Liraglutide on type 2 diabetes mellitus with nonalcoholic fatty liver disease: A systematic review and meta-analysis of 16 RCTs.

Objective To explore the relationship between serum osteocalcin levels and glucolipid metabolism in elderly type 2 diabetic patients with non-alcoholic fatty liver disease(NAFLD). Methods Data collected from 97 patients with type 2 diabetes mellitus(T2DM)admitted to the Department of Geriatric Endocrinology of the First Affiliated Hospital of Zhengzhou University from June 2014 to April 2015 were retrospectively analyzed.Patients were divided into the T2DM group(type 2 diabetic patients without NAFLD, n=47)and the NAFLD group(T2DM patients with NAFLD, N=50). Healthy elderly subjects(n=30)from the same period served as the control group.Body mass index(BMI), osteocalcin, fasting blood glucose, fasting insulin, homeostasis model assessment for insulin secretion index(HOMA-β)and insulin resistance(HOMA-IR), glycosylated hemoglobin(HbA1c), total cholesterol, triglyceride, high-density lipoprotein cholesterol(HDL-C)and low-density lipoprotein cholesterol(LDL-C)were compared between the 3 groups. Results Levels of fasting blood glucose, fasting insulin, HbA1c, total cholesterol, triglyceride, LDL-C and HOMA-IR were higher, while levels of HDL-C, HOMA-β and osteocalcin were lower in the T2DM and NAFLD groups than in the control group(all P<0.05). Levels of BMI, fasting glucose, fasting insulin, HbA1c, total cholesterol, triglyceride, LDL-C and HOMA-IR were higher and levels of osteocalcin were lower in the T2DM group than in the NAFLD group(all P<0.05). Pearson correlation analysis showed that the osteocalcin level was negatively correlated with fasting blood glucose, HbA1C, HOMA-IR and BMI(r=-0.701, -0.442, -0.337 and -0.543, P<0.05 or P<0.01), and positively correlated with HOMA-β(r=0.341, P<0.05)in the NAFLD group. With serum osteocalcin as the dependent variable, multiple linear regression results showed that fasting blood glucose was an independent influencing factor for serum osteocalcin(β=-1.57, P<0.05)in the fatty liver group. Conclusions Serum osteocalcin levels significantly decrease in elderly T2DM patients with NAFLD, are closely correlated with glucolipid metabolism, and may have some important clinical significance in the prevention and treatment of NAFLD in elderly patients with type 2 diabetes. Key words: Osteocalcin; Diabetes Mellitus, Type 2; Fatty Liver

Objective To investigate the risk factors of type 2 diabetes mellitus(T2DM) in patients with nonalcoholic fatty liver disease (NAFLD) and correlations with carotid atherosclerosis.Methods The clinical data of 51 cases of N AFLD with T2DM (NAFLD with T2DM group),43 cases of NAFLD(NAFLD group) and 45 healthy objects (control group) were collected.The clinical biochemical features,carotid intima-media thickness (IMT) were observed.Results The BMI and smoking rate in NAFLD with T2DM group and NAFLD group were significandy higher than those in control group [(27.25 ±3.16),(26.31 ± 2.63) kg/m2 vs.(23.12 ±3.44) kg/m2,43.1％(22/51),37.2％(16/43) vs.13.3％(6/45)](P＜0.05).The ratio of family history of T2DM in NAFLD with T2DM group was significantly higher than that in NAFLD group and control group[66.7％(34/51)vs.32.6％(14/43),8.9％(4/45)](P ＜ 0.05).Compared with control group,the level of total cholesterol (TC),trigalloyl glycerol (TG),low density lipoprotein cholesterol (LDL-C),alanine transaminase(ALT),aspartic transaminase(AST),IMT in NAFLD with T2DM group and NAFLD group were significantly higher [(5.39 ± 0.85),(5.12 ± 0.77) mmol/L vs.(4.11 ± 0.64) mmol/L,(2.77 ± 1.11),(2.32 + 1.04) mmol/L vs.(1.21 ± 0.52) mmol/L,(2.98 ±0.93),(2.76 +0.78) mmol/L vs.(2.15 ±0.57) mtmol/L,(48.4 ± 18.9),(43.3 ± 16.5) U/L vs.(21.4 ± 13.6) U/L,(46.2 ± 16.7),(42.1 ± 17.5) U/L vs.(20.5 ± 12.6) U/L,(1.95 ±0.93),(1.26±0.51) mmvs.(0.71 ±0.22) mm](P＜ 0.05),while the level of high density lipoprotein cholesterol (HDL-C) was significantly lower [(1.01 ± 0.35),(1.13 + 0.22) mmol/L vs.(1.31 ± 0.26) mmol/L] (P ＜ 0.05).The level of above mentioned index,there were no significant difference between NAFLD with T2DM group and NAFLD group (P ＞ 0.05).The level of fasting blood glucose (FBG),2-hour postprandial blood glucose (2 h PBG),glycosylated hemoglobin (HbA1c),fasting insulin (FINS),2-hour postprandial insulin (2 h PINS) and insulin resistance index of HOMA (HOMA-IR) in NAFLD with T2DM group were significantly higher than those in NAFLD group and control group [(8.15 ± 1.48) mmol/L vs.(5.10 ± 1.32),(5.62 ± 0.88) mmol/L,(13.67 ± 1.59) mmol/L vs.(7.31 ± 1.25),(8.64± 1.35) mmol/L,(7.03 ±0.84)％ vs.(5.16 ±0.72)％,(5.53 ±0.61)％,(13.32 ±4.55) mU/L vs.(6.06 ±3.11),(9.13 ±4.37) mU/L,(106.37 ±21.45) mU/L vs.(33.21 ± 18.87),(46.34 ± 16.39) mU/L,3.88 + 2.14 vs.1.13 ± 0.36,2.23 ± 1.15] (P ＜ 0.05).Carotid IMT,the incidence of carotid plaque and Crouse scores of plaque in NAFLD with T2DM group were significandy higher than those in NAFLD group [(1.95 ±0.93) mm vs.(1.26 ±0.51) mm,64.7％(33/51) vs.30.2％(13/43),(3.11 ±0.57) nn vs.(1.35 ± 0.49) mm] (P ＜ 0.05).The regression analysis showed that family history of T2DM,FBG,2 h PBG,FINS,2 h PINS were independently associated with T2DM.Conclusions Family history of T2DM,FBG,2 h PBG,FINS,2 h PINS are the main risk factors for the onset of T2DM in NAFLD.The risk of carotid atherosclerosis is increased in patients of NAFLD with T2DM. Key words: Fatty liver disease, nonalcoholic; Diabetes mellitus,type 2; Carotid artery disease; Risk factors

Novel data on the pathogenesis of atherosclerosis, treatment targets, and new therapeutic interventions in lipid-related cardiovascular risk factors.

Objective To analyze the differences of body composition and islet function between patients with or without nonalcoholic fatty liver disease (NAFLD), and between patients with or without visceral obesity in type 2 diabetes mellitus (T2DM). The effects of fatty liver and visceral fat on islet function were also investigated. Methods A total of 519 patients with T2DM were divided into 4 groups according to the presence or absence of fatty liver and visceral obesity. Group 1: 242 cases of T2DM+ NAFLD with visceral obesity, group 2: 59 cases of T2DM + NAFLD without visceral obesity, group 3: 101 cases of T2DM with visceral obesity but without NAFLD and group 4: 117 cases of T2DM without NAFLD and visceral obesity. Bioelectrical impedance method was used to analyze human body composition, including visceral fat area, skeletal muscle content, mineral content and other indicators. At the same time, biochemical indicators such as liver and kidney function, blood lipid, oral glucose tolerance and islet function were measured in all patients. Variance analysis or nonparametric test was used to compare the difference of body composition and biochemical indexes between groups. Spearman rank correlation was used for correlation analysis, and binary logistic regression was used for multivariate analysis. Results (1)The mineral content, protein content, total body water, body mass index in group 1 were higher than those in group 4 (F=16.202-100.482, all P<0.05); the percentage of fat was decreased gradually from group 1 to group 4 (T=47.027, P<0.05); the skeletal muscle content in group 2 was higher than that in group 1 (T=2.879, P<0.05). (2)The white blood cell, C-reactive protein, total protein, albumin, gamma glutamyl transferase, alanine aminotransferase, aspertate aminotransferase, estimated glomerular filtration rate, serum uric acid, triglyceride, low-density lipoprotein-cholesterol and very low-density lipoprotein-cholesterol showed a downward trend, and the level of high density lipoprotein-cholesterol was increased gradually (F/T=4.036-18.831, all P<0.05) from group 1 to group 4. (3)Among the four groups, homeostatic model assessment of insulin resistance, homeostasis model assessment of β cell function, insulin sensitivity index, area under curve of insulin and area under curve of C-peptide showed a downward trend from group 1 to group 4, with significant difference between group 1 and group 4 (F/T=5.757-13.860, all P<0.05). (4)After adjusting for age and sex, the visceral fat area was positively correlated with body mass index, waist to hip ratio, visceral fat content, subcutaneous fat content, basal metabolic volume, gamma glutamyl transferase, alanine aminotransferase, aspertate aminotransferase and serum uric acid(r=0.340-0.916, all P<0.05), and negatively correlated with high density lipoprotein-cholesterol(r=-0.442, P<0.05). (5)Visceral fat content(OR=5.463, 95% CI: 1.886-4.451, P=0.071)and low-density lipoprotein-cholesterol (OR=1.224, 95% CI: 1.180-1.227, P=0.025)were independent risk factors for NAFLD in patients with T2DM. Conclusions Both T2DM patients with NAFLD or visceral obesity have insulin resistance and compensatory increase of insulin secretion. The most serious insulin resistance is found in T2DM patients with NAFLD and visceral obesity simultaneously. Increasing skeletal muscle content is beneficial to control visceral obesity and improve islet function in patients with NAFLD. Reducing visceral fat area is beneficial to improve metabolic indicators. Key words: Type 2 diabetes mellitus; Non-alcoholic fatty liver disease; Visceral obesity; Body composition; Insulin resistance

To comprehensively assess the efficacy and safety of liraglutide on metabolic and hepatic outcomes in patients with non-alcoholic fatty liver disease (NAFLD), with or without type 2 diabetes mellitus (T2DM), based on randomised controlled trials (RCTs). Electronic databases (PubMed, Web of Science, Cochrane Library and Embase) were systematically searched for randomised RCTs evaluating liraglutide in the treatment of NAFLD. Outcome measures included body mass index (BMI), glycated haemoglobin A1c (HbA1c), fasting plasma glucose (FPG), aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and adverse events (AEs). Eight RCTs (with an overall moderate risk of bias as assessed by the Cochrane Risk of Bias tool) involving 478 participants were included in the analysis. The meta-analysis results demonstrated that liraglutide significantly improved BMI (standardised mean difference [SMD]: -0.85; 95% confidence interval [CI]: -1.04 to -0.66), FPG (SMD: -1.22; 95% CI: -1.97 to -0.46), and GGT (SMD: -1.10; 95% CI: -1.48 to -0.72; p < 0.00001) in patients with NAFLD, regardless of T2DM comorbidity. Furthermore, liraglutide showed positive effects on ALT (SMD: -0.44; 95% CI: -0.80 to -0.08) and TG (SMD: -1.08; 95% CI: -1.97 to -0.19) specifically in patients with NAFLD comorbid with T2DM. However, the effect of liraglutide on HbA1c was not statistically significant (SMD: 0.14; 95% CI: -0.39 to 0.67). Regarding safety, liraglutide was associated with a higher incidence of adverse events, primarily gastrointestinal disorders such as nausea and diarrhoea, though these were mostly transient. Liraglutide demonstrates beneficial effects on BMI, FPG and GGT in patients with NAFLD with or without comorbid T2DM. It also shows positive effects on ALT and TG in patients with NAFLD and T2DM. While the treatment was associated with a higher burden of mostly manageable gastrointestinal adverse events, the findings of this study warrant further validation in prospective high-quality studies.

Objectives:To analyze the clinicopathological features and risk factors of Type-2 diabetes mellitus (T2DM) patients with non-alcoholic fatty liver disease (NAFLD).Methods:The data of 145 patients with T2DM who received treatment in our hospital from May 2020 to May 2021 were collected. The patients were diagnosed with NAFLD by abdominal liver Doppler ultrasound; The general data and laboratory examination indexes of T2DM patients with and without NAFLD were compared; To analyze the risk factors of NAFLD in T2DM patients.Results:According to the results of the ultrasound examination, 71(48.97%) patients were simple T2DM, and 74(51.03%) patients were T2DM with NAFLD. Compared with simple T2DM, T2DM patients with NAFLD had higher BMI, hypertension, fasting plasma glucose(FPG), insulin resistance, triglycerides (TG), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and uric acid(UA) (P<0.05). Further logistic regression analysis showed a higher BMI (OR=1.841, P=0.013), FPG (OR=1.576, P=0.014), insulin resistance (OR=4.195, P<0.001) and elevated TG (OR=4.676, P=0.042) are risk factors for T2DM with NAFLD.Conclusion:High BMI, BPG, insulin resistance index and TG are independent risk factors for nonalcoholic fatty liver in T2DM patients. During intervention, attention should be paid to the monitoring of these indicators to effectively prevent the aggravation of the disease.

Background/Aims:The study analyzed the roles of circulating omentin-1 and irisin in patients with type 2 diabetes mellitus (T2DM) concomitant with metabolic-associated fatty liver disease (MAFLD).Materials and Methods:This cross-sectional study included 80 patients with T2DM but no MAFLD, 62 patients with MAFLD but no T2DM, 50 T2DM patients having MAFLD (T2DM/MAFLD), and 80 healthy individuals.Results:The serum levels of omentin-1 and irisin were both significantly reduced in patients with T2DM coexisting with MAFLD compared to T2DM or MAFLD patients alone. In T2DM patients, the level of omentin-1 decreased as the level of fasting plasma glucose (FPG) increased and the level of high-density lipoprotein cholesterol (HDL-C) reduced; the level of irisin decreased as the levels of FPG and fasting insulin (FINS) increased. In MAFLD patients, a lower level of omentin-1 was correlated with a lower level of HDL-C but with a greater waist-to-hip ratio (WHR), alanine aminotransferase and aspartate aminotransferase levels; a lower level of irisin was correlated with higher WHR and FINS level. In patients with T2DM coexisting with MAFLD, those with a lower level of omentin-1 were found to have a lower level of HDL-C concurrent with lower WHR and triglyceride level; and those with a lower level of irisin showed lower WHR, FPG and FINS levels. Combined evaluation of omentin-1 and irisin for diagnosing T2DM coexisting with MAFLD yielded an area under the curve of 0.943.Conclusion:These findings suggest the assessment potential of omentin-1 and irisin for T2DM coexisting with MAFLD.

BACKGROUNDNon-alcoholic fatty liver disease has become the most common chronic liver disease worldwide, which originates from the accumulation of triglyceride (TG) in the liver. Patients with type 2 diabetes mellitus (T2DM) are considered to have a predisposition to hepatic steatosis. However, the influencing factors for hepatic fat accumulation in T2DM patients remain unclear.AIMTo investigate the influencing factors for hepatic fat accumulation in T2DM patients. METHODSWe enrolled 329 T2DM patients admitted to the Endocrinology Department of the First Affiliated Hospital of Soochow University, who underwent MR mDIXON-Quant examination to quantify the hepatic fat fraction (HFF). According to body mass index (BMI), the patients were divided into normal weight, overweight, and obese groups. The differences in general statistics, biochemical parameters, islet function, and HFF were compared among the three groups. The associations between HFF and other parameters and the influences of various parameters on the severity of hepatic fat accumulation were analyzed. RESULTSThe HFF of T2DM patients gradually increased in the normal weight, overweight, and obese groups (P < 0.05). Spearman correlation analysis showed that in T2DM patients, HFF was negatively correlated with age and high-density lipoprotein cholesterol (P < 0.05), whereas it was positively correlated with BMI, waist-hip ratio, fasting plasma glucose, alanine aminotransferase (ALT), aspartate aminotransferase, bilirubin, glutamyl transpeptidase, lactate dehydrogenase, albumin (ALB), uric acid (UA), total cholesterol, TG, low-density lipoprotein cholesterol (LDL-C), C-reactive protein, free triiodothyronine, fasting insulin, fasting C-peptide, and homeostasis model assessment of insulin resistance (P < 0.05). Multiple linear regression analysis showed significant positive influences of BMI, ALT, LDL-C, UA, and ALB on HFF in T2DM patients (P < 0.05). Binary logistic regression analysis showed that BMI, ALT, ALB, and LDL-C were independent risk factors for moderate to severe fatty liver in T2DM patients, and obesity increased the risk of being complicated with moderate to severe fatty liver by 4.03 times (P < 0.05).CONCLUSIONThe HFF of T2DM patients increases with BMI. Higher BMI, ALT, ALB, and LDL-C are independent risk factors for moderate to severe fatty liver in T2DM patients.

Objective To investigate the value of high density lipoprotein-cholesterol (HDL-C) in the diagnosis and risk assessment of non-alcoholic fatty liver disease (NAFLD). Methods A cross-sectional study and multistage stratified random sampling method were performed in epidemiological survey. According to inclusion and exclusion criteria, a total of 3 312 individuals were enrolled and divided into NAFLD group (913 cases) and non-NAFLD group (2 399 cases). The serum lipid levels were compared between the two groups. Receiver operating characteristic (ROC) curve was performed to evaluate the value of HDL-C in the diagnosis of NAFLD. The binary logistic regression models were established based on HDL-C level.The differences in liver function indexes were compared among the research objects with different HDL-C levels.T test and Mann-Whitney U test were performed for statistical analysis. Results The serum levels of total cholesterol, triglyceride and low density lipoprotein-cholesterol (LDL-C) of NAFLD group were all higher than those of non-NAFLD group ((5.24±0.92) mmol/L vs.(4.98±0.92) mmol/L, (1.95±1.41) mmol/L vs.(1.13±0.68) mmol/L, (3.31±0.84) mmol/L vs.(3.09±0.84) mmol/L), and the differences were statistically significant (t=-7.29, -22.38 and -6.84, all P<0.01). However the serum HDL-C level of NAFLD group was lower than that of non-NAFLD group((1.30±0.33) mmol/L vs.(1.64±0.40) mmol/L), and the difference was statistically significant (t=24.93, P<0.01). The incidence of hypercholesterolemia, hypertriglyceridemia, hypo-high-density lipoprotein cholesterolemia and hyper-low-density lipoprotein cholesterolemia of NAFLD group was 48.0%(438/913), 44.8%(409/913), 31.0%(283/913) and 82.8%(756/913), respectively, which were significantly higher than that of non-NAFLD group (36.8%, 882/2 399; 13.2%, 317/2 399; 10.5%, 251/2 399; 71.8%, 1 723/2 399), and the differences were statistically significant (χ2=34.65, 385.43, 206.18 and 42.37, all P<0.01). Using the cut-off values of HDL-C≤1.66 mmol/L in female and≤1.33 mmol/L in male, the area under curve (AUC) values for NAFLD diagnosis were 0.720(95% confidence interval (CI) 0.693 to 0.747) and 0.708 (95%CI 0.679 to 0.737), respectively, the sensitivity was 79.1% and 76.6%, and the specificity was 55.0%and 54.6%. The results of binary logistic regression models based on HDL-C level indicated that prevalence of NAFLD in female with low HDL-C was 4.584 times (95%CI 3.530 to 5.940, P<0.01) higher than that in female with high HDL-C; the prevalence of NAFLD in male with low HDL-C was 3.898 times (95%CI 3.020 to 5.030, P<0.01) higher than that of male with high HDL-C. The alanine aminotransferase (ALT), aspartate transaminase (AST), gamma glutamyl transpeptidase (GGT) and alkaline phosphatase (ALP) levels of low HDL-C group were all higher than those of high HDL-C group (20.10 U/L, 14.40 U/L to 29.40 U/L vs. 16.80 U/L, 12.70 U/L to 23.00 U/L; 19.20 U/L, 16.00 U/L to 23.70 U/L vs. 19.00 U/L, 16.00 U/L to 22.17 U/L; 22.00 U/L, 14.00 U/L to 34.00 U/L vs. 15.00 U/L, 11.00 U/L to 23.00 U/L and 71.00 U/L, 59.00 U/L to 85.00 U/L vs. 66.00 U/L, 55.00 U/L to 82.00 U/L), and the differences were statistically significant (Z=-10.53, -2.20, -14.19 and -5.87, all P<0.05). Conclusion The serum HDL-C level is negatively correlated with the risk of NAFLD level, and the NAFLD risk of individuals with low HDL-C level is significantly higher than individuals with high HDL-C level. Key words: Cholesterol, HDL; Non-alcoholic fatty liver disease; Risk factors; Anti-inflammation effects

Objective To study the serum levels of oxidative stress markers in the new type 2 diabetes mellitus(T2DM) patients with nonalcoholic fatty liver disease(NAFLD), and the effect of α-lipoic acid(A-LA) on oxidative stress markers. Methods From August 2016 to August 2017, 80 new T2DM patients complicated with NAFLD (T2DM + NAFLD group) and 80 new T2DM patients without NAFLD (T2DM group) admitted to Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University were selected.The serum levels of Fasting blood glucose(FPG), body mass index(BMI), triglyceride(TG), total cholesterol(TC), high density lipoprotein cholesterol(HDL-C), low density lipoprotein cholesterol(LDL-C), insulin resistance index(HOMA-IR), serum superoxide dismutase(SOD), serum malondialdehyde(MDA), glutathione peroxidase(GSH-PX) were detected and compared between the two groups.And then, the T2DM patients with NAFLD were treated by A-LA for two weeks.The SOD, MDA, GSH-PX levels were compared before and after treatment. Results The FPG, BMI, TG, HOMA-IR of the T2DM+ NAFLD group were (10.71±3.63)mmol/L, (27.08±3.87)kg/m2, (3.40±1.85)mmol/L, (5.40±2.98), respectively, which were significantly higher than those of the T2DM group[(9.50±3.78)mmol/L, (23.58±2.75)kg/m2, (1.79±1.44)mmol/L, (2.41±1.18)](t=2.022, 6.603, 2.829, 4.157, all P 0.05). The level of MDA in the T2DM+ NAFLD group was (5.11±0.25)μmol/L, which was significantly higher than (4.56±0.28)μmol/L in the T2DM group(t=2.106, P<0.05). The levels of SOD, GSH-PX, SOD/MDA in the T2DM+ NAFLD group were (77.42±10.31)U/mL, (69.62±9.24)U, (15.39±2.23), respectively, which were significantly lower than those in the T2DM group[(93.26±11.21)U/mL, (87.54±9.58)U, (20.33±2.93)](t=2.455, 2.653, 3.148, all P<0.05). After treatment with A-LA, the MDA level of the T2DM+ NAFLD group was (4.81±0.26)μmol/L, which was significantly lower than that before treatment[(5.11±0.25)μmol/L, t=2.117, P<0.05], the levels of SOD, GSH-PX, SOD/MDA of the T2DM+ NAFLD group were (87.15±10.88)U/mL, (78.73±9.57)U, (18.05±2.51), respectively, which were significantly higher than those before treatment(t=2.117, 2.207, 2.228, 3.148, all P<0.05). Conclusion A-LA might prove usefully in the treatment of patients with T2DM and NAFLD by change the oxidative stress. Key words: Diabetes mellitus, Type 2; Fatty liver; Oxidative stress; Thioctic acid

Objective To measure levels of serum resistin in patients with nonalcoholic fatty liver disease (NAFLD) and explore the relationship between serum resistin and insulin resistance,and the role of serum resistin in the pathogenesis and progression of NAFLD.Methods 53 patients (including 30males and 23 females) with NAFLD and the 28 control subjects (including 16males and 12females) were enrolled in this study.The height,weight,waist circumstance,hip girth and blood pressure of all subjects were obtained by standard methods.To all the subjects,the parameters including fasting blood glucose (FBG),triglyceride ( TG),total cholesterol (TC),high-density lipoprotein cholesterol ( HDL-c ),lowdensity lipoprotein cholesterol ( LDL-c ),alanine aminotransferase ( ALT),aspartate aminotransferase (AST)and gamma glutamyl transferase (GGT) were measured.Serum resistin was measured by electrochemiluminescence immunoassay (ECLIA) and fasting serum insulin (FINS) were measured by enzymelinked immunosorbent assay (ELISA).Body mass indexes (BMI),waist hip ratio (WHR),body fat percentage ( BF％ ) were calculated with formula.Homeostasis model assessment was applied to assess the status of insulin resistance index (HOMA-IR).The relationships between serum resistin and various parameters in patients with NAFLD were observed and analyzed by statistical methods.Results There were no significant differences in the number of cases,average age,compositions of sex and BF％ between the NAFLD group and the control group ( P ＞ 0.05).In the NAFLD group,systolic blood pressure ( SBP),diastolic blood pressure(DBP).The waist circumference,hip girth and BMI and WHR were higher than those of control group ( t =3.54,3.32,3.56,5.85,5.56,4.10,P =0.001).There were no significant differences on the level of TC,HDL-c,LDL-c between the NAFLD group and the control group ( P ＞0.05).In the NAFLD group,FBG,TG,AST were higher than those of control group ( P =0.001,P =0.004,P =0.001 ).The levels of serum resistin,FINS,HOMA-IR,ALT and GGT in NAFLD group were significantly higher than those of control group,and there was significant difference between two groups ( P =0.0005).There was no significant correlation between serum resistin and age,BMI,WHR,BF％,FBG,TG,TC,HDL-C,LDL-C,AST in NAFLD group ( P ＞ 0.05).The levels of serum resistin in patients with NAFLD were positively correlated with GGT,ALT,FINS,HOMA-IR ( r =0.354,0.391,0.875,0.881,P ＜0.05 or ＜0.01 ).After multiple stepwise regression analysis,the results showed that HOMA-IR was the most important factor for affecting the levels of serum resistin.The levels of serum resistin in male and female patients with NAFLD were higher than those of control group ( P ＜0.05).But no statistical difference was found between males and females in two groups ( P ＞ 0.05).Conclusions The levels of serum resistin in patients with NAFLD were significantly higher than those of controls.Serum resistin in patients with NAFLD was closely correlated with insulin resistance,and it may participate in the pathogenetic progress of NAFLD.Serum resistin in patients with NAFLD might be associated with hepatic insulin resistance,and it has no correlations with obesity-related insulin resistance.Serum resistin in patients with NAFLD may participate in the inflammation of fatty liver disease as inflammatory cytokines. Key words: Fatty liver/BL; Resistin/BL; Insulin resistance

Treatment of type 2 diabetes mellitus (T2DM) patients with pioglitazone results in a more favorable lipid profile, and perhaps more favorable cardiac outcomes, than treatment with rosiglitazone. Pioglitazone treatment increases VLDL-triacylglycerol clearance, but the role of de novo lipogenesis (DNL) has not been explored, and no direct comparison has been made between the thiazolidinediones (TZDs). Twelve subjects with T2DM and hypertriacylglyceridemia were randomized to either rosiglitazone or pioglitazone treatment. Stable isotope infusion studies were performed at baseline and after 20 weeks of treatment. Both treatments reduced glucose and HbA(1c) concentrations equally. Pioglitazone treatment resulted in a 40% reduction in hepatic DNL (P < 0.01) and in a 25% reduction in hepatic glucose production (P < 0.05), while rosiglitazone did not significantly change either parameter, although comparisons of changes between treatments were not significantly different. These pilot results indicate that pioglitazone reduces hepatic DNL while rosiglitazone does not. Larger follow-up studies are required to confirm differential effects of these agents definitively. The reduction in DNL may underlie altered assembly or atherogenicity of lipoprotein particles and may reflect PPARalpha or other non-PPARgamma actions on the liver by pioglitazone. These differences might help explain previously reported differences in lipid profiles and cardiovascular disease outcomes for rosiglitazone and pioglitazone.

Objective To observe the effect of enteral nutrition therapy on metabolic status and adiponectin levels in elderly patients with metabolic syndrome (MS) complicated with nonalcoholic fatty liver disease (NAFLD). Methods 92 elderly hospitalized patients with mild to moderate non-alcoholic fatty liver disease underwent enteral nutrition (EN, n=46) and total parenteral nutrition (TPN, n=46) for 2 months. Body mass index, triceps skin-fold thickness, waist hip ratio, serum high-molecular weight (HMW) form of adiponectin, fasting blood glucose, postprandial 2-hour blood glucose, glycosylated hemoglobin, plasma insulin, alanine aminotransferase, aspartate aminotransferase, γ-glutamyltransferase, total bilirubin, direct bilirubin, total cholesterol, triglyceride, low density lipoprotein cholesterol, high density lipoprotein cholesterol, the blood pressure and liver ultrasound test were detected.The insulin resistance (HOMA-IR) was used to assess insulin resistance. Results In pre- versus post-treatment, serum level of HMW adiponectin 〔(6.8±4.0)μg/L vs.(7.1±3.9)μg/L, P>0.05 in enteral nutrition〕, and 〔(6.8±3.5)μg/L vs. (5.0±1.1)μg/L(P<0.05)〕in parenteral nutrition were found. The significantly decreased body mass index in the obese patients (P<0.05), significantly improved values of 2-hour blood glucose, glycated hemoglobin, liver function, triglycerides, low-density lipoprotein cholesterol levels (all P<0.05), and no obvious change in HOMA-IR were found after two months of enteral nutrition treatment. There were no significant changes in indicators mentioned above in TPN group after 2 months of treatment. Conclusions Enteral nutrition therapy can improve the glucose metabolism, lipid metabolism, the non-alcoholic fatty liver disease and body mass index, affect the level of adiponectin in the elderly patients with MS and NAFLD. It is vital to body metabolism. Key words: Enteral nutrition; Metabolic syndrome; Fatty liver disease; Adiponectin

Serum phospholipid omega-3 polyunsaturated fatty acids and insulin resistance in type 2 diabetes mellitus and non-alcoholic fatty liver disease

Effect of Dachaihu decoction on non-alcoholic fatty liver disease model rats induced by a high-fat high-sugar diet