NAFLD AND TYPE 2 DIABETES: A GENETIC OR METABOLIC ISSUE?

BackgroundType 2 diabetes (T2D) seems to be a risk factor for the development of Non Alcoholic Fatty Liver Disease (NAFLD) and for its progression to fibrosis. The pathogenesis of the NAFLD-T2D association is not known. Recent data have shown that hyperinsulinemia and insulinresistance (IR) may be the primary phenomenon in NAFLD as well as inflammation.Aim of the study was to evaluate the prevalence of NAFLD in T2D, to correlate NAFLD with the Metabolic Syndrome (MetS) features and with T2D therapy, to evaluate the relation between NAFLD and genetic polymorphisms associated to IR, PC-1 K121Q, and inflammation, IL-6\u2013174 C/G.Methods80 diabetic subjects were enrolled and underwent blood sample and medical history to ruled out alcohol consumption and other liver diseases aetiology. Steatosis was defined according to standardized ultrasonographic criteria and a score for each criterion was assigned like indicator of the severity of fatty liver infiltration (Fatty liver indicator, FLI).ResultsThe subjects studied were overweight with BMI=28.60 (25\ub0\uf7 75\ub0=25.35\uf7 32.95), had normal lipid profile and uric acid and had higher GPT levels (25\ub0\uf7 75\ub0; GOT: 7.00\uf7 27.25 and GPT: 21.00\uf738.00)22.5% subjects had no steatosis whereas 77.5% had different severity of fatty liver infiltrationFLI did correlate significantly with BMI (p< 0.01), total Cholesterol (p<0.01), glycosilated haemoglobin (p<0.05) and TG (p<0.01)No correlation was found between T2D therapy and severity of NAFLD.No significant difference in polymorphisms prevalence was observed when NAFLD subjects were compared to a control group.DiscussionOur data show that T2D patients have a very high prevalence of NAFLD which is probably related to hyperinsulinism and IR. This is further supported by the positive correlation of NAFLD with BMI and TG. The lipogenic effects of insulin may underlie such relationship. In our population NAFLD associates with some features of MetS whereas no significant genetic component is present

Comparison of interrupter resistance with flow/volume method in childREN

Airway resistance measurement with the Interrupter Technique (RINT) has been proposed as a valid method for the evaluation of bronchial obstruction and, being easy to administer, could find its application in the uncooperative child (Ch). In order to evaluate the possible clinical application of RINT (Micro Medical MICROLAB 4000), this technique was compared with the Flow/Volume curve (F/V) (SPIROPRO 2000 Pabysch) in Ch (mean age 109.39±39 months). We studied : A) 54 Ch with normal F/V in baseline conditions; B) 50 asthmatic Ch before and after the exercise test (6' free running); C) 102 asthmatic Ch before and after inhalation of 200 ug salbutamol MDI. RINT was calculated, both with mouthpiece and face mask, as the average of 20 measurements for test A and 10 for tests B and C. Paired t test (significant for p&lt;0.05) and Pearson correlation coefficient (significant for r2 0.50) were calculated. Results : A) RINT vs FEV1, PEF, MEF 25, 50 and 75 were not correlated (r2&lt;0.50) even though r revealed an inverse trend (negative sign). Mean values with mouthpiece were higher than those with face mask (p&lt;0.005). B) The change in mean values of expiratory flows was significant at 6', 12' and 20', while mean RINT change was significant only at 6' whether with mouthpiece or with face mask; r had a negative sign but r2&lt;0.50. C) The bronchodilator test showd significant changes in values (p&lt;0.001) both with RINT and F/V. r had a negative sign but r2 &lt; 0.50. Conclusions : RINT measurements are not generally comparable with F/V curve values. Only the bronchodilator test showed significant changes. The mouthpiece measurements are much lower than those with face mask. The results are extremely non-homogeneous and we conclude that the RINT system used has to be improved before it can be applied in clinical practice. © 1997 Wiley-Liss, Inc

Hepatic steatosis and insulin resistance: Does etiology make a difference?

Background/Aims: To ascertain whether the etiology of hepatic steatosis modulates insulin resistance (IR) and to determine the predictors of IR. Methods: We studied IR through HOMA IR in 146 subjects, 99 of whom had ultrasonographic and/or histologic steatosis. Twenty-two had familial heterozygous hypobetalipoproteinemia (FHBL), 48 had non-alcoholic fatty liver disease (NAFLD), 34 HCV infection (17 with HCV1b, 17 with HCV3a) and 42 were healthy controls without steatosis. Results: Steatosis was present in 77.3% of FHBL and, by enrolment criteria, in all NAFLD and HCV cases. Overall HOMA-IR correlated with BMI and GGT (P < 0.01). FHBL and healthy groups had similar HOMA-IR and GGT values, whereas higher levels were observed in HCV and NAFLD. HCV3a and FHBL patients were hypolipidemic. HONIA-IR was similar in FHBL patients and controls and lower than in HCV and NAFLD. FHBL patients had a high extent of steatosis, similar to that observed in HCV3a, but lower grading and staging than NAFLD and HCV. At multivariate analysis, steatosis and GGT predicted HOMA-IR. Conclusions: Data suggest that not all hepatic fat associates with IR. FHBL patients, for some aspects, resemble HCV3a infection, possibly suggesting a shared steatogenic mechanism. Among steatotic patients serum GGT levels is the independent predictor of IR. (c) 2005 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved

CARDIORESPIROGRAPHY AND SLEEP STATES IN FULL-TERM AND PRETERM INFANTS AT TERM CONCEPTIONAL AGE

NO ABSTRAC

Gallstone disease in non-alcoholic fatty liver: Prevalence and associated factors

Background: Insulin resistance is a risk factors for non-alcoholic fatty liver disease (NAFLD) and for gallstone disease (GD). Aims of the present study were to assess the prevalence of and factors associated with GD in unselected patients with NAFLD. Methods: A total of 161 consecutive patients with NAFLD diagnosed through compatible ultrasonography in the absence of known etiologies of liver disease (in all patients) and/or confirmed histologically (in 61 patients), was studied. Gallstone disease was diagnosed through ultrasound scanning or on the basis of previous cholecystectomy. Anthropometric and biochemical variables and concurrent diseases were compared in 32 NAFLD-GD patients and in 129 NAFLD patients without GD (controls) according to gender. Results: The overall prevalence of GD was 19.88%, higher in female patients (P< 0.05), who were older (P < 001). The overall percentage of GD increased with age (P < 0.05). The GD patients had higher uric acid (men), total cholesterol and apolipoprotein B (apo-B) serum concentrations (women, P < 0.05); women also had a higher prevalence of hypertriglyceridemia (P < 0.05). The age-corrected odds ratio of having GD by tertiles increased significantly with increasing uric acid (men) and with increasing total cholesterol, triglycerides and apo-B (women). At univariate continuous analysis GD was associated with insulin 120 min and uric acid in male patients; and with body mass index, insulin 120 min, apo-B, total cholesterol and triglycerides in female patients. On multivariate analysis it was found that among these factors only uric acid in men and apo-B in women were independently associated with GD in NAFLD. Conclusions: The prevalence of GD in NAFLD is more elevated than reported in the general population. The factors independently associated with GD in NAFLD are different from those reported in the general population and vary according to the gender

Epidemiologia e storia naturale dell'epatopatia steatosica non alcolica

Epidemiology of NAFLD is not well defined. Estimated prevalence in teh general population is 20% for NAFLD and 2% for NASH. the disease affects all ages, males are more affected than females . Associated conditions are obeisty ,type 2 diabetes , hyperlypemia, all features of metabolic syndroem. Natural history includes a clinically nenign course for steatosis and teh progression of nASH to cirrhosis in a significant proportion of cases(20%) and eventually to hepatocellular carcinoma.. steatosis is a negative predictor for graft surbvival in orthotopic liver transplantation and is associated with the progression of hepatitis C virus to cirrhosis

determinants of lt levels and fibrosis in non alcoholic fatty liver disease

The study suggets that as yet incomplety understood factors might account for the progression from steatosis to steatohepatitis and that predictors of fibrosis in our unselected population with non alcoholic fatty liver disease are differet compared to other studies

RISK FOR CARDIOVASCULAR EVENTS IN A LOCAL POPULATION OF DIABETIC PATIENTS.

Diabetes mellitus (DM) is a major risk factor for cardiovascular (CV) events. Many algorithms have been devised to assess CV risk, some of which specific for diabetics. Most of them, however, are based on data which can hardly be extrapolated to Mediterranean countries. AIM of the present study was to analyze CV risk and the incidence of CV events in a local cohort of patients with type 2 DM. METHODS. Clinical charts of two Diabetes Clinics of Modena in the period 1991-1994 were analyzed. Patients aged 35-65 with type 2 DM and no history of CV disease were eligible. Global CV risk was computed according to Framingham, RISCARD, Progetto Cuore and UKPDS algorithms and compared with the actual rate of CV events over the following 10 years. RESULTS. 774 patients were screened; 473 of them (61.1%) were eligible on the basis of predefined criteria and completeness of data. In such population an absolute 10-yr risk rate of 10.8% was observed. When comparing the estimated risk rate according to the different functions, a high degree of variability was present; Italian algorithms were more consistent with the observed data even if only 31% of patients with CV events had a risk > 20% at initial observation. CONCLUSIONS. Estimation of CV risk is largely dependent on the algorithm adopted and on the baseline risk of the reference cohort. Functions designed for a specific population should be adopted. The overall performance of such functions is however low. The algorithm derived from the present study will be utilized for a prospective evaluation of CV risk in our local cohort

Survival analysis in families affected by hereditary non-polyposis colorectal cancer

Previous survival studies suggested a better prognosis of hereditary nonpolyposis colorectal cancer (HNPCC) patients compared with the sporadic counterpart. In the present study we evaluated the clinical outcome of HNPCC patients with respect to that of patients with colorectal cancer re corded in a population-based cancer registry. We assessed survival of 85 colorectal cancer patients from 24 unrelated families defined as having HNPCC according to the criteria of the international Collaborative Group, for whom adequate information on subject- and tumor-related parameters and a 5-year follow-up (cancer diagnosis from 1980-1989) were available. Three hundred and seventy-seven colorectal cancer patients, registered from 1984-1986, with a 5-year followup, were used for comparison. Colorectal cancer-specific 5-year survival rates were 55.2% and 42.5% for HNPCC and non HNPCC, respectively. Using Cox regression analysis, tumor staging and location were independently associated with survival, whereas HNPCC diagnosis was not. Stage II HNPCC cases exhibited a better prognosis than non-HNPCC patients. By Cox regression analysis, none of the variables were significantly related to survival. Both overall and stage II HNPCC cases showed a survival advantage in comparison with non-HNPCC patients. However, the difference disappeared when clinical and pathological variables were controlled for with a Cox regression analysis