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Grandt J, Jensen ASH, Werge MP, Rashu EB, Møller A, Junker AE, Hobolth L, Mortensen C, Johansen CD, Vyberg M, Serizawa RR, Møller S, Gluud LL, Wewer Albrechtsen NJ. Postprandial dysfunction in fatty liver disease. Physiol Rep 2023; 11:e15653. [PMID: 37078380 PMCID: PMC10116394 DOI: 10.14814/phy2.15653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/20/2023] [Accepted: 03/07/2023] [Indexed: 04/21/2023] Open
Abstract
Fatty liver disease has mainly been characterized under fasting conditions. However, as the liver is essential for postprandial homeostasis, identifying postprandial disturbances may be important. Here, we investigated postprandial changes in markers of metabolic dysfunction between healthy individuals, obese individuals with non-alcoholic fatty liver disease (NAFLD) and patients with cirrhosis. We included individuals with biopsy-proven NAFLD (n = 9, mean age 50 years, mean BMI 35 kg/m2 , no/mild fibrosis), cirrhosis with hepatic steatosis (n = 10, age 62 years, BMI 32 kg/m2 , CHILD A/B) and healthy controls (n = 10, age 23, BMI 25 kg/m2 ), randomized 1:1 to fasting or standardized mixed meal test (postprandial). None of the patients randomized to mixed meal test had type 2 diabetes (T2D). Peripheral blood was collected for 120 min. After 60 min, a transjugular liver biopsy and liver vein blood was taken. Plasma levels of glucose, insulin, C-peptide, glucagon, and fibroblast growth factor 21 (FGF21) were measured. Postprandial peak glucose and C-peptide were significantly increased in NAFLD, and cirrhosis compared with healthy. Patients with NAFLD and cirrhosis had hyperglucagonemia as a potential sign of glucagon resistance. FGF21 was increased in NAFLD and cirrhosis independent of sampling from the liver vein versus peripheral blood. Glucagon levels were higher in the liver vein compared with peripheral blood. Patients with NAFLD and cirrhosis without T2D showed impaired glucose tolerance, hyperinsulinemia, and hyperglucagonemia after a meal compared to healthy individual. Postprandial characterization of patients with NAFLD may be important to capture their metabolic health.
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Affiliation(s)
- Josephine Grandt
- Gastro Unit, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Sofie H Jensen
- Gastro Unit, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel P Werge
- Gastro Unit, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Elias B Rashu
- Gastro Unit, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Andreas Møller
- Gastro Unit, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Anders E Junker
- Gastro Unit, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Lise Hobolth
- Gastro Unit, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Christian Mortensen
- Gastro Unit, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Christian D Johansen
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Mogens Vyberg
- Department of Pathology, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Center for RNA Medicine, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
| | | | - Søren Møller
- Department of Clinical Physiology and Nuclear Medicine, Center for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Hvidovre, Denmark
- Institute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lise Lotte Gluud
- Gastro Unit, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Institute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nicolai J Wewer Albrechtsen
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
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Schroll JB, Serizawa RR, Rebolj M. Human Papillomavirus Testing in the Last Cervical Screening Round at Age 60-64 Years. Obstet Gynecol 2021; 138:389-397. [PMID: 34352844 PMCID: PMC8366760 DOI: 10.1097/aog.0000000000004522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the real-life screening outcomes after cytology was replaced by human papillomavirus (HPV) testing for women aged 60-64 years. METHODS Using the Danish national pathology register, we compared screening outcomes during two consecutive calendar periods, one where women were screened with cytology and one where most women were screened with HPV testing. Our primary outcomes were the proportions of women with positive test results, high-grade cervical intraepithelial neoplasia (CIN 2 or worse), and cervical cancer. RESULTS Women screened during the HPV testing period were more likely to have a positive screening test result than were women screened during the cytology period (relative proportion 2.80, 95% CI 2.65-2.96). The detection of CIN 2 or worse was also increased (relative proportion 1.54, 95% CI 1.31-1.80), whereas there was no increase in screen-detected cervical cancer diagnoses (relative proportion 1.27, 95% CI 0.76-2.12). Within the first 4 years after a negative screening test result, including 168,477 woman-years at risk after a negative screen result in the HPV period and 451,421 woman-years after a negative screen result in the cytology period, the risk of a cervical cancer diagnosis was approximately 4 per 100,000 woman-years and was similar for both screening tests (relative risk 0.99, 95% CI 0.41-2.35). CONCLUSION Human papillomavirus testing led to more positive screening test results and diagnoses of high-grade CIN lesions. Few women were diagnosed with cervical cancer after a negative screening test result.
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Affiliation(s)
- Jeppe Bennekou Schroll
- Department of Gynaecology and Obstetrics and the Department of Pathology, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, and the Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; and the Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, Guy's Cancer Centre, Great Maze Pond, London, United Kingdom
| | - Reza Rafiolsadat Serizawa
- Department of Gynaecology and Obstetrics and the Department of Pathology, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, and the Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; and the Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, Guy's Cancer Centre, Great Maze Pond, London, United Kingdom
| | - Matejka Rebolj
- Department of Gynaecology and Obstetrics and the Department of Pathology, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, and the Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; and the Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, Guy's Cancer Centre, Great Maze Pond, London, United Kingdom
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St-Martin G, Viborg PH, Andersen ABT, Andersen B, Christensen J, Ejersbo D, Heje HN, Jochumsen KM, Johansen T, Larsen LG, Lynge E, Serizawa RR, Waldstrøm M. Histological outcomes in HPV-screened elderly women in Denmark. PLoS One 2021; 16:e0246902. [PMID: 33571319 PMCID: PMC7877658 DOI: 10.1371/journal.pone.0246902] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/28/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Danish women exit cervical cancer screening at age 65 years, but 23% of cervical cancer cases occur beyond this age. In addition, due to gradual implementation of cervical cancer screening, older women are underscreened by today´s standards. A one-time screening with HPV test was therefore offered to Danish women born before 1948. Methods Register based study reporting histology diagnoses and conizations in women found HPV positive in the one-time screening. Number and proportion of women with severe or non-severe histology results were calculated for screened and HPV-positive women by age group or region of residence. Number of women with biopsy and/or conization per case of cervical intraepithelial neoplasia (CIN) grade 2 or worse (CIN2+) or CIN3+ were also calculated by age groups and region. Results 4,479 (4.1% of screened women) had positive HPV test. 94% of these had one or more additional tests. 2,785 (62%) of HPV-positive women had histology results, and conization was performed in 1,076 (24% of HPV-positive and 1% of all screened women). HPV positivity and CIN3+ detection varied little between regions, but the proportions of HPV positive women undergoing histology varied between regions from 40% to 86% and the proportion with conization from 13% to 36%. Correspondingly, the number of histologies and conizations per CIN3+ detected varied from 5.9 to 11.2 and 1.8 to 4.7, respectively. In total, 514 CIN2+ (0.47% of screened women, 11% of HPV-positive) and 337 CIN3+ (0.31% of screened women, 7.5% of HPV-positive) were diagnosed, including 37 cervical cancer cases. Discussion HPV screening of insufficiently screened birth cohorts can potentially prevent morbidity and mortality from cervical cancer but longer follow-up is needed to see if cancer incidence declines in the screened women in the coming years. Management strategies differed among regions which influenced the proportions undergoing biopsy/conization.
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Affiliation(s)
- Gry St-Martin
- Center for Epidemiological research, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
- * E-mail:
| | - Petra Hall Viborg
- The Danish Clinical Registries (RKKP), Frederiksberg/Aarhus N, Denmark
| | | | - Berit Andersen
- Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jette Christensen
- Department of Pathology, Aalborg University Hospital, Aalborg, Denmark
| | - Dorthe Ejersbo
- Department of Pathology, Vejle, Lillebaelt Hospital, Vejle, Denmark
| | | | | | - Tonje Johansen
- Department of Pathology, Randers Regional Hospital, Randers NØ, Denmark
| | - Lise Grupe Larsen
- Department of Pathology, Zealand University Hospital, Naestved, Denmark
| | - Elsebeth Lynge
- Center for Epidemiological research, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Marianne Waldstrøm
- Department of Pathology, Vejle, Lillebaelt Hospital, Vejle, Denmark
- Institute of Regional Health Science, University of Southern Denmark, Odense, Denmark
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Pedersen JS, Rygg MO, Kristiansen VB, Olsen BH, Serizawa RR, Holst JJ, Madsbad S, Gluud LL, Bendtsen F, Wewer Albrechtsen NJ. Nonalcoholic Fatty Liver Disease Impairs the Liver-Alpha Cell Axis Independent of Hepatic Inflammation and Fibrosis. Hepatol Commun 2020; 4:1610-1623. [PMID: 33163832 PMCID: PMC7603528 DOI: 10.1002/hep4.1562] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/22/2020] [Accepted: 05/31/2020] [Indexed: 01/01/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is associated with impaired hepatic actions of glucagon and insulin. Glucagon and amino acids are linked in an endocrine feedback circuit, the liver-alpha cell axis, that may be disrupted by NAFLD. We investigated how NAFLD severity affects glucagon and insulin resistance in individuals with obesity and whether bariatric surgery improves these parameters. Plasma and liver biopsies from 33 individuals with obesity (collectively, OBE) were obtained before and 12 months after bariatric surgery (Roux-en-Y gastric bypass [RYGB] or sleeve gastrectomy [SG]). Nine healthy control individuals (collectively, CON) undergoing cholecystectomy were used as a comparison group. The NAFLD activity score (NAS) was used to subdivide study participants into the following groups: OBE-no steatosis, OBE+steatosis, and nonalcoholic steatohepatitis (NASH) and/or grade 2 fibrosis (Fib) (OBE-NASH-Fib). Measurements of amino acids by targeted metabolomics and glucagon were performed. Glucagon, amino acids (P < 0.05), and the glucagon-alanine index, a validated surrogate marker of glucagon resistance, were increased in OBE by 60%, 56%, and 61%, respectively, when compared with CON but irrespective of NAFLD severity. In contrast, markers of hepatic insulin resistance increased concomitantly with NAS. Hyperglucagonemia resolved in OBE-no steatosis and OBE+steatosis but not in OBE-NASH-Fib (median, 7.0; interquartile range, 5.0-9.8 pmol/L), regardless of improvement in insulin resistance and NAS. The type of surgery that participants underwent had no effect on metabolic outcomes. Conclusion: Glucagon resistance to amino acid metabolism exists in individuals with NAFLD independent of NAS severity. Patients with NASH showed persistent hyperglucagonemia 12 months after bariatric surgery, indicating that a disrupted liver-alpha cell may remain in NAFLD despite major improvement in liver histology.
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Affiliation(s)
- Julie Steen Pedersen
- GastrounitMedical DivisionCopenhagen University Hospital HvidovreHvidovreDenmark
| | - Marte Opseth Rygg
- GastrounitMedical DivisionCopenhagen University Hospital HvidovreHvidovreDenmark
| | | | - Beth Hærstedt Olsen
- Department of Nuclear Medicine and Functional Imaging, Ultrasound SectionCopenhagen University Hospital HvidovreHvidovreDenmark
| | | | - Jens Juul Holst
- Department of Biomedical SciencesFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Sten Madsbad
- Department of EndocrinologyCopenhagen University Hospital HvidovreHvidovreDenmark
| | - Lise Lotte Gluud
- GastrounitMedical DivisionCopenhagen University Hospital HvidovreHvidovreDenmark
| | - Flemming Bendtsen
- GastrounitMedical DivisionCopenhagen University Hospital HvidovreHvidovreDenmark
| | - Nicolai Jacob Wewer Albrechtsen
- Department of Biomedical SciencesFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Department of Clinical Biochemistry, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
- Novo Nordisk Foundation Center for Protein ResearchFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
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