Diagnostic accuracy of acyl-ghrelin and it association with non-alcoholic fatty liver disease in type 2 diabetic patients

Abstract

BackgroundGhrelin is a hormone produced mainly by the cells lining the fundus of the stomach, which is involved in regulation of lipid and glucose metabolism. Two major forms of ghrelin can be found in circulation: an acylated form, and non-acylated form. Serum acyl-ghrelin (AG) concentration is significantly increased in patients with visceral obesity and insulin resistance. This study was conducted to evaluate changes in serum AG levels, its diagnostic accuracy and association with NAFLD in patients with type two diabetes (T2D).MethodsIn this cross-sectional study, 91 T2D patients, age of 40–80 years, were included. All patients were divided into 3 groups. The control group included 28 T2D patients without NAFLD. The main group included 63 T2D patients with NAFLD, which was divided in 2 subgroups depending on transaminase levels: normal (n = 37) and elevated (n = 26) transaminases group. To assess the diagnostic accuracy of AG for NAFLD we used ROC-analysis.ResultsWe observed 1.5 (p = 0.016) and 2.5 (p < 0.001) fold increasing of serum AG levels in patients with NAFLD and normal or elevated transaminases compared to control groups. In multivariate logistic regression analysis high AG level was an independent, from transaminases activity, triglycerides (OR 1.791; 95 % CI 1.162–2.759; p = 0.008) and degree of IR (OR 1.599; 95 % CI 1.019–2.508; p = 0.044) predictor that associated with NAFLD. When serum AG used as non-invasive marker for NAFLD detection AUROC was 0.835 (95 % CI 0.752–0.918, p < 0.001). The cut-off value was >0.52 ng/ml, with sensitivity, specificity, PPV and NPV – 60.3 %, 92.8 %, 95.0 %, 50.9 % respectively. For distinguishing patients with NAFLD and elevated transaminases from patients with NAFLD and normal values AG was less effective.ConclusionsOur study has demonstrated that elevated AG level were associated with NAFLD. Patients with elevated transaminases had significantly higher AG levels. An increase of AG over 0.52 ng/ml can be used as a diagnostic marker for NAFLD detection in patients with T2D.

A Multi-strain Probiotic Reduces the Fatty Liver Index, Cytokines and Aminotransferase levels in NAFLD Patients: Evidence from a Randomized Clinical Trial

“…Adult participants (aged 18-65, BMI ≥25 kg/m 2 ) diagnosed with NAFLD according to the recommendations of the American Gastroenterology Association (AGA) and the American Association for the Study of Liver Disease (AASLD) on the basis of clinical examination, laboratory values of lipid and carbohydrate metabolism, liver enzyme activities (alanine aminotransferase -ALT, aspartate aminotransferase -AST), ALT/AST ratio, and ultrasound (US) examination [5,22] were in included in the study. The diagnosis of fatty liver was based on the results of abdominal ultrasonography, which was performed by trained technicians with Ultima PA (Radmir Co., Kharkiv, Ukraine).…”

“…Of 4 known US criteria for NAFLD (hepato-renal echo contrast, liver brightness, deep J Gastrointestin Liver Dis, March 2018 Vol. 27 No 1: 41-49 attenuation, and vascular blurring), the diagnosis of NAFLD in our patients was formulated if hepato-renal contrast and liver brightness were detected [5]. Individuals with T2D treated with diet and exercise alone or metformin, SUs and insulin were included, as well as individuals with AST and ALT ≤3x upper limit of normal.…”

“…NAFLD ranges from simple steatosis to non-alcoholic steatohepatitis (NASH) that can have different degrees of fibrosis and progress to liver cirrhosis and hepatocellular carcinoma [2]. The high prevalence of obesity and type 2 diabetes (T2D) and the improved management of chronic viral hepatitis has resulted in NAFLD becoming a leading cause of chronic liver disease [3] and a major health concern responsible for hepatic and extrahepatic morbidity/ mortality [4,5].…”

Pathophysiology of Non Alcoholic Fatty Liver Disease

“…Whether ghrelin levels are altered in NAFLD is still controversial, as Marchesini et al [151] reported low total ghrelin levels, while Mykhalchyshyn et al [152] found high serum levels of AG in NAFLD compared to controls. However, the above-mentioned effects of ghrelin on energy and lipid metabolism, IR, inflammation and apoptotic cell death, which are common to both obesity and NAFLD, highly suggest its interplay with NAFLD/NASH pathogenesis [137].…”

Acylated and desacyl ghrelin are associated with hepatic lipogenesis, β-oxidation and autophagy: role in NAFLD amelioration after sleeve gastrectomy in obese rats

“…In addition, opposite effects of ghrelin isoforms on hepatic glucose metabolism have been reported with desacyl ghrelin suppressing glucose release by hepatocytes as well as antagonizing the acylated ghrelin-induced increase in hepatic glucose output in vitro 23. NAFLD is associated with alterations in total ghrelin concentrations2425, but the specific role of acylated and desacyl in hepatic lipid metabolism has not been disentangled.…”