Bone Mineralization in Celiac Disease

Evidence indicates a well-established relationship between low bone mineral density (BMD) and celiac disease (CD), but data on the pathogenesis of bone derangement in this setting are still inconclusive. In patients with symptomatic CD, low BMD appears to be directly related to the intestinal malabsorption. Adherence to a strict gluten-free diet (GFD) will reverse the histological changes in the intestine and also the biochemical evidence of calcium malabsorption, resulting in rapid increase of BMD. Nevertheless, GFD improves BMD but does not normalize it in all patients, even after the recovery of intestinal mucosa. Other mechanisms of bone injury than calcium and vitamin D malabsorption are thought to be involved, such as proinflammatory cytokines, parathyroid function abnormalities, and misbalanced bone remodeling factors, most of all represented by the receptor activator of nuclear factor B/receptor activator of nuclear factor B-ligand/osteoprotegerin system. By means of dual-energy X-ray absorptiometry (DXA), it is now rapid and easy to obtain semiquantitative values of BMD. However, the question is still open about who and when submit to DXA evaluation in CD, in order to estimate risk of fractures. Furthermore, additional information on the role of nutritional supplements and alternative therapies is needed

Elastography in HCV patients

Summary Introduction:  Liver fibrosis (LB) assessment plays an important role in hepatology. A common characteristic of all chronic liver diseases is the occurrence and progression of fibrosis towards cirrhosis. Besides its plain interest for prognosis purposes, determining the fibrosis reveals the natural history of the disease and the risk factors associated with its progression to guide the antifibrotic action of different treatments. Discussion:  Today, in clinical practice there are three available methods for the evaluation of LB. Biopsy, which is still considered as the 'gold standard' method. Serological markers and their mathematical combination are suggested in the last years in alternative to LB. More recently, transient elastography (TE) was proposed. TE is a simple and noninvasive method for measuring liver stiffness. This technique is based on the progression speed of an elastic shear wave within the liver. Conclusions:  Currently, there are just a few studies capable of evaluating the TE effectiveness in chronic liver diseases, mainly in patients infected with hepatitis C virus (HCV). Its application must also be studied in the monitoring of patients suffering from chronic HCV infection and subjected to a treatment that can modify their degree of liver fibrosis. The results of TE must be interpreted according to the clinical background of the specialist

A Systematic Review on Natural Antioxidant Properties of Resveratrol

Polyphenols, including anthocyanins, flavonoids and stilbenes, which constitute one of the most abundant and ubiquitous groups of plant metabolites, are an integral part of the human diet. Resveratrol (3,5,4'-trihydroxystilbene), a naturally occurring polyphenol produced by some plants as a self-defence agent, has an antifungal activity. Resveratrol has been found in some plants (such as grapevine, pine and peanuts) and is considered to have beneficial effects also on human health. The number of studies on resveratrol greatly increased in PubMed database since 1997, after the anticancer effect of this molecule was first reported. The interest in resveratrol in grape was originally sparked by epidemiological studies indicating an inverse relationship between long-standing moderate consumption of red wine and the risk of coronary heart disease; this effect has been ascribed to resveratrol, which possesses diverse biochemical and physiological properties, including antiplatelet and anti-inflammatory proprieties, and provides a wide range of health benefits ranging from chemoprevention to cardioprotection. Recently, resveratrol has been described as an anti-aging compound. The consumption of resveratrol (red wine) together with a Mediterranean diet or a fast-food meal ("McDonald'sMeal") had a positive impact on oxidized (ox-) LDL and on the expression of oxidative and inflammatory genes. Therefore, this review summarized the most important scientific data about healing and preventive potential of resveratrol, acting as cardioprotective, neuroprotective, chemopreventive and antioxidant agent

Da li je endokan novi potencijalni biomarker za steatozu i fibrozu jetre?

Studies that evaluated endocan levels in nonalcoholic fatty liver disease (NAFLD) and liver fibrosis are scarce. We aimed to explore endocan levels in relation to different stages of liver diseases, such as NAFLD, as determined with fatty liver index (FLI) and liver fibrosis, as assessed with BARD score. A total of 147 participants with FLI≥60 were compared with 64 participants with FLI <30. An FLI score was calculated using waist circumference, body mass index, gamma-glutamyl transferase and triglycerides. Patients with FLI≥60 were further divided into those with no/mild fibrosis (BARD score 0-1 point; n=23) and advanced fibrosis (BARD score 2-4 points; n=124). BARD score was calculated as follows: diabetes mellitus (1 point) + body mass index≥28 kg/m2 (1 point) + aspartate amino transferase/alanine aminotransferase ratio≥0.8 (2 points). Endocan was independent predictor for FLI and BARD score, both in univariate [OR=1.255 (95% CI= 1.104-1.426), P=0.001; OR=1.208 (95% CI=1.029- 1.419), P=0.021, respectively] and multivariate binary logistic regression analysis [OR=1.287 (95% CI=1.055- 1.570), P=0.013; OR=1.226 (95% CI=1.022-1.470), P=0.028, respectively]. Endocan as a single predictor showed poor discriminatory capability for steatosis/fibrosis [AUC=0.648; (95% CI=0.568-0.727), P=0.002; AUC= 0.667 (95% CI=0.555-0.778), P=0.013, respectively], whereas in a Model, endocan showed an excellent clinical accuracy [AUC=0.930; (95% CI=0.886-0.975), P<0.001, AUC=0.840 (95% CI=0.763-0.918), P<0.001, respectively]. Endocan independently correlated with both FLI and BARD score. However, when tested in models (with other biomarkers), endocan showed better discriminatory ability for liver steatosis/fibrosis, instead of its usage as a single biomarkerUvod: Nema mnogo studija koje su ispitivale vrednosti endokana kod obolelih od nealkoholne steatoze i fibroze jetre. Naš cilj je bio da se ispita nivo endokana u različitim stadijumima oboljenja jetre, kao što su nealkoholna steatoza jetre, predstavljena indeksom masne jetre (FLI) i fibroza jetre, predstavljena BARD skorom. Metode: Ukupno 147 učesnika sa FLI≥60 poređeno je sa 64 učesnika sa FLI <30. FLI skor je izračunat koriste i vrednosti obim struka, indeksa telesne mase, aktivnosti gama-glutamil transferaze i vrednosti triglicerida. Ispitanici sa FLI≥60 su dalje podeljeni u 2 grupe: bez fibroze/blaga fibroza (BARD skor 0–1 poen; n=23) i uznapredovala fibroza (BARD skor 2–4 poena; n=124). BARD skor je računat na sledeći način: e erna bolest (1 poen) + indeks telesne mase≥28 kg/m2 (1 poen) + odnos aspartat aminotransferaza/alanin aminotransferaza≥0,8 (2 poena). Rezultati: Endokan je nezavisan prediktor FLI i BARD skora, kako u univarijantnoj [OR=1,255 (95% CI=1,104– 1,426), P=0,001; odnosno OR=1,208 (95% CI=1,029– 1,419), P=0,021], tako i u multivarijantnoj binarnoj logističkoj regresionoj analizi [OR=1.287 (95% CI=1,055– 1,570), P=0,013; odnosno OR=1,226 (95% CI=1,022– 1,470), P=0,028]. Endokan kao samostalan prediktor pokazao je slabu diskriminatornu mo za steatozu/fibrozu jetre [AUC=0,648; (95% CI=0,568–0,727), P=0,002; odnosno AUC=0,667 (95% CI=0,555–0,778), P=0,013], ali je u Modelu pokazao odličnu kliničku tačnost [AUC=0,930; (95% CI=0,886–0,975), P<0,001; odnosno AUC=0,840 (95% CI=0,763–0,918), P<0,001]. Zaključak: Endokan je nezavisno povezan kako sa FLI, tako i sa BARD skorom. Ipak, u modelu (sa drugim biomarkerima), endokan je pokazao bolju diskriminatornu sposobnost za steatozu/fibrozu jetre

Probiotics and smectite absorbent gel formulation reduce liver stiffness, transaminase and cytokine levels in NAFLD associated with type 2 diabetes: a randomized clinical study

Introduction. In double-blind single center randomized clinical trial (RCT), the efficacy of alive probiotics sup­plementation with smectite gel vs. placebo in type 2 diabetes patient with non-alcoholic fatty liver disease (NAFLD) detected on ultrasonography (US) were studied. Material and methods. A total of 50 patients met the criteria for inclusion. They were randomly assigned to receive Symbiter Forte combination of probiotic biomass with smectite gel (250 mg) or placebo for 8-weeks. The primary main outcomes were the change in fatty liver index (FLI) and liver stiffness (LS) meas­ured by shear wave elastography (SWE). Secondary outcomes were the changes in transaminases activity, serum lipids and cytokines levels. Results. All subjects completed the study and received more than 90% of prescribed sachets. In respect to our primary endpoints, FLI and LS insignificant de­crease in both interventional and placebo groups. However, when we compare mean changes across groups from baseline, expressed in absolute values, the reduction of both LS (–0.254 ± 0.85 vs. 0.262 ± 0.77; p = 0.031) were observed. Analysis of sec­ondary outcomes showed that co-administration of probiotic with smectite lead to significant reduction of alanine aminotransferase (ALT), aspartate amino­transferase (AST), total cholesterol, IL-1b, and tumor necrosis factor (TNF-a) after 8 weeks. Conclusion. In this RCT, we confirmed previously re­ported animal data, showing that co-administration of probiotic with smectite manifested with reduction of LS, liver transaminases and chronic systemic inflam­mation

Hepatic steatosis indices as predictors of vitamin D3 deficiency in patients with NAFLD associated with type 2 diabetes

Background. Recently, vitamin D3 deficiency is considered one of the factors associated with the development of non-alcoholic fatty liver disease (NAFLD). The aim was to evaluate steatosis indices and metabolic parameters in NAFLD depending on vitamin D3 status. Methods. According to the recommendations of the European Society of Endocrinology, all patients were divided into 3 groups: group 1 — with an optimal level of vitamin D3 (30 ng/mL); group 2 — vitamin D3 insufficiency (21–29 ng/mL) and group 3 — vitamin D3 deficiency (&lt; 20 ng/mL). Results. The study included 126 T2D patients with NAFLD diagnosed with ultrasound. The highest hepatic steatosis (HSI) and fatty liver (FLI) index values were diagnosed in vitamin D3 deficiency as compared to optimal group (HSI — 43.34 ± 6.59 vs. 39.67 ± 4.37; P = 0.032 and FLI — 79.21 ± 19.61 vs. 64.96 ± 17.72; P = 0.007). Triglyceride and glucose index (TyG) also were insignificantly elevated parallel to vitamin D3 status worsened (P = 0.175). In multivariate logistic regression analysis all steatosis indices were independent from transaminases activity, body mass index (BMI) and T2D duration associated with vitamin D3 deficiency. Conclusions. Hepatic steatosis indices (HSI, FLI and TyG) independently from anthropometric parameters and transaminase activity associated with D3 deficiency in NAFLD patient

Hepatic steatosis indices as predictors of vitamin D3 deficiency in patients with NAFLD associated with type 2 diabetes

Background. Recently, vitamin D3 deficiency is considered one of the factors associated with the development of non-alcoholic fatty liver disease (NAFLD). The aim was to evaluate steatosis indices and metabolic parameters in NAFLD depending on vitamin D3 status. Methods. According to the recommendations of the European Society of Endocrinology, all patients were divided into 3 groups: group 1 — with an optimal level of vitamin D3 (30 ng/mL); group 2 — vitamin D3 insufficiency (21–29 ng/mL) and group 3 — vitamin D3 deficiency (< 20 ng/mL). Results. The study included 126 T2D patients with NAFLD diagnosed with ultrasound. The highest hepatic steatosis (HSI) and fatty liver (FLI) index values were diagnosed in vitamin D3 deficiency as compared to optimal group (HSI — 43.34 ± 6.59 vs. 39.67 ± 4.37; P = 0.032 and FLI — 79.21 ± 19.61 vs. 64.96 ± 17.72; P = 0.007). Triglyceride and glucose index (TyG) also were insignificantly elevated parallel to vitamin D3 status worsened (P = 0.175). In multivariate logistic regression analysis all steatosis indices were independent from transaminases activity, body mass index (BMI) and T2D duration associated with vitamin D3 deficiency. Conclusions. Hepatic steatosis indices (HSI, FLI and TyG) independently from anthropometric parameters and transaminase activity associated with D3 deficiency in NAFLD patient

Probiotics and smectite absorbent gel formulation reduce liver stiffness, transaminase and cytokine levels in NAFLD associated with type 2 diabetes: a randomized clinical study

Introduction. In double-blind single center randomized clinical trial (RCT), the efficacy of alive probiotics sup­plementation with smectite gel vs. placebo in type 2 diabetes patient with non-alcoholic fatty liver disease (NAFLD) detected on ultrasonography (US) were studied. Material and methods. A total of 50 patients met the criteria for inclusion. They were randomly assigned to receive Symbiter Forte combination of probiotic biomass with smectite gel (250 mg) or placebo for 8-weeks. The primary main outcomes were the change in fatty liver index (FLI) and liver stiffness (LS) meas­ured by shear wave elastography (SWE). Secondary outcomes were the changes in transaminases activity, serum lipids and cytokines levels. Results. All subjects completed the study and received more than 90% of prescribed sachets. In respect to our primary endpoints, FLI and LS insignificant de­crease in both interventional and placebo groups. However, when we compare mean changes across groups from baseline, expressed in absolute values, the reduction of both LS (–0.254 ± 0.85 vs. 0.262 ± 0.77; p = 0.031) were observed. Analysis of sec­ondary outcomes showed that co-administration of probiotic with smectite lead to significant reduction of alanine aminotransferase (ALT), aspartate amino­transferase (AST), total cholesterol, IL-1b, and tumor necrosis factor (TNF-a) after 8 weeks. Conclusion. In this RCT, we confirmed previously re­ported animal data, showing that co-administration of probiotic with smectite manifested with reduction of LS, liver transaminases and chronic systemic inflam­mation