[Differential diagnosis of diabetic and alcoholic fatty liver. Studies on 171 diabetics and 100 patients with alcohol abuse]

gamma-Glutamyl-transpeptidase in diabetics: a case control study

Several investigators have reported high levels of gamma-glutamyl-transpeptidase (GGT) in the diabetic population. Therefore, we undertook a study to see the prevalence of 'isolated' high GGT in a large population of diabetics without chronic liver disease (CLD), as compared to an age- and sex-matched control group of non-diabetic subjects without CLD, and the role of extrahepatic factors in 'isolated' high GGT, as possible etiopathogenetic causes. We selected 351 diabetics with normal hepatologic screening, without echographic abnormalities of the hepatic parenchyma or the biliary tract. Age, duration and therapy of diabetes, body mass index (BMI), alcohol consumption, glycosylated hemoglobin (HbA1), and the presence of hepatitis B virus (HBV) were studied to see if they are related to high GGT. The control group included 260 age- and sex-matched non-diabetic subjects. We did not find any significant difference between diabetics and the control group in the prevalence of high GGT (mean: 17.5% vs. 23%; women: 16% vs. 14.5%). Multiple regression analysis showed that alcohol consumption plays the major role in the high GGT of both men and women.

Role of hepatitis B virus infection in chronic liver disease of diabetic patients: a case-control study

In the literature there is no agreement on the prevalence of chronic liver disease (CLD) and the role of hepatitis B virus (HBV) infection in diabetics. We undertook an epidemiological case-control study of the prevalence of CLD and HBV infection in 394 diabetics and 265 healthy subjects from Seriate and Como. The results did not show any significant differences between: 1) the prevalence of CLD in the diabetic population and in controls (4.8% vs 4.5%); 2) the prevalence of HBV infection in diabetics (HBsAg+: 8.3%; HBVAb+: 55.8%) and in controls (HBsAg+: 8.6%; HBVAb+: 54.7%); 3) the prevalence of HBV infection in diabetics with CLD (HBsAg+: 21%; HBVAb+: 52.6%) and in controls with CLD (HBsAg+: 16.6%; HBVAb+: 50%); 4) the prevalence of HBV infection in diabetics with and without CLD (HBsAg+: 21% vs 7.7%; HBVAb+: 52.6% vs 56%); 5) the prevalence of HBV infection in diabetics treated by injection and orally (HBsAg+: 6.9% vs 8.6%; HBVAb+: 58.3% vs 55.2%). The relative risk of CLD for the factor HBsAg+ was 3.2 in the diabetic population vs 1.4 in controls. In view of the presence of antidelta antibodies (HDVAb) in 25% of HBsAg+ diabetics with CLD and the lack of HBV markers in 26.3% of diabetics with CLD, we assume that other viruses (Delta, nonA-nonB) may play roles. Probably the interaction of all possible etiopathogenetic factors (alcohol, viruses, glycometabolic derangement) is determinant for CLD in diabetics.

Abnormal mitochondria in hepatocytes in human fatty liver

Liver biopsies from fatty livers in thirty patients whose daily alcohol consumption was excessive, or they were in a diabetic state or overweight, and liver biopsies from seven control patients not presenting the above disorders, were studied by light microscopy 0.75 micronm EPON embedded, toluidine blue stained sections, and electron microscopy. Abnormal mitochondria were rarely found in normal liver tissue and, if present, they were found only in periportal hepatocytes. The frequency of hepatocytes containing abnormal mitochondria was significantly higher in fatty liver than in normal liver (p less than 0.01). These cells were usually localized periportally, practically never in the centre of the lobule (p less than 0.01). The occurrence of abnormal mitochondria was not correlated with the degree of steatosis, and the increase in number of abnormal mitochondria was equally high in alcoholists, diabetics, and overweight subjects. The ultrastructural appearance and the periportal localization suggest a hyperfunction of the mitochondria, which may prevent a development of steatosis in these areas.

Fatty liver in patients with moderate alcohol consumption, diabetes mellitus and overweight

A relationship between the occurrence of fatty liver and moderate alcohol intake, maturity onset diabetes, overweight--and combinations of these three factors--was searched for in 112 patients. Fifty-three of 59 patients with moderate alcohol consumption, 49 of 57 overweight patients, and 42 of 51 diabetic patients had fatty liver. Patients who had a moderate alcohol consumption or suffered from a combination of diabetes and overweight were found to have a significantly higher frequency and degree of fatty liver than patients in the control group. Diabetes alone, and overweight alone were not significantly related to fatty liver. Whether the diabetic state was overt of latent, there was no influence on the frequency or degree of fatty liver. A correlation between the degree of overweight and the degree of fatty liver was found only in the group of overweight patients with moderate alcohol consumption. The degree of fatty liver produced by the combination of overweight and diabetes was not significantly increased by moderate alcohol consumption.

[The karyogram of normal and of fatty livers in man (author's transl)]

The karyomgrams of normal human livers (50 biopsides from patients of varied age) and of fatty livers (350 biopsies from patients with diabetes, alcoholism, and fatty cirrhosis) were investigated. The nuclear diameters were measured with an analyzer of particle size--the "TGZ-3 Zeiss"--, the cut surface of the nuclei was determined and the nuclei categorized accordingly. 1. The normal liver in each age group is characterized by a well-defined nuclear pattern that is specific for this organ. In the 3rd decade nuclei of the main class predominate. In later decades 2 classes of large nuclei gradually appear and reach their mximum after the 50th year. In the 7th decade a reduction of the cut nuclear surface takes place in all the categoreis, presumably determined by a reduction of function. 2. The increase in the number of large nuclei is explained by abortive karyokineses which in the course of the normal turnover of cells ("Zellmauserung"), increasingly replace normal mitoses. This is This is attributed to disturbances of the achromatic apparatus that occur with increasing age. 3. Alcoholic, and even more so diabetic, fatty change leads to the formation of particularly large nuclei. This appears to depend on the volume of the individual fat droplet within the individual cell rather than on the degree of fatty change of the whole liver. 4...