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Otsubo N, Fukuda T, Cho G, Ishibashi F, Yamada T, Monzen K. Utility of Indices Obtained during Medical Checkups for Predicting Fatty Liver Disease in Non-obese People. Intern Med 2023; 62:2307-2319. [PMID: 36517035 PMCID: PMC10484762 DOI: 10.2169/internalmedicine.1097-22] [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: 10/07/2022] [Accepted: 10/31/2022] [Indexed: 12/15/2022] Open
Abstract
Objective To predict fatty liver disease (FLD), including nonalcoholic FLD (NAFLD) and metabolic dysfunction-associated FLD (MAFLD), from blood tests and anthropometric measurements, the fatty liver index (FLI) and triglyceride glucose-body mass index (TyG-BMI) have been reported as promising indicators. We evaluated the predictive ability of several indices, including the waist circumference, BMI, FLI and TyG-BMI, that might predict FLD in non-obese individuals undergoing health checkups. Methods This retrospective observational study enrolled non-obese subjects who underwent abdominal ultrasonography between May 1, 2015, and June 30, 2022. Obesity was defined as a BMI <25 kg/m2. FLD was diagnosed by abdominal ultrasonography. Using a receiver operating characteristic analysis, we examined the predictive validity of indices for NAFLD and MAFLD by calculating the area under the curve (AUC). Results Of the 24,825 subjects (mean age 44.3±10.0 years old; 54% men) enrolled in this examination of the association of indices, including FLI and TyG-BMI, with NAFLD, NAFLD was diagnosed in 3,619 (27%) men and 733 (6%) women. In both men and women, the FLI and TyG-BMI had significantly higher AUC values for NAFLD prediction than the other indicators (FLI: 0.786 for men and 0.875 for women, TyG-BMI: 0.783 for men and 0.868 for women). In analyses of subjects with a BMI <23 kg/m2, the superiority of the FLI and TyG-BMI remained unchanged. The FLI and TyG-BMI also had significantly higher AUC values for MAFLD prediction than the other indicators. Conclusion The FLI and TyG-BMI had a particularly high predictive ability for NAFLD and MAFLD in non-obese subjects.
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Affiliation(s)
- Naoya Otsubo
- Shinjuku Tsurukame Clinic, Japan
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Health and Hospitals Corporation Okubo Hospital, Japan
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Tatsuya Fukuda
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Health and Hospitals Corporation Okubo Hospital, Japan
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
- Mirraza Shinjuku Tsurukame Clinic, Japan
| | - Genhin Cho
- Mirraza Shinjuku Tsurukame Clinic, Japan
| | - Fumiaki Ishibashi
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Japan
- Koganei Tsurukame Clinic, Japan
| | - Tetsuya Yamada
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
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Magnetic resonance elastography of the liver: everything you need to know to get started. Abdom Radiol (NY) 2022; 47:94-114. [PMID: 34725719 DOI: 10.1007/s00261-021-03324-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 12/17/2022]
Abstract
Magnetic resonance elastography (MRE) of the liver has emerged as the non-invasive standard for the evaluation of liver fibrosis in chronic liver diseases (CLDs). The utility of MRE in the evaluation of different CLD in both adults and children has been demonstrated in several studies, and MRE has been recommended by several clinical societies. Consequently, the clinical indications for evaluation of CLD with MRE have increased, and MRE is currently used as an add-on test during routine liver MRI studies or as a standalone test. To meet the increasing clinical demand, MRE is being installed in many academic and private practice imaging centers. There is a need for a comprehensive practical guide to help these practices to deliver high-quality liver MRE studies as well as troubleshoot the common issues with MRE to ensure smooth running of the service. This comprehensive clinical practice review summarizes the indications and provides an overview on why to use MRE, technical requirements, system set-up, patient preparation, acquiring the data, and interpretation.
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Meyer G, Dauth N, Grimm M, Herrmann E, Bojunga J, Friedrich-Rust M. Shear Wave Elastography Reveals a High Prevalence of NAFLD-related Fibrosis Even in Type 1 Diabetes. Exp Clin Endocrinol Diabetes 2021; 130:532-538. [PMID: 34784620 DOI: 10.1055/a-1666-0431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The association between type 2 diabetes mellitus (T2DM) and advanced stages of non-alcoholic fatty liver disease is well known. Some studies indicate a relevant prevalence also in type 1 diabetes mellitus (T1DM), but so far there is only limited data. OBJECTIVE To determine the prevalence of non-alcoholic fatty liver disease (NAFLD)-related liver fibrosis in individuals with T1DM and compare to those with type 2 diabetes. METHODS Diabetic patients from a single diabetes care centre were screened for liver fibrosis by sonographic shear wave elastography (SWE). In addition, all patients received laboratory evaluation including non-alcoholic fatty liver fibrosis score and Fibrosis-4 Index. RESULTS Three hundred and forty patients were included in the study, of these, 310 received SWE. Overall 254 patients (93 with type 1 and 161 with type 2 diabetes) had reliable measurements and were included in the final analysis. In patients with type 1 diabetes, the prevalence of NAFLD-related liver fibrosis was 16-21%, depending on the method of detection. Significant liver fibrosis was observed in 30-46% of patients with type 2 diabetes. CONCLUSIONS Our data revealed an unexpectedly high prevalence of NAFLD-related liver fibrosis in patients with type 1 diabetes. To our knowledge, this is one of the first studies using SWE to diagnose advanced NAFLD in type 1 diabetes in a non-preselected cohort. Considering the findings of our study, regular screening for hepatic complications must be recommended for all diabetic patients, even for those with type 1 diabetes.
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Affiliation(s)
- Gesine Meyer
- Department of Internal Medicine, Goethe-University Hospital, Frankfurt, Germany
| | - Nina Dauth
- Department of Internal Medicine, Goethe-University Hospital, Frankfurt, Germany
| | - Matthias Grimm
- Department of Internal Medicine, Goethe-University Hospital, Frankfurt, Germany
| | - Eva Herrmann
- Institute of Biostatistics and Mathematic Modelling, Goethe-University, Frankfurt, Germany
| | - Joerg Bojunga
- Department of Internal Medicine, Goethe-University Hospital, Frankfurt, Germany
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García-Escobar E, Valdés S, Soriguer F, Vendrell J, Urrutia-Etxebarria IM, Maldonado-Araque C, Ortega E, Ocón P, Montanya E, Menéndez E, Lago-Sampedro A, González-Frutos T, Gomis R, Goday A, García-Serrano S, Galán-García JL, Castell C, Bordiú E, Badía R, Aguilera-Venegas G, Girbés J, Gaztambide S, Delgado E, Chaves FJ, Castaño L, Calle-Pascual A, Rojo-Martínez G, Franch-Nadal J. Fatty liver index as a predictor for type 2 diabetes in subjects with normoglycemia in a nationwide cohort study. Sci Rep 2021; 11:16453. [PMID: 34385479 PMCID: PMC8361016 DOI: 10.1038/s41598-021-95546-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 07/20/2021] [Indexed: 01/21/2023] Open
Abstract
Our aim was to evaluate whether fatty liver index (FLI) is associated with the risk of type 2 diabetes (T2DM) development within the Spanish adult population and according to their prediabetes status; additionally, to examine its incremental predictive value regarding traditional risk factors. A total of 2260 subjects (Prediabetes: 641 subjects, normoglycemia: 1619 subjects) from the Di@bet.es cohort study were studied. Socio-demographic, anthropometric, clinical data and survey on habits were recorded. An oral glucose tolerance test was performed and fasting determinations of glucose, lipids and insulin were made. FLI was calculated and classified into three categories: Low (< 30), intermediate (30–60) and high (> 60). In total, 143 people developed diabetes at follow-up. The presence of a high FLI category was in all cases a significant independent risk factor for the development of diabetes. The inclusion of FLI categories in prediction models based on different conventional T2DM risk factors significantly increase the prediction power of the models when all the population was considered. According to our results, FLI might be considered an early indicator of T2DM development even under normoglycemic condition. The data also suggest that FLI could provide additional information for the prediction of T2DM in models based on conventional risk factors.
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Affiliation(s)
- E García-Escobar
- Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain. .,Endocrinology and Nutrition Department, Biomedical Research Institute of Malaga (IBIMA), Regional University Hospital of Malaga, Málaga, Spain.
| | - S Valdés
- Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain.,Endocrinology and Nutrition Department, Biomedical Research Institute of Malaga (IBIMA), Regional University Hospital of Malaga, Málaga, Spain
| | - F Soriguer
- Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain.,Endocrinology and Nutrition Department, Biomedical Research Institute of Malaga (IBIMA), Regional University Hospital of Malaga, Málaga, Spain
| | - J Vendrell
- Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain.,Rovira i Virgili University; Department of Endocrinology and Nutrition, Hospital Universitario Joan XXIII, Institut d'Investigacions Sanitaries Pere Virgili, Tarragona, Spain
| | - I M Urrutia-Etxebarria
- Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain.,Cruces University Hospital, BioCruces Bizkaia, UPV/EHU, Endo-ERN, Barakaldo, Spain.,Spanish Biomedical Research Network in Rare Diseases (CIBERER), Madrid, Spain
| | - C Maldonado-Araque
- Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain.,Endocrinology and Nutrition Department, Biomedical Research Institute of Malaga (IBIMA), Regional University Hospital of Malaga, Málaga, Spain
| | - E Ortega
- Department of Endocrinology and Nutrition, August Pi i Sunyer Biomedical Research Institute - IDIBAPS, Hospital Clínic of Barcelona, Barcelona, Spain.,Spanish Biomedical Research Network in Physiopathology of Obesity and Nutrition (CIBEROBN), Barcelona, Spain
| | - P Ocón
- General Laboratory, Regional University Hospital of Malaga, Málaga, Spain
| | - E Montanya
- Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Bellvitge University Hospital, Barcelona, Spain
| | - E Menéndez
- Spanish Biomedical Research Network in Rare Diseases (CIBERER), Madrid, Spain.,Department of Endocrinology and Nutrition, Central University Hospital of Asturias/University of Oviedo, Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
| | - A Lago-Sampedro
- Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain.,Endocrinology and Nutrition Department, Biomedical Research Institute of Malaga (IBIMA), Regional University Hospital of Malaga, Málaga, Spain
| | - T González-Frutos
- Cruces University Hospital, BioCruces Bizkaia, UPV/EHU, Endo-ERN, Barakaldo, Spain
| | - R Gomis
- Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain.,Department of Endocrinology and Nutrition, August Pi i Sunyer Biomedical Research Institute - IDIBAPS, Hospital Clínic of Barcelona, Barcelona, Spain
| | - A Goday
- Spanish Biomedical Research Network in Physiopathology of Obesity and Nutrition (CIBEROBN), Barcelona, Spain.,Endocrinology and Nutrition Department, Hospital del Mar/Medicine Departament, Univeristat Autonoma de Barcelona, Barcelona, Spain
| | - S García-Serrano
- Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain.,Endocrinology and Nutrition Department, Biomedical Research Institute of Malaga (IBIMA), Regional University Hospital of Malaga, Málaga, Spain
| | - J L Galán-García
- Department of Applied Mathematics, Malaga University, Málaga, Spain
| | - C Castell
- Department of Health, Public Health Agency of Catalonia, Barcelona, Spain
| | - E Bordiú
- Department of Endocrinology and Nutrition, San Carlos University Hospital of Madrid, Madrid, Spain
| | - R Badía
- Endocrinology and Nutrition Department, Biomedical Research Institute of Malaga (IBIMA), Regional University Hospital of Malaga, Málaga, Spain
| | | | - J Girbés
- Diabetes Unit, Hospital Arnau de Vilanova, Valencia, Spain
| | - S Gaztambide
- Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain.,Cruces University Hospital, BioCruces Bizkaia, UPV/EHU, Endo-ERN, Barakaldo, Spain.,Spanish Biomedical Research Network in Rare Diseases (CIBERER), Madrid, Spain
| | - E Delgado
- Spanish Biomedical Research Network in Rare Diseases (CIBERER), Madrid, Spain.,Department of Endocrinology and Nutrition, Central University Hospital of Asturias/University of Oviedo, Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
| | - F J Chaves
- Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain.,Genomic and Genetic Diagnosis Unit, Research Foundation of Valencia University Clinical Hospital-INCLIVA, Valencia, Spain
| | - L Castaño
- Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain.,Cruces University Hospital, BioCruces Bizkaia, UPV/EHU, Endo-ERN, Barakaldo, Spain.,Spanish Biomedical Research Network in Rare Diseases (CIBERER), Madrid, Spain
| | - A Calle-Pascual
- Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain.,Department of Endocrinology and Nutrition, San Carlos University Hospital of Madrid, Madrid, Spain
| | - G Rojo-Martínez
- Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain. .,Endocrinology and Nutrition Department, Biomedical Research Institute of Malaga (IBIMA), Regional University Hospital of Malaga, Málaga, Spain.
| | - J Franch-Nadal
- Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain.,EAP Raval Sud, Catalan Institute of Health, GEDAPS Network, Primary Care, Research Support Unit (IDIAP - Jordi Gol Foundation), Barcelona, Spain
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Shrestha U, van der Merwe M, Kumar N, Jacobs E, Satapathy SK, Morin C, Tipirneni-Sajja A. Morphological characterization of hepatic steatosis and Monte Carlo modeling of MRI signal for accurate quantification of fat fraction and relaxivity. NMR IN BIOMEDICINE 2021; 34:e4489. [PMID: 33586261 DOI: 10.1002/nbm.4489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/16/2020] [Accepted: 01/25/2021] [Indexed: 06/12/2023]
Abstract
Chemical-shift-based fat-water MRI signal models with single- or dual-R2 * correction have been proposed for quantification of fat fraction (FF) and assessment of hepatic steatosis. However, there is a void in our understanding of which model truly mimics the underlying biophysical mechanism of steatosis on MRI signal relaxation. The purpose of this study is to morphologically characterize and build realistic steatosis models from histology and synthesize MRI signal using Monte Carlo simulations to investigate the accuracy of single- and dual-R2 * models in quantifying FF and R2 *. Fat morphology was characterized by performing automatic segmentation on 16 mouse liver histology images and extracting the radius, nearest neighbor (NN) distance, and regional anisotropy of fat droplets. A gamma distribution function (GDF) was used to generalize extracted features, and regression analysis was performed to derive relationships between FF and GDF parameters. Virtual steatosis models were created based on derived morphological and statistical descriptors, and the MRI signal was synthesized at 1.5 T and 3 T. R2 * and FF values were calculated using single- and dual-R2 * models and compared with in vivo R2 *-FF calibrations and simulated FFs. The steatosis models generated with regional anisotropy and NN distribution closely mimicked the true in vivo fat morphology. For both R2 * models, predicted R2 * values showed positive correlation with FFs, with slopes similar to those of the in vivo calibrations (P > 0.05), and predicted FFs showed excellent agreement with true FFs (R2 > 0.99), with slopes close to unity. Our study, hence, demonstrates the proof of concept for generating steatosis models from histologic data and synthesizing MRI signal to show the expected signal relaxation under conditions of steatosis. Our results suggest that a single R2 * is sufficient to accurately estimate R2 * and FF values for lower FFs, which agrees with in vivo studies. Future work involves characterizing and building steatosis models at higher FFs and testing single- and dual-R2 * models for accurate assessment of steatosis.
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Affiliation(s)
- Utsav Shrestha
- Department of Biomedical Engineering, The University of Memphis, Memphis, Tennessee, USA
- Department of Computer Science, The University of Memphis, Memphis, Tennessee, USA
| | - Marie van der Merwe
- College of Health Sciences, The University of Memphis, Memphis, Tennessee, USA
| | - Nirman Kumar
- Department of Computer Science, The University of Memphis, Memphis, Tennessee, USA
| | - Eddie Jacobs
- Department of Electrical & Computer Engineering, The University of Memphis, Memphis, Tennessee, USA
| | - Sanjaya K Satapathy
- Department of Medicine, North Shore University Hospital/Northwell Health, Manhasset, New York, USA
| | - Cara Morin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Aaryani Tipirneni-Sajja
- Department of Biomedical Engineering, The University of Memphis, Memphis, Tennessee, USA
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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6
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Sheng G, Peng N, Hu C, Zhong L, Zhong M, Zou Y. The albumin-to-alkaline phosphatase ratio as an independent predictor of future non-alcoholic fatty liver disease in a 5-year longitudinal cohort study of a non-obese Chinese population. Lipids Health Dis 2021; 20:50. [PMID: 33993872 PMCID: PMC8126124 DOI: 10.1186/s12944-021-01479-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 05/06/2021] [Indexed: 02/06/2023] Open
Abstract
Background The albumin-to-alkaline phosphatase ratio (AAPR) is a newly developed index of liver function, but its association in patients with non-alcoholic fatty liver disease (NAFLD) has not been established. The aim of this study was to investigate the association between the AAPR and NAFLD in a non-obese Chinese population. Methods The study included 10,749 non-obese subjects without NAFLD at baseline and divided them into quintiles according to the AAPR. A Cox multiple regression model was used to examine the association between the AAPR and its quintiles and the incidence of NAFLD. Results The average age of the study population was 43.65 ± 15.15 years old. During the 5-year follow-up, 1860 non-obese subjects had NAFLD events. In the Cox multiple regression model, after adjusting the model according to important risk factors, the AAPR and NAFLD risk were independently correlated, and with a gradual increase in the AAPR, the NAFLD risk decreased gradually (HR: 0.61, 95% CI: 0.47, 0.81; P-trend< 0.0001). Additionally, there were significant interactions between the AAPR and BMI, blood pressure and lipids (P-interaction < 0.05). Stratified analysis showed that the risk of AAPR-related NAFLD decreased in people with normal blood pressure and lipid levels, while the risk of AAPR-related NAFLD increased abnormally in people who were underweight. Conclusions This longitudinal cohort study provides the first evidence that the AAPR is an independent predictor of future NAFLD events in non-obese people. For non-obese people with a low AAPR, especially those with BMI < 18.5 kg/m2, more attention should be given to the management of risk factors for NAFLD to prevent future NAFLD. Supplementary Information The online version contains supplementary material available at 10.1186/s12944-021-01479-9.
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Affiliation(s)
- Guotai Sheng
- Cardiology Department, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, 330006, China
| | - Nan Peng
- Cardiology Department, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, 330006, China
| | - Chong Hu
- Gastroenterology Department, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, 330006, China
| | - Ling Zhong
- Pediatrics Department, Lishui People's Hospital, Lishui, 323000, China
| | - Mingchun Zhong
- Cardiology Department, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, 330006, China
| | - Yang Zou
- Cardiology Department, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, 330006, China.
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7
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Liaqat M, Fatima M, Malik SS, Gillani SA, Manzoor I. Ultrasonographic Features Associated with Diffuse Hepatosteatosis among Diabetic Obese and Normal Body Mass Index Patients. J Med Ultrasound 2020; 28:235-238. [PMID: 33659163 PMCID: PMC7869742 DOI: 10.4103/jmu.jmu_94_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/09/2020] [Accepted: 03/06/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The purpose of the study is to evaluate and compare the changes associated with hepatosteatosis in diabetic obese versus diabetic normal-weight patients through ultrasonography. It is estimated that with the prevalence of about 30%-75% of obese individuals accordingto the body mass index (BMI) criteria are at increase risk of developing simple fatty live. Besides obesity, diabetes mellitus is also considered to be one of the important causes of hepatosteatosis. METHODS This prospective study was conducted in February 2015-December 2015 on a group of 181 diabetic patients, including 65 males and 116 females with an age range of 40-80 years. The patients were divided into two diabetic groups: those having a BMI ≥30 kg/m2 were included in the obese group (n = 116) and those with a BMI of 18.5-25 kg/m2 were included in the normal BMI group (n = 65). Ultrasound machine Esaote MyLab 50 equipped with a 3.5-5 MHz curvilinear multifrequency transducer was used to scan the liver. Independent samples t-test was performed to compare the liver span in the two groups. Chi-square tests were applied to compare the frequencies of fatty changes, border, and surface characteristics. RESULTS The presence of fatty changes among obese groups was statistically significant in the diabetic obese group compared to the normal-weight individuals with P < 0.0001. Similarly, hepatic spans were found to be significantly greater in the diabetic obese group than the diabetic normal BMI group on independent samples t-test with P < 0.0001. Females were seen to develop hepatosteatosis more frequently compared to males in all diabetic individuals with P = 0.02. CONCLUSION It is concluded that diabetic obese patients are more prone to develop hepatosteatosis as compared to normal BMI diabetic individuals.
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Affiliation(s)
- Mahjabeen Liaqat
- University Institute of Radiological Sciences and Medical Imaging Technology, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan
| | - Mehreen Fatima
- University Institute of Radiological Sciences and Medical Imaging Technology, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan
| | - Sajid Shaheen Malik
- University Institute of Radiological Sciences and Medical Imaging Technology, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan
| | - Syed Amir Gillani
- University Institute of Radiological Sciences and Medical Imaging Technology, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan
| | - Iqra Manzoor
- University Institute of Radiological Sciences and Medical Imaging Technology, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan
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8
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Drug-Induced Steatosis and Steatohepatitis: The Search for Novel Serum Biomarkers Among Potential Biomarkers for Non-Alcoholic Fatty Liver Disease and Non-Alcoholic Steatohepatitis. Drug Saf 2020; 42:701-711. [PMID: 30762163 DOI: 10.1007/s40264-018-00790-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Drug-induced steatosis (DIS) and drug-induced steatohepatitis (DISH) are two of several types of drug-induced liver injury (DILI). They can be caused by various drugs and may present as acute, potentially lethal disorders or as chronic slowly progressive liver injury. Despite the fact that they are distinct disorders, the slow progressive forms of DIS and DISH are often confused with or misdiagnosed as non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH), which are much more common and, by definition, not caused by drugs. Currently the only way to identify DIS is via imaging studies or a liver biopsy, while DISH can be identified only through liver biopsy. In addition, diagnosis of either DIS or DISH requires an exhaustive clinical evaluation and comprehensive causality assessment to rule out other possible causes and determine the association with the suspected drug. Furthermore, it is difficult, using existing methods, to monitor the progression of DIS and DISH and to determine the underlying mechanism. Therefore, there is a great unmet need for non-invasive biomarkers that will be able to identify the development of DIS or DISH during drug development and to monitor for progression or regression of the disorder during treatment or following drug discontinuation. Recent developments in the fields of NAFLD and NASH have introduced several novel biomarkers that show promise for the diagnosis, monitoring, and severity assessment of these common diseases. Given the significant overlap in possible underlying mechanisms and histological pattern between NAFLD/NASH and DIS/DISH, these postulated NAFLD and NASH biomarkers may have a potential application to DIS and DISH. This article reviews the existing medical literature and other publically available information pertaining to novel serum biomarkers for NAFLD and NASH, and explores the concurrent identification of these biomarkers for DIS and DISH.
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Shi Z, Xing H, Qi C, Fang M, Fu J, Zhang X. Chinese tree shrews as a primate experimental animal eligible for the study of alcoholic liver disease: characterization and confirmation by MRI. Exp Anim 2019; 69:110-118. [PMID: 31554748 PMCID: PMC7004808 DOI: 10.1538/expanim.19-0073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
There has been a lack of suitable fatty liver models and characterization techniques for
histopathological evaluation of alcoholic fatty liver (AFL). This work aimed to exploit an
magnetic resonance imaging (MRI) technique for characterizing an alcohol-induced fatty
liver model established in tree shrews (Tupaia belangeri chinese). The
animals were treated with 15% alcohol for two weeks instead of drinking water to induce
AFL. Blood alanine aminotransferase (ALT), aspartate aminotransferase (AST), alcohol, and
liver malondialdehyde (MDA) concentrations were determined, and the histopathology of the
liver was checked by hematoxylin & eosin (HE) and Oil red O staining on day 0 and on
the 4th, 7th and 14th days after alcohol feeding. MRI was used to trace the
histopathological changes in the liver of tree shrews in real time. Compared with the
control group, the levels of ALT, AST, and MDA significantly increased in the
alcohol-induced group and were positively correlated with the induction time. HE and Oil
red O staining revealed that a moderate fatty lesion occurred in the liver on the 4th day
and that a serious AFL was successfully induced on the 14th day. MRI further confirmed the
formation of AFL. MRI, as noninvasive examination technique, provides an alternative tool
for accurate characterization of AFL in live subjects. It is comparable to HE or Oil red O
staining for histopathological examination, but is more suitable by virtue of its high
flexibility and compliance. The AFL model of tree shrews combined with MRI
characterization can work as a platform for studying fatty liver diseases and medications
for their treatment.
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Affiliation(s)
- Zhihai Shi
- Institute of Animal Husbandry and Veterinary, Henan Academy of Agricultural Sciences, 116 Huayuan Road, Zhengzhou, Henan Province 450008, P.R. China
| | - Huijie Xing
- Institute of Laboratory Animals, Jinan University, 601 West Huangpu Avenue, Guangzhou, Guangdong Province 510632, P.R. China
| | - Chunli Qi
- Institute of Laboratory Animals, Jinan University, 601 West Huangpu Avenue, Guangzhou, Guangdong Province 510632, P.R. China
| | - Meixia Fang
- Institute of Laboratory Animals, Jinan University, 601 West Huangpu Avenue, Guangzhou, Guangdong Province 510632, P.R. China
| | - Jiangnan Fu
- Institute of Laboratory Animals, Jinan University, 601 West Huangpu Avenue, Guangzhou, Guangdong Province 510632, P.R. China
| | - Xingwang Zhang
- Department of Pharmaceutics, School of Pharmacy, Jinan University, 601 West Huangpu Avenue, Guangzhou, Guangdong Province 510632, P.R. China
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Noninvasive Evaluation of Liver Function in Morbidly Obese Patients. Gastroenterol Res Pract 2019; 2019:4307462. [PMID: 30863439 PMCID: PMC6378040 DOI: 10.1155/2019/4307462] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 12/30/2018] [Indexed: 12/12/2022] Open
Abstract
Background More than half of the obese patients develop nonalcoholic fatty liver disease (NAFLD), which may further progress to nonalcoholic steatohepatitis (NASH) and cirrhosis. The aim of this study was to assess alterations in liver function in obese patients with a noninvasive liver function test. Methods In a prospective cohort study 102 morbidly obese patients undergoing bariatric surgery were evaluated for their liver function. Liver function capacity was determined by the LiMAx® test (enzymatic capacity of cytochrome P450 1A2). Liver biopsy specimens were obtained intraoperatively and classified according to the NAFLD Activity Score (NAS). NASH clinical score was additionally calculated from laboratory and clinical parameters. Results Median liver function capacity was 286 (IQR = 141) μg/kg/h. 27% of patients were histologically categorized as definite NASH, 39% as borderline, and 34% as not NASH. A significant correlation was observed between liver function capacity and NAS (r = −0.492; p < 0.001). The sensitivity and specificity of the LiMAx® test to distinguish between definite NASH and not NASH were 85.2% and 82.9% (AUROC 0.859), respectively. According to the NASH clinical scoring system, 14% were classified as low risk, 31% as intermediate, 26% as high, and 29% as very high risk. Liver function capacity is also significantly correlated with the NASH clinical scoring system (r = −0.411; p < 0.001). Conclusions Obese patients show a diminished liver function capacity, especially those suffering from type 2 diabetes. The liver function capacity correlates with histological and clinical scoring systems. The LiMAx® test may be a valuable tool for noninvasive screening for NASH in obese patients.
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11
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Sayiner M, Lam B, Golabi P, Younossi ZM. Advances and challenges in the management of advanced fibrosis in nonalcoholic steatohepatitis. Therap Adv Gastroenterol 2018; 11:1756284818811508. [PMID: 30479664 PMCID: PMC6243399 DOI: 10.1177/1756284818811508] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 10/16/2018] [Indexed: 02/04/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is rapidly becoming the most common type of chronic liver disease worldwide. From the spectrum of NAFLD, it is nonalcoholic steatohepatitis (NASH) that predominantly predisposes patients to higher risk for development of cirrhosis and hepatocellular carcinoma. There is growing evidence that the risk of progression to cirrhosis and hepatocellular carcinoma is not uniform among all patients with NASH. In fact, NASH patients with increasing numbers of metabolic diseases such as diabetes, hypertension, visceral obesity and dyslipidemia are at a higher risk of mortality. Additionally, patients with higher stage of liver fibrosis are also at increased risk of mortality. In this context, NASH patients with fibrosis are in the most urgent need of treatment. Also, the first line of treatment for NASH is lifestyle modification with diet and exercise. Nevertheless, the efficacy of lifestyle modification is quite limited. Additionally, vitamin E and pioglitazone may be considered for subset of patients with NASH. There are various medications targeting one or more steps in the pathogenesis of NASH being developed. These drug regimens either alone or in combination, may provide potential treatment option for patients with NASH.
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Affiliation(s)
- Mehmet Sayiner
- Department of Medicine, Inova Fairfax Hospital, Falls Church, VA,Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA
| | - Brian Lam
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA
| | - Pegah Golabi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA
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12
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Oweira H, Sadeghi M, Volker D, Mieth M, Zidan A, Khajeh E, Ghamarnejad O, Fonouni H, Weiss KH, Schmidt J, Lahdou I, Mehrabi A. Serum Caspase-Cleaved Cytokeratin (M30) Indicates Severity of Liver Dysfunction and Predicts Liver Outcome. Ann Transplant 2018; 23:393-400. [PMID: 29880786 PMCID: PMC6248295 DOI: 10.12659/aot.908031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The Model for End-Stage Liver Disease (MELD) score is a well-established tool for assessing hepatic failure. The present retrospective study investigated whether serum keratin 18 (M65) and caspase-cleaved cytokeratin (M30) were associated with liver dysfunction and post-transplant graft failure. MATERIAL AND METHODS A total of 147 patients with liver cirrhosis were categorized into 2 groups according to their baseline MELD score (group I: MELD score <20, n=87, and group II: MELD score ≥20, n=60). Serum M65 and M30 levels were measured by ELISA. RESULTS Cirrhotic patients had significantly higher serum M65 and M30 levels than healthy controls (p<0.0001). Serum M65 was correlated with the MELD score and serum bilirubin (p≤0.007) and serum M30 was correlated with the MELD score, international normalized ratio, and serum bilirubin (p≤0.001). Group II had significantly higher serum M65 and M30 levels than group I (M65, p=0.025 and M30, p<0.001). Patients who lost the allograft during the first post-transplant year had significantly higher serum M30 levels than patients with a graft survival of >1 year (p=0.004). In the regression analysis, serum M30 was associated with the MELD score (odds ratio [OR]=2.545, p=0.005), serum bilirubin (OR=2.605, p=0.005) and 1-year graft loss (OR=3.61, p=0.006). CONCLUSIONS Our data indicate that serum M30 levels reflect the degree of liver dysfunction and can predict 1-year graft loss.
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Affiliation(s)
- Hani Oweira
- Department of General, Visceral, and Transplant Surgery, University of Heidelberg, Heidelberg, Switzerland.,Surgical Center Zürich, Hirslanden Hospital, Zürich, Switzerland
| | - Mahmoud Sadeghi
- Department of General, Visceral, and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Daniel Volker
- Department of Transplantation Immunology, University of Heidelberg, Heidelberg, Germany
| | - Markus Mieth
- Department of General, Visceral, and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Ahmed Zidan
- Department of Hepato-Pancreato-Biliary (HPB) and Liver Transplantation Surgery, Rajhy Liver Hospital, Assiut University Hospital, Assuit, Egypt
| | - Elias Khajeh
- Department of General, Visceral, and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Omid Ghamarnejad
- Department of General, Visceral, and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Hamidreza Fonouni
- Department of General, Visceral, and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Karl Heinz Weiss
- Department of Internal Medicine IV, University of Heidelberg, Heidelberg, Germany
| | - Jan Schmidt
- Department of General, Visceral, and Transplant Surgery, University of Heidelberg, Heidelberg, Switzerland.,Surgical Center Zürich, Hirslanden Hospital, Zürich, Switzerland
| | - Imad Lahdou
- Department of Transplantation Immunology, University of Heidelberg, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral, and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
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13
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Imran M, Sergent O, Tête A, Gallais I, Chevanne M, Lagadic-Gossmann D, Podechard N. Membrane Remodeling as a Key Player of the Hepatotoxicity Induced by Co-Exposure to Benzo[a]pyrene and Ethanol of Obese Zebrafish Larvae. Biomolecules 2018; 8:biom8020026. [PMID: 29757947 PMCID: PMC6023014 DOI: 10.3390/biom8020026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 05/04/2018] [Accepted: 05/04/2018] [Indexed: 12/11/2022] Open
Abstract
The rise in prevalence of non-alcoholic fatty liver disease (NAFLD) constitutes an important public health concern worldwide. Including obesity, numerous risk factors of NAFLD such as benzo[a]pyrene (B[a]P) and ethanol have been identified as modifying the physicochemical properties of the plasma membrane in vitro thus causing membrane remodeling—changes in membrane fluidity and lipid-raft characteristics. In this study, the possible involvement of membrane remodeling in the in vivo progression of steatosis to a steatohepatitis-like state upon co-exposure to B[a]P and ethanol was tested in obese zebrafish larvae. Larvae bearing steatosis as the result of a high-fat diet were exposed to ethanol and/or B[a]P for seven days at low concentrations coherent with human exposure in order to elicit hepatotoxicity. In this condition, the toxicant co-exposure raised global membrane order with higher lipid-raft clustering in the plasma membrane of liver cells, as evaluated by staining with the fluoroprobe di-4-ANEPPDHQ. Involvement of this membrane’s remodeling was finally explored by using the lipid-raft disruptor pravastatin that counteracted the effects of toxicant co-exposure both on membrane remodeling and toxicity. Overall, it can be concluded that B[a]P/ethanol co-exposure can induce in vivo hepatotoxicity via membrane remodeling which could be considered as a good target mechanism for developing combination therapy to deal with steatohepatitis.
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Affiliation(s)
- Muhammad Imran
- Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, University of Rennes, F-35000 Rennes, France.
| | - Odile Sergent
- Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, University of Rennes, F-35000 Rennes, France.
| | - Arnaud Tête
- Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, University of Rennes, F-35000 Rennes, France.
| | - Isabelle Gallais
- Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, University of Rennes, F-35000 Rennes, France.
| | - Martine Chevanne
- Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, University of Rennes, F-35000 Rennes, France.
| | - Dominique Lagadic-Gossmann
- Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, University of Rennes, F-35000 Rennes, France.
| | - Normand Podechard
- Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, University of Rennes, F-35000 Rennes, France.
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14
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Reesink KD, Hendrikx T, van Gorp PJ, Hoeks AP, Shiri-Sverdlov R. Ultrasonic Perfluorohexane-Loaded Monocyte Imaging: Toward a Minimally Invasive Technique for Selective Detection of Liver Inflammation in Fatty Liver Disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:921-933. [PMID: 28990215 DOI: 10.1002/jum.14432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 06/06/2017] [Accepted: 07/13/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To investigate the utility of ultrasonic (US) perfluorohexane (PFH)-loaded monocyte imaging for detection of liver inflammation in fatty liver disease. METHODS C57Bl6 mice were injected intraperitoneally with tumor necrosis factor α and assessed by US PFH-loaded monocyte imaging 3 hours later. Echogenic monocytes were injected intravenously, leading to a transient increase in liver tissue intensity on a US perfusion scan. The contrast wash-out time constant was hypothesized to reflect the degree of inflammation. Next, we evaluated US PFH-loaded monocyte imaging in Ldlr-/- mice fed a 1-week high-fat/high-cholesterol diet as model for early developing nonalcoholic steatohepatitis. Adjunct analyses included tissue markers of liver inflammation. RESULTS Tumor necrosis factor α-injected mice showed a reduced wash-out time constant (mean ± SEM, 0.013 ± 0.003; n = 8) compared to controls (0.054 ± 0.009; n = 7; P = .0006), indicative of increased inflammatory adhesion molecule expression on the endothelium. The Ldlr-/- mice fed the high-fat/high-cholesterol diet showed liver inflammation, as reflected by increased (3- to 4-fold) infiltration of inflammatory cells and increased (3- to 4-fold) gene expression of tumor necrosis factor α, integrin αM, intracellular adhesion molecule, and vascular cell adhesion molecule. However, in these mice, no difference was detected in the wash-out time constant as assessed by US PFH-loaded monocyte imaging (high-fat/high-cholesterol, 0.050 ± 0.017; n = 5; chow, 0.048 ± 0.006; n = 6; P = .91). CONCLUSIONS Our results indicate that US PFH-loaded monocyte imaging is able to detect vascularly expressed inflammatory adhesion molecules in the mouse liver on direct endothelial stimulation. However, in our mouse model of early developing nonalcoholic steatohepatitis, we did not detect inflammation by this method, which may suggest that the time-dependent relationship between parenchymal and endothelial inflammation remains a fundamental issue to be addressed.
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Affiliation(s)
- Koen D Reesink
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht School for Cardiovascular Diseases, Maastricht, the Netherlands
| | - Tim Hendrikx
- Department of Molecular Genetics, Nutrition and Toxicology Research Institute Maastricht School for Nutritional Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Patrick J van Gorp
- Department of Molecular Genetics, Nutrition and Toxicology Research Institute Maastricht School for Nutritional Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Arnold P Hoeks
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht School for Cardiovascular Diseases, Maastricht, the Netherlands
| | - Ronit Shiri-Sverdlov
- Department of Molecular Genetics, Nutrition and Toxicology Research Institute Maastricht School for Nutritional Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
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15
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Choi JW, Oh IH, Lee CH, Park JS. Is there a J-shaped relationship between the fatty liver index and risk of microalbuminuria in the general population? Clin Chim Acta 2017; 481:231-237. [PMID: 28818597 DOI: 10.1016/j.cca.2017.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/11/2017] [Accepted: 08/13/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND We investigated whether the fatty liver index (FLI), as a clinical indicator of hepatic fat accumulation based on body mass index, gamma-glutamyl-transferase, triglycerides, and waist circumference, has an association with microalbuminuria. METHODS We analyzed anthropometric and biochemical data from a nation-wide, population-based, cross-sectional study. A total of 1605 participants included were healthy native Korean 40years or older and divided into quintiles according to their log-FLI and sex. Microalbuminuria was defined as urine albumin/creatinine ratio (UACR) between 30 and 300mg/g. RESULTS Participants in higher quintiles of log-FLI were more obese and hypertensive and had greater glycemic exposure, poorer lipid profiles, and greater increases in log-UACR compared with lower quintiles. Linear regression analysis demonstrated that log-FLI was associated with systolic and diastolic blood pressure, body mass index, waist circumference, fasting plasma glucose, glycated hemoglobin, and log-UACR. In logistic regression adjusted for age, sex, body mass index, waist circumference, and fasting plasma glucose, the OR of microalbuminuria was elevated in quintile 1 (adjusted OR=2.161, 95% CI=0.453-10.31) and quintile 5 (adjusted OR=6.387, 95% CI=1.317-51.58), when compared to quintile 2. CONCLUSIONS There appears to be a J-shaped association between FLI and UACR in healthy general population.
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Affiliation(s)
- Jong Wook Choi
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Il Hwan Oh
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Chang Hwa Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea.
| | - Joon-Sung Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea.
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16
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Huh JH, Kim JY, Choi E, Kim JS, Chang Y, Sung KC. The fatty liver index as a predictor of incident chronic kidney disease in a 10-year prospective cohort study. PLoS One 2017; 12:e0180951. [PMID: 28738057 PMCID: PMC5524328 DOI: 10.1371/journal.pone.0180951] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 06/13/2017] [Indexed: 02/06/2023] Open
Abstract
Background Although non-alcoholic fatty liver disease (NAFLD) is considered to be associated with chronic kidney disease (CKD), long-term follow up data is lacking. We investigated whether NAFLD, as determined by the fatty liver index (FLI), could predict incident CKD in 10-year prospective cohort study. We also assessed the clinical utility of FLI to predict the development of CKD. Methods 6,238 adults aged 40 to 69 years without baseline CKD from the Ansan—Ansung cohort were examined. Patients were classified according to FLI as follows: FLI<30, no NAFLD; FLI≥60, NAFLD; and 30≤ FLI<60, intermediate. Incident CKD was defined as estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73 m2. The clinical utility of FLI in predicting incident CKD was estimated via area under the receiver-operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI) analyses. Results During an average of 10 years of follow-up, 724 subjects (15.21%) developed CKD. The adjusted hazard ratio [95% confidence interval (CI)] for incident CKD increased in a graded manner with FLI increased (<30 vs. 30–59 vs. ≥60 = 1 vs. 1.17 [0.997–1.375] vs. 1.459 [1.189–1.791], respectively, P for trend = 0.0012). Incorporation of FLI into traditional risk factors of CKD significantly increased prediction of incident CKD based on NRI (17%; 95% CI, 8.9–25%; P-value <0.001) and IDI (0.002; 95% CI, 0.0046–0.0143; P-value = 0.046). Conclusions FLI, a surrogate marker of NAFLD, was an independent risk factor for incident CKD. FLI provides meaningful incremental risk reclassification beyond that of conventional risk factors of CKD.
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Affiliation(s)
- Ji Hye Huh
- Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Korea
| | - Jang Young Kim
- Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Korea
- * E-mail: (JYK); (EC)
| | - Eunhee Choi
- Biostatistician, Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, United States of America
- * E-mail: (JYK); (EC)
| | - Jae Seok Kim
- Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Korea
| | - Yoosoo Chang
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Ki-Chul Sung
- Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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17
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Koo HJ, Lee S, Chang KJ, Sohn E, Sohn EH, Kang SC, Pyo S. Hepatic anti-inflammatory effect of hexane extracts of Dioscorea batatas Decne: Possible suppression of toll-like receptor 4-mediated signaling. Biomed Pharmacother 2017; 92:157-167. [PMID: 28538192 DOI: 10.1016/j.biopha.2017.05.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 05/03/2017] [Accepted: 05/08/2017] [Indexed: 12/14/2022] Open
Abstract
The hepatic anti-inflammatory potential of hexane extracts of Dioscorea batatas Decne edible part (EDH-1e) and bark (EDH-2b) were investigated in Western-type diet-fed apolipoprotein E null [ApoE (-/-)] mice and HepG2 cells. EDH-1e and EDH-2b suppressed the increased levels of tumor necrosis factor alpha (TNF-α), interleukin (IL)-6, transforming growth factor beta 1 (TGF-β1), vascular cell adhesion protein 1 (VCAM-1), and monocyte chemoattractant protein-1 (MCP-1), and reduced infiltration of monocytes into liver tissue. The protein levels of Toll-like receptor 4 (TLR4) were also downregulated by EDH-1e and EDH-2b treatment as were the levels of activator protein 1 (AP-1), c-fos, and c-jun in the livers from Western-type diet-fed ApoE (-/-) mice and in lipopolysaccharide-stimulated HepG2 cells. Taken together, EDH-1e and EDH-2b attenuated hepatic inflammation and fibrosis via suppression of the TLR4-AP1-mediated signaling pathway.
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Affiliation(s)
- Hyun Jung Koo
- Department of Medicinal and Industrial Crops, Korea National College of Agriculture and Fisheries, Jeonju 54874, Republic of Korea
| | - SungRyul Lee
- Department of Integrated Biomedical Science, Cardiovascular and Metabolic Disease Center, College of Medicine, Inje University, Busan, 47392, Republic of Korea
| | - Kwang Jin Chang
- Department of Medicinal and Industrial Crops, Korea National College of Agriculture and Fisheries, Jeonju 54874, Republic of Korea
| | - Eunsoo Sohn
- Department of Scientometric Research, Korea Institute of Science and Technology Information, Seoul, Republic of Korea
| | - Eun-Hwa Sohn
- Department of Herbal Medicine Resources, Kangwon National University, Samcheok 25913, Republic of Korea.
| | - Se Chan Kang
- Department of Oriental Medicine Biotechnology, College of Life Sciences, Kyung Hee University, Yongin 17104, Republic of Korea.
| | - Suhkneung Pyo
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, 16419, Republic of Korea.
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18
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Golabi P, Sayiner M, Fazel Y, Koenig A, Henry L, Younossi ZM. Current complications and challenges in nonalcoholic steatohepatitis screening and diagnosis. Expert Rev Gastroenterol Hepatol 2016; 10:63-71. [PMID: 26469309 DOI: 10.1586/17474124.2016.1099433] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Nonalcoholic steatohepatitis (NASH) can lead to complications such as liver failure, cirrhosis and hepatocellular carcinoma. The diagnostic gold standard for NASH is liver biopsy; however, other noninvasive methods have been developed. In this article, the authors evaluate current methods in NASH screening and diagnosis. Routine radiologic modalities were found to detect hepatic steatosis accurately, but were unable to establish the diagnosis of NASH or stage of fibrosis. Newly developed elastography based techniques seem promising to estimate liver fibrosis. Other noninvasive tests such as FibroTest, ELF, Hepascore, FIB-4, NFS, FLI and ION (biochemical panels) have AUROCs ranging between 0.80-0.98 for detecting advanced fibrosis but lack specificity for detecting mild fibrosis. Noninvasive tools, especially elastography, identify NASH associated advanced fibrosis potentially reducing liver biopsies. More research is needed to validate the clinical utility of these tests.
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Affiliation(s)
- Pegah Golabi
- a Betty and Guy Beatty Center for Integrated Research , Inova Health System , Falls Church , VA , USA
| | - Mehmet Sayiner
- a Betty and Guy Beatty Center for Integrated Research , Inova Health System , Falls Church , VA , USA
| | - Yousef Fazel
- a Betty and Guy Beatty Center for Integrated Research , Inova Health System , Falls Church , VA , USA
| | - Aaron Koenig
- a Betty and Guy Beatty Center for Integrated Research , Inova Health System , Falls Church , VA , USA
| | - Linda Henry
- a Betty and Guy Beatty Center for Integrated Research , Inova Health System , Falls Church , VA , USA
| | - Zobair M Younossi
- a Betty and Guy Beatty Center for Integrated Research , Inova Health System , Falls Church , VA , USA.,b Center for Liver Disease, Department of Medicine , Inova Fairfax Hospital , Falls Church , VA , USA
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Abstract
INTRODUCTION Non-alcoholic fatty liver disease is the commonest cause of liver disease worldwide, and is rapidly becoming the leading indication for liver transplantation. SOURCES OF DATA Original articles, reviews and meta-analyses, guidelines. AREAS OF AGREEMENT NAFLD strongly correlates with obesity and insulin resistance; currently, the best management strategy is weight loss and treatment of the metabolic syndrome. AREAS OF CONTROVERSY Recent data suggest that the presence of fibrosis and not non-alcoholic steatohepatitis (NASH) is the predictor of clinical outcome. GROWING POINTS Many phase 2 and 3 trials are underway. Drugs hoped to be effective are obeticholic acid, elafibranor, glucagon-like peptide-1 analogues and CCR2/5 inhibitors. AREAS TIMELY FOR DEVELOPING RESEARCH Improved understanding of the pathophysiology of NAFLD should help us identify which patients progress to significant liver disease and to develop therapies to target this population.
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Affiliation(s)
- S A Townsend
- National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit, Centre for Liver Research, University of Birmingham, Birmingham, UK Liver Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, B15 2WB, UK
| | - Philip N Newsome
- National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit, Centre for Liver Research, University of Birmingham, Birmingham, UK Liver Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, B15 2WB, UK
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20
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Yadav D, Choi E, Ahn SV, Koh SB, Sung KC, Kim JY, Huh JH. Fatty liver index as a simple predictor of incident diabetes from the KoGES-ARIRANG study. Medicine (Baltimore) 2016; 95:e4447. [PMID: 27495073 PMCID: PMC4979827 DOI: 10.1097/md.0000000000004447] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The fatty liver index (FLI), calculated from serum triglyceride, body mass index, waist circumference, and gamma-glutamyltransferase, is considered a surrogate marker of nonalcoholic fatty liver disease (NAFLD). We investigated whether FLI predicts the development of diabetes mellitus (DM) and assessed the predictive ability of FLI for new onset of DM in a prospective population-based cohort study.We analyzed a total of 2784 adults (944 men and 1840 women) aged 40 to 70 years without DM at baseline. Participants were classified according to FLI values into 3 groups: FLI < 30, no NAFLD; 30 ≤ FLI ≤ 59, intermediate NAFLD; and FLI ≥ 60, participants with NAFLD. The area under the receiver-operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were calculated to determine whether FLI improved DM risk prediction.During a mean of 2.6 years follow-up, 88 (3.16%) participants developed DM. The odds ratio analyzed from multivariable-adjusted models (95% confidence interval [CI]) for new onset of DM increased in a continuous manner with increased FLI (<30 vs 30-59 vs ≥60 = 1 vs 1.87 [95% CI 1.05-3.33] vs 2.84 [95% CI 1.4-5.75], respectively). The AUC significantly increased when FLI was added to the conventional DM prediction model (0.835, 95% CI: 0.789-0.881, P = 0.0289 vs traditional DM prediction model). The category-free NRI was 0.417 (95% CI: 0.199-0.635) and the IDI was 0.015 (95% CI: 0.003-0.026) for overall study participants.We found that FLI, a surrogate marker of hepatic steatosis, resulted in significant improvement in DM risk prediction. Our finding suggests that FLI may have clinical and prognostic information for incident DM among the Korean adult population.
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Affiliation(s)
- Dhananjay Yadav
- Department of Preventive Medicine, Yonsei University, Wonju College of Medicine, Wonju
- Institute of Genomic Cohort, Yonsei University, Wonju College of Medicine, Wonju
| | - Eunhee Choi
- Institute of Lifestyle Medicine, Yonsei University, Wonju College of Medicine, Wonju
- Correspondence: Ji Hye Huh, Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, South Korea (e-mail: ); Eunhee Choi, Institute of Life Style Medicine, Yonsei University, Wonju College of Medicine, Wonju, South Korea (e-mail: )
| | - Song Vogue Ahn
- Department of Preventive Medicine, Yonsei University, Wonju College of Medicine, Wonju
- Institute of Genomic Cohort, Yonsei University, Wonju College of Medicine, Wonju
| | - Sang Baek Koh
- Department of Preventive Medicine, Yonsei University, Wonju College of Medicine, Wonju
- Institute of Genomic Cohort, Yonsei University, Wonju College of Medicine, Wonju
| | - Ki-Chul Sung
- Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul
| | - Jang-Young Kim
- Institute of Genomic Cohort, Yonsei University, Wonju College of Medicine, Wonju
- Division of Cardiology, Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju
| | - Ji Hye Huh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, South Korea
- Correspondence: Ji Hye Huh, Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, South Korea (e-mail: ); Eunhee Choi, Institute of Life Style Medicine, Yonsei University, Wonju College of Medicine, Wonju, South Korea (e-mail: )
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21
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Fazel Y, Koenig AB, Sayiner M, Goodman ZD, Younossi ZM. Epidemiology and natural history of non-alcoholic fatty liver disease. Metabolism 2016; 65:1017-25. [PMID: 26997539 DOI: 10.1016/j.metabol.2016.01.012] [Citation(s) in RCA: 295] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 01/15/2016] [Accepted: 01/25/2016] [Indexed: 02/06/2023]
Abstract
Non-alcoholic steatohepatitis (NASH) is part of the spectrum of non-alcoholic fatty liver disease (NAFLD) that leads to progressive liver disease and presents a growing challenge to public health. Because of the increased prevalence of metabolic syndrome and obesity, NAFLD and NASH have expanded to a substantial extent. In NASH patients, advanced fibrosis is the major predictor of morbidity and liver-related mortality, and an accurate diagnosis of NASH is mandatory. Although there is currently no validated test of serum biomarkers available to diagnose NASH, and histologic evaluation with a liver biopsy remains the gold standard, screening for fibrosis is recommended in patients with suspicion of NASH. Clinical prediction models and serum biomarkers for advanced fibrosis have relatively good negative predictive value and can be useful for screening. Also, transient elastography is increasingly available to estimate fibrosis in NASH. Therefore, due to the lack of a reliable and accepted non-invasive diagnostic modality, screening for NASH in the general population is not currently recommended. Better understanding of the natural history of NASH is needed to evaluate the utility and cost-effectiveness of screening.
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Affiliation(s)
- Yousef Fazel
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Aaron B Koenig
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Mehmet Sayiner
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Zachary D Goodman
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA; Center for Liver Diseases Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Zobair M Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA; Center for Liver Diseases Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.
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22
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Petrick A, Benotti P, Wood GC, Still CD, Strodel WE, Gabrielsen J, Rolston D, Chu X, Argyropoulos G, Ibele A, Gerhard GS. Utility of Ultrasound, Transaminases, and Visual Inspection to Assess Nonalcoholic Fatty Liver Disease in Bariatric Surgery Patients. Obes Surg 2016; 25:2368-75. [PMID: 26003548 DOI: 10.1007/s11695-015-1707-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is common in adults with extreme obesity and can impact long-term health and survival. Liver biopsy is the only accurate test for diagnosis and staging, but is invasive and costly. Non-invasive testing offers an attractive alternate, but the overall accuracy remains a significant issue. This study was conducted to determine the accuracy and clinical utility of pre-operative ultrasound and liver transaminase levels, as well as intra-operative hepatic visual inspection, for assessing presence of NAFLD as confirmed by hepatic histology. METHODS Data was collected prospectively from 580 morbidly obese adult patients who underwent Roux-en-Y gastric bypass surgery with intraoperative wedge biopsy between January 2004 and February 2009. Complete data for ultrasound, ALT and AST levels, and documented visual inspection was available for 513 patients. RESULTS The prevalence of NAFLD was 69 % and that of NASH was 32 %. The individual non-invasive clinical assessments demonstrated low sensitivity, specificity, and accuracy for detecting the presence of steatosis, steatohepatitis, or fibrosis. The combination of normal or abnormal results for all tests improved predictive utility. Abnormal tests with all three assessments had a sensitivity of 95-98 % and a specificity of 28-48 % for major histologic findings in NAFLD/NASH. Normal tests with all three assessments had a sensitivity of 12-22 % and a specificity of 89-97 % for major histologic findings in NAFLD/NASH. CONCLUSIONS Although individual clinical tests for NAFLD have limited accuracy, the use of combined clinical tests may prove useful.
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Affiliation(s)
| | - Peter Benotti
- Geisinger Obesity Research Institute, Danville, PA, USA.
| | - G Craig Wood
- Geisinger Obesity Research Institute, Danville, PA, USA
| | | | | | | | - David Rolston
- Geisinger Obesity Research Institute, Danville, PA, USA
| | - Xin Chu
- Geisinger Obesity Research Institute, Danville, PA, USA
| | | | - Anna Ibele
- Geisinger Obesity Research Institute, Danville, PA, USA
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23
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Alizai PH, Wendl J, Roeth AA, Klink CD, Luedde T, Steinhoff I, Neumann UP, Schmeding M, Ulmer F. Functional Liver Recovery After Bariatric Surgery--a Prospective Cohort Study with the LiMAx Test. Obes Surg 2016; 25:2047-53. [PMID: 25869925 DOI: 10.1007/s11695-015-1664-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Bariatric surgery provides long-term weight loss and improvement of obesity-associated diseases such as nonalcoholic steatohepatitis (NASH). Histologic improvement of NASH has been reported in some studies after bariatric surgery. This study was designed to assess the liver function in obese patients as well as its recovery after bariatric surgery with a noninvasive test method. METHODS In a prospective cohort study from October 2011 to May 2014, morbidly obese individuals receiving bariatric surgery were investigated for functional liver recovery (n = 34). Liver function was determined by the LiMAx test (enzymatic capacity of cytochrome P450 1A2) preoperatively, 6 and 12 months postoperatively. Liver biopsy specimens were obtained from 18 participants and classified according to the nonalcoholic fatty liver disease (NAFLD) activity score (NAS). RESULTS The mean age of participants was 44 years, and the mean body mass index (BMI) was 52 kg/m(2). The mean percent excess BMI loss (%EBMIL) was 53 % after 6 months and 68 % after 1 year. Mean liver function capacity increased significantly from 255 μg/kg/h preoperative to 324 μg/kg/h after 6 months and 342 μg/kg/h after 12 months. A negative correlation was observed between %EBMIL and alteration of liver function capacity in the first 6 months. Finally, the median NAS showed a negative correlation with liver function capacity. CONCLUSIONS Bariatric surgery leads to a significant functional recovery of the liver. An initial marked weight loss may negatively influence functional liver recovery.
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Affiliation(s)
- Patrick H Alizai
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Janica Wendl
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Anjali A Roeth
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Christian D Klink
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Tom Luedde
- Department of Gastroenterology, Digestive Diseases and Intensive Care Medicine, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Inga Steinhoff
- Institute of Pathology, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Ulf P Neumann
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Maximilian Schmeding
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Florian Ulmer
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany.
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Guo NJ, Li J, Zhu YF, Guo LR, Chen QF, Huang B. Exenatide inhibits fatty acid induced hepatocyte steatosis and inflammation through activating AMPK. Shijie Huaren Xiaohua Zazhi 2016; 24:1649-1657. [DOI: 10.11569/wcjd.v24.i11.1649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To detect the effect of glucagon-like peptide-1 (GLP-1) agonist exenatide (EXE) on fat deposition in liver cells and explore the underlying mechanism.
METHODS: A HepG2 cell deposition model was induced with palmitic acid (PA). After cells were incubated with different doses of EXE (25-100 nmoL/L) and PA (500 μmoL/L) for 24 h, fatty deposition was assessed by oil red O staining and the level of intracellular triglyceride (TG). Real-time quantitative PCR (qRT-PCR) was used to detect the expression of lipid metabolism related genes, including fatty acid synthase (FAS), tumor necrosis factor α (TNF-α), and interleukin 6 (IL-6). The expression of p-AMPK and AMPK protein was tested by Western blot. An AMPK inhibitor was used to explore the role of AMPK in fat deposition and inflammation.
RESULTS: Compared with the control group, PA significantly elevated TG and oil red O content, as well as the expression of FAS in HepG2 cells (P < 0.05). EXE significantly inhibited PA induced elevation of TG and oil red O content, as well as FAS gene expression in a dose dependent manner (P < 0.05). The expression of TNF-α and IL-6 significantly increased in the PA treated group (P < 0.05). EXE significantly inhibited the expression of TNF-α and IL-6 in PA treated HepG2 cells (P < 0.05). Co-treatment with AMPK inhibitor significantly reduced the effect of EXE on AMPK, and reduced the inhibitory effect of EXE on fatty deposition and PA induced FAS activation (P < 0.05). AMPK inhibitor significantly diminished the inhibitory effect of EXE on TNF-α and IL-6 activation induced by PA (P < 0.05).
CONCLUSION: EXE reduces fatty acid induced fatty deposition and inflammatory response in liver cells through activation of AMPK.
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Dulger AC, Suvak B, Gonullu H, Gonullu E, Gultepe B, Aydın İ, Batur A, Karadas S, Olmez Ş. High prevalence of chronic hepatitis D virus infection in Eastern Turkey: urbanization of the disease. Arch Med Sci 2016; 12:415-20. [PMID: 27186189 PMCID: PMC4848352 DOI: 10.5114/aoms.2015.52030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 07/27/2014] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Both hepatitis B virus (HBV) and hepatitis D virus (HDV) infection play an increasingly important role in liver diseases. The main objective of this study was to investigate the socio-epidemiological, laboratory and radiological aspects of both HBV and HDV infection near the Iranian border of Turkey. MATERIAL AND METHODS The study included 3352 patients with HBV and HDV infection. Socioepidemiological, laboratory and radiological aspects of the study subjects were retrospectively examined. Comorbid metabolic diseases were not assessed due to the retrospective design of the study. RESULTS Most of the study subjects were HBe antigen negative. No significant difference in terms of HBV-DNA levels or HBe antigen seropositivity was detected between the city centre and rural areas (p > 0.005). The mean HBV-DNA level in the anti-HDV-positive group was significantly lower than in the anti-HDV-negative group (p < 0.001). The rate of HDV-RNA positivity in women was higher than in their male counterparts (p = 0.017). Anti-HDV-IgG was detected in 18.4% of tested subjects who came from an urban area. In contrast, 12.5% of subjects of the rural group had a positive result for anti-HDV-IgG. Among 134 ultrasonographically evaluated delta hepatitis patients, 37.3% had liver cirrhosis. On the other hand, in 1244 patients with hepatitis B monoinfection, there were 90 patients with liver cirrhosis. Radiologically, the rate of hepatic steatosis in delta hepatitis patients was lower than in those with HBV monoinfection. CONCLUSIONS Hepatitis D virus infection was particularly prevalent among the urban population as well as in female subjects. More broadly, the current observations are the first to suggest an inverse correlation between delta hepatitis and ultrasonography-proven hepatic steatosis.
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Affiliation(s)
- Ahmet Cumhur Dulger
- Department of Gastroenterology, School of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Burak Suvak
- Department of Gastroenterology, School of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Hayriye Gonullu
- Department of Emergency Medicine, School of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Edip Gonullu
- Department of Anesthesiology, Van Region Training and Research Hospital, Van, Turkey
| | - Bilge Gultepe
- Department of Microbiology, School of Medicine, Bezmialem Vakıf University, Istanbul, Turkey
| | - İbrahim Aydın
- Department of Gastroenterology, School of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Abdüssamet Batur
- Department of Radiology, School of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Sevdegul Karadas
- Department of Emergency Medicine, School of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Şehmus Olmez
- Department of Gastroenterology, School of Medicine, Yuzuncu Yil University, Van, Turkey
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Al-Shaaibi SNK, Waly MI, Al-Subhi L, Tageldin MH, Al-Balushi NM, Rahman MS. Ameliorative Effects of Pomegranate Peel Extract against Dietary-Induced Nonalcoholic Fatty Liver in Rats. Prev Nutr Food Sci 2016; 21:14-23. [PMID: 27069901 PMCID: PMC4827630 DOI: 10.3746/pnf.2016.21.1.14] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/16/2016] [Indexed: 12/30/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is caused by fat accumulation and is associated with oxidative stress. In this study, we investigated the potential protective effect of pomegranate (Punica granatum L.) peel extract (PPE) against oxidative stress in the liver of rats with NAFLD. Sprague-Dawley rats were fed a high fat diet (HFD), 20% corn oil, or palm oil for 8 weeks in the presence or absence of PPE. The control group was fed a basal diet. The progression of NAFLD was evaluated histologically and by measuring liver enzymes (alanine transaminase and aspartate transaminase), serum lipids (triglycerides and total cholesterol), and oxidative stress markers. The HFD feeding increased the body weight and caused NAFLD, liver steatosis, hyperlipidemia, oxidative stress, and elevated liver enzymes. Administration of PPE ameliorated the hepatic morphology, reduced body weight, improved liver enzymes, and inhibited lipogenesis. Furthermore, PPE enhanced the cellular redox status in the liver tissue of rats with NAFLD. Our findings suggest that PPE could improve HFD-induced NAFLD via abolishment of hepatic oxidative damage and hyperlipidemia. PPE might be considered as a potential lead material in the treatment of NAFLD and obesity through the modulation of lipid metabolism.
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Affiliation(s)
- Siham N K Al-Shaaibi
- Department of Food Science and Nutrition, College of Agricultural and Marine Sciences, Sultan Qaboos University, Muscat 123, Sultanate of Oman
| | - Mostafa I Waly
- Department of Food Science and Nutrition, College of Agricultural and Marine Sciences, Sultan Qaboos University, Muscat 123, Sultanate of Oman
| | - Lyutha Al-Subhi
- Department of Food Science and Nutrition, College of Agricultural and Marine Sciences, Sultan Qaboos University, Muscat 123, Sultanate of Oman
| | - Mohamed H Tageldin
- Department of Animal and Veterinary Sciences, College of Agricultural and Marine Sciences, Sultan Qaboos University, Muscat 123, Sultanate of Oman
| | - Nada M Al-Balushi
- Department of Animal and Veterinary Sciences, College of Agricultural and Marine Sciences, Sultan Qaboos University, Muscat 123, Sultanate of Oman
| | - Mohammad S Rahman
- Department of Food Science and Nutrition, College of Agricultural and Marine Sciences, Sultan Qaboos University, Muscat 123, Sultanate of Oman
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Gallstones are associated with hidradenitis suppurativa: a population-based and hospital-based cross-sectional study from Denmark. Eur J Gastroenterol Hepatol 2015; 27:1392-8. [PMID: 26426833 DOI: 10.1097/meg.0000000000000469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory dermatological disease that was recently linked to the metabolic syndrome (MetS). MetS has been associated with gallstones, and nonalcoholic fatty liver has been suggested to be the hepatic expression of MetS. OBJECTIVE The objective of the study was to investigate whether there was an association of HS with gallstones as well as with hepatic dysfunction. PATIENTS AND METHODS This was a cross-sectional study comparing a hospital-based HS group, a population-based HS group, and controls for self-reported gallstone and blood sample verified hepatic dysfunction. Blood samples were analyzed for alanine transaminase, bilirubin, alkaline phosphatase, albumin, thrombocytes, and the international normalized ratio. RESULTS A total of 32 hospital HS patients, 430 population-based HS patients, and 20 780 non-HS controls were identified. The age-sex-smoking-adjusted analysis of gallstones revealed a significant OR of 1.72 (95% CI 1.23-2.42, P=0.0191) and a borderline significant OR of 3.28 (95% CI 1.24-8.74, P=0.0516) for the population HS group and hospital HS group versus controls, respectively. Furthermore, no clinically significant evidence was found with regard to hepatic dysfunction. CONCLUSION This study demonstrates an association of HS with gallstones, but not with hepatic dysfunction. The association with gallstones may be partly explained by the comorbidity of hypertriglyceridemia and obesity as a part of MetS.
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28
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Kara M, Dogru T, Genc H, Sertoglu E, Celebi G, Gurel H, Kayadibi H, Cicek AF, Ercin CN, Sonmez A. Neutrophil-to-lymphocyte ratio is not a predictor of liver histology in patients with nonalcoholic fatty liver disease. Eur J Gastroenterol Hepatol 2015; 27:1144-8. [PMID: 26062078 DOI: 10.1097/meg.0000000000000405] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES It has been reported that the neutrophil-to-lymphocyte ratio (NLR) can be measured relatively easily and can serve as a valuable index for much clinical pathology. The aim of this study was to investigate the association between NLR and hepatic histological findings in patients with nonalcoholic fatty liver disease (NAFLD). DESIGN AND METHODS A total of 226 consecutive patients with biopsy-proven NAFLD [nonalcoholic steatohepatitis (NASH, n=105), borderline-NASH (n=74), and simple steatosis (n=47)] were enrolled. NASH and fibrosis were diagnosed histologically using the NAFLD Clinical Research Network criteria. RESULTS Significant differences were found in aspartate aminotransferase (P<0.001), alanine aminotransferase (P<0.001) levels, and white blood cell (P=0.007) and neutrophil counts (P=0.042) between the three groups of patients. In addition, significantly higher BMI (P=0.024), waist circumference (P=0.011), aspartate aminotransferase (P=0.003), alanine aminotransferase (P=0.005), insulin (P=0.008), and homeostasis model assessment-insulin resistance (P=0.009) levels were found in patients with fibrosis (n=133) in comparison with those without fibrosis (n=93). There was no correlation between NLR and glucose, homeostasis model assessment-insulin resistance, lipid parameters, and the NAFLD activity score. Analysis of the NLR in relation to histological findings also showed no association between these parameters. CONCLUSION To the best of our knowledge, this is the largest study that has investigated these relationships in this clinically relevant condition. The findings of the present study show that NLR is not associated with the severity of hepatic inflammation or fibrosis and thus cannot be recommended as a surrogate marker of liver injury in patients with NAFLD.
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Affiliation(s)
- Muammer Kara
- aDepartment of Gastroenterology, GATA Haydarpasa Training Hospital, Istanbul bBiochemistry Laboratory, Ankara Mevki Military Hospital, Anittepe Dispensary Departments of cGastroenterology dPathology eEndocrinology and Metabolism, Gulhane School of Medicine, Ankara fDepartment of Gastroenterology, Izmir Military Hospital, Izmir gBiochemistry Laboratory, Adana Military Hospital, Adana, Turkey
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29
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Ozturk O, Colak Y, Senates E, Yilmaz Y, Ulasoglu C, Doganay L, Ozkanli S, Oltulu YM, Coskunpinar E, Tuncer I. Increased serum soluble lectin-like oxidized low-density lipoprotein receptor-1 levels in patients with biopsy-proven nonalcoholic fatty liver disease. World J Gastroenterol 2015; 21:8096-8102. [PMID: 26185381 PMCID: PMC4499352 DOI: 10.3748/wjg.v21.i26.8096] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 04/02/2015] [Accepted: 05/07/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze the relationship between the serum lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) levels and clinical and histopathological features of biopsy-confirmed nonalcoholic fatty liver disease (NAFLD) patients.
METHODS: Fifty-three consecutive, biopsy-proven NAFLD patients (31 males and 22 females, mean age 42.5 ± 9.6 years) and 26 age- and gender-matched, healthy controls (14 males and 12 females, mean age 39 ± 10.7 years) were included. The patients with NAFLD were consecutive patients who had been admitted to the hepatology outpatient clinic within the last year and had been diagnosed with NAFLD as the result of liver biopsy. The healthy controls were individuals who attended the outpatient clinic for routine health control and had no known chronic illnesses. The histological evaluation was conducted according to the NAFLD activity scoring system recommended by The National Institute of Diabetes and Digestive and Kidney Diseases Nonalcoholic Steatohepatitis Clinical Research Network. The serum LOX-1 levels were measured using an ELISA kit (Life Science Inc. USCN. Wuhan, Catalog No. E1859Hu) in both patients and healthy controls. A receiver operating characteristic (ROC) curve analysis was used to identify the optimal cutoff value of LOX-1 and thereby distinguish between patients with nonalcoholic steatohepatitis (NASH) and healthy controls. A P-value < 0.05 was considered statistically significant.
RESULTS: NAFLD and healthy control groups were similar in terms of age and sex. NAFLD patients consisted of 8 patients with simple steatosis (15%), 27 with borderline NASH (51%) and 18 with definitive NASH (34%). Metabolic syndrome was found in 62.2% of the patients with NAFLD. The mean serum LOX-1 level in biopsy-proven NAFLD patients was 8.49 ± 6.43 ng/mL compared to 4.08 ± 4.32 ng/mL in healthy controls (P = 0.001). The LOX-1 levels were significantly different between controls, simple steatosis and NASH (borderline+definite) cases (4.08 ± 4.32 ng/mL, 6.1 ± 6.16 ng/mL, 8.92 ± 6.45 ng/mL, respectively, P = 0.004). When the cut-off value for the serum LOX-1 level was set at 5.35 ng/mL, and a ROC curve analysis was performed to distinguish between steatohepatitis patients and controls; the sensitivity and specificity of the serum LOX-1 level were 69.8% and 69.2%, respectively.
CONCLUSION: The serum LOX-1 levels were significantly higher in NAFLD patients than in healthy controls. Additionally, the serum LOX-1 levels could differentiate between steatohepatitis patients and healthy controls.
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30
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Chon YE, Jung KS, Kim KJ, Joo DJ, Kim BK, Park JY, Kim DY, Ahn SH, Han KH, Kim SU. Normal controlled attenuation parameter values: a prospective study of healthy subjects undergoing health checkups and liver donors in Korea. Dig Dis Sci 2015; 60:234-42. [PMID: 25118979 DOI: 10.1007/s10620-014-3293-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 07/13/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND/AIMS The controlled attenuation parameter (CAP) is a noninvasive method of assessing hepatic steatosis. We defined the normal range of CAP values in healthy subjects and evaluated the associated factors. METHODS CAP values were measured in a cohort of healthy subjects who were screened as living liver transplantation donors and those who underwent health checkups. Subjects with current or a history of chronic liver disease, abnormalities on liver-related laboratory tests, or fatty liver on ultrasonography or biopsy were excluded. RESULTS The mean age of the 264 recruited subjects (131 males and 133 females; 76 potential liver donors and 188 subjects who had undergone health checkups) was 49.2 years. The mean CAP value was 224.8 ± 38.7 dB/m (range 100.0-308.0 dB/m), and the range of normal CAP values (5th-95th percentiles) was 156.0-287.8 dB/m. The mean CAP value was significantly higher in the health checkup than in the potential liver donor group (227.5 ± 42.0 vs. 218.2 ± 28.3 dB/m, P = 0.040). CAP values did not differ significantly according to gender or age in either group (all P > 0.05). In a multivariate linear regression analysis, body mass index (β = 0.271, P = 0.024) and triglyceride levels (β = 0.348, P = 0.008) were found to be independently associated with CAP values. CONCLUSION We determined the normal range of CAP values and found that body mass index and triglyceride levels were associated with the CAP values of healthy subjects.
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Affiliation(s)
- Young Eun Chon
- Department of Internal Medicine, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, 120-752, Korea
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31
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Topal NB, Orcan S, Sığırlı D, Orcan G, Eritmen Ü. Effects of fat accumulation in the liver on hemodynamic variables assessed by Doppler ultrasonography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2015; 43:26-33. [PMID: 24867781 DOI: 10.1002/jcu.22157] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 12/06/2013] [Accepted: 03/13/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE To investigate the effect of various degrees of fatty liver infiltration on hepatic hemodynamics using Doppler ultrasonography. METHODS We included 40 patients with hepatic steatosis and 20 healthy volunteers. Hepatic steatosis was quantified by a chemical shift MRI. Hepatic artery peak systolic and end-diastolic velocity, resistance index (RI) and pulsatility index (PI), hepatic vein RI and PI, portal vein RI, PI, congestion index, and peak maximum velocity were evaluated by Doppler ultrasonography. The hepatic vein waveforms were classified as triphasic, biphasic, or monophasic. Kruskal-Wallis test was performed for comparing more than two groups. If significant differences were found, Mann-Whitney U test with Bonferroni correction was performed for pair-wise comparisons. Pearson &gch;(2) and Fisher's exact tests were used to compare categorical variables. RESULTS According to MRI, 15 patients had mild, 14 patients had moderate, and 11 patients had severe fatty infiltration. Portal vein peak maximum velocity was median: 19.8 (range 12-33.3), 21.1 (8-41.8), 16.6 (10.6-24.9), and 29.2 (14.1-40.4) cm/s. Congestion index was 0.05 (0.02-0.16), 0.07 (0.01-0.17), 0.11 (0.06-0.24), and 0.05 (0.02-0.16). Hepatic artery RI was 0.75 (0.56-1.00), 0.66 (0.52-0.87), 0.83 (0.38-1.00), and 0.76 (0.48-2.76), and PI was 1.83 (0.90-3.13), 1.38 (1.04-2.63), 1.97 (0.86-2.90), and 1.82 (0.70-2.90) (p = .046 and p = .036) in the mild, moderate, severe steatosis, and control groups, respectively. The rate of triphasic hepatic vein waveforms was higher in controls than in patients with severe steatosis. CONCLUSIONS Portal vein flow velocity decreases in severe hepatic steatosis when compared with controls.
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Affiliation(s)
- Naile Bolca Topal
- Uludag University Faculty of Medicine, Department of Radiology, Nilufer/Bursa, Turkey
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Maggio R, Viscomi C, Andreozzi P, D'Ettorre G, Viscogliosi G, Barbaro B, Gori M, Vullo V, Balsano C. Normocaloric low cholesterol diet modulates Th17/Treg balance in patients with chronic hepatitis C virus infection. PLoS One 2014; 9:e112346. [PMID: 25532016 PMCID: PMC4273946 DOI: 10.1371/journal.pone.0112346] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 10/01/2014] [Indexed: 02/07/2023] Open
Abstract
UNLABELLED Hepatitis C virus (HCV) infection is associated with hepatic and extrahepatic manifestations, including immunological disorders. Chronic Hepatitis C (CHC) is often characterized by cholesterol and lipid metabolism alterations, leading to hepatic steatosis. Cholesterol metabolism, in fact, is crucial for the viral life cycle. Recent works described that a higher dietary cholesterol intake is associated with the progression of HCV-related liver disease. CHC patients have increased levels of T helper 17 (Th17)-cells, a lymphocytic population involved in the pathogenesis of liver inflammation and autoimmune hepatitis. The balance between Th17 and regulatory T (Treg) cells is crucial for chronic inflammation and autoimmunity. Th17-cell differentiation is deeply influenced by the activation LXRs, nuclear receptors modulating cholesterol homeostasis. Moreover, HCV may affect these nuclear receptors, and cholesterol metabolism, through both direct and indirect mechanisms. On these bases, we hypothesized that modulation of cholesterol levels through Normocaloric Low Cholesterol Diet (NLCD) may represent an innovative strategy to reduce the progression of HCV infection, through the modulation of peripheral Th17/Treg balance. To this end, we performed a pilot study to investigate whether a Normocaloric Low Cholesterol Diet may be able to modulate Th17/Treg balance in patients affected by chronic HCV infection. After 30 days of NLCD CHC patients showed a significant reduction in Th17 cells frequency, which correlated with strong reduction of IL-17 and IL-22 serum levels. At the same time, we appreciated an increase in the percentage of Treg cells, thus improving Treg/Th17 balance. Moreover, we observed an increased expression of LXRs and their target genes: SREBP-1c and ABCA-1. In conclusion, NLCD finely regulates Th17/Treg balance, improving immune system response in CHC patients. This study could pave the way for new treatments of CHC patients, suggesting that change in lifestyle could support the management of these patients, promoting well-being and possibly hindering disease progression. TRIAL REGISTRATION ClinicalTrials.gov NCT02038387.
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Affiliation(s)
- Roberta Maggio
- Laboratory of Molecular Virology and Oncology, Francesco Balsano Foundation, Rome, Italy
- Institute of Molecular Biology and Pathology, National Research Council, Rome, Italy
| | - Carmela Viscomi
- Laboratory of Molecular Virology and Oncology, Francesco Balsano Foundation, Rome, Italy
| | | | - Gabriella D'Ettorre
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | | | - Barbara Barbaro
- Laboratory of Molecular Virology and Oncology, Francesco Balsano Foundation, Rome, Italy
| | - Manuele Gori
- Laboratory of Molecular Virology and Oncology, Francesco Balsano Foundation, Rome, Italy
| | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Clara Balsano
- Laboratory of Molecular Virology and Oncology, Francesco Balsano Foundation, Rome, Italy
- Institute of Molecular Biology and Pathology, National Research Council, Rome, Italy
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Gluud LL, Knop FK, Vilsbøll T. Effects of lixisenatide on elevated liver transaminases: systematic review with individual patient data meta-analysis of randomised controlled trials on patients with type 2 diabetes. BMJ Open 2014; 4:e005325. [PMID: 25526792 PMCID: PMC4275683 DOI: 10.1136/bmjopen-2014-005325] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 07/17/2014] [Accepted: 07/28/2014] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To evaluate the effects of the glucagon-like peptide-1 receptor agonist lixisenatide on elevated liver blood tests in patients with type 2 diabetes. DESIGN Systematic review. DATA SOURCES Electronic and manual searches were combined. STUDY SELECTION Randomised controlled trials (RCTs) on lixisenatide versus placebo or active comparators for type 2 diabetes were included. PARTICIPANTS Individual patient data were retrieved to calculate outcomes for patients with elevated liver blood tests. MAIN OUTCOME MEASURES Normalisation of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). DATA SYNTHESIS The results of included trials were combined in meta-analyses. Sequential, subgroup and regression analyses were performed to evaluate heterogeneity and bias. RESULTS We included 12 RCTs on lixisenatide versus placebo and 3 RCTs with the active comparators liraglutide, exenatide or sitagliptin. The mean treatment duration was 29 weeks. Lixisenatide increased the proportion of patients with normalisation of ALT (risk difference: 0.07; 95% CI 0.01 to 0.14; number needed to treat: 14 patients, p=0.042). The effect was not confirmed in sequential analysis. No effects of lixisenatide were identified on AST, alkaline phosphatase or bilirubin. No evidence of bias was identified. Mixed effect multilevel meta-regression analyses suggest that the benefit of lixisenatide on ALT was limited to patients who were overweight or obese. CONCLUSIONS This review suggests that lixisenatide increases the proportion of obese or overweight patients with type 2 diabetes who achieve normalisation of ALT. Additional research is needed to determine if the findings translate to clinical outcome measures. TRIAL REGISTRATION NUMBER PROSPERO; CRD42013005779.
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Affiliation(s)
- Lise L Gluud
- Department of Medicine, Diabetes Research Centre, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Gastroenterology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Filip K Knop
- Department of Medicine, Diabetes Research Centre, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Tina Vilsbøll
- Department of Medicine, Diabetes Research Centre, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
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Amacher DE. Progress in the search for circulating biomarkers of nonalcoholic fatty liver disease. Biomarkers 2014; 19:541-52. [PMID: 25189636 DOI: 10.3109/1354750x.2014.958535] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
CONTEXT The definitive standard for the diagnosis of nonalcoholic fatty liver disease (NAFLD) is clinico-pathological correlation, but frequently the only laboratory abnormality is an elevation of serum aminotransferases. OBJECTIVE This has resulted in the search for more specific laboratory biomarkers. METHODS The literature was searched for novel plasma/serum markers of NAFLD. RESULTS Studies reviewed here included histologically-confirmed patients presenting some stage of NAFLD and monitored one or more novel serum/plasma biomarkers. CONCLUSION The most promising application of some of these novel biomarkers for the detection and quantification of NAFLD and particularly NASH appears to be in the combination of several into diagnostic panels.
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Chen J, Zhu Y, Zheng Q, Jiang J. Serum cytokeratin-18 in the diagnosis of non-alcoholic steatohepatitis: A meta-analysis. Hepatol Res 2014; 44:854-62. [PMID: 23834322 DOI: 10.1111/hepr.12197] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 06/05/2013] [Accepted: 07/01/2013] [Indexed: 12/11/2022]
Abstract
AIM Identifying patients with non-alcoholic steatohepatitis (NASH), a more aggressive form with a worse prognosis than for simple steatosis, is highly important. Liver biopsy still remains the gold standard for diagnosing NASH, but with limitations. The diagnostic value of serum cytokeratin-18 (CK-18) in predicting NASH is still indefinite. METHODS We selected relevant studies by a literature search of the PubMed, Ovid Medline and Cochrane Library databases up to January 2012. A DerSimonian-Laird random effects model was used to compute the pooled estimates of sensitivity (SEN), specificity (SPE), and diagnostic odds ratio (DOR), and a summary receiver operating characteristic (SROC) curve was constructed. Stratified analysis was performed to explore the heterogeneity in test accuracy. Funnel plot and Egger's regression were performed to assess publication bias. RESULTS A total of 10 studies with 838 patients were included (nine CK-18 fragments and five total CK-18 studies) in this meta-analysis. Among nine CK-18 fragment studies with a significant publication bias, the pooled results on SEN, SPE and DOR were 0.83 (95% CI, 0.80-0.86), 0.71 (95% CI, 0.66-0.76) and 11.90 (95% CI, 6.05-23.40), respectively, and age and body mass index were most strongly associated with the observed heterogeneity. Among five total CK-18 studies with homogeneity, the pooled results of SEN, SPE and DOR were 0.77% (95% CI, 0.70-0.83), 0.71 (95% CI, 0.65-0.77) and 7.99 (95% CI, 4.09-15.62), respectively. The area under the ROC curve (± SE) of CK-18 fragments and total CK-18 were 0.8445 (± 0.0306) and 0.8170 (± 0.0429), respectively. CONCLUSION Both CK-18 fragments and total CK-18 have a clinically meaningful benefit in noninvasive diagnosing of NASH, though total CK-18 has a relatively low diagnostic accuracy. CK-18 fragments may be a useful biomarker for screening rather than identifying NASH.
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Affiliation(s)
- Jing Chen
- Department of Liver Diseases Research Center, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Solga SF. Breath volatile organic compounds for the gut-fatty liver axis: Promise, peril, and path forward. World J Gastroenterol 2014; 20:9017-9025. [PMID: 25083075 PMCID: PMC4112861 DOI: 10.3748/wjg.v20.i27.9017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 01/15/2014] [Accepted: 04/09/2014] [Indexed: 02/06/2023] Open
Abstract
The worldwide interest in the gut microbiome and its impact on the upstream liver highlight a critical upside to breath research: it can uniquely measure otherwise unmeasurable biology. Bacteria make gases [volatile organic compounds (VOCs)] that are directly relevant to pathophysiology of the fatty liver and associated conditions, including obesity. Measurement of these VOCs and their metabolites in the exhaled breath, therefore, present an opportunity to safely and easily evaluate, on both a personal and a population level, some of our most pressing public health threats. This is an opportunity that must be pursued. To date, however, breath analysis remains a slowly evolving field which only occasionally impacts clinical research or patient care. One major obstacle to progress is that breath analysis is inherently and emphatically mutli-disciplinary: it connects engineering, chemistry, breath mechanics, biology and medicine. Unbalanced or incomplete teams may produce inconsistent and often unsatisfactory results. A second impediment is the lack of a well-known stepwise structure for the development of non-invasive diagnostics. As a result, the breath research landscape is replete with orphaned single-center pilot studies. Often, important hypotheses and key observations have not been pursued to maturation. This paper reviews the rationale and requirements for breath VOC research applied to the gut-fatty liver axis and offers some suggestions for future development.
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Toshikuni N, Tsutsumi M, Arisawa T. Clinical differences between alcoholic liver disease and nonalcoholic fatty liver disease. World J Gastroenterol 2014; 20:8393-8406. [PMID: 25024597 PMCID: PMC4093692 DOI: 10.3748/wjg.v20.i26.8393] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 01/29/2014] [Accepted: 03/19/2014] [Indexed: 02/06/2023] Open
Abstract
Alcoholic liver disease (ALD) and nonalcoholic fatty liver disease (NAFLD) are serious health problems worldwide. These two diseases have similar pathological spectra, ranging from simple hepatic steatosis to steatohepatitis, liver cirrhosis, and hepatocellular carcinoma. Although most subjects with excessive alcohol or food intake experience simple hepatic steatosis, a small percentage of individuals will develop progressive liver disease. Notably, both ALD and NAFLD are frequently accompanied by extrahepatic complications, including cardiovascular disease and malignancy. The survival of patients with ALD and NAFLD depends on various disease-associated conditions. This review delineates the clinical characteristics and outcomes of patients with ALD and NAFLD by comparing their epidemiology, the factors associated with disease susceptibility and progression, and the predictors and characteristics of outcomes. A comprehensive understanding of the characteristics and outcomes of ALD and NAFLD is imperative in the management of these chronic liver diseases.
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Khov N, Sharma A, Riley TR. Bedside ultrasound in the diagnosis of nonalcoholic fatty liver disease. World J Gastroenterol 2014; 20:6821-6825. [PMID: 24944472 PMCID: PMC4051921 DOI: 10.3748/wjg.v20.i22.6821] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 01/25/2014] [Accepted: 03/19/2014] [Indexed: 02/06/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in the United States. While the American Association for the Study of Liver Diseases guidelines define NAFLD as hepatic steatosis detected either on histology or imaging without a secondary cause of abnormal hepatic fat accumulation, no imaging modality is recommended as standard of care for screening or diagnosis. Bedside ultrasound has been evaluated as a non-invasive method of diagnosing NAFLD with the presence of characteristic sonographic findings. Prior studies suggest characteristic sonographic findings for NAFLD include bright hepatic echoes, increased hepatorenal echogenicity, vascular blurring of portal or hepatic vein and subcutaneous tissue thickness. These sonographic characteristics have not been shown to aid bedside clinicians easily identify potential cases of NAFLD. While sonographic findings such as attenuation of image, diffuse echogenicity, uniform heterogeneous liver, thick subcutaneous depth, and enlarged liver filling of the entire field could be identified by clinicians from bedside ultrasound. The accessibility, ease of use, and low-side effect profile of ultrasound make bedside ultrasound an appealing imaging modality in the detection of hepatic steatosis. When used with appropriate clinical risk factors and steatosis involves greater than 33% of the liver, ultrasound can reliably diagnose NAFLD. Despite the ability of ultrasound in detecting moderate hepatic steatosis, it cannot replace liver biopsy in staging the degree of fibrosis. The purpose of this review is to examine the diagnostic accuracy, utility, and limitations of ultrasound in the diagnosis of NAFLD and its potential use by clinicians in routine practices.
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Kahl S, Straßburger K, Nowotny B, Livingstone R, Klüppelholz B, Keßel K, Hwang JH, Giani G, Hoffmann B, Pacini G, Gastaldelli A, Roden M. Comparison of liver fat indices for the diagnosis of hepatic steatosis and insulin resistance. PLoS One 2014; 9:e94059. [PMID: 24732091 PMCID: PMC3986069 DOI: 10.1371/journal.pone.0094059] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 03/11/2014] [Indexed: 12/20/2022] Open
Abstract
Context Hepatic steatosis, defined as increased hepatocellular lipid content (HCL), associates with visceral obesity and glucose intolerance. As exact HCL quantification by 1H-magnetic resonance spectroscopy (1H-MRS) is not generally available, various clinical indices are increasingly used to predict steatosis. Objective The purpose of this study was to test the accuracy of NAFLD liver fat score (NAFLD-LFS), hepatic steatosis index (HSI) and fatty liver index (FLI) against 1H-MRS and their relationships with insulin sensitivity and secretion. Design, Setting and Participants Ninety-two non-diabetic, predominantly non-obese humans underwent clinical examination, 1H-MRS and an oral glucose tolerance test (OGTT) to calculate insulin sensitivity and β-cell function. Accuracy of indices was assessed from the area under the receiver operating characteristic curve (AROC). Results Median HCL was 2.49% (0.62;4.23) and correlated with parameters of glycemia across all subjects. NAFLD-LFS, FLI and HSI yielded AROCs of 0.70, 0.72, and 0.79, respectively, and related positively to HCL, insulin resistance, fasting and post-load β-cell function normalized for insulin resistance. Upon adjustment for age, sex and HCL, regression analysis revealed that NAFLD-LFS, FLI and HSI still independently associated with both insulin sensitivity and β-cell function. Conclusion The tested indices offer modest efficacy to detect steatosis and cannot substitute for fat quantification by 1H-MRS. However, all indices might serve as surrogate parameters for liver fat content and also as rough clinical estimates of abnormal insulin sensitivity and secretion. Further validation in larger collectives such as epidemiological studies is needed.
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Affiliation(s)
- Sabine Kahl
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich-Heine University, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Klaus Straßburger
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich-Heine University, Düsseldorf, Germany
| | - Bettina Nowotny
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich-Heine University, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Roshan Livingstone
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich-Heine University, Düsseldorf, Germany
| | - Birgit Klüppelholz
- Institute for Biometrics and Epidemiology, German Diabetes Center at Heinrich-Heine University, Düsseldorf, Germany
| | - Kathrin Keßel
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich-Heine University, Düsseldorf, Germany
| | - Jong-Hee Hwang
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich-Heine University, Düsseldorf, Germany
| | - Guido Giani
- Institute for Biometrics and Epidemiology, German Diabetes Center at Heinrich-Heine University, Düsseldorf, Germany
| | - Barbara Hoffmann
- IUF – Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
| | - Giovanni Pacini
- National Research Council, Institute of Biomedical Engineering, Metabolic Unit, Padova, Italy
| | - Amalia Gastaldelli
- National Research Council, Institute of Clinical Physiology, Pisa, Italy
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich-Heine University, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research, Partner Düsseldorf, Germany
- * E-mail:
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Pappachan JM, Antonio FA, Edavalath M, Mukherjee A. Non-alcoholic fatty liver disease: a diabetologist's perspective. Endocrine 2014; 45:344-53. [PMID: 24287794 DOI: 10.1007/s12020-013-0087-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 10/12/2013] [Indexed: 02/06/2023]
Abstract
In the recent years, non-alcoholic fatty liver disease (NAFLD) has emerged as the commonest cause of chronic liver disease in the developed world. The global epidemic of obesity secondary to physical inactivity and adverse food habits accounts for the alarming rise in NAFLD. Metabolic syndrome plays a major role in the pathogenesis of both NAFLD and type 2 diabetes mellitus (T2DM). Whilst most cases of NAFLD remain asymptomatic with only hepatic steatosis, about 30 % progress to non-alcoholic steatohepatitis with chronic liver inflammation that can lead on to fibrosis, cirrhosis, liver failure, and hepatocellular carcinoma. Because of the similar pathogenesis shared between T2DM and NAFLD, T2DM occurs as an important complication in many cases of NAFLD, and many cases of T2DM are further complicated by NAFLD. Rapid progression and increased complications of the individual diseases is the end result of this dual coexistence. Diagnosis of NAFLD relies upon hepatic imaging, serum biochemical markers, and liver biopsy. As in T2DM, the most important management option for patients with NAFLD is lifestyle changes targeted at weight reduction. Other treatment options include insulin sensitizers (metformin and pioglitazone), vitamin E, incretin mimetics, omega-3 fatty acids, cholesterol lowering agents, orlistat, and bariatric surgery. The clinical spectrum, patho-physiological features and therapeutic options of NAFLD share many things in common with T2DM and therefore, this review is to highlight the diabetologist's perspective of the disease.
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Affiliation(s)
- Joseph M Pappachan
- Department of Endocrinology, Diabetes & Metabolism, University Hospital of North Staffordshire, Stoke-on-Trent, ST4 6QG, UK,
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Bulum T, Kolarić B, Duvnjak M, Duvnjak L. Alkaline phosphatase is independently associated with renal function in normoalbuminuric type 1 diabetic patients. Ren Fail 2014; 36:372-7. [PMID: 24455970 DOI: 10.3109/0886022x.2013.872569] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is associated with an increased prevalence of chronic kidney disease in patients with type 1 diabetes. The aim of this study was to explore the relationship between markers of NAFLD, namely concentrations of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALK), γ-glutamyltransferase (GGT), bilirubin, and renal function in type 1 diabetic patients. This study included 313 normoalbuminuric type 1 diabetic patients with estimated glomerular filtration rate (eGFR) >60 mL/min/1.73 m(2), without clinical evidence of cirrhosis or other causes of chronic liver disease and before any interventions with statins, angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers. ALT, GGT, and bilirubin levels were significantly higher in subjects in the highest quartile of serum creatinine compared to those in lowest quartile (21 vs. 20 U/L, 18 vs. 14 U/L, and 14 vs. 10 µmol/L, respectively, for all p < 0.05). ALK levels were significantly higher in subjects in the highest quartile of urinary albumin excretion rate compared to those in lowest quartile (71 vs. 69 U/L, p = 0.03), as well as in hyperfiltrating subjects compared to those with normal or mildly impaired eGFR (81 vs. 68 and 64 U/L, p < 0.001). In a multiple logistic regression model adjusted for age, sex, duration of diabetes, HbA1c, and body mass index (BMI), only ALK levels were significantly associated with disturbances in serum creatinine and eGFR in our subjects (p ≤ 0.007), with odds ratios of 0.98-1.02. NAFLD associated markers, particularly ALK, are associated with renal function in normoalbuminuric type 1 diabetic patients.
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Affiliation(s)
- Tomislav Bulum
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur , Zagreb , Croatia
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Younossi ZM, Reyes MJ, Mishra A, Mehta R, Henry L. Systematic review with meta-analysis: non-alcoholic steatohepatitis - a case for personalised treatment based on pathogenic targets. Aliment Pharmacol Ther 2014; 39:3-14. [PMID: 24206433 DOI: 10.1111/apt.12543] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 08/06/2013] [Accepted: 10/11/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is an umbrella term, which encompasses simple steatosis and non-alcoholic steatohepatitis (NASH). The entire spectrum of NAFLD has been associated with metabolic syndrome. NASH is associated with increased mortality compared with that of the general population. Many therapeutic options for NASH have been studied. However, there is very little evidence supporting the efficacy of most regimens for the treatment of NASH. AIM To provide a review focusing on the current therapeutic options available for patients with NASH as well as to briefly introduce possible future interventions. METHODS A MEDLINE, Pubmed and Cochrane Review database search using a combination of keywords, which included non-alcoholic fatty liver disease, non-alcoholic hepatic steatosis, NAFLD, NASH, treatment, therapeutics, vitamin E, orlistat and bariatric surgery. An overall summary of the articles was developed for each section of discussion in this review. RESULTS NASH associated with metabolic syndrome can progress advanced fibrosis and cirrhosis. Weight loss and lifestyle modification have been shown to improve NASH. Other medications used for weight loss and metabolic syndrome have been evaluated, such as orlistat, metformin and thiazolidinediones. Alternative regimens using ursodeoxycholic acid, statins and probiotics as well as bariatric surgery have been evaluated, but have not been recommended as first-line treatment for NASH. Vitamin E for NASH patients without diabetes seems to be promising. The lack of effective treatment for NASH suggests the heterogeneity of patients presenting with the NASH phenotype. The best treatment strategy for these patients may be to identify their pathogenic target and develop personalised treatment protocols. CONCLUSIONS Currently, there are few options available for the management of NASH. Future targeted treatment strategies based on the pathogenic pathways may be needed to develop effective treatment for patients with NASH.
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Affiliation(s)
- Z M Younossi
- Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, VA, USA; Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
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Torkadi PP, Apte IC, Bhute AK. Biochemical Evaluation of Patients of Alcoholic Liver Disease and Non-alcoholic Liver Disease. Indian J Clin Biochem 2014; 29:79-83. [PMID: 24478554 PMCID: PMC3903934 DOI: 10.1007/s12291-013-0310-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 02/05/2013] [Indexed: 11/29/2022]
Abstract
Alcoholic liver disease (ALD) is due to excessive alcohol intake for long duration. Distinguishing ALD from non-ALD (non-alcoholic steatohepatitis, hepatitis of viral origin) is difficult as patient may deny alcohol abuse. Clinical examination, histology and serology may not differentiate these conditions. Accurate diagnosis is important as management of ALD differs from non-ALD patients. The aim of our study was (1) To evaluate the patients of ALD and non-ALD by biochemical parameters compared to controls, (2) To assess whether these parameters can differentiate ALD from non-ALD. Study was carried out on 50 patients of ALD in group I and 35 patients of NASH (non-alcoholic steatohepatitis) and acute viral hepatitis each in group II. Age matched healthy controls n = 50. Selection criteria-history of alcohol intake (amount and duration), clinical examination, sonography of abdomen, serum alanine transaminase (ALT) and bilirubin levels. Blood samples were analyzed for bilirubin, aspartate transaminase (AST), ALT, alkaline phosphatase (ALP), gamma glutamyl transferase (GGT) by kinetic method. Statistical analysis was done by Student unpaired 't' test. Patients of ALD have raised AST/ALT ratio (De Ritis ratio) (>2), ALP and GGT compared to controls (P < 0.01).There is significant difference in AST/ALT ratio, serum GGT and ALP in ALD group compared to that in NASH and acute viral hepatitis (P < 0.05). This study suggests that De Ritis ratio >2 in ALD patients may be due to alcohol induced hepatic mitochondrial injury and pyridoxine deficiency. High GGT and ALP values may indicate enzyme induction by alcohol and mild cholestasis. Thus ALD patients have severe hepatic damage. De Ritis ratio <1 and normal to mild elevation in GGT level in NASH and acute viral hepatitis suggest mild hepatic injury of non-alcoholic origin. Our study concludes that ALD patients can be differentiated from NASH and acute viral hepatitis with certainty by measuring serum AST/ALT ratio, GGT and ALP. These biochemical parameters may help clinicians to support the diagnosis of ALD and non-ALD.
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Affiliation(s)
- Prasad P. Torkadi
- />Department of Biochemistry, Dr. P.D.M. Medical College, Amravati, 444603 Maharashtra India
| | - I. C. Apte
- />Department of Biochemistry, Indira Gandhi Govt. Medical College, Nagpur, Maharashtra India
| | - A. K. Bhute
- />Department of Biochemistry, Dr. P.D.M. Medical College, Amravati, 444603 Maharashtra India
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Fierbinteanu Braticevici C, Sporea I, Panaitescu E, Tribus L. Value of acoustic radiation force impulse imaging elastography for non-invasive evaluation of patients with nonalcoholic fatty liver disease. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:1942-50. [PMID: 23932277 DOI: 10.1016/j.ultrasmedbio.2013.04.019] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 03/19/2013] [Accepted: 04/22/2013] [Indexed: 05/16/2023]
Abstract
The goals of the work described here were to evaluate the clinical utility of acoustic radiation force impulse (ARFI) elastography in differentiating non-alcoholic fatty liver disease (NAFLD) histologic subtypes and to determine if ARFI elastography measurements correlate with the severity of liver fibrosis. We compared ARFI elastography measurements with clinical, biologic and histologic features (simple steatosis or steatohepatitis) in 64 patients with histologically proven NAFLD. ARFI elastography is suitable for distinguishing patients with non-alcoholic steatohepatitis from those with simple steatosis, with an area under the receiver operating characteristic curve (AUROC) of 0.867 (95% confidence interval = 0.782-0.953). There was a highly significant correlation (r = 0.843) between ARFI elastography measurements and fibrosis (p < 0.001). In patients with non-alcoholic steatohepatitis, the diagnostic performance of ARFI elastography in predicting significant fibrosis (F ≥ 2) had an AUROC of 0.944. ARFI elastography better predicted F = 4 fibrosis (AUROC = 0.984). In conclusion, ARFI elastography is a promising method for differentiating patients with non-alcoholic steatohepatitis from patients with simple steatosis and can also predict significant fibrosis in these patients.
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Affiliation(s)
- Carmen Fierbinteanu Braticevici
- "Carol Davila" University of Medicine and Pharmacy, II Medical Clinic and Gastroenterology, University Hospital Bucharest, Bucharest, Romania.
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Abstract
It is critical to assess the degree of liver fibrosis for clinical management. However, liver biopsy has many drawbacks and is invasive. Promising non-invasive methods including serum markers and new imaging studies to predict liver fibrosis have been developed in past decades. This editorial provides a succinct overview and update of the new non-invasive technologies, especially the three-dimensional magnetic resonance imaging (3-D MRI) that has been studied by Dr. Kawamura's group in Japan. It also highlights the merit and weakness of this 3D-MRI technology in predicting liver fibrosis and indicates future studies to understand where 3D-MRI fits into the current armamentarium of non-invasive serum-based and imaging technologies.
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Affiliation(s)
- Yan Bi
- Gastroenterology Research Unit and Department of Internal Medicine, Mayo Clinic, 200 First ST SW, Rochester, MN, 55905, USA
| | | | - Vijay H Shah
- Gastroenterology Research Unit and Department of Internal Medicine, Mayo Clinic, 200 First ST SW, Rochester, MN, 55905, USA.
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Czech B, Neumann ID, Müller M, Reber SO, Hellerbrand C. Effect of chronic psychosocial stress on nonalcoholic steatohepatitis in mice. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2013; 6:1585-1593. [PMID: 23923077 PMCID: PMC3726974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 06/20/2013] [Indexed: 06/02/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is characterized by hepatic lipid accumulation which may progress towards inflammation (nonalcoholic steatohepatitis (NASH)). NAFLD is regarded as a consequence of a sedentary, food-abundant lifestyle which, in the modern world, often coincides with chronically high levels of perceived psychosocial stress. Here, we aimed to characterize the effect of chronic psychosocial stress on the development of NAFLD/NASH in male mice either fed with standard chow or NASH-inducing high fat diet. Chronic psychosocial stress was induced by chronic subordinate colony housing (CSC), a pre-clinically validated paradigm relevant for human affective and somatic disorders. Single housed (SHC) mice served as controls. Under standard chow conditions CSC mice revealed lower hepatic triglyceride levels but higher hepatic TNFα, MCP-1 and HMOX mRNA expression, while serum transaminase levels did not significantly differ from SHC mice. Under the NASH-inducing high-fat diet CSC and SHC mice showed similar body weight-gain and serum levels of glucose and adiponectin. Moreover, liver histology as well as TNFα, MCP-1 and HMOX expression were similar in CSC and SHC mice fed with HFD. Surprisingly, CSC showed even significantly lower transaminase levels than SHC mice fed with the same NASH-inducing diet. Together, these data indicate that under normal dietary conditions the CSC model induces noticeable hepatic oxidative stress and inflammation without causing manifest hepatocellular injury. In contrast, CSC exhibited a protective effect on hepatocellular injury in a dietary NASH-model. Identification of the underlying mechanisms of this phenomenon may lead to novel therapeutic strategies to prevent progression of NAFLD.
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Affiliation(s)
- Barbara Czech
- Department of Internal Medicine I, University Hospital RegensburgGermany
| | - Inga D Neumann
- Department of Behavioral and Molecular Neurobiology, Institute of Zoology, University of RegensburgGermany
| | - Martina Müller
- Department of Internal Medicine I, University Hospital RegensburgGermany
| | - Stefan O Reber
- Department of Behavioral and Molecular Neurobiology, Institute of Zoology, University of RegensburgGermany
- Laboratory for Molecular Psychosomatics, Clinic for Psychosomatic Medicine and Psychotherapy, University of UlmGermany
| | - Claus Hellerbrand
- Department of Internal Medicine I, University Hospital RegensburgGermany
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Chung GE, Kim D. Noninvasive markers: a double-edged sword that stratifies nonalcoholic steatohepatitis. Clin Mol Hepatol 2013; 19:116-9. [PMID: 23837135 PMCID: PMC3701843 DOI: 10.3350/cmh.2013.19.2.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 05/15/2013] [Indexed: 11/05/2022] Open
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Illnait J, Rodríguez I, Mendoza S, Fernández Y, Mas R, Miranda M, Piñera J, Fernández JC, Mesa M, Fernández L, Carbajal D, Gámez R. Effects of D-002, a mixture of high molecular weight beeswax alcohols, on patients with nonalcoholic fatty liver disease. Korean J Intern Med 2013; 28:439-48. [PMID: 23864802 PMCID: PMC3712152 DOI: 10.3904/kjim.2013.28.4.439] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 03/14/2013] [Accepted: 05/10/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND/AIMS Nonalcoholic fatty liver disease (NAFLD) is intimately related to insulin resistance and ranges from a benign course to liver fibrosis and cirrhosis. NAFLD management mainly involves dietary modification and weight loss. Although no fully successful pharmacological intervention is available, alternative therapies to treat NAFLD have shown promising results. Experimental studies have shown that D-002, a mixture of beeswax alcohols with antioxidant effects, is hepatoprotective. The aim of this study was to investigate the efficacy and safety of D-002 in patients with NALFD. METHODS Fifty patients with NAFLD were randomized to receive a placebo or D-002 (100 mg/day) for 24 weeks. The primary endpoint was a significant ultrasonography-detected reduction of liver fat infiltration versus a placebo. Secondary endpoints were decreases in the homeostatic model assessment (HOMA) index, insulin levels, serum liver enzymes, increases in plasma total antioxidant status (TAS) and improved clinical symptoms versus the placebo recipients. RESULTS At randomization, all indicators were comparable in both groups. At study completion, seven (28.0%) D-002-patients, but none of the placebo recipients, exhibited a normal liver echo pattern on ultrasonography (p < 0.01). Also, D-002 significantly reduced (p < 0.01 vs. baseline and placebo) the HOMA index and insulin levels and increased the TAS, but did not affect other parameters. The proportion of D-002-patients (12/25, 48.0%) showing symptom improvement was higher (p < 0.001) than that of the placebo group (1/25, 4.0%). The treatment was safe and well tolerated. Three patients in each group withdrew from the study. CONCLUSIONS D-002 (100 mg/day) improved ultrasonographic findings, indicators of insulin resistance, plasma TAS and clinical evolution on NAFLD patients. Further studies, however, are needed to confirm these results.
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Affiliation(s)
- José Illnait
- Centre of Natural Products, National Centre for Scientific Research, Havana, Cuba
| | - Iván Rodríguez
- Surgical Medical Research Centre, National Centre for Scientific Research, Havana, Cuba
| | - Sarahí Mendoza
- Centre of Natural Products, National Centre for Scientific Research, Havana, Cuba
| | - Yolanda Fernández
- Surgical Medical Research Centre, National Centre for Scientific Research, Havana, Cuba
| | - Rosa Mas
- Centre of Natural Products, National Centre for Scientific Research, Havana, Cuba
| | - Mirtha Miranda
- Surgical Medical Research Centre, National Centre for Scientific Research, Havana, Cuba
| | - Jesús Piñera
- Surgical Medical Research Centre, National Centre for Scientific Research, Havana, Cuba
| | | | - Meilis Mesa
- Surgical Medical Research Centre, National Centre for Scientific Research, Havana, Cuba
| | - Lilia Fernández
- Centre of Natural Products, National Centre for Scientific Research, Havana, Cuba
| | - Daisy Carbajal
- Centre of Natural Products, National Centre for Scientific Research, Havana, Cuba
| | - Rafael Gámez
- Centre of Natural Products, National Centre for Scientific Research, Havana, Cuba
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