Moderate Nonalcoholic Fatty Liver Disease Research Articles

Presence of diabetic retinopathy is lower in type 2 diabetic patients with non-alcoholic fatty liver disease.

To analyze the association between non-alcoholic fatty liver disease (NAFLD) and the presence of diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM).Total 411 T2DM patients were divided into NAFLD and control groups. NAFLD was diagnosed by ultrasound. Retinopathy was diagnosed by fundus photography. All patients were screened based on medical history, physical examinations, and laboratory measurements.The prevalence of NAFLD and DR in T2DM patients was 60.8% and 40.9%, respectively. The presence of DR was associated with diabetes duration, systolic blood pressure (SBP), glycated hemoglobin (HbA1c), and proteinuria (all P < .001) using univariate and multivariate regression analyses. The prevalence of DR was lower in patients with NAFLD than those without NAFLD (37.2% vs 46.6%, P = .065), and significantly lower in patients with moderate and severe NAFLD (30.2% vs 46.6%, P = .012; 14.3% vs 46.6%, P = .024). The presence of DR in NAFLD patients was associated with diabetes duration (P = .032) in Chi-squared analysis.NAFLD and DR were highly prevalent in T2DM patients. Diabetes duration, SBP, HbA1c, and proteinuria were risk factors for DR in T2DM patients. The presence of DR was lower in T2DM patients with NAFLD, which was mainly due to their shorter diabetes duration.

The association between nonalcoholic fatty liver disease and risk of colorectal adenoma and cancer incident and recurrence: a meta-analysis of observational studies

ABSTRACTBackground & aim: Lifestyle modification plays a key role in nonalcoholic fatty liver disease (NAFLD) and colorectal adenoma and/or cancer (CRA/CRC) development. However, the association between NAFLD and the risk of CRA/CRC has not been carefully evaluated.Methods: In this meta-analysis, we assessed 21 eligible studies including 124,206 participants to determine the association between NAFLD and the risk of incident and recurrent CRA/CRC.Results: NAFLD presence was associated with an increased risk of any incident CRA (aOR: 1.30, 95% CI: 1.19–1.43) and advanced incident CRA/CRC (aOR: 1.57, 95% CI: 1.21–2.04). The severity of NAFLD affected this correlation: compared to mild and/or moderate NAFLD, severe NAFLD was associated with an increased risk of incident CRA/CRC (aOR: 2.19, 95% CI: 1.33–3.60). Although pooled cOR revealed that NAFLD was associated with an increased risk of recurrent CRA/CRC (cOR = 1.73; 95% CI: 1.12–2.68), after adjustment for confounding factors, NAFLD had less correlation with the risk of recurrent CRA/CRC (aOR: 1.81, 95% CI: 0.70–4.65).Conclusions: The presence and severity of NAFLD are associated with an increased risk of incident CRA/CRC. However, there is insufficient evidence to indicate that NAFLD is associated with an increased risk of recurrent CRA/CRC.

Evaluation of Plasma Trace Elements in Different Stages of Nonalcoholic Fatty Liver Disease.

Nonalcoholic fatty liver disease (NAFLD) is considered as the hepatic manifestation of metabolic syndrome. Its global prevalence is estimated between 25 and 45%, occurring mainly in overweight individuals with unhealthy dietary habits and low levels of physical activity. Many studies have investigated the association of trace elements with liver diseases, though not with NAFLD. In this work, we investigated trace element levels in plasma of patients and not-patients and their possible association with various stages of the disease. Inductively coupled plasma mass spectrometry (ICP-MS) was employed for the determination of As, Ba, Cd, Co, Cs, Cu, Fe, Rb, Sr, Tl, and Zn in the plasma of 189 free-living residents of Athens, Greece, either healthy or patients with mild, moderate, or severe NAFLD. The disease was diagnosed by abdominal ultrasound; blood samples were analyzed for total, HDL and LDL cholesterol, triglycerides, fasting glucose, fasting insulin, and liver enzymes, namely aspartate aminotransferase (AST), alanine transaminase (ALT), and γ-glutamyltransferase (Gamma-GT); insulin resistance was determined by the homeostatic model assessment (HOMA-IR). Zinc exhibited a statistically significant negative association with the severity of the disease, while cesium showed a statistically significant positive association. Moreover, thallium and iron were inversely associated with insulin levels. Trace element determination in plasma could be useful for establishing relationships with NAFLD status of patients. Further research is required for the verification and interpretation of these findings.

Association of Lipoprotein-Associated Phospholipase A2 with the Prevalence of Nonalcoholic Fatty Liver Disease: A Result from the APAC Study

Nonalcoholic fatty liver disease (NAFLD) is a worldwide chronic liver disease. Few studies have investigated the association between NAFLD and Lipoprotein-associated phospholipase A2 (Lp-PLA2), a unique enzyme correlated with oxidative stress. The aim of this study was to assess the relationship between Lp-PLA2 and NAFLD in a Chinese community-based cohort. A total of 1587 adults aged ≥40 years were enrolled in the current study. Participants underwent a standardized evaluation. The serum Lp-PLA2 concentration was measured by ELISA and NAFLD was diagnosed by ultrasonography. Multivariable logistic regression was used to assess the association between Lp-PLA2 and NAFLD. Increased Lp-PLA2 levels were significantly associated with decreased NAFLD prevalence after adjusting for other potential confounders. The adjusted ORs of NAFLD in Q2, Q3 and Q4 compared with Q1 were 0.88 (0.64–1.21), 0.71 (0.51–0.98) and 0.67 (0.48–0.95), respectively (P < 0.05). Furthermore, the adjusted ORs of moderate and heavy NAFLD in Q2, Q3 and Q4 compared to Q1 were 0.64 (0.41–1.01), 0.48 (0.29–0.80) and 0.47 (0.28–0.79), respectively (P < 0.01). In conclusions, increased Lp-PLA2 levels were independently associated with decreased NAFLD prevalence.

12. A study of staging of non-alcoholic fatty liver disease on the basis of transient elastography

Background and Aims: Globally, non-alcoholic fatty liver disease (NAFLD) has emerged as leading cause of liver diseases. The prevalence of NAFLD in India is about 24–33%. There is scarce data on the relative severity of Indian NAFLD patients. Since fibrosis is the predominant determinant of outcomes in NAFLD, it was deemed prudent to classify NAFLD patients on the basis of severity of fibrosis. Hence this study was designed to classify the incidentally detected NAFLD (IDNAFLD) cases into mild, moderate and severe NAFLD based on Transient elastography (TE). Methods: Consecutive cases of IDNAFLD were subjected to TE during the period from 2016 to 2018 and they were classified based on the median stiffness value ranges derived from a meta-analysis on TE. These cases were classified as mild, moderate and severe if the median stiffness on TE was <6 kPa, 6–8.5 kPa and >8.5 kPa respectively. Results: 296 consecutive cases of IDNAFLD were subjected to TE. Out of them 218 (73.9%) were male and 77 (26.1%) were female. There was a trend towards high median stiffness values among men compared to women (7.10 ± 2.66 vs. 6.48 ± 2.13 kPa; p = 0.06). Patients with age >40 years had significantly higher median stiffness values compared to patients with age <40 years (7.34 ± 2.78 vs. 6.47 ± 2.13 kPa; p = 0.003). As per mentioned criteria for classification of severity of fibrosis in NAFLD patients, the proportion of subjects with mild, moderate and severe fibrosis was 38.3%, 42.7% and 19% respectively. Conclusions: On TE, there was a trend towards higher median stiffness in males compared to females. Patients older than 40 years have significantly higher median stiffness compared to younger patients. Almost a fifth of NAFLD patients have severe fibrosis of liver as measured by median stiffness assessed by TE. The authors have none to declare.

Risk of Ischemic Heart Disease in Patients with Non-alcoholic Fatty Liver Disease

Background and study aim: Non-alcoholic fatty liver disease (NAFLD) has an increasing prevalence worldwide. It has also been closely associated with obesity and metabolic syndrome - two conditions known to be associated with ischemic heart disease (IHD). The aim of this study was to assess the association between NAFLD and ischemic heart disease. Subjects and Methods: 140 patients with NAFLD and 70 non-NAFLD subjects were selected. Full history taking, clinical examination and laboratory tests including blood sugar, lipid profile and liver profile were done. Ultrasonography was performed to prove NAFLD while ECG and echo-cardiography were used for detection of myocardial ischemia. Results: Of the NAFLD group, the frequency of mild, moderate and severe NAFLD was 42.9%, 30% and 27.1% respectively. Subjects with NAFLD had a significantly higher BMI, waist circumference and weight compared to those of non NAFLD group (p=0.014, 0.0218 and <0.001 respectively). Independent risk factors for NAFLD were obesity, DM, high LDL, low HDL, waist circumference, glycated hemoglobin and IHD with odds ratios 1.09, 2.12, 1.01, 1.15, 1.13, 1.37 and 1.17 respectively. While independent risk factors for IHD included obesity, DM, high LDL, total cholesterol, triglycerides and the presence of NAFLD with odds ratios 1.31, 1.23, 1.19, 1.132, 1.68 respectively. Conclusion: NAFLD was independently associated with increased risk of myocardial ischemia.

Serum fetuin A level is associated with nonalcoholic fatty liver disease in Chinese population.

ObjectiveTo investigate the association between serum fetuin A concentration and non-alcoholic fatty liver disease (NAFLD) in Chinese population.MethodsThis case-control study enrolled 79 NAFLD cases and 79 non-NAFLD controls. All subjects were selected from Chinese population who received annual health examination in the First Affiliated Hospital of Zhejiang University in 2016. NAFLD was diagnosed mainly based on abdominal ultrasonography. The severity of NAFLD was categorized by serum level of alanine aminotransferase. Serum fetuin A was measured by ELISA.ResultsSerum fetuin A level in NAFLD patients was significantly lower than that in controls (0.27±0.17 vs. 0.32±0.12g/L, P < 0.05). Compared with controls, mild NAFLD (0.24±0.16 g/L, P < 0.05) and moderate NAFLD (0.25±0.17 g/L, P < 0.05) had significantly lower concentration of Fetuin A, while Fetuin A level tended to slightly increase with the severity of NAFLD. The prevalence rate of NAFLD decreased (75 %, 40 %, and 36 %), as Fetuin A level elevated. ROC curve of Fetuin A was developed to predict the presence of NAFLD. Area under ROC was 0.656.ConclusionSerum level of Fetuin A was lower in NAFLD patients than controls, while Fetuin A level increased with the severity of NAFLD, indicating a potential predicting role of Fetuin A in the development of NAFLD.

Evaluation of Biomarkers in Egyptian Patients with Different Grades of Nonalcoholic Fatty Liver Disease.

Background and Aims: Nonalcoholic fatty liver disease (NAFLD) is a silent disease; its spectrum includes simple steatosis, nonalcoholic steatohepatitis and fibrosis. Pro- and anti-inflammatory cytokines play roles in the pathogenesis of NAFLD and insulin resistance (IR). Moreover, plasma cell antigen-1 (PC-1) is related to IR and associated with NAFLD progression. Therefore, we aimed to detect biomarkers, ultrasonographic and anthropometric findings capable of differentiating NAFLD grades, since most previous investigators were concerned more with NAFLD patients without classifying them into grades.Methods: A total of 87 NAFLD patients (31 with grade 1 (mild NAFLD), 26 with grade 2 (moderate NAFLD) and 30 with grade 3 (severe NAFLD) were included in the study, in addition to 47 controls (grade 0). All subjects underwent ultrasonographic examination for NAFLD diagnosis. Serum interleukin-10 (IL-10), plasma interleukin-18 (IL-18) and plasma PC-1 levels were determined using enzyme-linked immunosorbent assay.Results: Homoeostasis model assessment (HOMA)-IR was higher in different NAFLD grades than in controls. Ultrasonographic and anthropometric findings and lipid profile indices (except for high-density lipoprotein cholesterol, which was decreased) were increased with NAFLD progression. Grade 3 patients showed significant increase in levels of IL-18 and significant decrease in IL-10 and PC-1 levels when compared to grade 1 patients.Conclusion: Anthropometric and ultrasonographic findings were valuable in differentiating NAFLD grades. IR is very important in NAFLD pathogenesis. IL-18, HOMA-index and PC-1 levels could be used to differentiate between NAFLD grades, together with other measurements.

Effect of enteral nutrition treatment on metabolism and serum adiponectin level in elderly patients with metabolic syndrome

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

Endoplasmic reticulum stress contributes to ferritin molecules-mediated macrophage migration via P-selectin glycoprotein ligand-1.

Obesity is associated with elevated serum ferritin and increased macrophage activation and infiltration; however, the causal mechanisms underlying this relationship remain undefined. Serum ferritin and soluble P-selectin glycoprotein ligand (sPSGL)-1 level were higher in obese adolescents and patients with moderate nonalcoholic fatty liver disease (NAFLD) compared with controls (all p < 0.05). Multivariate linear regression revealed that serum ferritin was independently associated with sPSGL-1 (B = 0.249, 95% confidence interval: 0.011-0.487, p = 0.041) after adjustment for covariates. The messenger (m) RNA expression of GRP78/Bip, ferritin, and PSGL-1 in leukocytes was greater in patients with nonalcoholic fatty liver disease than in controls. An animal study showed that a tunicamycin injection (an endoplasmic reticulum stress inducer) triggered serum sPSGL-1 and ferritin elevation (all p < 0.01). An in vitro study revealed that serum ferritin and apoferritin induced tumor necrosis factor-α and sPSGL-1 secretion (all p < 0.01). A wound healing assay showed that PSGL-1 blocking inhibited apoferritin-mediated macrophage migration. GRP78/Bip knockdown by the endotoxin EGF-SubA completely inhibited apoferritin-mediated macrophage migration and PSGL-1 expression at the protein and mRNA levels (all p < 0.05). ER stress associated mechanisms are required for apoferritin-/ferritin-mediated macrophage migration via the PSGL-1-dependent pathway.

Effect of a Low Glycemic Index Mediterranean Diet on Non-Alcoholic Fatty Liver Disease. A Randomized Controlled Clinici Trial.

Non-Alcoholic Fatty Liver Disease (NAFLD) is currently the most common form of liver disease worldwide affecting all ages and ethnic groups and it has become a consistent threat even in young people. Our aim was to estimate the effect of a Low Glycemic Index Mediterranean Diet (LGIMD) on the NAFLD score as measured by a Liver Ultrasonography (LUS). NUTRIzione in EPAtologia (NUTRIEPA) is a population-based Double-Blind RCT. Data were collected in 2011 and analyzed in 2013-14. 98 men and women coming from Putignano (Puglia, Southern Italy) were drawn from a previous randomly sampled population-based study and identified as having moderate or severe NAFLD. The intervention strategy was the assignment of a LGIMD or a control diet. The main outcome measure was NAFLD score, defined by LUS. After randomization, 50 subjects were assigned to a LGIMD and 48 to a control diet. The study lasted six months and all participants were subject to monthly controls/checks. Adherence to the LGIMD as measured by Mediterranean Adequacy Index (MAI) showed a median of 10.1. A negative interaction between time and LGIMD on the NAFLD score (-4.14, 95% CI -6.78,-1.49) was observed, and became more evident at the sixth month (-4.43, 95%CI -7.15, -1.71). A positive effect of the interaction among LGIMD, time and age (Third month: 0.07, 95% CI 0.02, 0.12; Sixth month: 0.08, 95% CI 0.03,0.13) was also observed. LGIMD was found to decrease the NAFLD score in a relatively short time. Encouraging those subjects who do not seek medical attention but still have NAFLD to follow a LGIMD and other life-style interventions, may reduce the degree of severity of the disease. Dietary intervention of this kind, could also form the cornerstone of primary prevention of Type 2 Diabetes Mellitus (T2DM) and cardiovascular disease.

Hepatic NAD(+) deficiency as a therapeutic target for non-alcoholic fatty liver disease in ageing.

Ageing is an important risk factor of non-alcoholic fatty liver disease (NAFLD). Here, we investigated whether the deficiency of nicotinamide adenine dinucleotide (NAD(+) ), a ubiquitous coenzyme, links ageing with NAFLD. Hepatic concentrations of NAD(+) , protein levels of nicotinamide phosphoribosyltransferase (NAMPT) and several other critical enzymes regulating NAD(+) biosynthesis, were compared in middle-aged and aged mice or patients. The influences of NAD(+) decline on the steatosis and steatohepatitis were evaluated in wild-type and H247A dominant-negative, enzymically-inactive NAMPT transgenic mice (DN-NAMPT) given normal or high-fat diet (HFD). Hepatic NAD(+) level decreased in aged mice and humans. NAMPT-controlled NAD(+) salvage, but not de novo biosynthesis pathway, was compromised in liver of elderly mice and humans. Given normal chow, middle-age DN-NAMPT mice displayed systemic NAD(+) reduction and had moderate NAFLD phenotypes, including lipid accumulation, enhanced oxidative stress, triggered inflammation and impaired insulin sensitivity in liver. All these NAFLD phenotypes, especially release of pro-inflammatory factors, Kupffer cell accumulation, monocytes infiltration, NLRP3 inflammasome pathway and hepatic fibrosis (Masson's staining and α-SMA staining), deteriorated further under HFD challenge. Oral administration of nicotinamide riboside, a natural NAD(+) precursor, completely corrected these NAFLD phenotypes induced by NAD(+) deficiency alone or HFD, whereas adenovirus-mediated SIRT1 overexpression only partially rescued these phenotypes. These results provide the first evidence that ageing-associated NAD(+) deficiency is a critical risk factor for NAFLD, and suggest that supplementation with NAD(+) substrates may be a promising therapeutic strategy to prevent and treat NAFLD.

SERUM 25‐HYDROXY D3 LEVELS IN NONALCOHOLIC FATTY LIVER DISEASE

BackgroundIt has become the most common liver disease in the world. Nonalcoholic fatty liver disease (NAFLD) is a wide range of disorders from a simple steatosis to fibrosis/cirrhosis. Although some studies show association between vitamin D and NAFLD; studies showing the association in different severity of NAFLD are limited.AimThe aim of this study to evaluate serum 25‐hydroxy vitamin D 3 levels in different severity of NAFLD.Materials and MethodsFifty three morbidly obese subjects (BMI ≥40 kg/m2) were included into the study. NAFLD activity scores (NAS) were calculated according to liver biopsies and subjects were divided into 3 group; mild NAFLD (n =15, NAS score: ≤2), moderate NAFLD (n =23, NAS score: 3–4), severe NAFLD (n =15, NAS score: ≥5). Blood samples were collected. Liquid chromatography/tandem mass spectrometry was used to analyze the serum vitamin D levels.ResultsSerum 25‐Hydroxy vitamin D 3 levels were significantly lower in moderate and severe NAFLD groups (25.9 ± 9.10 ng/ml and 21.9 ± 7.14 ng/ml, respectively) than the mild NAFLD group (34.5 ± 10.19 ng/ml). Total cholesterol and HDL cholesterol levels were lower in severe NAFLD group (165.0 ± 38.64 mg/dl and 39.8 ±8.33 mg/dl). Furthermore, serum folic acid levels were significantly lower in moderate and severe NAFLD groups (13.8 ± 4.00 nmol/L and 14.9 ± 4.38 nmol/L, respectively) than mild NAFLD group (17.9 ± 3.98 nmol/L). Serum 25‐ Hydroxy D 3 levels and NAS were not significantly different between gender groups. Serum vitamin D levels showed an inverse correlation with NAS (r = −0.332, p &lt; 0.05). NAS levels did not show any significant difference between gender groups.ConclusionSerum 25‐Hydroxy vitamin D 3 levels may differ in different severity of NAFLD.

Hepatic enzyme concentrations as indicators of nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) has emerged as a world-wide problem because it runs an asymptomatic course, ultimately leading to cirrhosis of the liver and portal hypertension, resulting in death. The prevalence of the disease accounts for 3-24% of the population in several countries. Generally there are increased concentrations of hepatic enzymes as markers of liver damage, such as serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT) and gamma glutamyl transferase (GGT). The aim of the present study was to determine the concentrations of hepatic enzymes as markers of NAFLD. The study design was cross-sectional, involving 90 subjects meeting the inclusion and exclusion criteria. The degree of severity NAFLD was determined by ultrasonography and the concentrations of SGOT, SGPT and GGT by automated clinical chemistry analyzer. The results indicated that there were 32 subjects with mild NAFLD (35.6%), 35 subjects with moderate NAFLD (38.9%) and 23 subjects with severe NAFLD (25.6%). There was a significant difference in degree of NAFLD by gender (p&lt;0.05), where severe NAFLD was more frequent in males than in females. Concentrations of SGOT, SGPT and GGT were significantly different between degrees of NAFLD (p&lt;0.05). The conclusion is that SGOT, SGPT and GGT concentrations are indicators of degree of NAFLD.

Nonalcoholic Fatty Liver Disease for Identification of Preclinical Carotid Atherosclerosis.

Nonalcoholic fatty liver disease (NAFLD) is associated with cardiovascular disease, yet whether identification of NAFLD in asymptomatic individuals is helpful over established risk factors remains unknown. A total of 37,799 asymptomatic adults aged 20 years or older who underwent comprehensive health check-up examination, including abdominal and carotid artery duplex ultrasonography (US) were included in the analysis. Nonalcoholic fatty liver disease was diagnosed with US and exclusion of secondary causes of fat accumulation or other causes of chronic liver disease, and graded as mild or moderate to severe fatty liver. Individuals with carotid plaque identified on carotid artery US were considered at risk for cardiovascular disease. Metabolic syndrome (MetS) was defined by the adult treatment panel III criteria. Nonalcoholic fatty liver disease was an independent factor associated with carotid plaque in a dose-dependent manner (odds ratio [OR]; 95% confidence interval [CI]: 1.09 [1.03–1.16] and 1.13 [1.06–1.21] for mild and ≥ moderate degree of NAFLD). Among clinically-relevant subgroups, NAFLD was more closely associated with carotid plaque in young adults (aged < 60 years) without MetS (OR [95% CI]: 1.13 [1.03–1.19] and 1.16 [1.06–1.27] for mild and ≥ moderate degree of NAFLD) than old adults (aged ≥ 60 years) or with MetS (OR [95% CI]: 1.06 [0.97–1.17] and 1.07 [0.97–1.19] for mild and ≥ moderate degree NAFLD). In young adults without MetS, the prevalence of carotid plaques was 32.8% and the sensitivity and specificity of NAFLD for carotid plaque was 0.38 and 0.67, respectively. In conclusion, NAFLD is associated with carotid plaque independent of traditional risk factors, especially in young adults without MetS. Nonalcoholic fatty liver disease could help identify additional individuals with preclinical atherosclerosis in asymptomatic young adults without MetS, yet, showed suboptimal performance as a screening tool.

Association between sonographic diagnosis of fatty liver with histopathologic abnormalities and liver biopsy findings in middle age patient with non-alcoholic fatty liver disease.

Background:Liver biopsy is required to diagnose non-alcoholic steatohepatitis in patients with suspected non-alcoholic fatty liver disease (NAFLD). This study aimed to examine the relationship between sonographic diagnosis of fatty liver with histopathologic abnormalities and liver biopsy findings in patient with NAFLD.Materials and Methods:In this cross-sectional study, a total of 180 patients, with an age range of 18-60 year old, with NAFLD based on ultrasonograghic findings were evaluated. Age, sex, body mass index, diabetes mellitus, hypertension, family history of liver disease and laboratory parameters recorded for all patients. Hence, grade of steatosis and stage of fibrosis were evaluated by liver biopsy.Results:A total of 220 patients were enrolled. Liver biopsy was performed in 180 patients. Mean age was 43 ± 10.6 years old and 66% were male. Ultrasonograghic findings showed mild, moderate and severe NAFLD was define in 100 (55.5%), 72 (40%) and 8 (4.5%) of patients, respectively. Liver biopsies showed that steatosis scores of <5%, 5-33% and 33-66% was define in 56 (31%), 116 (64%) and 9 (5%) of patients, respectively. Furthermore, fibrosis was defined as follow; none 92 (51%), mild 68 (38%), moderate 11 (6%), bridging 5 (3%) and cirrhosis 3 (2%) patients. There was no statistically significant relationship between ultrasonograghic findings and steatosis scores (P = 0.44), but statistically significant relationship was found between ultrasonograghic findings and fibrosis stage (P = 0.017).Conclusion:Findings revealed that, in patients with NAFLD, ultrasonographic finding were not in associate to steatosis, but were in relation with fibrosis stage.

Association Between the Severity of Nocturnal Hypoxia in Obstructive Sleep Apnea and Non-Alcoholic Fatty Liver Damage.

Background:Obstructive sleep apnea (OSA) is a major disease that can cause significant mortality and morbidity. Chronic intermittent hypoxia is a potential causal factor in the progression from fatty liver to nonalcoholic steatohepatitis.Objectives:This study evaluated the association between the degree of liver steatosis and severity of nocturnal hypoxia.Patients and Methods:In this study, between December 2011 and December 2013, patients with ultrasound-diagnosed NAFLD evaluated by standart polysomnography were subsequentally recorded. Patients with alcohol use, viral hepatitis and other chronic liver diseases were excluded. We analyzed polysomnographic parameters, steatosis level and severity of obstructive sleep apnea (OSA) in consideration of body mass index (BMI), biochemical tests and ultrasonographic liver data of 137 subjects. Patients with sleep apnea and AHI scores of < 5, 5 - 14, 15 - 29 and ≥30 are categorized as control, mild, moderate and severe, respectively.Results:One hundred and thirty-seven patients (76 women, 61 men) with a mean age of 55.75 ± 10.13 years who underwent polysomnography were included in the study. Of 118 patients diagnosed with OSA, 19 (16.1%) had mild OSA, 39 (33.1%) moderate OSA and 60 (50.8%) severe OSA. Nineteen cases formed the control group. Apnea/hypopnea index and oxygen desaturation index (ODI) values were significantly higher in moderate and severe non-alcoholic fatty liver disease (NAFLD) compared to the non-NAFLD group. Mean nocturnal SpO2 values were significantly lower in mild NAFLD and severe NAFLD compared to the non-NAFLD group. Lowest O2 saturation (LaSO2) was found low in mild, moderate and severe NAFLD compared to the non-NAFLD group in a statistically significant manner.Conclusions:We assessed polysomnographic parameters of AHI, ODI, LaSO2 and mean nocturnal SpO2 levels, which are especially important in the association between NAFLD and OSAS. We think that it is necessary to be attentive regarding NAFLD development and progression in patients with OSA whose nocturnal hypoxia is severe.

Increased microalbuminuria prevalence among patients with nonalcoholic fatty liver disease

Aim: To determine the prevalence of microalbuminuria, that is an indirect predictor of coronary artery disease, among non-obese and non-diabetic patients with fatty liver disease. Material and method: This retrospective study was carried out on non-obese (body mass index (BMI) < 30) and non-diabetic 290 female and 189 male, totally 479 cases. All subjects underwent liver ultrasonography scanning to determine the presence and stage of fatty liver disease. Results: The subjects were grouped according to the ultrasound findings as follows: 182 (37.9%) cases without any fat accumulation in liver were regarded as control group; and among remaining cases, 124 (25.8%) had mild, 93 (19.4%) had moderate, and 80 (16.7%) had severe fatty liver disease. There was not any statistically significant difference between groups in regards to the age, gender, liver function tests, renal function tests or glomerular filtration rate. However urinary protein/creatinine ratio was statistically significantly higher in severe nonalcoholic fatty liver disease (NAFLD) group than the other three groups. In moderate and severe NAFLD groups, microalbuminuria was statistically significantly more common compared with the control and mild NAFLD groups. Regarding the results of multiple logistic regression analysis, presence of fatty liver disease increased the risk of microalbuminuria for 1.87 times independently from increased BMI and increased HOMA-IR values. Conclusion: We have determined that microalbuminuria is more prevalent among NAFLD cases compared with control cases and microalbuminuria prevalence was increasing with the advanced stages of NAFLD although two main etiologic factors of microalbuminuria, type 2 diabetes, and obesity were excluded.

Relationship between serum retinol-binding protein 4 and non-alcoholic fatty liver disease in schizophrenia

Objective To investigate the serum retinol-binding protein 4 (RBP4) level in olanzapine-treated schizophrenia with non-alcoholic fatty liver disease (NAFLD) via a case-control study and to explore its relationship with NAFLD. Methods Schizophrenia receiving olanzapine treatment, with or without NAFLD were enrolled as cases (n=60) or controls (n=60). The serum retinol-binding protein 4, metabolic syndrome component including body mass index (BMI), waist-to-hip ratio (WHR), fasting plasma glucose (FPG), total cholesterol (TG), total glycerin (TC) and blood pressure were assayed. TyG index, CT value ratio of liver and spleen were used for insulin resistance or NAFLD diagnosis and severity assessment respectively. Results The serum level of RBP4 was significantly higher in cases than that in controls ((70±13)mg/L vs (52±12)mg/L ; t=4.943, P<0.01) and the same result was showed after influencing factor adjustment thru covariance analysis (F=16.797, P<0.01). Moreover, cases had significantly higher TyG index, BMI, WHR, FPG, TG and systolic pressure (t=2.383-4.300, P<0.05-0.01). Cases with severe or moderate NAFLD had significantly elevated serum RBP4 level compared with mild cases((79±16)mg/L, (72±8)mg/L vs (63±9)mg/L, d=16.2, 9.9; P<0.01, 0.05). A significantly negative correlation between RBP4 level and the CT value ratio of liver and spleen (r=-0.244, P<0.05), and a significantly positive correlation between RBP4 level and TyG index, BMI, WHR, TG(r=0.197-0.244, all P<0.05) were observed. The partial coefficient between RBP4 level and CT value of liver and spleen was significant with influence adjusted(r=-0.453, P<0.01). Logistic regression showed that serum RBP4 level(β=0.105, P<0.01)and TyG index, hyperlipidemia, obesity, central obesity or high blood pressure (β=1.288-9.711, P<0.05-0.01) were closely associated with NAFLD. Conclusion A heighten serum RBP4 level may be one of NAFLD risk factors in schizophrenia treated with olanzapine. Key words: Retinol-binding protein 4; Non-alcoholic fatty liver disease; Schizophrenia; Metabolic syndrome

Nonalcoholic fatty liver disease is associated with significant coronary artery disease in type 2 diabetic patients: a computed tomography angiography study 2：.

To investigate whether nonalcoholic fatty liver disease (NAFLD) is associated with coronary artery disease (CAD) in type 2 diabetic patients, who underwent coronary computed tomography angiography (CTA). Between June 2007 and May 2010, a total of 273 type 2 diabetic patients without known liver disease underwent coronary CTA for chest pain were enrolled. Axial, multiplanar, and Maximum intensity projection (MIP) images were used for determining the cardiovascular disease. Liver fat content was measured from unenhanced CT images obtained for calcium scoring. Moderate and severe NAFLD was defined when mean liver attenuation value is ≤40 Hounsfield Unit (HU). Among 273 patients, 76% of the patients (n = 207) had CAD; 48% of them had significant CAD (≥50 stenosis) by coronary CTA. Patients with CAD were older and male gender was predominant. Mean liver attenuation value calculated with CT was 50 ± 12 HU. Mean liver attenuation value was lower in patients with metabolic syndrome compared to patients without metabolic syndrome (P < 0.001). Moderate and severe NAFLD was observed in 22% of the patients (n = 59) with a mean attenuation value of 30 HU. After adjustment of age, gender, obesity, hypertension, smoking status and serum low-density lipoprotein (LDL) levels as coronary risk factors, NAFLD was associated with significant CAD (P = 0.04). In conclusion, the results of the present study indicate that NAFLD is associated with significant CAD in type 2 diabetic patients. Assessment of liver attenuation by CT represents noninvasive evaluation for detection of asymptomatic individuals with NAFLD during coronary CT angiography.