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Kvist AAS, Sharma A, Sommer C, Qvigstad E, Gulseth HL, Sollid ST, Nermoen I, Sattar N, Gill J, Tannæs TM, Birkeland KI, Lee-Ødegård S. Adipose Tissue Insulin Resistance in South Asian and Nordic Women after Gestational Diabetes Mellitus. Metabolites 2024; 14:288. [PMID: 38786765 PMCID: PMC11123011 DOI: 10.3390/metabo14050288] [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: 04/13/2024] [Revised: 05/13/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
South Asians (SAs) have a higher risk of developing type 2 diabetes (T2D) than white Europeans, especially following gestational diabetes mellitus (GDM). Despite similar blood glucose levels post-GDM, SAs exhibit more insulin resistance (IR) than Nordics, though the underlying mechanisms are unclear. This study aimed to assess markers of adipose tissue (AT) IR and liver fat in SA and Nordic women post-GDM. A total of 179 SA and 108 Nordic women in Norway underwent oral glucose tolerance tests 1-3 years post-GDM. We measured metabolic markers and calculated the AT IR index and non-alcoholic fatty liver disease liver fat (NAFLD-LFS) scores. Results showed that normoglycaemic SAs had less non-esterified fatty acid (NEFA) suppression during the test, resembling prediabetes/T2D responses, and higher levels of plasma fetuin-A, CRP, and IL-6 but lower adiponectin, indicating AT inflammation. Furthermore, normoglycaemic SAs had higher NAFLD-LFS scores, lower insulin clearance, and higher peripheral insulin than Nordics, indicating increased AT IR, inflammation, and liver fat in SAs. Higher liver fat markers significantly contributed to the ethnic disparities in glucose metabolism, suggesting a key area for intervention to reduce T2D risk post-GDM in SAs.
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Affiliation(s)
- Ahalya Anita Suntharalingam Kvist
- Institute of Clinical Medicine, University of Oslo, 0372 Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, 0424 Oslo, Norway
| | - Archana Sharma
- Institute of Clinical Medicine, University of Oslo, 0372 Oslo, Norway
- Department of Endocrinology, Akershus University Hospital, 1478 Lørenskog, Norway
| | - Christine Sommer
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, 0424 Oslo, Norway
| | - Elisabeth Qvigstad
- Institute of Clinical Medicine, University of Oslo, 0372 Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, 0424 Oslo, Norway
| | | | - Stina Therese Sollid
- Department of Medicine, Drammen Hospital, Vestre Viken Health Trust, 3004 Drammen, Norway
| | - Ingrid Nermoen
- Institute of Clinical Medicine, University of Oslo, 0372 Oslo, Norway
- Department of Endocrinology, Akershus University Hospital, 1478 Lørenskog, Norway
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, BHF Glasgow Cardiovascular Research Centre, 126 University Place, Glasgow G12 8TA, UK
| | - Jason Gill
- School of Cardiovascular and Metabolic Health, University of Glasgow, BHF Glasgow Cardiovascular Research Centre, 126 University Place, Glasgow G12 8TA, UK
| | - Tone Møller Tannæs
- EpiGen, Medical Division, Akershus University Hospital, 1478 Lørenskog, Norway
| | - Kåre Inge Birkeland
- Institute of Clinical Medicine, University of Oslo, 0372 Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, 0424 Oslo, Norway
| | - Sindre Lee-Ødegård
- Institute of Clinical Medicine, University of Oslo, 0372 Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, 0424 Oslo, Norway
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Kannan S, Nelliyanil M, Mendagudli R, Rajeshwari S, Kona C, Kundapur R, Sathyanath S, Kulkarni V, Aggarwal S. Evaluation of risk factors for non-alcoholic fatty liver disease in India: A systematic review and meta-analysis. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 12:435. [PMID: 38464628 PMCID: PMC10920698 DOI: 10.4103/jehp.jehp_208_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/23/2023] [Indexed: 03/12/2024]
Abstract
INTRODUCTION NAFLD is emerging as an important cause of liver disease in India. It is estimated that 16-32% of general population in India (nearly 120 million) has NAFLD. OBJECTIVE This study aimed to identify the risk factors of NAFLD and to identify the association of lifestyle (dietary and physical activity), genetic, and environmental factors with NAFLD in India. MATERIALS AND METHODS A systematic literature search was conducted using an international electronic database: PubMed (MEDLINE) and Google Scholar from the date of inception 31st March 2021 to 28th September 2021. We included studies examining patients with NAFLD: Adults above 18 years of age. Studies with or without a control population were both eligible. The studies with a diagnosis of NAFLD based solely on abnormal liver tests were excluded. We tried to get unpublished data but they were not of the quality of inclusion. Meta-analysis was performed using the software STATA 14.2 (StataCorp, College Station, TX, USA). For each of the studies, the standard error was calculated using the reported number of outcomes and the sample size. A forest plot was used to graphically represent the study-specific and pooled prevalence estimates for overall and subgroup analysis. RESULTS In a systematic review and meta-analysis of 8 studies including data from over 1800 individuals, we found that among components of lipid profile, LDL and HDL had a negative effects on NAFLD while triglycerides had a positive effect on NAFLD. CONCLUSION Type 2 Diabetes Mellitus, Hypertension, and Obesity were the potential risk factors for NAFLD but the evidence generated was only from single studies.
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Affiliation(s)
- Suthanthira Kannan
- Department of Community Medicine, ESIC Medical College, Chennai, Tamil Nadu, India
| | - Maria Nelliyanil
- Department of Community Medicine, AJ Institute of Medical Sciences and Research Center, Mangalore, Karnataka, India
| | - Roopa Mendagudli
- Department of Community Medicine, MR Medical College, Kalaburgai, Karnataka, India
| | - Swetha Rajeshwari
- Department of Community Medicine, ESIC Medical College, Sanathnagar, Hyderabad, Telangana, India
| | - Chandralekha Kona
- Department of Community Medicine and Family Medicine, AIIMS Bibinagar, Hyderabad, Telangana, India
| | - Rashmi Kundapur
- Department of Community Medicine and Family Medicine, AIIMS Bibinagar, Hyderabad, Telangana, India
| | - Shreyaswi Sathyanath
- Department of Community Medicine, AJ Institute of Medical Sciences and Research Center, Mangalore, Karnataka, India
| | - Vaman Kulkarni
- Department of Community Medicine and Family Medicine, AIIMS Bibinagar, Hyderabad, Telangana, India
| | - Sumit Aggarwal
- Scientist and Program Officer, ICMR, Headquarters, New Delhi, India
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Reinshagen M, Kabisch S, Pfeiffer AF, Spranger J. Liver Fat Scores for Noninvasive Diagnosis and Monitoring of Nonalcoholic Fatty Liver Disease in Epidemiological and Clinical Studies. J Clin Transl Hepatol 2023; 11:1212-1227. [PMID: 37577225 PMCID: PMC10412706 DOI: 10.14218/jcth.2022.00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/16/2022] [Accepted: 03/21/2023] [Indexed: 07/03/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is strongly associated with the metabolic syndrome and type 2 diabetes and independently contributes to long-term complications. Being often asymptomatic but reversible, it would require population-wide screening, but direct diagnostics are either too invasive (liver biopsy), costly (MRI) or depending on the examiner's expertise (ultrasonography). Hepatosteatosis is usually accommodated by features of the metabolic syndrome (e.g. obesity, disturbances in triglyceride and glucose metabolism), and signs of hepatocellular damage, all of which are reflected by biomarkers, which poorly predict NAFLD as single item, but provide a cheap diagnostic alternative when integrated into composite liver fat indices. Fatty liver index, NAFLD LFS, and hepatic steatosis index are common and accurate indices for NAFLD prediction, but show limited accuracy for liver fat quantification. Other indices are rarely used. Hepatic fibrosis scores are commonly used in clinical practice, but their mandatory reflection of fibrotic reorganization, hepatic injury or systemic sequelae reduces sensitivity for the diagnosis of simple steatosis. Diet-induced liver fat changes are poorly reflected by liver fat indices, depending on the intervention and its specific impact of weight loss on NAFLD. This limited validity in longitudinal settings stimulates research for new equations. Adipokines, hepatokines, markers of cellular integrity, genetic variants but also simple and inexpensive routine parameters might be potential components. Currently, liver fat indices lack precision for NAFLD prediction or monitoring in individual patients, but in large cohorts they may substitute nonexistent imaging data and serve as a compound biomarker of metabolic syndrome and its cardiometabolic sequelae.
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Affiliation(s)
- Mona Reinshagen
- Department of Endocrinology and Metabolism, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany
- Deutsches Zentrum für Diabetesforschung e.V., Geschäftsstelle am Helmholtz-Zentrum München, Neuherberg, Germany
| | - Stefan Kabisch
- Department of Endocrinology and Metabolism, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany
- Deutsches Zentrum für Diabetesforschung e.V., Geschäftsstelle am Helmholtz-Zentrum München, Neuherberg, Germany
| | - Andreas F.H. Pfeiffer
- Department of Endocrinology and Metabolism, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany
- Deutsches Zentrum für Diabetesforschung e.V., Geschäftsstelle am Helmholtz-Zentrum München, Neuherberg, Germany
| | - Joachim Spranger
- Department of Endocrinology and Metabolism, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany
- Deutsches Zentrum für Diabetesforschung e.V., Geschäftsstelle am Helmholtz-Zentrum München, Neuherberg, Germany
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Kuchay MS, Misra A. Sodium-glucose cotransporter-2 inhibitors as first-line pharmacological therapy for type 2 diabetes? Diabetes Metab Syndr 2022; 16:102580. [PMID: 35921765 DOI: 10.1016/j.dsx.2022.102580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Mohammad Shafi Kuchay
- Division of Endocrinology and Diabetes, Medanta the Medicity Hospital, Gurugram, 122001, Haryana, India.
| | - Anoop Misra
- Fortis CDOC Hospital for Diabetes and Allied Sciences, New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation (NDOC), and Diabetes Foundation, India
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Ghosh A, Dutta K, Bhatt SP, Gupta R, Tyagi K, Ansari IA, Venugopal VK, Mahajan H, Pandey RM, Pandey S, Misra A. Dapagliflozin Improves Body Fat Patterning, and Hepatic and Pancreatic Fat in Patients With Type 2 Diabetes in North India. J Clin Endocrinol Metab 2022; 107:e2267-e2275. [PMID: 35263436 DOI: 10.1210/clinem/dgac138] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Indexed: 01/01/2023]
Abstract
CONTEXT Excess hepatic and pancreatic fat may contribute to hyperglycemia. OBJECTIVE The objective of this study was to examine the effect of dapagliflozin (an SGLT2 inhibitor) on anthropometric profile, liver, and pancreatic fat in patients with type 2 diabetes mellitus (T2DM). METHODS This is an observational interventional paired study design without a control group. Patients (n = 30) were given dapagliflozin 10 mg/day (on top of stable dose of metformin and/or sulfonylureas) for 120 days. Changes in anthropometry (circumferences and skinfold thickness), surrogate markers of insulin resistance, body composition, liver, and pancreatic fat (as measured by magnetic resonance imaging (MRI)-derived proton density fat fraction [FF]) were evaluated. RESULTS After 120 days of treatment with dapagliflozin, a statistically significant reduction in weight, body mass index (BMI), body fat, circumferences, and all skinfold thickness was seen. A statistically significant reduction in blood glucose, glycated hemoglobin A1c, hepatic transaminases, fasting insulin, homeostatic model assessment of insulin resistance (HOMA-IR), and postprandial C-peptide was noted, while HOMA-β, postprandial insulin sensitivity, and fasting adiponectin were statistically significantly increased. There was no change in lean body mass. Compared to baseline there was a statistically significant decrease in mean liver FF (from 15.2% to 10.1%, P < .0001) and mean pancreatic FF (from 7.5% to 5.99%, P < .0083). Reduction in liver fat was statistically significant after adjustment for change in body weight. CONCLUSION Dapagliflozin, after 120 days of use, reduced pancreatic and liver fat and increased insulin sensitivity in Asian Indian patients with T2DM.
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Affiliation(s)
- Amerta Ghosh
- Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, India
- National Diabetes, Obesity and Cholesterol Foundation (N-DOC), New Delhi, India
| | - Koel Dutta
- Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, India
| | - Surya Prakash Bhatt
- Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, India
- National Diabetes, Obesity and Cholesterol Foundation (N-DOC), New Delhi, India
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
- Diabetes Foundation (India), New Delhi, India
| | - Ritesh Gupta
- Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, India
| | - Kanika Tyagi
- Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, India
| | - Irshad Ahmad Ansari
- Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, India
| | | | | | - Ravindra Mohan Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Shivam Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Anoop Misra
- Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, India
- National Diabetes, Obesity and Cholesterol Foundation (N-DOC), New Delhi, India
- Diabetes Foundation (India), New Delhi, India
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Mohamadi A, Shiraseb F, Mirzababaei A, Hosseininasab D, Rasaei N, Clark CCT, Mirzaei K. Circulating Inflammatory Markers May Mediate the Relationship between Healthy Plant-Based Diet and Metabolic Phenotype Obesity in Women: A Cross-Sectional Study. Int J Clin Pract 2022; 2022:8099382. [PMID: 35685490 PMCID: PMC9159206 DOI: 10.1155/2022/8099382] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/29/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND It has been posited that both metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUHO) could be emergent from diet and inflammatory markers. Thus, we sought to investigate the influence of plant-based diet on MHO and MUHO phenotypes mediated by inflammatory markers in overweight and obese women. METHODS This cross-sectional study was conducted on 289 women aged ≥18 years, with a body mass index (BMI) ≥25 kg/m2. Dietary intake was measured using 147 item food frequency questionnaire, as well as anthropometrics and biochemistry panel, in all participants. Metabolic health phenotypes were considered using Karelis score, while plant-based diet indices (PDI) were evaluated based on 18 food groups, where healthy and unhealthy PDI were identified. RESULTS Accordingly, 26.9% of women had MHO and 73.1% had MUHO phenotypes. After adjusting for potential confounders, TGF-β1 had a significant inverse association with hPDI (β: -0.28; 95% CI: 452.99, -85.25; P: 0.004). Moreover, we found that women with higher hPDI had lower odds of MUHO (OR: 0.95; 95% CI: 0.39, 2.30; P: 0.03). Regarding the mediatory effect of the inflammatory markers, TGF-β1 (P: 0.73), IL-β1 (P: 0.14), and MCP1 (P: 0.51) played a role in decreasing the odds of MUHO among hPDI tertiles. CONCLUSION There was a significant inverse relationship between adherence to hPDI and MUHO phenotype in overweight and obese Iranian women. This association appeared to be mediated by TGF-β1, IL-β1, and MCP1.
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Affiliation(s)
- Azam Mohamadi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Farideh Shiraseb
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Atieh Mirzababaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Dorsa Hosseininasab
- Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Niloufar Rasaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Cain C. T. Clark
- Centre for Intelligent Healthcare, Coventry University, Coventry, CV1 5FB, UK
| | - Khadijeh Mirzaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Gupta A, Anoop S, Ansari IA, Prakash S, Misra A. High prevalence of hepatic steatosis and hepatic fibrosis in patients with type 2 diabetes mellitus. Clin Nutr ESPEN 2021; 46:519-526. [PMID: 34857244 DOI: 10.1016/j.clnesp.2021.08.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/29/2021] [Accepted: 08/23/2021] [Indexed: 01/10/2023]
Abstract
AIM To determine the prevalence of hepatic steatosis and fibrosis in patients with T2DM from North India. RESEARCH DESIGN AND METHODS In this cross-sectional study, Asian Indian patients with T2DM (n,250) underwent liver ultrasonography (USG), Fibroscan for assessment of hepatic steatosis (Controlled Attenuation Parameter, CAP) and hepatic fibrosis (Kilopascals, kPa) respectively. Pearson's correlation analysis & logistic regression analysis for significant predictors of hepatic steatosis and fibrosis were done. The cut-off value of liver span was calculated by ROC-AUC analysis. RESULTS Grade 3 hepatic steatosis was seen in 213 T2DM patients (85.2%). It was higher in males than females and in those with high BMI values. Any degree of fibrosis and severe fibrosis were seen in 205 (62%) and 46 (18.4%) patients, respectively; these were higher in males, specifically in those with BMI >30 kg/m2, and diabetes of a duration more than 5 years. BMI and SGPT were the significant predictors of hepatic steatosis. An increase of 1 unit of BMI above 23 kg/m2 led to 19.6 times increased risk of hepatic steatosis in T2DM patients aged 50 years and above. SGOT and GGTP were significant predictors of any degree of hepatic fibrosis. On ROC-AUC analysis, liver span cut-off values of ≥16.4 cms and ≥16.8 cm in males and females respectively, were predictive of hepatic fibrosis. CONCLUSION High prevalence of grade 3 hepatic steatosis and hepatic fibrosis needs increased vigilance and corrective lifestyle and pharmacological measures. Asian Indian patients with T2DM and BMI >30 kg/m2, with duration of diabetes above 5 years & an ultrasound derived liver span ≥16.4 cms, should be further evaluated for hepatic fibrosis.
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Affiliation(s)
- Aanchal Gupta
- Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Chirag Enclave, Nehru Place, New Delhi, India
| | - Shajith Anoop
- Centre of Nutrition & Metabolic Research (C-NET), National Diabetes, Obesity and Cholesterol Foundation (N-DOC), SDA, New Delhi, India; Diabetes Foundation (India), SDA, New Delhi, India
| | - Irshad Ahmad Ansari
- Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Chirag Enclave, Nehru Place, New Delhi, India; Centre of Nutrition & Metabolic Research (C-NET), National Diabetes, Obesity and Cholesterol Foundation (N-DOC), SDA, New Delhi, India
| | - Satya Prakash
- Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Chirag Enclave, Nehru Place, New Delhi, India
| | - Anoop Misra
- Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Chirag Enclave, Nehru Place, New Delhi, India; Centre of Nutrition & Metabolic Research (C-NET), National Diabetes, Obesity and Cholesterol Foundation (N-DOC), SDA, New Delhi, India; Diabetes Foundation (India), SDA, New Delhi, India; Fortis Flt. Lt. Rajan Dhall Hospital, Vasant Kunj, New Delhi, India.
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Tsaban G, Bilitzky-Kopit A, Yaskolka Meir A, Zelicha H, Gepner Y, Shelef I, Orr O, Chassidim Y, Sarusi B, Ceglarek U, Stumvoll M, Blüher M, Stampfer MJ, Shai I, Schwarzfuchs D. The Effect of Weight-Loss Interventions on Cervical and Chin Subcutaneous Fat Depots; the CENTRAL Randomized Controlled Trial. Nutrients 2021; 13:nu13113827. [PMID: 34836081 PMCID: PMC8617936 DOI: 10.3390/nu13113827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/24/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022] Open
Abstract
Accumulation of cervical and chin subcutaneous adipose tissues (SAT) represent known phenotypes of obesity. We aimed to evaluate the sensitivity of these fat storages to long-term weight-loss directed lifestyle-intervention and to assess their relations to bodily-adiposity, insulin-resistance, and cardiometabolic risk; We randomly assigned 278 participants with abdominal-obesity/dyslipidemia to low-fat or Mediterranean/low-carbohydrate diets +/- physical-activity. All participants underwent an 18 month whole-body magnetic resonance imaging follow-up, from which we assessed cervical and chin SAT-areas; Participants (age = 48 years; 90% men; body-mass-index = 30.9 kg/m2) had an 18-month adherence-rate of 86%. Cervical-SAT and chin-SAT decreased after 6-months (-13.1% and -5.3%, respectively, p < 0.001). After 18-months only cervical-SAT remained decreased compared to baseline (-5%, p < 0.001). Cervical and chin-SAT 18-month changes were associated with changes in weight (r = 0.70, r = 0.66 respectively; <0.001 for both) and visceral-adipose-tissue (VAT; r = 0.35, r = 0.42 respectively; <0.001 for both). After adjustment to VAT, waist-circumference, or weight-changes, chin-SAT 18-month reduction was associated with favorable changes in fasting-glucose (β = 0.10; p = 0.05), HbA1c (β = 0.12; p = 0.03), and homeostasis-model-assessment-of-insulin-resistance (β = 0.12; p = 0.03). Cervical-SAT 18-month reduction was associated with decreased triglycerides (β = 0.16; p = 0.02) and leptin (β = 0.19; p = 0.01) independent of VAT; Cervical and chin-SATs are dynamic fat depots that correspond with weight-loss and are associated with changes in cardiometabolic profile. In long-term, chin-SAT displays a larger rebound compared with cervical-SAT. Chin-SAT accumulation is associated with in insulin-resistance, independent of central obesity. (ClinicalTrials identifier NCT01530724).
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Affiliation(s)
- Gal Tsaban
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (A.B.-K.); (A.Y.M.); (H.Z.); (O.O.); (I.S.)
- Department of Cardiology, Soroka University Medical Center, Beer-Sheva 84101, Israel
- Correspondence: ; Tel.: +972-8-647-7449/3
| | - Avital Bilitzky-Kopit
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (A.B.-K.); (A.Y.M.); (H.Z.); (O.O.); (I.S.)
| | - Anat Yaskolka Meir
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (A.B.-K.); (A.Y.M.); (H.Z.); (O.O.); (I.S.)
| | - Hila Zelicha
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (A.B.-K.); (A.Y.M.); (H.Z.); (O.O.); (I.S.)
| | - Yftach Gepner
- Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, and Sylvan Adams Sports Institute, School of Public Health, Tel-Aviv University, Tel-Aviv 96678, Israel;
| | - Ilan Shelef
- Division of Clinical Radiology, Soroka University Medical Center, Beer-Sheva 84101, Israel;
| | - Omri Orr
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (A.B.-K.); (A.Y.M.); (H.Z.); (O.O.); (I.S.)
| | - Yoash Chassidim
- Research Center, Soroka University Medical Center, Beer-Sheva 84101, Israel;
| | - Benjamin Sarusi
- Department of Medicine, Nuclear Research Center Negev, Dimona 84190, Israel; (B.S.); (D.S.)
| | - Uta Ceglarek
- Department of Medicine, University of Leipzig, 04103 Leipzig, Germany; (U.C.); (M.S.); (M.B.)
| | - Michael Stumvoll
- Department of Medicine, University of Leipzig, 04103 Leipzig, Germany; (U.C.); (M.S.); (M.B.)
| | - Matthias Blüher
- Department of Medicine, University of Leipzig, 04103 Leipzig, Germany; (U.C.); (M.S.); (M.B.)
| | - Meir J. Stampfer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
| | - Iris Shai
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (A.B.-K.); (A.Y.M.); (H.Z.); (O.O.); (I.S.)
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
| | - Dan Schwarzfuchs
- Department of Medicine, Nuclear Research Center Negev, Dimona 84190, Israel; (B.S.); (D.S.)
- Emergency Medicine Division, Soroka University Medical Center, Beer-Sheva 84101, Israel
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Kamalraj N, Sathishkumar M, Arunvignesh M, Baskar V, Jebarani S, Amutha A, Deepa M, Shanthi Rani CS, Chandru S, Unnikrishnan R, Anjana RM, Harish M, Mohan V. Retrospective analysis (2009-2017) of factors associated with progression and regression of non-alcoholic fatty liver disease (Hepatic steatosis) in patients with type 2 diabetes seen at a tertiary diabetes centre in Southern India. Diabetes Metab Syndr 2021; 15:102261. [PMID: 34464909 DOI: 10.1016/j.dsx.2021.102261] [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: 07/26/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 10/20/2022]
Abstract
AIM To identify the profiles and factors associated with progression/regression of ultrasound-derived hepatic steatosis with type 2 diabetes mellitus seen at a tertiary diabetes center in southern India. METHODS Participants were individuals with type 2 diabetes mellitus with at least two consecutive ultrasound measurements available. Hepatic steatosis was assessed using high-resolution B-mode ultrasonography. Admittedly ultrasonography has lower sensitivity and specificity, however, it is the only modality available in a routine clinical setting to screen for hepatic steatosis. Progression or regression of hepatic steatosis was assessed after a mean follow-up of 3.0 ± 2.1 years and correlated with clinical and biochemical parameters. RESULTS A total of 1835 participants with type 2 diabetes mellitus were studied, of whom 88.6% had some form of hepatic steatosis at baseline which included mild steatosis (grade 1) in 982 (53.5%), moderate steatosis (grade 2) in 628 (34.2%) and severe steatosis (grade 3) in 15 (0.8%). Hepatic steatosis progression, regression or no change in grade of hepatic steatosis were seen in 21.5%, 26.6% and 51.9% of participants. Increase in body weight, body mass index, glycated haemoglobin, serum triglycerides and gamma glutamyl transferase were the factors associated with progression of hepatic steatosis, whereas regression showed reduction in body weight, body mass index, fasting plasma glucose and glycated haemoglobin. CONCLUSION Among South Indian type 2 diabetes patients with hepatic steatosis, severity of steatosis progressed in 1/3rd while it regressed in 1/4th. These retrospective data need proper ascertainment in controlled studies.
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Affiliation(s)
| | | | | | | | | | | | - Mohan Deepa
- Madras Diabetes Research Foundation, Chennai, India
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10
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Liver fat scores do not reflect interventional changes in liver fat content induced by high-protein diets. Sci Rep 2021; 11:8843. [PMID: 33893355 PMCID: PMC8065150 DOI: 10.1038/s41598-021-87360-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 02/03/2021] [Indexed: 11/16/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is common in Metabolic Syndrome and type 2 diabetes (T2DM), driven by energy imbalance, saturated fats and simple carbohydrates. NAFLD requires screening and monitoring for late complications. Liver fat indices may predict NAFLD avoiding expensive or invasive gold-standard methods, but they are poorly validated for use in interventional settings. Recent data indicate a particular insensitivity to weight-independent liver fat reduction. We evaluated 31 T2DM patients, completing a randomized intervention study on isocaloric high-protein diets. We assessed anthropometric measures, intrahepatic lipid (IHL) content and serum liver enzymes, allowing AUROC calculations as well as cross-sectional and longitudinal Spearman correlations between the fatty liver index, the NAFLD-liver fat score, the Hepatosteatosis Index, and IHL. At baseline, all indices predicted NAFLD with moderate accuracy (AUROC 0.731–0.770), supported by correlation analyses. Diet-induced IHL changes weakly correlated with changes of waist circumference, but no other index component or the indices themselves. Liver fat indices may help to easily detect NAFLD, allowing cost-effective allocation of further diagnostics to patients at high risk. IHL reduction by weight-independent diets is not reflected by a proportional change in liver fat scores. Further research on the development of treatment-sensitive indices is required. Trial registration: The trial was registered at clinicaltrials.gov: NCT02402985.
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11
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Zaki M, Amin D, Mohamed R. Body composition, phenotype and central obesity indices in Egyptian women with non-alcoholic fatty liver disease. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2020; 18:385-390. [PMID: 34187121 DOI: 10.1515/jcim-2020-0073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 06/12/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide. The aim of this study is to investigate body composition and phenotype of Egyptian women with non-alcoholic fatty liver disease (NAFLD) and compare with those without and determine the optimal cut-off values of central obesity indices for predicting NAFLD. METHODS The study included 100 women with NAFLD and 100 age and sex matched healthy controls without NAFLD. All women were subjected to ultrasonography examination. Anthropometric measurements included weight, height, waist circumference (WC), hip circumference (HC) and skinfolds thickness were assessed for all participants. Body fat % was evaluated by Tanita body composition analyzer. Body mass index (BMI), WC / height ratio (WHtR), WC / HC ratio (WHR) and visceral adiposity index (VAI) were calculated. Receiver-operating characteristic (ROC) curve was used to determine the optimal cut-off values. RESULTS Data showed significant higher levels of WHtR, WHR, BMI, sum of skinfolds, body fat %, serum fasting blood lipids and glucose in NAFLD women compared to group of patients without NAFLD. The area under curve (AUC) was 0.920 for VIA, 0.883 for WHtR and 0.647 for WHR. The optimal cutoff value of VAI was 3.66, of WHtR was 0.66 and WHR was 0.84. All values showed high sensitivity and specificity values. CONCLUSION NAFLD women were obese, had excess subcutaneous fat and body fat ratio. Central obesity indices are closely associated with the presence of NAFLD in Egyptian women and might be responsible for its development. Visceral adiposity index had superior diagnostic performance.
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Affiliation(s)
- Moushira Zaki
- Biological Anthropology Department, Medical Research Division, National Research Centre, Cairo, Egypt
| | - Darine Amin
- Biological Anthropology Department, Medical Research Division, National Research Centre, Cairo, Egypt
| | - Ramy Mohamed
- Biological Anthropology Department, Medical Research Division, National Research Centre, Cairo, Egypt
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12
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Kuchay MS, Misra A. From non-alcoholic fatty liver disease (NAFLD) to metabolic-associated fatty liver disease (MAFLD): A journey over 40 years. Diabetes Metab Syndr 2020; 14:695-696. [PMID: 32442920 DOI: 10.1016/j.dsx.2020.05.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/10/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Mohammad Shafi Kuchay
- Division of Diabetes and Endocrinology, Medanta The Medicity Hospital, Gurugram, 122001, Haryana, India.
| | - Anoop Misra
- Fortis CDOC Hospital for Diabetes and Allied Sciences, New Delhi, India; National Diabetes Obesity and Cholesterol Foundation (NDOC) and Diabetes Foundation, India
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Misra A, Gopalan H, Jayawardena R, Hills AP, Soares M, Reza-Albarrán AA, Ramaiya KL. Diabetes in developing countries. J Diabetes 2019; 11:522-539. [PMID: 30864190 DOI: 10.1111/1753-0407.12913] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/27/2019] [Accepted: 03/08/2019] [Indexed: 12/24/2022] Open
Abstract
There has been a rapid escalation of type 2 diabetes (T2D) in developing countries, with varied prevalence according to rural vs urban habitat and degree of urbanization. Some ethnic groups (eg, South Asians, other Asians, and Africans), develop diabetes a decade earlier and at a lower body mass index than Whites, have prominent abdominal obesity, and accelerated the conversion from prediabetes to diabetes. The burden of complications, both macro- and microvascular, is substantial, but also varies according to populations. The syndemics of diabetes with HIV or tuberculosis are prevalent in many developing countries and predispose to each other. Screening for diabetes in large populations living in diverse habitats may not be cost-effective, but targeted high-risk screening may have a place. The cost of diagnostic tests and scarcity of health manpower pose substantial hurdles in the diagnosis and monitoring of patients. Efforts for prevention remain rudimentary in most developing countries. The quality of care is largely poor; hence, a substantial number of patients do not achieve treatment goals. This is further amplified by a delay in seeking treatment, "fatalistic attitudes", high cost and non-availability of drugs and insulins. To counter these numerous challenges, a renewed political commitment and mandate for health promotion and disease prevention are urgently needed. Several low-cost innovative approaches have been trialed with encouraging outcomes, including training and deployment of non-medical allied health professionals and the use of mobile phones and telemedicine to deliver simple health messages for the prevention and management of T2D.
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Affiliation(s)
- Anoop Misra
- National-Diabetes, Obesity and Cholesterol Foundation, Safdarjung Development Area, New Delhi, India
- Diabetes Foundation (India), New Delhi, India
- Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, India
| | - Hema Gopalan
- National-Diabetes, Obesity and Cholesterol Foundation, Safdarjung Development Area, New Delhi, India
| | | | - Andrew P Hills
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Mario Soares
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Alfredo A Reza-Albarrán
- Endocrinology and Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Abstract
PURPOSE OF REVIEW Obesity has increased in South Asian countries that are still grappling with undernutrition. In this review, we highlight the characteristics of obesity, its relation to morbidities, and its management in South Asians. A literature search was conducted using relevant search engines and based on key words focusing on obesity in South Asians. RECENT FINDINGS The increasing trend in obesity prevalence is caused by imbalanced diets and physical inactivity. South Asians, in general, have higher body fat and lower skeletal muscle mass at the same or lower BMIs compared to white people ("high body fat-normal BMI-low muscle mass" phenotype). In addition, excess abdominal adiposity, typically seen in South Asians, and increased hepatic fat (non-alcoholic fatty liver disease) are associated with an increased risk for type 2 diabetes and cardiovascular disease. Challenges in treatment include lack of awareness regarding correct diets and non-compliance to diet and exercise regimens. Social and cultural issues limit physical activity in South Asian women. Finally, there is a lack of expert health professionals to deal with increased cases of obesity. Aggressive management of obesity is required in South Asians, with more intensive and earlier diet and exercise interventions (i.e., at lower BMI levels than internationally accepted). At a population level, there is no clear policy for tackling obesity in any South Asian country. Prevention strategies focusing on obesity in childhood and the creation of food and activity environments that encourage healthy lifestyles should be firmly applied. Obesity in South Asians should be evaluated with ethnic-specific guidelines and prevention and management strategies should be applied early and aggressively.
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Affiliation(s)
- Anoop Misra
- Metabolic Diseases and Allied Specialties, Fortis-C-DOC Hospital for Diabetes, B-16, Chirag Enclave, New Delhi, India.
- National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India.
- Diabetes Foundation (India), New Delhi, India.
| | - Ranil Jayawardena
- Department of Physiology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Shajith Anoop
- Metabolic Diseases and Allied Specialties, Fortis-C-DOC Hospital for Diabetes, B-16, Chirag Enclave, New Delhi, India
- National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India
- Diabetes Foundation (India), New Delhi, India
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15
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Kabisch S, Bäther S, Dambeck U, Kemper M, Gerbracht C, Honsek C, Sachno A, Pfeiffer AFH. Liver Fat Scores Moderately Reflect Interventional Changes in Liver Fat Content by a Low-Fat Diet but Not by a Low-Carb Diet. Nutrients 2018; 10:nu10020157. [PMID: 29385034 PMCID: PMC5852733 DOI: 10.3390/nu10020157] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/15/2018] [Accepted: 01/25/2018] [Indexed: 12/19/2022] Open
Abstract
Background: Non-alcoholic fatty liver disease (NAFLD) is a common metabolic disorder all over the world, mainly being associated with a sedentary lifestyle, adiposity, and nutrient imbalance. The increasing prevalence of NAFLD accommodates similar developments for type 2 diabetes and diabetes-related comorbidities and complications. Therefore, early detection of NAFLD is an utmost necessity. Potentially helpful tools for the prediction of NAFLD are liver fat indices. The fatty liver index (FLI) and the NAFLD-liver fat score (NAFLD-LFS) have been recently introduced for this aim. However, both indices have been shown to correlate with liver fat status, but there is neither sufficient data on the longitudinal representation of liver fat change, nor proof of a diet-independent correlation between actual liver fat change and change of index values. While few data sets on low-fat diets have been published recently, low-carb diets have not been yet assessed in this context. Aim: We aim to provide such data from a highly effective short-term intervention to reduce liver fat, comparing a low-fat and a low-carb diet in subjects with prediabetes. Methods: Anthropometric measurements, magnetic resonance (MR)-based intrahepatic lipid (IHL) content, and several serum markers for liver damage have been collected in 140 subjects, completing the diet phase in this trial. Area-under-the-responder-operator-curves (AUROC) calculations as well as cross-sectional and longitudinal Spearman correlations were used. Results: Both FLI and NAFLD-LFS predict liver fat with moderate accuracy at baseline (AUROC 0.775–0.786). These results are supported by correlation analyses. Changes in liver fat, achieved by the dietary intervention, correlate moderately with changes in FLI and NAFLD-LFS in the low-fat diet, but not in the low-carb diet. A correlation analysis between change of actual IHL content and change of single elements of the liver fat indices revealed diet-specific moderate to strong correlations between ΔIHL and changes of measures of obesity, ΔTG, and ΔALT (all low-fat, only) and between ΔIHL and ΔGGT (low-carb, only). With exception for a stronger decrease of triglycerides (TG) levels in the low-carb diet, there is no statistically significant difference in the effect of the diets on anthropometric or serum-based score parameters. Conclusion: While liver fat indices have proved useful in the early detection of NAFLD and may serve as a cost-saving substitute for expensive MR measurements in the cross-sectional evaluation of liver status, their capability to represent interventional changes of liver fat content appears to be diet-specific and lacks accuracy. Liver fat reduction by low-fat diets can be monitored with moderate precision, while low-carb diets require different measuring techniques to demonstrate the same dietary effect.
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Affiliation(s)
- Stefan Kabisch
- Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.
- German Center for Diabetes Research (Deutsches Zentrum für Diabetesforschung e.V.), Ingolstädter Landstraße 1, 85764 Neuherberg, Germany.
| | - Sabrina Bäther
- Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.
- German Center for Diabetes Research (Deutsches Zentrum für Diabetesforschung e.V.), Ingolstädter Landstraße 1, 85764 Neuherberg, Germany.
- Department of Geriatrics, Campus Virchow, Charité University Medicine, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Ulrike Dambeck
- Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.
- German Center for Diabetes Research (Deutsches Zentrum für Diabetesforschung e.V.), Ingolstädter Landstraße 1, 85764 Neuherberg, Germany.
- Department of Geriatrics, Campus Virchow, Charité University Medicine, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Margrit Kemper
- Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.
- German Center for Diabetes Research (Deutsches Zentrum für Diabetesforschung e.V.), Ingolstädter Landstraße 1, 85764 Neuherberg, Germany.
| | - Christiana Gerbracht
- Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.
| | - Caroline Honsek
- Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.
| | - Anna Sachno
- Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.
- German Center for Diabetes Research (Deutsches Zentrum für Diabetesforschung e.V.), Ingolstädter Landstraße 1, 85764 Neuherberg, Germany.
| | - Andreas F H Pfeiffer
- Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.
- German Center for Diabetes Research (Deutsches Zentrum für Diabetesforschung e.V.), Ingolstädter Landstraße 1, 85764 Neuherberg, Germany.
- Department of Endocrinology, Diabetes and Nutrition, Campus Benjamin Franklin, Charité University Medicine, Hindenburgdamm 30, 12203 Berlin, Germany.
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Choudhary NS, Saraf N, Saigal S, Duseja A, Gautam D, Lipi L, Rastogi A, Goja S, Bhangui P, Ramchandra SK, Babu YR, Soin AS. Prediction of nonalcoholic fatty liver in prospective liver donors. Clin Transplant 2017; 31. [PMID: 27988988 DOI: 10.1111/ctr.12890] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Metabolic risk factors should be important in addition to imaging for prediction of steatosis in prospective liver donors. MATERIALS AND METHODS The study group included all prospective liver donors who had a liver biopsy during workup. Risk factors of metabolic syndrome were analyzed, and body mass index (BMI) ≥25 kg/m2 was used in place of waist circumference. Three BMI cutoffs (25, 28, and 30 kg/m2 ) and two CT-measured liver attenuation index (LAI) cutoffs (<5 and ≤10) were used for steatosis assessment of ≥5%, ≥10%, and ≥20%. RESULTS Of the 573 prospective donors (307 females), 282 (49.2%) donors had nonalcoholic fatty liver (NAFL). When donors with NAFL were compared with donors having normal histology, multivariate analysis showed BMI, ALT, triglycerides, and LAI as significant predictors of NAFL. BMI ≥25 kg/m2 and LAI <10 were better cutoffs. The presence of ≥2 metabolic risk factors had better sensitivity than CT-LAI for the presence of NAFL and ≥20% steatosis (58% and 54% vs 47% and 22%, respectively, for CT-LAI ≤10). The presence of LAI >10 and <2 metabolic risk factors predicted <10% steatosis with 96% specificity and 92% positive predictive value. CONCLUSION The presence of ≥2 metabolic risk factors improves sensitivity of CT-LAI for prediction of donor steatosis.
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Affiliation(s)
| | - Neeraj Saraf
- Medanta Liver Institute, Medanta The Medicity, Gurgaon, India
| | - Sanjiv Saigal
- Medanta Liver Institute, Medanta The Medicity, Gurgaon, India
| | - Ajay Duseja
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Medanta The Medicity, Gurgaon, Chandigarh, India
| | - Dheeraj Gautam
- Department of Histopathology, Medanta The Medicity, Gurgaon, India
| | - Lipika Lipi
- Department of Histopathology, Medanta The Medicity, Gurgaon, India
| | - Amit Rastogi
- Medanta Liver Institute, Medanta The Medicity, Gurgaon, India
| | - Sanjay Goja
- Medanta Liver Institute, Medanta The Medicity, Gurgaon, India
| | | | | | | | - Arvinder S Soin
- Medanta Liver Institute, Medanta The Medicity, Gurgaon, India
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Shrivastava U, Fatma M, Mohan S, Singh P, Misra A. Randomized Control Trial for Reduction of Body Weight, Body Fat Patterning, and Cardiometabolic Risk Factors in Overweight Worksite Employees in Delhi, India. J Diabetes Res 2017; 2017:7254174. [PMID: 29318159 PMCID: PMC5727835 DOI: 10.1155/2017/7254174] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/01/2017] [Accepted: 09/18/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND We studied the impact of the multicomponent interventions on body weight and cardiometabolic risk factors in overweight individuals working in corporate worksites. METHODS Overweight (BMI ≥ 23 kg/m2) subjects were recruited from four randomised worksites [two active intervention (n, recruited, 180, completed 156) and two control (n, recruited 130, completed 111)]. Intensive intervention was given at intervention worksite. RESULTS High prevalence (%) of obesity (90.9, 80.2), abdominal obesity (93.5, 84.3), excess skinfold thickness (70.3, 75.9), and low high-density lipoprotein cholesterol (HDL-c) levels (56.8, 63.7) were seen in the intervention and the control group, respectively. At the end of intervention, the following significant changes were observed in the intervention group: decrease in weight, BMI, waist circumference, serum triglycerides, and increase in HDL-c. Weight loss of more than 5% was seen in 12% and 4% individuals in the intervention and control groups, respectively. Most importantly, the sum of all the skinfold measurements (mm) in the intervention group decreased significantly more than the control group (12.51 ± 10.38 versus 3.50 ± 8.18, resp.). CONCLUSION This multicomponent worksite trial showed a reduction in weight, excess subcutaneous fat, and cardiometabolic risk factors after 6 months of active intervention in overweight Asian Indians. TRIAL REGISTRATION This trial is registered with NCT03249610.
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Affiliation(s)
- Usha Shrivastava
- National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India
- Diabetes Foundation (India), New Delhi, India
- Centre for Public Health India, New Delhi, India
| | - Mahrukh Fatma
- National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India
- Diabetes Foundation (India), New Delhi, India
| | - Smriti Mohan
- National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India
- Diabetes Foundation (India), New Delhi, India
| | - Padam Singh
- Fortis C-DOC Hospital for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, India
| | - Anoop Misra
- National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India
- Diabetes Foundation (India), New Delhi, India
- Centre for Public Health India, New Delhi, India
- Fortis C-DOC Hospital for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, India
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