Abstract
The rationale for this study is the controversial data regarding the efficacy of hepatoprotectors and antioxidants for lipid profile correction in non-alcoholic fatty liver disease, the prevalence of which is increasing especially in association with diabetes mellitus. We examined 100 non-alcoholic fatty liver disease patients (40–75 years old) with concomitant type 2 diabetes mellitus (n = 73) or without it (n = 27), the groups were standardized by age and gender. In patients with non-alcoholic fatty liver disease with diabetes mellitus we revealed significantly higher rates of total cholesterol, triglycerides and atherogenic factor in association with a significantly lower high-density lipoproteins level versus the group of patients without concomitant diabetes. We recommended the modification of lifestyle as basic management of their condition to all patients, hypoglycemic therapy with metformin to persons with concomitant diabetes mellitus and rosuvastatin to patients with non-alcoholic fatty liver disease without diabetes. In addition, 25 patients received essential phospholipids (2 caps. 3 times a day) and omega-3 polyunsaturated fatty acids (1000 mg per day) for 3 months; 26 patients – α-lipoic acid (600 mg daily) for 3 months, 22 patients received rosuvastatin (10 mg daily), 27 patients with non-alcoholic fatty liver disease without diabetes mellitus received rosuvastatin (10 mg daily). We evaluated the treatment efficiency after 3 months treatment, and the remote consequences – 12 months after the start of combined treatment. After 3 months, the alanine-aminotransferase rate had decreased by 15.1% in the group taking combined essential phospholipids and ω3-polyunsaturated fatty acids and by 12.9% in the group taking alpha-lipoic acid, which was significantly larger than in the rosuvastatin group (7.5%); gamma-glutamate transpeptidase level decreased by 16.7%, 18.7% and 9.4% respectively indicating anticholestatic and hepatoprotective effect of both proposed treatment combinations. The same tendency of cytolysis and cholestasis processes inhibition was observed after 12 months as well. In conclusion, the combination of standard treatment with antioxidant and hepatoprotective agents (omega-3 polyunsaturated fatty acids with essential phospholipids or only alpha-lipoic acid) promotes both cytolysis and cholestasis syndromes inhibition in non-alcoholic fatty liver disease patients with concomitant type 2 diabetes mellitus.
Highlights
Non-alcoholic fatty liver disease (NAFLD) is a multi-stage disease that starts with excessive lipids accumulation in hepatocytes (Brunt & Tiniakos, 2010; Takahashi & Fukusato, 2014), progresses to the development of necrotic inflammation liver parenchyma (Schleicher et al, 2014) and associated with risk factors (obesity, type 2 diabetes mellitus (DM-2), dyslipidemia, genetic predisposition) (Jonathan et al, 2016; Stepanov et al, 2018)
Biochemical screen of NAFLD patients with concomitant DM-2 is shown in Table 1, where mean group values are presented in comparison to control group values and the group of patients with NAFLD without diabetes
The abovementioned treatment combinations led to biochemical screen correction in such patients due to both cytolysis and cholestasis as well as improvement in dyslipidemia laboratory indices with reduction in hepatocytes triglycerides deposits
Summary
Non-alcoholic fatty liver disease (NAFLD) is a multi-stage disease that starts with excessive (over 5%) lipids (predominantly triglycerides) accumulation in hepatocytes (hepatosteatosis stage) (Brunt & Tiniakos, 2010; Takahashi & Fukusato, 2014), progresses to the development of necrotic inflammation liver parenchyma (steatohepatitis stage) (Schleicher et al, 2014) and associated with risk factors (obesity, type 2 diabetes mellitus (DM-2), dyslipidemia, genetic predisposition) (Jonathan et al, 2016; Stepanov et al, 2018). NAFLD can progress to non-alcoholic steatohepatitis (NASH) in about 30% of cases (Michelotti et al, 2013; Firneisz, 2014; Sharma et al, 2015; Lee et al, 2017). Prevalence of NAFLD in dyslipidemia patients is estimated at 50% and characterized by increased triglycerides (TG) rate and decreased low density lipoproteins (LDL) level (Nseir & Mahamid, 2013). Prevalence of NASH in DM-2 patients is 12.2% versus 7.4% in patients without diabetes and in cases of coexistent DM-2 and obesity the rate of NASH reaches 21–40% (Ballestri, 2016)
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