Non-alcoholic fatty liver disease is characterised by a reduced polyunsaturated fatty acid transport via free fatty acids and high-density lipoproteins (HDL).

BACKGROUND AND OBJECTIVES: Non-alcoholic fatty liver disease (NAFLD) develops due to impaired hepatic lipid fluxes and is a risk factor for chronic liver disease and atherosclerosis. Lipidomic studies consistently reported characteristic hepatic/VLDL "lipid signatures" in NAFLD; whole plasma traits are more debated. Surprisingly, the HDL lipid composition by mass spectrometry has not been characterised across the NAFLD spectrum, despite HDL being a possible source of hepatic lipids delivered from peripheral tissues alongside free fatty acids (FFA). This study characterises the HDL lipidomic signature in NAFLD, and its correlation with metabolic and liver disease markers. METHODS: We used liquid chromatography-mass spectrometry to determine the whole serum and HDL lipidomic profile in 89 biopsy-proven NAFLD patients and 20 sex and age-matched controls. RESULTS: In the whole serum of NAFLD versus controls, we report a depletion in polyunsaturated (PUFA) phospholipids (PL) and FFA; with PUFA PL being also lower in HDL, and negatively correlated with BMI, insulin resistance, triglycerides, and hepatocyte ballooning. In the HDL of the NAFLD group we also describe higher saturated ceramides, which positively correlate with insulin resistance and transaminases. CONCLUSION: NAFLD features lower serum lipid species containing polyunsaturated fatty acids; the most affected lipid fractions are FFA and (HDL) phospholipids; our data suggest a possible defect in the transfer of PUFA from peripheral tissues to the liver in NAFLD. Mechanistic studies are required to explore the biological implications of our findings addressing if HDL composition can influence liver metabolism and damage, thus contributing to NAFLD pathophysiology.

Parent perceptions of school-based support for students with traumatic brain injuries.

PRIMARY OBJECTIVE: To determine whether parents believe schools provided necessary support to their children who sustained traumatic brain injuries. RESEARCH DESIGN: Interview, to determine parent perceptions. METHODS AND PROCEDURE: Sixty-six primary caregivers of school-age children who experienced a TBI within the previous 2 years were interviewed regarding what types of special support were needed by and provided for their children during the 3 months immediately following school re-entry. They then rated how difficult it was to obtain support or services from the school and how satisfied they were with the support or services. MAIN OUTCOMES AND RESULTS: The majority of participants did not perceive the need for school-based services, even when the injury was severe. Almost all students whose parents perceived a need for an adjusted schedule were granted that accommodation, but few students received school-based counselling or behavioural support. CONCLUSIONS: Results indicated that participants perceived relatively few school-based supports, particularly given the actual academic, behavioural and social challenges experienced by children who have sustained a TBI. Schools and hospitals must take steps to ensure appropriate post-head injury support services.