non-NAFLD Group Research Articles

Insulin resistance, body composition, and fat distribution in obese children with nonalcoholic fatty liver disease.

The aim of this study was to evaluate the influence of body composition, especially distribution of body fat, and insulin resistance on nonalcoholic fatty liver disease (NAFLD) in obese children. One hundred obese children (66 boys, 34 girls) with (n=60) and without NAFLD (n=40) were assessed. Anthropometry, laboratory tests, abdominal ultrasonography, and dual energy x-ray absorption metry (DXA) were evaluated in all subjects. Subject age and measurements of liver enzymes, γ- glutamyl transpeptidase (γGT), uric acid, high-density lipoprotein cholesterol, and insulin resistance were significantly different between the non-NAFLD group and NAFLD group. Body fat and trunk fat percentage were significantly different between the two groups (p<0.001 and p=0.003), whereas extremity fat percentage was not (p=0.683). Insulin resistance correlated significantly with body fat and trunk fat percentages, age, liver enzymes, γGT, and uric acid in obese children. Multiple logistic regression analysis indicated that insulin resistance and trunk fat percentage significantly affected the development of NAFLD in obese children. Body fat, especially abdominal fat, influences the development of insulin resistance and subsequent NAFLD in obese children. Therefore, body composition measurement using DXA, in conjunction with biochemical tests, may be beneficial in evaluating obese children with NAFLD.

I148M variant in PNPLA3 reduces central adiposity and metabolic disease risks while increasing nonalcoholic fatty liver disease

The I148M variant because of the substitution of C to G in PNPLA3 (rs738409) is associated with the increased risk of nonalcoholic fatty liver disease (NAFLD). In liver, I148M variant reduces hydrolytic function of PNPLA3, which results in hepatic steatosis; however, its association with the other clinical phenotype such as adiposity and metabolic diseases is not well established. To identify the impact of I148M variant on clinical risk factors of NAFLD, we recruited 1363 generally healthy Korean males after excluding alcoholic and secondary causes of hepatic steatosis. Central adiposity was assessed by computed tomography, and hepatic steatosis was evaluated by abdominal ultrasonography. The participants were predominantly middle-aged (49.0 ± 7.1 years; range 30-60 years), and the frequency of NAFLD was 44.2%. The rs738409-G allele carriers had a 1.19-fold increased risk for NAFLD (minor allele frequency 0.43; allelic odds ratio 1.38; P = 4.3 × 10(-5) ). Interestingly, the rs738409 GG carriers showed significantly lower levels of visceral and subcutaneous adiposity (P < 0.001 and = 0.015, respectively), BMI (P < 0.001), triglycerides (P < 0.001) and insulin resistance (P = 0.002) compared to CC carriers. These negative associations between clinical risk factors and rs738409-G dosage were more prominent in non-NAFLD group compared to those in NAFLD group. The I148M variant, although increasing the risk of NAFLD, was associated with reduced levels of central adiposity, BMI, serum triglycerides and insulin resistance, suggesting differential roles in fat storage and distribution according to cell types and metabolic status.

Independent Association Between Improvement of Nonalcoholic Fatty Liver Disease and Reduced Incidence of Type 2 Diabetes.

Only a few studies have evaluated the long-term effects of nonalcoholic fatty liver disease (NAFLD) on type 2 diabetes mellitus (T2DM), and none have examined whether NAFLD improvement reduces T2DM incidence. We investigated the association between NAFLD improvement and T2DM incidence. Between 2000 and 2012, 4,604 participants who underwent a health check twice with >10 years between were enrolled. Exclusion criteria were positive hepatitis B surface antigen, positive hepatitis C antibody, ethanol intake >20 g/day, and diabetes. The 3,074 eligible participants were divided into an NAFLD group (n = 728) and a non-NAFLD group (n = 2,346) according to ultrasonography-detected fatty liver. The NAFLD group was categorized into an improved group (n = 110) and a sustained NAFLD group (n = 618) based on fatty liver disappearance at the second visit. Incident T2DM odds ratios (ORs) were estimated by logistic regression models adjusted for age, sex, BMI, impaired fasting glucose, family history of diabetes, dyslipidemia, hypertension, and physical exercise. T2DM occurred in 117 participants (16.1%) in the NAFLD group and 72 (3.1%) in the non-NAFLD group. NAFLD at baseline was associated with T2DM incidence (multivariate OR 2.37 [95% CI 1.60-3.52]). T2DM occurred in 7 participants (6.4%) in the improved group and in 110 (17.8%) in the sustained NAFLD group. NAFLD improvement was associated with reduced T2DM incidence (multivariate OR 0.27 [95% CI 0.12-0.61]). NAFLD improvement is associated with T2DM incidence reduction.

Serum microRNAs explain discordance of non-alcoholic fatty liver disease in monozygotic and dizygotic twins: a prospective study

ObjectiveIn the setting where two individuals are genetically similar, epigenetic mechanisms could account for discordance in the presence or absence of non-alcoholic fatty liver disease (NAFLD). This study investigated if...

Non‐alcoholic fatty liver disease predicts type 2 diabetes mellitus, but not prediabetes, in Xi'an, China: a five‐year cohort study

Emerging studies have focused the association between non-alcoholic fatty liver disease (NAFLD) and the risk of type 2 diabetes mellitus (T2DM) but the results were inconsistent. In addition, few studies have put focus on the association between NAFLD and the risk of prediabetes. We aimed to investigate whether NAFLD diagnosed by ultrasonography could predict the risk of future T2DM and prediabetes in Chinese population. The population-based cohort study held in Xi'an, Northwestern China, was based on China National Diabetes and Metabolic Disorders Survey. During a follow-up of 5years, 508 healthy subjects were included as study sample. NAFLD was determined by abdominal ultrasonography. T2DM and prediabetes were diagnosed based on oral glucose tolerance test. Of 508 subjects, 97 (19.1%) were diagnosed as NAFLD and 411 (80.9%) were as non-NAFLD; 20 (3.9%) developed diabetes and 85 (16.7%) developed prediabetes during follow-up. The incidence of diabetes and prediabetes in the NAFLD group was 20.6 and 51.6 per 1000 person-years, respectively, whereas that in non-NAFLD group was 4.9 and 29.2 per 1000 person-years respectively. Cox proportional hazard regression showed that the multivariable-adjusted relative risk (RR) of T2DM and prediabetes in the NAFLD group was 4.462 [95% confidence interval (CI): 1.855-10.734, P<0.001] and 1.642 (95% CI: 0.965-2.793, P=0.067), respectively, compared with non-NAFLD group. Non-alcoholic fatty liver disease was a significant predictor for future diabetes, but not for prediabetes, in Xi'an, China. More cohort studies are needed to confirm our findings.

A prospective study of serum fibroblast growth factor 21 changes in nonalcoholic fatty liver patients

To investigate the prospective association of fibroblast growth factor 21 (FGF-21) with NAFLD development in a 5-year prospective study involving a population-based cohort comprising 352 Chinese subjects. The clinical data of subjects were recorded, serum FGF-21 levels at baseline and follow-up were measured using an enzyme-linked immunosorbent assay,whether FGF-21 was independent predictor of NAFLD development were identified using logistic regressions. Chi-square test, non-parametric test and logistic regression analysis were used in statistical analyses. (1) Serum FGF-21 levels of NAFLD group was significantly higher than that of non-NAFLD group (318.34(169.64,520.77)pg/ml vs 197.22 (121.57, 318.76) pg/ml, Probability value less than 0.05). (2)At follow-up,significant increase of FGF-21 level was observed in those subjects who developed NAFLD (399.4 (253.9,754.2) pg/ml vs 318.34(169.64, 520.77)pg/ml, Probability value less than 0.05), but in non-NAFLD group, there was no significant difference of FGF-21 level between baseline and follow-up. (3) BMI, TC, HOMA-IR and FGF-21 were independent predictors of NAFLD through logistic regressions. High FGF-21 levels was independent predictor of NAFLD, it may be useful for early diagnosis and intervention of NAFLD.

Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) is known to be associated with an increased risk of colorectal cancer (CRC). However, the relationship between NAFLD and the prognosis of CRC remains unclear. The primary objective of this study was to evaluate the overall survival (OS) and disease-free survival (DFS) rates in patients with CRC and the secondary objective was to compare clinicopathologic variables which were stratified by NAFLD.We performed a large cohort study of 1314 patients who were first diagnosed with CRC between January 2006 and April 2011. Postoperative follow-up data were collected from out-patient medical records, telephone consultations, and social security death indices. The Kaplan–Meier method was used to calculate the cumulative survival rate. Clinicopathologic variables were analyzed by univariate analysis and multivariate analysis through a Cox proportional hazard regression model.The mean follow-up time was 52.7 ± 25.3 months. Upon baseline comparison, the NAFLD group had significantly higher values of body mass index, triglycerides, and uric acid and significantly lower values of high-density lipoprotein, compared with the non-NAFLD group (P < 0.05 for all). There were no significant differences between the 2 groups with regard to tumor location, TNM staging, tumor differentiation, carcinoembryonic antigen, and vascular invasion. The cumulative 1-, 3-, and 5-year OS rates were 96.1%, 85.2%, and 80.6%, respectively, in the NAFLD group, which were statistically significantly higher than the OS rates of 91.6%, 76.2%, and 67.8%, respectively, in the non-NAFLD group (P = 0.075, P = 0.002, P = 0.030, respectively). There was no difference in DFS rates between the CRC patients with and without NAFLD (P = 0.267). Multivariate analysis showed that the presence of NAFLD was an independent negative risk factor for OS after adjusting for clinicopathologic covariates (hazard ratio = 0.593; 95% confidence interval 0.442, 0.921; P = 0.020), but not for DFS (P = 0.270).NAFLD may play a protective role in OS for CRC patients. Further studies are needed to elucidate the molecular mechanisms of putative protective effects in CRC patients with NAFLD.

Free triiodothyronine levels are positively associated with non-alcoholic fatty liver disease in euthyroid middle-aged subjects

Background: Studies on the relationship between thyroid function and non-alcoholic fatty liver disease (NAFLD) among euthyroid subjects have produced conflicting results. Objectives: The aim of this study was to investigate the association between thyroid function and the presence of NAFLD in a large-sample middle-aged euthyroid subjects. Methods: A total of 2576 euthyroid subjects who underwent health check-up were included. NAFLD was diagnosed by hepatic ultrasonography. Conventional risk factors for NAFLD were assessed as well as serum levels of TSH, FT3 and FT4. Results: Levels of FT3 were significantly higher in NAFLD group (5.12 ± 0.58 versus 4.84 ± 0.58 pmol/L, adjusted p = 0.000) than non-NAFLD group, while levels of TSH and FT4 were comparable between NAFLD and non-NAFLD groups (TSH: 2.13 ± 0.90 versus 2.20 ± 0.93 mIU/L, adjusted p = 0.190; FT4: 16.41 ± 2.04 versus 16.18 ± 2.06 pmol/L, adjusted p = 0.146, respectively). Levels of FT3 were positively correlated with components of metabolic syndrome. Multivariate logistic regression analysis revealed that high level of FT3 was an independent predictor for NAFLD (odds ratio: 1.253, p = 0.040). The relationship between FT4 and NAFLD in women was different according to menopausal status, with negative association in pre-menopausal women (OR: 0.777, 95% CI: 0.617–0.979, p = 0.032) and null association in post-menopausal women (OR: 1.037, 95% CI: 0.841–1.277, p = 0.736). Conclusions: Our findings suggested that high levels of FT3 were significantly associated with NAFLD among middle-aged euthyroid subjects independently of known metabolic risk factors. A negative correlation of serum FT4 level with NAFLD was only observed in pre-menopausal women.

Thyroid Function in Obese Children with Non-Alcoholic Fatty Liver Disease

Ob­jec­ti­ve: To investigate the relationships between thyroid function and metabolic risk factors in obese adolescents with non-alcoholic fatty liver disease (NAFLD).Methods: One hundred sixty obese adolescents and 40 control subjects were enrolled in the study. The obese subjects were divided into two groups based on presence or absence of liver steatosis (NAFLD group and non-NAFLD group). Serum samples were assayed for glucose, insulin, cholesterol, alanine aminotransferase, aspartate aminotransferase, free thyroxine (fT4), free triiodothyronine (fT3) and thyroid-stimulating hormone (TSH). The ratio of fT3 to fT4 was evaluated as an indirect index of deiodinase activity. Insulin resistance was evaluated by homeostasis model assessment (HOMA-IR) from fasting samples.Results: NAFLD and non-NAFLD groups had slightly higher fasting blood glucose values than the control group. Fasting insulin levels in the NAFLD group were significantly higher than those in the non-NAFLD and control groups. The NAFLD group had significantly greater HOMA-IR values compared with the non-NAFLD group and also with the control group. The NAFLD group had significantly higher fT3/fT4 ratio values compared to both non-NAFLD and control groups. fT3/fT4 was positively correlated with serum insulin levels in the NAFLD group. Conclusion: This study showed that obese adolescents with hepatosteatosis had elevated values for fT3/fT4 ratio. This finding suggested a high conversion of T4 to T3 due to increased deiodinase activity as a compensatory mechanism for fat accumulation.

Relationship between serum uric acid levels and hepatic steatosis in non-obese postmenopausal women

Objective Serum uric acid levels have been reported to be associated with non-alcoholic fatty liver disease (NAFLD). However, very few studies specifically examining the relationship between serum uric acid (SUA) levels and NAFLD in postmenopausal women have been reported in China, especially in postmenopausal women with normal body mass index (BMI) in whom NAFLD is not uncommon.Methods A cross-sectional study was employed of 528 Chinese normal-BMI postmenopausal women (aged 41–79 years) who participated in annual health check-ups. NAFLD is defined as a hepatic steatosis observed on liver ultrasonography in the absence of a second cause. Of all the participants, 121 women were diagnosed with hepatic steatosis (NAFLD group) and the others were without (non-NAFLD group). SUA quartiles were defined as follows: Q1, < 3.8 mg/dl; Q2, 3.8–4.4 mg/dl; Q3, 4.5–5.0 mg/dl; Q4, 5.1–6.0 mg/dl. Stepwise multivariable regression analysis was used to assess the relationships between SUA level and other variables. The association between SUA quartiles and hepatic steatosis was assessed using binary logistic regression.Results Compared to the non-NAFLD group, the mean level of SUA was significantly higher in the NAFLD group (p < 0.01). The adjusted odds ratio (95% confidence interval) for the presence of hepatic steatosis in the highest SUA quartile vs. the lowest quartile was 2.774 (1.396–5.513) for all women (p < 0.01) after adjusting for the factors which were independently associated with uric acid level including waist circumference, high blood pressure, blood urea nitrogen, creatinine, γ-glutamyltransferase, and triglycerides. Most estimates changed little after further adjustment for age, metabolic syndrome, drinking status, and smoking status. The presence of hepatic steatosis significantly increased in the third and fourth quartiles of SUA. The prevalence of hepatic steatosis increased gradually with an increasing SUA quartile (p for trend < 0.01).Conclusion Higher SUA levels even within the normal range are positively and independently associated with the presence of hepatic steatosis in Chinese postmenopausal women with normal BMI.

PNPLA3 genotype increases susceptibility of nonalcoholic steatohepatitis among obese patients with nonalcoholic fatty liver disease

BackgroundThe patatin-like phospholipase domain-containing protein 3 (PNPLA3) rs738409 variant is associated with histologic disease severity in patients with nonalcoholic fatty liver disease (NAFLD); however, whether the PNPLA3 genotype has an effect on susceptibility of nonalcoholic steatohepatitis (NASH) from NAFLD among severely obese patients remains unclear. The objective of this study was to investigate the role of the PNPLA3 genotype on NASH in severely obese Asian patients with NAFLD. MethodsThe PNPLA3 rs738409 genotype was determined in 181 severely obese patients who underwent bariatric surgery. The diagnosis of NASH and the NAFLD activity score (NAS) were determined by liver histopathology. ResultsOf the 181 patients, 29 (16.0%), 60 (33.2%), and 92 (50.8%) were in the non-NAFLD, steatosis, and NASH groups, respectively. The PNPLA3 rs738409 GG genotype was associated with higher liver enzymes and a higher risk for NASH (odds ratio [OR], 3.72; 95% CI, 1.25–11.05). The GG genotype was also associated with histologic severity of NAFLD, including higher steatosis grade (OR, 9.94; 95% CI, 2.20–44.83 for patients with grade 3 steatosis) and NAS (OR, 11.49; 95% CI, 2.50–52.83 for patients with a NAS ≥5). Finally, multiple logistic regression also showed that the GG genotype was an independent risk factor for NASH (OR, 3.58; 95% CI, 1.15–11.12) in NAFLD patients. ConclusionThe PNPLA3 rs738409 GG genotype increases susceptibility of NASH in severely obese Asians with NAFLD and correlates to histologic severity of NAFLD.

The cytokeratin-18 fragment level as a biomarker of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus

BackgroundThe serum cytokeratin-18 fragment (CK-18) concentration has been suggested to be a biomarker of nonalcoholic fatty liver disease (NAFLD), although its usefulness in patients with type 2 diabetes mellitus (T2DM) is unknown. MethodsThe study was divided into two parts. In the first cross-sectional study, a total of 200 patients with T2DM and 58 healthy control subjects were recruited. NAFLD was diagnosed using ultrasonography. In the subsequent longitudinal study, we evaluated the three-month change (Δ) in the CK-18 concentration and other parameters in 40 T2DM patients with NAFLD. ResultsThe serum CK-18 values were significantly higher in the NAFLD group than in the nonNAFLD group among both diabetic and nondiabetic subjects. The CK-18 concentration was found to be an independent determinant of NAFLD and was positively correlated with the ultrasonography score and AST and ALT concentrations in the T2DM patients. Positive correlations were also identified between the CK-18 and transaminase concentrations in the T2DM and NAFLD cohorts. ΔCK-18 was found to be significantly associated with ΔBMI in the T2DM patients with NAFLD. ConclusionsA dose effect between the CK-18 concentration and the severity of NAFLD was found in the T2DM patients; thus, the CK-18 concentration is a potentially useful biomarker for assessing the efficacy of treatment and the improvement in NAFLD in patients with T2DM.

Association of nonalcoholic fatty liver disease with cardiovascular risk factors in obese adolescents: the role of interdisciplinary therapy.

Obesity is associated with several cardiovascular risk factors, including nonalcoholic fatty liver disease (NAFLD). These risk factors can induce changes in the arteries such as an increase in the carotid intima-media thickness (cIMT), which contributes to the early development of atherosclerosis. To determine whether NAFLD is associated with an atherogenic lipid profile, inflammatory markers, or cIMT in obese adolescents and to compare the effects of therapeutic lifestyle changes in NAFLD and non-NAFLD groups. A total of 79 obese adolescents were divided into two groups: 33 NAFLD and 46 non-NAFLD. They were submitted to an interdisciplinary therapy involving diet exercise and psychological support during the course of 1 year. The cIMT and estimates of fat mass (liver, intra-abdominal, and subcutaneous) were determined ultrasonographically. Body composition, glucose, lipid profile, and adipokines were analyzed before and after the therapy. At baseline, only in the NAFLD group was the homeostasis model assessment of insulin resistance positively correlated with cIMT and triglyceride/high-density lipoprotein cholesterol ratio. Therapy was associated with an increase in adiponectin concentrations and reduced visceral fat, cIMT, leptin, and plasminogen activator inhibitor-1 concentrations, as well as the ratios of total cholesterol/high-density lipoprotein cholesterol and triglycerides/high-density lipoprotein cholesterol in both groups. Only in the non-NAFLD group did therapy result in a reduction in the low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio and increased high-density lipoprotein cholesterol concentration. In obese adolescents, NAFLD is associated with cardiovascular risk factors and inflammatory markers of atherosclerosis that were positively correlated with cIMT only in the NAFLD group. Nevertheless, the strength of the present study is that the interdisciplinary therapy effectively improved cIMT and other proinflammatory adipokines in both groups.

Associations between nonalcoholic fatty liver disease and obstructive sleep apnea syndrome

Objective To explore the relativity of nonalcoholic fatty liver disease(NAFLD)and obstructive sleep apnea syndrome (OSAHS). Methods A total of 1 693 patients were randomly recruited from 2005 to 2009 from in-hospital hypertensive patients checked by polysomnography (PSG) at our Sleep Center. Among them, 841 patients were diagnosed with fatty liver and another 852 non-fatty liver by type B ultrasound. The subjects underwent PSG and were divided into 4 groups according to apnea-hypopnea index (AHI). The indices of NAFLD and non-NAFLD groups, including age, gender, abdominal girth, body mass index (BMI), apnea hypopnea index (AHI), lowest arterial oxygen saturation, total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and fasting blood-glucose(FBG), were analyzed. Results Gender, age, TC[(4.5±1.0) vs.(4.4±0.9) mmol/L], TG[(2.4±2.0) vs.(2.1±1.8) mmol/L], LDL-C [(2.69±0.76) vs.(2.60±0.75) mmol/L], FBG [(5.3±1.4) vs.(5.0±1.1) mmol/L], ALT[(33±23) U/L vs.(30±21)U/L]and LDH[(169±37) vs.(163±36) U/L]α-HDBH [(134±29) vs.(130±29) U/L] had significant differences between OSAHS and non-OSAHS groups (P<0.05). The proportion of fatty liver was 52.3% in OSAHS group versus 40.9% in non-OSAHS group. Patients in severe OSAHS group had a higher detection rate of NAFLD than the other three groups (P<0.05). Multivariate logistic regression suggested that AHI, BMI, FBG, TC and TG/HDL-C were risk factors of fatty liver(P<0.05)while age was a protective factor(P<0.05). Conclusion There are correlations between OSAHS and NAFLD. And patients in severe OSAHS group have a higher detection rate of NAFLD. Key words: Sleep apnea syndromes; Fatty liver; Association studies

Association of nonalcoholic fatty liver disease and albuminuria in patients with type 2 diabetes mellitus

Objective To investigate the prevalence and risk fatcors of nonalcoholic fatty liver disease (NAFLD) and its relationship with albuminuria in in-patients with type 2 diabetes mellitus (T2DM).Methods A total of 1 205 in-patients with T2DM were enrolled in this study.The patients were divided into NAFLD group and nonNAFLD group by mean of liver uhrasonography,and into negative albuminuria group (NA) and albuminuria group (AU) according to albumin-to-creatinine ratio.The general information and laboratory data of patients were collected.Chi-square test and binary logistic regression analysis were conducted.Results (1) The prevalence of NAFLD in the patients with T2DM was 60.8％.Binary logistic regression revealed that NAFLD was positively correlated with triglyceride,body mass index (BMI),fasting plasma glucose,waist circumference,diastolic blood pressure,and systolic blood pressure (SBP),and negatively correlated with serum creatinine,duration of diabetes,AU,and high density lipoprotein-cholesterol (HDL-C,all P＜0.05).(2) The prevalence of AU was 31.0％ in these patients.Binary logistic regression revealed that AU was positively correlated with total cholesterol (TC),HbA1C,BMI,duration of diabetes,SBP,and creatinine; and negatively correlated with NAFLD and HDL-C (all P ＜0.05).(3) As subjects were divided into three groups based on their age,the prevalence of NAFLD was decreased and that of AU was increased with aging and diabetes duration (all P＜0.05).The prevalence of NAFLD in patients with AU was significantly lower than that in patients without AU (53.4％ vs 64.2％,P＜0.05).Partial correlations analysis indicated no significant correlation between NAFLD and AU after being adjusted by age and duration of diabetes(P＞0.05).Conclusions With aging and prolonged diabetes,the prevalence of NAFLD is decreased and that of AU is increased.NAFLD is negatively correlated with AU,but this correlation does disappear after adjustment for age and duration of diabetes. Key words: Diabetes mellitus, type 2; Nonalcoholic fatty liver disease; Albuminuria

Relationship between normal serum uric acid levels and nonalcoholic fatty liver disease in postmenopausal women

To analyze the relationship between normal serum uric acid (SUA) levels and nonalcoholic fatty liver disease (NAFLD) among postmenopausal women, and determine the possible risk factors of NAFLD in this patient population. Chinese postmenopausal women who participated in the annual health check-up program from March 2009 to February 2010 were retrospectively assessed to identify individuals with SUA within normal range for study inclusion. For the total 1425 study participants, the recorded data of anthropometric parameters, metabolic factors, and serum biochemical parameters were collected. Results from abdominal ultrasonography examination were used to group participants according to presence of fatty liver. Women with fatty liver were divided into NAFLD and non-NAFLD groups. Further sub-grouping was performed according to SUA quartiles, as follows: Q1 group: less than 226.1 mumol/L); Q2 group: 226.1 mumol/L less than or equal to SUA less than 267.8 mumol/L; Q3 group: 267.8 mumol/Lless than or equal to SUA less than 303.5 mumol/L); Q4 group: 303.5 mumol/Lless than or equal toSUAless than or equal to357.0 mumol/L. The independent-sample t-test was used to compare normally distributed variables between groups, and the Mann-Whitney U test was used to analyze variables with skewed distribution. Categorical variables were examined by the R * C x2 test. Binary logistic analysis was used to determine the risk factors for fatty liver and to adjust for possible confounders. The multiple non-parameter independent-sample test (Kruskal-Wallis test) was used to compare the differences of SUA levels among NAFLD groups with different disease severity. The prevalence of NAFLD among Chinese postmenopausal women with normal SUA was 32.8%, with NAFLD prevalences of 20.4% (70/343) in women with Q1 SUA, 26.3% (104/395) with Q2 SUA, 35.2% (128/364) with Q3 SUA, and 51.4% (166/323) with Q4 SUA. The prevalence of fatty liver showed a significant increasing trend according to the SUA quartile (x2 = 76.470, P-trend less than 0.01). Women in the SUA Q3 and Q4 groups had significantly higher risk of fatty liver presence than women in the Q1 group (P less than 0.01 for both, with or without adjustment of confounders). Disease severity did not appear to be related to disease severity, as the SUA levels in women with mild, moderate or severe fatty liver were not significantly different (286.8+/-48.2 mumol/L vs. 277.9+/-53.0 mumol/L vs. 281.4+/-48.2 mumol/L, respectively; x2 = 3.025, P more than 0.05). SUA levels were independently correlated with NAFLD in Chinese postmenopausal women. SUA levels in the higher quartiles of the normal range may be an independent risk factor of NAFLD.

Low serum sex hormone‐binding globulin is associated with nonalcoholic fatty liver disease in type 2 diabetic patients

Studies have indicated that low serum sex hormone-binding globulin (SHBG) and testosterone levels are associated with nonalcoholic fatty liver disease (NAFLD). However, it remains unclear whether an association exists between SHBG and NAFLD independent of testosterone. This study was aimed to investigate the relationship between SHBG and both total and free testosterone levels with NAFLD. One hundred and twenty patients with NAFLD and 120 age-, sex- and BMI-matched patients with non-NAFLD were enrolled into a case-control study. Serums SHBG, total testosterone (TT), liver enzymes, lipids, insulin, C-peptide and plasma glucose were measured. Free testosterone (FT) and fatty liver index were calculated. Serum SHBG levels were significantly lower in NAFLD group than in non-NAFLD group (24·5 ± 11·0 vs 37·6 ± 14·4 nm, P < 0·001). After adjustment for age, smoking status, alcohol use, duration of diabetes, BMI and fasting C-peptide, serum SHBG levels in men and women were inversely associated with NAFLD, with odds ratio (OR) and 95% confidence interval (CI) in the forth quartile as 0·05 (0·01-0·30) and 0·25 (0·08-0·77) compared with the first quartile (OR = 1·00). Additional adjustment for TT in men and FT in women did not materially alter the association. The relationship between serum TT (for men) and FT (for women) with NAFLD was attenuated and even diminished after multivariable adjustment for known risk factors and SHBG. Low serum SHBG levels, but not TT or FT, are associated with NAFLD in type 2 diabetic patients.

Cross-sectional study of multiple metabolic disorders in patients with essential hypertension and nonalcoholic fatty liver disease

Objective To investigate the incidence of non-alcoholic fatty liver disease (NAFLD) in essential hypertension patients and the relation between NAFLD and multiple metabolic disorders. Methods Cross-sectional study.Between January 2006 and July 2008,1109 inpatients in Beijing Anzhen hospital diagnosed with essential hypertension were enrolled into this study (542 femal,567 male,mean age 61±11).All patients had ultrasound screening for fatty liver.The prevalence of NAFLD,serum alanine aminotransferase abnormality ratio,the relationship between NAFLD and multiple metabolic abnormalitiesincluding glucose,dyslipidemia,hyperuricemia.471 cases of non-EH as a control group in the same period of admission (216 femal,255 male,mean age 62±10).The measurement data of two groups were compared with t test,while the count data were compared withχ2test.Multiple Logistic regression was used to analysis therisk factors of EH with NAFLD. Results Among 1109 recruited patients,37.3% (414/1109) had fatty liver by ultrasonography.EH patients were divided into NAFLD group and non-NAFLD group.In EH co-existed with NAFLD group,the prevalence of diabetes mellitus (21.0%∶10.8%),metabolic syndrome (59.4%∶44.7%),overweight (71.3%∶62.9%) and the levels of BMI (26.90±3.66∶26.35±3.56),TC (5.30±1.17∶5.12±1.09),TG (2.11±1.43∶1.85±1.33),ALT (45.18±37.62∶39.22±32.27) were significantly higher than those in the non-NAFLD group (P<0.05).HDL-C (1.53±0.53:1.62±0.54) was significantly lower than that in the non-NAFLD group (P<0.05).In non-NAFLD group,prevalence of overweight and the levels of BMI,TC,TG,ALT were significantly higher than those in non-EH group (P<0.01).By multivariable logistic regression analysis,diabetes mellitus, hypercholesteremia,hyperuricemia and BMI were risk factors in NAFLD patients with essential hypertension. Conclusion NAFLD was more prevalent in patients with EH complicated with multiple metabolic disorders,such as hyperlipemia and hyperuricemia.(Chin J Lab Med,2013,36:926-930) Key words: Hypertension; Fatty liver; Metabolic diseases

The association between serum ferritin level, microalbuminuria and non-alcoholic fatty liver disease in non-diabetic, non-hypertensive men

Background: Iron-mediated cell injury may cause glomerular endothelial dysfunction, which precedes microalbumuria. However, there have been no reports on the relationship between serum ferritin level and microalbuminuria. The aim of this study is to assess the relationship between serum ferritin level and microalbuminuria in apparently healthy men and to evaluate how non-alcoholic fatty liver disease (NAFLD) affects this association.Methods: Microalbuminuria and serum ferritin level were measured, and hepatic ultrasound was performed in a sample of 2489 non-diabetic, non-hypertensive men. The patients were classified into two groups according to urinary albumin–creatinine ratio (UACR) in morning urine specimens: normoalbuminuria (<30 µg/mg) and microalbuminuria (30–300 µg/mg).Results: The overall prevalence of microalbuminuria and NAFLD based on ultrasound findings were 4.5% (113 subjects) and 41.9% (1042 subjects), respectively. The microalbuminuric group had significantly higher levels of serum ferritin than the normoalbuminuric group (255.4 pmol/L versus 207.5 pmol/L, p < 0.001). In the multivariate regression analysis, serum ferritin level was independently associated with microalbuminuria irrespective of multiple covariates (OR [95% CI] 1.746 [1.221–2.497]). Subgroup analyses according to NAFLD revealed that the NAFLD group had higher serum ferritin level and a higher prevalence of microalbuminuria compared with the non-NAFLD group (233.8 pmol/L versus 194.3 pmol/L, p < 0.001) (6.3% versus 3.2%, p < 0.001). However, in the multivariate regression analysis, there was a significant association between serum ferritin level and microalbuminuria in both the non-NAFLD and the NAFLD group.Conclusions: Our results indicate that serum ferritin level is associated with microalbuminuria in non-hypertensive, non-diabetic men, irrespective of NAFLD.

Relationship Between Aspartate Aminotransferase-to-Platelet Ratio Index and Carotid Intima-Media Thickness in Obese Adolescents with Non-Alcoholic Fatty Liver Disease

Objective: There is increasing evidence for an association between non-alcoholic fatty liver disease (NAFLD) and an increased risk of cardiovascular morbidity and mortality. The aim of this study was to investigate the association between aspartate aminotransferase-to-platelet ratio index (APRI) and carotid intima-media thickness (IMT) in obese adolescents with NAFLD.Methods: Seventy-six obese adolescents and 36 lean subjects were enrolled in this cross-sectional single-centre study. The obese subjects were divided into two subgroups based on the presence or absence of fatty liver with high transaminase levels (NAFLD group and non-NAFLD group). Fasting blood samples were assayed for transaminase, glucose, and insulin levels. Insulin resistance was calculated by the homeostasis model assessment (HOMA-IR).Results: APRI values were higher in both obese groups (NAFLD and non-NAFLD) in comparison with the lean group. The NAFLD group had significantly higher APRI values than the non-NAFLD obese group and the lean group. Carotid IMT was higher in both obese groups (NAFLD and non-NAFLD) in comparison with the lean group. The NAFLD group had significantly higher measurements of carotid IMT than the non-NAFLD group and the lean group. APRI was positively correlated with most of the metabolic parameters (total cholesterol, low-density lipoprotein cholesterol, glucose, insulin, HOMA-IR) and with carotid IMT in the NAFLD obese group.Conclusions: This study demonstrated that a significant relationship exists between APRI and carotid IMT in obese adolescents with NAFLD. We suggest that an increased APRI score in obese adolescents with NAFLD can possibly serve to predict a more adverse cardiovascular risk profile. Conflict of interest:None declared.