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2.
Liver Int ; 40(9): 2182-2193, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32559006

RESUMO

BACKGROUND & AIMS: Low-grade systemic inflammation is a crucial landmark in NAFLD favouring disease progression and comorbidities. We evaluated the input of circulating bacterial antigens on systemic markers of inflammation in NAFLD patients. PATIENTS & METHODS: Multicenter cross-sectional study including consecutive patients with biopsy-proven NAFLD. Demographic, metabolic and fibrosis-related variables were collected. Circulating bacterial antigens were quantified in blood. Toll-like receptor SNPs were genotyped. Serum cytokine levels were evaluated. Peripheral blood mononuclear cell response to bacterial antigens was evaluated in vitro. RESULTS: Three hundred and fifteen patients from five Spanish hospitals were distributed by BMI. At least, one bacterial antigenic type was found in 66 patients with BMI < 30 (63.4%) and 163 patients with BMI > 30 (77.3%) (P = .014). HOMA-IR was significantly higher in the presence of circulating antigens among patients with BMI < 30. NASH and significant fibrosis in non-obese patients were more frequent in the presence of at least two circulating antigenic types. Allelic frequencies of TLR variants were similar to controls and did not affect clinical or laboratory parameters. Pro-inflammatory cytokines were significantly increased in patients with bacterial antigens, regardless of BMI. TLR gene and protein expression levels were significantly increased in PBMCs from patients with bacterial antigens. Antigen concentrations independently influenced TNF-α and IL-6, in both BMI subgroups of patients. Age independently influenced TNF-α and IL-6 in non-obese patients, and TNF-α in obese patients. CONCLUSION: Serum circulating bacterial antigens as well as age were BMI-independent factors related to increased systemic inflammation in NAFLD and provides insight on the multifaceted sources of inflammation in these patients.

3.
Nutr. hosp ; 37(3): 497-505, mayo-jun. 2020. tab, graf
Artigo em Espanhol | IBECS-Express | IBECS | ID: ibc-ET2-6107

RESUMO

OBJETIVO: el objetivo del estudio fue evaluar el tiempo de respuesta, definido como pérdida del 10 % del peso, al tratamiento con un método multidisciplinar de pérdida de peso que incluye dieta (inicialmente cetogénica), ejercicio físico y soporte emocional. MÉTODOS: los datos se obtuvieron a partir del registro de pacientes reclutados en el estudio Promet Lipoinflamación, un estudio observacional de práctica clínica real en pacientes obesos o con sobrepeso tratados con el método multidisciplinar, basado inicialmente en una dieta cetogénica de muy bajas calorías. La velocidad se valoró mediante un análisis de supervivencia Kaplan-Meier y los factores asociados mediante regresión de Cox. RESULTADOS: la muestra estudiada fue de 6369 sujetos. El 74,4 % consiguió alcanzar una pérdida de peso del 10 % en una media de tiempo de 57,64 días (IC 95 %: 56,95-58,33]. Los factores asociados a mayor probabilidad de alcanzar pérdida del 10 % o más fueron género masculino (RR: 1,37; p < 0,001), obesidad de tipos I, II y III frente a sobrepeso (RR: 1,24; p < 0,001; 1,26; p < 0,001 y 1,22; p < 0,001, respectivamente) y edad joven frente a mayor de 55 años (RR: 2,17; p < 0,001). CONCLUSIONES: los resultados obtenidos a través de la práctica clínica real muestran que el método produce una pérdida de peso rápida e intensa. Tres de cada cuatro pacientes perdieron, como mínimo, el 10 % del peso corporal en una media de 58 días


OBJECTIVE: the aim of the current work was to evaluate the response time to a method of weight loss that includes dietary guidelines, physical exercise and emotional support. The response was defined as a loss of 10 % of the baseline weight. METHODS: data was obtained from the patients' record recruited in Promet Lipoinflamación, an observational study of real world data in obese or overweight patients treated with a multidisciplinary method and based initially on a very-low-calorie ketogenic (VLCK) diet. Weight loss rate was evaluated through a survival analysis Kaplan-Meier and related factors through Cox regression). RESULTS: 6,369 subjects were included and 74.4 % managed to reach a weight loss of 10 % in a mean time of 57.64 days (IC 95 %: 56.95-58.33). The factors associated with a greater probability of reaching a loss of 10 % or more were male gender (RR: 1.37, p < 0.001), obesity types I, II and III vs. overweight (RR: 1.24, p < 0.001, 1.26, p < 0.001 and 1.22, p < 0.001, respectively) and young age vs. more than 55 years old (RR: 2.17, p < 0.001). CONCLUSION: results obtained through real clinical practice show that the method produces fast and intense weight loss. Three out of four patients lost at least 10 % of body weight in an average of 58 days

4.
Nutr Hosp ; 34(3): 497-505, 2020 Jul 13.
Artigo em Espanhol | MEDLINE | ID: mdl-32379476

RESUMO

Introduction: Objective: the aim of the current work was to evaluate the response time to a method of weight loss that includes dietary guidelines, physical exercise and emotional support. The response was defined as a loss of 10% of the baseline weight. Methods: data was obtained from the patients' record recruited in Promet Lipoinflamación, an observational study of real world data in obese or overweight patients treated with a multidisciplinary method and based initially on a very-low-calorie ketogenic (VLCK) diet. Weight loss rate was evaluated through a survival analysis Kaplan-Meier and related factors through Cox regression). Results: 6,369 subjects were included and 74.4% managed to reach a weight loss of 10% in a mean time of 57.64 days (IC 95%: 56.95-58.33). The factors associated with a greater probability of reaching a loss of 10% or more were male gender (RR: 1.37, p < 0.001), obesity types I, II and III vs. overweight (RR: 1.24, p < 0.001, 1.26, p < 0.001 and 1.22, p < 0.001, respectively) and young age vs. more than 55 years old (RR: 2.17, p < 0.001). Conclusion: Results obtained through real clinical practice show that the method produces fast and intense weight loss. Three out of four patients lost at least 10% of body weight in an average of 58 days.

5.
Endocrine ; 68(3): 557-563, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32239453

RESUMO

BACKGROUND AND AIMS: The prevalence of the non-alcoholic fatty liver disease (NAFLD) in developed countries is up to 30% of the general population, and 50% of patients present type 2 diabetes mellitus (DM2). Fibrosis is the most important prognostic factor in NAFLD. The aim of this study was to search evidence for an early diagnosis of liver fibrosis in subjects with DM2 and to evaluate potential risk and protective factors. METHODS: This study was conducted among 160 diabetic patients with NAFLD proven biopsy. Anthropometric assessments, laboratory test, liver histological features and follow-up of a Mediterranean diet were evaluated. RESULTS: Diabetic patients with liver fibrosis showed a greater number of positive metabolic criteria than diabetic patients without liver fibrosis. Patients with hepatic fibrosis have a lower score on the PREDIMED test (9.0 (2.4) vs. 6.2 (2.3); p < 0.05). Diabetic patients with liver fibrosis showed higher glucose levels (delta: 10.1 (4.5) mg/dl), fasting insulin levels (delta: 3.1 (1.5) UI/L), HOMA-IR (delta: 2.1 (0.3) units) and HbA1c (delta: 0.6 (0.2)%). Non-invasive tests showed a higher score (non-alcoholic fatty liver disease fibrosis score and fibrosis-4) in liver fibrosis subjects than no liver fibrosis subjects. A logistic regression analysis adjusted by age, gender, HbA1c and body mass index showed independent significant direct association between liver fibrosis and homeostatic model assessment of insulin resistance as indicator of insulin resistance (odds ratio (OR) = 1.53: 95% confidence interval (CI): 1.1-2.2; p = 0.026) and inverse association with PREDIMED score as an indicator of adherence to Mediterranean diet (OR = 0.6; 95% CI: 0.4-0.8; p = 0.01). CONCLUSION: In patients with DM2, insulin resistance is an independent risk factor associated with liver fibrosis, and the adherence of a Mediterranean diet is a protective factor associated with absence of liver fibrosis.

6.
J Hepatol ; 73(1): 17-25, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32147361

RESUMO

BACKGROUND & AIMS: Non-alcoholic fatty liver disease (NAFLD) could play a catalytic role in the development of metabolic comorbidities, although the magnitude of this effect in metabolically healthy patients with NAFLD remains unclear. We assessed the role of biopsy-proven NAFLD on the risk of developing type 2 diabetes mellitus (T2DM) and other metabolic comorbidities (arterial hypertension [AHT], and dyslipidemia) in metabolically healthy patients. METHODS: We included 178 metabolically healthy-defined by the absence of baseline T2DM, AHT, dyslipidemia-patients with biopsy-proven NAFLD from the HEPAmet Registry (N = 1,030). Hepamet fibrosis score (HFS), NAFLD fibrosis score, and Fibrosis-4 were calculated. Follow-up was computed from biopsy to the diagnosis of T2DM, AHT, or dyslipidemia. RESULTS: During a follow-up of 5.6 ± 4.4 years, T2DM occurred in 9% (16/178), AHT in 8.4% (15/178), low HDL in 9.6% (17/178), and hypertriglyceridemia in 23.6% (42/178) of patients. In multivariate analysis, significant fibrosis predicted T2DM and AHT. Independent variables related to T2DM appearance were significant fibrosis (HR 2.95; 95% CI 1.19-7.31; p = 0.019), glucose levels (p = 0.008), age (p = 0.007) and BMI (p = 0.039). AHT was independently linked to significant fibrosis (HR 2.39; 95% CI 1.14-5.10; p = 0.028), age (p = 0.0001), BMI (p = 0.006), glucose (p = 0.021) and platelets (p = 0.050). The annual incidence rate of T2DM was higher in patients with significant fibrosis (4.4 vs. 1.2 cases per 100 person-years), and increased in the presence of obesity, similar to AHT (4.6 vs. 1.1 cases per 100 person-years). HFS >0.12 predicted the risk of T2DM (25% [4/16] vs. HFS <0.12 4.5% [4/88]; logRank 6.658, p = 0.010). CONCLUSION: Metabolically healthy patients with NAFLD-related significant fibrosis were at greater risk of developing T2DM and AHT. HFS >0.12, but not NAFLD fibrosis score or Fibrosis-4, predicted the occurrence of T2DM. LAY SUMMARY: Patients with biopsy-proven non-alcoholic fatty liver disease and significant fibrosis were at risk of developing type 2 diabetes mellitus and arterial hypertension. The risk of metabolic outcomes in patients with significant fibrosis was increased in the presence of obesity. In addition to liver biopsy, patients at intermediate-to-high risk of significant fibrosis by Hepamet fibrosis score were at risk of type 2 diabetes mellitus.

7.
J Diabetes Complications ; 34(4): 107534, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32057567

RESUMO

BACKGROUND & AIMS: The risk allele (G) of rs10830963 in the melatonin receptor 1 B (MTNR1B) gene presents an association with biochemical parameters and obesity. We study the effect of this SNP on insulin resistance and weight loss secondary to two hypocaloric diets. METHODS: 270 obese subjects were randomly allocated during 9 months (Diet HP: a high protein/low carbohydrate vs. Diet S: a standard severe hypocaloric diets). Anthropometric parameters, fasting blood glucose, C-reactive protein (CRP), insulin concentration, insulin resistance (HOMA-IR), lipid profile and adipocytokines levels were measured. Genotype of MTNR1B gene polymorphism (rs10830963) was evaluated. RESULTS: All adiposity parameters, systolic blood pressure and leptin levels decreased in all subjects after both diets. This improvement of adiposity parameters was higher in non-G allele carriers than G allele carriers. After weight loss with Diet HP, (CC vs. CG + GG at 9 months); total cholesterol (delta: -9.9 ±â€¯2.4 mg/dl vs. -4.8 ±â€¯2.2 mg/dl:p < 0.05), LDL-cholesterol (delta: -8.3 ±â€¯1.9 mg/dl vs. -5.1 ±â€¯2.2 mg/dl: p < 0.05), insulin (delta: -4.7 ±â€¯0.8 UI/L vs. -0.9 ±â€¯1.0 UI/L: p < 0.05), triglycerides (delta: -17.7 ±â€¯3.9 mg/dl vs. -6.1 ±â€¯2.8 mg/dl: p < 0.05) and HOMA IR (delta: -0.8 ±â€¯0.2 units vs. -0.2 ±â€¯0.1 units: p < 0.05) improved only in no G allele carriers. After weight loss with Diet S in non G allele carriers, insulin levels (delta (CC vs. CG + GG): -3.4 ±â€¯0.6 UI/L vs. -1.2 ±â€¯0.4 UI/L: p < 0.05), triglycerides (delta: -29.2 ±â€¯3.4 mg/dl vs. -8.2 ±â€¯3.8 mg/dl: p < 0.05), HOMA-IR (delta (CC vs. CG + GG): -1.1 ±â€¯0.2 units vs. -0.1 ±â€¯0.1 units: p < 0.05), total cholesterol (delta: -15.9 ±â€¯7.4 mg/dl vs. -5.8 ±â€¯2.9 mg/dl:ns) and LDL-cholesterol (delta: -13.7 ±â€¯5.9 mg/dl vs. -6.0 ±â€¯2.9 mg/dl: ns) decreased, too. CONCLUSIONS: our study detected a relationship of rs10830963 variant of MTNR1B gene with adiposity changes, cholesterol changes and insulin resistance modification induced by two different hypocaloric during 9 months.

8.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(1): 43-52, ene. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-186146

RESUMO

ANTECEDENTES Y OBJETIVOS: El alelo de riesgo (G) de la variante rs10830963 en el gen del receptor de melatonina 1 B (MTNR1B) se relaciona con la obesidad. En este trabajo evaluamos el efecto de este SNP sobre los factores de riesgo cardiovascular y la pérdida de peso secundaria a 2 dietas hipocalóricas. MÉTODOS: Trescientos sesenta y un sujetos obesos fueron asignados aleatoriamente durante 3 meses (dieta M: dieta hipocalórica alta en grasas monoinsaturadas vs. dieta P: dieta hipocalórica alta en grasas poliinsaturadas). Se midieron los parámetros antropométricos, glucemia en ayunas, proteína C reactiva, concentración de insulina, resistencia a la insulina (HOMA-IR), perfil de lípidos y los niveles de adipocitoquinas. Se evaluó el genotipo del polimorfismo del gen MTNR1B (rs10830963). RESULTADOS: Todos los parámetros antropométricos, la presión arterial sistólica y los niveles de leptina disminuyeron en todos los sujetos después de ambas dietas. Esta mejora de los parámetros antropométricos fue mayor en los no portadores del alelo G que en los portadores del alelo G. Tras la intervención con dieta M (CC vs. CG + GG), el colesterol total (delta: -10,4 ± 2,1 mg/dl vs. -6,4 ± 1,2 mg/dl: p < 0,05), colesterol LDL (delta: -7,1 ± 0,9 mg/dl vs. -2,8 ± 0,8 mg/dl: p < 0,05), insulina (delta: -3,0 ± 0.8 UI/l vs. -2,0 ± 1,0 UI/l: p < 0,05) y HOMA IR (delta: -3,4 ± 1,0 unidades vs. -2,9 ± 0,9 unidades: p < 0,05) mejoraron en los no portadores del alelo G. Tras la dieta P, en el grupo de sujetos sin alelo G, los niveles de insulina (delta: -2,9 ± 1,0 UI/l vs. -0,6 ± 0,2 UI/l: p < 0,05) y HOMA-IR (delta [CC vs. CG + GG]: -0,8 ± 0,2 unidades vs. -0,4 ± 0,3 unidades: p < 0,05) también disminuyeron. CONCLUSIONES: Nuestro estudio detectó una relación de la variante rs10830963 de MTNR1B con la pérdida de peso corporal y la modificación de la resistencia a la insulina inducida por 2 dietas hipocalóricas diferentes. Solo la dieta hipocalórica enriquecida en grasa monoinsaturada y los no portadores del alelo G mostraron un efecto significativo sobre las lipoproteínas


BACKGROUND & AIMS: The risk allele (G) of rs10830963 in the melatonin receptor 1 B (MTNR1B) gene presents an association with obesity. We study the effect of this SNP on cardiovascular risk factors and weight loss secondary to 2hypocaloric diets. Methods: 361 obese subjects were randomly allocated during 3 months (Diet M - high monounsaturated fat hypocaloric diet vs. Diet P - high polyunsaturated fat hypocaloric diet). Anthropometric parameters, fasting blood glucose, C-reactive protein (CRP), insulin concentration, insulin resistance (HOMA-IR), lipid profile and adipocytokines levels were measured. Genotype of MTNR1B gene polymorphism (rs10830963) was evaluated. Results: All anthropometric parameters, systolic blood pressure and leptin levels decreased in all subjects after both diets. This improvement of anthropometric parameters was higher in non G allele carriers than G allele carriers. After dietary intervention with Diet M, (CC vs. CG + GG); total cholesterol (delta: -10.4 ± 2.1 mg/dl vs. -6.4 ± 1.2 mg/dl: P <.05), LDL-cholesterol (delta:-7.1 ± 0.9 mg/dl vs. -2.8 ± 0.8 mg/dl: P <.05), insulin (delta:-3.0 ± 0.8 UI/L vs. -2.0 ± 1.0 UI/L: P<.05) and HOMA-IR (delta:-3.4 ± 1.0 units vs. -2.9 ± 0.9 units: P<.05) improved in no G allele carriers. After Diet P, in the group of subjects without G allele CC, insulin levels (delta: -2.9 ± 1.0 UI/L vs. -0.6 ± 0.2 UI/L: P <.05) and HOMA-IR (delta (CC vs. CG + GG): -0.8 ± 0.2 units vs. -0.4 ± 0.3 units: P <.05) decreased, too. Conclusions: Our study detected a relationship of rs10830963 MTNR1B SNP with body weight loss and insulin resistance modification induced by 2 different hypocaloric. Only monounsaturated enriched hypocaloric diet and in no-G allele carriers showed a significant effect on lipoproteins


Assuntos
Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Polimorfismo Genético , Gorduras na Dieta/uso terapêutico , Resistência à Insulina , Perda de Peso/efeitos dos fármacos , Obesidade/dietoterapia , Fatores de Risco , Gorduras na Dieta/metabolismo , Doenças Cardiovasculares , Antropometria , Glicemia , Composição Corporal , Relação Cintura-Quadril , Radioimunoensaio/métodos
9.
Lifestyle Genom ; 13(1): 20-27, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31747677

RESUMO

BACKGROUND: The role of ADIPOQ gene variants in weight loss after different dietary fat amounts remains unclear. OBJECTIVE: Our aim was to analyze the effects of ADIPOQ gene polymorphism rs266729 on metabolic changes after two different amounts of dietary fat in two hypocaloric diets. DESIGN: A population of 283 obese patients was recruited in a randomized clinical trial with two diets: Diet HF (high-fat diet: 38% carbohydrates, 24% proteins, and 38% fats) versus Diet LF (low-fat diet: 53% carbohydrates, 20% proteins, and 27% fats). Before and after 3 months, an anthropometric evaluation, an assessment of nutritional intake, and a biochemical analysis were carried out. The variant of the ADIPOQgene was assessed by real-time PCR. RESULTS: Weight loss was similar with both diets in both genotypes (CC vs. CG+GG). After dietary intervention with Diet HF, only subjects with CC genotype showed a significant improvement in insulin levels (-3.3 ± 0.6 vs. -1.8 ± 0.9 mU/L; p = 0.03) and the homeostasis model assessment for insulin resistance (HOMA-IR) (-1.3 ± 0.1 vs. -0.8 ± 0.2 units; p = 0.02). After Diet LF, subjects with CC genotype showed a significant improvement in total cholesterol levels (CC vs. CG+GG) (-15.3 ± 1.4 vs. -6.4 ± 1.3 mg/dL; p = 0.01), LDL cholesterol (-14.6 ± 1.8 vs. -6.4 ± 1.3 mg/dL; p = 0.01), insulin levels (-4.6 ± 1.0 vs. -1.6 ± 0.5 mU/L; p = 0.01), and HOMA-IR (-1.6 ± 0.1 vs. -1.0 ± 0.2 units; p = 0.02). Only subjects with CC genotype showed a significant increase of adiponectin levels after both diets (CC vs. CG+GG): Diet HF (10.6 ± 2.0 vs. 1.8 ± 1.0 ng/dL; p = 0.01) and Diet LF (16.1 ± 2.8 vs. 1.3 ± 1.0 ng/dL: p = 0.03). CONCLUSION: CC genotype of ADIPOQgene variantrs266729 was associated with a better metabolic response after both diets. Additionally, Diet LF produced a significant improvement in lipid profile in noncarriers of allele G.

10.
Endocrinol Diabetes Nutr ; 67(1): 43-52, 2020 Jan.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30981681

RESUMO

BACKGROUND & AIMS: The risk allele (G) of rs10830963 in the melatonin receptor 1 B (MTNR1B) gene presents an association with obesity. We study the effect of this SNP on cardiovascular risk factors and weight loss secondary to 2hypocaloric diets. METHODS: 361 obese subjects were randomly allocated during 3 months (Diet M - high monounsaturated fat hypocaloric diet vs. Diet P - high polyunsaturated fat hypocaloric diet). Anthropometric parameters, fasting blood glucose, C-reactive protein (CRP), insulin concentration, insulin resistance (HOMA-IR), lipid profile and adipocytokines levels were measured. Genotype of MTNR1B gene polymorphism (rs10830963) was evaluated. RESULTS: All anthropometric parameters, systolic blood pressure and leptin levels decreased in all subjects after both diets. This improvement of anthropometric parameters was higher in non G allele carriers than G allele carriers. After dietary intervention with Diet M, (CC vs. CG + GG); total cholesterol (delta: -10.4 ± 2.1mg/dl vs. -6.4 ± 1.2mg/dl: P <.05), LDL-cholesterol (delta:-7.1 ± 0.9mg/dl vs. -2.8 ± 0.8mg/dl: P <.05), insulin (delta:-3.0 ± 0.8 UI/L vs. -2.0 ± 1.0 UI/L: P<.05) and HOMA-IR (delta:-3.4 ± 1.0 units vs. -2.9 ± 0.9 units: P<.05) improved in no G allele carriers. After Diet P, in the group of subjects without G allele CC, insulin levels (delta: -2.9 ± 1.0 UI/L vs. -0.6 ± 0.2 UI/L: P <.05) and HOMA-IR (delta (CC vs. CG + GG): -0.8 ± 0.2 units vs. -0.4 ± 0.3 units: P <.05) decreased, too. CONCLUSIONS: Our study detected a relationship of rs10830963 MTNR1B SNP with body weight loss and insulin resistance modification induced by 2different hypocaloric. Only monounsaturated enriched hypocaloric diet and in no-G allele carriers showed a significant effect on lipoproteins.

11.
Clin Gastroenterol Hepatol ; 18(1): 216-225.e5, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31195161

RESUMO

BACKGROUND & AIMS: Fibrosis affects prognoses for patients with nonalcoholic fatty liver disease (NAFLD). Several non-invasive scoring systems have aimed to identify patients at risk for advanced fibrosis, but inconclusive results and variations in features of patients (diabetes, obesity and older age) reduce their diagnostic accuracy. We sought to develop a scoring system based on serum markers to identify patients with NAFLD at risk for advanced fibrosis. METHODS: We collected data from 2452 patients with NAFLD at medical centers in Italy, France, Cuba, and China. We developed the Hepamet fibrosis scoring system using demographic, anthropometric, and laboratory test data, collected at time of liver biopsy, from a training cohort of patients from Spain (n = 768) and validated the system using patients from Cuba (n = 344), Italy (n = 288), France (n = 830), and China (n = 232). Hepamet fibrosis score (HFS) were compared with those of previously developed fibrosis scoring systems (the NAFLD fibrosis score [NFS] and FIB-4). The diagnostic accuracy of the Hepamet fibrosis scoring system was assessed based on area under the receiver operating characteristic (AUROC) curve, sensitivity, specificity, diagnostic odds ratio, and positive and negative predictive values and likelihood ratios. RESULTS: Variables used to determine HFS were patient sex, age, homeostatic model assessment score, presence of diabetes, levels of aspartate aminotransferase, and albumin, and platelet counts; these were independently associated with advanced fibrosis. HFS discriminated between patients with and without advanced fibrosis with an AUROC curve value of 0.85 whereas NFS or FIB-4 did so with AUROC values of 0.80 (P = .0001). In the validation set, cut-off HFS of 0.12 and 0.47 identified patients with and without advanced fibrosis with 97.2% specificity, 74% sensitivity, a 92% negative predictive value, a 76.3% positive predictive value, a 13.22 positive likelihood ratio, and a 0.31 negative likelihood ratio. HFS were not affected by patient age, body mass index, hypertransaminasemia, or diabetes. The Hepamet fibrosis scoring system had the greatest net benefit in identifying patients who should undergo liver biopsy analysis and led to significant improvements in reclassification, reducing the number of patients with undetermined results to 20% from 30% for the FIB-4 and NFS systems (P < .05). CONCLUSIONS: Using clinical and laboratory data from patients with NAFLD, we developed and validated the Hepamet fibrosis scoring system, which identified patients with advanced fibrosis with greater accuracy than the FIB-4 and NFS systems. the Hepamet system provides a greater net benefit for the decision-making process to identify patients who should undergo liver biopsy analysis.

12.
Gastroenterol. hepatol. (Ed. impr.) ; 42(10): 657-676, dic. 2019. ilus, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-188200

RESUMO

La enfermedad hepática alcohólica (EHA) es la causa más prevalente de enfermedad hepática avanzada y cirrosis hepática en Europa incluyendo a España. De acuerdo con la Organización Mundial de la Salud la fracción de cirrosis hepática atribuible al uso de alcohol en España es del 73,8% entre varones y del 56,3% entre mujeres. La EHA incluye diversos estadios como la esteatohepatitis, la cirrosis y el cáncer hepatocelular. Además, enfermos con EHA de base e ingesta abundante de alcohol pueden desarrollar hepatitis alcohólica, que cursa con una elevada mortalidad. Hasta la fecha, el único tratamiento efectivo para tratar la EHA es la abstinencia prolongada. No existen tratamientos específicos, y el único tratamiento que aumenta la esperanza de vida en la hepatitis alcohólica es la prednisolona. Para enfermos con hepatitis alcohólica que no responden al tratamiento, algunos centros ofrecen la posibilidad de un trasplante precoz. Estas guías de práctica clínica tienen como objetivo proponer recomendaciones sobre la EHA teniendo en cuenta su relevancia como causa de hepatopatía crónica avanzada y cirrosis hepática en nuestro medio. En el presente trabajo se propone como objetivo responder las preguntas claves para la práctica clínica de Gastroenterología, Hepatología, así como de Medicina Interna y centros de salud primaria, poniendo al servicio del profesional de la salud la información más actualizada respecto al manejo y tratamiento de la EHA. Estas guías proporcionan recomendaciones basadas en la evidencia para el manejo clínico de esta enfermedad


Alcohol-related liver disease (ARLD) is the most prevalent cause of advanced liver disease and liver cirrhosis in Europe, including Spain. According to the World Health Organization the fraction of liver cirrhosis attributable to alcohol use in Spain is 73.8% among men and 56.3% among women. ARLD includes various stages such as steatohepatitis, cirrhosis and hepatocellular cancer. In addition, patients with underlying ARLD and heavy alcohol intake may develop alcoholic hepatitis, which is associated with high mortality. To date, the only effective treatment to treat ARLD is prolonged withdrawal. There are no specific treatments, and the only treatment that increases life expectancy in alcoholic hepatitis is prednisolone. For patients with alcoholic hepatitis who do not respond to treatment, some centres offer the possibility of an early transplant. These clinical practice guidelines aim to propose recommendations on ARLD taking into account their relevance as a cause of advanced chronic liver disease and liver cirrhosis in our setting. This paper aims to answer the key questions for the clinical practice of Gastroenterology, Hepatology, as well as Internal Medicine and Primary Health Centres, making the most up-to-date information regarding the management and treatment of ARLD available to health professionals. These guidelines provide evidence-based recommendations for the clinical management of this disease


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Hepatite Alcoólica/epidemiologia , Consenso , Hepatopatias/epidemiologia , Alcoolismo/epidemiologia , Espanha/epidemiologia , Hepatopatias/diagnóstico , Hepatopatias/terapia , Saúde Pública , História Natural , Cirrose Hepática/complicações , Fatores de Risco
13.
Nutr. hosp ; 36(6): 1288-1295, nov.-dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-191147

RESUMO

Antecedentes y objetivos: las variantes genéticas del gen APOA1 se han relacionado con el perfil lipídico en sujetos obesos. Nuestro objetivo fue analizar los efectos del polimorfismo del gen rs670 APOA1 sobre el estado metabólico tras la ingesta de dos dietas hipocalóricas enriquecidas con grasas poliinsaturadas o con grasas monoinsaturadas. Métodos: trescientos sesenta sujetos obesos se asignaron al azar a dos grupos de intervención. Un grupo recibió una dieta enriquecida en grasas poliinsaturadas (dieta P) y el otro grupo una dieta enriquecida en grasas monoinsaturadas (dieta M) durante 12 semanas. Se evaluaron los efectos sobre los biomarcadores relacionados con el metabolismo lipídico y de hidratos de carbono antes y después de la intervención. Resultados: el índice de masa corporal, el peso, la masa grasa, la circunferencia de la cintura, la presión arterial sistólica, las concentraciones plasmáticas de leptina y la circunferencia de la cintura disminuyeron en todos los pacientes tras ambas dietas. En los portadores del alelo A, después de 12 semanas con la dieta P, los niveles de insulina (delta: -7,3 ± 2,2 UI/I; p = 0,01) y HOMA-IR (delta: -2,8 ± 0,5 unidades; p = 0,02) mejoraron de manera significativa. Tras el tratamiento con la dieta M, los niveles plasmáticos de insulina (delta: -5,9 ± 1,2 UI/I; p = 0,01) y HOMAIR (delta: -2,1 ± 0,8 unidades; p = 0,02) también mejoraron en los portadores del alelo A. Después de la intervención dietética con la dieta P, el colesterol-LDL (delta: -12,1 ± 4,3 UI/I; p = 0,01) y el colesterol-HDL (delta: 2,6 ± 0,7 unidades; p = 0,01) disminuyeron significativamente en los portadores del alelo A. Conclusiones: nuestro estudio mostró la asociación del polimorfismo rs670 ApoA1 con los cambios de resistencia a la insulina inducidos por ambas dietas y aportó evidencia adicional sobre la mejoría del colesterol-HDL y el colesterol-LDL después de una dieta rica en grasas poliinsaturadas en los portadores del alelo A


Background and objectives: genetic variants of the APOA1 gene have been related to lipid profile in obese subjects. Our aim was to analyze the effects of the rs670 APOA1 gene polymorphism on metabolic changes secondary to an enriched-polyunsaturated fat vs. an enriched-monounsaturated fat hypocaloric diet. Methods: 360 Caucasian obese subjects were randomly allocated to two groups. One group received an enriched-polyunsaturated fat (diet P) and the other an enriched-monounsaturated fat hypocaloric diet (diet M) during 12 weeks. The effects on serum biomarkers related to lipid and carbohydrate metabolism were evaluated before and after the dietary intervention. Results: after both diets, body mass index, weight, fat mass, waist circumference, systolic blood pressure, plasma leptin concentration, and waist circumference decreased in all patients. After 12 weeks of intervention with diet P, plasma insulin levels and HOMA-IR decreased in A-allele carriers: delta: -7.3 ± 2.2 IU/L (p = 0.01), and delta: -2.8 ± 0.5 units (p = 0.02), respectively. The same changes in delta were observed after diet M in A-allele carriers: insulin delta: -5.9 ± 1.2 IU/L (p = 0.01), and HOMA-IR delta: -2.1 ± 0.8 units (p = 0.02). In A-allele carriers, LDL-cholesterol decreased and HDL-cholesterol increased after the dietary intervention with diet P: delta: -12.1 ± 4.3 mg/dL (p = 0.01), and delta: 2.6 ± 0.7 mg/dL (p = 0.01), respectively. No differences in lipid profile were observed after diet M. These improvements were not observed in non-A-allele carriers after both interventions. Conclusions: our study showed the association of the rs670 ApoA1 polymorphism with insulin resistance changes as induced by both diets. An enriched-polyunsaturated fat diet produced an additional improvement of HDL-cholesterol and LDL-cholesterol in A-allele carriers


Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Apolipoproteína A-I/genética , HDL-Colesterol/sangue , Dieta Redutora , Ácidos Graxos Monoinsaturados/administração & dosagem , Ácidos Graxos Insaturados/administração & dosagem , Obesidade/dietoterapia , Variação Genética , Obesidade/genética , Obesidade/metabolismo
14.
Gastroenterol Hepatol ; 42(10): 657-676, 2019 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31771785

RESUMO

Alcohol-related liver disease (ARLD) is the most prevalent cause of advanced liver disease and liver cirrhosis in Europe, including Spain. According to the World Health Organization the fraction of liver cirrhosis attributable to alcohol use in Spain is 73.8% among men and 56.3% among women. ARLD includes various stages such as steatohepatitis, cirrhosis and hepatocellular cancer. In addition, patients with underlying ARLD and heavy alcohol intake may develop alcoholic hepatitis, which is associated with high mortality. To date, the only effective treatment to treat ARLD is prolonged withdrawal. There are no specific treatments, and the only treatment that increases life expectancy in alcoholic hepatitis is prednisolone. For patients with alcoholic hepatitis who do not respond to treatment, some centres offer the possibility of an early transplant. These clinical practice guidelines aim to propose recommendations on ARLD taking into account their relevance as a cause of advanced chronic liver disease and liver cirrhosis in our setting. This paper aims to answer the key questions for the clinical practice of Gastroenterology, Hepatology, as well as Internal Medicine and Primary Health Centres, making the most up-to-date information regarding the management and treatment of ARLD available to health professionals. These guidelines provide evidence-based recommendations for the clinical management of this disease.

15.
Nutr Hosp ; 36(6): 1288-1295, 2019 Dec 26.
Artigo em Espanhol | MEDLINE | ID: mdl-31682461

RESUMO

Introduction: Background and objectives: genetic variants of the APOA1 gene have been related to lipid profile in obese subjects. Our aim was to analyze the effects of the rs670 APOA1 gene polymorphism on metabolic changes secondary to an enriched-polyunsaturated fat vs. an enriched-monounsaturated fat hypocaloric diet. Methods: 360 Caucasian obese subjects were randomly allocated to two groups. One group received an enriched-polyunsaturated fat (diet P) and the other an enriched-monounsaturated fat hypocaloric diet (diet M) during 12 weeks. The effects on serum biomarkers related to lipid and carbohydrate metabolism were evaluated before and after the dietary intervention. Results: after both diets, body mass index, weight, fat mass, waist circumference, systolic blood pressure, plasma leptin concentration, and waist circumference decreased in all patients. After 12 weeks of intervention with diet P, plasma insulin levels and HOMA-IR decreased in A-allele carriers: delta: -7.3 ± 2.2 IU/L (p = 0.01), and delta: -2.8 ± 0.5 units (p = 0.02), respectively. The same changes in delta were observed after diet M in A-allele carriers: insulin delta: -5.9 ± 1.2 IU/L (p = 0.01), and HOMA-IR delta: -2.1 ± 0.8 units (p = 0.02). In A-allele carriers, LDL-cholesterol decreased and HDL-cholesterol increased after the dietary intervention with diet P: delta: -12.1 ± 4.3 mg/dL (p = 0.01), and delta: 2.6 ± 0.7 mg/dL (p = 0.01), respectively. No differences in lipid profile were observed after diet M. These improvements were not observed in non-A-allele carriers after both interventions. Conclusions: our study showed the association of the rs670 ApoA1 polymorphism with insulin resistance changes as induced by both diets. An enriched-polyunsaturated fat diet produced an additional improvement of HDL-cholesterol and LDL-cholesterol in A-allele carriers.

16.
Diabetes Res Clin Pract ; 156: 107825, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31449874

RESUMO

BACKGROUND AND AIMS: Few studies have assessed the effect of the NPY gene rs16147 variant on metabolic response following a dietary intervention. We evaluated the effect of rs16147 on body weight and biochemical changes after a high-protein/low-carbohydrate hypocaloric diet compared with a standard severe hypocaloric diet over 9 months. MATERIALS AND METHODS: A population of 270 obese individuals was enrolled. At baseline, participants were randomly allocated to one of two hypocaloric diets, high protein (Diet HP) or standard (Diet S), for a period of 9 months. RESULTS: After both diets, all genotypes showed decreased body mass index, weight, fat mass, waist circumference, and leptin levels. Participants with the minor allele (A) assigned to the HP diet showed decreases in total cholesterol (-6.5 ±â€¯4.8 vs 10.1 ±â€¯4.1 mg/dL; p < 0.05), LDL cholesterol (-5.9 ±â€¯3.8 vs 9.6 ±â€¯2.4 mg/dL; p < 0.05), triglycerides (-1.0 ±â€¯4.8 vs 16.2 ±â€¯4.1 mg/dL; p < 0.05), insulin (-0.5 ±â€¯2.8 vs 1.7 ±â€¯2.1 UI/L; p < 0.05), HOMA-IR (-0.2 ±â€¯2.1 vs 0.5 ±â€¯2.0 units; p < 0.05), and CRP (-0.3 ±â€¯0.4 vs 1.3 ±â€¯0.2 mg/dL; p < 0.05). Participants with the minor allele assigned to diet S also showed decreases in total cholesterol (-6.1 ±â€¯4.1 vs 14.4 ±â€¯3.1 mg/dL; p < 0.05), LDL-cholesterol (-3.1 ±â€¯2.8 vs 15.0 ±â€¯3.1 mg/dL; p < 0.05), triglycerides (-6.9 ±â€¯4.1 vs 13.2 ±â€¯4.0 mg/dL; p < 0.05), insulin (-0.3 ±â€¯2.1 vs. -1.2 ±â€¯0.2 UI/L: p < 0.05), HOMA-IR (-0.3 ±â€¯2.1 vs. -1.6 ±â€¯1.1 units: p < 0.05), and CRP (-0.4 ±â€¯0.1 vs 1.1 ±â€¯0.2 mg/dL; p < 0.05). CONCLUSION: In obese Caucasians, the presence of the A allele of the rs16147 genetic variant produces a better metabolic response that is secondary to weight loss with two different hypocaloric diets.


Assuntos
Dieta Rica em Proteínas e Pobre em Carboidratos/métodos , Resistência à Insulina/genética , Neuropeptídeo Y/metabolismo , Obesidade/dietoterapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
17.
Nutrition ; 65: 44-49, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31029921

RESUMO

OBJECTIVE: Some adiponectin gene (ADIPOQ) single-nucleotide polymorphisms (SNPs) have been related to basal and adiponectin levels and metabolic parameters. The aim of this study was to evaluate the effect of the genetic variant rs1501299 ADIPOQ gene on biochemical changes after weight loss secondary to a high-protein and low-carbohydrate diet versus a standard severe hypocaloric diet over 9 mo as the primary endpoint. METHODS: A white population of 270 obese patients was enrolled in a randomized clinical trial with two hypocaloric diets (high-protein and low carbohydrate diet [HP] versus standard diet [S]) over 9 mo of intervention. The statistical analysis was performed for the combined GT and TT as a group (T-allele carriers) and GG as second group (non-T-allele carriers). Before and after 12 wk on each hypocaloric diet, an anthropometric evaluation, an assessment of nutritional intake, and a biochemical analysis were realized. RESULTS: With both dietary interventions, body weight, body mass index (BMI), fat mass, waist circumference, systolic blood pressure, and leptin levels decreased. In non-T-allele carriers after both diets, the decrease in total cholesterol levels -12.3 ± 2.2 mg/dL (T-allele carriers -6.9 ± 2.1 mg/dL; P = 0.01 diet HP) and 12.2 ± 3.1 mg/dL (T-allele carriers -4.7 ± 1.2 mg/dL; P = 0.02 after diet S), low-density lipoprotein cholesterol -13.2 ± 2.7 mg/dL (T-allele carriers -6.1 ± 2.1 mg/dL; P = 0.02 after diet HP) and -9.3 ± 1.8 mg/dL (T-allele carriers -4.8 ± 2.9 mg/dL; P = 0.01 after diet S), triacylglycerol levels -12.7 ± 6.1 mg/dL (T-allele carriers -6 ± 2.9 mg/dL; P = 0.01 after diet HP) and -16.3 ± 7.2 mg/dL (T-allele carriers -5.3 ± 1.4 mg/dL; P = 0.03 after diet S), insulin levels -5 ± 1.1 mUI/L (in T-allele -1.7 ± 0.9 mUI/L; P = 0.02 after diet HP) and -3.2 1.1 mUI/L (T-allele carriers -0.7 ± 0.7 mUI/L; P = 0.02 after diet S), and homeostatic model assessment of insulin resistance levels -0.4 ± 0.2 units (T-allele group -0.1 ± 0.1; P = 0.04 after diet HP) and -0.7 ± 0.1 units (T-allele carriers -0.1 ± 0.5 mg/dL; P = 0.01 after diet S) was higher than T-allele carriers. Only no T-allele carriers showed an increase in adiponectin levels after both diets. CONCLUSION: After two different hypocaloric diets during 9 mo of intervention, the GG genotype of an ADIPOQ gene variant (rs1501299) is related to better improvement in adiponectin levels, insulin resistance, and lipid profile than T-allele carriers.

18.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(4): 217-222, abr. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-183171

RESUMO

Background and rationale: This study was intended to assess the influence of the rs16147 variant of the NPY gene on liver histology in patients with non-alcoholic fatty liver disease (NAFLD). Material and methods: Eighty-nine patients with NAFLD were recruited into the study. Serum chemistry tests were done including lipid profile, transaminases, adipokines, and insulin resistance. Genotype of polymorphism (rs161477) of the NPY gene was studied. Results: Twenty-three patients (25.0%) had the GG genotype (wild type) and sixty-six patients (75%) the GA (n=39) or AA (n=27) (mutant) types. Patients with A allele had a lower percentage of lobular inflammation and steatohepatitis (lobular inflammation plus ballooning) than those with wild genotype. Patients with A allele showed lower SAF (Steatosis, Activity, Fibrosis) scores than non-A allele carriers (5.4±2.7 points vs. 4.1±1.1 points; p=0.01). In the analysis without fibrosis (NAS score), the same differences were detected (4.5±1.8 points vs. 3.4±1.8 points; p=0.01). In the logistic regression analysis A allele carriers showed lower odds for inflammation (OR 0.11, 95% CI 0.02-0.84, p=0.03) and steatohepatitis (OR 0.39, 95% CI 0.14-0.86, p=0.04) after adjusting for age, sex, and body mass index. Conclusions: A variant of polymorphism rs16147 of the NPY gene is independently associated to a lower percentage of steatohepatitis and lobular inflammation in obese subjects with biopsy-proven NAFLD


Antecedentes y justificación: El objetivo de nuestro estudio fue estudiar la influencia de la variante rs16147 del gen NPY en la histología hepática en pacientes con enfermedad de hígado graso no alcohólico (NAFLD). Material y métodos: Se reclutó una muestra de 89 pacientes con NAFLD. Se realizó un análisis bioquímico del suero que incluyó perfil lipídico, transaminasas, adipoquinas y resistencia a la insulina. Se estudió el genotipo de polimorfismo (rs161477) del gen NPY. Resultados: Un total de 23 pacientes (25,0%) presentaron el genotipo GG (genotipo salvaje) y 66 pacientes (75%) GA (n=39) o AA (n=27) (genotipo mutante). Los pacientes con alelo A presentaron un menor porcentaje de inflamación lobulillar y esteatohepatitis que los pacientes con genotipo salvaje. Los pacientes con alelo A mostraron una puntuación más baja de SAF (esteatosis, actividad, fibrosis) que los no portadores de alelos A (5,4±2,7 puntos vs. 4,1±1,1 puntos, p=0,01). En el análisis realizado sin fibrosis (solo puntaje NAS), también se detectaron las mismas diferencias (4,5±1,8 puntos vs. 3,4±1,8 puntos, p=0,01). En el análisis de regresión logística a presencia del alelo A a una menor probabilidad de presentar con inflamación lobulillar (OR 0,11, IC 95%: 0,02-0,84; p=0,03) y esteatohepatitis (OR 0,39, IC 95%: 0,14-0,86, p=0,04) después de ajustar por edad, sexo e índice de masa corporal. Conclusiones: La variante del polimorfismo rs16147 del gen NPY se asocia de forma independiente con un menor porcentaje de esteatohepatitis e inflamación lobulillar en sujetos obesos con NAFLD diagnosticado con biopsia


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Neuropeptídeo Y/genética , Neuropeptídeo Y/fisiologia , Obesidade/complicações , Obesidade/fisiopatologia , Hepatopatia Gordurosa não Alcoólica/etiologia , Hepatopatia Gordurosa não Alcoólica/fisiopatologia , Hepatopatia Gordurosa não Alcoólica/sangue , Polimorfismo Genético , Genótipo
19.
Rev. esp. enferm. dig ; 111(4): 256-263, abr. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-189921

RESUMO

Background and aims: non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disorder in the western world. Although NAFLD prevalence is higher in patients with a BMI > 25 kg /m2, it is unclear if there are differences between overweight and obese patients. The associated biochemical, dietary and genetic parameters were compared between overweight and obese patients with NAFLD. Methods: patients with biopsy-proven NAFLD (n = 203) were enrolled in a cross-sectional study. The MEDAS questionnaire was used to assess adherence to the Mediterranean diet. Biochemical, anthropometrical parameters and the I148M variant (rs738409) of the PNPLA3 gene and rs180069 of the TNF-alfa gene were evaluated. Results: overweight patients had higher serum adiponectin levels (22.5 +/- 21.9 vs 11.2 +/- 18.1 ng/ml; p < 0.05) and lower resistin (3.3 +/- 1.7 vs 8.1 +/- 8 ng/ml; p < 0.001) and leptin concentrations (22.9 +/- 21.9 vs 55.8 +/- 45 ng/ml; p < 0.001) than obese patients. Non-alcoholic steatohepatitis (NASH) was more frequent in the obese group (59.3% vs 41.3%; p = 0.02). The multivariate analysis showed adherence to the Mediterranean diet to be an independent protective factor for NASH and liver fibrosis in overweight patients (OR 0.7, 95% CI 0.5-0.8). Conclusions: NASH was more prevalent in obese patients than in overweight subjects. HOMA-IR and adherence to the Mediterranean diet provided protection against fibrosis in overweight patients. Adherence to the Mediterranean diet was the only independent factor associated with NASH in these patients


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Síndrome Metabólica/epidemiologia , Fígado Gorduroso/epidemiologia , Hepatopatia Gordurosa não Alcoólica/fisiopatologia , Fenótipo , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Dieta Mediterrânea/estatística & dados numéricos , Leptina/sangue , Adiponectina/sangue , Estudos Transversais , Polimorfismo de Nucleotídeo Único/genética
20.
Rev. esp. enferm. dig ; 111(4): 264-269, abr. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-189922

RESUMO

Background: recent evidence suggests a causal link between serum uric acid and the metabolic syndrome, diabetes mellitus, arterial hypertension, and renal and cardiac disease. Uric acid is an endogenous danger signal and activator of the inflammasome, and has been independently associated with an increased risk of cirrhosis. Aim and methods: six hundred and thirty-four patients from the nation-wide HEPAMET registry with biopsy-proven NAFLD (53% NASH) were analyzed to determine whether hyperuricemia is related with advanced liver damage in patients with non-alcoholic fatty liver disease (NAFLD). Patients were divided into three groups according to the tertile levels of serum uric acid and gender. Results: the cohort was composed of 50% females, with a mean age of 49 years (range 19-80). Patients in the top third of serum uric acid levels were older (p = 0.017); they had a higher body mass index (p < 0.01), arterial blood pressure (p = 0.05), triglyceridemia (p = 0.012), serum creatinine (p < 0.001) and total cholesterol (p = 0.016) and lower HDL-cholesterol (p = 0.004). According to the univariate analysis, the variables associated with patients in the top third were more advanced steatosis (p = 0.02), liver fibrosis (F2-F4 vs F0-1; p = 0.011), NASH (p = 0.002) and NAS score (p = 0.05). According to the multivariate logistic regression analysis, the top third of uric acid level was independently associated with steatosis (adjusted hazard ratio 1.7; CI 95%: 1.05-2.8) and NASH (adjusted hazard ratio 1.8; CI 95%: 1.08-3.0) but not with advanced fibrosis (F2-F4) (adjusted hazard ratio 1.09; CI 95%: 0.63-1.87). Conclusion: higher levels of serum uric acid were independently associated with hepatocellular steatosis and NASH in a cohort of patients with NAFLD. Serum uric acid levels warrants further evaluation as a component of the current non-invasive NAFLD scores of histopathological damage


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Hiperuricemia/complicações , Hepatopatia Gordurosa não Alcoólica/fisiopatologia , Fígado Gorduroso/fisiopatologia , Hipercolesterolemia/epidemiologia , Hipertrigliceridemia/epidemiologia , Fatores Etários , Hiperuricemia/fisiopatologia , Biomarcadores/análise , Hipercolesterolemia/complicações , Creatinina/sangue , Cirrose Hepática/patologia , Estudos Retrospectivos
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