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PubMed2006

Gastric bypass surgery improves metabolic and hepatic abnormalities associated with nonalcoholic fatty liver disease.

BACKGROUND & AIMS: Most patients with extreme obesity have nonalcoholic fatty liver disease (NAFLD). Although gastric bypass (GBP) surgery is the most common bariatric operation performed in obese patients in the United States, the effect of GBP surgery-induced weight loss on the metabolic and hepatic abnormalities associated with NAFLD are not clear. METHODS: Whole-body glucose, fatty acid and lipoprotein kinetics, liver histology, and hepatic cellular factors involved in inflammation and fibrogenesis were evaluated in 7 extremely obese subjects (body mass index, 58 +/- 4 kg/m(2)) before and 1 year after GBP surgery. RESULTS: At 1 year after surgery, subjects lost 29% +/- 5% of initial body weight (P < .01); palmitate rate of appearance in plasma, an index of adipose tissue lipolysis, decreased by 47% +/- 4% (P < .01); endogenous glucose production rate decreased by 27% +/- 7% (P < .01); and very-low-density lipoprotein-triglyceride secretion rate decreased by 44% +/- 9% (P < .05). In addition, GBP surgery-induced weight loss decreased hepatic steatosis but did not change standard histologic assessments of inflammation and fibrosis. However, there was a marked decrease in hepatic factors involved in regulating fibrogenesis (collagen-alpha1(I), transforming growth factor-beta1, alpha-smooth muscle actin, and tissue inhibitor of metalloproteinase 1 expression and alpha-smooth muscle actin content) and inflammation (macrophage chemoattractant protein 1 and interleukin 8 expression) (P < .05, compared with values before weight loss). CONCLUSIONS: These data demonstrate that weight loss induced by GBP surgery normalizes the metabolic abnormalities involved in the pathogenesis and pathophysiology of NAFLD and decreases the hepatic expression of factors involved in the progression of liver inflammation and fibrosis.

Analysis of Variance↗
PubMed1975

Evidence for a lesion in carbohydrate metabolism in fatty liver and kidney syndrome in chicks.

Liver and kidney slices from chicks affected with fatty liver and kidney syndrome (FLKS) were incubated in vitro with a variety of non-carbohydrate precursors and their ability to form glucose was studied. The results show that the affected liver was unable to form significant quantities of glucose from the precursors (gluconeogenesis). Glycogen breakdown was also drastically reduced because the tissue was almost devoid of this carbohydrate store. Blood chemistry revealed no evidence of overall liver malfunction but reflected the consequences of lack of gluconeogenesis. In contrast, kidney gluconeogenic activity was significantly higher than in the controls, suggesting an attempt by this organ to offset the reduced hepatic capability. Attempts to restore activity in vitro were made by adding known cofactors of gluconeogenesis. Asmall but significant improvement resulted from addition of biotin to liver slices.

Alanine↗
PubMed1980

Coenzyme A is required for rat liver fatty acid synthetase activity.

Inhibition of highly purified rat liver fatty acid synthetase occurs when it is assayed in the presence of the ATP citrate lyase reaction components. Citrate, Mg2+, ATP, and ATP citrate lyase were all necessary for the inhibition to take place. Inhibition was prevented by hydroxycitrate, a competitive inhibitor for ATP citrate lyase. The length of time for the onset of inhibition to take place was proportional to the ratio of ATP citrate lyase activity to the fatty acid synthetase activity. The inhibition was reversed by the addition of coenzyme A. This indicates a reaction mechanism for fatty acid synthetase which involves free coenzyme A. Two possible roles for CoA are discussed, one as an allosteric activator and the other in the cleavage of palmitoyl enzyme in the last step of the reaction.

ATP Citrate (pro-S)-Lyase↗
PubMed1998

Differential influence of rat liver fatty acid binding protein isoforms on phospholipid fatty acid composition: phosphatidic acid biosynthesis and phospholipid fatty acid remodeling.

The ability of two rat liver fatty acid binding protein (L-FABP) isoforms to influence microsomal phosphatidic acid biosynthesis, a key intermediate in glycerolipid formation, and phospholipid fatty acid remodeling was examined in vitro. Isoform I enhanced microsomal incorporation of [1-14C]-oleoyl-CoA into phosphatidic acid 7-fold while isoform II had no effect relative to basal. In contrast, isoform II enhanced microsomal incorporation of [1-14C]-palmitoyl-CoA into phosphatidic acid 4-fold while isoform I had no effect. These results suggest that each L-FABP isoform selectively utilized different acyl-CoAs for glycerol-3-phosphate esterification. Both isoforms stimulated phosphatidic acid formation by increasing glycerol-3-phosphate acyltransferase activity, not by increasing lysophosphatidic acid acyltransferase activity. Furthermore, the effects of L-FABP on phosphatidic acid biosynthesis could not be correlated with protection from acyl-CoA hydrolysis. L-FABP isoforms also influenced phospholipid fatty acid remodeling in a phospholipid-dependent manner. Isoform I preferentially enhanced oleate and palmitate esterification into phosphatidylethanol-amine, while isoform II stimulated esterification into phosphatidylcholine, phosphatidylserine and sphingomyelin. Taken together, these data demonstrated a unique role of each L-FABP isoform in modulating microsomally derived phospholipid fatty acid composition. (c) 1998 Elsevier Science B.V.

Acyl Coenzyme A↗
PubMed1986

A high cholesterol/cholate diet induced fatty liver in spontaneously hypertensive rats.

A high cholesterol diet was found to induce fatty liver in spontaneously hypertensive rats. Although cholesterol ester and triacylglycerol accumulated in large amounts in liver, the increases of these lipids in plasma were relatively small and no increase in cholesterol and cholesterol ester was observed in aorta. In rats fed normal diet, plasma cholesterol ester mainly consisted of arachidonate species; however, oleate and linoleate esters became the most prominent species in rats fed a high-cholesterol diet. The amounts of oleate and linoleate at the 2-position of phosphatidylcholine in both plasma and liver were increased slightly, but the fatty acids of aorta lipids changed little by feeding a high cholesterol diet. These results indicate that the livers of rats fed the high cholesterol diet do not secrete cholesterol ester and triacylglycerol with altered fatty acids as rapidly as they are synthesized and that the increased levels of cholesterol oleate in liver and plasma are not directly correlated with atherogenic lesions under these conditions.

Animals↗
PubMed1975

Steroid hormones and their binding in plasma of male patients with fatty liver, chronic hepatitis and liver cirrhosis.

Oestrone (E1), oestradiol (E2), testosterone (T), androstenedione (A) and cortisol (F) as well as LH and the percentage of binding of E1, E2, T and F in plasma were measured and compared in normal young and old male subjects and in male patients with fatty liver, chronic hepatitis and cirrhosis of the liver. The alterations seen were most marked in the cirrhotic patients, but were partially also found in patients with fatty liver and in normal old subjects: a definite increase in E1, a smaller increase in E2, a decrease in T and a rise in LH. F remained unchanged. The ratios of E2/T and E1/T were higher in cirrhotic patients than in healthy young subjects. As the percentage of bound T in plasma rose, the oestrogen/androgen imbalance was greater in patients with liver disease and in old subjects than the ratio of total hormone plasma concentration indicates. The biological relevance of the extremely high E1 plasma concentrations in patients with cirrhosis of the liver is not known. It is suggested that the combination of elevated E1 and E2 and reduced T, which is strongly bound by increased sexual hormone binding globulin (SHBG) may be responsible for gynaecomastia and hypogonadism in chronic liver diseases. As similar alterations of steroid plasma concentrations and their binding to plasma proteins are found both in patients with liver disease and in old men, these changes may be caused by the same mechanism: namely an altered liver function.

Adult↗
PubMed1991

Metabolic changes in blood and liver during development and early treatment of experimental fatty liver and ketosis in cows.

Eighteen cows were assigned in equal numbers to three groups: control, ketosis induction by using feed restriction plus dietary 1,3-butanediol to provide ketone bodies, and glucose treatment with 484 g/d of glucose infused intraduodenally starting 7 d after beginning ketosis induction. Ketosis induction, begun at d 15 postpartum, caused ketonemia and gradual development of clinical ketosis by d 40 to 45. None of the cows in the control or glucose-treated groups became ketotic. Concentrations of NEFA in plasma of cows that became ketotic increased 3.0-, 2.6-, and 1.9-fold at 3 wk before, 2 wk before, and at ketosis, respectively, but increased nonsignificantly for glucose-treated cows. Concurrently, beta-hydroxybutyrate increased 3.5-, 5.8- and 8.4-fold for cows that became ketotic but 1.6-fold or less for glucose-treated cows. Plasma acetate increased dramatically 2 wk before ketosis. Liver glycogen content decreased to nearly 0 by 2 wk before ketosis occurred, but it increased to prepartal values in glucose-treated cows. Liver triglycerides averaged 2.0% of wet weight at d 5 for all cows but increased to 8 to 10% for about 2 wk before ketosis occurred. Microscopy of liver samples demonstrated progressive accumulation of lipid globules, which began in hepatocytes near the central vein and progressed toward the portal triad. Visible lipid content reached a peak 2 wk before ketosis. Hepatic in vitro gluconeogenic capacity decreased significantly for ketosis induction protocol cows when clinical ketosis was detected. Results indicate that experimental ketosis was preceded by metabolic abnormalities up to 2 wk before clinical ketosis occurred. The key events for onset of clinical ketosis, however, were not elucidated.

3-Hydroxybutyric Acid↗
PubMed2002

Imaging the fatty liver.

Even though various imaging techniques are available to detect fat, chemical-shift imaging is the most accurate for both qualitative and quantitative measurement of fat. It can be very useful in liver studies, not only because it definitively demonstrates fatty liver but also because it improves lesion detection and characterization in some cases.

Fatty Liver↗
PubMed1978

Acute fatty liver of pregnancy with disseminated intravascular coagulation.

A patient with acute fatty liver of pregnancy associated with disseminated intravascular coagulation (DIC) is reported. The case lends support to the hypothesis that DIC may be of pathophysiologic significance in this disorder. Treatment principles are discussed and the importance of prompt Caesarean section as early as possible after the onset of symptoms is emphasized.

Acute Disease↗
PubMed1994

The development of fatty liver is accelerated in transgenic mice expressing cynomolgus monkey cholesteryl ester transfer protein.

Expression of cynomolgus monkey cholesteryl ester transfer protein (CETP) in C57BL/6 mice has been shown to have a profound effect on the lipoprotein profile in those animals. The objective of this study was to examine the effect of CETP expression on the hepatic lipids of the CETP transgenic mice. The triglyceride, cholesterol and phospholipid composition of livers from 6- and 12-month-old transgenic mice were evaluated and compared with those of age-matched C57BL/6 mice. Statistical analysis indicated that fatty liver was more severe in CETP transgenic mice than C57BL/6 controls (p < 0.01); progressed with age (p < 0.01); and developed more rapidly in males than females (p < 0.01). The lipid that accumulated was triglyceride. These data indicate that CETP expression accelerates the development of fatty liver in the C57BL/6 mouse and raise the possibility that CETP may also contribute to the process of hepatic steatosis in man.

Aging↗
PubMed2005

[Role of PPARs in the pathophysiology of nonalcoholoic fatty liver disease].

Pathogenic role of intrahepatic lipid accumulation in insulin resistance and metabolic syndrome has been well documented. Liver steatosis constitutes a risk factor for nonalcoholic steatohepatitis (NASH), one of the leading causes of obesity-related morbidity and mortality. Although pathophysiology of steatosis is multifactorial, a line of evidence from rodent studies suggests that PPARalpha and PPARgamma are involved. PPARalpha is highly expressed in liver and its activation by agonists leads to augmented fatty acid oxidation and protects against steatosis. PPARgamma, which is transcriptionally up-regulated in steatosis, activates lipogenic enzymes and exacerbates steatosis. However, recent human studies have suggested that PPARgamma agonists improve NASH possibly by its primary insulin-sensitizing effect on adipocytes. PPARs modulation is becoming a rational and effective therapeutic approach for the treatment of nonalcoholic fatty liver disease.

Fatty Liver↗
PubMed2006

Non-alcoholic fatty liver disease and increased risk of cardiovascular disease.

Non-alcoholic fatty liver disease (NAFLD) is present in up to one-third of the general population and in the majority of patients with cardio-metabolic risk factors such as abdominal obesity, type 2 diabetes and other components of the metabolic syndrome (MetS). Currently, the importance of NAFLD and its relationship to the MetS is increasingly recognized, and this has stimulated an interest in the possible role of NAFLD in the development of cardiovascular disease (CVD). Indeed, the impact of NAFLD on CVD risk deserves particular attention in view of the implications for screening/surveillance strategies in this growing number of patients. Recent evidence suggests that the severity of liver histology in NAFLD patients is closely associated with markers of early atherosclerosis such as greater carotid artery wall thickness and lower endothelial flow-mediated vasodilation independently of classical risk factors and components of the MetS. Moreover, NAFLD is associated with greater overall mortality and independently predicts the risk of future CVD events. Overall, the current body of evidence strongly suggests that NAFLD is likely to be associated with increased CVD risk, and raises the possibility that NAFLD may be not only a marker but also an early mediator of atherosclerosis.

Atherosclerosis↗
PubMed1988

Acute fatty liver of pregnancy: clinical features and diagnosis.

Five cases of acute fatty liver of pregnancy are described. These are the only recognized cases of this disorder occurring in a 2 year period in Western Australia. Clinical and laboratory features are presented. There was no maternal death. Of the six babies, there were three intrauterine deaths, including the only set of twins. All the babies were male. Vomiting in the third trimester was the chief presenting feature in all cases, often accompanied by a systemic illness with malaise and tiredness. Extreme polydipsia was noted as a prominent symptom in all cases. The combination of moderately abnormal liver function tests, extreme leucocytosis with other blood film abnormalities, hypoglycaemia, impaired renal function, coagulopathy and gross elevation of uric acid level is regarded as highly suggestive of the diagnosis. Features of a preeclamptic illness were present in several cases. Three of the patients have since had uneventful pregnancies. The constellation of clinical and laboratory features is sufficiently characteristic to allow accurate clinical diagnosis in most cases of this disorder. The chances of both maternal and fetal survival are enhanced by early diagnosis allowing intervention in the form of prompt delivery of the infant.

Acute Disease↗
PubMed2004

Nonalcoholic fatty liver disease in patients with type 2 diabetes.

BACKGROUND & AIMS: Nonalcoholic fatty liver disease (NAFLD) is reported commonly in patients with type 2 diabetes mellitus (DM), which has been suggested as a risk factor for the progressive form of NAFLD, or nonalcoholic steatohepatitis. The aim of this study was to assess the outcome of patients with NAFLD and DM. METHODS: A cohort of patients with NAFLD was identified, and patients with other causes of liver disease (alcohol, medication, etc.) were excluded. Clinical, pathological, and mortality data were available for this cohort. Patients were categorized and compared according to the presence or absence of DM. RESULTS: Of 132 patients with NAFLD, 44 patients (33%) had an established diagnosis of DM. Patients with DM were older and had greater serum glucose and triglyceride levels and a greater aspartate aminotransferase-alanine aminotransferase ratio. Liver biopsy specimens from patients with DM showed more vacuolated nuclei and acidophilic bodies. Cirrhosis (histological or clinical) occurred in 25% of patients with DM (11 of 44 patients) and NAFLD compared with only 10.2% (9 of 88 patients) of patients without DM with NAFLD (P = 0.04). After adjusting for potential confounders (age, body mass index, and the presence of cirrhosis), both overall mortality (risk ratio [RR], 3.30; 95% confidence interval [CI], 1.76-6.18; P = 0.002) and mortality related to liver disease (RR, 22.83; 95% CI, 2.97-175.03; P = 0.003) were greater in diabetic patients with NAFLD. Markers of hepatic dysfunction (low albumin level, high total bilirubin level, and prolonged prothrombin time) were the only independent predictors of increased mortality. CONCLUSIONS: Patients with NAFLD and DM are at risk for the development of an aggressive outcome, such as cirrhosis and mortality. This study supports the potential role of insulin resistance in the development of poor clinical outcomes in patients with NAFLD.

Age Distribution↗
PubMed1981

Cytotoxicity of mononuclear cells and vulnerability of hepatocytes in alcoholic fatty liver of baboons.

Mononuclear cell cytotoxicity against autologous, allogeneic and xenogeneic (rabbit) hepatocytes was investigated in nine baboons fed alcohol for 17-21 months and in nine pair-fed controls. All alcohol-fed animals developed fatty liver. Cytotoxicity of mononuclear cells was not observed when rabbit hepatocytes were used as target cells, but mononuclear cells of alcohol-fed baboons were cytotoxic against hepatocytes of both control animals and hepatocytes from alcohol-fed baboons, including the animals' own hepatocytes. Increased vulnerability of hepatocytes of alcohol-fed baboons was also demonstrated since mononuclear cells of both controls and alcohol-fed animals were more cytotoxic against hepatocytes of alcohol-fed baboons than against those of controls. Thus, autologous and heterologous hepatocytes are more sensitive in the baboon than rabbit hepatocytes in demonstrating cytotoxicity already at the stage of fatty liver. Two factors are contributory: mononuclear cells cytotoxicity and vulnerability of hepatocytes.

Animals↗
PubMed1977

Studies of fatty liver and kidney syndrome in chickens: dynamics of glucose metabolism.

1. Fatty liver and kidney syndrome (FLKS) was induced in a proportion of a group of 4-week-old chickens by giving a diet of meat meal and wheat; inclusion in the diet of animal tallow for 54 h substantially reduced the occurrence of FLKS. 2. Measurements of dynamic aspects of glucose metabolism were made with single injections of [2-3H]glucose which indicated that birds given the 'FLKS-inducing' diet and showing physical symptoms of FLKS had significantly lower rates of synthesis of glucose than birds given either the same diet supplemented with tallow or a commercial diet. 3. In a second series of experiments glucose metabolism was studied in birds (1) with or without physical symptoms that were given the 'FLKS-inducing' diet and (2) birds given the same diet supplemented with tallow or biotin. Affected birds fed the 'FLKS-inducing' diet had significantly lower plasma glucose concentrations, pool sizes and synthesis rates than birds fed the same diet and not showing symptoms, or birds fed the supplemented diets. 4. It is suggested that the cause of death in birds with FLKS is a low rate of gluconeogenesis during periods without feed which results in a lack of glucose to meet essential functions.

Animals↗
PubMed2006

Smoking is not associated with nonalcoholic fatty liver disease.

AIM: To analyze the relationship between smoking and nonalcoholic fatty liver disease (NAFLD). METHODS: This is a cross-sectional study of a healthy population, carried out in a check-up unit of a university hospital in Mexico City. We enrolled 933 subjects, 368 current smokers (cases) and 565 persons who had never smoked (controls). Demographic, metabolic and biochemical variables were measured in the two groups. NAFLD was determined by ultrasound and metabolic syndrome according to ATPIII. RESULTS: A total of 548 men (205 cases and 343 controls) and 337 women (114 cases and 223 controls) were included in the analysis. Statistical differences between cases and controls were observed only in high blood pressure prevalence (6.6% vs 11.3%, P < 0.05; cases and controls respectively), high-density lipoproteins (1.00 +/- 0.26 vs 1.06 +/- 0.28 mmol/L, P < 0.005), triglycerides (2.18 +/- 1.49 vs 1.84 +/- 1.1 mmol/L, P < 0.001), and erythrocyte sedimentation rate (11.3 +/- 9.3 vs 13.5 +/- 11.9 mm/h, P < 0.001). No differences were observed in the prevalence of NAFLD (22.27% vs 29.68%, P = NS) and metabolic syndrome (41.69% vs 36.74%, P = NS). Univariate analysis showed that smoking was not a risk factor for NAFLD (OR = 0.89, 95% CI 0.65-1.21). CONCLUSION: No differences in NAFLD prevalence were observed between current smokers and nonsmokers, and furthermore, no differences were observed in heavy smokers (more than 20 packs/year), indicating that there is no relationship between smoking and NAFLD.

Adult↗
PubMed1994

Acute fatty liver of pregnancy: laparoscopy-assisted diagnosis.

We report a case of fatty infiltration of the liver in a 27-year-old Hispanic woman. She went to an outside hospital in her third trimester of pregnancy with abdominal pain, jaundice, peripheral edema, and diffuse intravascular coagulation. An emergent cesarean section was performed, and she developed symptoms of acute hemorrhagic pancreatitis and altered mental status. She was transferred to Harbor County Hospital, where a computed tomography scan showed a fatty liver, and a liver biopsy confirmed the diagnosis of fatty liver of pregnancy. Prompt recognition and immediate termination of pregnancy with intensive, supportive care are essentials in the management of fatty liver of pregnancy.

Acute Disease↗