Lipoprotein Profiles in Class III Obese Caucasian and African American Women with Nonalcoholic Fatty Liver Disease

Triglyceride content in the liver is regulated by the uptake, production and elimination of lipoproteins, and derangements in these processes contribute to nonalcoholic fatty liver disease (NAFLD). Previous studies show a direct relationship between intrahepatic fat and production of apolipoprotein B100 (apoB100) containing particles, VLDL and LDL, but little consensus exists regarding changes in lipoprotein production in the development of simple steatosis (SS) versus nonalcoholic steatohepatitis (NASH). Further, ethnic variations in lipoproteins among SS and NASH are unknown as is how such variations might contribute to the differential prevalence of disease among Caucasians versus African Americans. In this study, we assessed plasma lipoprotein profiles by nuclear magnetic resonance (NMR) spectroscopy in 70 non-diabetic class III obese females recruited from the surgical weight loss clinic. Of these, 51 females were stratified by biopsy-staged NAFLD severity (histologically normal, SS, or NASH). NASH females displayed increased circulating triglycerides and increased VLDL particle number and size relative to those with histologically normal livers, while total and large LDL concentration decreased in SS versus NASH and correlated with increased insulin resistance (via HOMA2-IR). When Caucasian women were examined alone (n = 41), VLDL and triglycerides increased between normal and SS, while total LDL and apoB100 decreased between SS and NASH along with increased insulin resistance. Compared to Caucasians with SS, African American women with SS displayed reduced triglycerides, VLDL, and small LDL and a more favorable small to large HDL ratio despite having increased BMI and HOMA2-IR. These findings suggest that ApoB100 and lipoprotein subclass particle number and size can delineate steatosis from NASH in obese Caucasian females, but should be interpreted with caution in other ethnicities as African Americans with SS display relatively improved lipoprotein profiles. This may reflect variation in the relationship between dyslipidemia and NAFLD progression across gender and ethnicity

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

La Información Médica : revista quincenal de medicina, cirugía y especialidades. Órgano del Colegio de Médicos de la provincia: Año II Número 47 - 1918 diciembre 30

Copia digital. Madrid : Ministerio de Cultura. Subdirección General de Coordinación Bibliotecaria, 200

Lipid and lipoprotein measures in class III obese African American females stratified by histology.

<p>Data presented as mean ± SEM. AU, arbitrary units.</p><p>Lipid and lipoprotein measures in class III obese African American females stratified by histology.</p

Lipid and lipoprotein measures in class III obese Caucasian females stratified by histology.

<p>Data presented as mean ± SEM. AU, arbitrary units. P values represent difference between groups.</p><p>^aP < 0.05 vs. normal</p><p>^bP < 0.01 vs. normal</p><p>^cP < 0.05 vs. SS</p><p>^dP < 0.01 vs. SS</p><p>Lipid and lipoprotein measures in class III obese Caucasian females stratified by histology.</p

Schematic illustrating lipoproteins particles under investigation in this study.

<p>Schematic illustrating lipoproteins particles under investigation in this study.</p

Ethnic Lipoparticle Comparisons.

<p>African American women with simple steatosis had less atherogenic lipoprotein profiles relative than Caucasian women with simple steatosis. <b>A)</b> African Americans with simple steatosis (SS) were heavier (*P<0.05) and more insulin resistant <b>B</b>) as measured by homeostatic model assessment index 2 (HOMA2-IR, *P<0.05), yet displayed lower triglycerides (***P<0.001, not shown) and <b>C</b>) lower alanine aminotransferase (ALT, *P<0.05) than Caucasian SS. <b>D</b>) African Americans with SS displayed lower total very-low-density lipoprotein (VLDL) and VLDL sub-fractions (**P<0.01 for all, except small VLDL particle concentration, *P<0.05), <b>E</b>) decreased total and small low-density lipoprotein (LDL; *P<0.05 and **P<0.01, respectively), and <b>F</b>) improved high-density lipoprotein (HDL) profiles (increased large HDL, p = 0.002, and lower small LDL, P = 0.04) relative to Caucasian SS (E-F). Values are mean ± SEM. Data were analyzed by one-way ANOVA, followed by Mann-Whitney t Tests.</p

Baseline characteristics of class III obese females stratified by histology.

<p>Data presented as mean ± SEM. AU, arbitrary units. Asterisks represent significant difference between lean and obese:</p><p>***P<0.001</p><p>****P<0.0001</p><p>One-way ANOVA P values among obese groups (far-right). Dunn’s Multiple Comparison test results for obese group:</p><p>^aP <0.05 vs. normal</p><p>^bP <0.01 vs. normal</p><p>^cP <0.05 vs. SS</p><p>^dP <0.001 vs. normal</p><p>Abbreviations: BMI, body mass index; HOMA2-IR, updated homeostasis model assessment of insulin resistance; AST, aspartate aminotransferase; ALT, alanine aminotransferase; NAS, NAFLD Activity Score.</p><p>Baseline characteristics of class III obese females stratified by histology.</p