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Rho HS, Choi WS. Low Muscle Strength as Risk Factor for Non-Alcoholic Fatty Liver Disease in Different Metabolic Conditions. Korean J Fam Med 2024; 45:89-95. [PMID: 38012004 DOI: 10.4082/kjfm.23.0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/26/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) recently became a leading liver disease that threatens health worldwide. Low muscle strength, obesity, insulin resistance, and metabolic syndrome are recognized key factors for NAFLD. However, the impact of low muscle strength itself in different metabolic conditions has not been widely studied. METHODS A cross-sectional analysis was performed of a sample of 5,427 participants from the 2019 Korea National Health and Nutrition Examination Survey. Relative handgrip strength (rHGS, defined as handgrip strength/body mass index) was used to assess muscle strength. The cut-off values for a low rHGS were 1.405 for men and 0.850 for women. NAFLD was diagnosed if the Hepatic Steatosis Index was >36. Participants were stratified according to insulin resistance, metabolic syndrome, and central obesity for the subgroup analyses. RESULTS Complex sample multivariate logistic regression analysis revealed a significant association between low muscle strength and NAFLD after the adjustment for other confounders (odds ratio [OR], 1.92; P<0.001). In the insulin resistance, metabolic syndrome, and central obesity subgroups, a significant association between low muscle strength and NAFLD remained (OR, 1.66-4.19 depending on subgroup; all P<0.05), whereas it did not in the no central obesity group. CONCLUSION This study demonstrated that low muscle strength is correlated with a risk of NAFLD. This relationship was independent of insulin resistance and metabolic syndrome but was dependent on the presence of central obesity.
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Affiliation(s)
- Hye-Sun Rho
- Department of Family Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Whan-Seok Choi
- Department of Family Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Ferreira S, Mendes J, Couto D, Ferreira D, Rêgo C. Nonalcoholic Fatty Liver Disease and Continuous Metabolic Syndrome in Adolescents with Overweight/Obesity. ACTA MEDICA PORT 2024; 37:177-186. [PMID: 38330918 DOI: 10.20344/amp.19834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 07/10/2023] [Indexed: 02/10/2024]
Abstract
INTRODUCTION Nonalcoholic fatty liver disease is the leading cause of pediatric chronic liver disease. Although nonalcoholic fatty liver disease is closely associated with obesity, its relationship with metabolic syndrome in children is not fully understood. The main aim of this study was to evaluate the association between nonalcoholic fatty liver disease and a combination of cardiometabolic risk factors in adolescents with overweight/obesity, using a pediatric metabolic syndrome score (PsiMS) to predict metabolic syndrome. METHODS A retrospective cohort study was conducted. Subjects with overweight/obesity aged 10 to 17 followed at two clinical centers in Portugal (2018 - 2021) were enrolled. The independent association of nonalcoholic fatty liver disease with PsiMS, and of other potential predictors, was tested through multiple regression analyses. Receiver operator characteristic curve analysis was performed to estimate the optimal cutoff of PsiMS to discriminate metabolic syndrome. RESULTS Eighty-four subjects were included (median age at baseline 11.5 years). The prevalence rate of nonalcoholic fatty liver disease was 51% and the prevalence rate of metabolic syndrome was 7%. The mean PsiMS was 2.05 ± 0.48 at the first evaluation, and 2.11 ± 0.52 at the last evaluation (mean follow-up time was 15 months). The nonalcoholic fatty liver disease group had significantly (p < 0.05) higher weight and body mass index z-scores, higher rate of severe obesity and higher waist circumference percentile. PsiMS was highly accurate in predicting metabolic syndrome (area under the curve = 0.96), with an optimal cutoff of 2.46 (sensitivity 100%, specificity 89%). In the univariate analysis, no statistically significant association was observed between nonalcoholic fatty liver disease and PsiMS. In the multiple regression analysis, female sex had a negative association with PsiMS (first and last evaluation). Independent predictors of a higher PsiMS at first evaluation were: ≥ 2 metabolic syndrome criteria, body mass index z-score, insulin resistance and dyslipidemia. At the last evaluation, independent predictors of a higher PsiMS were: nonalcoholic fatty liver disease, baseline PsiMS and body mass index increase from baseline. CONCLUSION The results suggest a good performance of the PsiMS to assess metabolic syndrome and that nonalcoholic fatty liver disease is associated with PsiMS at follow-up.
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Affiliation(s)
- Sofia Ferreira
- Centro Hospitalar Universitário Cova da Beira. Covilhã; Faculty of Health Sciences. Universidade da Beira Interior. Covilhã. Portugal
| | - Joana Mendes
- Centro Hospitalar Universitário Cova da Beira. Covilhã. Portugal
| | - Daniela Couto
- Centro Hospitalar Universitário Cova da Beira. Covilhã. Portugal
| | - Dário Ferreira
- Department of Mathematics and Center of Mathematics and Applications. Universidade da Beira Interior. Covilhã. Portugal
| | - Carla Rêgo
- Hospital CUF Porto. Oporto; Center for Health Technology and Services Research (CINTESIS). Faculty of Medicine. Universidade do Porto. Oporto; Faculty of Biotechnology. Universidade Católica. Oporto. Portugal
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Ziamanesh F, Mohammadi M, Ebrahimpour S, Tabatabaei-Malazy O, Mosallanejad A, Larijani B. Unraveling the link between insulin resistance and Non-alcoholic fatty liver disease (or metabolic dysfunction-associated steatotic liver disease): A Narrative Review. J Diabetes Metab Disord 2023; 22:1083-1094. [PMID: 37975107 PMCID: PMC10638269 DOI: 10.1007/s40200-023-01293-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 08/24/2023] [Indexed: 11/19/2023]
Abstract
Objective Non-alcoholic fatty liver disease (NAFLD) is rapidly becoming a significant global health concern, representing the leading cause of chronic liver disease and posing a substantial public health challenge. NAFLD is associated with higher insulin resistance (IR) levels, a key pathophysiological mechanism contributing to its development and progression. To counter this growing trend, it is crucial to raise awareness about NAFLD and promote healthy lifestyles to mitigate the impact of this disease. Methods Relevant studies regarding IR and NAFLD published until May 30, 2023, were extracted from Google PubMed, Scopus, and Web Of Science web databases. The following keywords were used: IR, diabetes mellitus, Non-alcoholic fatty liver disease, and metabolic syndrome. Results IR leads to an accumulation of fatty acids within liver cells, resulting from increased glycolysis and decreased apolipoprotein B-100. Furthermore, the manifestations of NAFLD extend beyond liver-related morbidity and mortality, affecting multiple organs and giving rise to various non-communicable disorders such as diabetes mellitus, metabolic syndrome, polycystic ovary syndrome, obstructive sleep apnea, and cardiovascular disease. Although lifestyle modification remains the primary treatment approach for NAFLD, alternative therapies, including pharmacological, herbal, and surgical interventions, may be considered. By implementing early and simple measures, cirrhosis, end-stage liver disease, and hepatocellular carcinoma can be prevented. Conclusions There is a clear association between NAFLD and elevated levels of IR. Several metabolic conditions, such as obesity, type 2 diabetes mellitus, dyslipidemia, and metabolic syndrome, are closely interrelated with NAFLD and IR. Raising awareness about NAFLD and promoting a healthy lifestyle are crucial steps to reverse the impact of this disease.
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Affiliation(s)
- Fateme Ziamanesh
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Mohammadi
- Department of Clinical Pharmacy, School of Pharmacy, Alborz University of Medical Sciences, Karaj, Iran
| | - Sholeh Ebrahimpour
- Department of Clinical Pharmacy, School of Pharmacy, Alborz University of Medical Sciences, Karaj, Iran
| | - Ozra Tabatabaei-Malazy
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Alexopoulos AS, Parish A, Olsen M, Batch BC, Moylan C, Crowley MJ. Prescribing of evidence-based diabetes pharmacotherapy in patients with metabolic dysfunction-associated steatohepatitis. BMJ Open Diabetes Res Care 2023; 11:e003763. [PMID: 38030391 PMCID: PMC10689360 DOI: 10.1136/bmjdrc-2023-003763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Metabolic dysfunction-associated steatohepatitis (MASH) is highly prevalent in type 2 diabetes (T2D). Pioglitazone and glucagon-like peptide-1 receptor agonists (GLP-1RA) are medications used in T2D that can resolve MASH and should be considered in all patients with T2D and MASH. We assessed prescription rates of evidence-based T2D pharmacotherapy (EBP) in MASH, and ascertained racial/ethnic disparities in prescribing. RESEARCH DESIGN AND METHODS We conducted a cross-sectional study on patients in Duke University Health System with diagnosis codes for T2D and MASH between January 2019 and January 2021. Only patients with ≥1 primary care or endocrinology encounter were included. The primary outcome was EBP, defined as ≥1 prescription for pioglitazone and/or a GLP-1RA during the study period. A multivariable logistic regression model was used to examine the primary outcome. RESULTS A total of 847 patients with T2D and MASH were identified; mean age was 59.7 (SD 12) years, 61.9% (n=524) were female, and 11.9% (n=101) and 4.6% (n=39) were of Black race and Latino/a/x ethnicity, respectively. EBP was prescribed in 34.8% (n=295). No significant differences were noted in the rates of EBP use across racial/ethnic groups (Latino/a/x vs White patients: adjusted OR (aOR) 1.82, 95% CI 0.78 to 4.28; Black vs White patients: aOR 0.76, 95% CI 0.44 to 1.33, p=0.20). CONCLUSIONS EBP prescriptions, especially pioglitazone, are low in patients with T2D and MASH, regardless of race/ethnicity. These data underscore the need for interventions to close the gap between current and evidence-based care.
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Affiliation(s)
- Anastasia-Stefania Alexopoulos
- Department of Medicine, Division of Endocrinology, Duke University, Durham, North Carolina, USA
- Center of Innovation to Accelerate Discover and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, North Carolina, USA
- Department of Medicine, Division of Endocrinology, Durham VA Medical Center, Durham, North Carolina, USA
| | - Alice Parish
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Maren Olsen
- Center of Innovation to Accelerate Discover and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Bryan C Batch
- Department of Medicine, Division of Endocrinology, Duke University, Durham, North Carolina, USA
- Department of Medicine, Division of Endocrinology, Durham VA Medical Center, Durham, North Carolina, USA
| | - Cynthia Moylan
- Department of Medicine, Division of Gastroenterology, Duke University, Durham, North Carolina, USA
| | - Matthew J Crowley
- Department of Medicine, Division of Endocrinology, Duke University, Durham, North Carolina, USA
- Center of Innovation to Accelerate Discover and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, North Carolina, USA
- Department of Medicine, Division of Endocrinology, Durham VA Medical Center, Durham, North Carolina, USA
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Park H, Choi JE, Jun S, Lee H, Kim HS, Lee HA, Park H. Metabolic complications of obesity in children and adolescents. Clin Exp Pediatr 2023:cep.2023.00892. [PMID: 37986568 DOI: 10.3345/cep.2023.00892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/18/2023] [Indexed: 11/22/2023] Open
Abstract
The global prevalence of childhood and adolescent obesity, exacerbated by the COVID-19 pandemic, is affecting not only school-aged children but also preschoolers. Early-onset obesity, along with a higher risk of metabolic complications, may contribute to a lower age of onset of cardiovascular disease (CVD). As metabolic diseases such as diabetes, dyslipidemia, and non-alcoholic fatty liver disease (NAFLD) observed in adulthood are increasingly recognized in the pediatric population, there is an emphasis on moving disease susceptibility assessment from adulthood to childhood for early detection. Unlike adults, there is a lack of consensus in the definition of metabolic diseases in children. In response to this, various indicators such as pediatric simple metabolic syndrome score (PsiMS), continuous metabolic syndrome score (cMetS), single point insulin sensitivity estimator (SPISE), and fatty liver index (FLI) have been proposed in several studies. These indicators may help explain and early detect metabolic complications associated with pediatric obesity, although more validity studies are needed. Meanwhile, obesity assessment is shifting its perspective from visual obesity to metabolic health and body composition considerations to fill the gap in health impact assessment. Sarcopenic obesity, defined as muscle-to-fat ratio (MFR), has been proposed in pediatric populations and has also been found to be associated with metabolic health in children and adolescents. The National health screening program for children in Korea has expanded but still faces limitations in laboratory testing. These tests facilitate timely intervention by identifying high-risk groups for metabolic complications. Early detection and intervention through comprehensive health screening are critical to mitigate long-term complications of childhood obesity.
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Affiliation(s)
- Hyunjin Park
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
- Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul, Korea
| | - Jung Eun Choi
- Department of Pediatrics, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Seunghee Jun
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
- Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul, Korea
| | - Hyelim Lee
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
- Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul, Korea
| | - Hae Soon Kim
- Department of Pediatrics, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Hye Ah Lee
- Clinical Trial Center, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Hyesook Park
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
- Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul, Korea
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Calin-Necula A, Enciu V, Ologeanu P, Moldoveanu AC, Braticevici CF. The correlation between Body Mass Index and histological features of Nonalcoholic Fatty Liver Disease. Rom J Intern Med 2023; 61:147-153. [PMID: 37148286 DOI: 10.2478/rjim-2023-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Indexed: 05/08/2023]
Abstract
Introduction: NAFLD is strongly associated with metabolic syndrome, and for many years, fatty liver was an exclusive feature of obese patients. The study tries to assess whether the body mass index (BMI) and body circumference is correlated to steatosis, fibrosis, or inflammatory activity of the liver. Methods: 81 patients with recent hepatic biopsy were included in the study and were weighed and measured. The biopsy results were compared to the measurements. Results: The average BMI overall for the whole lot was 30.16. There was a significant difference in BMI across the inflammatory activity categories (p = 0.009): groups with higher necro inflammatory activity tended to have higher BMI values (average values per grade: 0-28, 1-29, 2-33, 3-32, 4-29). There was no significant difference for grades of steatosis (p = 0.871). With regards to waist circumference, the overall average was 90.70cm/35.70in. There was a significant difference across the steatosis categories (p < 0.001): groups with higher steatosis scores had higher waist circumferences (average values per grade: 1-77cm / 30 in, 2-95 cm / 37 in, 3-94 cm / 37 in). There was no significant difference for grades of activity (p = 0.058). Conclusion: BMI and waist circumference are easy to measure, non-invasive parameters, which could be useful in screening patients at higher risk for necro inflammatory activity or severe steatosis.
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Affiliation(s)
- Ana Calin-Necula
- 1Internal Medicine II and Gastroenterology Department, "Carol Davila" University of Medicine and Pharmacy Bucharest
- 2Emergency University Hospital Bucharest
| | - Vlad Enciu
- 1Internal Medicine II and Gastroenterology Department, "Carol Davila" University of Medicine and Pharmacy Bucharest
- 2Emergency University Hospital Bucharest
| | - Priscila Ologeanu
- 1Internal Medicine II and Gastroenterology Department, "Carol Davila" University of Medicine and Pharmacy Bucharest
- 2Emergency University Hospital Bucharest
| | - Alexandru Constantin Moldoveanu
- 1Internal Medicine II and Gastroenterology Department, "Carol Davila" University of Medicine and Pharmacy Bucharest
- 2Emergency University Hospital Bucharest
| | - Carmen Fierbinteanu Braticevici
- 1Internal Medicine II and Gastroenterology Department, "Carol Davila" University of Medicine and Pharmacy Bucharest
- 2Emergency University Hospital Bucharest
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Schwarz C, Chromy D, Bauer D, Duong N, Schmidbauer VU, Schwarz M, Mandorfer M, Rieger A, Trauner M, Gschwantler M, Reiberger T. Prevalence and dynamics of NAFLD-associated fibrosis in people living with HIV in Vienna from first presentation to last follow-up. Wien Klin Wochenschr 2023; 135:420-428. [PMID: 36576556 PMCID: PMC10444631 DOI: 10.1007/s00508-022-02133-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/19/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND/AIMS Non-alcoholic fatty liver disease (NAFLD) is frequent in people living with HIV (PLWH) and may be aggravated by metabolic comorbidities and antiretroviral therapy (ART)-associated adverse effects. METHODS We retrospectively assessed epidemiological, clinical and laboratory parameters and ART regimens at HIV diagnosis (BL) and at last follow-up (FU) in 1458 PLWH without viral hepatitis coinfection attending our HIV clinic in 2014-2016. Fibrosis was non-invasively assessed by the NAFLD fibrosis score (NFS). RESULTS The median age of subjects was 37.8 years, 77.4% were male and 67.2% on ART, median CD4+ count was 356.0 cells/µL. At BL, 503 (34.5%) and 20 (1.4%) PLWH had dyslipidemia and diabetes, respectively. According to the NFS 16 (1.3%) showed advanced fibrosis (NFS ≥ 0.676), among which 1 (6.3%) had diabetes, 7 (43.8%) had dyslipidemia, and 5 (31.3%) were on HIV-protease inhibitors (PI). In addition, 191(15.1%) had intermediate NFS results, while fibrosis was ruled out (NFS ≤ 1.455) in 1065 (83.7%) PLWH. After a median follow-up of 6.3 years, 590 (42.8%) had dyslipidemia and 61 (4.4%) had diabetes. Also, 21 (1.6%) showed advanced fibrosis, of which 10 (47.6%) had diabetes, 4 (19.0%) had dyslipidemia, and 9 (42.9%) were on PI-based ART, 223 (17.4%) had intermediate NFS results, while 1039 (81.0%) showed no fibrosis. CONCLUSION During FU, advanced NAFLD fibrosis occurred in 1.3-1.6% of PLWH. Dyslipidemia, diabetes, and PI-based ART were associated with advanced NAFLD fibrosis. Prospective investigations of NAFLD severity and risk factors in PLWH are warranted.
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Affiliation(s)
- Caroline Schwarz
- Division of Gastroenterology & Hepatology, Department of Medicine III, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, Red Tower, Gastro-Office 7i, 1090, Vienna, Austria
- Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
- Department of Internal Medicine IV, Klinik Ottakring, Vienna, Austria
| | - David Chromy
- Division of Gastroenterology & Hepatology, Department of Medicine III, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, Red Tower, Gastro-Office 7i, 1090, Vienna, Austria
- Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - David Bauer
- Division of Gastroenterology & Hepatology, Department of Medicine III, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, Red Tower, Gastro-Office 7i, 1090, Vienna, Austria
- Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
- Department of Internal Medicine IV, Klinik Ottakring, Vienna, Austria
| | - Nikki Duong
- Department of Gastroenterology and Hepatology, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Victor Ulrich Schmidbauer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Michael Schwarz
- Division of Gastroenterology & Hepatology, Department of Medicine III, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, Red Tower, Gastro-Office 7i, 1090, Vienna, Austria
- Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
- Department of Internal Medicine IV, Klinik Ottakring, Vienna, Austria
| | - Mattias Mandorfer
- Division of Gastroenterology & Hepatology, Department of Medicine III, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, Red Tower, Gastro-Office 7i, 1090, Vienna, Austria
- Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
- Rare Liver Disease (RALID) Center of the ERN RARE-LIVER, Medical University of Vienna, Vienna, Austria
| | - Armin Rieger
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Michael Trauner
- Division of Gastroenterology & Hepatology, Department of Medicine III, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, Red Tower, Gastro-Office 7i, 1090, Vienna, Austria
- Rare Liver Disease (RALID) Center of the ERN RARE-LIVER, Medical University of Vienna, Vienna, Austria
| | - Michael Gschwantler
- Department of Internal Medicine IV, Klinik Ottakring, Vienna, Austria
- Sigmund Freud University, Vienna, Austria
| | - Thomas Reiberger
- Division of Gastroenterology & Hepatology, Department of Medicine III, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, Red Tower, Gastro-Office 7i, 1090, Vienna, Austria.
- Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria.
- Rare Liver Disease (RALID) Center of the ERN RARE-LIVER, Medical University of Vienna, Vienna, Austria.
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Gracen L, Muthukumara W, Aikebuse M, Russell A, O'Beirne J, Irvine KM, Williams S, Puri G, Valery PC, Hayward KL, Powell EE. Lower prevalence of elevated liver stiffness measurements in people with type 2 diabetes taking sodium-glucose co-transporter 2 inhibitors or glucagon-like peptide-1 receptor agonists. Ann Hepatol 2023:101142. [PMID: 37468097 DOI: 10.1016/j.aohep.2023.101142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/08/2023] [Accepted: 07/13/2023] [Indexed: 07/21/2023]
Abstract
INTRODUCTION AND OBJECTIVES Among people with type 2 diabetes (T2D), non-alcoholic fatty liver disease (NAFLD) is very common and has an increased risk of clinically significant liver disease. The use of sodium-glucose co-transporter 2 (SGLT2i) inhibitors and glucagon-like peptide-1 (GLP-1a) receptor agonists is endorsed to reduce major cardiovascular events and/or progression of chronic kidney disease. Their prevalence of use in people with T2D and co-existent NAFLD remains unclear. We sought to determine the prevalence of use of these medications at two different time periods, and their association with prevalence of clinically significant liver disease. MATERIALS AND METHODS Consecutive people with type 2 diabetes (T2D) and non-alcoholic fatty liver disease (NAFLD) were recruited from diabetes clinics between Jun-2021 and Jun-2022 ('current' cohort). Liver stiffness measurements (LSM) using FibroScan were performed. Medication data were collected prospectively at recruitment and verified with the dispensing pharmacy or general practitioner medical records. Data for a historical cohort with NAFLD and T2D recruited from the same clinics during 2015-2017 ('historical' cohort) were available. Logistic regression was used to evaluate factors associated with LSM <8.0 or ≥8 kPa (clinically significant fibrosis). RESULTS There were 292 participants, 177 in the historical cohort and 115 in the current cohort. In the current cohort, 57.4% of patients with T2D and NAFLD were taking a GLP-1a and 42.6% were taking a SGLT2i; a 2.6 to 3.4-fold higher prevalence than in 2015-2017. A lower proportion of the current cohort (23.9% compared to 38.4%) had clinically significant fibrosis (LSM ≥8 kPa; p=0.012). When the cohorts were pooled and differences adjusted for in multivariable logistic regression analysis, patients taking a GLP-1a or a SGLT2i were 2 times more likely to have a lower LSM (<8 kPa) compared to patients not taking these drugs (OR=2.05, 95%CI 1.07-3.94, p=0.03 and OR 2.07 95%CI 1.04-4.11, p=0.04, respectively). CONCLUSIONS The observation of a lower LSM in people taking SGLT2i and/or GLP-1a following adjustment for other relevant clinico-demographic variables provides support for clinical trials to assess their efficacy in reducing the progression of NAFLD.
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Affiliation(s)
- Lucy Gracen
- Centre for Liver Disease Research, Faculty of Medicine, Translational Research Institute, The University of Queensland, Brisbane, 4102, Australia; Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, 4102, Australia
| | - Withma Muthukumara
- Centre for Liver Disease Research, Faculty of Medicine, Translational Research Institute, The University of Queensland, Brisbane, 4102, Australia; Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, 4102, Australia
| | - Melanie Aikebuse
- Centre for Liver Disease Research, Faculty of Medicine, Translational Research Institute, The University of Queensland, Brisbane, 4102, Australia; Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, 4102, Australia
| | - Anthony Russell
- Department of Endocrinology and Diabetes, The Alfred Hospital, Melbourne, 3004, Australia; Faculty of Medicine, Monash University, Melbourne, 3800, Australia; Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, 4102, Australia
| | - James O'Beirne
- Department of Gastroenterology and Hepatology, Sunshine Coast University Hospital, Sunshine Coast, 4560, Australia
| | - Katharine M Irvine
- Mater Research, Translational Research Institute, Brisbane, 4102, Australia
| | | | - Gaurav Puri
- Department of Endocrinology and Diabetes, Logan hospital, Brisbane, 4131, Australia; HIU Clinical Excellence Queensland, Brisbane, 4131, Australia
| | - Patricia C Valery
- Centre for Liver Disease Research, Faculty of Medicine, Translational Research Institute, The University of Queensland, Brisbane, 4102, Australia; QIMR Berghofer Medical Research Institute, Brisbane, 4006, Australia
| | - Kelly L Hayward
- Centre for Liver Disease Research, Faculty of Medicine, Translational Research Institute, The University of Queensland, Brisbane, 4102, Australia; Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, 4102, Australia
| | - Elizabeth E Powell
- Centre for Liver Disease Research, Faculty of Medicine, Translational Research Institute, The University of Queensland, Brisbane, 4102, Australia; Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, 4102, Australia; QIMR Berghofer Medical Research Institute, Brisbane, 4006, Australia.
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Sim KC, Kim MJ, Cho Y, Kim HJ, Park BJ, Sung DJ, Han NY, Han YE, Kim TH, Lee YJ. Radiomics Analysis of Magnetic Resonance Proton Density Fat Fraction for the Diagnosis of Hepatic Steatosis in Patients With Suspected Non-Alcoholic Fatty Liver Disease. J Korean Med Sci 2022; 37:e339. [PMID: 36536543 PMCID: PMC9763710 DOI: 10.3346/jkms.2022.37.e339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/23/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This study aimed to assess the diagnostic feasibility of radiomics analysis based on magnetic resonance (MR)-proton density fat fraction (PDFF) for grading hepatic steatosis in patients with suspected non-alcoholic fatty liver disease (NAFLD). METHODS This retrospective study included 106 patients with suspected NAFLD who underwent a hepatic parenchymal biopsy. MR-PDFF and MR spectroscopy were performed on all patients using a 3.0-T scanner. Following whole-volume segmentation of the MR-PDFF images, 833 radiomic features were analyzed using a commercial program. Radiologic features were analyzed, including median and mean values of the multiple regions of interest and variable clinical features. A random forest regressor was used to extract the important radiomic, radiologic, and clinical features. The model was trained using 20 repeated 10-fold cross-validations to classify the NAFLD steatosis grade. The area under the receiver operating characteristic curve (AUROC) was evaluated using a classifier to diagnose steatosis grades. RESULTS The levels of pathological hepatic steatosis were classified as low-grade steatosis (grade, 0-1; n = 82) and high-grade steatosis (grade, 2-3; n = 24). Fifteen important features were extracted from the radiomic analysis, with the three most important being wavelet-LLL neighboring gray tone difference matrix coarseness, original first-order mean, and 90th percentile. The MR spectroscopy mean value was extracted as a more important feature than the MR-PDFF mean or median in radiologic measures. Alanine aminotransferase has been identified as the most important clinical feature. The AUROC of the classifier using radiomics was comparable to that of radiologic measures (0.94 ± 0.09 and 0.96 ± 0.08, respectively). CONCLUSION MR-PDFF-derived radiomics may provide a comparable alternative for grading hepatic steatosis in patients with suspected NAFLD.
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Affiliation(s)
- Ki Choon Sim
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Min Ju Kim
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
| | - Yongwon Cho
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
- AI Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hyun Jin Kim
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Beom Jin Park
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Deuk Jae Sung
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Na Yeon Han
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yeo Eun Han
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Tae Hyung Kim
- Department of Gastroenterology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Yoo Jin Lee
- Department of Pathology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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Klaebel JH, Lykkesfeldt J, Tveden-Nyborg P. Efficacy of Fibroblast Growth Factor 21 in non-alcoholic fatty liver disease in guinea pigs. Basic Clin Pharmacol Toxicol 2022; 130:385-393. [PMID: 35014168 DOI: 10.1111/bcpt.13705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 11/28/2022]
Abstract
Fibroblast Growth Factor 21 (FGF21) agonists have shown promising effects in preclinical models of non-alcoholic fatty liver disease (NAFLD) as well as in short-term clinical trials in patients with non-alcoholic steatohepatitis (NASH). Comparing drug formulation, dose, administration route and age, this exploratory study investigated effects of FGF21 on NAFLD-associated measures in a validated guinea pig model. In three separate studies, female guinea pigs received a high-fat diet prior to intervention with escalating doses of either recombinant native human FGF21 or a human FGF21 human recombinant analogue (FGF21/19 chimer) with an extended half-life. While no significant effects of native FGF21 on the investigated endpoints were observed, the long-acting FGF21/19 chimer significantly altered the levels of circulating lipids, increasing plasma concentrations of cholesterol (TC, LDLc and HDLc) in young guinea pigs (p<0.01 for all three parameters). Relative liver weights were reduced in FGF21/19-treated young animals (p<0.05) compared to mature animals, whereas FGF21/19 reduced body weights in both age groups (p<0.001). The FGF21/19 chimer effects on dyslipidemia, body and liver weights particularly in young animals, support an age-associated difference in the FGF21 response. The limited effects of the native human FGF21 highlights potential species-associated differences of this compound.
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Affiliation(s)
- Julie Hviid Klaebel
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - Jens Lykkesfeldt
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - Pernille Tveden-Nyborg
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg C, Denmark
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García-López NA, Jiménez-Álvarez A, Murillo-Zamora E. [Detecting non-alcoholic fatty liver in children with owerweight and obesity.]. Rev Med Inst Mex Seguro Soc 2021; 59:465-472. [PMID: 34905320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/29/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) has serious health implications and upward trends of the disease, accompanied by the obesity epidemic worldwide. OBJECTIVE To screen for fatty liver in overweight and obese children and evaluate the factors associated with an increased likelihood of presenting a positive-screen result. MATERIAL AND METHODS In a cross-sectional study, 102 children were recruited at a secondary care medical unit. Serum alanine aminotransferase (ALT) levels were quantified and hepatic ultrasounds were performed; multiple logistic regression models were used to evaluate factors associated with the increased odds of presenting with NAFLD (fatty infiltration on ultrasound and ALT > 52 U/L for boys and > 44 U/L for girls). RESULTS The overall prevalence of NAFLD was 10.8%. In multivariate analysis, a waist-to-hip ratio ≥ 1 was associated with increased odds of screening positive for NAFLD (odds ratio (OR) = 4.96, 95% CI 1.17-20.90). CONCLUSIONS Our findings indicate that one out of ten children with overweight or obesity has data suggestive of NAFLD and is at risk of presenting its consequences on health.
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Affiliation(s)
- Nallely A García-López
- 1Instituto Mexicano del Seguro Social, Centro Médico Nacional Sigo XXI, Hospital de Oncología, Programa de Especialidad Médica en Cuidados Paliativos. Ciudad de México, México
| | - Alicia Jiménez-Álvarez
- Instituto Mexicano del Seguro Social, Hospital General de Zona No. 1, Servicio de Endocrinología Pediátrica. Villa de Álvarez, Colima, México
| | - Efrén Murillo-Zamora
- 3Instituto Mexicano del Seguro Social, Unidad de Medicina Familiar No. 19, Departamento de Epidemiología. Colima, Colima, México
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Yoo HW, Jin HY, Yon DK, Effenberger M, Shin YH, Kim SY, Yang JM, Kim MS, Koyanagi A, Jacob L, Smith L, Yoo IK, Shin JI, Lee SW. Non-alcoholic Fatty Liver Disease and COVID-19 Susceptibility and Outcomes: a Korean Nationwide Cohort. J Korean Med Sci 2021; 36:e291. [PMID: 34697932 PMCID: PMC8546310 DOI: 10.3346/jkms.2021.36.e291] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/05/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Evidence for the association between underlying non-alcoholic fatty liver disease (NAFLD), the risk of testing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive, and the clinical consequences of coronavirus disease 2019 (COVID-19) is controversial and scarce. We aimed to investigate the association between the presence of NAFLD and the risk of SARS-CoV-2 infectivity and COVID-19-related outcomes. METHODS We used the population-based, nationwide cohort in South Korea linked with the general health examination records between January 1, 2018 and July 30, 2020. Data for 212,768 adults older than 20 years who underwent SARS-CoV-2 testing from January 1 to May 30, 2020, were obtained. The presence of NAFLDs was defined using three definitions, namely hepatic steatosis index (HSI), fatty liver index (FLI), and claims-based definition. The outcomes were SARS-CoV-2 test positive, COVID-19 severe illness, and related death. RESULTS Among 74,244 adults who completed the general health examination, there were 2,251 (3.0%) who were SARS-CoV-2 positive, 438 (0.6%) with severe COVID-19 illness, and 45 (0.06%) COVID-19-related deaths. After exposure-driven propensity score matching, patients with pre-existing HSI-NAFLD, FLI-NAFLD, or claims-based NAFLD had an 11-23% increased risk of SARS-CoV-2 infection (HSI-NAFLD 95% confidence interval [CI], 1-28%; FLI-NAFLD 95% CI, 2-27%; and claims-based NAFLD 95% CI, 2-31%) and a 35-41% increased risk of severe COVID-19 illness (HSI-NAFLD 95% CI, 8-83%; FLI-NAFLD 95% CI, 5-71%; and claims-based NAFLD 95% CI, 1-92%). These associations are more evident as liver fibrosis advanced (based on the BARD scoring system). Similar patterns were observed in several sensitivity analyses including the full-unmatched cohort. CONCLUSION Patients with pre-existing NAFLDs have a higher likelihood of testing SARS-CoV-2 positive and severe COVID-19 illness; this association was more evident in patients with NAFLD with advanced fibrosis. Our results suggest that extra attention should be given to the management of patients with NAFLD during the COVID-19 pandemic.
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Affiliation(s)
- Hae Won Yoo
- Division of Gastroenterology and Hepatology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Hyun Young Jin
- Department of Data Science, Sejong University College of Software Convergence, Seoul, Korea
| | - Dong Keon Yon
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
| | - Maria Effenberger
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Austria
| | - Youn Ho Shin
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - So Young Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jee Myung Yang
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Seo Kim
- Genomics and Digital Health, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
- Korea University College of Medicine, Seoul, Korea
| | - Ai Koyanagi
- Catalan Institution for Research and Advanced Studies (ICREA), Pg. Lluis Companys, Barcelona, Spain
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Barcelona, Spain
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - In Kyung Yoo
- Department of Gastroenterology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
| | - Seung Won Lee
- Department of Data Science, Sejong University College of Software Convergence, Seoul, Korea.
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Lee KW, Devaraj NK, Ching SM, Veettil SK, Hoo FK, Deuraseh I, Soo MJ. Effect of SGLT-2 Inhibitors on Non-alcoholic Fatty Liver Disease among Patients with Type 2 Diabetes Mellitus: Systematic Review with Meta-analysis and Trial Sequential Analysis of Randomized Clinical Trials. Oman Med J 2021; 36:e273. [PMID: 34239714 PMCID: PMC8246653 DOI: 10.5001/omj.2021.62] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/06/2020] [Indexed: 12/14/2022] Open
Abstract
Objectives Non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH) is a common problem associated with obesity and type 2 diabetes mellitus (T2DM). There have been anecdotal reports of the efficacy of sodium-glucose cotransporter 2 inhibitors (SGLT2Is) in improving liver function parameters in those with concomitant T2DM and NAFLD/NASH. We sought to systematically evaluate the evidence of SGLT2Is in improving liver function parameters in T2DM patients with NAFLD, considering the risks of random error based on trial sequential analysis (TSA). We also performed a meta-analysis based on a random-effects model. Methods A systematic literature search was performed using the Medline, Cochrane, and Embase databases from inception to 20 October 2018. Primary outcome for meta-analyses was the changes in hepatic enzyme levels (alanine transaminase, aspartate transaminase, and gamma-glutamyl transpeptidase). We also performed a meta-analysis on changes in insulin resistance, glycemic, and lipid parameters using SGLT2Is as a secondary objective. Results Eight eligible randomized controlled studies were eligible for analysis. Meta-analysis showed the efficacy of two SLT2Is, dapagliflozin, and canagliflozin in reducing these enzymes level. TSA showed that canagliflozin significantly reduced the gamma-glutamyl transpeptidase level by weighted mean difference (-5.474, 95% confidence interval (CI): -6.289??-4.659) compared to others comparators, and the evidence is conclusive. Dapagliflozin also had a statistically significant reduction in glycated hemoglobin, which is a parameter of glycemic control and homeostatic model assessment for insulin sensitivity (HOMA-IR), which is a parameter of insulin sensitivity by a weight mean difference, -0.732 (95% CI: -1.087??-0.378) and -0.804 (95% CI: -1.336??0.272), respectively. Conclusions This study indicated that canagliflozin effectively improves liver function parameters among patients with diabetes, while dapagliflozin is more effective in improving glycemic indices and insulin sensitivity.
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Affiliation(s)
- Kai Wei Lee
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Navin Kumar Devaraj
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia.,Malaysian Research Institute on Ageing (MyAgeing), Universiti Putra Malaysia, Selangor, Malaysia
| | - Siew Mooi Ching
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia.,Malaysian Research Institute on Ageing (MyAgeing), Universiti Putra Malaysia, Selangor, Malaysia
| | - Sajesh K Veettil
- School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
| | - Fan Kee Hoo
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Inas Deuraseh
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Man Jun Soo
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
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Choi SY, Yi DY, Kim SC, Kang B, Choe BH, Lee Y, Lee YM, Lee EH, Jang HJ, Choi YJ, Kim HJ. Severe Phenotype of Non-alcoholic Fatty Liver Disease in Pediatric Patients with Subclinical Hypothyroidism: a Retrospective Multicenter Study from Korea. J Korean Med Sci 2021; 36:e137. [PMID: 34032030 PMCID: PMC8144595 DOI: 10.3346/jkms.2021.36.e137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/12/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND It is uncertain whether non-alcoholic fatty liver disease (NAFLD) is associated with subclinical hypothyroidism (SH) in pediatric patients. The purpose of this study was to investigated the prevalence and related factors of SH in pediatric patients with NAFLD. We also evaluate the association between liver fibrosis and SH. METHODS We retrospectively reviewed medical records for patients aged 4 to 18 years who were diagnosed with NAFLD and tested for thyroid function from January 2015 to December 2019 at 10 hospitals in Korea. RESULTS The study included 428 patients with NAFLD. The prevalence of SH in pediatric NAFLD patients was 13.6%. In multivariate logistic regression, higher levels of steatosis on ultrasound and higher aspartate aminotransferase to platelet count ratio index (APRI) score were associated with increased risk of SH. Using receiver operating characteristic curves, the optimal cutoff value of the APRI score for predicting SH was 0.6012 (area under the curve, 0.67; P < 0.001; sensitivity 72.4%, specificity 61.9%, positive predictive value 23%, and negative predictive value 93.5%). CONCLUSION SH was often observed in patients with NAFLD, more frequently in patients with more severe liver damage. Thyroid function tests should be performed on pediatric NAFLD patients, especially those with higher grades of liver steatosis and fibrosis.
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Affiliation(s)
- So Yoon Choi
- Department of Pediatrics, Kosin Gospel Hospital, Kosin University College of Medicine, Busan, Korea
- Department of Pediatrics, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Dae Yong Yi
- Department of Pediatrics, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Soon Chul Kim
- Department of Pediatrics, Jeonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Ben Kang
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Byung Ho Choe
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Yoon Lee
- Department of Pediatrics, Korea University Anam Hospital, Seoul, Korea
| | - Yoo Min Lee
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Eun Hye Lee
- Department of Pediatrics, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Hyo Jeong Jang
- Department of Pediatrics, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - You Jin Choi
- Department of Pediatrics, Inje University, Ilsan Paik Hospital, Inje University College of Medicine, Korea
| | - Hyun Jin Kim
- Department of Pediatrics, Chungnam National University Hospital, Daejeon, Korea.
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Jalali M, Rahimlou M, Mahmoodi M, Moosavian SP, Symonds ME, Jalali R, Zare M, Imanieh MH, Stasi C. The effects of metformin administration on liver enzymes and body composition in non-diabetic patients with non-alcoholic fatty liver disease and/or non-alcoholic steatohepatitis: An up-to date systematic review and meta-analysis of randomized controlled trials. Pharmacol Res 2020; 159:104799. [PMID: 32278041 DOI: 10.1016/j.phrs.2020.104799] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/15/2020] [Accepted: 04/05/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide. One treatment is the use of metformin but its efficacy remains to be established. OBJECTIVE The present systematic review and meta-analysis aimed to provide a more robust examination of the evidence for the effectiveness of metformin for treating non-diabetic NAFLD patients. METHODS An extensive literature search was undertaken using online databases (PubMed, Embase, Scopus, Web of Science and Cochrane Library) to detect randomized controlled trials (RCTs) investigating the effect of metformin administration on liver enzymes and body composition in non-diabetic NAFLD patients up to 10 December 2019. A random-effects or fixed-effect models were performed to pool weighted mean difference (WMD) and 95% confidence intervals (CI). RESULTS Six RCTs involving 307 individuals were included to the present meta-analysis. Compared to controls, metformin significantly reduced body mass index (BMI) (WMD: -0.77 kg/m2, 95 % CI = [-1.46, -0.07], P = 0.03, I2 = 0.0 %) and serum aspartate aminotransferase (AST) (WMD: -5.94 U/L, 95 % CI = [-11.51, -0.38], P = 0.03, I2 = 67.6 %). Also, body weight (WMD: -2.70 kg, 95 % CI = [-5.49, 0.09], P = 0.05, I2 = 33.7%) was marginally significant and serum alanine transaminase (ALT) (WMD: -5.04 U/L, 95 % CI = [-13.92, 3.84], P = 0.26, I2 = 60.9 %) was not statistically significant affected by metformin administration. There was no evidence of publication bias. CONCLUSION In summary, the present study emphasizes the clinical importance of metformin administration for improving liver function and body composition in non-diabetic NAFLD patients. Moreover, the further large-scale and well-designed RCTs are required to confirm these findings.
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Affiliation(s)
- Mohammad Jalali
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran; Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehran Rahimlou
- Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Marzieh Mahmoodi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyedeh Parisa Moosavian
- Department of Clinical Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Michael E Symonds
- The Early Life Research Unit, Academic Division of Child Health, Obstetrics and Gynaecology, and Nottingham Digestive Disease Centre and Biomedical Research Centre, The School of Medicine, The University of Nottingham, Nottingham, NG7 2UH, United Kingdom
| | - Ronak Jalali
- Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran
| | - Morteza Zare
- Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hadi Imanieh
- Gastroenterology and Hepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Cristina Stasi
- Interdepartmental Hepatology Center MASVE, Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy.
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Langroudi TF, Haybar H, Parsa SA, Mahjoorian M, Khaheshi I, Naderian M. The severity of coronary artery disease was not associated with non-alcoholic fatty liver disease in a series of 264 non-diabetic patients who underwent coronary angiography. ACTA ACUST UNITED AC 2018; 56:167-72. [PMID: 29561732 DOI: 10.2478/rjim-2018-0009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND It is now suggested an association between non-alcoholic fatty liver disease (NAFLD) and the occurrence of coronary artery disease even in non-diabetic patients. We will determine the rate of NAFLD and its main determinants in non-diabetic patients undergoing coronary angiography. METHODS This cross-sectional study was accomplished on 264 patients who were candidates for coronary angiography during the year 2016. Coronary angiography has been done to depict the presence or absence of coronary involvement, and the severity of coronary artery disease by determining the number of vessels involved and also the SYNTAX score. During 48 hours after coronary angiography, the patients underwent abdominal ultrasonography for detection of NAFLD. RESULTS The overall prevalence of NAFLD in the patients was 72.3%. The prevalence of NAFLD in those with and without coronary involvement was 71.9% and 73.1% respectively, with no notable difference (p = 0.837). The mean SYNTAX score in the patients with and without NAFLD was 22.32 ± 11.10 and 21.75 ± 10.71 respectively with no difference (p = 0.702). According to the multivariable regression models, the presence of NAFLD could not predict the likelihood of coronary artery disease (OR = 0.879, p = 0.669) or its severity assessed by the SYNTAX score (beta = 0.046, p = 0.456). NAFLD grade was also not a determinant for coronary artery disease (OR = 1.139, p = 0.178) or its severity (beta = 0.058, p = 0.165). CONCLUSION It seems that the presence and grade of NAFLD may not be correlated with atherosclerotic involvement of coronary arteries and its severity in non-diabetic patients. Future large studies and trials could elucidate the independent role of fatty liver in nondiabetic non-alcoholic patients.
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Lad A, Su RC, Breidenbach JD, Stemmer PM, Carruthers NJ, Sanchez NK, Khalaf FK, Zhang S, Kleinhenz AL, Dube P, Mohammed CJ, Westrick JA, Crawford EL, Palagama D, Baliu-Rodriguez D, Isailovic D, Levison B, Modyanov N, Gohara AF, Malhotra D, Haller ST, Kennedy DJ. Chronic Low Dose Oral Exposure to Microcystin-LR Exacerbates Hepatic Injury in a Murine Model of Non-Alcoholic Fatty Liver Disease. Toxins (Basel) 2019; 11:E486. [PMID: 31450746 DOI: 10.3390/toxins11090486] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/15/2019] [Accepted: 08/19/2019] [Indexed: 12/17/2022] Open
Abstract
Microcystins are potent hepatotoxins that have become a global health concern in recent years. Their actions in at-risk populations with pre-existing liver disease is unknown. We tested the hypothesis that the No Observed Adverse Effect Level (NOAEL) of Microcystin-LR (MC-LR) established in healthy mice would cause exacerbation of hepatic injury in a murine model (Leprdb/J) of Non-alcoholic Fatty Liver Disease (NAFLD). Ten-week-old male Leprdb/J mice were gavaged with 50 μg/kg, 100 μg/kg MC-LR or vehicle every 48 h for 4 weeks (n = 15–17 mice/group). Early mortality was observed in both the 50 μg/kg (1/17, 6%), and 100 μg/kg (3/17, 18%) MC-LR exposed mice. MC-LR exposure resulted in significant increases in circulating alkaline phosphatase levels, and histopathological markers of hepatic injury as well as significant upregulation of genes associated with hepatotoxicity, necrosis, nongenotoxic hepatocarcinogenicity and oxidative stress response. In addition, we observed exposure dependent changes in protein phosphorylation sites in pathways involved in inflammation, immune function, and response to oxidative stress. These results demonstrate that exposure to MC-LR at levels that are below the NOAEL established in healthy animals results in significant exacerbation of hepatic injury that is accompanied by genetic and phosphoproteomic dysregulation in key signaling pathways in the livers of NAFLD mice.
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White CM, Lee JY. The impact of turmeric or its curcumin extract on nonalcoholic fatty liver disease: a systematic review of clinical trials. Pharm Pract (Granada) 2019; 17:1350. [PMID: 31015871 PMCID: PMC6463416 DOI: 10.18549/pharmpract.2019.1.1350] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 01/20/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Turmeric and its curcumin extract have been evaluated in patients with nonalcoholic fatty liver disease (NAFLD), a common ailment that can lead to irreparable liver damage. Objective: To identify the evidence supporting the use of turmeric or curcumin therapy in NAFLD. Methods: We searched PubMed, EMBASE, and Cochrane Central from the earliest possible date to 12/17/18 including terms for turmeric, curcumin, and NAFLD. We assessed the impact of turmeric or its curcumin extract on alanine transaminase (ALT), aspartate transaminase (AST), and NAFLD severity via ultrasound. Results: Five trials assessed the comparative efficacy of curcumin/turmeric in NAFLD. One trial was single armed with comparisons only versus baseline and another trial was only available in abstract form. All of the trials had small sample sizes, 4 of 5 trials had limited durations of follow-up, and all trials had methodological limitations that negatively impacted the strength and applicability of evidence. Clinical and methodological heterogeneity precluded statistical pooling. Three of the 4 trials with evaluable data for turmeric or curcumin versus their own baseline demonstrated significant reductions in ALT, AST, and NAFLD severity grade. Two of the 4 placebo controlled trials had significant mean difference reductions in ALT and AST for turmeric or curcumin versus placebo while 2 of 3 of these trials found significant reductions in NAFLD severity grade. Among these trials, only one used turmeric instead of a curcumin extract and this turmeric trial did not demonstrate any differences in ALT, AST, or NAFLD severity between the turmeric and placebo groups. Conclusions: Curcumin extract is a promising, but not proven, treatment for NAFLD while the role for turmeric is less clear. The general findings are that ALT, AST and NAFLD severity are reduced with the use of curcumin.
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Affiliation(s)
- C Michael White
- UConn/Hartford Hospital HOPES Research Group; and Department of Pharmacy Practice, University of Connecticut. Storrs, CT (United States).
| | - Ji-Young Lee
- Departments of Nutritional Sciences, University of Connecticut. Storrs, CT (United States).
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Abstract
BACKGROUND The prevalence of metabolic syndrome (MS) and non-alcoholic fatty liver disease (NAFLD) and their associated risk factors are not well-established in young children with obesity. The purpose of this study was to evaluate the prevalence of early onset NAFLD and identify its biochemical predictors in obese children aged less than 10 years. METHODS Anthropometric measurements, blood pressure, laboratory tests, and abdominal ultrasonography (USG) were performed in all subjects. National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) criteria for MS diagnosis and liver enzymes and USG for NAFLD diagnosis were assessed. RESULTS A total of 356 children with obesity (233 boys, 123 girls) were included, with 172 children age ≤ 10 years and 184 adolescents. The prevalence of MS was 23.3% in young children and 35.3% in adolescents (P = 0.020); while the prevalence of NAFLD was 36.0% and 70.7%, respectively (P = 0.001). In obese children aged 10 years or less, there were significant differences in levels of serum γ-glutamyltranspeptidase (γGT) (P < 0.001), triglycerides (P = 0.042), and homeostatic model assessment of insulin resistance (P < 0.001) between the non-NAFLD and the NAFLD group. Multivariate logistic regression analysis revealed significant increase in serum γGT and uric acid levels in young children. CONCLUSION Although MS and NAFLD were more prevalent in adolescents, young children also demonstrated MS and NAFLD as obesity-related complications. Elevated serum γGT and uric acid levels may serve as biochemical predictors in detecting NAFLD in young children with obesity before investigation with abdominal USG.
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Affiliation(s)
- Ju Young Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jinmin Cho
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye Ran Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
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Modares Mousavi SR, Geramizadeh B, Anushiravani A, Ejtehadi F, Anbardar MH, Moini M. Correlation between Serum Ferritin Level and Histopathological Disease Severity in Non-alcoholic Fatty Liver Disease. Middle East J Dig Dis 2018; 10:90-95. [PMID: 30013757 PMCID: PMC6040928 DOI: 10.15171/mejdd.2018.96] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 03/09/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease worldwide. Recently several parameters, such as serum ferritin, have emerged as possible predictors for the severity of NAFLD and insulin sensitivity. We aimed to investigate the value of serum ferritin level as a useful biomarker for the prediction of histopathological disease severity in non-alcoholic steatohepatitis (NASH), the necro-inflammatory form of NAFLD. METHODS This was a prospective cross sectional study in which demographic, clinical, histological, laboratory, and anthropometric data of 30 adult patients with biopsy-proven NAFLD/NASH were analyzed. RESULTS In our patients population with mean age of 37.9 years and mean BMI of 26.5, statistical analysis did not show a significant difference between the three grades of steatosis in the mean ferritin levels (p = 0.559). It was also observed that ferritin level did not have a significant correlation with the stage of fibrosis (p = 0.228). The mean transferrin saturation did not show significant difference in different stages and grades of NASH (p = 0.260 and 0.944, respectively), either. CONCLUSION Serum ferritin level may not be useful as a single marker for the prediction of histopathological severity of disease in young patients with NASH who are not morbidly obese.
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Affiliation(s)
- Seyed Reza Modares Mousavi
- Division of Gastroenterology, Department of Internal Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahwaz, Iran
| | - Bita Geramizadeh
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Anushiravani
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fardad Ejtehadi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Maryam Moini
- Non-communicable Disease Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Beigy M. Comments on "Rural Residency has a Protective Effect and Marriage is a Risk Factor for NAFLD". Hepat Mon 2016; 16:e40244. [PMID: 27822267 PMCID: PMC5088733 DOI: 10.5812/hepatmon.40244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 07/16/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Maani Beigy
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
- Students’ Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Maani Beigy, Students’ Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2188989161, Fax: +98-2188989161, E-mail:
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Liu Y, Lu LL, Yuan DX, Geng N, Xuan SY, Xin YN. AGTR1 rs3772622 gene polymorphism increase the risk of nonalcoholic fatty liver disease patients suffer coronary artery disease in Northern Chinese Han population. Lipids Health Dis 2016; 15:113. [PMID: 27342049 PMCID: PMC4919839 DOI: 10.1186/s12944-016-0279-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 06/15/2016] [Indexed: 12/19/2022] Open
Abstract
Background Cardiovascular disease (CAD) responsible and nonalcoholic fatty liver disease (NAFLD) are both metabolic diseases, and they are mostly influenced by genetic factors. The aim of our study is to evaluate the relationship between angiotensin II type-1 receptor (AGTR1) gene rs3772622 polymorphisms and the risk of developing coronary artery disease (CAD) in Chinese patients with NAFLD. Methods Genotype for AGTR1 rs3772622 in 574 NAFLD patients with CAD or 589 NAFLD patients without CAD, 332 CAD patients exclude NAFLD and 338 health control subjects were determined by sequencing and polymerase chain reaction analysis. Relevant statistical methods were employed to analyze the genotypes, alleles and the clinical date. Inter-group differences and associations were assessed statistically using t-tests and Chi square and logistic analyses. The relative risk of AGTR1 rs3772622 for NAFLD was estimated by logistic regression analysis. Results No significant difference in genotype and allele frequency of AGTR1 rs3772622 was found between the NAFLD without CAD population and the controls (P > 0.05). However, makeable difference was found when compared the CAD in patients with NAFLD and CAD free NAFLD patients (P < 0.001 OR = 2.09). Similarly, significant difference was found in AGTR1 rs3772622 genotype distribution between the groups of CAD patients and control (P = 0.046 OR = 1.71). Conclusions AGTR1 rs3772622 gene polymorphism was not associated with the risk of NAFLD, but could increase the risk of NAFLD patients suffering from CAD in the Chinese Han population. Deeply mechanisms underlying the association between AGTR1 rs3772622 gene polymorphism and the risk of CAD in NAFLD patients need more research.
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Affiliation(s)
- Yang Liu
- Department of Gastroenterology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China.,Department of Gastroenterology, Qingdao Municipal Hospital, 1 Jiaozhou Road, Qingdao, 266021, China
| | - Lin-Lin Lu
- Digestive Disease Key Laboratory of Qingdao, Qingdao, Shandong Province, China.,Central Laboratories, Qingdao Municipal Hospital, Qingdao, Shandong Province, China
| | - De-Xi Yuan
- Department of Anorecta, Qilu Hospital, of Shandong University, Qingdao, China
| | - Ning Geng
- Department of Gastroenterology, Qingdao Municipal Hospital, 1 Jiaozhou Road, Qingdao, 266021, China
| | - Shi-Ying Xuan
- Department of Gastroenterology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China.,Department of Gastroenterology, Qingdao Municipal Hospital, 1 Jiaozhou Road, Qingdao, 266021, China.,Digestive Disease Key Laboratory of Qingdao, Qingdao, Shandong Province, China
| | - Yong-Ning Xin
- Department of Gastroenterology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China. .,Department of Gastroenterology, Qingdao Municipal Hospital, 1 Jiaozhou Road, Qingdao, 266021, China. .,Digestive Disease Key Laboratory of Qingdao, Qingdao, Shandong Province, China.
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Cortez-Pinto H, Borralho P, Machado J, Lopes MT, Gato IV, Santos AM, Guerreiro AS. Microbiota Modulation With Synbiotic Decreases Liver Fibrosis in a High Fat Choline Deficient Diet Mice Model of Non-Alcoholic Steatohepatitis (NASH). GE Port J Gastroenterol 2016; 23:132-141. [PMID: 28868449 PMCID: PMC5580012 DOI: 10.1016/j.jpge.2016.01.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 01/18/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gut microbiota may play a role in non-alcoholic steatohepatitis (NASH). Previous studies showed that prebiotics and probiotics might halt the progression of steatohepatitis. AIM To clarify the potential effect of Synbiotic 2000®Forte (Synb) in preventing or ameliorating diet induced steatohepatitis, particularly in fibrosis progression and how this intervention correlates with gut microbiota composition and endotoxinemia. METHODS Twenty-seven C57BL/6 mice were divided into three groups: chow diet (CD, n = 7); high-fat choline deficient diet (HFCD, n = 10) and HFCD diet supplemented with Synbiotic 2000®Forte (four probiotic strains and four prebiotics mixture) (HFCD + Synb, n = 10). At 6 and 18 weeks, blood samples (lipopolysaccharides assay - LPS), cecal feaces (gut microbiota) and liver tissue (histology) were collected for analysis. RESULTS Both HCFD diet mice developed steatohepatitis with ballooning at 6 and 18 weeks, opposite to CD. Comparison of histological scores in HFCD and HFCD + Synb, at 6 and 18 weeks showed no significant difference regarding steatosis, inflammation, or ballooning. Evaluating fibrosis with Sirius Red, and degree of smooth-muscle cell activation, HFCD mice had significantly more fibrosis; addition of Synb significantly reduced fibrosis at 6 weeks and 18 weeks. Serum endotoxin levels were similarly increased in HFCD and HFCD + Synb at week 6; however at week 18 HFCD + Synb had significantly lower endotoxin levels than HFCD. Gut microbiota of HFCD vs CD, showed no significant differences regarding the phyla Firmicutes and Bacteroidetes, either at 6 or 18 weeks; Proteobacteria increased at 6 week (3.3) and 18 week (7.5), while the addition of Synb resulted in a decrease at week 18 (-3.90). Fusobacteria markedly increase at week 18 (10.0), but less so with the addition of Synb (5.2). CONCLUSION Synbiotic 2000®Forte is able to modulate the mouse gut microbiota reducing the degree of fibrosis while simultaneously decreasing endotoxemia.
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Affiliation(s)
- Helena Cortez-Pinto
- Gastroenterology and Hepatology Department, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.,Nutrition Laboratory, Faculdade de Medicina de Lisboa, Lisbon, Portugal
| | - Paula Borralho
- Pathology Institut, Faculdade de Medicina de Lisboa, Lisbon, Portugal
| | - Jorge Machado
- Infectious Diseases Department, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | - Maria T Lopes
- CEDOC - Chronic Diseases Research Center, NOVA Medical School, Faculdade de Ciências Médicas de Lisboa, Lisbon, Portugal
| | - Inês V Gato
- Infectious Diseases Department, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | - António M Santos
- CEDOC - Chronic Diseases Research Center, NOVA Medical School, Faculdade de Ciências Médicas de Lisboa, Lisbon, Portugal
| | - António S Guerreiro
- CEDOC - Chronic Diseases Research Center, NOVA Medical School, Faculdade de Ciências Médicas de Lisboa, Lisbon, Portugal
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Cheng Y, An B, Jiang M, Xin Y, Xuan S. Association of Tumor Necrosis Factor-alpha Polymorphisms and Risk of Coronary Artery Disease in Patients With Non-alcoholic Fatty Liver Disease. Hepat Mon 2015; 15:e26818. [PMID: 25825591 PMCID: PMC4359363 DOI: 10.5812/hepatmon.26818] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 02/02/2015] [Accepted: 02/14/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cardiovascular events account for the main cause of death in patients with non-alcoholic fatty liver disease (NAFLD), and are largely influenced by genetic factors. Although multiple studies showed that tumor necrosis factor-alpha (TNF-α) polymorphisms are risk factors in the progression of NAFLD, few papers on the association of the polymorphisms and the developing coronary artery disease (CAD) in NAFLD patients have been reported. OBJECTIVES The present study was designed to evaluate the association of TNF-α polymorphisms at residues -238 and -308, with the risk of developing CAD in Chinese patients with NAFLD. PATIENTS AND METHODS The TNF-α polymorphisms at residues 238 and 308 were genotyped in B-type ultrasonography proven NAFLD patients with (n = 246), without (n = 247) CAD and healthy controls (n = 304), using polymerase chain reaction (PCR). Serum lipid profiles were determined using biochemical methods. Statistical analyses were performed using SPSS statistical software, version 20.0 for Mac. RESULTS We found a significant association between TNF-α-238 guanine to alanine (GA) polymorphism and carriers of variant allele A between NAFLD patients with and without CAD (P < 0.05). Carriers of the A allele of TNF-α-238 had higher serum triglycerides (TG) and low density lipoprotein (LDL) levels in NAFLD patients with CAD (P = 0.025 and 0.001, respectively) and a higher TG level in NAFLD patients without CAD (P = 0.017), than their non-carrier counterparts. CONCLUSIONS In the Chinese Han population that we studied, NAFLD patients who carry the TNF-α-238 GA polymorphism have an increased risk of developing CAD. Mechanisms underlying this potentially important association require further investigation.
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Affiliation(s)
- Yuting Cheng
- Department of Gastroenterology, Qingdao Medical College; Nanjing Medical University, Qingdao, China
| | - Baiquan An
- Department of Gastroenterology, Qingdao Medical College; Nanjing Medical University, Qingdao, China
| | - Man Jiang
- Department of Gastroenterology, Qingdao Municipal Hospital, Qingdao Medical College, Nanjing Medical University, Qingdao, China
| | - Yongning Xin
- Department of Gastroenterology, Qingdao Municipal Hospital, Qingdao Medical College, Nanjing Medical University, Qingdao, China
- Corresponding Author: Yongning Xin, Department of Gastroenterology, Qingdao Municipal Hospital, Qingdao 266021, China. Tel:+86-53288905289, Fax: +8653288905293, E-mail:
| | - Shiying Xuan
- Department of Gastroenterology, Qingdao Medical College; Nanjing Medical University, Qingdao, China
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25
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Garjani A, Safaeiyan A, Khoshbaten M. Association between platelet count as a noninvasive marker and ultrasonographic grading in patients with nonalcoholic Fatty liver disease. Hepat Mon 2015; 15:e24449. [PMID: 25741373 PMCID: PMC4344651 DOI: 10.5812/hepatmon.24449] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 11/27/2014] [Accepted: 12/27/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Nonalcoholic fatty liver disease has become a worldwide challenge. Liver biopsy remains the single most reliable approach to determine the severity of this disease. As patients with nonalcoholic fatty liver disease require close follow-up, performing this invasive method repeatedly seems impractical; therefore, designing a noninvasive system to follow up patients has become a common interest. OBJECTIVES We intended to investigate the association between platelet counts of patients with nonalcoholic fatty liver disease and the severity of their disease based on serum levels of liver enzymes and grade of fatty liver on ultrasonography. PATIENTS AND METHODS One thousand, three hundred and five patients with nonalcoholic fatty liver disease were included in this descriptive study. Serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP) and platelet counts of patients were measured. The grade of fatty liver was determined by abdominal ultrasonography. RESULTS Of our study population, 54.3% (n = 708) were women. Patients with mild fatty liver on ultrasonography had lower platelet counts than those with moderate and severe fatty liver. However, no cutoff value of platelet count could reliably distinguish different grades of fatty liver. We found no significant association between platelet counts and serum levels of AST, ALT or ALP. However, we showed that male patients with abnormal levels of ALT had higher platelet counts. CONCLUSIONS Platelet count in nonalcoholic fatty liver disease can serve as a clue to the severity of disease, but it cannot be considered as a sole test to follow up patients.
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Affiliation(s)
- Afagh Garjani
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Abdolrasoul Safaeiyan
- Department of Vital Statistics and Epidemiology, Faculty of Health and Nutrition, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Manouchehr Khoshbaten
- Liver and Gastrointestinal Diseases Research Center, Emam Reza Educational Hospital, Tabriz, IR Iran
- Corresponding Author: Manouchehr Khoshbaten, Liver and Gastrointestinal Diseases Research Center, Emam Reza Educational Hospital, Golgasht St., Tabriz, IR Iran. Tel: +98-4133347554, E-mail:
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Ramezani-Binabaj M, Motalebi M, Karimi-sari H, Rezaee-Zavareh MS, Alavian SM. Are women with polycystic ovarian syndrome at a high risk of non-alcoholic Fatty liver disease; a meta-analysis. Hepat Mon 2014; 14:e23235. [PMID: 25598791 PMCID: PMC4286712 DOI: 10.5812/hepatmon.23235] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
CONTEXT Insulin resistance is a hallmark of metabolic syndrome (MS). It has been proposed that both polycystic ovarian syndrome (PCOS) and nonalcoholic fatty liver disease (NAFLD) are correlated with Insulin resistance. Therefore, PCOS and NAFLD can be attributed with insulin resistance and therefore MS. The aim of this meta-analysis was to determine whether PCOS patients are at a high risk of NAFLD. EVIDENCE ACQUISITION Google scholar, Scopus, ISI Web of Science, Embase, MEDLINE, and some Iranian databases such as scientific information database (SID), IranMedex, and MagIran were searched to identify relevant studies. We included all papers regardless of their language from January 1985 to June 2013. By using data on prevalence of NAFLD in patients with and without PCOS, odds ratio (OR) with 95% confidence intervals (CIs) were calculated in each study. Chi-squared test was used to assess heterogeneity between studies. RESULTS We finally included seven eligible studies. According to chi-squared test, there was a significant heterogeneity (73.6%) between studies (P = 0.001). NAFLD prevalence was significantly higher in patients with PCOS compared to healthy control, with an overall OR of 3.93 (95% CI: 2.17, 7.11).There was no significant publication bias based on Begg's and Egger's tests. CONCLUSIONS According to the results of this meta-analysis, there was a high risk of NAFLD in women with PCOS. We suggest evaluating patients with PCOS regarding NAFLD.
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Affiliation(s)
- Mahdi Ramezani-Binabaj
- Students' Research Committee, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Middle East Liver Diseases Center (MELD), Tehran, IR Iran
| | - Mohsen Motalebi
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Mohsen Motalebi, Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran. Tel/Fax: +98-2181262073, E-mail:
| | - Hamidreza Karimi-sari
- Students' Research Committee, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Saeid Rezaee-Zavareh
- Students' Research Committee, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Middle East Liver Diseases Center (MELD), Tehran, IR Iran
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Cho JY, Chung TH, Lim KM, Park HJ, Jang JM. The impact of weight changes on nonalcoholic Fatty liver disease in adult men with normal weight. Korean J Fam Med 2014; 35:243-50. [PMID: 25309705 PMCID: PMC4192788 DOI: 10.4082/kjfm.2014.35.5.243] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 06/16/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Although it is known that losing weight has an effect on the treatment of non-alcoholic fatty liver disease, the studies that show how losing weight affects the non-alcoholic fatty liver disease for the normal weight male adults are limited so far. In this study, we set body mass index as criteria and investigated how the weight changes for 4 years makes an impact on the risk of non-alcoholic fatty liver disease for the male adults who have the normal body mass index. METHODS From January to December of 2004, among the normal weight male adults who had general check-up at the Health Promotion Center of Ulsan University Hospital, 180 people (average age, 47.4 ± 4.61 years) who were diagnosed with fatty liver through abdominal ultrasonography were included in this study and were observed according to the variety of data and ultrasonography after 4 years (2008). People who had a history of drinking more than 140 g of alcohol per week or who had a past medical history were excluded from the analysis. The weight change of subjects was calculated using the formula 'weight change = weight of 2008 (kg) - weight of 2004 (kg)' and classified into three groups, loss group (≤-3.0 kg), stable group (-2.9 to 2.9 kg), and gain group (≥3.0 kg). The odds for disappearance of non-alcoholic fatty liver disease in those three different groups were compared. RESULTS Among 180 subjects, compared with stable group (67.2%, 121 subjects), loss group (11.7%, 21 subjects) showed 18.37-fold increase in the odds of disappearance of non-alcoholic fatty liver disease (95% confidence interval [CI], 4.34 to 77.80) and gain group (21.1%, 38 subjects) showed 0.28-fold decrease in the odds of disappearance of non-alcoholic fatty liver disease (95% CI, 0.10 to 0.83). CONCLUSION Even for the normal weight people, losing weight has an effect on the improvement of non-alcoholic fatty liver disease.
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Affiliation(s)
- Ji-Young Cho
- Department of Family Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Tae-Heum Chung
- Department of Family Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Kyoung-Mo Lim
- Department of Family Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hee-Jin Park
- Department of Family Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jung-Mi Jang
- Department of Family Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Maleki I, Aminafshari MR, Taghvaei T, Hosseini V, Rafiei A, Torabizadeh Z, Barzin M, Orang E. Serum immunoglobulin A concentration is a reliable biomarker for liver fibrosis in non-alcoholic fatty liver disease. World J Gastroenterol 2014; 20:12566-12573. [PMID: 25253959 PMCID: PMC4168092 DOI: 10.3748/wjg.v20.i35.12566] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 04/20/2014] [Accepted: 06/23/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the diagnostic accuracy of serum Immunoglobulin A (IgA) for differentiating early stage nonalcoholic fatty liver disease (NAFLD) from nonalcoholic steatohepatitis (NASH).
METHODS: All cases had fatty liver change confirmed by ultrasound and aminotransferases of at least twice the normal level. Clinical and biochemical data, including serum IgA, were obtained from 50 histologically proven NAFLD cases and 54 healthy controls. Fasting whole blood samples were obtained from the study population. Immunoturbidimetric methods were used to measure the IgA levels. All NAFLD cases were hospitalized for liver biopsy. Liver specimens were examined for steatosis, steatohepatitis and fibrosis within hepatocytes. Patients were categorized into two groups: NASH and non-NASH. Variables were compared within cases (NASH vs non-NASH) and controls. Cut-off values of serum IgA were evaluated using analysis of receiver operating characteristic (ROC curves). Associations between the variables were tested using calculations of correlation coefficients. Statistical significances were assigned to P values < 0.05.
RESULTS: The extent of liver fibrosis correlated positively with IgA levels. Subjects with no fibrosis in their liver biopsies had a lower IgA level (301.5 ± 91.2 mg/dL) than subjects with any degree of fibrosis (388.8 ± 140.8 mg/dL), (P = 0.01). IgA levels were higher in NASH cases, and its value was significantly higher for higher degrees of fibrosis. Patients with perisinusoidal or pericellular fibrosis had significantly higher levels of IgA (403.5 ± 133.9 mg/dL, 418.2 ± 129.5 mg/dL) compared to those without it (301.8 ± 94.9 mg/dL, 297.7 ± 91.5 mg/dL), respectively. No significant correlation was found between steatosis grade and serum IgA levels. Based on ROC analysis, the best predictive IgA cutoff value for detecting liver fibrosis was 360 mg/dL (61% sensitivity, 81% specificity).
CONCLUSION: The serum IgA level is useful to evaluate the severity of liver fibrosis and can be used serially for evaluation and follow-up of NAFLD cases.
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Moshayedi H, Ahrabi R, Mardani A, Sadigetegad S, Farhudi M. Association between non-alcoholic fatty liver disease and ischemic stroke. Iran J Neurol 2014; 13:144-8. [PMID: 25422733 PMCID: PMC4240931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 04/11/2014] [Indexed: 12/03/2022]
Abstract
BACKGROUND Some studies in recent years showed that carotid intima-media thickness (IMT), indicator of the presence of atherosclerosis, was higher in non-alcoholic fatty liver disease (NAFLD) in comparison with normal subjects. They concluded that NAFLD patients may be resulted in more cardiovascular events. Hence, we aimed to study the association of NAFLD and ischemic stroke. METHODS For this reason, 110 brain magnetic resonance imaging confirmed ischemic stroke patients and 110 patients age and sex matched controls went through liver ultrasound to detect NAFLD and common carotid ultrasound to measure IMT. Demographic and vascular risk factors were detailed for all subjects. RESULTS NAFLD was found in 47 (42.7%) of ischemic stroke patients and 25 (22.7%) of controls. By adjusting sex and age in table 2, odds ratio (OR) for NAFLD was 2.15 (95% confidence interval [CI]: 1.25-3.71) that was statistically significant (P = 0.006). However, after adjusting for other confounding risk factors (waist circumference, hypertension, diabetes mellitus, low-density lipoprotein, triglyceride, alanine aminotransferase, aspartate aminotransferase, creatine, body mass index, cigarette smoking, and ischemic heart disease), the OR decrease to 1.68 (95% CI: 0.42-6.76) that was not statistically significant (P = 0.460). The OR for IMT of right and left common carotid was 1.23 (95% CI: 0.48-3.15) and 1.24 (95% CI: 0.57-2.69), respectively that none of them were statistically significant. CONCLUSION Although the risk of occurrence of ischemic stroke is higher in NAFLD patients, but NAFLD is not associated independently with ischemic stroke.
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Affiliation(s)
- Hanieh Moshayedi
- Department of Neurology, School of Medicine, Tabriz University of Medical Science, Tabriz, Iran
| | - Reza Ahrabi
- Department of Radiology, School of Medicine, Tabriz University of Medical Science, Tabriz, Iran
| | - Afshin Mardani
- Department of Neurology, School of Medicine, Tabriz University of Medical Science, Tabriz, Iran
| | - Saieed Sadigetegad
- Department of Neurology, School of Medicine, Tabriz University of Medical Science, Tabriz, Iran
| | - Mehdi Farhudi
- Department of Neurology, School of Medicine, Neurosciences Research Center, Student Research Committee, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
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Engelmann G, Hoffmann GF, Grulich-Henn J, Teufel U. Alanine aminotransferase elevation in obese infants and children: a marker of early onset non alcoholic Fatty liver disease. Hepat Mon 2014; 14:e14112. [PMID: 24748893 PMCID: PMC3989734 DOI: 10.5812/hepatmon.14112] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 02/21/2014] [Accepted: 02/28/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Elevated aminotransferases serve as surrogate markers of non-alcoholic fatty liver disease, a feature commonly associated with the metabolic syndrome. Studies on the prevalence of fatty liver disease in obese children comprise small patient samples or focus on those patients with liver enzyme elevation. OBJECTIVES We have prospectively analyzed liver enzymes in all overweight and obese children coming to our tertiary care centre. PATIENTS AND METHODS In a prospective study 224 healthy, overweight or obese children aged 1 - 12 years were examined. Body Mass Index-Standard Deviation Score, alanine aminotransferase, aspartate aminotransferase and gamma-glutamyl-transpeptidase were measured. RESULTS Elevated alanine aminotransferase was observed in 29% of children. 26 % of obese and 30 % of overweight children had liver enzyme elevations. Obese children had significantly higher alanine aminotransferase levels than overweight children (0.9 vs. 0.7 times the Upper Limit of Normal; P = 0.04). CONCLUSIONS Elevation of liver enzymes appears in 29 % obese children in a tertiary care centre. Absolute alanine aminotransferase levels are significantly higher in obese than in overweight children. Even obese children with normal liver enzymes show signs of fatty liver disease as demonstrated by liver enzymes at the upper limit of normal.
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Affiliation(s)
- Guido Engelmann
- Department of Pediatrics, Lukas Hospital, Neuss, Germany
- Corresponding Author: Guido Engelmann, Department of Pediatrics, Lukas Hospital, Preussen Str 84, D-41464 Neuss, Germany. Tel: +49-21318883500, Fax: +49-21318883599, E-mail:
| | | | | | - Ulrike Teufel
- Department of Pediatrics, University of Heidelberg, Heidelberg, Germany
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Hashemi Kani A, Alavian SM, Haghighatdoost F, Azadbakht L. Diet macronutrients composition in nonalcoholic Fatty liver disease: a review on the related documents. Hepat Mon 2014; 14:e10939. [PMID: 24693306 PMCID: PMC3950571 DOI: 10.5812/hepatmon.10939] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 06/24/2013] [Accepted: 01/22/2014] [Indexed: 12/11/2022]
Abstract
CONTEXT Non-alcoholic fatty liver disease (NAFLD) is a growing health problem in both developed and developing countries. Metabolic abnormalities, specially insulin resistance and hyperglycemia are highly correlated with NAFLD. Lifestyle modifications including physical activity and promoting nutrient intakes are critical in prevention and treatment of NAFLD. Hence, in this article we aimed to review the evidence regarding the effects of various macronutrients on fat accumulation in hepatic cells as well as the level of liver enzymes. EVIDENCE ACQUISITIONS The relevant English and non-English published papers were searched using online databases of PubMed, ISI Web of Science, SCOPUS, Science Direct and EMBASE from January 2000 to January 2013. We summarized the findings of 40 relevant studies in this review. RESULTS Although a hypocaloric diet could prevent the progression of fat accumulation in liver, the diet composition is another aspect which should be considered in diet therapy of patients with NAFLD. CONCLUSIONS Several studies assessed the effects of dietary composition on fat storage in liver; however, their findings are inconsistent. Most studies focused on the quantity of carbohydrate and dietary fat; whilst there is very limited information regarding the role of protein intake.
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Affiliation(s)
- Ali Hashemi Kani
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | | | - Fahimeh Haghighatdoost
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Leila Azadbakht
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, IR Iran
- Corresponding Author: Leila Azadbakht, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, IR Iran. Tel: +98-3117922719, Fax: +98-3116682509, E-mail:
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Abangah G, Yousefi A, Asadollahi R, Veisani Y, Rahimifar P, Alizadeh S. Correlation of Body Mass Index and Serum Parameters With Ultrasonographic Grade of Fatty Change in Non-alcoholic Fatty Liver Disease. Iran Red Crescent Med J 2014; 16:e12669. [PMID: 24719704 PMCID: PMC3964422 DOI: 10.5812/ircmj.12669] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Revised: 08/31/2013] [Accepted: 06/29/2013] [Indexed: 01/01/2023]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is a common liver disease in the western population and expanding disease in the world. Pathological changes in fatty liver are like alcohol liver damage, which can lead to end-stage liver disease. The prevalence of NAFLD in obese or overweight people is higher than general population, and it seems that people with high Body Mass Index (BMI) or abnormality in some laboratory tests are more susceptible for severe fatty liver and high grade of NAFLD in ultrasonography (U.S). OBJECTIVES This study aimed to evaluate the correlation of BMI and laboratory tests with NAFLD in ultrasonography. MATERIALS AND METHODS During a multi-step process, we selected two-hundred and thirteen cases from four hundred and eighteen patients with NAFLD. Laboratory tests performed included: ALT, AST, FBS, Triglyceride and cholesterol levels, hepatitis B surface antigen, hepatitis C antibody, ceruloplasmin, serum iron, TIBC, transferrin saturation, ferritin, AMA, ANA, ANTI LKM1, serum protein electrophoresis, TSH, anti TTG (IgA). BMI and ultrasonography for 213 patients were performed, and then data was analyzed. These parameters and grades of ultrasonography were compared with the values obtained using one way ANOVA. An ordinal logistic regression model was used to estimate the probability of ultrasonography grade. The Statistical Package for the Social Science program (SPSS, version 16.0) was used for data analysis. RESULTS Two-hundred and thirteen cases including 140 male and 73 female, were studied. In general, 72.3% of patients were overweight and obese. Post-hoc tests showed that only BMI (P < 0.001) and TG (P < 0.011) among variables had statistically significant associations with ultrasonography grade (USG), and ordinal logistic regression model showed that BMI and AST were the best predictors. DISCUSSION Our results suggest that in patients with NAFLD, BMI and TG are most effective factors in severity of fatty liver disease and ultrasonography grade (USG). On the other hand, BMI as a predictor can be helpful. But, AST has not been a reliable finding, because it changes in many conditions.
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Affiliation(s)
- Ghobad Abangah
- Department of Gastroenterology and Hepatology, Ilam University of Medical Sciences, Ilam, IR Iran
| | - Atefeh Yousefi
- Student Research Committee, Ilam University of Medical Sciences, Ilam, IR Iran
| | | | - Yousef Veisani
- Department of Clinical Epidemiology, Ilam University of Medical Sciences, Ilam, IR Iran
| | - Paria Rahimifar
- Student Research Committee, Ilam University of Medical Sciences, Ilam, IR Iran
| | - Sajjad Alizadeh
- Student Research Committee, Ilam University of Medical Sciences, Ilam, IR Iran
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Jamali R, Mofid A, Vahedi H, Farzaneh R, Dowlatshahi S. The effect of helicobacter pylori eradication on liver fat content in subjects with non-alcoholic Fatty liver disease: a randomized open-label clinical trial. Hepat Mon 2013; 13:e14679. [PMID: 24358044 PMCID: PMC3867002 DOI: 10.5812/hepatmon.14679] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 10/18/2013] [Accepted: 11/19/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND The role of Helicobacter pylori (HP) in the pathogenesis of nonalcoholic fatty liver disease (NAFLD) is unclear. OBJECTIVES The aim of this study was to evaluate the effect of HP eradication on liver fat content (LFC), liver function tests (LFT), lipid profile, and homeostasis model assessment-IR (HOMA-IR) index in NAFLD. PATIENTS AND METHODS Dyspeptic patients with increased serum aminotransferase levels were enrolled in the study. The exclusion criteria were factors affecting serum aminotransferase or HP treatment strategy. Participants with persistent elevated serum aminotransferase level and ultrasound criteria for identification of fatty liver were presumed to have NAFLD. "NAFLD liver fat score" was used to classify NAFLD. Those with "NAFLD liver fat score" greater than -0.64 and positive results for urea breath test (UBT), were included. Lifestyle modification was provided to all participants. HP eradication was performed in intervention arm. LFC, fasting serum glucose (FSG), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), triglyceride (TG), cholesterol (CHOL), high and low-density lipoprotein (HDL, LDL), and HOMA-IR were checked at baseline and after that, at intervals of eight weeks and twenty four weeks. RESULTS One hundred (49 males) patients with the mean age of 43.46 (± 11.52) were studied. Repeated measure ANOVA showed a significant reduction in LFC, anthropometric measurements, and laboratory parameters (except for HDL) in the both groups during the study; however, no significant difference was observed between the groups. CONCLUSIONS It seems that HP eradication per se might not affect LFC, LFT, lipid profile, and insulin resistance in dyspeptic NAFLD patients.
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Affiliation(s)
- Raika Jamali
- Student Scientific Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Alireza Mofid
- Internal Medicine Ward, Sina Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Homayoon Vahedi
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Rojin Farzaneh
- Internal Medicine Ward, Sina Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Shahab Dowlatshahi
- Internal Medicine Ward, Sina Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Shahab Dowlatshahi, Corresponding Author: Shahab Dowlatshahi, Internal Medicine Ward, Sina Hospital, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2163120000, Fax: +98-2166348553, E-mail:
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Hashemi kani A, Alavian SM, Esmaillzadeh A, Adibi P, Azadbakht L. Dietary Quality Indices and Biochemical Parameters Among Patients With Non Alcoholic Fatty Liver Disease (NAFLD). Hepat Mon 2013; 13:e10943. [PMID: 24065998 PMCID: PMC3776150 DOI: 10.5812/hepatmon.10943] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 06/03/2013] [Accepted: 06/15/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Dietary intake might have important role in non-alcoholic fatty liver diseases (NAFLD). Although, there are some reports on dietary intake and anthropometrics measurements, few studies have focused on the markers of assessing whole diet like dietary quality indices. OBJECTIVES Therefore, our aim was to determine the diet quality indices and biochemical parameters among patients with NAFLD and healthy individuals. PATIENTS AND METHODS This case-control study was performed on 100 patients with NAFLD and 100 healthy subjects who were attending to Gastrointestinal Research Center, Baqiyatallah University, Tehran, Iran during the recent years. Usual dietary intake was assessed by three dietary records (one weekend and two week days). Healthy eating index (HEI), dietary diversity score (DDS), dietary energy density (DED), mean adequacy ratio of nutrients (MAR) were assessed according to the standard methods. RESULTS Patients with NAFLD had higher body mass index, weight and waist circumference compared to the healthy group (P < 0.05). Serum levels of liver enzymes, triglyceride, LDL, BUN, and uric acid were higher in patients with NAFLD (P < 0.05). Although patients with NAFLD had higher energy, carbohydrate and fat intake, their values for antioxidant vitamins, calcium and vitamin D were lower than healthy subjects (P < 0.05). HEI and MAR were higher among healthy group, and DED was lower among them. Nutrient adequacy ratio for calcium, vitamin D, and antioxidant micronutrients were lower in patients with NAFLD (P < 0.05). CONCLUSIONS It seems that dietary quality indices may be associated with NAFLD. Calcium, vitamin D, and antioxidant micronutrients intake might be lower among patients with NAFLD based on this case-control study. Further prospective studies should be conducted in this regard.
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Affiliation(s)
- Ali Hashemi kani
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Seyed Moayed Alavian
- Baqiyatallah Research Center for Gastroenterology and Liver Disease, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Ahmad Esmaillzadeh
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Peyman Adibi
- Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Leila Azadbakht
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, IR Iran
- Corresponding author: Leila Azadbakht, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, IR Iran. Tel: +98-3117922719, Fax: +98-3116682509, E-mail:
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Ahn AL, Choi JK, Kim MN, Kim SA, Oh EJ, Kweon HJ, Cho DY. Non-alcoholic Fatty Liver Disease and Chronic Kidney Disease in Koreans Aged 50 Years or Older. Korean J Fam Med 2013; 34:199-205. [PMID: 23730487 PMCID: PMC3667227 DOI: 10.4082/kjfm.2013.34.3.199] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 05/07/2013] [Indexed: 12/16/2022] Open
Abstract
Background Non-alcoholic fatty liver disease (NAFLD) and chronic kidney disease (CKD) share common pathogenic mechanisms and many risk factors, and both are linked to an increased risk of cardiovascular diseases. The aim of this study was to assess the association between NAFLD and CKD according to the presence of hypertension and diabetes mellitus in Koreans aged 50 years or older. Methods A cross-sectional study of 1,706 subjects who received their routine health examination was conducted between May 2008 and April 2010 at Konkuk University medical center. Biochemical tests for liver and abdominal ultrasonography were performed. CKD was defined as either proteinuria or glomerular filtration rate ≤60 mL/min per 1.73 m2. Results Among the 1,706 subjects, There were 545 (31.9%) with non-alcoholic fatty liver disease and 424 (24.9%) with chronic kidney disease. In univariate logistic regression analysis, NAFLD was significantly associated with CKD (odds ratio [OR], 1.69; 95% confidence interval [CI], 1.34 to 2.12). In multivariate logistic regression analysis adjusted for age, sex, current smoking, abdominal obesity, aspartate aminotransferases, alanine aminotransferases, γ-glutamyltransferase, hypertension, diabetes mellitus, hypertriglyceridemia, and low high-density lipoprotein cholesterol, NAFLD was associated with CKD (adjusted OR, 1.68; 95% CI, 1.27 to 2.24). This relationship remained significant after classification according to the presence of hypertension or diabetes mellitus. Conclusion NAFLD diagnosed by ultrasonography was significantly associated with CKD in Koreans aged 50 years or older.
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Affiliation(s)
- Ah-Leum Ahn
- Department of Family Medicine, Konkuk University School of Medicine, Seoul, Korea
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Ghamar Chehreh ME, Vahedi M, Pourhoseingholi MA, Ashtari S, Khedmat H, Amin M, Zali MR, Alavian SM. Estimation of diagnosis and treatment costs of non-alcoholic Fatty liver disease: a two-year observation. Hepat Mon 2013; 13:e7382. [PMID: 23914227 PMCID: PMC3728974 DOI: 10.5812/hepatmon.7382] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 02/18/2013] [Accepted: 04/06/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND There are insufficient data available on utilization and health care costs of non-alcoholic fatty liver disease. The cost data for different health conditions and services is a major gap in Iranian health system. So this study is the primary or first step towards filling this gap. OBJECTIVES This study aims to estimate the diagnosis and treatment costs of Non-alcoholic Fatty Liver. PATIENTS AND METHODS This cross-sectional study was conducted on 528 subjects. The subjects had been diagnosed with non-alcoholic fatty liver. All the subjects had been referred to the Tehran Fatty Liver Clinic, a clinic of the Baqiyatallah Research Center for Gastroenterology and Liver Diseases, in 2009 and they had been observed for 2 years to determine the frequency of health care utilization (physician visit, laboratory tests, medication and cost of sonography). The costs of diagnosis and treatment for each person were estimated in Purchasing Power Parity dollars (PPP$). RESULTS The average total cost was 5,043 PPP$ per person in the 2 years of observation. Majority of these 528 patients (87.9%) had a BMI ≥ 25 (kg/m2). Also, 33.9% were diagnosed with comorbid diseases such as Diabetes Mellitus (DM), Coronary Artery Disease (CAD), hypertension (HTN) and hypothyroidism (HYPO). CONCLUSIONS The results confirmed that the total costs for non-alcoholic fatty liver among the Iranian adult urban population alone exceeded 1 billion PPP$ per year. These costs can be saved or reduced by effective disease management and early prevention.
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Affiliation(s)
- Mohammad Ebrahim Ghamar Chehreh
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Mohsen Vahedi
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, IR Iran
| | | | - Sara Ashtari
- Gastroenterology and Liver Disease Research Center, Shahid Beheshti University of Medical Science, Tehran, IR Iran
- Corresponding author: Sara Ashtari, Gastroenterology and Liver Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-2122432515, Fax: +98-2122432517, E-mail:
| | - Hossein Khedmat
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Mohsen Amin
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Reza Zali
- Gastroenterology and Liver Disease Research Center, Shahid Beheshti University of Medical Science, Tehran, IR Iran
| | - Seyed Moayed Alavian
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
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Bessa SSED, Mohamed Ali EM, Abd El-Wahab AES, Nor El-Din SAEM. Heme oxygenase-1 mRNA expression in egyptian patients with chronic liver disease. Hepat Mon 2012; 12:278-85. [PMID: 22690236 PMCID: PMC3360938 DOI: 10.5812/hepatmon.846] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Revised: 01/19/2012] [Accepted: 02/04/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chronic liver disease (CLD) is a global medical problem. This disease is associated with increased hepatic oxidative stress. One of the antioxidant enzymes that protect cells against this stress is heme oxygenase-1 (HO-1). OBJECTIVES This study aimed to investigate the mRNA expression of HO-1 in Egyptian patients with CLD and its relation to oxidative stress biomarkers. PATIENTS AND METHODS Levels of serum ferritin, carboxyhemoglobin, malondialdehyde (MDA), and erythrocyte-reduced glutathione (GSH) were measured, and HO-1 mRNA expression was detected in 45 CLD patients (15 with nonalcoholic steatohepatitis [NASH], 15 with chronic hepatitis C, and 15 with liver cirrhosis) and 15 healthy controls. RESULTS HO-1 mRNA expression was increased in patients with NASH, chronic hepatitis C, and liver cirrhosis compared to controls. The expression in cirrhotic patients was significantly higher than that in patients with NASH and chronic hepatitis C. Compared to controls, patients with NASH, chronic hepatitis C, and liver cirrhosis had higher levels of ferritin, carboxyhemoglobin, and MDA and lower levels of GSH. HO-1 mRNA expression was positively correlated with levels of carboxyhemoglobin, serum ferritin, and serum MDA and negatively correlated with levels of erythrocyte GSH in CLD patients. CONCLUSIONS HO-1 mRNA expression was significantly increased in CLD patients, and the increase reflected the severity of the disease. The significant relationship between the increased HO-1 expression and oxidative stress biomarkers in patients with CLD suggests that HO-1 may play an important role in protecting the liver from oxidative stress-dependent damage. Therefore, induction of HO-1 could be a novel therapeutic option for CLD.
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Affiliation(s)
- Sahar Saad El-Din Bessa
- Department of Internal Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
- Corresponding author: Sahar Saad El-Din Bessa, Department of Internal Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt. Tel.: +2020403419831, Fax: +2020403419831, E-mail:
| | - Ehab Mostafa Mohamed Ali
- Departments of Chemistry, Division of Biochemistry, Faculty of Science, Tanta University, Tanta, Egypt
| | - Abeer El-Sayed Abd El-Wahab
- Department of Medical Biotechnology, Genetic Engineering and Biotechnology Research Institute, The Scientific Research´s City and Technology Applications, Alexandria, Egypt
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Abstract
The objective of the present study was to determine the relationship between serum uric acid (SUA) level and the presence of nonalcoholic fatty liver disease (NAFLD). We analyzed data of 9,019 Koreans who visited a health check up center. The SUA levels of all of these subjects were within the normal range. The participants were divided into 4 groups according to the quartiles of the SUA levels for both sexes. Hepatic steatosis was diagnosed on the basis of ultrasonographic findings. Multivariate logistic regression modeling was performed across the SUA quartiles. The presence of NAFLD and metabolic abnormalities were found significantly in subjects with high-normal SUA levels. After adjustment for age, metabolic components, and the liver-function test, the adjusted odds ratio (OR, 95% CIs) for the presence of NAFLD in the subjects with the highest SUA level was 1.46 (1.17-1.82) for men and 2.13 (1.42-3.18) for women, as compared to the subjects with the lowest SUA level. Our results suggest that increased SUA concentrations, even within the normal range, are independently associated with the presence of NAFLD.
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Affiliation(s)
- In-Cheol Hwang
- Department of Family Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Sang-Yeon Suh
- Department of Medicine, Dongguk University, Seoul, Korea
| | - Ah-Ram Suh
- Department of Statistics, Dongguk University, Seoul, Korea
| | - Hong-Yup Ahn
- Department of Statistics, Dongguk University, Seoul, Korea
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Khoshbaten M, Aliasgarzadeh A, Masnadi K, Tarzamani MK, Farhang S, Babaei H, Kiani J, Zaare M, Najafipoor F. N-acetylcysteine improves liver function in patients with non-alcoholic Fatty liver disease. Hepat Mon 2010; 10:12-6. [PMID: 22308119 PMCID: PMC3270338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2009] [Revised: 12/08/2009] [Accepted: 01/13/2010] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Non-alcoholic fatty liver change is a common disease of the liver in which oxidative stress plays a basic role. Studies are largely focused on protecting the liver by means of anti-oxidative material. The aim of this study is to evaluate the role of N- acetylcysteine in the process of liver injury. METHODS Thirty patients with non-alcoholic fatty liver steatosis were randomly selected to receive either N-acetylcysteine or vitamin C. Liver function tests (alanine aminotransfrase, aspartate aminotransfrase and alkaline phosphatase) were measured as well as the grade of steatosis, the pattern of its echogenicity, the span of the liver and the spleen and the portal vein diameter before the intervention. Patients were followed up using the same method of evaluation repeated in the first, second and third months. RESULTS The mean age (SD) was 40.1(12.4) in patients receiving NAC and 46(10.4) years in patients receiving vitamin C (P = 0.137). NAC resulted in a significant decrease of serum alanine aminotransfrase after three months, compared to vitamin C. This effect was independent of the grade of steatosis in the initial diagnosis. NAC was able to significantly decrease the span of the spleen. CONCLUSIONS N-acetylcysteine can improve liver function in patients with non-alcoholic fatty liver disease. Better results may be achievable in a longer follow up.
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Affiliation(s)
| | - Akbar Aliasgarzadeh
- Department of Endocrinology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Koorosh Masnadi
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Sara Farhang
- Liver and Gastrointestinal Diseases Research Center, Imam Reza Hospital, Tabriz, Iran,Corresponding author at: Sara Farhang, Liver and Gastrointestinal Diseases Research Center, Imam Reza Hospital, Golbad St, Tabriz, East Azerbaijan, Iran. Tel.: +98 411 336 7499, E-mail:
| | - Hosain Babaei
- Department of Pharmacology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Javad Kiani
- Department of Internal Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Zaare
- Department of Internal Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farzad Najafipoor
- Department of Internal Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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