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Rastgoo S, Fateh ST, Nikbaf-Shandiz M, Rasaei N, Aali Y, Zamani M, Shiraseb F, Asbaghi O. The effects of L-carnitine supplementation on inflammatory and anti-inflammatory markers in adults: a systematic review and dose-response meta-analysis. Inflammopharmacology 2023; 31:2173-2199. [PMID: 37656233 DOI: 10.1007/s10787-023-01323-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 07/31/2023] [Indexed: 09/02/2023]
Abstract
L-carnitine supplementation may be beneficial in improving inflammatory conditions and reducing the level of inflammatory cytokines. Therefore, according to the finding of randomized controlled trials (RCTs), the systematic review and meta-analysis aimed to investigate the effect of L-carnitine supplementation on inflammation in adults. To obtain acceptable articles up to October 2022, a thorough search was conducted in databases including PubMed, ISI Web of Science, the Cochrane Library, and Scopus. A random-effects model was used to estimate the weighted mean difference (WMD). We included the 48 RCTs (n = 3255) with 51 effect sizes in this study. L-carnitine supplementation had a significant effect on C-reactive protein (CRP) (p < 0.001), interleukin-6 (IL-6) (p = 0.001), tumor necrosis factor-α (TNF-α) (p = 0.002), malondialdehyde (MDA) (p = 0.001), total antioxidant capacity (TAC) (p = 0.029), alanine transaminase (ALT) (p < 0.001), and aspartate transaminase (AST) (p < 0.001) in intervention, compared to the placebo group. Subgroup analyses showed that L-carnitine supplementation had a lowering effect on CRP and TNF-α in trial duration ≥ 12 weeks in type 2 diabetes and BMI ≥ 25 kg/m2. L-carnitine supplementation reduced ALT levels in overweight and normal BMI subjects at any trial dose and trial duration ≥ 12 weeks and reduced AST levels in overweight subjects and trial dose ≥ 2 g/day. This meta-analysis revealed that L-carnitine supplementation effectively reduces the inflammatory state by increasing the level of TAC and decreasing the levels of CRP, IL-6, TNF-α and MDA in the serum.
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Affiliation(s)
- Samira Rastgoo
- Department of Cellular and Molecular Nutrition, Faculty of Nutrition Science and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | - Niloufar Rasaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Yasaman Aali
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mohammad Zamani
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Shiraseb
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
| | - Omid Asbaghi
- Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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2
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Ganesan R, Gupta H, Jeong JJ, Sharma SP, Won SM, Oh KK, Yoon SJ, Kim DJ, Suk KT. A metabolomics approach to the validation of predictive metabolites and phenotypic expression in non-alcoholic fatty liver disease. Life Sci 2023; 322:121626. [PMID: 37003543 DOI: 10.1016/j.lfs.2023.121626] [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: 02/14/2023] [Revised: 03/15/2023] [Accepted: 03/23/2023] [Indexed: 04/03/2023]
Abstract
AIMS Nonalcoholic fatty liver disease (NAFLD) is becoming more common and severe. Individuals with NAFLD have an altered composition of gut- microbial metabolites. We used metabolomics profiling to identify microbial metabolites that could indicate gut-liver metabolic severity. Noninvasive biomarkers are required for NAFLD, especially for patients at high risk of disease progression. MAIN METHODS We compared the stool metabolomes, untargeted metabolomics, and clinical data of 80 patients. Patients with nonalcoholic fatty liver (NAFL: n = 16), nonalcoholic steatohepatitis (NASH: n = 26), and cirrhosis (n = 19) and healthy control individuals (HC: n = 19) were enrolled. The identified metabolites in NAFLD were evaluated by multivariate statistical analysis and metabolic pathotypic expression. Gas chromatography-mass spectrometry (GC-MS) and liquid chromatography coupled to time-of-flight-mass spectrometry (LC-TOF-MS) were used to analyze metabolites. KEY FINDINGS Untargeted metabolomics was used to identify and quantify 103 metabolites. Principal component analysis (PCA) was used to assess the metabolic discrimination of NAFL, NASH, and cirrhosis. Short-chain fatty acids (SCFA) levels were significantly lower in NAFLD patients, including those of acetate (p = 0.03), butyrate (p = 0.0008), and propionate. The stool cholic acid (p = 0.001) level was significantly increased in NAFLD patients. Palmitoylcarnitine and l-carnitine levels were significantly increased in NASH and cirrhosis patients. The phenotypic expression of these metabolites was linked to β-oxidation. SIGNIFICANCE We demonstrated a distinct metabolome profile in NAFLD patients with NAFL, NASH, and cirrhosis. We also discovered that the expression of certain metabolites and metabolic pathways was linked to NAFLD.
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Affiliation(s)
- Raja Ganesan
- Institute for Liver and Digestive Diseases, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Haripriya Gupta
- Institute for Liver and Digestive Diseases, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Jin-Ju Jeong
- Institute for Liver and Digestive Diseases, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Satya Priya Sharma
- Institute for Liver and Digestive Diseases, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Sung-Min Won
- Institute for Liver and Digestive Diseases, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Ki-Kwang Oh
- Institute for Liver and Digestive Diseases, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Sang Jun Yoon
- Institute for Liver and Digestive Diseases, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Dong Joon Kim
- Institute for Liver and Digestive Diseases, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Ki Tae Suk
- Institute for Liver and Digestive Diseases, College of Medicine, Hallym University, Chuncheon, Republic of Korea.
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3
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Rashad WA, Saadawy SF, Refaay NE. Mitigating effect of L-carnitine against atrazine-induced hepatotoxicity: histopathological and biochemical analyses in albino rats. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:22034-22045. [PMID: 36282381 PMCID: PMC9938065 DOI: 10.1007/s11356-022-23568-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
Atrazine (ATR) is an extensively used herbicide that is often found in drinking water and waterways. After metabolization and excretion in the liver, ATR residues or its metabolites were found in tissues causing harmful effects mainly to the endocrine system and liver. This study aimed to elucidate the toxic impact of ATR on the liver and possible ameliorative effects of L-carnitine (LC). It utilized 30 adult male albino rats divided into three equal groups; the control group received 0.5 cc distilled water orally for 14 days, an ATR-treated group received ATR in a dose of 400 mg/kg BW dissolved in distilled water by oral gavage daily for 14 days, and a protected group (ATR + LC) received 400 mg/kg BW of ATR dissolved in distilled water, plus 100 mg/kg LC dissolved in distilled water by oral gavage daily for 14 days. At the end of the experiment, the liver tissue was prepared for histological and biochemical analyses and showed significant elevation of liver enzymes and oxidative parameters, altered expression of apoptotic and antiapoptotic genes, and hepatic degenerative changes in the ATR-treated group. In conclusion, atrazine induces oxidative stress, inflammation, and apoptosis in the liver of rats, and these toxic effects can be alleviated by L-carnitine.
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Affiliation(s)
- Walaa A Rashad
- Faculty of Medicine, Human Anatomy & Embryology Department, Zagazig University, Zagazig, Egypt.
| | - Sara F Saadawy
- Faculty of Medicine, Medical Biochemistry Department, Zagazig University, Zagazig, Egypt
| | - Nehal E Refaay
- Faculty of Medicine, Human Anatomy & Embryology Department, Zagazig University, Zagazig, Egypt
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4
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Yoon EL, Ahn SB, Jun DW, Cho YK, Song DS, Jeong JY, Kim HY, Jung YK, Song MJ, Kim SE, Kim HS, Jeong SW, Kim SG, Lee TH. Effect of L-carnitine on quality of life in covert hepatic encephalopathy: a randomized, double-blind, placebo-controlled study. Korean J Intern Med 2022; 37:757-767. [PMID: 35526858 PMCID: PMC9271723 DOI: 10.3904/kjim.2021.338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/05/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS L-carnitine is potentially beneficial in patients with hepatic encephalopathy (HE). We aimed to evaluate the impact of L-carnitine on the quality of life and liver function in patients with liver cirrhosis and covert HE. METHODS We conducted an investigator-initiated, prospective, multi-center, double- blind, randomized phase III trial in patients with covert HE. A total of 150 patients were randomized 1:1 to L-carnitine (2 g/day) or placebo for 24 weeks. Changes in quality of life and liver function were assessed at 6 months. The model for end-stage liver disease (MELD), the 36-Item Short Form Survey (SF-36), the psychometric hepatic encephalopathy score (PHES), and the Stroop Test were evaluated in all patients. RESULTS The total SF-36 score significantly improved in the L-carnitine group after 24 weeks (difference: median, 2; interquartile range, 0 to 11; p < 0.001); however, these values were comparable between the two groups. Furthermore, there was a significant ordinal improvement in PHES scores among patients with minimal HE who were in the L-carnitine group (p = 0.007). Changes in the total carnitine level also positively correlated with improvements in the Stroop test in the L-carnitine group (color test, r = 0.3; word test, r = 0.4; inhibition test, r = 0.5; inhibition/switching test, r = 0.3; all p < 0.05). Nevertheless, the MELD scores at week 24 did not differ between the groups. CONCLUSION Twenty-four weeks of L-carnitine supplementation was safe but ineffective in improving quality of life and liver function.
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Affiliation(s)
- Eileen L. Yoon
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Seoul,
Korea
- Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul,
Korea
| | - Sang Bong Ahn
- Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul,
Korea
| | - Dae Won Jun
- Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul,
Korea
| | - Yong Kyun Cho
- Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Do Seon Song
- St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon,
Korea
| | | | - Hee Yeon Kim
- Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu,
Korea
- Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon,
Korea
| | - Young Kul Jung
- Korea University Ansan Hospital, Korea University College of Medicine, Ansan,
Korea
| | - Myeong Jun Song
- Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon,
Korea
| | - Sung Eun Kim
- Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang,
Korea
| | - Hyoung Su Kim
- Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul,
Korea
| | - Soung Won Jeong
- Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul,
Korea
| | - Sang Gyune Kim
- Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon,
Korea
| | - Tae Hee Lee
- Konyang University College of Medicine, Daejeon,
Korea
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5
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Oh TS, Zabalawi M, Jain S, Long D, Stacpoole PW, McCall CE, Quinn MA. Dichloroacetate improves systemic energy balance and feeding behavior during sepsis. JCI Insight 2022; 7:153944. [PMID: 35730570 PMCID: PMC9309051 DOI: 10.1172/jci.insight.153944] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 05/13/2022] [Indexed: 02/01/2023] Open
Abstract
Sepsis is a life-threatening organ dysfunction caused by dysregulated host response to an infection. The metabolic aberrations associated with sepsis underly an acute and organism-wide hyperinflammatory response and multiple organ dysfunction; however, crosstalk between systemic metabolomic alterations and metabolic reprogramming at organ levels remains unknown. We analyzed substrate utilization by the respiratory exchange ratio, energy expenditure, metabolomic screening, and transcriptional profiling in a cecal ligation and puncture model to show that sepsis increases circulating free fatty acids and acylcarnitines but decreases levels of amino acids and carbohydrates, leading to a drastic shift in systemic fuel preference. Comparative analysis of previously published metabolomics from septic liver indicated a positive correlation with hepatic and plasma metabolites during sepsis. In particular, glycine deficiency was a common abnormality of the plasma and liver during sepsis. Interrogation of the hepatic transcriptome in septic mice suggested that the septic liver may contribute to systemic glycine deficiency by downregulating genes involved in glycine synthesis. Interestingly, intraperitoneal injection of the pyruvate dehydrogenase kinase (PDK) inhibitor dichloroacetate reversed sepsis-induced anorexia, energy imbalance, inflammation, dyslipidemia, hypoglycemia, and glycine deficiency. Collectively, our data indicated that PDK inhibition rescued systemic energy imbalance and metabolic dysfunction in sepsis partly through restoration of hepatic fuel metabolism.
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Affiliation(s)
- Tae Seok Oh
- Department of Pathology, Section on Comparative Medicine, and
| | - Manal Zabalawi
- Department of Internal Medicine, Section of Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Shalini Jain
- Department of Internal Medicine, Section of Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - David Long
- Department of Internal Medicine, Section of Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Peter W. Stacpoole
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine and Department of Biochemistry and Molecular Biology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Charles E. McCall
- Department of Internal Medicine, Section of Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Matthew A. Quinn
- Department of Pathology, Section on Comparative Medicine, and,Department of Internal Medicine, Section of Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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6
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Effects of L-carnitine supplementation in patients with mild-to-moderate COVID-19 disease: a pilot study. Pharmacol Rep 2022; 74:1296-1305. [PMID: 35997951 PMCID: PMC9395946 DOI: 10.1007/s43440-022-00402-y] [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: 03/06/2022] [Revised: 07/23/2022] [Accepted: 07/27/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The present single-center clinical trial was designed to evaluate the potential benefits of L-carnitine supplementation in patients with COVID-19 disease. METHODS AND PATIENTS The study was conducted on 75 patients with mild-to-moderate COVID-19 hospitalized in Shahid Beheshti Hospital-Hamadan, IRAN. The participants were randomly divided into intervention (n = 32) and control groups (n = 43). The control group received their standard hospital treatment only. In addition to standard medications, the intervention group received 3000 mg oral L-carnitine daily in three divided doses for five days. The blood samples were collected and para-clinical parameters were measured at the beginning and end of the treatment. Clinical outcomes were also recorded, and data were analyzed using χ2 and t-tests. RESULTS Higher means of O2 saturation were observed in the intervention rather than in the control group. Mean erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were significantly lower in the intervention group. Furthermore, mean alkaline phosphatase (ALP) activity and lactate dehydrogenase (LDH) were lower in the intervention group. Also, lower mean serum creatine phosphokinase (CPK) was observed in the intervention group. No significant differences were observed in terms of clinical symptoms; however, six patients (14%) in the control group died due to the complications of COVID-19, while all patients in the intervention group survived. CONCLUSION Taken together, L-carnitine can be considered as a drug supplement in patients with COVID-19.
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7
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Li N, Zhao H. Role of Carnitine in Non-alcoholic Fatty Liver Disease and Other Related Diseases: An Update. Front Med (Lausanne) 2021; 8:689042. [PMID: 34434943 PMCID: PMC8381051 DOI: 10.3389/fmed.2021.689042] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/15/2021] [Indexed: 12/13/2022] Open
Abstract
Carnitine is an amino acid-derived substance that coordinates a wide range of biological processes. Such functions include transport of long-chain fatty acids from the cytoplasm to the mitochondrial matrix, regulation of acetyl-CoA/CoA, control of inter-organellar acyl traffic, and protection against oxidative stress. Recent studies have found that carnitine plays an important role in several diseases, including non-alcoholic fatty liver disease (NAFLD). However, its effect is still controversial, and its mechanism is not clear. Herein, this review provides current knowledge on the biological functions of carnitine, the “multiple hit” impact of carnitine on the NAFLD progression, and the downstream mechanisms. Based on the “multiple hit” hypothesis, carnitine inhibits β-oxidation, improves mitochondrial dysfunction, and reduces insulin resistance to ameliorate NAFLD. L-carnitine may have therapeutic role in liver diseases including non-alcoholic steatohepatitis, cirrhosis, hepatocellular carcinoma, alcoholic fatty liver disease, and viral hepatitis. We also discuss the prospects of L-carnitine supplementation as a therapeutic strategy in NAFLD and related diseases, and the factors limiting its widespread use.
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Affiliation(s)
- Na Li
- Second Affiliated Hospital of Dalian Medical University, Dalian, China.,Department of General Practice, Xi'an People's Hospital (Xi'an Fourth Hospital), Xi'an, China
| | - Hui Zhao
- Department of Health Examination Center, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
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8
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Farshad O, Keshavarz P, Heidari R, Farahmandnejad M, Azhdari S, Jamshidzadeh A. The Potential Neuroprotective Role of Citicoline in Hepatic Encephalopathy. J Exp Pharmacol 2020; 12:517-527. [PMID: 33235522 PMCID: PMC7678475 DOI: 10.2147/jep.s261986] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 11/03/2020] [Indexed: 12/29/2022] Open
Abstract
Purpose Hepatic encephalopathy (HE) is described as impaired brain function induced by liver failure. Ammonia is the most suspected chemical involved in brain injury during HE. Although the precise mechanism of HE is not clear, several studies mentioned the role of oxidative stress in ammonia neurotoxicity. In animal models, the use of some compounds with antioxidant properties was reported to reduce the neurotoxic effects of ammonia, improve energy metabolism, and ameliorate the HE symptoms. Citicoline is a principal intermediate in the biosynthesis pathway of phosphatidylcholine that acts as neurovascular protection and repair effects. Various studies mentioned the neuroprotective and antioxidative effects of citicoline in the central nervous system. This study aims to investigate the potential protective effects of citicoline therapeutic in an animal model of HE. Materials and Methods Mice received acetaminophen (APAP,1g/kg, i. p.) and then treated with citicoline (500 mg/kg, i.p) one and two hours after APAP. Animals were monitored for locomotor activity and blood and brain ammonia levels. Moreover, markers of oxidative stress were assessed in the brain tissue. Results The result of the study revealed that plasma and brain ammonia and the liver injury markers increased, and locomotor activity impaired in the APAP-treated animals. Besides, an increase in markers of oxidative stress was evident in the brain of the APAP-treated mice. It was found that citicoline supplementation enhanced the animal’s locomotor activity and improved brain tissue markers of oxidative stress. Conclusion These data propose citicoline as a potential protective agent in HE. The effects of citicoline on oxidative stress markers could play a fundamental role in its neuroprotective properties during HE.
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Affiliation(s)
- Omid Farshad
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pedram Keshavarz
- Department of Radiology, Tbilisi State Medical University (TSMU), Tbilisi, Georgia
| | - Reza Heidari
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mina Farahmandnejad
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Pharmacology and Toxicology, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Azhdari
- Department of Anatomy and Embryology, School of Medicine, Bam University of Medical Sciences, Bam, Iran
| | - Akram Jamshidzadeh
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Pharmacology and Toxicology, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
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9
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Sato S, Namisaki T, Furukawa M, Saikawa S, Kawaratani H, Kaji K, Takaya H, Shimozato N, Sawada Y, Kitagawa K, Moriya K, Akahane T, Mitoro A, Hoki N, Ann T, Yoshiji H. Effect of L-carnitine on health-related quality of life in patients with liver cirrhosis. Biomed Rep 2020; 13:65. [PMID: 33149909 PMCID: PMC7605124 DOI: 10.3892/br.2020.1372] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/01/2020] [Indexed: 12/17/2022] Open
Abstract
L-carnitine (4-N-trimethylammonium-3-hydroxybutyric acid) is the physiologically active form of carnitine and is a natural compound that has been shown to exhibit antioxidant activity. L-carnitine is used as a supplementary treatment in patients with cirrhosis with hepatic encephalopathy, hyperammonemia or muscle cramps. In the present study, the effect of L-carnitine supplementation on health-related quality of life in 30 patients with cirrhosis was prospectively examined. L-carnitine (1,800 mg/day) was administered orally for 6 months. To assess the effects of L-carnitine on chronic fatigue, patients filled out a self-report questionnaire regarding their physical and mental health. The levels of total and free carnitine, and acylcarnitine were found to be significantly higher 1, 3 and 6 months after therapy initiation compared with before treatment. Serum albumin levels were significantly increased 3 and 6 months after initiation of therapy. L-carnitine supplementation significantly increased the BAP/d-ROM ratio, a marker of antioxidant status in patients with cirrhosis. Changes in serum carnitine concentrations were positively correlated with changes in serum albumin levels (R2=0.369; P=0.012), but not with changes in serum ammonia levels (R2= 0.005; P=0.78). Total and mental health scores improved significantly, and physical scores improved marginally 3 and 6 months after initiation of L-carnitine. These findings may be attributed to the enhanced serum albumin levels and oxidative stress rather than the reduced serum ammonia levels. Based on these results, it is suggested that L-carnitine can potentially alleviate chronic fatigue, along with the increased BAP/d-ROM ratio, which were involved in increased oxidative stress in patients with cirrhosis. The specific mechanisms by which L-carnitine ameliorates chronic fatigue is not fully understood and requires further investigation.
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Affiliation(s)
- Shinya Sato
- Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Tadashi Namisaki
- Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Masanori Furukawa
- Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Soichiro Saikawa
- Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Hideto Kawaratani
- Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Kosuke Kaji
- Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Hiroaki Takaya
- Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Naotaka Shimozato
- Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Yasuhiko Sawada
- Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Koh Kitagawa
- Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Kei Moriya
- Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Takemi Akahane
- Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Akira Mitoro
- Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Noriyuki Hoki
- Department of Gastroenterology in Bellland General Hospital, Sakai, Osaka 599-8247, Japan
| | - Tatsuichi Ann
- Department of Gastroenterology in Bellland General Hospital, Sakai, Osaka 599-8247, Japan
| | - Hitoshi Yoshiji
- Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara 634-8522, Japan
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10
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Savic D, Hodson L, Neubauer S, Pavlides M. The Importance of the Fatty Acid Transporter L-Carnitine in Non-Alcoholic Fatty Liver Disease (NAFLD). Nutrients 2020; 12:E2178. [PMID: 32708036 PMCID: PMC7469009 DOI: 10.3390/nu12082178] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 12/16/2022] Open
Abstract
L-carnitine transports fatty acids into the mitochondria for oxidation and also buffers excess acetyl-CoA away from the mitochondria. Thus, L-carnitine may play a key role in maintaining liver function, by its effect on lipid metabolism. The importance of L-carnitine in liver health is supported by the observation that patients with primary carnitine deficiency (PCD) can present with fatty liver disease, which could be due to low levels of intrahepatic and serum levels of L-carnitine. Furthermore, studies suggest that supplementation with L-carnitine may reduce liver fat and the liver enzymes alanine aminotransferase (ALT) and aspartate transaminase (AST) in patients with Non-Alcoholic Fatty Liver Disease (NAFLD). L-carnitine has also been shown to improve insulin sensitivity and elevate pyruvate dehydrogenase (PDH) flux. Studies that show reduced intrahepatic fat and reduced liver enzymes after L-carnitine supplementation suggest that L-carnitine might be a promising supplement to improve or delay the progression of NAFLD.
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Affiliation(s)
- Dragana Savic
- Radcliffe Department of Medicine, Oxford Centre for Magnetic Resonance Research, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK; (S.N.); (M.P.)
| | - Leanne Hodson
- Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology & Metabolism, Churchill Hospital, University of Oxford, Oxford OX3 7LE, UK;
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford OX3 7LE, UK
| | - Stefan Neubauer
- Radcliffe Department of Medicine, Oxford Centre for Magnetic Resonance Research, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK; (S.N.); (M.P.)
| | - Michael Pavlides
- Radcliffe Department of Medicine, Oxford Centre for Magnetic Resonance Research, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK; (S.N.); (M.P.)
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford OX3 7LE, UK
- Translational Gastroenterology Unit, University of Oxford, Oxford OX3 9DU, UK
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11
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Askarpour M, Djafarian K, Ghaedi E, Sadeghi O, Sheikhi A, Shab-Bidar S. Effect of L-Carnitine Supplementation on Liver Enzymes: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Arch Med Res 2020; 51:82-94. [DOI: 10.1016/j.arcmed.2019.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/02/2019] [Accepted: 12/06/2019] [Indexed: 02/06/2023]
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12
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Yousefi Rad E, Eslampour E, Falahi E, Mardani M, Hekmatdoost A, Asbaghi O, Saboori S. Effects of carnitine supplementation on liver aminotransferase enzymes: A systematic review and meta-analysis of randomized controlled clinical trials. Indian J Gastroenterol 2019; 38:470-479. [PMID: 31828538 DOI: 10.1007/s12664-019-00983-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 08/13/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS This meta-analysis of the randomized controlled trials was performed to assess effects of carnitine supplementation on serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. METHODS A comprehensive literature search of PubMed, Cochrane's library, Web of Science, Scopus, and Embase was performed up to May 2018. From a total of 2012 articles identified initially, only 17 articles were included in the final meta-analysis to evaluate the effects of carnitine supplementation on serum levels of ALT and AST enzymes. RESULTS Random effects model meta-analysis showed that carnitine supplementation led to reduction in serum ALT (weighted mean difference [WMD] - 10.25 IU/L; 95% CI = - 15.73, - 4.77; p < 0.001) and AST levels (WMD - 7.85 IU/L; 95% CI = - 11.85, - 3.86; p < 0.001). The results of subgroup analysis showed that carnitine could reduce serum AST levels at dosages equal to 2000 mg/day (p = 0.014) or more than 2000 mg/day (p < 0.001). However, carnitine supplementation at dosages of ≤ 1000 mg/day (p = 0.035) or equal to 2000 mg/day (p = 0.013) resulted in significant reduction in ALT level, while doses more than 2000 mg/day did not change ALT significantly. Carnitine exerts its reducing effect on serum ALT and AST levels only when these aminotransferases are raised or when the duration of supplementation lasts at least 3 months. CONCLUSION Results of the current meta-analysis showed that carnitine supplementation can decrease serum AST and ALT levels significantly, especially when supplementation lasts 3 months or more in patients with elevated serum aminotransferase levels.
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Affiliation(s)
- Esmaeil Yousefi Rad
- Nutritional Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Elham Eslampour
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Ebrahim Falahi
- Nutritional Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mahnaz Mardani
- Nutritional Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Azita Hekmatdoost
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology, Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Division of Gastroenterology, Hepatology and Nutrition, British Columbia's Children's Hospital and Child and Family Research Institute, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Omid Asbaghi
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Somayeh Saboori
- Nutritional Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.
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13
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Does L-carnitine supplementation affect serum levels of enzymes mainly produced by liver? A systematic review and meta-analysis of randomized controlled clinical trials. Eur J Nutr 2019; 59:1767-1783. [PMID: 31385062 DOI: 10.1007/s00394-019-02068-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/23/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS L-carnitine supplementation is proposed to reduce liver enzymes levels; however, previous findings were equivocal. The current systematic review and meta-analysis of randomized controlled clinical trials (RCTs) were performed to assess the effect of L-carnitine supplementation on serum levels of enzymes mainly produced by liver [alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transpeptidase (GGTP)]. METHODS Online databases as well as the reference lists of relevant studies were searched from inception up to June 2019. The risk of bias in individual studies was assessed using Cochrane Collaboration's tool. Data were pooled using the random-effects model and expressed as mean differences (MDs) with 95% confidence intervals (CIs). RESULTS In total, 18 RCTs (1161 participants) met the eligibility criteria. L-carnitine supplementation dose ranged from 500 to 4000 mg/day. L-carnitine supplementation significantly reduced serum ALT (MD = - 8.65 IU/L, 95% CI - 13.40, - 3.90), AST (MD = - 8.52 IU/L, 95% CI - 12.16, - 4.89), and GGTP (MD = - 8.80 IU/L, 95% CI - 13.67, - 3.92) levels. The subgroup analysis showed that L-carnitine might be more effective in reducing the enzymes when supplemented in higher doses (≥ 2000 mg/day), for longer durations (> 12 weeks), and among patients with liver diseases. The meta-evidence was graded as "moderate" for ALT and AST, and "low" for GGTP according to NutriGrade scoring system. CONCLUSION L-carnitine supplementation significantly improves circulating ALT, AST and GGTP levels; therefore, it might positively affect liver function, especially among patients with liver diseases. Further high-quality RCTs are recommended to confirm our results.
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14
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Li S, Gao D, Jiang Y. Function, Detection and Alteration of Acylcarnitine Metabolism in Hepatocellular Carcinoma. Metabolites 2019; 9:E36. [PMID: 30795537 PMCID: PMC6410233 DOI: 10.3390/metabo9020036] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/07/2019] [Accepted: 02/14/2019] [Indexed: 01/01/2023] Open
Abstract
Acylcarnitines play an essential role in regulating the balance of intracellular sugar and lipid metabolism. They serve as carriers to transport activated long-chain fatty acids into mitochondria for β-oxidation as a major source of energy for cell activities. The liver is the most important organ for endogenous carnitine synthesis and metabolism. Hepatocellular carcinoma (HCC), a primary malignancy of the live with poor prognosis, may strongly influence the level of acylcarnitines. In this paper, the function, detection and alteration of acylcarnitine metabolism in HCC were briefly reviewed. An overview was provided to introduce the metabolic roles of acylcarnitines involved in fatty acid β-oxidation. Then different analytical platforms and methodologies were also briefly summarised. The relationship between HCC and acylcarnitine metabolism was described. Many of the studies reported that short, medium and long-chain acylcarnitines were altered in HCC patients. These findings presented current evidence in support of acylcarnitines as new candidate biomarkers for studies on the pathogenesis and development of HCC. Finally we discussed the challenges and perspectives of exploiting acylcarnitine metabolism and its related metabolic pathways as a target for HCC diagnosis and prognosis.
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Affiliation(s)
- Shangfu Li
- State Key Laboratory of Chemical Oncogenomics, Graduate School at Shenzhen, Tsinghua University, Shenzhen 518055, China.
- National & Local United Engineering Lab for Personalized Anti-tumour Drugs, Graduate School at Shenzhen, Tsinghua University, Shenzhen 518055, China.
| | - Dan Gao
- State Key Laboratory of Chemical Oncogenomics, Graduate School at Shenzhen, Tsinghua University, Shenzhen 518055, China.
- National & Local United Engineering Lab for Personalized Anti-tumour Drugs, Graduate School at Shenzhen, Tsinghua University, Shenzhen 518055, China.
- Key Laboratory of Metabolomics at Shenzhen, Shenzhen 518055, China.
| | - Yuyang Jiang
- State Key Laboratory of Chemical Oncogenomics, Graduate School at Shenzhen, Tsinghua University, Shenzhen 518055, China.
- School of Pharmaceutical Sciences, Tsinghua University, Beijing 100084, China.
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Badawi AA, Hegazy MM, Louis D, Eldegwy MA. Solving manufacturing problems for L-carnitine-L-tartrate to improve the likelihood of successful product scale-up. ACTA PHARMACEUTICA 2017; 67:511-525. [PMID: 29337668 DOI: 10.1515/acph-2017-0033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
L-carnitine-L-tartrate, a non-essential amino acid, is hygroscopic. This causes a problem in tablet production due to pronounced adhesion of tablets to punches. A 33 full factorial design was adopted to suggest a tablet formulation. Three adsorbents were suggested (Aerosil 200, Aerosil R972, talc) to reduce stickiness at three concentrations (1, 3 and 5 %), and three fillers (mannitol, Avicel PH 101, Dibasic calcium phosphate) were chosen to prepare 27 formulations. Micromeritic properties of formulations were studied, and tablets were prepared by wet granulation. Absence of picking, sticking or capping, recording of sufficient hardness, acceptable friability and tablet ejection force indicated formulation success. The resulting formulation prepared using Avicel PH 101 and 1 % Aerosil 200 was submitted to further investigation in order to choose the most suitable compression conditions using a 33 full factorial design. Variables included compression force, tableting rate and magnesium stearate (lubricant) concentration. The formulation prepared at compression force of 25 kN, using 2 % magnesium stearate, at a production rate of 30 tablets/ minute, was found to be the most appropriate scale up candidate.
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Affiliation(s)
- Aliaa A. Badawi
- Department of Pharmaceutics and Industrial Pharmacy Faculty of Pharmacy, Cairo University Cairo , Egypt
| | - Mahmoud M. Hegazy
- Research & Development Department, Mepaco-Medifood Company, El Sharkia , Egypt
| | - Dina Louis
- Department of Pharmaceutics and Industrial Pharmacy Faculty of Pharmacy, Cairo University Cairo , Egypt
- Department of Pharmaceutics and Pharmaceutical Technology Faculty of Pharmacy and Drug Technology, Heliopolis University for Sustainable Development, Heliopolis , Egypt
| | - Mohammed A. Eldegwy
- Research & Development Department, Mepaco-Medifood Company, El Sharkia , Egypt
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Kawai A, Matsumoto H, Endou Y, Honda Y, Kubota H, Higashida M, Hirai T. Repeated Combined Chemotherapy with Cisplatin Lowers Carnitine Levels in Gastric Cancer Patients. ANNALS OF NUTRITION AND METABOLISM 2017; 71:261-265. [PMID: 29237151 DOI: 10.1159/000485808] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/28/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND/AIMS Carnitine plays an important role in the metabolism of fatty acids. It has also been reported that the administration of anticancer drugs may lead to reductions in serum carnitine levels due to decreased activity of organic cation transporter novel 2, which plays a role in the reabsorption of carnitine in the tubules of the kidney. We therefore studied the change in carnitine levels when chemotherapy was administered repeatedly to patients with gastric cancer. METHODS Ten patients with upper gastrointestinal cancer were enrolled in this study between December 2014 and August 2015. All patients were administered chemotherapy consisting of TS-1 and cisplatin every 3 weeks: 3 received it as adjuvant therapy post resection, the remaining 7 received it as treatment for unresectable tumors. Before the start of each chemotherapy cycle, serum was collected. RESULTS The mean total carnitine level was 54.5 ± 13.7 μmol/L prior to commencing chemotherapy; it was 46.7 ± 13.5 and 41.4 ± 14.8 μmol/L at the second and third cycles respectively. The total carnitine level was decreased in a statistically significant manner (p = 0.0039). The serum level of total protein and cholinesterase was also decreased significantly (p = 0.0218 and p = 0.0418). CONCLUSION Carnitine levels decreased during repeated chemotherapy in patients with gastric cancer, and they are associated with the nutritional status.
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Affiliation(s)
- Akimasa Kawai
- Department of Surgery, Mitsugi Public General Hospital, Onomichi, Japan
| | - Hideo Matsumoto
- Department of Surgery, Mitsugi Public General Hospital, Onomichi, Japan
| | - Youko Endou
- Department of Nutrition, Kawasaki Medical School Hospital, Japan, Kurashiki, Japan
| | - Yui Honda
- Department of Nutrition, Kawasaki Medical School Hospital, Japan, Kurashiki, Japan
| | - Hisako Kubota
- Department of Digestive Surgery, Kawasaki Medical School, Kurashiki, Japan
| | - Masaharu Higashida
- Department of Digestive Surgery, Kawasaki Medical School, Kurashiki, Japan
| | - Toshihiro Hirai
- Department of Clinical Nutrition, Kawasaki University of Medical Welfare, Kurashiki, Japan
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