, Merino-Torres JF. Outcomes in patients with diabetes 10 years after liver transplantation. J Diabetes 2017; 9:1033-1039. [PMID: 28039959 DOI: 10.1111/1753-0407.12520] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 12/04/2016] [Accepted: 12/28/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND There are discrepancies between studies regarding the effect of diabetes mellitus on morbidity and mortality in patients undergoing liver transplantation. The aim of the present study was to compare mortality, risk of liver graft rejection, and cardiovascular events in patients with and without diabetes undergoing liver transplantation over a 10-year follow-up period. METHODS A retrospective study was performed on 183 patients who underwent liver transplantation in 2005 and 2006. Mortality and morbidity data were collected until 2016, including information on mortality and survival time, graft rejection and graft survival time, coronary heart disease, stroke, and peripheral arterial ischemia. RESULTS During the follow-up, 41.3% and 27.8% of patients in the groups with and without diabetes, respectively, died. A trend for lower survival time was observed in patients with diabetes, although this effect was not confirmed by the Cox regression model. There was an increased risk of graft rejection in the group with diabetes compared with the group without diabetes ( P < 0.001). In the survival analysis, diabetes was associated with reduced graft survival time ( P = 0.001). Cardiovascular events were also more likely in the group with diabetes ( P = 0.005). CONCLUSIONS In the present study diabetes was associated with a higher risk of liver graft rejection and cardiovascular events. There was also a trend for higher mortality, although the effect was not statistically significant. These findings suggest that patients with diabetes require a more rigorous pretransplant evaluation and closer monitoring after transplantation in order to try to reduce associated complications.
Collapse
Affiliation(s)
- Agustín Ramos-Prol
- Department of Internal Medicine (Endocrinology and Nutrition), Francesc de Borja Hospital, Gandía, Spain
- Joint Research Unit of Endocrinology, Nutrition and Clinical Dietetics, Valencia, Spain
| | | | - Alia García-Castell
- Endocrinology and Nutrition Department, University and Polytechnic La Fe Hospital, Valencia, Spain
| | - Juan F Merino-Torres
- Joint Research Unit of Endocrinology, Nutrition and Clinical Dietetics, Valencia, Spain
- Endocrinology and Nutrition Department, University and Polytechnic La Fe Hospital, Valencia, Spain
| |
Collapse
|
19
|
Braillon A. Hepatocellular Carcinoma, Diabetes, and Metabolic Syndrome: Correlation Does Not Mean Causality. Am J Med 2017; 130:e411. [PMID: 28487106 DOI: 10.1016/j.amjmed.2017.02.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 02/08/2017] [Indexed: 10/19/2022]
|
20
|
GFD-Net: A novel semantic similarity methodology for the analysis of gene networks. J Biomed Inform 2017; 68:71-82. [PMID: 28274758 DOI: 10.1016/j.jbi.2017.02.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 02/08/2017] [Accepted: 02/22/2017] [Indexed: 02/06/2023]
Abstract
Since the popularization of biological network inference methods, it has become crucial to create methods to validate the resulting models. Here we present GFD-Net, the first methodology that applies the concept of semantic similarity to gene network analysis. GFD-Net combines the concept of semantic similarity with the use of gene network topology to analyze the functional dissimilarity of gene networks based on Gene Ontology (GO). The main innovation of GFD-Net lies in the way that semantic similarity is used to analyze gene networks taking into account the network topology. GFD-Net selects a functionality for each gene (specified by a GO term), weights each edge according to the dissimilarity between the nodes at its ends and calculates a quantitative measure of the network functional dissimilarity, i.e. a quantitative value of the degree of dissimilarity between the connected genes. The robustness of GFD-Net as a gene network validation tool was demonstrated by performing a ROC analysis on several network repositories. Furthermore, a well-known network was analyzed showing that GFD-Net can also be used to infer knowledge. The relevance of GFD-Net becomes more evident in Section "GFD-Net applied to the study of human diseases" where an example of how GFD-Net can be applied to the study of human diseases is presented. GFD-Net is available as an open-source Cytoscape app which offers a user-friendly interface to configure and execute the algorithm as well as the ability to visualize and interact with the results(http://apps.cytoscape.org/apps/gfdnet).
Collapse
|
21
|
Lee WG, Murphy R, McCall JL, Gane EJ, Soop M, Tura A, Plank LD. Nadolol reduces insulin sensitivity in liver cirrhosis: a randomized double-blind crossover trial. Diabetes Metab Res Rev 2017; 33. [PMID: 27667324 DOI: 10.1002/dmrr.2859] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 09/01/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Liver cirrhosis is frequently complicated by portal hypertension leading to increased mortality from variceal bleeding and hepatic decompensation. Noncardioselective β-blockers not only reduce portal hypertension and prevent variceal bleeding in cirrhosis but also impair glucose tolerance and insulin sensitivity in other settings. This study aimed to determine whether nonselective β-blockade with nadolol impairs glucose metabolism in liver cirrhosis. METHODS A randomized, double-blind, placebo-controlled crossover trial of nadolol in cirrhotic patients examined insulin sensitivity, disposition index, and glucose tolerance. Stable cirrhotic patients of mixed etiology underwent an intravenous glucose tolerance test and hyperinsulinemic-euglycemic clamp for the measurement of insulin secretion and insulin sensitivity (n = 16) and a 75-g oral glucose tolerance test (n = 17). These measurements were conducted twice (after 3 months of treatment with nadolol or placebo and, after a 1-month washout period, after 3 months on the alternative treatment). Total body fat and plasma catecholamines were measured at the end of each 3-month treatment. RESULTS Compared with placebo, nadolol treatment reduced insulin sensitivity (79.7 ± 10.1 vs 99.6 ± 10.3 μL/kg fat-free mass·min-1 ·(mU/L)-1 , P = .005). Insulin secretion was unchanged (P = .24), yielding a lower disposition index with nadolol (6083 ± 2007 vs 8692 ± 2036, P = .050). There was no change in total body fat or plasma catecholamines. A 2-hour plasma glucose concentration from the oral glucose tolerance test was higher on nadolol than placebo (10.8 ± 0.9 vs 9.9 ± 0.9 mmol/L, P = .035). CONCLUSIONS Nadolol significantly worsened insulin sensitivity, glycemia, and disposition index in patients with liver cirrhosis. These findings may have significant clinical implications because cirrhosis is already associated with an increased prevalence of diabetes.
Collapse
Affiliation(s)
- Wai Gin Lee
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Rinki Murphy
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - John L McCall
- Section of Surgery, Department of Medical and Surgical Sciences, University of Otago, Dunedin, New Zealand
| | - Edward J Gane
- New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand
| | - Mattias Soop
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Andrea Tura
- Metabolic Unit, Institute of Biomedical Engineering, National Research Council, Padua, Italy
| | - Lindsay D Plank
- Department of Surgery, University of Auckland, Auckland, New Zealand
| |
Collapse
|
22
|
Mohamad M, Mitchell SJ, Wu LE, White MY, Cordwell SJ, Mach J, Solon‐Biet SM, Boyer D, Nines D, Das A, Catherine Li S, Warren A, Hilmer SN, Fraser R, Sinclair DA, Simpson SJ, Cabo R, Le Couteur DG, Cogger VC. Ultrastructure of the liver microcirculation influences hepatic and systemic insulin activity and provides a mechanism for age-related insulin resistance. Aging Cell 2016; 15:706-15. [PMID: 27095270 PMCID: PMC4933657 DOI: 10.1111/acel.12481] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2016] [Indexed: 12/16/2022] Open
Abstract
While age‐related insulin resistance and hyperinsulinemia are usually considered to be secondary to changes in muscle, the liver also plays a key role in whole‐body insulin handling and its role in age‐related changes in insulin homeostasis is largely unknown. Here, we show that patent pores called ‘fenestrations’ are essential for insulin transfer across the liver sinusoidal endothelium and that age‐related loss of fenestrations causes an impaired insulin clearance and hyperinsulinemia, induces hepatic insulin resistance, impairs hepatic insulin signaling, and deranges glucose homeostasis. To further define the role of fenestrations in hepatic insulin signaling without any of the long‐term adaptive responses that occur with aging, we induced acute defenestration using poloxamer 407 (P407), and this replicated many of the age‐related changes in hepatic glucose and insulin handling. Loss of fenestrations in the liver sinusoidal endothelium is a hallmark of aging that has previously been shown to cause deficits in hepatic drug and lipoprotein metabolism and now insulin. Liver defenestration thus provides a new mechanism that potentially contributes to age‐related insulin resistance.
Collapse
Affiliation(s)
- Mashani Mohamad
- Ageing and Alzheimers Institute Centre for Education and Research on Ageing University of Sydney and Concord Hospital Sydney NSW Australia
- ANZAC Research Institute University of Sydney and Concord Hospital Sydney NSW Australia
- Faculty of Pharmacy Universiti Teknologi MARA Selangor Malaysia
| | - Sarah Jayne Mitchell
- Translational Gerontology Branch National Institute on Aging National Institutes of Health Baltimore MD USA
| | - Lindsay Edward Wu
- Laboratory for Ageing Research School of Medical Sciences University of New South Wales Sydney NSW Australia
| | | | | | - John Mach
- Kolling Institute of Medical Research Royal North Shore Hospital and University of Sydney Sydney NSW Australia
| | - Samantha Marie Solon‐Biet
- Ageing and Alzheimers Institute Centre for Education and Research on Ageing University of Sydney and Concord Hospital Sydney NSW Australia
- ANZAC Research Institute University of Sydney and Concord Hospital Sydney NSW Australia
- Charles Perkins Centre University of Sydney Sydney NSW Australia
| | - Dawn Boyer
- Translational Gerontology Branch National Institute on Aging National Institutes of Health Baltimore MD USA
| | - Dawn Nines
- Translational Gerontology Branch National Institute on Aging National Institutes of Health Baltimore MD USA
| | - Abhirup Das
- Laboratory for Ageing Research School of Medical Sciences University of New South Wales Sydney NSW Australia
| | - Shi‐Yun Catherine Li
- Laboratory for Ageing Research School of Medical Sciences University of New South Wales Sydney NSW Australia
| | - Alessandra Warren
- Ageing and Alzheimers Institute Centre for Education and Research on Ageing University of Sydney and Concord Hospital Sydney NSW Australia
- ANZAC Research Institute University of Sydney and Concord Hospital Sydney NSW Australia
| | - Sarah Nicole Hilmer
- Kolling Institute of Medical Research Royal North Shore Hospital and University of Sydney Sydney NSW Australia
| | - Robin Fraser
- Department of Pathology University of Otago Christchurch New Zealand
| | - David Andrew Sinclair
- Laboratory for Ageing Research School of Medical Sciences University of New South Wales Sydney NSW Australia
- Department of Genetics Harvard Medical School Boston MA USA
| | | | - Rafael Cabo
- Translational Gerontology Branch National Institute on Aging National Institutes of Health Baltimore MD USA
| | - David George Le Couteur
- Ageing and Alzheimers Institute Centre for Education and Research on Ageing University of Sydney and Concord Hospital Sydney NSW Australia
- ANZAC Research Institute University of Sydney and Concord Hospital Sydney NSW Australia
- Charles Perkins Centre University of Sydney Sydney NSW Australia
| | - Victoria Carroll Cogger
- Ageing and Alzheimers Institute Centre for Education and Research on Ageing University of Sydney and Concord Hospital Sydney NSW Australia
- ANZAC Research Institute University of Sydney and Concord Hospital Sydney NSW Australia
- Charles Perkins Centre University of Sydney Sydney NSW Australia
| |
Collapse
|
23
|
Barton JC, Barton JC, Adams PC, Acton RT. Risk Factors for Insulin Resistance, Metabolic Syndrome, and Diabetes in 248 HFE C282Y Homozygotes Identified by Population Screening in the HEIRS Study. Metab Syndr Relat Disord 2016; 14:94-101. [PMID: 26771691 DOI: 10.1089/met.2015.0123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We sought to identify risk factors for insulin resistance, metabolic syndrome (MetS), and diabetes mellitus in 248 non-Hispanic white HFE C282Y homozygotes identified by population screening. METHODS We analyzed observations obtained prospectively in a postscreening examination: age; sex; body mass index (BMI); systolic/diastolic blood pressure; metacarpophalangeal (MP) joint hypertrophy; hepatomegaly; complete blood counts; alanine/aspartate aminotransferase levels; elevated C-reactive protein (>0.5 mg/dL); transferrin saturation; serum ferritin; homeostasis model assessment-insulin resistance (HOMA-IR); and MetS. RESULTS Twenty-six participants (10.5%) had diabetes diagnoses. A significant trend across HOMA-IR quartiles was observed only for blood neutrophils. Logistic regression on HOMA-IR fourth quartile revealed positive associations: age (P = 0.0002); male sex (P = 0.0022); and BMI (P < 0.0001). HOMA-IR fourth quartile predicted MetS (P < 0.0001). Logistic regression on diabetes revealed positive associations: age (P = 0.0012); male sex (P = 0.0068); MP joint hypertrophy (P = 0.0167); neutrophils (P = 0.0342); and MetS (P = 0.0298). Serum ferritin did not predict HOMA-IR fourth quartile, MetS, or diabetes. CONCLUSIONS In screening C282Y homozygotes, age, male sex, and BMI predicted HOMA-IR fourth quartile. HOMA-IR fourth quartile alone predicted MetS. Diabetes was associated with greater age, male sex, MP joint hypertrophy, greater blood neutrophil counts, and MetS.
Collapse
Affiliation(s)
- James C Barton
- 1 Southern Iron Disorders Center , Birmingham, Alabama.,2 Department of Medicine, University of Alabama at Birmingham , Birmingham, Alabama
| | | | - Paul C Adams
- 3 Department of Medicine, University of Western Ontario , London, Ontario, Canada
| | - Ronald T Acton
- 1 Southern Iron Disorders Center , Birmingham, Alabama.,4 Department of Microbiology, University of Alabama at Birmingham , Alabama
| |
Collapse
|
24
|
Ho TW, Wu JM, Yang CY, Lai HS, Lai F, Tien YW. Total gastrectomy improves glucose metabolism on gastric cancer patients: a nationwide population-based study. Surg Obes Relat Dis 2015; 12:635-641. [PMID: 27012876 DOI: 10.1016/j.soard.2015.11.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2011] [Revised: 11/12/2015] [Accepted: 11/23/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Total gastrectomy (TG) is potentially curative for upper gastric cancer (GC) and includes both stomach removal and enteral bypass reconstruction. Therefore, similar to bariatric surgery, TG may contribute to a change in glucose metabolism. OBJECTIVES The aim of this population-based study was to determine if there are any changes in glucose metabolism after TG in patients with GC. SETTING Nationwide population database. METHODS We conducted a nationwide cohort study using data from Taiwan's National Health Insurance Research Database collected between 2000 and 2011. Two cohorts were sampled for further analysis of changes in glucose metabolism after TG, including a diabetes group and non-diabetes group. RESULTS A total of 8593 patients with TG were identified. Of the 579 patients with diabetes with GC, 178 (30.7%) achieved diabetes remission after TG. On Cox multivariate analysis, patients aged 50 to 64 years (odds ratio [OR], .48; 95% confidence interval [CI], .31-.75; P<.01) and those who used insulin (OR, .31; 95% CI, .19-.51; P<.01) had lower rates of diabetes remission, whereas liver cirrhosis patients had higher rates of diabetes remission (OR, 1.77; 95% CI, 1.16-2.69; P<.01). On the other hand, patients without diabetes but who had GC (n = 1565) had lower rates of newly diagnosed diabetes after TG compared with the general population as assessed by control-to-case analysis (OR, .56; 95% CI, .47-.66; P< .01). CONCLUSION Our data showed that TG contributes to improved glucose metabolism in patients with GC.
Collapse
Affiliation(s)
- Te-Wei Ho
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan, ROC
| | - Jin-Ming Wu
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan, ROC; Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, ROC
| | - Ching-Yao Yang
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, ROC
| | - Hong-Shiee Lai
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, ROC
| | - Feipei Lai
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan, ROC
| | - Yu-Wen Tien
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, ROC.
| |
Collapse
|
25
|
Ramos-Prol A, Hervás-Marín D, Rodríguez-Medina B, Campos-Alborg V, Berenguer M, Moya-Herraiz Á, Merino-Torres JF. Alterations in carbohydrate metabolism in cirrhotic patients before and after liver transplant. Diabetes Res Clin Pract 2015; 110:123-8. [PMID: 26506435 DOI: 10.1016/j.diabres.2015.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 09/06/2015] [Accepted: 10/01/2015] [Indexed: 12/15/2022]
Abstract
AIM The main objective of this study is to demonstrate whether carbohydrate metabolism alterations identified in patients with advanced cirrhosis show any improvement after liver transplant. METHODS The study included 86 patients who underwent liver transplant between March 2010 and February 2011. An oral glucose tolerance test was performed before the liver transplant, and 6 and 12 months after. Beta cell function and insulin resistance were also calculated, applying formulae that use basal plasma glycaemia and insulin, and plasma glycaemia and insulin during an oral glucose tolerance test. Risk factors for pre- and post-transplant diabetes were also studied. The diagnosis of diabetes was based on an OGTT. RESULTS The proportion of patients with diabetes before transplant, and at month 6 and 12 after transplant were 70.9%, 48.8% and 39.2%, respectively. Compared to baseline, at month 6 the odds ratio of having diabetes was 0.39 (IC 95% [0.21, 0.73]) and at month 12 it was 0.26 (IC 95% [0.14, 0.50]). The composite insulin sensitivity index values at 6 and 12 months were 1.72 units higher (IC 95% [0.84, 2.58]) and 1.58 units higher (IC 95% [0.68, 2.44)] than baseline. A statistically significant association was found between high MELD values and high body mass index, and risk of pre-transplant diabetes (p=0.001 and p=0.033, respectively). Cirrhosis aetiology did not influence the risk of diabetes. CONCLUSIONS In this study, we were able to ascertain that alterations in carbohydrate metabolism typical of advanced cirrhosis improve after liver transplant. This improvement is mainly due to an improvement in insulin resistance.
Collapse
Affiliation(s)
- Agustín Ramos-Prol
- Endocrinology and Nutrition Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe (Health Research Institute La Fe), Valencia, Spain
| | | | - Beatriz Rodríguez-Medina
- Liver Transplantation and Hepatology Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Vicente Campos-Alborg
- Endocrinology and Nutrition Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Marina Berenguer
- Liver Transplantation and Hepatology Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Ángel Moya-Herraiz
- Liver Transplantation and Hepatology Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | |
Collapse
|
26
|
Taguchi K, Yamanaka-Okumura H, Mizuno A, Nakamura T, Shimada M, Doi T, Takeda E. Insulin resistance as early sign of hepatic dysfunction in liver cirrhosis. THE JOURNAL OF MEDICAL INVESTIGATION 2015; 61:180-9. [PMID: 24705764 DOI: 10.2152/jmi.61.180] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Glucose intolerance characterized by postprandial hyperglycemia and hyperinsulinemia is commonly seen in patients with liver cirrhosis (LC). The aim of this study is to clarify the relation between glucose intolerance and disorder of liver function in patients with LC. The 75 g oral glucose tolerance test (75 g OGTT) and the hyperinsulinemic euglycemic clamp combined with 0.2 g/kg oral glucose load (HECGL) were conducted in 61 patients with LC. Based on the results of 75 g OGTT, the 61 patients with LC were divided into groups, 21 (34.4%) patients with normal glucose tolerance (LC-NGT), 12 (19.7%) patients with impaired glucose tolerance (LC-IGT) and 28 (45.9%) patients with diabetes mellitus (LC-DM). Fasting plasma glucose (FPG) level was normal in 50 (82.0%) patients with LC. All patients with LC showed insulin resistance in both peripheral (skeletal and adipose) and hepatic tissues evaluated by HECGL, although significant correlation between the degree of glucose intolerance and the severity of hepatic dysfunction was not observed. Insulin resistance in both liver and peripheral tissues is the early sign in the patients with LC. This fact indicates that nutritional care from early stages of LC would be necessary in the patients.
Collapse
Affiliation(s)
- Kayo Taguchi
- Department of Clinical Nutrition, Institute of Health Biosciences, University of Tokushima Graduate School
| | | | | | | | | | | | | |
Collapse
|
27
|
Mouzaki M, Ng V, Kamath BM, Selzner N, Pencharz P, Ling SC. Enteral Energy and Macronutrients in End-Stage Liver Disease. JPEN J Parenter Enteral Nutr 2014; 38:673-681. [DOI: 10.1177/0148607114522488] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Marialena Mouzaki
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto
- Department of Paediatrics, University of Toronto, Toronto
| | - Vicky Ng
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto
- Department of Paediatrics, University of Toronto, Toronto
| | - Binita M. Kamath
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto
- Department of Paediatrics, University of Toronto, Toronto
| | - Nazia Selzner
- Division of Medicine, University Health Network, Toronto
| | - Paul Pencharz
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto
- Department of Paediatrics, University of Toronto, Toronto
| | - Simon C. Ling
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto
- Department of Paediatrics, University of Toronto, Toronto
| |
Collapse
|
28
|
Jeon HK, Kim MY, Baik SK, Park HJ, Choi H, Park SY, Kim BR, Hong JH, Jo KW, Shin SY, Kim JM, Kim JW, Kim HS, Kwon SO, Kim YJ, Cha SH, Kim DJ, Suk KT, Cheon GJ, Kim YD, Choi DH, Lee SJ. Hepatogenous diabetes in cirrhosis is related to portal pressure and variceal hemorrhage. Dig Dis Sci 2013; 58:3335-41. [PMID: 23912248 DOI: 10.1007/s10620-013-2802-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 07/14/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM The clinical impact and complications of hepatogenous diabetes (HD) on cirrhosis have not been elucidated. This study aimed to evaluate the relationship of HD with portal hypertension (PHT) and variceal hemorrhage and to assess the prevalence of HD. METHODS From July 2007 to December 2009, 75-g oral glucose tolerance test and insulin resistance (IR) were evaluated for 195 consecutive cirrhotic liver patients (M:F = 164:1, 53.0 ± 10.2 years) who had no history of diabetes mellitus. IR was calculated using the homeostasis model of assessment-insulin resistance (HOMA-IR) formula. Endoscopy for varices, hepatic venous pressure gradient (HVPG), and serologic tests were also conducted. RESULTS HD was observed in 55.4 % (108/194) of the patients. Among them, 62.0 % required OGTT for diagnosis because they did not show an abnormal fasting plasma glucose level. The presence of HD showed a significant correlation with high Child-Pugh's score, variceal hemorrhage, and HVPG (p = 0.004, 0.002, and 0.019, respectively). In multivariate analysis, Child-Pugh's score (OR 1.43, 95 % CI 1.005-2.038) and HVPG (OR 1.15, 95 % CI 1.003-2.547) had significant relationships with HD. Patients with recent variceal hemorrhages (within 6 months) exhibited significantly higher glucose levels at 120 min in OGTT compared to patients without hemorrhages (p = 0.042). However, there was no difference in fasting glucose levels. The 120-min glucose level and HOMA-IR score were significantly and linearly correlated with HVPG (r (2) = 0.189, p < 0.001 and r (2) = 0.033, p = 0.011, respectively). CONCLUSION HD and IR have significant relationships with PHT and variceal hemorrhage. Postprandial hyperglycemia in particular had a significant relationship with variceal hemorrhage.
Collapse
Affiliation(s)
- Hyo Keun Jeon
- Department of Internal Medicine, Wonju College of Medicine, Wonju Christian Hospital, Yonsei University, 162, Ilsan-dong, Wonju, Republic of Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Berzigotti A, Abraldes JG. Impact of obesity and insulin-resistance on cirrhosis and portal hypertension. GASTROENTEROLOGIA Y HEPATOLOGIA 2013; 36:527-33. [PMID: 23731977 DOI: 10.1016/j.gastrohep.2013.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 03/15/2013] [Indexed: 12/14/2022]
Abstract
Obesity is sharply rising worldwide and is increasingly recognized in patients with cirrhosis. This review summarizes the available data documenting a detrimental role of obesity and insulin-resistance on the risk of appearance of clinical events in patients with cirrhosis. Molecular pathways explaining the harmful effect of obesity and insulin resistance in the natural history of cirrhosis are largely unknown. Increasing knowledge of mechanisms leading to white adipose tissue dysfunction on one side, and to portal hypertension on the other side, allow hypothesizing that a link between the pathophysiology of obesity, insulin resistance and portal hypertension in cirrhosis exists. Mechanisms likely involved in this interplay are discussed in this article.
Collapse
Affiliation(s)
- Annalisa Berzigotti
- Laboratorio de Hemodinámica Hepática, Unidad de Hepatología, Hospital Clínic, IDIBAPS, Barcelona, Spain; CIBERehd, Barcelona, Spain.
| | | |
Collapse
|
30
|
Mattick JSA, Kamisoglu K, Ierapetritou MG, Androulakis IP, Berthiaume F. Branched-chain amino acid supplementation: impact on signaling and relevance to critical illness. WILEY INTERDISCIPLINARY REVIEWS-SYSTEMS BIOLOGY AND MEDICINE 2013; 5:449-460. [PMID: 23554299 DOI: 10.1002/wsbm.1219] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The changes that occur in mammalian systems following trauma and sepsis, termed systemic inflammatory response syndrome, elicit major changes in carbohydrate, protein, and energy metabolism. When these events persist for too long they result in a severe depletion of lean body mass, multiple organ dysfunction, and eventually death. Nutritional supplementation has been investigated to offset the severe loss of protein, and recent evidence suggests that diets enriched in branched-chain amino acids (BCAAs) may be especially beneficial. BCAAs are metabolized in two major steps that are differentially expressed in muscle and liver. In muscle, BCAAs are reversibly transaminated to the corresponding α-keto acids. For the complete degradation of BCAAs, the α-keto acids must travel to the liver to undergo oxidation. The liver, in contrast to muscle, does not significantly express the branched-chain aminotransferase. Thus, BCAA degradation is under the joint control of both liver and muscle. Recent evidence suggests that in liver, BCAAs may perform signaling functions, more specifically via activation of mTOR (mammalian target of rapamycin) signaling pathway, influencing a wide variety of metabolic and synthetic functions, including protein translation, insulin signaling, and oxidative stress following severe injury and infection. However, understanding of the system-wide effects of BCAAs that integrate both metabolic and signaling aspects is currently lacking. Further investigation in this respect will help rationalize the design and optimization of nutritional supplements containing BCAAs for critically ill patients.
Collapse
Affiliation(s)
- John S A Mattick
- Department of Chemical and Biochemical Engineering, Rutgers, the State University of New Jersey, Piscataway, New Jersey
| | - Kubra Kamisoglu
- Department of Chemical and Biochemical Engineering, Rutgers, the State University of New Jersey, Piscataway, New Jersey
| | - Marianthi G Ierapetritou
- Department of Chemical and Biochemical Engineering, Rutgers, the State University of New Jersey, Piscataway, New Jersey
| | - Ioannis P Androulakis
- Department of Chemical and Biochemical Engineering, Rutgers, the State University of New Jersey, Piscataway, New Jersey.,Department of Biomedical Engineering, Rutgers, the State University of New Jersey, Piscataway, New Jersey
| | - Francois Berthiaume
- Department of Biomedical Engineering, Rutgers, the State University of New Jersey, Piscataway, New Jersey
| |
Collapse
|
31
|
Johnson TM, Overgard EB, Cohen AE, DiBaise JK. Nutrition Assessment and Management in Advanced Liver Disease. Nutr Clin Pract 2013; 28:15-29. [DOI: 10.1177/0884533612469027] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
| | | | | | - John K. DiBaise
- Division of Gastroenterology, Mayo Clinic in Arizona, Phoenix, Arizona
| |
Collapse
|
32
|
Insulin resistance, ceramide accumulation, and endoplasmic reticulum stress in human chronic alcohol-related liver disease. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2012; 2012:479348. [PMID: 22577490 PMCID: PMC3347750 DOI: 10.1155/2012/479348] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Revised: 12/28/2011] [Accepted: 01/10/2012] [Indexed: 12/14/2022]
Abstract
Background. Chronic alcohol-related liver disease (ALD) is mediated by insulin resistance, mitochondrial dysfunction, inflammation, oxidative stress, and DNA damage. Recent studies suggest that dysregulated lipid metabolism with accumulation of ceramides, together with ER stress potentiate hepatic insulin resistance and may cause steatohepatitis to progress. Objective. We examined the degree to which hepatic insulin resistance in advanced human ALD is correlated with ER stress, dysregulated lipid metabolism, and ceramide accumulation. Methods. We assessed the integrity of insulin signaling through the Akt pathway and measured proceramide and ER stress gene expression, ER stress signaling proteins, and ceramide profiles in liver tissue. Results. Chronic ALD was associated with increased expression of insulin, IGF-1, and IGF-2 receptors, impaired signaling through IGF-1R and IRS1, increased expression of multiple proceramide and ER stress genes and proteins, and higher levels of the C14, C16, C18, and C20 ceramide species relative to control. Conclusions. In human chronic ALD, persistent hepatic insulin resistance is associated with dysregulated lipid metabolism, ceramide accumulation, and striking upregulation of multiple ER stress signaling molecules. Given the role of ceramides as mediators of ER stress and insulin resistance, treatment with ceramide enzyme inhibitors may help reverse or halt progression of chronic ALD.
Collapse
|
33
|
Su AP, Cao SS, Le Tian B, Da Zhang Z, Hu WM, Zhang Y, Wang ZL, Babu SR, Hu T. Effect of transjugular intrahepatic portosystemic shunt on glycometabolism in cirrhosis patients. Clin Res Hepatol Gastroenterol 2012; 36:53-9. [PMID: 22099870 DOI: 10.1016/j.clinre.2011.09.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 09/10/2011] [Accepted: 09/20/2011] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Patients with liver cirrhosis suffer from hyperinsulinemia, hyperglucagonemia and a certain degree of insulin resistance, and portosystemic shunts may be involved in the etiology. A transjugular intrahepatic portosystemic shunt (TIPS) as a treatment for the complications of portal hypertension leads to hemodynamic changes. The objective of the present study is to evaluate whether TIPS can also affect glycometabolism in cirrhosis patients. METHODS Forty-six liver cirrhosis patients (experimental group [EG]) without diabetes who underwent TIPS were evaluated. Portal venous pressure (PVP), cardiac output (CO) and blood flow in the shunt (BFS) were measured or calculated before TIPS, after 15 minutes and, finally, after 90 days. Twenty-five liver cirrhosis patients without diabetes and without TIPS were included as the control group (CG). Oral glucose tolerance tests (OGTTs) were carried out at 0, 1, 7, 30 and 90 days after TIPS or after inclusion in the study. Indices related to glycometabolism and liver function, which included biochemical values, were also investigated. RESULTS PVP changed immediately from 39.43 ± 1.29 cmH(2)O to 21.43 ± 1.42 cmH(2)O and remained stable thereafter. A pronounced increase in CO was observed after TIPS, while BFS did not change significantly. Also, glycosylated hemoglobin A(1c) (HbA(1c)), fasting plasma glucose (FPG), fasting plasma C-peptide (FPC), glucagon-like peptide-1 (GLP-1) and 2-h post-challenge plasma glucose (2 hPG) were non significantly increased after the shunt. Statistically significant hyperinsulinemia and hyperglucagonemia persisted for 90 days after TIPS. In addition, TIPS was followed by an increase in insulin resistance (IR) and β-cell function. Thirty-four patients in the EG and 15 in the CG were diagnosed with diabetes or prediabetes after 90 days. No significant differences in biochemical values were observed 90 days after the shunt. CONCLUSION In addition to causing hemodynamic changes, TIPS augments hyperglucagonemia because of increased secretion and decreased clearance of glucagon in the liver, whereas IR deteriorates after the procedure. However, glycemic control does not worsen after TIPS, and the procedure is not associated with a higher risk of diabetes largely because of the simultaneous increase in insulin.
Collapse
Affiliation(s)
- An Ping Su
- Department of Hepatobiliopancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Plauth M, Schuetz T. Hepatology - Guidelines on Parenteral Nutrition, Chapter 16. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2009; 7:Doc12. [PMID: 20049084 PMCID: PMC2795384 DOI: 10.3205/000071] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Indexed: 12/13/2022]
Abstract
Parenteral nutrition (PN) is indicated in alcoholic steatohepatitis (ASH) and in cirrhotic patients with moderate or severe malnutrition. PN should be started immediately when sufficientl oral or enteral feeding is not possible. ASH and cirrhosis patients who can be sufficiently fed either orally or enterally, but who have to abstain from food over a period of more than 12 hours (including nocturnal fasting) should receive basal glucose infusion (2–3 g/kg/d). Total PN is required if such fasting periods last longer than 72 h. PN in patients with higher-grade hepatic encephalopathy (HE); particularly in HE IV° with malfunction of swallowing and cough reflexes, and unprotected airways. Cirrhotic patients or patients after liver transplantation should receive early postoperative PN after surgery if they cannot be sufficiently rally or enterally nourished. No recommendation can be made on donor or organ conditioning by parenteral administration of glutamine and arginine, aiming at minimising ischemia/reperfusion damage. In acute liver failure artificial nutrition should be considered irrespective of the nutritional state and should be commenced when oral nutrition cannot be restarted within 5 to 7 days. Whenever feasible, enteral nutrition should be administered via a nasoduodenal feeding tube.
Collapse
Affiliation(s)
- M Plauth
- Dept. of Internal Medicine, Municipal Clinic Dessau, Germany
| | | | | |
Collapse
|
35
|
ESPEN Guidelines on Parenteral Nutrition: hepatology. Clin Nutr 2009; 28:436-44. [PMID: 19520466 DOI: 10.1016/j.clnu.2009.04.019] [Citation(s) in RCA: 174] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Accepted: 04/27/2009] [Indexed: 12/13/2022]
Abstract
Parenteral nutrition (PN) offers the possibility to increase or to ensure nutrient intake in patients, in whom sufficient nutrition by oral or enteral alone is insufficient or impossible. Complementary to the ESPEN guideline on enteral nutrition of liver disease (LD) patients the present guideline is intended to give evidence-based recommendations for the use of PN in LD. For this purpose three paradigm conditions of LD were chosen: alcoholic steatohepatitis (ASH), liver cirrhosis and acute liver failure. The guideline was developed by an interdisciplinary expert group in accordance with officially accepted standards and is based on all relevant publications since 1985. The guideline was presented on the ESPEN website and visitors' criticism and suggestions were welcome and included in the final revision. PN improves nutritional state and liver function in malnourished patients with ASH. PN is safe and improves mental state in patients with cirrhosis and severe HE. Perioperative (including liver transplantation) PN is safe and reduces the rate of complications. In acute liver failure PN is a safe second-line option to adequately feed patients in whom enteral nutrition is insufficient or impossible.
Collapse
|
36
|
Bahr MJ, Boeker KHW, Manns MP, Tietge UJF. Decreased hepatic RBP4 secretion is correlated with reduced hepatic glucose production but is not associated with insulin resistance in patients with liver cirrhosis. Clin Endocrinol (Oxf) 2009; 70:60-5. [PMID: 18466349 DOI: 10.1111/j.1365-2265.2008.03295.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Patients with liver cirrhosis have a high incidence of insulin resistance and diabetes. This study was designed to determine circulating levels and hepatic production of retinol-binding protein 4 (RBP4) in relation to parameters of hepatic and systemic metabolism in patients with liver cirrhosis. DESIGN AND METHOD Circulating RBP4 levels were measured in 19 patients with liver cirrhosis at different clinical stages of the disease and in 20 age-, sex- and body mass index (BMI)-matched controls. Hepatic production rates of RBP4 and glucose were assessed by measuring the arterial hepatic venous concentration difference together with hepatic blood flow. Insulin resistance was determined by the Quantitative Insulin Sensitivity Check Index (QUICKI) and the homeostasis model assessment of insulin resistance (HOMA-IR), energy expenditure by indirect calorimetry and body composition by bioelectrical impedance analysis (BIA). RESULTS Compared with controls, RBP4 levels in cirrhosis were decreased (8.1 +/- 1.8 vs. 22.6 +/- 2.4 mg/l, P < 0.001) due to decreased hepatic production (P < 0.05). RBP4 correlated with hepatic protein synthesis capacity (P < 0.01), but not with insulin resistance, energy expenditure, BMI or body fat mass. Plasma RBP4 correlated with hepatic glucose production (P < 0.05). CONCLUSIONS These data demonstrate that RBP4 in cirrhosis (i) is decreased due to reduced hepatic production, (ii) is not associated with insulin resistance, and (iii) might have a beneficial role by decreasing hepatic glucose production and could thus also be regarded as a hepatokine.
Collapse
Affiliation(s)
- Matthias J Bahr
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany
| | | | | | | |
Collapse
|
37
|
Chen W, Wong T, Tomlinson G, Krahn M, Heathcote EJ. Prevalence and predictors of obesity among individuals with positive hepatitis C antibody in a tertiary referral clinic. J Hepatol 2008; 49:711-7. [PMID: 18619698 DOI: 10.1016/j.jhep.2008.05.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Revised: 04/02/2008] [Accepted: 05/11/2008] [Indexed: 12/26/2022]
Abstract
BACKGROUND/AIMS To determine the prevalence of obesity and investigate factors associated with obesity in a hepatitis C antibody positive clinic population. METHODS We reviewed 3505 patient records (1990-2006) from a liver clinic in Toronto. We used regression analysis to explore factors associated with obesity. We compared the prevalence of obesity among propensity matched patients by hepatitis C ribonucleic acid status. RESULTS Patients (1118) met inclusion criteria. The prevalence of obesity in this clinic population was 28.8%. In multiple regression analyses, older age (odds ratio 1.02; 95% confidence interval 1.00-1.04) and a positive hepatitis C ribonucleic acid test (odds ratio 1.80; 95% confidence interval 1.11-2.92) were independently associated with obesity. In the analysis comparing 112 propensity matched pairs, the prevalence of obesity was significantly higher among hepatitis C ribonucleic acid positive patients than in matched patients who tested negative (32.1% vs. 18.8%; p=0.02). Supplemental analysis by excluding patients with probable fatty liver disease strengthened the association between hepatitis C viremia and obesity. CONCLUSIONS Hepatitis C viremia may be associated with an increased prevalence of obesity observed in a tertiary referral clinic for hepatitis C.
Collapse
Affiliation(s)
- Wendong Chen
- Department of Health Policy, Management and Evaluation, University of Toronto, Toronto Western Hospital, Toronto, Ont, Canada M5T 2S8
| | | | | | | | | |
Collapse
|
38
|
Veldt BJ, Chen W, Heathcote EJ, Wedemeyer H, Reichen J, Hofmann WP, de Knegt RJ, Zeuzem S, Manns MP, Hansen BE, Schalm SW, Janssen HLA. Increased risk of hepatocellular carcinoma among patients with hepatitis C cirrhosis and diabetes mellitus. Hepatology 2008; 47:1856-62. [PMID: 18506898 DOI: 10.1002/hep.22251] [Citation(s) in RCA: 206] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
UNLABELLED Recent studies suggest that diabetes mellitus increases the risk of developing hepatocellular carcinoma (HCC). The aim of this study is to quantify the risk of HCC among patients with both diabetes mellitus and hepatitis C in a large cohort of patients with chronic hepatitis C and advanced fibrosis. We included 541 patients of whom 85 (16%) had diabetes mellitus. The median age at inclusion was 50 years. The prevalence of diabetes mellitus was 10.5% for patients with Ishak fibrosis score 4, 12.5% for Ishak score 5, and 19.1% for Ishak score 6. Multiple logistic regression analysis showed an increased risk of diabetes mellitus for patients with an elevated body mass index (BMI) (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.00-1.11; P = 0.060) and a decreased risk of diabetes mellitus for patients with higher serum albumin levels (OR, 0.81; 95% CI, 0.63-1.04; P = 0.095). During a median follow-up of 4.0 years (interquartile range, 2.0-6.7), 11 patients (13%) with diabetes mellitus versus 27 patients (5.9%) without diabetes mellitus developed HCC, the 5-year occurrence of HCC being 11.4% (95% CI, 3.0-19.8) and 5.0% (95% CI, 2.2-7.8), respectively (P = 0.013). Multivariate Cox regression analysis of patients with Ishak 6 cirrhosis showed that diabetes mellitus was independently associated with the development of HCC (hazard ratio, 3.28; 95% CI, 1.35-7.97; P = 0.009). CONCLUSION For patients with chronic hepatitis C and advanced cirrhosis, diabetes mellitus increases the risk of developing HCC.
Collapse
Affiliation(s)
- Bart J Veldt
- Erasmus MC University Medical Center, Department of Gastroenterology and Hepatology, Rotterdam, the Netherlands
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Kim PK, Kim MR, Kim HJ, Yoo HS, Kim JS, Cho EH, Kim CW. Proteome analysis of the rat hepatic stellate cells under high concentrations of glucose. Proteomics 2007; 7:2184-8. [PMID: 17549797 DOI: 10.1002/pmic.200700051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
To study the change in hepatic stellate cell (HSC) function under diabetic conditions, we cultured rat HSC in the presence of 5 and 30 mM glucose, which correspond to blood glucose concentrations during the early and late stages of diabetes, respectively. The differentially expressed HSC proteins were analyzed using 2-DE and ESI-Q-TOF MS/MS and confirmed with Western blotting. The changed protein expression will provide greater understanding of glycolysis in HSC at the high concentration of glucose.
Collapse
Affiliation(s)
- Pan-Kyeom Kim
- School of Life Sciences and Biotechnology, Korea University, Seoul, Korea
| | | | | | | | | | | | | |
Collapse
|
40
|
Nickkholgh A, Schneider H, Encke J, Büchler MW, Schmidt J, Schemmer P. PROUD: effects of preoperative long-term immunonutrition in patients listed for liver transplantation. Trials 2007; 8:20. [PMID: 17723147 PMCID: PMC2018725 DOI: 10.1186/1745-6215-8-20] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Accepted: 08/27/2007] [Indexed: 01/27/2023] Open
Abstract
Background Patients with end stage liver disease are characteristically malnourished which is associated with poor outcome. Formulas enriched with arginine, ω-3 fatty acids, and nucleotides, "immunonutrients", potentially improve their nutritional status. This study is designed to evaluate the clinical outcome of long-term "immunonutrition" of patients with end-stage liver disease while on the waiting list for liver transplantation. Methods/design A randomized controlled double blind multi-center clinical trial with two parallel groups comprising a total of 142 newly registered patients for primary liver transplantation has been designed to assess the safety and efficacy of the long-term administration of ORAL IMPACT®, an "immunonutrient" formula, while waiting for a graft. Patients will be enrolled the day of registration on the waiting list for liver transplantation. Study ends on the day of transplantation. Primary endpoints include improved patients' nutritional and physiological status, as measured by mid-arm muscle area, triceps skin fold thickness, grip strength, and fatigue score, as well as patients' health related quality of life. Furthermore, patients will be followed for 12 postoperative weeks to evaluate anabolic recovery after transplantation as shown by reduced post-transplant mechanical ventilation, hospital stay, wound healing, infectious morbidities (pneumonia, intraabdominal abscess, sepsis, line sepsis, wound infection, and urinary tract infection), acute and chronic rejection, and mortality. Discussion Formulas enriched with arginine, ω-3 fatty acids, and nucleotides have been proven to be beneficial in reducing postoperative infectious complications and length of hospital stay among the patients undergoing elective gastrointestinal surgery. Possible mechanisms include downregulation of the inflammatory responses to surgery and immune modulation rather than a sole nutritional effect. Trial registration ClinicalTrials.gov NCT00495859
Collapse
Affiliation(s)
- Arash Nickkholgh
- Department of General Surgery, Ruprecht-Karls University, Heidelberg, Germany
| | | | - Jens Encke
- Department of Internal Medicine, Ruprecht-Karls University, Heidelberg, Germany
| | - Markus W Büchler
- Department of General Surgery, Ruprecht-Karls University, Heidelberg, Germany
| | - Jan Schmidt
- Department of General Surgery, Ruprecht-Karls University, Heidelberg, Germany
| | - Peter Schemmer
- Department of General Surgery, Ruprecht-Karls University, Heidelberg, Germany
| |
Collapse
|
41
|
Buyse S, Valla D. [Carbohydrate metabolism dysregulation in cirrhosis: pathophysiology, prognostic impact and therapeutic implications]. ACTA ACUST UNITED AC 2007; 31:266-73. [PMID: 17396083 DOI: 10.1016/s0399-8320(07)89371-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The liver plays a key-role in carbohydrates metabolism. Glucose intole-rance, overt diabetes mellitus and insulin resistance are characteristic features of patients with cirrhosis. Central hyperinsulinemia and peripheral insulin-resistance are the main explanations for the high prevalence of diabetes in patients with cirrhosis. On the other hand, type 2 diabetes is associated with a wide spectrum of liver diseases ranging from nonalcoholic fatty liver to cirrhosis and hepatocellular carcinoma. Carbohydrate metabolism abnormalities are a major aggravating risk factor in cirrhosis. Diabetes is also an independent negative prognostic factor in cirrhotic patients. This leads to specific diagnostic procedures and therapeutic issues. Patients with diabetes and liver disease frequently need insulin treatment. The presence of liver disease makes the treatment of diabetes complex, and additional research is needed to determine the best treatment strategies in these patients.
Collapse
Affiliation(s)
- Sophie Buyse
- Fédération d'Hépato-Gastroentérologie Médico-Chirurgicale, Hôpital Beaujon, Clichy
| | | |
Collapse
|
42
|
Plauth M, Merli M, Kondrup J, Weimann A, Ferenci P, Müller MJ. ESPEN guidelines for nutrition in liver disease and transplantation. Clin Nutr 2007; 16:43-55. [PMID: 16844569 DOI: 10.1016/s0261-5614(97)80022-2] [Citation(s) in RCA: 212] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- M Plauth
- IV. Medizinische Klinik, Klinikum Charitéder Humboldt Universität, D-10098 Berlin, Germany
| | | | | | | | | | | |
Collapse
|
43
|
Nomiyama Y, Tashiro M, Yamaguchi T, Watanabe S, Taguchi M, Asaumi H, Nakamura H, Otsuki M. High glucose activates rat pancreatic stellate cells through protein kinase C and p38 mitogen-activated protein kinase pathway. Pancreas 2007; 34:364-72. [PMID: 17414061 DOI: 10.1097/mpa.0b013e31802f0531] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Hyperglycemia is implicated in fibrosis in many organs. Exocrine and endocrine pancreas are closely linked both anatomically and physiologically, and pathological conditions in the exocrine gland can cause impairment of endocrine function and vice versa. Chronic pancreatitis causes pancreatic fibrosis and sometimes results in diabetes mellitus. Pancreatic stellate cells (PSCs) play a pivotal role in pancreatic fibrogenesis. However, the effects of high glucose concentrations on PSC activation have not been fully elucidated. METHODS Cultured PSCs were incubated in the presence of various concentrations of glucose. Pancreatic stellate cell proliferation, alpha-smooth muscle actin (alpha-SMA) expression, and collagen production were determined by colorimetric conversion assay, Western blot analysis, and Sirius red dye binding assay, respectively. RESULTS High glucose concentrations significantly increased PSC proliferation, alpha-SMA expression, and collagen type I production in PSCs. High glucose concentrations activated protein kinase C (PKC) in PSCs, and PKC inhibitor GF109203X inhibited glucose-stimulated PSC proliferation, alpha-SMA expression, and collagen secretion. High glucose also activated p38 mitogen-activated protein kinase (MAPK) in PSCs, and p38 MAPK inhibitor SB203580 inhibited glucose-stimulated collagen secretion. CONCLUSIONS Our results indicate that high glucose concentrations stimulate PSC activation via PKC-p38 MAP kinase pathway and suggest that high glucose may aggravate pancreatic fibrosis.
Collapse
Affiliation(s)
- Yoko Nomiyama
- Third Department of Internal Medicine, University of Occupational and Environmental Health, Japan, School of Medicine, Kitakyushu, Japan
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Matsumoto D, Yamanaka-Okumura H, Arai H, Sakuma M, Yamamoto H, Taketani Y, Tani Y, Morine Y, Shimada M, Takeda E. Nutritional treatment of a patient with hepatic cirrhosis with the novel low glycemic index liquid food (Inslow). THE JOURNAL OF MEDICAL INVESTIGATION 2007; 54:375-80. [PMID: 17878691 DOI: 10.2152/jmi.54.375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
A sixty-six year-old patient with liver cirrhosis and diabetes was nutritionally treated by administration of the low glycemic index liquid food (Inslow) as a late evening sack (LES) for 6 weeks. The mean energy intake increased from 825+/-48 kcal/d to 1567+/-66 kcal/d after the 6-week treatment period. The fasting glucose level did not change, remaining at about 100 mg/dl throughout this period. Interestingly, the amount of insulin administered was reduced from 38 units before treatment to 28 units in the fifth week of treatment without a change in the fasting glucose level. This indicates a marked improvement in insulin sensitivity due to Inslow administration in this patient. In conclusion, the long-term administration of Inslow as an LES may be an effective treatment for cirrhotic patients.
Collapse
Affiliation(s)
- Dai Matsumoto
- Department of Clinical Nutrition, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Jessen N, Buhl ES, Schmitz O, Lund S. Impaired insulin action despite upregulation of proximal insulin signaling: novel insights into skeletal muscle insulin resistance in liver cirrhosis. J Hepatol 2006; 45:797-804. [PMID: 17046094 DOI: 10.1016/j.jhep.2006.07.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2006] [Revised: 07/24/2006] [Accepted: 07/25/2006] [Indexed: 12/27/2022]
Abstract
BACKGROUND/AIMS Disturbance in glucose metabolism is a common feature in liver diseases and this is associated with skeletal muscle insulin resistance. However, the underlying molecular mechanisms are unclear. To characterize skeletal muscle insulin resistance associated with liver disease, we examined muscles from animals after an acute, 5 weeks perturbation of the common bile duct. Clinical findings, elevated plasma levels of liver enzymes and histological examinations confirmed cirrhosis. METHODS/RESULTS : Cirrhotic animals were insulin resistant and this was associated with reduced glucose transport into muscles. Interestingly, activity in the proximal part of the insulin signaling cascade was not decreased, as evinced by increased activity of key enzymes in the signal to glucose transport. Expression of the glucose transporter, GLUT4, was normal. So together these results indicate that signaling downstream of PKB/Akt and/or the translocation of GLUT4 is impaired in skeletal muscle from cirrhotic animals. CONCLUSIONS In conclusion, in an animal model of liver cirrhosis whole body insulin resistance is associated with insulin resistance in skeletal muscles. Unlike other common forms of insulin resistance, muscles from cirrhotic animals have increased activity in the proximal insulin signaling cascade. This emphasizes the fact that skeletal muscle insulin resistance associated with liver cirrhosis is a unique entity.
Collapse
Affiliation(s)
- Niels Jessen
- Medical Research Laboratory and Medical Department M (Endocrinology and Diabetes), Aarhus University Hospital, Aarhus Sygehus (NBG), DK-8000 Aarhus C, Denmark.
| | | | | | | |
Collapse
|
46
|
Bahr MJ, Ockenga J, Böker KHW, Manns MP, Tietge UJF. Elevated resistin levels in cirrhosis are associated with the proinflammatory state and altered hepatic glucose metabolism but not with insulin resistance. Am J Physiol Endocrinol Metab 2006; 291:E199-206. [PMID: 16478779 DOI: 10.1152/ajpendo.00291.2005] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The adipokine resistin has been implicated in obesity and insulin resistance. Liver cirrhosis is associated with decreased body fat mass and insulin resistance. We determined plasma resistin levels in 57 patients with cirrhosis, 13 after liver transplantation, and 30 controls and correlated these with hemodynamic as well as hepatic and systemic metabolic parameters. Patients with cirrhosis had, dependent on the clinical stage, an overall 86% increase in resistin levels (P < 0.001) with hepatic venous resistin being higher than arterial levels (P < 0.001). Circulating resistin was significantly correlated with plasma TNF-alpha levels (r = 0.62, P < 0.001). No correlation was observed between resistin and hepatic hemodynamics, body fat mass, systemic energy metabolism, and the degree of insulin resistance. However, plasma resistin in cirrhosis was negatively associated with hepatic glucose production (r = -0.47, P < 0.01) and positively with circulating free fatty acids (FFA; r = 0.40, P < 0.01) and ketone bodies (r = 0.48, P < 0.001) as well as hepatic ketone body production (r = 0.40, P < 0.01). After liver transplantation, plasma resistin levels remained unchanged, whereas insulin resistance was significantly improved (P < 0.01). These data provide novel insights into the role of resistin in the pathophysiological background of a catabolic disease in humans and also indicate that resistin inhibition may not represent a suitable therapeutic strategy for the treatment of insulin resistance and diabetes in patients with liver cirrhosis.
Collapse
Affiliation(s)
- Matthias J Bahr
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Germany
| | | | | | | | | |
Collapse
|
47
|
Krag A, Simonsen L, Henriksen JH, Ottesen L, Bendtsen F. Effect of meal and propranolol on whole body and splanchnic oxygen consumption in patients with cirrhosis. Am J Physiol Gastrointest Liver Physiol 2006; 291:G8-15. [PMID: 16500921 DOI: 10.1152/ajpgi.00315.2005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Our aim was to measure whole body energy expenditure after a mixed liquid meal, with and without simultaneous propranolol infusion, in patients with cirrhosis. We also wanted to investigate the effect of propranolol on substrate fluxes and oxygen uptake in the tissues drained by the hepatic vein and azygos vein in the postprandial period in these patients. Whole-body oxygen uptake, hepatic blood flow, hepatic venous pressure gradient and net-hepatic fluxes of oxygen, lactate, glucose, glycerol, and free fatty acids (FFA) were measured in 12 patients with alcoholic cirrhosis before and for 2 h after ingestion of a mixed liquid meal (700 kcal). Half of the patients (n = 6) were randomized to a treatment group receiving intravenous infusion of propranolol in combination with the meal. The meal-induced energy expenditure was significantly lower in patients given propranolol [15.0 +/- 18.9 vs. 67.0 +/- 26.1 kJ/120 min (means +/- SD), P < 0.01]. Meal-induced whole body oxygen uptake was lower in patients receiving propranolol (19.2 +/- 38 vs. 135.7 +/- 61 mmol/120 min, P < 0.01), and the meal-induced increase in splanchnic oxygen uptake was nonexistent when propranolol was administered in combination (-13.2 +/- 34.8 vs. 110.4 +/- 34.8 mmol/120 min, P = 0.04). Postprandially, the propranolol group had a tendency toward a reduced splanchnic glucose output, and the FFA uptake was significantly reduced. Propranolol reduces meal-induced whole body oxygen uptake and energy expenditure as well as splanchnic oxygen uptake. The splanchnic reduction in oxygen consumption can explain almost the entire reduction in whole body oxygen consumption.
Collapse
Affiliation(s)
- Aleksander Krag
- Department of Gastroenterology, Hvidovre Hospital, Kettegaard Allé 30, 2650 Hvidovre, Denmark.
| | | | | | | | | |
Collapse
|
48
|
Abstract
1. Diabetes mellitus is common in patients with cirrhosis; patients with DM undergoing liver transplantation often have many other co-morbid illnesses including obesity, coronary artery disease (CAD), autonomic neuropathy, gastroparesis, and nephropathy. 2. Long-term survival of patients with diabetes mellitus (DM) is significantly lower and morbidity higher when compared to non-diabetics mainly because of cardiovascular complications, infections, and renal failure. 3. Obesity, CAD, and renal failure are confounding factors that result in poor patient survival. 4. Patients with DM should undergo careful cardiovascular diagnostic work up, including routine coronary arteriogram, and necessary interventions before liver transplantation. This is especially important in those over 50 years old, and in those with retinopathy, nephropathy, and neuropathy. 5. Patients with coronary artery disease that is not amenable to surgery or stents, and those with impaired left ventricular function, should not be considered for liver transplantation. Other relative or absolute contraindications are those with proteinura and renal failure who are not candidates for combined liver/kidney transplantation, those with severe gastroparesis, especially when it is associated with diabetic autonomic neuropathy, and those with two or more risk factors such as CAD, morbid obesity, and renal failure. 6. Future studies should focus on risk stratification of patients with DM undergoing liver transplantation and better interventions to reduce the risk of diabetic complications before and after liver transplantation.
Collapse
Affiliation(s)
- Paul J Thuluvath
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
| |
Collapse
|
49
|
Sugimoto R, Enjoji M, Kohjima M, Tsuruta S, Fukushima M, Iwao M, Sonta T, Kotoh K, Inoguchi T, Nakamuta M. High glucose stimulates hepatic stellate cells to proliferate and to produce collagen through free radical production and activation of mitogen-activated protein kinase. Liver Int 2005; 25:1018-26. [PMID: 16162162 DOI: 10.1111/j.1478-3231.2005.01130.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Nonalcoholic steatohepatitis is a clinicopathologic condition that may progress to liver fibrosis. Hyperglycemia is supposed to be one of the factors inducing hepatic fibrogenesis, but the mechanism has not been fully clarified. Oxidative stress is increasingly found in patients with diabetes/hyperglycemia in which conditions reactive oxygen species (ROS) are produced. METHODS We performed experiments using hepatic stellate cells (HSCs) in culture in order to confirm the effect of high glucose concentrations on cell proliferation, type I collagen production, ROS production and activation of mitogen-activated protein (MAP) kinase pathway. RESULTS High glucose stimulated cell growth of HSCs and up-regulated the levels of activated/phosphorylated extracellular signal-regulated kinase 1/2 and free radical production in HSCs. The MAP kinase phosphorylation and cell proliferation were suppressed by diphenylene iodonium chloride, an NADPH oxidase inhibitor, and by calphostin C, a protein kinase C (PKC)-specific inhibitor. Increased type I collagen mRNA and protein levels were also observed in HSCs at high glucose concentrations. CONCLUSIONS Our findings indicate that high glucose concentrations may stimulate ROS production through PKC-dependent activation of NADPH oxidase, and induce MAP kinase phosphorylation subsequent to proliferation and type I collagen production by HSCs.
Collapse
Affiliation(s)
- Rie Sugimoto
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka 812-8582, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Tietge UJF, Selberg O, Kreter A, Bahr MJ, Pirlich M, Burchert W, Müller MJ, Manns MP, Böker KHW. Alterations in glucose metabolism associated with liver cirrhosis persist in the clinically stable long-term course after liver transplantation. Liver Transpl 2004; 10:1030-40. [PMID: 15390330 DOI: 10.1002/lt.20147] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
With increasing long-term survival rates after orthotopic liver transplantation (OLT), metabolic alterations complicating the clinical course, such as diabetes mellitus (DM), become increasingly important. Liver cirrhosis is associated with severe alterations in glucose metabolism. However, it is currently unclear whether these changes are reversed by successful OLT. We therefore characterized glucose metabolism in patients with liver cirrhosis and normal fasting glucose levels before OLT (cir), in the clinically stable long-term course after OLT (OLT), and control subjects (con) using oral glucose tolerance tests (cir = 100, OLT = 62, con = 32), euglycemic-hyperinsulinemic clamps (cir = 10, OLT = 27, con = 14), and positron emission tomography (PET) scan analysis with 18F-fluorodeoxyglucose (FDG) as a tracer (cir = 7, OLT = 7, con = 5). Fasting insulin and C-peptide levels were significantly elevated in patients with liver cirrhosis compared with both control subjects (P <.001) and patients after OLT (P <.001). After OLT, insulin was normalized, whereas C-peptide remained elevated (P < 0.01). In the patients with liver cirrhosis, 27% had a normal glucose tolerance, 38% had an impaired glucose tolerance (IGT), and 35% were diabetic. After OLT, 34% had a normal glucose tolerance, 29% an IGT, and 37% were diabetic. Comparison of the same patients before and after OLT demonstrated that IGT or diabetes before OLT was the major risk factor for these conditions after OLT, which was independent of either immunosuppression (cyclosporine vs FK506) or low-dose prednisolone. Total glucose uptake was reduced in patients with liver cirrhosis to less than half the values in control subjects (21.2 +/- 2.8 vs 43.7 +/- 2.4 micromol/kg/minute, respectively, P <.001), whereas patients after OLT showed intermediate values (35.7 +/- 1.4 micromol/kg/minute, P < 0.05 vs con, P < 0.01 vs cir). This difference was caused by a reduction in nonoxidative glucose metabolism in patients with liver cirrhosis compared with control subjects (7.4 +/- 1.9 vs 28.7 +/- 1.8 micromol/kg/minute, respectively, P <.01) and patients after OLT (20.1 +/- 1.4 micromol/kg/minute, P < 0.05 vs con and OLT). In the PET study, skeletal muscle glucose uptake was significantly reduced in patients with liver cirrhosis compared with control subjects (3.5 +/- 0.4 vs 11.8 +/- 2.5 micromol/100g/minute, respectively, P <.05). After OLT, muscle glucose uptake improved compared with patients with liver cirrhosis (5.9 +/- 1.0 micromol/100g/minute, P <.05) but remained significantly lower than in control subjects (P <.05). In conclusion, these results demonstrate that preexisting IGT or diabetes are the major risk factors for IGT and diabetes after OLT. This finding was independent of the immunosuppressive medication. The peripheral insulin resistance in cirrhosis is characterized by a decrease in nonoxidative glucose disposal that is improved, but not normalized, after OLT.
Collapse
Affiliation(s)
- Uwe J F Tietge
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|