Dissertations / Theses on the topic 'Fatty liver syndrome of chickens'

Obesity and metabolic dysfunction are worldwide health epidemics and they have grown to unprecedented levels. Human NAFLD is directly linked to obesity and metabolic dysfunction, so attention was given to elucidating a more complete understanding of the liver's role in mediating the metabolically healthy obese phenotype and to better characterizing the potential contribution of dietary fat and fatty acids as a therapeutic supplement to obesogenic diets. Specifically, flaxseed is high in α-linolenic acid (ALA; 18:3 n-3) and low in linoleic acid (LA; 18:2 n-6), and contains multiple other components such as fiber and lignans, and was investigated for its high potential to modify obesity phenotype and fatty liver disease. Additionally, we explored the temporal effect of initiating high-fat diets in various phases of adulthood. However, work in this field is complicated by an ongoing search for appropriate preclinical animal models of NAFLD as they have not been able to replicate the full spectrum of human NAFLD. As such, this dissertation sought to explore fatty liver disease in popular murine models of overnutrition, as well as a novel hen model. Major findings from this work showed that (1) exposure to a high-fat diet during early adulthood preserves metabolic homeostasis, modifies liver morphology, and protects against obesity-related disease, (2) dietary enrichment with flaxseed is capable of increasing tissue n3PUFA content, but this appeared to be only weakly related to metabolic and histological outcomes, and (3) there are limitations to the laying hen as a model of NAFLD as the pathogenic changes may not adequately match the human condition.

Oxidative stress, lipid peroxidation, and endotoxaemia with cytokine-mediated injury have been implicated as factors in the pathogenesis of non-alcoholic fatty liver disease (NAFLD). The degree of insulin resistance together with co-existing inadequacies of vital antioxidant defence mechanisms may be important determinants of progression to fibrosis in patients with non-alcoholic steatohepatitis (NASH). Current therapies are targeted at improving insulin sensitivity as well as addressing hepatic repair including anti-inflammatory strategies. Anti-oxidants remedies have also been tested but the role of selenoenzymes with antioxidant action, namely thioredoxin reductase 1 (TR1) and glutathione peroxidase 1 (GPX1) have been ignored. The aim of this thesis is to investigate the role of selenium in the pathophysiology of NAFLD both in vitro and in vivo. The in vitro studies used cell lines representing the cell types involved in the disorder; hepatocytes (C3A line) and hepatic stellate cells (LX-2 line). In order to assess the influence of selenium status and selenoenzymes expression on the pathogenesis of NAFLD it was necessary to develop a culture system which allowed good cell viability in selenium free culture medium. This was achieved by the use of an insulin and transferrin (IT)-supplemented medium which importantly was free of any animal serum additions. Using this IT culture medium, selenium addition (as selenite) produced a significant increase in the expression of GPX1 and TR1 in both C3A and LX2 cells. TR1 and GPX1 were expressed at similar levels in both C3A and LX-2 cells. It was also necessary to develop an in-vitro model for fat loading C3A cells to mimic fatty liver pathophysiology. Two models of fat loading were investigated. One model used lactate, pyruvate, octanoate and ammonium (LPON). LPON has been previously used to increase the functionality of C3A cells but it was observed that fat droplets accumulated in these LPON treated cells. Dissection of the agents in the LPON revealed that octanoate was the factor that increased the triglyceride accumulation. Interestingly, octanoate also increased the expression of TR1 and GPX1, suggesting that it could induce oxidative stress leading to the induction of selenoenzymes to afford a protective defence mechanism. In the second model, oleate and/or palmitate were used to fat-load C3A cells. These cells had significantly higher triglyceride content than the LPON-fat-loaded cells. However, oleate and/or palmitate treatments did not increase the expression of either TR1 or GPX1 in C3A cells suggesting perhaps these cells were not under oxidative stress. LPON and oleate/palmitate were also capable of fat loading LX2 cells. Selenium-supplementation of C3A and LX-2 cells efficiently protected (measured by their lactate dehydrogenase retention) them from oxidative damage induced by t-butylhydroperoxide. This suggests that selenium supplementation through its incorporation into selenoenzymes could protect the cells from the oxidative damage. The role of selenium was also investigated in the regulation of α-1 pro-collagen mRNA expression. In LX-2 cells, the expression of α-1 pro-collagen mRNA was unaffected by the selenium status of the cell. Similarly the selenium status of C3A cells had no effect on modifying α-1 pro-collagen mRNA of LX2 cells when co-culture or conditioned medium experiments were performed. These results suggest that LX-2 cells were already largely activated and at a stage unable to be ameliorated by selenium treatment. In contrast, studies on C3A cells revealed that TGF-β1 (common inducer of α-1 pro-collagen mRNA in hepatic stellate cells) dramatically increased the expression of α-1 pro-collagen mRNA in C3A cells to the levels observed in LX-2 cells. More interestingly, selenium supplementation of C3A cells notably decreased α-1 pro-collagen mRNA expression in response to TGF-1. In the in vivo study, plasma selenium in type 2 diabetics (high risk of developing NAFLD) were inversely related to the body mass index and in most patients selenium levels were below that required to maximally express GPX1 in red cells. Furthermore, type 2 diabetics had lower plasma selenium levels compared to the healthy control group. Collectively, this suggests that in the UK population, obesity is a risk factor for both insulin resistance and decreased selenium status leading to sub-optimal antioxidant protection. In conclusion, this study provides evidence that selenium through increasing the expression of selenoenzymes is beneficial in protecting liver cells from oxidative stress. Furthermore, selenium is capable of suppressing α-1 pro-collagen mRNA expression in hepatocytes although not in activated hepatic stellate cells. Taken together these data support the view that suboptimal selenium intake in the UK may be a risk factor in the pathogenesis of NAFLD.

ABCD2 (D2) is a peroxisomal ATP binding cassette (ABC) transporter that is expressed in brain, adrenal and liver. D2 is transcriptionally regulated by key transcriptional factors that control lipid and glucose metabolism. Therefore, we examined its role in adipose tissue. These studies revealed that D2 is highly abundant in adipose tissue and upregulated during adipogenesis. However, D2 deficiency does not affect either adipogenesis or lipid accumulation. An examination of the lipid profile of adipose tissue revealed the accumulation of C20 and C22 fatty acids in D2 deficient (D2‐/‐) mice. When challenged with a diet enriched in erucic acid (C22:1, 10% kcal), this lipid accumulated in both liver and adipose tissue. Following 8 weeks of diet, D2‐/‐ mice showed increased adiposity, glucose intolerance, dyslipidemia and steatosis. Analysis of the hepatic lipid profile showed significant changes away from poly unsaturated fatty acids (PUFAs) and toward C18‐22 mono‐unsaturated fatty acids (MUFA). RT‐PCR of the mRNA from the adipose tissue and liver revealed significant changes in lipogenic (ACC, SCD1 & 2) and PUFA synthesis (Δ5 & 6‐desaturase) genes in D2‐/‐ mice. The molecular mechanisms by which D2 regulates lipid metabolism in adipose tissue remains unclear. To explore potential mechanisms, the subcellular localization of D2 in adipose tissue was determined. Our results demonstrated that D2 resides in a distinct subclass of peroxisomes that does not containing classical peroxisomal markers such as pex19 or PMP70, but are positive for pex14. In conclusion, our studies reveal a novel role of D2 and peroxisomes in the protection from disruptions of lipid metabolism induced by dietary erucic acid and that D2 resides in a unique compartment within adipocytes that plays a yet to be elucidated role in the regulation of lipid metabolism.

Thesis (Ph.D.)--Indiana University, 2010.
Title from screen (viewed on July 21, 2010). Department of Cellular and Integrative Physiology, Indiana University-Purdue University Indianapolis (IUPUI). Advisor(s): Michael Sturek, Jeffrey A. Breall, Robert V. Considine, Alexander Obukhov, Johnathan D. Tune. Includes vitae. Includes bibliographical references (leaves 212-240).

Abstract Metabolic syndrome is a constellation of metabolic abnormalities predisposing to cardiovascular diseases (CVD), type 2 diabetes, and increased mortality. Due to the high prevalence and severe co-morbidities, metabolic syndrome constitutes a major burden for both public health and the global economy. Improved understanding of the detailed molecular mechanisms could provide novel strategies for the treatment and preferably prevention of the metabolic syndrome-related health issues. Recent advancements in ‘omics’ technologies have facilitated the development of novel tools to examine the links between genetic variation and human health. The new techniques allow determination of millions of genotypes or quantification of hundreds of metabolic measures from a single blood sample. In this thesis, genomics and metabolomics approaches are coupled to improve our understanding of the metabolic syndrome-related health issues. More precisely, my projects evaluate the metabolic effects of two lipid-lowering therapies and non-alcoholic fatty liver, as well as assess genetic determinants of chronic inflammation. The present results indicate generally consistent metabolic effects of statins and proprotein convertase subtilisin/kexin type 9 (PCSK9) genetic inhibition. The subtle discrepancies observed could potentially contribute to differences in the efficacy to lower CVD risk between statins and PCSK9 inhibitors. The dissimilar metabolic effects of the four genetic variants that increase the risk of non-alcoholic fatty liver disease (NAFLD) highlight the heterogeneity of the molecular mechanisms involved in NAFLD pathogenesis. The results further suggest that fatty liver by itself might not promote unfavourable metabolic aberrations associated with fatty liver on a population level. The newly identified loci associating with inflammatory phenotypes elucidate the genetic mechanisms contributing to the inflammatory load. In particular, the present results suggest the important role of the locus determining the ABO blood types in the regulation of the soluble adhesion molecule levels. To conclude, this thesis successfully complements the knowledge of the molecular mechanisms involved in metabolic syndrome-related traits and provides examples of how to couple omics technologies in the study of complex traits or in the evaluation of drug effects
Tiivistelmä Metabolinen oireyhtymä on tila, jossa useiden aineenvaihdunnallisten riskitekijöiden kasautuminen suurentaa riskiä sairastua tyypin 2 diabetekseen ja sydän- ja verisuonitauteihin sekä lisää kokonaiskuolleisuutta. Vakavista liitännäissairauksista ja suuresta esiintyvyydestä johtuen metabolinen oireyhtymä kuormittaa merkittävästi sekä terveydenhuoltoa että kansantaloutta. Jotta metabolisen oireyhtymän hoitoon ja ennaltaehkäisyyn voitaisiin kehittää uusia keinoja, on tärkeää ymmärtää paremmin oireyhtymän syntyyn vaikuttavat täsmälliset molekyylimekanismit. Niin sanottujen ’omiikka-tekniikoiden’ viimeaikainen kehitys tarjoaa uusia mahdollisuuksia tutkia geenimuutosten vaikutuksia terveyteen. Uusien tekniikoiden avulla voidaan määrittää miljoonia genotyyppejä tai satoja aineenvaihdunnan merkkiaineita yhdestä verinäytteestä. Tässä väitöskirjatyössä yhdistetään genomiikan ja metabolomiikan menetelmiä metaboliseen oireyhtymään liittyvien terveysongelmien tutkimiseksi. Väitöskirjani osatöissä arvioin kahden lipidilääkkeen sekä ei-alkoholiperäisen rasvamaksan aineenvaihdunnallisia vaikutuksia sekä pyrin tunnistamaan krooniseen tulehdukseen vaikuttavia geneettisiä tekijöitä. Tulosten mukaan statiinien ja PCSK9:n (engl. proprotein convertase subtilisin/kexin type 9) geneettisen eston aineenvaihduntavaikutukset ovat hyvin samankaltaiset. Kuitenkin havaitut pienet poikkeavuudet tietyissä merkkiaineissa voivat vaikuttaa eroavaisuuksiin siinä, kuinka tehokkaasti lääkeaineet alentavat sydäntautiriskiä. Suuret erot rasvamaksan riskiä lisäävien geenimuutosten vaikutuksissa aineenvaihduntaan korostavat rasvamaksaan liittyvien molekyylimekanismien monimuotoisuutta. Tulosten perusteella vaikuttaa siltä, että rasvan kertyminen maksaan ei luultavasti itsessään aiheuta suuria muutoksia verenkierron aineenvaihduntatuotteiden pitoisuuksiin. Tulehdusmerkkiaineisiin assosioituvat uudet geenialueet täydentävät tulehduksen molekyylimekanismeihin liittyvää tietoa. Tulokset korostavat ABO-veriryhmän määräävän geenin vaikutusta liukoisten adheesiomolekyylien pitoisuuksiin. Kaiken kaikkiaan väitöskirjan osatyöt tuovat uutta tietoa metaboliseen oireyhtymään liittyvien terveysongelmien molekyylimekanismeihin. Projektit havainnollistavat, miten omiikka-tekniikoita voidaan hyödyntää monitekijäisten fenotyyppien tutkimuksessa sekä lääkeaineiden aineenvaihduntavaikutusten arvioinnissa

Devido a controvérsias sobre a freqüência, diagnóstico e possibilidade de progressão para doença crônica da degeneração gordurosa do fígado em portadores de obesidade mórbida, planejou-se uma investigação retrospectiva em pacientes candidatos à cirurgia bariátrica. Foram analisados 60 indivíduos com indicação de gastroplastia com derivação intestinal em Y de Roux. Os pacientes foram submetidos a questionário clínico, provas bioquímicas e posteriormente, à biópsia hepática intraoperatória. A freqüência de EHNA e esteatose hepática foi elevada, e detectou-se 5% de cirrose. Na análise univariada houve correlação de diversos testes bioquímicos com as enzimas hepáticas. Na análise multivariada a albumina foi a variável determinante; apesar de seu debilitado valor preditivo. Nestas condições, apenas a avaliação histológica configura-se como critério definitivo para diagnóstico e acompanhamento desta população
Because of controversies about frequency, diagnosis and possibility of progression toward chronic disease of fatty degeneration of the liver in morbidly obese patients, a retrospective study was done in patients who underwent bariatric surgery. Sixty individuals with indication for gastroplasty with Roux-en-Y jejunal bypass were enrolled. They were submitted to clinical questionnaire, biochemistry tests and subsequently, intraoperative liver biopsy. Frequency of NASH and steatosis was high, and 5.0% suffered from cirrhosis. In univariate analysis there was correlation between various biochemical measurements and liver enzymes. In multivariate analysis only serum albumin was a determinant variable, with low predictive value. The histological grading system remains the definitive criterion for diagnosis and follow-up of this population

Les plaquettes sanguines jouent un rôle majeur dans le maintien de l’intégrité vasculaire. Elles sont les premiers éléments à intervenir lors d’une brèche vasculaire afin d’arrêter le saignement par la formation d’un thrombus. La plaquette est également un acteur critique dans la survenue d’évènements thrombotiques associées à certaines pathologies comme par exemple le syndrome métabolique, ce qui en fait une cible pharmacologique majeure. Au cours de ma thèse, je me suis focalisée sur deux axes de recherche : (i) l’étude de l’activation plaquettaire dans le syndrome de Noonan (SN) et le syndrome de Noonan avec Lentigines Multiples (SNLM) et (ii) la caractérisation du rôle des plaquettes dans le développement des maladies hépatiques non alcooliques (NAFLD). Dans un premier temps, motivée par le fait que les patients atteints du SN présentent des troubles de l’hémostase encore inexpliqués, mes travaux de recherche ont eu pour but de caractériser l’activation plaquettaire dans le SN et le SNLM causés respectivement par une hyper- ou une hypo-activation de la protéine tyrosine phosphatase SHP2. Nous avons tout d’abord observé que les plaquettes de patients Noonan présentent in vitro une agrégation fortement diminuée en réponse à de faibles doses d’un ligand du récepteur GPVI, le collagène, associée ex vivo à une réduction significative de la formation de thrombi en condition de flux artériel sur matrice de collagène. Le modèle murin mimant phénotypiquement le SN présente également un défaut d’agrégation plaquettaire in vitro induite par de faibles doses d’agonistes de GPVI associé à une diminution de la signalisation en aval de GPVI. La formation de thrombi plaquettaire ex vivo en condition de flux artériel mais aussi in vivo à la suite d’une lésion de la carotide est aussi significativement altérée. L’hémostase primaire des souris Noonan est aussi très fortement affectée, comme montré par une augmentation significative du temps de saignement à la queue. A l’opposé, le modèle murin de SNLM est responsable d’une hyper-activation plaquettaire induite par la stimulation de GPVI et présente un phénotype prothrombotique ex vivo en condition de flux artériel. De façon intéressante, cette hyperactivation plaquettaire est également observée chez les patients atteints du SNLM et est exacerbée dans des conditions de flux à haute vitesse. Ainsi, cette étude permet de mettre en lumière deux nouvelles thrombopathies associées à un dysfonctionnement de la signalisation plaquettaire, ce qui permet une meilleure compréhension et prise en charge des potentiels risques hémorragiques/thrombotiques des patients SN et SNLM. D’un point de vue moléculaire, cette étude a permis de préciser le rôle de SHP2 dans l’activation plaquettaire. Dans un second temps, je me suis intéressée au rôle des plaquettes dans le développement de la NAFLD. Pour ce faire, plusieurs modèles murins ont été mis sous régimes hyperlipidiques mimant différents stades de la pathologie. De façon intéressante, nous avons montré un rôle protecteur des plaquettes sur le statut glucido-lipidique du foie en inhibant le stockage de lipides, mais également sur l’état inflammatoire et fibrotique hépatique en protégeant de l’infiltration des cellules inflammatoires et de l’installation de la fibrose. Ce rôle est associé à un recrutement de plaquettes dans les sinusoïdes hépatiques durant l’installation de la pathologie. De plus, nous démontrons que la délétion de Vps34 plaquettaire permet de ralentir le développement de la NAFLD. Ainsi, ces résultats ont permis de mettre un jour pour la première fois un nouveau rôle protecteur des plaquettes sur le développement de la NAFLD et pourrait permettre d’identifier de potentielles pistes thérapeutiques permettant de réduire ou prévenir la NAFLD. En conclusion, mes travaux de thèse apportent de nouvelles données quant au rôle des plaquettes dans différents contextes pathologiques : le SN, le SNLM et la NAFLD
Blood platelets play a major role in the maintenance of vascular integrity. They are the first blood cells recruited after vessel injury to stop bleeding by thrombus formation. Platelet hyper-activation is also a critical element in thrombotic events associated to several pathologies such as metabolic syndrome, which makes them major pharmacologic targets. My thesis work was focused on two main axis: (i) analysis of platelet activation in Noonan syndrome (NS) and Noonan syndrome with multiple lentigines (NSML) and (ii) characterization of the role of platelets in non-alcoholic fatty liver disease (NAFLD). Firstly, motivated by the occurrence of bleeding anomalies frequently reported in NS, we focused on characterizing platelet activation in NS and NSML caused respectively by a gain or a loss of function of the protein tyrosine phosphatase SHP2. We observed that platelets from NS patients display a defective in vitro aggregation to low concentrations of collagen, a GPVI agonist, associated to a decrease in thrombus growth ex vivo on a collagen surface under arterial shear stress. The mouse model phenocopying NS also exhibit a significant reduction in in vitro platelet aggregation induced by low concentrations of GPVI agonists, which is associated to a deficiency in GPVI signalling. The thrombus formation ex vivo under arterial shear stress as well as in vivo following a local carotid injury was also significantly affected. Primary haemostasis is also defective in NS mice as shown by a significant increase in mouse tail bleeding time. In contrast, NSML mouse platelets exhibited an increased activation after GPVI stimulation and an enhanced platelet thrombotic phenotype on collagen matrix under arterial shear stress. Interestingly, this platelet hyper-activation is also observed in blood samples from NSML patients ex vivo in arterial shear rate and exacerbated in high shear rate condition. This study allows the discovery of two new thrombopathies linked to platelet signalling defects and provides important information for the medical care of patient with NS or NSML in risk of bleeding or thrombosis situations. Besides, this study brings new insights into the understanding of SHP2 function in platelet activation. Secondly, I studied the role of platelets in NAFLD development. Using mouse models fed with different hyperlipidic diets mimicking different step of the NAFLD, we showed a protective role for platelets in hepatic glucidic and lipidic metabolism by inhibition of lipid storage. Furthermore, platelets protect against hepatic inflammation and fibrosis by decreasing inflammatory cells recruitment and fibrosis development. This protective role is associated to the presence of platelet aggregates in liver sinusoids. Interestingly, we demonstrate that platelet Vps34 deletion allows to slow down NAFLD development. Thereby, these innovative results highlight a new protective role of platelet in NAFLD development and could allow the identification of potential pharmacologic targets for preventing or limiting the disease. In conclusion, my thesis work brings new data on the role of platelets in different physiopathologic conditions: NS, NSML and NAFLD

A doença hepática gordurosa não-alcoólica (DHGNA) e a esteatohepatite (EHNA) são freqüentes nos obesos. O objetivo foi determinar a prevalência de DHGNA/EHNA e Síndrome Metabólica (SM) nos grandes obesos; definir preditores de EHNA; estabelecer critérios histológicos para o diagnóstico da EHNA. Avaliados 325 pacientes encaminhados à cirurgia bariátrica (IMC = 35 kg/m2), dos quais 146 foram submetidos à análise histológica; as variáveis clínicas e bioquímicas analisadas e correlacionadas com a histologia. A DHGNA ocorreu em 111 (76%) pacientes e a prevalência de EHNA, conforme critério histológico usado, em 25,3% a 55,5%; SM ocorreu em 57,2%. Os preditores da EHNA foram: SM; alterações glicêmicas; hipertrigliceridemia e HAS. Foram preditores de fibrose: idade acima de 30 anos e AST elevada
Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) has been associated with obesity. Determine prevalence of NAFLD/NASH and metabolic syndrome (MS) in severe obesity; define clinical predictor of steatohepatitis; establish histological criteria necessary to diagnose NASH. Evaluation of 325 patients submitted to bariatric surgery (BMI = 35 kg/m2), among which 146 were submitted to histological analysis; variables clinical and biochemical were analyzed and correlated to histological characteristics. NAFLD occurred in 111 (76%) patients and NASH, according to histological criteria used, in 25.3% to 55.5%; MS was present in 57.2%. Predictors of NASH: MS; glycaemic alterations; hypertriglyceridaemia and high blood pressure (HBP). Predictors of fibrosis: age above 30 years and high AST

A síndrome dos ovários policísticos (SOP) é um distúrbio endócrino complexo, associado a resistência insulínica, hiperinsulinemia, obesidade, acúmulo de gordura visceral e dislipidemia. Essas alterações podem levar a aumento de risco de doenças como \"diabetes mellitus\", doenças cardiovasculares, esteatose hepática ou até mesmo esteato-hepatite. Em ratas, o excesso de androgênios ou estrogênios no período neonatal induz a alterações metabólicas e reprodutivas similares às observadas na SOP em humanos. O objetivo deste estudo é analisar os efeitos da exposição neonatal à testosterona e ao estrogênio no fígado de ratas adultas. Para isso foram utilizadas 30 ratas, divididas em três grupos de 10 animais cada. Foi administrada por via subcutânea, entre 1 e 3 dias de vida, uma única dose dos seguintes compostos: 0,1 mL de óleo de oliva (veículo) - grupo Controle (n=10); propionato de testosterona (1,25 mg/0,1mL de veículo) - grupo Testosterona (n=10); benzoato de estradiol (0,5 mg/0,1mL de veículo) - grupo Estradiol (n=10), de acordo com o grupo a que pertenciam. Após cerca de 90 dias, os animais foram sacrificados, sendo retirados fragmentos do fígado que foram preparados para análise da metabolômica e da histomorfologia. Histologicamente, o fígado dos animais do grupo testosterona apresentaram maior infiltração gordurosa e infiltrado inflamatório; e do grupo estradiol apresentou hepatócitos binucleados, além do aumento do volume nuclear. Houve, no grupo testosterona modificações no perfil metabolômico ligadas a maior resistência à insulia e maior risco para diabete. O grupo exposto ao estrogênio apresentou alterações relacionadas ao metabolismo e síntese de lipídeos. Nossos resultados sugerem que os riscos metabólicos associados à SOP podem ter origem e mecanismos diferentes
Polycystic ovary syndrome (PCOS) is a complex endocrine disorder associated with insulin resistance, hyperinsulinemia, central obesity, accumulation of visceral fat and dyslipidemia. Those changes can lead to increased risk of diseases such as diabetes mellitus, cardiovascular disease, nonalcoholic fat liver disease or even nonalcoholic steatohepatitis. In rats, the excess of androgens or estrogens in the neonatal period leads to metabolic and reproductive alterations similar to those observed in SOP in humans. The objective of this study is to analyze the effects of exposure to neonatal testosterone and estrogen in the liver of adult rats. For this we used 30 female rats, sorted into three groups of 10 animals each. It was administered subcutaneously between 1 and 3 days of age a single dose of the following compounds: 0.1 mL olive oil (vehicle) - Control Group (n = 10); testosterone propionate (1.25 mg / 0.1 mL vehicle) - Testosterone (n = 10); estradiol benzoate (0.5 mg / 0.1 mL vehicle) - Estradiol group (n = 10). After 90 days, the animals were sacrificed, and the liver removed fragments were prepared for analysis of metabolomics and histomorphometry. Histologically, the testosterone group displayed greater fat deposition and higher degree of inflammatory infiltration. The estradiol group had binucleate hepatocytes and increased nuclear volume. Testosterone group showed changes in the metabolomic profile linked to increased insulin resistance and increased risk for diabetes mellitus. The group exposed to estrogen showed changes related to metabolism and synthesis of lipids. Our results indicate that the metabolic risks associated with PCOS may have origin and different mechanisms

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Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)
O aumento da permeabilidade intestinal promove o influxo de toxinas bacterianas do lúmen intestinal para o interior do hospedeiro, desencadeando em resposta inflamatória de baixo grau, semelhante à observada na expansão do tecido adiposo e na etiologia das doenças crônicas. Foi realizado estudo transversal para identificar os determinantes das concentrações plasmáticas de proteína ligadora de lipopolissacarídeo (LBP) em mulheres adultas ingressantes em programa para mudança do estilo de vida. Foram avaliadas 74 mulheres com idade entre 35 a 67 anos, as quais foram submetidas à avaliação sociodemográfica e clínica, antropométrica, de composição corporal e consumo alimentar, coleta sanguínea e bioquímica padrão. Todas as análises foram efetuadas pelo programa estatístico SPSS versão 19.0, e o nível de significância adotado foi de 5%. Observou-se que as concentrações da LBP foram significativamente maiores em mulheres com excesso de peso e que este biomarcador apresentou correlações moderadas com a circunferência abdominal, a pressão arterial e com o índice de gordura hepática. Similarmente, notou-se que a ingestão de frutose e de gordura poli-insaturada, a pressão arterial diastólica, a transaminase glutâmico-pirúvica e o percentual de gordura corporal total, influenciaram os níveis plasmáticos da LBP de maneira independente das demais variáveis. Desta forma, o presente estudo demonstra que a LBP está relacionada a dois componentes da síndrome metabólica e ao acúmulo hepático de gordura em mulheres adultas. Elevações plasmáticas deste biomarcador podem refletir o consumo de alimentos industrializados, o excesso de peso e as alterações metabólicas que são provocadas ou agravadas pela permeabilidade intestinal aumentada.
Increased intestinal permeability promotes the influx of bacterial toxins from the intestinal lumen into the host, triggering low grade inflammatory response similar to that observed in the expansion of adipose tissue and in the etiology of chronic diseases. A cross-sectional study was conducted in adult women to identify the determinants of plasma lipopolysaccharide binding protein (LBP) concentrations in adult women entering a lifestyle modification program. A total of 74 women aged 35-67 years were assessed, which were submitted to sociodemographic and clinical, anthropometric, body composition and food consumption evaluations, blood collection and standard biochemistry. All analyzes were performed by the SPSS software version 19.0 and the significance level adopted was 5%. It was observed that LBP concentrations were significantly higher in overweight women and this biomarker showed moderate correlations with waist circumference, blood pressure and liver fat index. Similarly, the ingestion of fructose and polyunsaturated fat, diastolic blood pressure, glutamic-pyruvic transaminase and total body fat percentage influenced plasma LBP levels independently of the other variables. Thus, the present study demonstrates that LBP is related to two components of metabolic syndrome and to the hepatic accumulation of fat in adult women. Plasma elevations of this biomarker may reflect consumption of processed foods, overweight, and metabolic changes that are caused by increased intestinal permeability.
130378/2016-0

The non-alcoholic fat liver diseases (NAFLD) have been presented, recently, as a novel component of the Metabolic Syndrome (MetS), representing the oxidative stress a critical role in their progression. In this context, the present study aimed to assess the morphofunctional hepatic alterations and the redox balance in a murine model for the MetS induced by a high calorie diet, after treatment with tempol and apocinina. C57Bl/6 male mice, young (6-8 weeks) and elderly (53-57 weeks), were divided in four groups: control group (CT; n young=8 and n elderly=5), fed with chow diet (14% calories from lipids); DHC group ( n young=9 and n elderly=5), receiving hypercaloric diet for 14 weeks (58,4% calories from lipids); DHC + Tempol group ( n young=4 and n elderly=9), which received hypercaloric diet and treatment with tempol (50mg/kg) in the water for drinking; DHC + Apocinin group ( n young=4 and n elderly=9), fed with a hypercaloric diet and under apocinin treatment (50mg/kg) in the water for drinking. Metabolic and the redox state assessment, as well as the histological analyses were performed. After the end of the experimental period, young DHC animals were not shown to present significant weight gain, being the latter observed in the elderly DHC animals, when compared to CT group. The treatment with tempol and apocinin was not effective in modifying this parameter in both groups. The DHC animals, both young and elderly, showed fasting hyperglicaemia, and the treatment with tempol and apocinin did not change this profile. A significant improvement in the glucose tolerance was observed in the young animals after the treatment with apocinin, but the treatment with tempol failed to show so. In the elderly animals, a significant improvement in the glucose tolerance and insulin sensitivity was identified after the treatment with tempol and apocinin. An elevated accumulation of visceral fat was identified in the DHC animals (young and elderly), so that the treatment with tempol and apocinin did not alter this profile. An elevated serum concentration of total cholesterol was shown in the young and elderly DHC animals when compared to the CT group, the same not happening to triglycerides, VLDL and lipid peroxidation in both groups, young and elderly. The pharmacological treatment was not shown to be effective in altering these serum parameters. In the young DHC animals, it was not observed significant changes in the enzymatic activities of the AST and ALT, as well as AST/ALT ratio, ALP, γ-GT, LDH, albumin and total proteins, when compared to the CT group. However, in the DHC elderly animals, and increased AST activity and AST/ALT ratio were observed among these parameters of hepatic assessment. The DHC animals, young and elderly, presented elevated lipid peroxidation and fat liver accumulation, with numerous fat vacuoles at histology. The pharmacological treatment with tempol and apocinin ameliorated, in a qualitative manner, the fat accumulation in the liver, both in the young and elderly animals, without, however, modifying the hepatic lipid peroxidation. Furthermore, the DHC elderly animals presented high hepatic levels of total lipids, triglycerides, total cholesterol and VLDL cholesterol, with a similar condition not being observed in the DHC young animals. The hepatic activity of the antioxidant enzymes (SOD and CAT) was not shown to be significantly different after the dietary and pharmacological treatments. An increase in the NADPH oxidase activity, and consequently the increased production of superoxide anion ( O2-), may be involved in the mechanisms associated to the MetS and the NAFLD.
Conselho Nacional de Desenvolvimento Científico e Tecnológico
As doenças hepáticas gordurosas não-alcoólicas (DHGNA) foram apresentadas, recentemente, como um novo componente da Síndrome Metabólica (SMet), desempenhando o estresse oxidativo papel fundamental na progressão destas. Nesse contexto, o presente estudo objetivou avaliar as alterações morfo-funcionais hepáticas e do balanço redox em um modelo murino para a SMet induzida por uma dieta hipercalórica, após tratamentos com tempol e apocinina. Camundongos machos C57Bl/6, jovens (6-8 semanas) e idosos (53-57 semanas), foram divididos em quatro grupos: grupo controle (CT; n jovem=8 e n idoso=5), alimentado com dieta chow (14% calorias provenientes dos lipídios); grupo DHC ( n jovem=9 e n idoso=5), que recebeu dieta hipercalórica por 14 semanas (58,4% calorias provenientes dos lipídios); grupo DHC + Tempol ( n jovem=4 e n idoso=9), que recebeu dieta hipercalórica e tratamento com tempol (50mg/kg) na água de beber; grupo DHC + Apocinina ( n jovem=4 e n idoso=9), alimentado com dieta hipercalórica e tratado com apocinina (50mg/kg) na água de beber. Avaliações metabólicas, do estado redox e análise histológica hepática foram realizadas. Após o término do período experimental, os animais DHC jovens não apresentaram significativo ganho de peso corporal, sendo este observado nos animais DHC idosos quando comparados ao grupo CT. O tratamento com tempol e apocinina não modificou este parâmetro em ambos os grupos. Os animais DHC, tanto jovens quanto idosos, apresentaram hiperglicemia de jejum e o tratamento com tempol e apocinina não modificou este perfil. Uma significante melhora na tolerância à glicose dos animais jovens foi observada após o tratamento com a apocinina, o mesmo não ocorrendo após o tratamento com o tempol. Nos animais idosos, uma melhora significativa foi observada na tolerância à glicose e sensibilidade à insulina após o tratamento com tempol e apocinina. Acentuado acúmulo de gordura visceral foi identificado nos animais DHC (jovens e idosos), de modo que o tratamento com o tempol e a apocinina não alterou este perfil. Elevada concentração plasmática de colesterol total foi observada nos animais DHC jovens e idosos comparado ao CT, o mesmo não ocorrendo para triglicerídeos, VLDL e peroxidação lipídica plasmática em ambos grupos DHC, jovens e idosos. O tratamento farmacológico em questão não modificou estes parâmetros plasmáticos. Nos animais DHC jovens, não foram observadas mudanças significativas na atividade das enzimas AST, ALT, razão AST/ALT, ALP, γ-GT, LDH, albumina e proteínas totais, quando comparado ao grupo CT. Contudo, nos animais idosos DHC, elevada atividade da AST e da razão AST/ALT foram observadas dentre estes parâmetros de avaliação hepática. Os animais DHC, jovens e idosos, apresentaram elevada peroxidação lipídica e acúmulo de gordura hepática, com numerosos vacúolos gordurosos à histologia. O tratamento farmacológico com tempol e apocinina melhorou, de forma qualitativa, o acúmulo de gordura hepática, tanto nos animais jovens quanto nos idosos, sem, entretanto, modificar a peroxidação lipídica hepática. Além disso, os animais idosos DHC apresentaram elevados níveis hepáticos de lipídios totais, triglicerídeos, colesterol total e VLDL colesterol, não sendo observado o mesmo nos animais jovens DHC. A atividade hepática das enzimas antioxidantes (SOD e CAT) não diferiu significativamente após os tratamentos dietético e farmacológico. O aumento na atividade da NADPH oxidase, e consequentemente a produção de anion superóxido ( O2-), pode estar envolvida nos mecanismos associados à SMet e às DHGNA.

Abstract Blood pressure is usually measured on a clinic visit as a momentary value. It can also be defined as a continuum based on several repeated measurements. Ambulatory blood pressure measurement (ABPM) is a method of repeated BP measurements targeted to evaluate the circadian blood pressure (BP). Nondipping, i.e., the lack of reduction of BP during the night, has been shown to associate with cardiovascular endpoints. The aim of this study was to investigate the association between 24-hour ABPM and cardio-metabolic confounders in a cross-sectional, population-based study design. Particular attention was paid to the nondipping phenomenon. Adiponectin, a hormone secreted by the adipose tissue, has vasoprotective and anti-inflammatory effects. Reduced adiponectin level has been associated with hypertension. In this study adiponectin level was inversely associated with daytime systolic BP, but showed no association with nondipping. Hypertension is one component of metabolic syndrome (MS). MS has been associated with nondipping. The association between ABPM and metabolic abnormalities was studied in subjects without known hypertension or type 2 diabetes. Subjects with impaired glucose metabolism were more likely to belong to the group of nondippers. Fatty liver is considered as the hepatic manifestation of MS. A significantly higher prevalence of fatty liver has been seen in hypertensives compared to normotensive controls, elevating their risk for cardiovascular morbidity. The association between ABPM characteristics and fatty liver was evaluated in the present study. Significantly higher systolic ABPM levels were seen in subjects with fatty liver, but no association with nondipping existed. The kidney vasculature is prone to injury under a high continuous circadian BP load and lacking nighttime drop. This may lead to diminished glomerular filtration rate. Our study showed a significant independent association between renal function and the dipping status. Reduction in renal function was associated with increased risk of nondipping pattern. Carotid intima-media thickness (cIMT), the surrogate marker of early atherosclerosis, has been associated with blunted nocturnal BP drop. The association between cIMT and dipping status was explored. Nondipping pattern was associated with increased cIMT. In conclusion, ABPM specifies the information of circadian and nighttime BP level not achievable with conventional BP measurement. This is especially beneficial in metabolic abnormalities when the risk of cardiovascular morbidity is increased
Tiivistelmä Väitöstutkimuksessa osoitettiin, että vuorokausiverenpaineen mittauksella eli ambulatorisella verenpaineenmittauksella on erityistä merkitystä sydän- ja verenpainesairastavuutta lisäävien metabolisten häiriöiden yhteydessä. Työssä haluttiin selvittää 24 tunnin aikana mitatun verenpainetason ja puuttuvan yöaikaisen verenpaineenlaskun eli nondipping-ilmiön yhteyttä tunnettuihin metabolisiin riskitekijöihin ja kaulavaltimoseinämän paksuuntumaan. Kyseessä on suomalaiseen, keski-ikäiseen väestöotokseen kohdistunut poikkileikkaustutkimus. Tavallisesti yöaikainen verenpainetaso laskee 10 % tai enemmän päiväaikaiseen verenpainetasoon nähden (dipping). Verenpaineen lasku voi kuitenkin jäädä puutteelliseksi (nondipping). Nondipping-ilmiön on todettu lisäävän sydän- ja verisuonisairastuvuuden riskiä. Kaulavaltimoseinämän paksuuntumaa on pidetty merkkinä varhaisesta valtimosairaudesta ja maksan rasvakertymä katsottu osaksi metabolista oireyhtymää. Metabolisiin häiriöihin sekä munuaistoiminnan häiriöihin liittyy lisääntynyt valtimosairauden riski. Väitöstutkimuksessa vuorokausiverenpaine mitattiin mukana kannettavalla automaattisella verenpaineenmittausmenetelmällä eli ambulatorisella verenpaineenmittauksella. Lisäksi verenpaine mitattiin tavalliseen tapaan vastaanottokäynnin yhteydessä. Maksan rasvaisuutta ja kaulavaltimon seinämäpaksuutta tutkittiin ultraäänilaitteella. Tavanomaisten taustamuuttujien lisäksi kerättiin laboratoriotietoa sokeriaineenvaihdunnasta, munuaissuodoksen määrästä sekä rasvakudoksen erittämän adiponektiinihormonin määrästä. Nondipping-ilmiön todettiin olevan itsenäisesti yhteydessä sokeriaineenvaihdunnan häiriöön, munuaissuodoksen alenemaan ja kaulavaltimon seinämäpaksuuntumaan. Kohonnut päiväaikainen systolinen verenpainetaso oli yhteydessä verisuoniston kannalta epäedulliseen adiponektiinihormonitasoon. Sekä systolinen että diastolinen verenpainetaso oli korkeampi henkilöillä, joilla todettiin maksan rasvoittuma kuin niillä, joilla ei ollut maksan rasvoittumaa. Tutkimus osoitti ambulatorisen verenpaineenmittauksen tuovan merkittävää lisätietoa etenkin sydän- ja verisuonisairastuvuuden riskiä jo sinällään lisäävissä tiloissa, kuten metabolisissa häiriöissä ja munuaistoiminnan alentumassa. Koska metaboliset häiriöt lisääntyvät jatkuvasti, on todennäköistä, että vuorokausiverenpaineen mittaus yleistyy osana valtimosairastavuuden kokonaisriskin arviointia

Non-Alcoholic Fatty Liver Disease (NAFLD) is characterized by accumulation of lipids in hepatocytes, which accounts for at least 5% of the weight of this tissue. It affects patients in different age groups; these tend to present hepatic alterations characterized not only by the accumulation of fat but, in some cases, also by the presence of inflammation and fibrosis, even evolving to cirrhosis. It is considered the hepatic component of Metabolic Syndrome (MS) and this, in turn, is also an inducer of NAFLD. The present study proposes to evaluate the degree of steatosis in patients with NAFLD and their relationship with cardiovascular risk, the prevalence of OSAS and quality of life. This is a cross-sectional study, where 173 patients were interviewed at the outpatient clinic. Hepatology, which is a reference service of the State, University Hospital of the Federal University of Sergipe. Socio-demographic data and anthropometric measurements, results of biochemical laboratory tests and image of medical records were collected, and these patients were submitted to quality of life (QOL) questionnaires (WHOQOL bref), CVD risk (Framinghan score), individual risk of OSAS (Berlin scale) and bioimpedance test. We obtained as results a prevalence in the low risk population to develop CVD (58.4%), a prevalence of the sample for high risk of OSAS (64%), the QV assessment showed better results in the psychological and social relations domains . We conclude that there is an association between the degree of NAFLD and the evolution of OSA in the patients studied. There was no association with the increase in the risk of CVD, and when we assessed the association with the QOL, there was no significant difference between the total score quality of life in patients with mild steatosis for individuals who presented them in marked form. Thus, we emphasize the importance of the global evaluation of these patients, from the beginning of the detection of NAFLD.
A Doença Hepática Gordurosa Não Alcoólica (DHGNA) é caracterizada por acúmulo de lipídios em hepatócitos, que representa, ao menos, 5% do peso deste tecido. Acomete pacientes em diferentes faixas etárias; estes tendem a apresentar alterações hepáticas caracterizadas não apenas pelo acúmulo de gordura, mas, em alguns casos, também pela presença de inflamação e fibrose, inclusive evoluindo para cirrose. É considerada o componente hepático da Síndrome Metabólica (SM) e esta, por sua vez, também um indutor da DHGNA. O presente estudo propõe avaliar o grau de esteatose em pacientes com DHGNA e a relação destes com o risco cardiovascular, a prevalência de SAOS e a qualidade de vida. Trata-se de um estudo transversal, onde foram entrevistados 173 pacientes atendidos no ambulatório de Hepatologia, um serviço de referência no Estado, do Hospital Universitário da Universidade Federal de Sergipe. Foram coletados dados sociodemográficos e medidas antropométricas, resultados de exames laboratoriais bioquímicos e de imagem dos prontuários, e estes pacientes foram submetidos a questionários de qualidade de vida (QV) (WHOQOL bref), risco de doenças cardiovasculares (DCV’s) (Escore de Framinghan), a avaliação do risco individual de Síndrome da Apneia Obstrutiva do Sono (SAOS) (Escala de Berlim) e ao teste de bioimpedância. Obtivemos como resultados uma prevalência na população estudada de baixo risco para desenvolver DCV’s (58,4%), houve uma prevalência da amostra para alto risco de SAOS (64%), a avaliação da QV demonstrou melhores resultados nos domínios psicológicos e das relações sociais. Concluímos que há uma associação do grau de DHGNA com a evolução do SAOS nos pacientes estudados, não havendo a mesma associação em relação ao aumento do risco de DCV’s e quando avaliamos a associação com a QV não observou-se diferença significativa entre o escore total de qualidade de vida em pacientes com esteatose leve para os indivíduos que as apresentavam na forma acentuada. Sendo assim, enfatizamos a importância da avaliação global desses pacientes, desde o início da detecção da DHGNA.
Aracaju

Background: Obesity has become one of our times most endemic disease on a global scale and changes to lifestyle is the most cost-effective way to treat patients, when the cost for healthcare related treatment is staggeringly high for obesity and sequela diseases NAFLD, diabetes typ 2, dyslipidaemia and metabolic syndrome.The problem with this remedy is that it requires work and dedication. But changes require hard work, and in this patient group- low compliance, weight gain after treatment, dropping out of programs and small desire to change are the most common problems. Motivational studies report that readiness in obese patients is low and the best way to help patients to move forward is by motivational conversations. The obesity sequela disease NAFLD is an asymptomatic disease it displays no symptoms until very late stages. Therefore it’s a problem to get patients make the patient understand his illness and the seriousness of it. Aim: This literature work was aimed at investigating compliance in lifestyle changes in obese subject and to see if close contact with healthcare staff affected the achieved results. Method: In this literature study, the databases Pubmed, Science Direct, Medline and Sportdiscus were used to find information. Article inclusion criteria were that the articles were not older than 10 years and were in English. Result: Frequent and regular contacts between participants and professional staff provided good results both with regard to weight loss, biochemical response, and the participants' willingness to change. Also it shows that return visits at least every three months will improve weight loss if the participant is motivated to implement a change to lifestyle. Conclusion: Overall, this literature study shows the difficulties with lifestyle changes in people with obesity and sequela NAFLD. Close contacts of the patients with healthcare staff has proven to have a positive impact on treatment compliance, but there are other lifestyle difficulties in these patient groups which hamper compliance.

OBJETIVO: Avaliamos se a presença da síndrome dos ovários policísticos (SOP) altera múltiplos marcadores ultrassonográficos e laboratoriais de risco metabólico e doença cardiovascular em mulheres obesas sem outras condições que interferem com o critério de elegibilidade do contraceptivo oral combinado (COC). MÉTODOS: Estudo caso-controle avaliando 90 mulheres obesas ( 30,0 Kg/m² e < 40 Kg/m²), com idade entre 18 e 40 anos, sem outras condições de saúde que interferem com os critérios de elegibilidade de COC: 45 com SOP e 45 controles, pareadas por idade. Índice de massa corporal; circunferência da cintura e do quadril; pressão arterial sanguínea; insulina e glicemia de jejum; quantitative insulin sensitivity check index (QUICKI); HDL, LDL e colesterol total; triglicérides; testosterona; globulina carreadora de hormônios sexuais (SHBG); índice de androgênio livre (FAI); índice de rigidez da carótida e espessura íntimamédia (EIM); dilatação mediada por fluxo da artéria braquial (DMF) e doença hepática gordurosa não alcoólica (DHGNA) foram avaliados. RESULTADOS: Em mulheres obesas com SOP, observamos uma maior freqüência de DHGNA quando comparada a obesas sem SOP (73,4% vs. 46,6%, p<0,01). Embora não significativo, observamos uma tendência a aumento da insulina (10,06±6,66 UI/mL vs. 7,45±5,88 UI/mL, p=0,05), diminuição do QUICKI (0,36±0,06 vs. 0,39±0,07, p=0,05) e diminuição da DMF (7,00±3,87% vs. 8,41±3,79%, p=0,08). Nenhuma outra diferença significativa foi observada. CONCLUSÕES: DHGNA é freqüente em mulheres obesas sem outras condições que interferem com o critério de elegibilidade do COC, especialmente naquelas com SOP. Isto deveria ser considerado na escolha da melhor opção contraceptiva.
OBJECTIVE: To evaluate whether the presence of polycystic ovary syndrome (PCOS) alters multiple ultrasonographic and laboratorial markers of metabolic and cardiovascular disease risk in obese women without any other health condition that interferes with combined oral contraceptive (COC) eligibility criteria. METHOD: A case-control study evaluating 90 obese women ( 30.0kg/m² and <40kg/m²) aged between 18 and 40 years without any other health condition that interferes with COC eligibility criteria: 45 with PCOS and 45 age-matched controls. Body mass index; waist and hip circumference; arterial blood pressure; fasting insulin and glucose; quantitative insulin sensitivity check index (QUICKI); HDL, LDL and total cholesterol; triglycerides; testosterone; sex hormone-binding globulin (SHBG), free androgen index (FAI); carotid stiffness index and intima media thickness; flow-mediated dilatation of brachial artery; and nonalcoholic fatty liver disease (NAFLD) were assessed. Results: In PCOS women, we observed a higher frequency of NAFLD (73.4% vs. 46.6%, p<0.01) and higher FAI (10.43% vs. 6.84%, p<0.01). We also observe a trend of increased insulin (10.06±6.66IU/mL vs. 7.45±5.88IU/mL, p=0.05), decreased QUICKI (0.36±0.06 vs. 0.39±0.07, p = 0.05), and decreased FMD (7.00±3.87% vs. 8.41±3.79%, p=0.08). No other significant difference was observed. Conclusions: NAFLD is frequent in obese women without any other health condition that interferes with COC eligibility criteria, especially in those with PCOS. This should be considered when choosing the best contraceptive option.

Introdução e Objetivos: A Doença hepática gordurosa não alcóolica (DHGNA) é claramente marcada por influência ambiental, no entanto, fatores genéticos têm sido associados a progressão para formas mais graves de DHGNA. O estresse oxidativo tem sido cada vez mais enfatizado nesta evolução e o sistema NADPH parece ser uma importante fonte de produção de espécies reativas de oxigênio. O papel dos polimorfismos do sistema NADPH nessa população e sua possível relação com progressão de doença e síndrome metabólica são desconhecidos. Desta maneira, investigamos dois polimorfismos de nucleotídeo único (SNPs) na região reguladora dos genes que codificam a NADPH oxidase 4 subunidade catalítica (NOX4) e sua subunidade regulatória p22phox (CYBA) e sua relação com variáveis histológicas e bioquímicas em pacientes com DHGNA. Métodos: 207 pacientes com DHGNA com biópsia hepática (esteatose=27; esteato-hepatite=180), sendo (70% do sexo feminino), foram genotipados para SNPs da Nox4 (rs3017887) e CYBA -675 T/A. O DNA genômico foi extraído a partir de células do sangue periférico e a genotipagem foi realizada utilizando primers específicos e sondas fluorescentes marcadas por sequenciamento. A análise histológica foi baseada na classificação de Kleiner et al (2005). Todos os pacientes eram negativos para os marcadores de hepatites virais, doença de Wilson, hemocromatose, doenças auto-imunes e tinham ingestão diária de álcool < 100 g/semana. Resultados:Associação do CYBA -675 T/A com triglicerídeos foi observada: 176,87 ± 12,93 (TT) versus 228,70 ± 21,66 (XA), p = 0,007 . Quando a população é estratificada, a associação aparece apenas entre os pacientes que possuem esteatohepatite não alcoólica (EHNA). Foi observada uma associação do CYBA-675 T / A com HDL: 48,05 ± 1,71 (TT) vs 41,70 ± 2,91 (TA) vs 28,03 ± 9,47 mg / dL (AA), p = 0,001. Quando a população é estratificada, a associação aparece apenas entre os pacientes que possuem EHNA. Quando se estudou o SNP no gene da NOX4, observou-se associação com ALT (CA + AA: 60,10 ± 6,01 U/L vs CC: 44,23 ± 4,36 U/L; P = 0,02). Porém, quando a população foi estratificada em esteatose e EHNA não se verificou diferença estatisticamente significante na frequência dos genótipos. Não houve associação de SNPs de genes que codificam proteínas do sistema NADPH oxidase nos genes CYBA (não registrado) e Nox4 (rs 3017887) e a presença de EHNA, nos portadores de DHGNA. Quanto aos resultados clínicos, observou-se que os graus de fibrose mais avançados ocorreram em pacientes com diagnóstico de Diabetes Mellitus tipo 2 (66,9% vs 37,5%; p= 0,007), além de serem mais obesos (32,2% vs 29%; p=0,003). Além disso, os níveis séricos de glicose e insulina aumentaram significantemente, de acordo com a presença de EHNA. A frequência da SM foi significativamente maior em pacientes com EHNA. Conclusões: 1) Houve associação entre a presença do genótipo CC na Nox4 SNP com uma maior concentração de ALT na população em geral 2) Houve associação entre a presença do genótipo AA no polimorfismo do gene -675 T/A CYBA com uma maior concentração de TGL e menor de HDL, nos pacientes com EHNA 3) Houve associação entre a presença de síndrome metabólica e graus avançados de fibrose hepática em portadores de DHGNA. No entanto, a amostra deve ser ampliada para confirmar estas associações, bem como, para melhor explorar possíveis relações com escores de fibrose e inflamação
Background/Aims: Oxidative stress has been implicated in progression to severe forms of non-alcoholic fatty liver disease (NAFLD). NADPH oxidase appears to be an important source of production of reactive oxygen species. We investigated by the first time two single nucleotide polymorphisms (SNPs) in the regulatory region of genes encoding the NADPH oxidase 4 (NOX4) and p22phox (CYBA) in NAFLD. Methods: 207 biopsy-proven NAFLD patients (27 = steatosis; 180= NASH) were evaluated. Genomic DNA was extracted from peripheral blood cells and on Nox4 and CYBA polymorphisms were determined by direct sequencing of PCR. All the patients were negative for markers of viral hepatitis, Metabolic diseases, autoimmune diseases and had daily intake of alcohol < 100 g/week. Results: An association of CYBA -675 T / A with triglycerides was observed: 176.87 ± 12.93 (TT) versus 228.70 ± 21.66 (XA), mean ± SEM, p = 0.007. When the population is stratified, the association appears only among patients who have non-alcoholic steatohepatitis (NASH). An association of CYBA-675 T/A with HDL was observed: 48.05 ± 1.71 (TT) vs 41.70 ± 2.91 (TA) vs 28.03 ± 9.47 mg/dL (AA), mean ± SEM, p = 0.001. When the population is stratified, the association appears only among patients who have NASH. When the NOX4 (rs 3017887) gene was studied, there was association with ALT (CA + AA: 60.10 ± 6.01 U / L vs CC: 44.23 ± 4.36 U/L; P = 0, 02). However, when the population was stratified in steatosis and NASH, there was no statistically significant difference in the frequency of genotypes. There was no association of SNPs from genes encoding NADPH oxidase system proteins in the CYBA (unregistered) and Nox4 (rs 3017887) genes and the presence of NASH in the DHGNA carriers. Regarding the clinical results, it was observed that the most advanced degrees of fibrosis occurred in patients diagnosed with Type 2 Diabetes Mellitus (66.9% vs 37.5%, p = 0.007), in addition to being more obese (32.2% % vs 29%, p = 0.003). In addition, serum glucose and insulin levels increased significantly, according to the presence of NASH. The frequency of MS was significantly higher in patients with NASH. Conclusions: 1) There was an association between the presence of the CC genotype in the Nox4 SNP with a higher concentration of ALT in the general population. 2) There was an association between the presence of the AA genotype in the CYBA gene -675 T / A polymorphism with a higher concentration of TGL and lower HDL in patients with NASH. 3) There was an association between the presence of metabolic syndrome and advanced degrees of hepatic fibrosis in patients with NAFLD. However, the sample should be expanded to confirm these associations, as well as to better explore possible relationships with fibrosis and inflammation scores

Objetivos: 1. Principales. 1.1. Analizar la relación de la enfermedad renal inicial (ER inicial) con la enfermedad del hígado graso no alcohólico (HGNA). 1.2. Conocer la prevalencia de la ER inicial y los factores asociados a la misma. 1.3. Analizar la asociación de la ER inicial con el síndrome metabólico (SM) y sus diferentes componentes como factores de riesgo para la enfermedad renal. 2. Secundarios: 2.1. Estimar el riesgo coronario en pacientes afectos de ER incial según REGICOR. 2.2. Conocer la prevalencia de enfermedades hepáticas en población general mediante la elastografía hepática y su valor predictivo para la detección de fibrosis hepática. Material y métodos: Diseño del estudio: Estudio transversal, descriptivo, multicéntrico de base poblacional. Población de estudio: individuos de entre 18 y 75 años procedentes de 16 centros de Atención Primaria seleccionados aleatoriamente de la base de datos SIAP para el estudio “Detección precoz de enfermedades hepáticas en población sana”. Criterios de exclusión: enfermedad hepática crónica conocida, enfermedades graves en estado avanzado, deterioro cognitivo, enfermedad mental grave, individuos institucionalizados o que no den su consentimiento. Variables: datos sociodemográficos, anamnesis (antecedentes patológicos, hábitos tóxicos), exploración física, presión arterial, analítica basal sanguínea, determinación del cociente albúmina/creatinina (ACR) en orina simple, elastografía hepática, diagnóstico de SM, REGICOR, marcadores serológicos no invasivos (FLI, NFS, FIB-4). Resultados: Muestra analizada 3014 individuos: 42,5% hombres y 56,6% mujeres. Prevalencias de ER inicial del 3,8%, de SM del 28,6% y de HGNA del 39,7%. Las tres entidades fueron más frecuentes entre los hombres y aumentaron con la edad. La ER inicial se observó en el 7,9% de los sujetos con SM y en el 7,4% de los que presentaban HGNA. El 4,3% de la población presentó las tres entidades de manera concomitante. Los factores asociados a la ER inicial fueron el sobrepeso en el 34,8%, obesidad en el 56%, la prediabetes en el 53,8%, la diabetes en el 43,1% y la hipertensión en el 59,6%. En el modelo multivariante el SM, el HGNA y el género masculino se comportaron como factores de riesgo de ER inicial con OR de 3.1 (IC95% 2.1-4.6), 3.7 (IC95% 2.3-5.8) y 3.01 (IC95% 1.74-5.23) respectivamente ajustado por edad y género. La ER inicial se comportó como factor de riesgo para HGNA con OR 3.2 (IC95% 1.6-6.6). Todos los componentes del SM se asociaron con la ER inicial excepto los bajos niveles de HDL. El valor de ACR (mg/g) se incrementó con la presencia de los componentes del SM, siendo este incremento mayor cuando se cumplen criterios de SM (β=0,58; IC95% 0.47-0.68). El 18,8% de la población con REGICOR ≥10 presentaba ER inicial frente al 6,1% con REGICOR <10. El 9% de los individuos presentaron una elastografía ≥6.8 kPa, el 6,8% elastografía ≥7.6 Kpa y el 5,8% elastografía ≥8 kPa que en comparación con las biopsias realizadas (92) clasificaban correctamente al 32%, 39% y 45% de los pacientes con fibrosis respectivamente. El valor con mayor capacidad predictiva fue 9.2 kPa (AUROC 0,87). La prevalencia de ER inicial en individuos con elastografía ≥6.8 kPa fue del 11%, con NFS alto del 14,1% y con FIB-4 elevado del 20%. Conclusiones: La ER inicial, el SM y el HGNA son entidades comunes entre la población general. El SM y sus componentes, excepto la HDL, se asociaron con ER inicial. Existe una relación significativa entre la presencia de ER inicial e HGNA. La elastografía hepática, en combinación con marcadores serológicos, sería un buen método diagnóstico de HGNA y fibrosis hepática en población de riesgo. La presencia de ER inicial fue más frecuente entre los individuos con REGICOR alto.
Objectives: 1. Main objectives: 1.1. To analyze the relation between the initial renal disease and the non-alcoholic fatty liver disease (NAFLD). 1.2. To study the prevalence of initial renal disease and the factors associated to it. 1.3. To analyze the association between the initial renal disease and the metabolic syndrome (MS), and the different components which act as risk factors to renal disease. 2. Secondary objectives: 2.1. To estimate the risk of coronary disease in patients suffering from initial renal disease according to REGICOR. 2.2. To study the prevalence of hepatic disease in the general population by hepatic elastography and its predictive value for detection of hepatic fibrosis. Materials and methods: Design of the study: Cross-sectional, descriptive, multicenter, population study. Study population: Individuals between 18 and 75 years-old from 16 different medical centers selected randomly of SIAP database for the study “Early detection of hepatic disease in healthy population”. Exclusion criterion: Chronic liver disease, severe diseases at advanced stages, cognitive impairment, severe mental disease, institutionalized individuals, or people that refused to consent for the study. Variables: Sociodemographic data, anamnesis (pathological background, toxic habits), physical exploration, arterial pressure, basal blood analysis, albumin/creatinine ratio (ACR) in urine samples, hepatic elastography, diagnosis of MS, REGICOR, non-invasive serological markers (FLI, NFS, FIB-4). Results: Population analyzed of 3.014 individuals: 42.5% men and 56.6% women. Prevalence of initial renal disease 3.8%, MS 28.6%, and NAFLD 39.7%. The three conditions were more frequent in men and increased with age. The initial renal disease was observed in the 7.9% of subjects with MS and in the 7.4% of subjects with NAFLD. The 4.3% of the population presented the three conditions in a concomitant manner. The factors associated to initial renal disease were overweight in the 34.8%, obesity in the 56%, prediabetes in the 53.8%, diabetes in the 43.1% and hypertension in the 59.6%. In the multivariate model, MS, NAFLD, and the male gender behaved as risk factors of initial renal disease, with an OR of 3.1 (95%CI 2.1-4.6), 3.7 (95%CI 2.3-5.8), and 3.01 (95%CI 1.74-5.23) respectively, fitted by age and gender. The initial renal disease behaved as a risk factor to NAFLD with an OR of 3.2 (95%CI 1.6-6.6). All components of SM were associated with the initial renal disease, with the exception of low levels of HDL. The ACR value (mg/g) increased with the presence of MS components, and the highest value was obtained when MS criteria were met (β=0.58; 95%CI 0.47-0.68). The 18.8% of population with REGICOR≥10 presented initial renal disease versus a 6.1% with REGICOR<10. The 9% of the individuals presented an elastography of ≥6.8 kPa, the 6.8% of ≥7.6 kPa, and the 5.8% of ≥8 kPa, which in comparison to the performed biopsies (92), classified correctly to the 32%, 39%, and 45% of patients with fibrosis respectively. The value with greater predictive capacity was 9.2 kPa (AUC 0.87). The prevalence of initial renal disease in individuals with elastography ≥6.8 kPa was 11%, with a high NFS of 14.1%, and with an elevated FIB-4 of 20%. Conclusions: The initial renal disease, the MS, and the NAFLD, are common conditions in the general population. MS and their components, except for HDL, were associated with the initial renal disease. There is a significant relation between the initial renal disease and the NAFLD. The hepatic elastography, in combination with serological markers, would be a good method to diagnose NAFLD and hepatic fibrosis in the risk population. The presence of the initial renal disease was more frequent among individuals with high REGICOR.

S obzirom na visoku prevalencu metaboličkog sindroma (10-40% u svetskoj populaciji) i na činjenicu da prisustvo metaboličkog sindroma duplira rizik od nastanka aterosklerotske bolesti kardiovaskularnog sistema jasna je potreba za identifikacijom indivudualnih parametara koji doprinose njenom razvoju. Metabolički sindrom je klaster faktora rizika metaboličkog porekla koji je udružen sa povećanim rizikom za nastanak aterosklerotske bolesti kardiovaskularnog sistema i dijabetes melitusa tipa 2. Insulinska rezistencija, abdominalna gojaznost, aterogena dislipidemija, hipertenzija, proinflamatorno i protrombotično stanje su faktori koji su u osnovi metaboličkog sindroma a često su i praćeni nagomilavanjem masti u jetri. Cilj rada je bio da se utvrdi odnos između markera disfunkcije hepatocita (AST, ALT, GGT), serumskog nivoa inflamatornih biomarkera (broj leukocita, elektroforeza serumskih proteina, CRP, fibrinogen, TNF-α), biomarkera endotelne disfunkcije (ADMA i homocistein), kao i nivoa serumskih adipokina (leptin i adiponektin) i debljine intima-medija kompleksa (IMT) karotidne arterije kao pokazatelja prisustva aterosklerotskog procesa. Ispitivanje je dizajnirano kao studija preseka. U ispitivanje je uključeno 58 ispitanika oba pola sa karakteristikama metaboličkom sindroma (NCEP:ATP III kriterijumi). Odabir ispitanika je vršen u Odeljenju za pravilnu ishranu i zdravstvenu bezbednost hrane, Instituta za javno zdravlje Vojvodine. Kontrolnu grupu su sačinjavale 30 klinički i biohemijski zdravih ispitanika nepušača koji su prema polnoj i dobnoj strukturi odgovarali ispitivanim grupama bolesnika. Iz ispitivanja su isključene osobe koje konzumiraju više od 20g/dan alkohola, pušači, koji imaju dijagnostikovan virusni hepatitis B ili C ili pozitivan Hbs antigen, anti-Hbs antitela i anti-HCV antitela, osobe koje imaju verifikovana oboljenja kardiovaskularnog sistema, bubrega, CNS-a, infektivna, maligna i autoimuna oboljenja kao i druga oboljenja jetre i žučnih puteva, osobe koje su pod medikamentoznom terapijom koja može uticati na nivo serumskih biomarkera endotelne disfunckije, lipidni i lipoproteinski status, glikoregulaciju kao i menstruacioni ciklus. Sve laboratorijske analize su urađene u Centru za laboratorijsku medicinu, Kliničkog centra Vojvodine. Doppler ultrasonografski pregled karotidnih arterija i ultrazvuk abdomena i jetre je urađen u Centru za radiologiju Kliničkog centra Vojvodine. Signifikantna pozitivna korelacija niskog stepena je utvrđena između IMT zajedničke karotidne arterije i serumskih koncentracija GGT, hsCRP i leptina kao i odnosa neutrofili/limfociti. Prema prvom konstruisanom regresionom modelu u kojem je zavisna varijabla bila IMT preko 0,09 cm statistički značajan uticaj na predviđanje debljine IMT zajedničke karotidne arterije imaju hsCRP (Exp (B) 1,112 i glikemija (Exp (B) 1,973). Prema modelu neuronske mreže sa istom zavisnom varijablom najveću mogućnost predviđanja IMT imaju glikemija, AST i fibrinogen. Prema drugom konstruisanom regresionom modelu gde su zavisne varijable bile IMT zajedničke karotidne arterije preko 0,09 cm i prisutnost hepatične steatoze najveću mogućnost predviđanja imaju leptin Exp (B) 1,1022 i ALT Exp (B) 1,053. Prema modelu neuronske mreže sa istom zavisnom varijablom najveću mogućnost predviđanja IMT imaju ALT, ADMA i leptin.
Given the high prevalence of metabolic syndrome (10-40% in the world population) and the fact that the presence of metabolic syndrome doubles the risk of atherosclerotic disease of the cardiovascular system, there is a clear need to identify individual parameters that contribute to its development. Metabolic syndrome is a cluster of the risk factors of metabolic origin that is associated with an increased risk for the onset of atherosclerotic disease of the cardiovascular system and type 2 diabetes mellitus. Insulin resistance, abdominal obesity, atherogenic dyslipidemia, hypertension, proinflammatory and prothrombotic conditions are the factors at the base of the metabolic syndrome and are often accompanied by fat accumulation in the liver. The aim of this work was to determine the relation between markers of hepatic dysfunction (AST, ALT and GGT), serum levels of inflammatory biomarkers (white blood cell count, electrophoresis of serum proteins, CRP, fibrinogen, TNF-α), biomarkers of endothelial dysfunction (ADMA and homocysteine) as well as levels of serum adipokines (leptin and adiponectin) and intima-media thickness of carotid artery as indicators of atherosclerotic process in the patients with metabolic syndrome. Study was cross-sectional. It included 58 participants with metabolic syndrome (NCEP:ATP III criteria) as well as 30 clinically and biochemically healthy nonsmokers, age and gender matched controls. Participants were selected in the Department for Nutrition and Food Safety, Center of Hygiene and Human Ecology Institute of Public Health of Vojvodina. Patients that consumed alcohol more than 20g/day were excluded. Participants with positive HBsAg, anti-HBs-antibodies or anti- HCV antibodies were excluded also. Smokers were also excluded. Patients with cardiovascular diseases, renal diseases, infective, hepatic, malignant and autoimmune diseases were excluded from this study. Subjects which used drugs that could affect biomarker levels of endothelial dysfunction, lipid metabolism, glucose metabolism and menstrual cycle were also excluded. All laboratory analyzes were done in Centre for Laboratory Medicine, Clinical Centre of Vojvodina. Doppler ultrasonography of carotid arteries and ultrasound of abdomen and liver were done in Centre for Radiology, Clinical Centre of Vojvodina. Significant positive correlation of low degree was determined between IMT of common carotid artery and serum concentrations between GGT, hsCRP and leptin and relationship neutrophils/lymphocytes. According to the first constructed regression model where dependent variable was IMT of common carotid artery above 0.09 cm statistically significant influence on foreseeing IMT of common carotid artery have hsCRP (Exp (B) 1.112 and glycaemia (Exp (B) 1.973). According to the neuronal network with the same dependent variable greatest probability for foreseeing IMT have glycaemia, AST and fibrinogen. According to the second constructed regression model where dependent variable was IMT above 0.09 cm and present hepatic steatosis greatest probability for foreseeing IMT have leptin Exp (B) 1.1022 and ALT Exp (B) 1.053. According to the neuronal network with the same dependent variable greatest probability for foreseeing IMT have ALT, ADMA and leptin.

En France, la consommation excessive d’alcool est la première cause de cirrhose et de carcinome hépatocellulaire (CHC), devant les hépatites virales et le syndrome métabolique. En 2016, on recense près de 10 500 décès par cirrhose ou CHC, et ce malgré une diminution significative de la consommation per capita d’alcool depuis 1960 (26L en 1960, 11,7L en 2017).Les personnes consommant de l’alcool ont un risque de développer une maladie du foie liée à l’alcool (MFLA). Elle évolue du stade initial de stéatose vers des stades plus avancés de fibrose et de cirrhose, pouvant se compliquer d’une décompensation ou d’un CHC. Avant l’apparition des complications, la MFLA est une pathologie asymptomatique et nombre de patients sont diagnostiqués tardivement, ce qui a des conséquences sur leur pronostic vital.Mettre en place des actions précoces auprès des consommateurs excessifs d’alcool pourrait permettre de réduire la morbi-mortalité hépatique par l’évitement ou le diagnostic plus précoce des complications. L’évaluation du bénéfice éventuel de telles actions de santé publique nécessite d’une part de connaitre les différentes étapes conduisant au développement des complications et d’autre part l’impact des facteurs de risque sur la progression ; ce afin de pouvoir déterminer les populations à cibler. Parmi les facteurs de risque identifiés, le syndrome métabolique joue un rôle important. Ainsi pour comprendre les mécanismes d’évolution de la MFLA, il est nécessaire d’étudier en parallèle ceux conduisant à la stéatopathie métabolique.L’histoire naturelle de la MFLA est encore mal décrite, notamment pour les stades précédant la cirrhose. La modélisation mathématique offre un cadre conceptuel qui permet de remédier aux problèmes éthiques que poserait une étude de terrain sur l’évolution de la MFLA.Ce travail a pour objectif principal de reconstruire mathématiquement l’histoire naturelle de la MFLA et de prédire la morbi-mortalité associée. Les objectifs secondaires sont d’estimer l’incidence de cette pathologie et d’identifier la population à risque. Pour cela, nous avons développé un modèle de Markov qui simule la trajectoire de cohortes d’individus à partir du moment où ils débutent une consommation d’alcool à risque jusqu’à leur décès. Il intègre les principaux facteurs de risque décrits comme associés à la progression de la MFLA dans la littérature (sexe, âge, surpoids et obésité, quantité d’alcool, polymorphisme génétique). Les paramètres inconnus de progression sont estimés par une méthode de rétrocalcul.Trois étapes ont été nécessaires pour alimenter et calibrer ce modèle : 1) caractériser la mortalité par cirrhose décompensée et par CHC liée à la consommation d’alcool ou au syndrome métabolique à partir des données fournies par Programme de Médicalisation des Systèmes d’Information ; 2) mettre en place un modèle de Markov sur des données d’hospitalisation de consommateurs excessifs pour estimer la progression de la fibrose; 3) mettre en place un modèle de Markov sur des données d’enquêtes réalisées en population générale française pour estimer le processus d’entrée dans une consommation à risque d’alcool ou de l’apparition du surpoids et de l’obésité.En conclusion, ce travail est le premier à caractériser la progression de la MFLA en population générale française. Il s’appuie sur des données épidémiologiques robustes auxquelles un éclairage nouveau est apporté. Les outils développés pourraient servir à tester l’impact de politiques de santé publique qui pourraient être mises en oeuvre auprès des populations les plus susceptibles de développer des lésions hépatiques
In France, excessive alcohol consumption is the leading cause of cirrhosis and hepatocellular carcinoma (HCC), ahead of viral hepatitis and metabolic syndrome. In 2016, there were nearly 10,500 deaths by cirrhosis or HCC, despite a significant decrease in per capita alcohol consumption since 1960 (26L in 1960, 11.7L in 2017).Alcohol drinkers are at risk of developing alcohol-related liver disease (ALD). It progresses from the initial stage of steatosis to more advanced stages of fibrosis and cirrhosis, which may lead to complications: decompensation and HCC. ALD is an asymptomatic disease prior to the onset of complications, and many patients are diagnosed late with life-threatening consequences.Implementing early actions targeting excessive alcohol drinkers could help to reduce liver morbidity and mortality through the avoidance or earlier diagnosis of complications. The evaluation of the possible benefit of such public health actions requires, on the one hand, knowledge of the different stages leading to the development of complications and, on the other hand, knowledge of the impact of risk factors on progression, in order to be able to determine the populations to target. Among the risk factors identified, the metabolic syndrome plays an important role. Thus, in order to understand the mechanisms of evolution of ALD, it is necessary to study in parallel those leading to non-alcoholic fatty liver disease (NAFLD).The natural history of ALD is still poorly described, especially for the stages preceding cirrhosis. Mathematical modeling provides a conceptual framework to overcome the ethical issues that would arise from a cohort study of the evolution of ALD.The main objective of this work is to mathematically reconstruct the natural history of ALD and to predict the associated morbidity and mortality. The secondary objectives are to estimate the incidence of this pathology and to identify the at-risk population. For this purpose, we developed a Markov model that simulates the trajectory of cohorts of individuals from the moment they start at-risk alcohol consumption until their death. It integrates the main risk factors described as associated with the progression of ALD in the literature (sex, age, overweight and obesity, amount of alcohol, genetic polymorphism). Unknown parameters of progression are estimated by a back-calculation method.Three steps were necessary to supply and calibrate this model : 1) characterize mortality by decompensated cirrhosis and HCC related to alcohol consumption or metabolic syndrome from data provided by the French National Hospital Discharge database; 2) set up a Markov model on hospitalization data of excessive consumers to estimate the progression of fibrosis; 3) implement a Markov model on survey data from the general French population to estimate the process of entry into at-risk alcohol consumption or the onset of overweight and obesity.In conclusion, this work is the first to characterize the progression of ALD in the general French population. It is based on robust epidemiological data to which new insights are provided. The developed tools could be used to test the impact of public health policies that could be implemented in populations most likely to develop liver damage

碩士
國立臺灣大學
動物科學技術學研究所
102
Fatty liver hemorrhagic syndrome (FLHS) is a metabolic diease of laying hens. It is characterized by the accumulation of excess fat in the liver due to enhanced lipogenesis, leading to rupture and hemorrhagic lesions with liver of hens during late laying stage. It tends to result in sudden egg production drop and increase mortality in some serious cases and thus causes considerable economic loss by the egg producers. In this study, we aim to improve FLHS by dietary supplementation of docosahexaenoic acid (DHA) and Goji in laying hens, and furthermore to produce functional eggs in order to increase the value of eggs as well as. Eighty-four Hy-line strain W-36 layers (36 week of age) were used in the study with a factorial design of dietary supplementation of Algal DHA oil and Goji (Algal DHA oil 0, 1% × Goji 0, 2%). Feed and water were supplied ad libitum during the trial for 24 weeks (36-60 week of age). Results showed that Algal DHA oil and Goji had no effect on the body weight and egg production (P > 0.05). In all treatments, no significant difference in plasma total cholesterol (TC) and triglyceride (TG) level were observed (P > 0.05). Compared to the control diet (Algal DHA oil 0%, Goji 0%), Algal DHA oil treatments decreased hemorrhagic score, TC and TG content and fat accumulation in the liver (P < 0.05) at 60 week of age. Goji treatments reduced hepatic TC (P < 0.05) at 60 week of age. However, there were no significant difference in all treatments along age at 36 and 48 week (P > 0.05). Moreover, Algal DHA oil suppressed hepatic transcript level of lipogenic enzymes, including acyl-CoA oxidase (ACC) and fatty acid synthase (FAS) from 48 to 60 week of age (P < 0.05), consistently with attenuated fat accumulation in the liver. All treatments had no significant effect on the transcript abundance of proinflammatory cytokine genes, such as tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6). In addition, yolk color from hens with dietary supplementation of Goji had higher a (red) and b (yellow) values than those from control treatment. In conclusion, Algal DHA oil and Goji may have the potential to be used as a dietary supplementation to improve FLHS in laying hens, and also increase the economic and nutritional value of the eggs.

Indiana University-Purdue University Indianapolis (IUPUI)
Non-alcoholic fatty liver disease and metabolic syndrome induced by high nutrient status have increasingly become a global health concern as it cause multiple complications. The mTOR complex is central in regulating anabolic reactions within cells under growth factors or under high nutrients stimulation. Constitutive and persistent activation of mTOR can impair cellular functions. In the first part of this study, we demonstrate a damping oscillation of mTOR activity during a long-term treatment of high fat diet. TFEB translocation and lysosomal enzyme activity also oscillate, but in an opposite direction. TFEB controls the lysosomal activity, autophagic degradation and lipid metabolism. Overexpression of wild type and mutant TFEB could inhibit NAFLD development in mice. In addition, TFEB location in nucleus inversely correlates with NAFLD severity in patients. mTOR activation under hypernutrition status suppresses TFEB translocation, inhibits lysosomal functions and autophagic degradation of lipid droplets. Inhibition of mTOR activity by rapamycin reverse the above phenotypes. Because mTOR activation also requires normal lysosomal function, the inhibition of TFEB by mTOR leads to decreased lysosomal function and mTOR downregulation. This negative feedback may explain the oscillation pattern of mTOR activation in long term high fat diet regimen and is a novel mechanism for inhibition of mTOR. In the second part of study, we report that Bid protein, previously known for its pro-apoptosis function in promoting mitochondrial permeability, plays an unexpected role in regulating fatty acid beta oxidation. Deletion of Bid in mice reprograms the body's response to hyper-nutrition caused by high fat diet, leading to the resistance to the development of obesity, liver steatosis and metabolic syndrome. These mice present a higher oxygen consumption, a lower respiratory quotient, and an increased beta-oxidation rate. Mechanistically, the high fat diet regimen triggers translocation of the full length Bid molecule to mitochondrial membrane. Genetic deletion of Bid also affects the stability of its binding protein, MTCH2 in the mitochondrial membrane. In summary, we describe in this study a mTOR-TFEB-lysosome feedback loop, which can regulate NAFLD development, and a novel Bid-mediated regulatory mechanism in beta-oxidation, which limits energy expenditure and promotes obesity development.

Student Number : 0101826W - M Med dissertation - School of Clinical Medicine - Faculty of Health Sciences
Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease with hepatic histology that resembles alcoholic liver disease. It is a frequent cause of chronic liver disease and is attracting increasing scientific attention worldwide. I explored the possibility that increased gastrointestinal alcohol production may have a role as a “second hit” in the pathogenesis of NAFLD in study subjects with the metabolic syndrome. In an attempt to investigate this hypothesis, this study looked at blood, urine and breath levels of alcohol in patients with the metabolic syndrome versus matched age and ethnic group healthy controls. Of the twenty study subjects, 80% had dyslipidaemia, 60% had hypertension and 70% had type 2 diabetes mellitus. Their mean BMI was 35.1±8.2 kg/m² (mean ± SD, P < 0.0001 versus controls). The serum aminotransferases were significantly elevated in the study subjects, their ALT levels being 57.4±44.79 U/L versus 17.4±4.60 U/L in the controls (95% CI 18.02 – 61.42, P < 0.001), and their AST levels 52.5±36.21 U/L versus 23.4±4.86 U/L in the controls (95% CI 11.99 – 46.20, P < 0.01). Seventy five percent of the study group had sonar features suggestive of fatty liver disease. Two adipocytokines, adiponectin and leptin, mediators of insulin resistance, an important factor in the development and progression of NAFLD, were also measured. Adiponectin levels were significantly lower (6875 ng/L versus 15475 ng/L; median value, P < 0.01), and leptin concentration levels significantly higher (13.56 ng/L versus 3.05 ng/L; median value, P < 0.05) in the study subjects than in the control group. Alcohol was detected in 60% of the study subjects, of which 35% tested positive for ethanol, 55% tested positive for methanol, and 30% tested positive for both ethanol and methanol. This was a statistically significant result, as none of the control group tested positive for any of the alcohols. The ethanol concentration in the study subjects’ blood was 7.14±3.28 mg% (mean ± SD), in their urine 3.71± 12.87 mg% (mean ± SD) whilst none was detected in their breath. The methanol concentration in the study subjects’ blood was 16.17±17.95 mg% (mean ± SD), in their urine 6.8± 13.58 mg% (mean ± SD) while their breath level was 2.05±3.19 mg (mean ± SD). This study therefore suggests that endogenous alcohol production may be indeed be involved in the pathogenesis of NAFLD in subjects with the metabolic syndrome. Not only ethanol but also methanol was detected in the subjects tested. Endogenous alcohol may therefore be responsible for the ‘second hit’ theory in the pathogenesis of NAFLD, and it is likely that formaldehyde, the metabolite of methanol may be a more potent toxin of hepatocyte injury as opposed to acetaldehyde, the metabolite of ethanol. The most likely source of the alcohol is from intestinal bacterial flora. These findings provide further insight into the pathogenesis of NALFD, suggesting other therapeutic alternatives such as the use of antibiotics and probiotics as a potential treatment strategy for NAFLD.

碩士
國立中興大學
生命科學系所
100
Fatty liver disease has been defined as intrahepatic triglyceride (IHTG) content ＞5% of liver volume or liver weight in animal or human being. Fatty liver is commonly associated with obesity, insulin resistance, and diabetes. It is estimated that about 16-23% of population exhibits the syndrome of the non-alcoholic fatty liver disease (NAFLD) in world wide. Severe fatty liver is sometimes accompanied by steatohepatitis or develop hepatocellular carcinoma. To date, there is still no effective therapy to treat NAFLD, so the focus of current investigations has been on the development of effective components or functional products with bioactivities. In this study, we used leptin gene knockout ob/ob mice as a NAFLD animal disease model. Six-week-old ob/ob mice were administered with fermented product (140 mg/kg of body weight per day) for four weeks. Four experimental groups were designed as followed: (1) ob/ob mice treated with ddH2O group, (2) ob/ob mice treated with fermented product group, (3) WT mice treated with ddH2O group, and (4) WT mice treated with fermented product group (n=6). After oral administration, fermented product treatment improves fatty liver syndrome by inhibiting liver lipogenesis gene expression, and decreasing the contents of cholesterol and triacylglyceride (TG) in liver (p<0.05). In addition, the result showed that treatment with fermented product has significantly reduced oil drops in liver tissue examed by H&E stain and oil red stain. Furthermore, we found that fermented product treatment with ob/ob mice markedly decreased the expression of sterol regulatory element-binding protein-1 (SREBP-1), fatty acid synthase (FAS) and acetyl-CoA carboxylase (ACC) gene that was an effect on reducing lipogenesis gene (p<0.05). Fatty acid-riched HepG2 cell culture treated with the peptide fractions from fermented product also decrease lipogenesis gene expression. We speculated that fermented product improve the NAFLD throught the inhibition of lipogenesis pathway. In conclusion, our data suggested that peptides derived from fermented product may have potentials for clinical applications in the prevention or treatment of NAFLD.

Many individuals presumed to have non-alcoholic fatty liver disease (NAFLD) consume moderate amounts of alcohol; however, little is known regarding patterns of alcohol use and how drinking behaviors may influence liver fat. We conducted a cross-sectional study of 2,475 participants of the Framingham Heart Study who underwent computed tomography (CT) to define liver fat. We performed multivariable-adjusted logistic regression models for the association between different alcohol drinking patterns, including the average alcoholic drinks/week, frequency of alcohol use, usual quantity of alcohol consumed, maximum drinks consumed in 24 hours, and binge drinking behavior, and CT-defined hepatic steatosis. We excluded heavy alcohol users defined as women who drink > 14 drinks/week and men who drink > 21 drinks/week. We also performed an analysis specific to beverage type (beer, wine, or liquor/spirit drinks).The prevalence of hepatic steatosis in our study sample (mean age ± standard deviation (SD) 49.8±10.2, 50.3% women) was 17.5%. Among individuals with presumed NAFLD, binge drinking occurred in 25.4% of individuals. In adjusted models, the odds of hepatic steatosis increased by 20% for each SD increase in the number of alcoholic drinks consumed per week (OR 1.20; 95% confidence interval (CI) 1.08, 1.36). Frequency of alcohol use (drinking days/week) was also associated with hepatic steatosis (OR 1.09; 95% CI 1.03, 1.15). The odds of hepatic steatosis increased by 15% for each SD increase in the maximum drinks per week (OR 1.15; 95% CI 1.02, 1.30). In the beverage specific analysis, alcohol use patterns were associated with hepatic steatosis among beer drinkers, but no significant associations were observed among wine drinkers. Conclusions: Even after excluding heavy alcohol users from our sample, alcohol use contributed to liver fat, which suggests alcohol-related liver fat may be present among individuals presumed to have NAFLD. Additional prospective studies are needed to validate our findings and to determine if more comprehensive alcohol use screening tools should be used in practice or clinical trial settings.
2020-06-03T00:00:00Z

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver dysfunction in the western world and one of the main contributors to cirrhosis and potentially liver cancer and liver failure. A variety of behaviors and other factors can predispose certain individuals to an increased risk of developing NAFLD and non-alcoholic steatohepatitis (NASH). These factors include, but are not limited to, obesity, insulin resistance, hyperglycemia, and high levels of fat in the blood. The result is the accumulation of fat in hepatocytes that over time leads to inflammation and scarring of the liver and ultimately liver damage. At present, the mainstay of therapy remains weight loss through dietary modification and lifestyle change. Due to the lack of specific targeted pharmacotherapies, there is great interest from the scientific community to find a potential therapy that can provide benefit to the many patients in need. Some existing medications, including pioliglitazones and angiotensin receptor antagonists, may be repurposed to help treat this condition. Vitamin E may improve the histology in NASH, but safety issues limit its use. Other drugs, such as farnesoid X receptor agonist, obeticholic acid, are also in clinical trials with great hope for the future. However, as the cause of NAFLD and thereby NASH is poorly understood, there is a need for further research in the field to better understand the pathophysiology of the disease and the potential for pharmacotherapy for treatment of the disease. There has, however, been evidence that the antidiabetic drug class known as glucagon-like receptor agonists (GLP-1 RAs) has been shown to reduce liver damage in patients with non-alcoholic steatohepatitis. Liraglutide, currently a drug for type 2 diabetes and obesity, has been shown to provide great benefit in type 2 diabetes and obesity and after reviewing multiple studies, seems to provide a potential treatment also for patients with NAFLD and NASH. However, more research needs to be done to confirm this hypothesis. Its more potent version, called semaglutide, is currently in phase 2 clinical trials and provides great hope in potentially further reducing liver damage. This class of drugs provides a huge opportunity to address an unmet clinical need that could benefit millions of patients worldwide. .

碩士
輔仁大學
公共衛生學系碩士班
107
Backgroud: As the aging population in Taiwan deepens, various chronic diseases are gradually becoming a new challenge for public health. The incidence of metabolic syndrome is increasing, and metabolic syndrome is one of the risk factors for many chronic diseases, and the relationship between metabolic syndrome and nonalcoholic fatty liver is still lacking in long-term research. Methods: This paper uses big data analysis and meta analysis to conduct research. In the meta-analysis, literature collection was performed using Embase, Pubmed and Cochrane Library. In the big data analysis, the data between NHIRD 1996-2013 was used for analysis. Analytical methods are COX regression and survival analysis. RESULTS: In the meta-analysis, metabolic syndrome, hyperglycemia, and obesity all increased the risk of nonalcoholic fatty liver disease. In big data analysis, the number of components of metabolic syndrome increases the risk of nonalcoholic fatty liver disease. This is reflected in different genders and ages. Conclusion: Metabolic syndrome significantly increases the risk of nonalcoholic fatty liver disease, and the additive effect of this risk increases with the increased composition of metabolic syndrome.

Tese no âmbito do Doutoramento em Biociências, especialização em Bioquímica, apresentada à Faculdade de Ciências e Tecnologia da Universidade de Coimbra
Chronic metabolic diseases related to obesity and lifestyle are imposing an ever-increasing burden on healthcare worldwide. Incidences of non-alcoholic fatty liver disease (NAFLD) and Type-2 diabetes (T2D) have been rising particularly rapidly in Western Societies, showing strong associations with sedentary lifestyle and excessive caloric intake in relation to daily expenditure. A significant fraction of this hypercaloric intake is accounted by sugar, in particular fructose, present in processed food and sweetened beverages. This diet promotes weight gain, insulin resistance and dyslipidemia thereby providing the foundations for NAFLD and T2D development. In addition to directly disrupting the control of systemic carbohydrate and lipid metabolism, such diets may also mediate these effects indirectly via the gut microbiome. The gut microbiome is a complex ecosystem that is normally in a symbiotic relationship with the host and having a key role in nutrient processing and energy harvest. In obesity-related diseases such as NAFLD and T2D, dysbiotic alterations in the microbiome composition, its metabolic endproducts, and its interactions with host tissues, are implicated in their pathogenesis. The first part of this work aimed to study the effects of a diet high in simple sugars on the composition of the intestinal microbiome and its metabolite products in mouse models. It was hypothesized that dietary glucose and fructose have distinct effects on these parameters with focus on the relative abundance of Gram-negative species and alterations in SCFA levels. Three groups of mice were fed over 10 weeks with standard, high glucose or high fructose chow. Fecal samples were periodically collected and the microbiome was profiled by real-time quantitative polymerase chain reaction (qPCR). Fecal metabolites were analyzed by proton nuclear magnetic resonance (1H NMR). On the metabolites content significant differences were also observed with a reduction in beneficial SCFA like butyrate, to be induced by fructose. For the mice fed the high fructose diet, unmetabolized fructose was found in the feces indicating that the intestinal absorption capacity had been saturated and that fructose was available to the entire intestinal microbiome. Mice fed the high fructose diets also showed a shift in microbiome species towards Gram-negative bacteria and decreased fecal levels of butyrate relative to acetate and propionate. An increased abundance of Gram-negative bacteria could promote visceral inflammation through increased abundance and leakage of endotoxin from the intestinal lumen into surrounding tissues. In addition, alterations in microbiome metabolic endproducts such as lactate and short-chain fatty acids (SCFA) can have an impact on intestinal as well as hepatic and peripheral metabolism through direct substrate effects as well as by activation of substrate-specific receptors such as the GPR family. In the second part of the Thesis, the specific contributions of dietary glucose and fructose to hepatic and adipose tissue lipogenesis were determined by integrating 2H-enrichment of triglyceride from deuterated water to provide estimates of de novo lipogenesis (DNL) and glycerol synthesis from all sources with 13C-triglyceride (TG) enrichment from 13C-glucose and fructose tracers to provide specific contributions of each exogenous sugar. In liver, exogenous fructose contributed significantly more to both DNL and glycerol synthesis compared to exogenous glucose. Moreover, fructose promoted the synthesis of saturated fatty acids to a greater degree than that of oleate whereas glucose did not. Fructose also contributed to mesenteric adipose tissue TG synthesis, albeit to a lesser degree than glucose while only glucose contributed to subcutaneous adipose tissue TG synthesis. In conclusion, this dissertation provided new insights on the role of the intestine and visceral adipose tissue in the metabolism of dietary glucose and fructose and has opened two important new lines of research. First, the potential for overflow of fructose into the lower intestine: to what extent does this happen in humans in the Western diet setting and how does this influence microbiome composition and metabolism? In this context, there is evidence that fructose malabsorption in the human population may be more widespread than initially thought. Second, the lipogenic utilization of fructose carbons by mesenteric adipose tissue begs the question of how this sugar became available to these adipocytes. Was it via direct absorption or was it converted beforehand to glucose by intestinal gluconeogenesis? If it was by direct absorption, this implies that mesenteric adipocytes have a capacity for fructose uptake and metabolism. Also, it suggests that mesenteric adipose tissue has some degree of privileged access to nutrients that are absorbed by the intestine.
As doenças metabólicas crónicas associadas a obesidade e estilo de vida representam um encargo significativamente crescente na saúde mundial. Nas sociedades ocidentais, as incidências de fígado gordo não alcoólico (NAFLD) e diabetes tipo 2 (T2D) têm aumentado consideravelmente correlacionando-se com sedentarismo e consumo excessivo de calorias perante o consumo diário. Nestas dietas hipercalóricas, o açúcar é maioritário em especial a frutose, presente em concentrações elevadas nos alimentos processados. Estas condições estimulam o aumento de peso, resistência à insulina e dislipidémia, que estão na base do desenvolvimento de NAFLD e T2D. Para além destas dietas promoverem distúrbios diretos no metabolismo de lípidos e hidratos de carbono, podem derivar indiretamente os mesmos efeitos, através do microbioma intestinal. Este é um ecossistema complexo que normalmente se encontra em simbiose com o hospedeiro, o que é fundamental para o processamento de nutrientes e extração de energia. Alterações às populações microbianas e perda de simbiose, produtos metabólicos dessas espécies e a respetiva interação com vários tecidos do hospedeiro estão na origem das patologias referidas. A primeira parte deste trabalho visou estudar, em modelos de ratinho, o efeito de dietas ricas em açúcares simples, na composição do microbioma intestinal e dos seus produtos metabólicos. A hipótese propunha que a glicose e frutose produzem efeitos distintos, com foco para alterações na abundância relativa de espécies Gram-negativas e nos níveis de ácidos gordos de cadeia curta (SCFA). Três grupos foram alimentados por um período de 10 semanas com 3 tipos de dieta: standard, rica em glucose ou rica em frutose. Periodicamente, recolheram-se amostras fecais e o perfil microbiológico analisado por real-time quantitative polymerase chain reaction (qPCR). Os metabolitos fecais foram analisados por ressonância magnética nuclear de protão (1H NMR). Observaram-se diferenças significativas no conteúdo em metabolitos com uma redução, induzida por frutose, em SCFA benéficos como o butirato. Nos animais alimentados com elevados níveis de frutose, moléculas não metabolizadas deste açúcar foram encontradas nas fezes, indicando uma saturação da absorção intestinal que resulta em maior disponibilidade de frutose para o microbioma. No mesmo grupo de ratinhos verificou-se uma alteração na composição microbiana com maior tendência para espécies Gram-negativas e um decréscimo nas concentrações de butirato em relação a acetato e propionato. A prevalência destas bactérias pode promover inflamação visceral pelo seu crescimento e libertação de endotoxinas do lúmen intestinal para os tecidos circundantes. Adicionalmente, variações nos metabolitos bacterianos como lactato e SCFA podem alterar o metabolismo intestinal, hepático e periférico através de modificações diretas por substratos, como ativação específica de recetores sensíveis a esses, tais como os da família GPR. Na segunda parte desta Tese, foram determinadas as contribuições específicas da glucose e frutose nas dietas, para a lipogénese no fígado e tecido adiposo, através da integração do enriquecimento nos triglicerídeos (TG) em 2H proveniente de água deuterada para quantificação da lipogénese de novo (DNL) e síntese de glicerol gerais, com o enriquecimento nos mesmos TG em 13C proveniente de marcadores 13C-glucose e 13C-frutose para analisar as contribuições específicas destes açúcares exógenos. No fígado, a frutose deteve um contributo significativamente superior para a DNL e síntese de glicerol quando comparada com glucose. Neste contexto, a frutose promoveu a produção de ácidos gordos saturados em maior escala, efeito não verificado com a glucose. No tecido adiposo mesentérico a frutose contribuiu para a síntese de TG embora em menor porção que a glicose. No tecido adiposo subcutâneo apenas a glicose contribuiu para a lipogénese. Em nota conclusiva, esta dissertação apresenta novas evidências no papel do intestino e tecido adiposo visceral no metabolismo da glicose e frutose e estabelece bases para duas novas linhas de investigação. A primeira reporta à saturação de frutose no intestino grosso: em que medida este fenómeno ocorre em humanos sob dietas ocidentais e a influência que terá na composição do microbioma e metabolismo? Existem evidências de que a malabsorção de frutose em humanos poderá ser transversal a um grupo maior de populações que inicialmente esperado. A segunda refere-se à utilização dos carbonos da frutose para lipogénese no tecido adiposo mesentérico em que se questiona por que processo este açúcar fica disponível aos adipócitos. Por via de absorção direta ou através de gluconeogénese intestinal por conversão prévia a glicose? Se se verificar a absorção direta, será demonstrado que os adipócitos mesentéricos são capazes de assimilar e metabolizar frutose inferindo que o tecido adiposo mesentérico possui, em alguma medida, um acesso privilegiado a nutrientes absorvidos pelo intestino.

This thesis focuses on the effects of n-3 polyunsaturated fatty acids (n-3 PUFA) on development of non-alcoholic fatty liver disease (NAFLD) in experiment, on prevalence of this condition in patients with type 2 diabetes mellitus and metabolic syndrome and also on non-invasive diagnostics. The aim was to study the effect of n-3 PUFA on NAFLD development in an experimental model and based on analysis of a group of patients with type 2 diabetes and metabolic syndrome to assess the prevalence of this condition. Lastly we aimed to evaluate non-invasive diagnostic methods of liver fibrosis and NASH. We demonstrated beneficial effects of n-3 PUFA administration on NAFLD development in a C57/Bl6 mice high fat methionin-cholin defficient dietary model of NAFLD. n-3 PUFA administration led to biochemical improvement, decrease of lipid accumulation in the liver as well as improvement of histology. These effects are determined by complex modulation of lipid metabolism, mainly due to decrease in availability of fatty acids for triglyceride synthesis in the liver, changes of adipokine levels and amelioration of proinflammatory status in the liver. In a group of type 2 diabetics we found NAFLD prevalence of almost 80%, 14% of these patients had also signs of liver fibrosis or cirrhosis. Non-invasive methods...

This study explores the possible efficacy of a low carbohydrate and high fat nutritional intervention (LCHF) as a treatment possibility aiming to improve the ability of self-control and regulation in the context of carbohydrate-addiction. The study first outlines why increased simple carbohydrate consumption has been implicated as a risk-factor in numerous chronic conditions, and then explores the possibility that a reduction of such consumption could lower general medical expenditure in the healthcare sector of already overburdened institutions, especially in developing countries like South Africa. Since the neurobiological evidence for food addiction is compelling, this study investigates the impact of a low carbohydrate and high fat eating (LCHF) regimen by measuring the change in the severity of addictive behaviour in relation to a reduced carbohydrate consumption. Results indicate that a LCHF nutritional intervention lessened addictive behaviour after just 30 days, resulting in a statistically significant decrease in addiction symptoms from day 1 to day 30. The weight and BMI values of the participants recorded at the end of the study showed a reduction from those obtained during the pre- treatment stage, and the self-perceived ‘feeling in control’ also improved in all participants after the intervention. The introduction of a LCHF nutritional intervention presents a relatively cost-effective treatment and preventative measure to combat carbohydrate over-consumption and its numerous health complications, and it is therefore hoped that the positive findings of this study will foster further research, using larger samples, into this type of nutritional intervention against addictive eating behaviour.
Psychology
M.A. (Psychology)