Nonalcoholic fatty liver disease-related cardiovascular risk: Is there an association with blood hemoglobin levels?

The interactive effects of non-alcoholic fatty liver disease and hemoglobin concentration in the first trimester on the development of gestational diabetes mellitus

Gestational diabetes mellitus (GDM) is associated with adverse perinatal and maternal outcomes. Epidemiological studies have reported that non-alcoholic fatty liver disease (NAFLD) and a high hemoglobin (Hb) concentration are risk factors for GDM in the middle trimester. However, no consistent conclusions have been reached, especially in Chinese pregnant women. A case-control study was conducted to better understand the associations between NAFLD and Hb concentration in the first trimester and the risk of GDM and their interactive effects. Multivariable logistic regression analysis and a cross-product term of Hb and steatosis were used to evaluate the associations between first trimester Hb concentration, steatosis, and GDM and their interactive effects. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using two-sided statistical tests at an alpha level of 0.05. For the study, 1,017 normal pregnant women, and 343 pregnant women diagnosed with GDM (25.22%) were recruited from the First Hospital of Shanxi Medical University, Shanxi Province, China. NAFLD-associated steatosis was found to be independent risk factors for developing GDM compared with grade 0 steatosis, with ORs of 1.98 (95% CI: 1.35–2.89) and 2.27 (95% CI:1.29–3.96), respectively. Meanwhile, a high Hb concentration was found to be a risk factor for developing GDM compared with the normal Hb concentration (OR = 1.88; 95% CI:1.24–2.83). The risk of developing GDM was more pronounced among pregnant women who had both high-grade steatosis and higher Hb concentrations during their first trimester (OR = 6.24; 95% CI: 1.81–23.66). However, we found no significant interactions between Hb concentration and steatosis grade. In conclusion, our study confirmed that a high Hb concentration and NAFLD-associated steatosis during the first trimester play important roles in predicting the risk of GDM in Chinese women. Future studies are required to verify the interactive effects between NAFLD-associated steatosis and Hb concentration.

Association between hemoglobin levels and non-alcoholic fatty liver disease in patients with young-onset type 2 diabetes mellitus

This retrospective study aimed to investigate the relationship between hemoglobin (Hb) levels and non-alcoholic fatty liver disease (NAFLD) in patients with young-onset type 2 diabetes mellitus (T2DM). Data were collected for 296 patients with young-onset T2DM admitted to the first Affiliated Hospital of Guangxi Medical University from May 2017 to January 2020. Subjects were divided into NAFLD (n = 186) and non-NAFLD groups (n = 110). Patients with NAFLD had significantly higher Hb levels (p = 0.001). According to logistic regression analysis, Hb levels were significantly correlated with NAFLD after adjusting for confounding factors [odds ratio (OR) = 1.024, 95% confidence interval = 1.003-1.046, p = 0.028]. Subjects were also grouped according to Hb quartiles. After adjusting for sex and body mass index (BMI), the OR (95%CI) for NAFLD significantly increased with increasing Hb levels (p for trend = 0.009). Patients were also divided into lean (BMI <25 kg/m², n = 139) and overweight/obese groups (BMI ≥25 kg/m², n = 157), with adjusted ORs (95%CI) for the highest quartiles of 1.797 (0.559-5.776) and 6.009 (1.328-27.181), respectively. Further quartile classification of Hb according to sex showed adjusted OR (95%CI) for the highest compared with the lowest quartile of 2.796 (1.148-6.814) for males and 2.945 (0.482-17.997) for females. In conclusion, high Hb levels were associated with the presence of NAFLD in patients with young-onset T2DM, especially in males and overweight/obese patients.

Association between Hemoglobin Levels and Colorectal Polyps in Asymptomatic Chinese Adults

Methods

A cross-sectional analysis was performed among 1633 asymptomatic adults who underwent colonoscopy examinations during routine health check-ups at the First Affiliated Hospital, College of Medicine, Zhejiang University, between 2015 and 2018.

Results

A total of 449 (27.50%) participants were diagnosed with colorectal polyps, and those with colorectal polyps had significantly higher hemoglobin levels than did those without colorectal polyps. Hemoglobin levels were positively associated with the prevalence of colorectal polyps, with rates of 16.43%, 26.20%, 32.17%, and 35.87% among participants with hemoglobin levels in the first, second, third, and fourth quartiles, respectively (P for trend < 0.001). Stepwise multiple regression analysis showed that elevated hemoglobin levels independently increased the risk of colorectal polyps (odd ratio = 1.017; 95% confidence interval: 1.008–1.026).

Conclusion

Elevated hemoglobin levels were significantly and independently associated with the prevalence and risk of colorectal polyps in asymptomatic adults.

Iron Status and Metabolically Unhealthy Obesity in Prepubertal Children

OBJECTIVE

This study aimed to evaluate the association of metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) with iron status markers in prepubertal children.

METHODS

Three hundred twelve prepubertal children with overweight and obesity from a pediatric general Spanish population were evaluated. MHO and MUO were defined as obesity with the absence or presence of metabolic syndrome components. Phenotypes of metabolically healthy overweight including obesity (MHOV) and metabolically unhealthy overweight including obesity (MUOV) were also studied and defined using the same criteria. Serum ferritin, transferrin, and blood hemoglobin levels were evaluated.

RESULTS

Prevalence rates of MHOV and MHO were 35% (n = 111/312) and 27.1% (n = 42/155), respectively. Ferritin and hemoglobin levels were higher in children with MUOV versus MHOV (P < 0.05). MUO was positively associated with ferritin (beta [95% CI] = 0.43 [0.05 to 0.81]) and hemoglobin levels (0.43 [0.05 to 0.81]). These associations remained significant independently of age, sex, C-reactive protein, physical activity, and BMI/waist z scores in bivariate linear regression models. In multivariable models, transaminase levels attenuated the association of MUO with ferritin and hemoglobin levels (P > 0.05).

CONCLUSIONS

MUOV and MUO are associated with higher ferritin and hemoglobin levels in prepubertal children affected by overweight and obesity. Increased circulating ferritin in MUO might be influenced by liver injury.

Association Between Serum Hemoglobin Levels and Non Alcoholic Fatty Liver Disease in a Mexican Population

INTRODUCTION AND AIM

Nonalcoholic fatty liver disease (NAFLD) is closely associated with overweight and obesity, becoming one of the most prevalent hepatic diseases nowadays. Circulating hemoglobin (Hb) concentration is significantly higher in people with NAFLD, compared to healthy patients. While liver biopsy remains the gold standard for NAFLD diagnosis, it is not the best technique due to adverse events that may occur. Therefore it is important to find less invasive and more sensitive markers. This study aimed to determine the association of serum Hb levels in patients with steatosis and fibrosis as a noninvasive marker.

MATERIAL AND METHODS

A 1,186 patient cross-sectional study nested in a randomized clinical trial (NCT01874249) was conducted. Patients were diagnosed by ultrasound for hepatic steatosis and fibroscan for fibrosis; blood test and anthropometric measurements were also assessed.

RESULTS

Serum Hb increased proportionally related to the steatosis level, being significantly higher in patients with severe steatosis than in patients with moderate and mild steatosis.

CONCLUSION

Patients with non-alcoholic fatty liver disease showed elevated levels of circulating Hb, evidence that suggests that Hb exerts a protective role, as it may act as an antioxidant and may counteract the adverse effects of this disease.

Evaluation of endothelial dysfunction in patients with nonalcoholic fatty liver disease: Association of selenoprotein P with carotid intima-media thickness and endothelium-dependent vasodilation

BACKGROUND

In patients with NAFLD, there is an increased risk of cardiovascular disease (CVD). Selenoprotein P (SelP), a hepatokine, is associated with insulin resistance (IR) and serum SelP was found to be elevated in patients with NAFLD.

AIM

This study aimed to determine the risk of CVD in NAFLD patients and the association of serum SelP levels with this NAFLD related CVD risk.

METHODS

Ninety-three patients with NAFLD and 37 healthy controls were included in the study. Complete blood count, C-reactive protein (CRP), fasting glucose, serum lipid levels, and SelP levels were tested from fasting blood samples. Moreover, body mass index (BMI), HOMA-IR, carotid intima-media thickness (cIMT) and flow-mediated dilatation (FMD) were measured.

RESULTS

In patients with NAFLD, the FMD ratio was significantly lower than in controls (P=0.027). cIMT measurements were similar in both groups (P=0.996). Serum SelP levels were significantly higher than controls (P<0.001). SelP levels were significantly correlated with BMI, fasting glucose, LDL-cholesterol and HOMA-IR (r=0.395, P<0.001; r=0.322, P=0.002; r=0.353, P<0.001; r=0.521, P<0.001, respectively). Also, SelP levels were significantly lower and correlated with FMD (r=-0.674, P<0.001). SelP, ESR and CRP were significantly higher (P<0.05) and FMD ratios were significantly lower (P<0.05) in patients with nonalcoholic steatohepatitis (NASH) when compared to patients with simple steatosis.

CONCLUSION

These results suggest that in young NAFLD patients without additional comorbidities, there is an increased risk of CVD. FMD may be a better predictor for assessment of CVD risk when compared with cIMT. We assume that there could also be an important role of SelP in the pathogenesis of NASH.

Neglected features of lifestyle: Their relevance in non-alcoholic fatty liver disease

AIM

To investigated in non-alcoholic-fatty-liver-disease (NAFLD), with ultrasound (US)-detected fatty liver, and in a group of non-alcoholic and otherwise healthy subjects, relationship of neglected features of lifestyle with NAFLD and obesity.

METHODS

Five hundred and thirty-two NAFLD and 667 non-NAFLD healthy subjects, age 21-60 years were studied. Severity of liver steatosis was assessed by US bright liver score. The adherence to mediterranean diet score (AMDS) was assessed on the basis of a 1-wk recall computerized questionnaire which included a detailed physical activity reports (Baecke questionnaire). The western dietary profile score, as a simplified paradigm of unhealthy diet, a questionnaire quantifying sun exposure score and a sleep habits questionnaires provided a further comprehensive lifestyle assessment.

RESULTS

Body mass index (BMI), insulin resistance (HOMA), and triglycerides, poorer adherence to a mediterranean diet profile, sedentary habits, minor sun exposure and use of “western diet” foods are greater in NAFLD. Multiple linear regression analysis, weighted by years of age, displays BMI, HOMA and AMDS as the most powerful independent predictors of fatty liver severity; however, also the physical activity score, the western diet habit and the sun exposure score are acting inside the model with significant independent effects.

CONCLUSION

Articulated clinical intervention, according to our results, are justified in NAFLD and can be pursued addressing by focused intervention nutritional profile, physical exercise mainly in open-air subsets for enhancing sun exposure and healthier sleep duration and rhythm.