RESUMO
BACKGROUND: Osteocalcin is a hormone with a complex cross-talk between adipose tissue and the skeleton. The aim of the present study was to explore the relation of osteocalcin with histopathological changes of NALFD patients. SUBJECTS: A population of 69 NAFLD patients was analyzed. A liver biopsy was realized. Weight, fat mass, body mass index, basal glucose, insulin, insulin resistance (HOMA), total cholesterol, LDLcholesterol, HDL-cholesterol, triglycerides and osteocalcin levels were measured. RESULTS: Patients were divided in two groups by median osteocalcin value (11.34 ng/mL), group I (patients with the low values) and group II (patients with the high values). Only liver fibrosis frequencies were different between groups (group I: 22.9% vs group II: 9.4%; p < 0.05). Patients in group I had higher levels of glucose (115.6 ± 28.1 mg/dL vs. 103.7 ± 24.3 mg/dL; p < 0.04), HOMA (4.6 ± 3.1 units vs. 3.6 ± 1.8 units; p < 0.04), weight (102.9 ± 32.4 kg vs. 85.9 ± 16.8 kg; p = 0.002) and body mass index (38.3 ± 11.4 kg/m(2) vs. 30.1 ± 5.7 kg/m(2); p = 0.001)) than patients in group II. Osteocalcin was inverse correlated with glucose (r =-0.4; p = 0.002) and HOMA (r = -0.3:p = 0.01). CONCLUSION: Osteocalcin is associated with liver fibrosis. However, this association disappeared in a multivariate analysis, and HOMA remained as an independent factor.
Assuntos
Resistência à Insulina , Cirrose Hepática/sangue , Fígado/patologia , Osteocalcina/sangue , Adulto , Biomarcadores/sangue , Biópsia , Distribuição de Qui-Quadrado , Estudos Transversais , Fígado Gorduroso/sangue , Fígado Gorduroso/patologia , Fígado Gorduroso/fisiopatologia , Feminino , Humanos , Cirrose Hepática/patologia , Cirrose Hepática/fisiopatologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , EspanhaRESUMO
Some studies have pointed to a role of TNF-alpha in pathogenesis of non alcoholic fatty liver disease (NAFLD). The aim of our study was to investigate the influence of G308A polymorphism TNF alpha gene on the histological changes, insulin resistance and TNF-alpha levels in overweight patients. A population of 66 patients with NAFLD was recruited in a cross sectional study. A biochemical analysis of serum was measured. Genotype of TNF alpha gene G308A was studied. Fifteen patients (22.7%) had the genotype G308A (mutant type group) and 51 patients (77.3%) G308G (wild type group). Patients with mutant type group presented more moderate-severe portal inflammation (86.7%) in liver biopsy compared to patient with wild genotype (19.7%). Mutant type group had more moderate-severe fibrosis (73.3%) than wild type group (51.3%). The multivariate analysis adjusted by age, sex, BMI and genotype with the dependent variable (fibrosis) showed that HOMA remained in the model, with an increase of the probability to develop fibrosis of 1.78 (CI95%:1.06-3.2) and develop moderate-severe inflammation of 1.45 (CI95%:1.02-2.1) with each increase of one unit on HOMA levels. In conclusion, Patients with mutant genotype have more frequently moderate-severe portal inflammation and fibrosis than wild type genotype.
Assuntos
Resistência à Insulina/genética , Polimorfismo de Nucleotídeo Único/genética , Fator de Necrose Tumoral alfa/genética , Adulto , Índice de Massa Corporal , Estudos Transversais , Fígado Gorduroso/genética , Fígado Gorduroso/patologia , Feminino , Predisposição Genética para Doença/genética , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Hepatopatia Gordurosa não Alcoólica , Sobrepeso/genética , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Influence of adipokines and insulin resistance on liver histology is an unclear area in morbidly obese patients. OBJECTIVE: The aim of our study was to study the influence of insulin resistance and adipokines in the grade of liver steatosis and fibrosis in morbidly obese patients undergoing bariatric surgery. SETTING: Tertiary hospital. MATERIALS AND METHODS: A sample of 36 morbidly obese patients undergoing bariatric surgery was analyzed in a cross-sectional study. A liver biopsy was performed. Weights, basal glucose, insulin, insulin resistance (homeostasis model assessment for insulin resistance [HOMA-IR]), total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, and adipokine blood levels were measured. RESULTS: Seventeen patients (47.2%) had low-grade steatosis, and 19 patients (52.8%) had high-grade steatosis. Sixteen patients (44.4%) did not have liver fibrosis, and 20 patients (56.6%) had liver fibrosis. Only insulin levels, HOMA-IR, and aspartate aminotransferase activity were higher in the patients with high-grade steatosis. Insulin levels and HOMA-IR were higher in patients with fibrosis. In the logistic regression analysis with a dependent dichotomous variable (grades of steatosis: low vs high), the HOMA-IR remained in the model, with an odds ratio to develop high-grade steatosis of 1.33 (95% confidence interval, 1.09-1.86). In the second logistic regression analysis with a dependent dichotomy variable (grades of fibrosis: present vs absent), the HOMA-IR remained in the model, with an odds ratio to develop fibrosis of 1.53 (95% confidence interval, 1.13-2.51). CONCLUSION: Insulin resistance determined with HOMA-IR model is associated with high-grade steatosis and liver fibrosis in obese patients before bariatric surgery.