Inhibition of enteropathogens by Clostridium butyricum MIYAIRI 588

The inhibitory effect of Clostridium butyricum MIYAIRI 588 against various enteropathogens was investigated in mixed cultures. It was observed that C. butyricum M588 inhibited the growth of Vibrio cholerae O1, V. cholerae non-O1, Aeromonas hydrophila, and Shigella flexneri. Considering that the interaction between C. butyricum and Shigella is especially important because of their proliferation site in the lower intestine, further examinations were carried out on Shigella in particular. Results were as follows: 1) In BHI broth culture of Shigella, the pH of culture fluid went down to 5.2, but the growth of Shigella was not inhibited. 2) In the mixed culture of Shigella and C. butyricum, the growth of Shigella was inhibited, nevertheless the pH of the culture fluid was 5.6. 3) In the mixed culture with phosphate buffered BHI maintaining the pH higher than 6.0, the growth of Shigella was inhibited. 4) In case of pure culture of C. butyricum in BHI broth, the pH of culture fluid indicated 5.5, and Shigella failed to grow in the cell free culture supernatant. 5) The growth of Shigella was not inhibited in the culture supernatant when the pH was adjusted at 7.2. These results suggested that the inhibition of Shigella in the mixed culture with C. butyricum was not due to a single factor such as pH or fatty acid etc. but due to multifactors including live cells of C. butyricum.     

Efficacy of Probiotics and Smectite in Rats with Non-Alcoholic Fatty Liver Disease

Introduction and aim. Today probiotics have been suggested as a treatment for the prevention of non-alcoholic fatty liver disease (NAFLD). Smectite is a natural silicate that binds to digestive mucous and has the ability to bind endo- and exotoxins. The present study was designed to determine whether probiotics plus smectite is superior to probiotic alone on the monosodium glutamate (MSG) induced NAFLD model in rats.Materials and methods. We included 60 rats divided into 4 groups 15 animals in each. Rats of group I were intact. Newborns rats of groups II-IV were injected with MSG. The III (Symbiter) group received 2.5 ml/kg of multiprobiotic “Symbiter” containing concentrated biomass of 14 probiotic bacteria genera. The IV (Symbiter+Smectite) groups received “Symbiter Forte” combination of probiotic biomass with smectite gel (250 mg).Results. In both interventional groups reduction of total NAS score as compared to MSG-obesity was observed. Indeed similar values of steatosis score (0.93 ± 0.22 vs. 0.87 ± 0.16) in both treatment groups, we observed that lower total score for Symbiter+ Smectite are associated with more pronounced reduction of lobular inflammation (0.13 ± 0.09 vs. 0.33 ± 0.15) as compared to administration of probiotic alone. This data accompanied with significant reduction of IL-1 and restoration of IL-10 between these 2 groups.Conclusions. Additional to alive probiotic administration of smectite gel due to his absorbent activity and mucus layer stabilization properties can impact on synergistic enhancement of single effect which manifested with reduction of lobular inflammation and at list partly steatohepatitis prevention.     

New Onset Diabetes and Non-Alcoholic Fatty Liver Disease after Liver Transplantation

Background & AimsNon-alcoholic fatty liver disease (NAFLD) is an emerging cause of graft dysfunction after liver transplantation (LT) frequently related to the development of new onset diabetes after LT (NODAT). This study was undertaken to evaluate the frequencies of NODAT and NAFLD after LT, to investigate their major risk factors and the impact of de novo or recurrent NAFLD in graft function.Material and methods119 patients submitted to LT were prospectively evaluated.ResultsAfter 4 ± 1 years, NODAT, recurrent and de novo NAFLD were observed in 31%, 56% and 43% of the subjects, respectively. Only 3 patients had non-alcoholic steatohepatitis (NASH) without fibrosis. Other risk factors for NAFLD such as arterial hypertension (AHT), metabolic syndrome (MS), hypertriglyceridemia and obesity were seen in 51%, 50%, 35% and 24% of the subjects, respectively. In addition, insulin resistance (IR), assessed by HOMA-IR and β-cell dysfunction, determined by HOMA-β, were observed in 16% and 94% of the patients, respectively. Occurrence of NODAT was associated with male gender, higher waist circumference, higher HOMA-IR and lower HOMA-β values. No correlation was found between NAFLD and NODAT, MS, hypertriglyceridemia, obesity and HOMA-IR and HOMA-β levels.ConclusionsNODAT, recurrent and de novo NAFLD are common after LT but are not associated with signs of graft dysfunction, possibly due to the low frequency of IR and NASH. No correlation is observed between NAFLD and NODAT, MS, hypertriglyceridemia, obesity and IR. β-cell dysfunction and diabetes, however, are seen in most of the patients, possibly due to calcineurin inhibitor toxicity.     

GLP-1 Receptor Agonist and Non-Alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD), one of the most common liver diseases, is caused by the disruption of hepatic lipid homeostasis. It is associated with insulin resistance as seen in type 2 diabetes mellitus. Glucagon-like peptide-1 (GLP-1) is an incretin that increases insulin sensitivity and aids glucose metabolism. In recent in vivo and in vitro studies, GLP-1 presents a novel therapeutic approach against NAFLD by increasing fatty acid oxidation, decreasing lipogenesis, and improving hepatic glucose metabolism. In this report, we provide an overview of the role and mechanism of GLP-1 in relieving NAFLD.     

Thyroid Function in Obese Children with Non-Alcoholic Fatty Liver Disease

Ob­jec­ti­ve: To investigate the relationships between thyroid function and metabolic risk factors in obese adolescents with non-alcoholic fatty liver disease (NAFLD).Methods: One hundred sixty obese adolescents and 40 control subjects were enrolled in the study. The obese subjects were divided into two groups based on presence or absence of liver steatosis (NAFLD group and non-NAFLD group). Serum samples were assayed for glucose, insulin, cholesterol, alanine aminotransferase, aspartate aminotransferase, free thyroxine (fT4), free triiodothyronine (fT3) and thyroid-stimulating hormone (TSH). The ratio of fT3 to fT4 was evaluated as an indirect index of deiodinase activity. Insulin resistance was evaluated by homeostasis model assessment (HOMA-IR) from fasting samples.Results: NAFLD and non-NAFLD groups had slightly higher fasting blood glucose values than the control group. Fasting insulin levels in the NAFLD group were significantly higher than those in the non-NAFLD and control groups. The NAFLD group had significantly greater HOMA-IR values compared with the non-NAFLD group and also with the control group. The NAFLD group had significantly higher fT3/fT4 ratio values compared to both non-NAFLD and control groups. fT3/fT4 was positively correlated with serum insulin levels in the NAFLD group. Conclusion: This study showed that obese adolescents with hepatosteatosis had elevated values for fT3/fT4 ratio. This finding suggested a high conversion of T4 to T3 due to increased deiodinase activity as a compensatory mechanism for fat accumulation.     

非酒精性脂肪性肝病合并代谢综合征的临床研究

目的探讨非酒精性脂肪性肝病(NAFLD)合并代谢综合征(MS)的患病情况、临床特点。方法选取在我院体检中心体检诊断的NAFLD患者207例,按有无合并MS分为单纯NAFLD组114例,NAFLD合并MS组93例,比较两组患者的临床资料。结果 (1)NAFLD中合并MS的患病率为44.93%,两组患者的性别比及发病年龄无明显差异(P>0.05);(2)肝脏血清酶学指标:NAFLD合并MS组患者的ALT及AST和单纯NAFLD组相比无明显差异(P>0.05),但AST/ALT>1的发生率较单纯NAFLD组显著增多(P<0.05);(3)代谢指标:NAFLD合并MS组患者的腰围、甘油三酯、空腹血糖及血尿酸均较单纯NAFLD组明显增高(P<0.05),但是血压、血清总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇无明显差异(P>0.05);(4)并发症:NAFLD合并MS组冠心病、糖尿病及高血压病的发生率均较单纯NAFLD组显著增多(P<0.05)。结论 NAFLD合并MS患者的肝酶(AST/ALT>1)异常及并发症发生率高,代谢异常程度严重,应给予有效的干预措施。     

Relationship between Neck Circumference and Non-Alcoholic Fatty Liver Disease in Childhood Obesity

Objective:

The aim of this study was to establish the association between anthropometric parameters and non-alcoholic fatty liver disease (NAFLD) and to determine the most reliable measurement as a parameter in predicting NAFLD.

Methods:

Two-hundred fifty-three obese children of ages 10 to 18 years were enrolled in this study. Anthropometric data and metabolic parameters such as fasting blood glucose, insulin and lipid levels, were measured. Liver function tests were assessed. NAFLD was determined by ultrasound.

Results:

Most metabolic parameters and anthropometric indices were significantly higher in children with NAFLD. A univariate logistic regression analysis was performed, taking NAFLD status as the dependent variable and anthropometric parameters as the independent variables. NAFLD was affected significantly by the anthropometric values. The multiple logistic regression analysis showed that neck circumference (NC) was the only parameter which determined the risk in both genders. Each 1 cm increase in the NC increased the risk of NAFLD 1.544-fold (p<0.001, 95% confidence interval (CI): 1.357-2.214) in the boys and 1.733-fold (p=0.001, 95% CI: 1.185-2.012) in the girls. Receiver operating characteristic analysis was performed to compare the reliability of anthropometric measurements. NC was observed to be a better indicator.

Conclusion:

Measurement of the NC was shown to be associated with NAFLD in children. We suggest the use of NC as a novel, simple, practical, and reliable anthropometric index in predicting children at risk for NAFLD.     

Thyroid Function and Risk of Non-Alcoholic Fatty Liver Disease in Euthyroid Subjects

Introduction and aims. The association between thyroid function and non-alcoholic fatty liver disease (NAFLD) remained controversial. A large cross-sectional study aimed to explore the relationship in euthyroid population.Material and methods. A total of 1773 euthyroid subjects who underwent health check-up during one-year period were enrolled. NAFLD was diagnosed by ultrasound and fatty liver index (FLI). Fibrosis was estimated by BARD score. Thyroid function parameters, including thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4), were recorded. Multivariate logistic regression analyses were performed to identify the independent risk factors. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.Results. NAFLD was diagnosed by ultrasound in 638 (35.98%) subjects and by FLI ≥ 60 in 694 (39.14%) subjects. Regardless of ultrasound or FLI, the overall analysis demonstrated that TSH and FT3 levels were significantly higher in subjects with NAFLD than subjects without NAFLD, but FT4 level was not significantly different between them. This association remained in middle-age subjects, but not elderly subjects. In the multivariate logistic regression analysis, TSH (OR = 1.108, 95%CI = 1.056-1.398, P = 0.024) and FT3 (OR = 1.258, 95%CI = 1.123-1.409, P = 0.000) levels were independently associated with the risk of NAFLD diagnosed by ultrasound; and only FT3 level (OR = 1.252, 95%CI = 1.074 - 1.460, P = 0.004) was independently associated with the risk of NAFLD estimated by FLI ≥ 60. Additionally, FT3 level (OR = 1.178, 95%CI = 1.025 − 1.354, P = 0.021) was independently associated with the risk of fibrosis estimated by BARD score ≥ 2 in NAFLD subjects.Conclusion. Among the euthyroid population, FT3 and TSH levels were positively associated with the risk of NAFLD.     

Thyroid Hormone Levels in Obese Children and Adolescents with Non-Alcoholic Fatty Liver Disease

Ob­jec­ti­ve: We aimed to determine the association of thyroid functions with the components of metabolic syndrome (MS) and non-alcoholic fatty liver disease (NAFLD) in pediatric obese patients.Methods: The study included 109 obese children (aged 9-15 years) and a control group of 44 healthy age and gender-matched children of normal weight. NAFLD was diagnosed by conventional ultrasound examination. We assessed the anthropometric data and serum biochemical parameters including lipid profile, alanine aminotransferase (ALT), fasting glucose and insulin levels and thyroid stimulating hormone (TSH), free thyroxine (fT4) and free triiodothyronine (fT3) levels. The homeostasis model assessment of insulin resistance (HOMA-IR) was calculated as a measure of IR.Results: The mean age and gender distributions in the groups were similar (p=0.23). The mean body mass index (BMI) z-scores of obese children with grade 2-3 NAFLD were significantly higher than those of the obese children without hepatic steatosis (p<0.001). Mean ALT, triglyceride (TG) and LDL cholesterol increased and HDL-cholesterol significantly decreased as the hepatic steatosis increased (p<0.05). HOMA-IR levels in obese subjects with grade 2-3 NAFLD were significantly higher than those in both obese children without NAFLD and grade 1 NADFL (p=0.05 and 0.001, respectively). In the obese subjects, TSH levels were increased significantly as the degree of steatosis increased (p=0.04) but fT3 and fT4 levels were not different. In correlation analysis, TSH was significantly correlated with ALT, BMI SDS and the degree of steatosis.Conclusions: Obese children demonstrate an increase in TSH levels as the degree of steatosis increased.     

Assessment of Cardiovascular Parameters in Obese Children and Adolescents with Non-Alcoholic Fatty Liver Disease

Objective:The aim of this study was to evaluate the periaortic fat thickness (PAFT) using conventional echocardiography in obese children and adolescents with non-alcoholic fatty liver disease (NAFLD).Methods:Two hundred and ninety-seven obese children and adolescents were included in the study. Anthropometric measurements were made in all subjects, and fasting venous blood samples were taken for determination of glucose, insulin, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Ultrasonography of the liver was used for assessment of NAFLD and the subjects were grouped as NAFLD and non-NAFLD. Echocardiography was performed in all subjects.Results:PAFT was higher in patients with NAFLD compared with the non-NAFLD group. In patients with NAFLD, PAFT was positively correlated with waist circumference and with total cholesterol levels. In multiple regression analysis, waist circumference (β=0.28, p=<0.001) was found to be the best predictor of PAFT.Conclusion:Conventional echocardiography may be used to determine increased PAFT at an early stage in obese children and adolescents with NAFLD for careful monitoring of cardiovascular risk.     

The Effect of Berberis Vulgaris Extract on Transaminase Activities in Non-Alcoholic Fatty Liver Disease

Background:

Non-alcoholic fatty liver disease (NAFLD) is the most prevalent liver disorder in western countries and an important cause of liver cirrhosis, as well as liver failure. Up to now, 20‒40% of the individuals suffer from this disorder and its prevalence is estimated around 5‒30% in Asia. The NAFLD is one of the most prevalent causes for increases in liver enzymes and has a close relationship with obesity, dyslipidemia, hypertension, and type II diabetes. However, no definite treatment has been identified for it yet.

Objectives:

The present study aimed to investigate the effect of berberis vulgaris extract in inducing changes in liver enzymes levels.

Patients and Methods:

The present clinical trial was conducted on 80 patients, including 32 males (40%) and 48 females (60%), who were randomly assigned into two groups of case and control. All the patients had ultrasound evidence of lipid accumulation in the liver and increases in liver enzymes. The case group received two capsules (750 mg) containing berberis vulgaris extract every day for 3 months, while the control group was treated with placebo. The weight, liver transaminases levels and lipid profiles of the two groups were assessed before, during, and after the study.

Results:

In the case group, the mean serum levels of alanine transaminase (ALT) and aspartate transaminase (AST) decreased from 49 to 27.48 and 48.22 to 29.8 u/L, respectively, which was statistically significant compared to the control group (P < 0.001, P < 0.001). In the control group, the mean of ALT and AST decreased from 50.4 to 46.8 and 45.7 to 44.9 u/L, respectively. The difference was not statistically significant. In addition, a significant decrease was observed in weight, triglycerides, and cholesterol, while no significant change was found in fasting blood sugar, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL).

Conclusions:

Considering the significant decrease in the liver enzymes, triglycerides and cholesterol after using berberis vulgaris extract, further studies with larger sample sizes will identify the accurate dose as well as duration of consumption for this extract, to recommend in the treatment of patients with NAFLD.