Hypoadiponectinemia and its Association with Liver Fibrosis in Morbidly Obese Patients

Nazal, Leyla; Riquelme, Arnoldo; Solı́s, Nancy; Pizarro, Margarita; Escalona, Alex; Burotto, Mauricio; Méndez, Juan Ignacio; Saint-Jean, Catalina; Concha, M; Giovanni, Stefano Di; Awruch, Diego; Morales, Arturo; Baudrand, René; Carrasco, Gonzalo; Domínguez, María Angélica; Padilla, Oslando; Espinoza, Manuel; Miquel, Juan Francisco; Nervi, Flavio; Arrese, Marco

doi:10.1007/s11695-009-0051-0

Cited by 26 publications

(29 citation statements)

References 52 publications

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“…One approach utilizes the testing of biochemical markers of liver fibrosis: hyaluronic acid [8], [28], adiponectin [11], high-sensitivity CRP [9], type IV collagen [8], serum IL-6 [10], leptin [28], laminin [8], [28], c-peptide [7], and cytokeratin-18 [29], [19]. Using only a single biochemical marker to predict significant fibrosis has been evaluated in a few studies with inadequate diagnostic accuracy [14], [30].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, it has been attempted to establish non-invasive methods for the detection of liver fibrosis. Various biochemical markers reflecting inflammatory activity [7]–[11], activity of apoptosis [12], and oxidative stress [13] have been evaluated. None of these markers has proven sufficient diagnostic accuracy and numbers of cases were rather low [14].…”

Section: Introductionmentioning

confidence: 99%

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NIKEI: A New Inexpensive and Non-Invasive Scoring System to Exclude Advanced Fibrosis in Patients with NAFLD

et al. 2013

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AimsTo develop, validate and compare a non-invasive fibrosis scoring system for non-alcoholic fatty liver disease (NAFLD) derived from routinely obtained clinical and biochemical parameters.Methods267 consecutive patients with biopsy proven fatty liver or non-alcoholic steatohepatitis were randomly assigned to the estimation (2/3) or validation (1/3) group to develop a model for the prediction of advanced fibrosis. Univariate statistics were performed to compare patients with and without advanced fibrosis, and following a multivariate logistic regression analysis a new scoring system was constructed. This non-invasive Koeln-Essen-index (NIKEI) was validated and compared to the FIB-4 index by calculating the area under the receiver operating characteristic curve (AUC). We evaluated a stepwise combination of both scoring systems for the precise prediction of advanced fibrosis. To set in contrast, we additionally tested the diagnostic accuracy of the AST/ALT ratio, BARD score and the NAFLD fibrosis score in our cohort.ResultsAge, AST, AST/ALT ratio, and total bilirubin were identified as significant predictors of advanced fibrosis and used to construct the NIKEI with an AUC of 0.968 [0.937; 0.998] compared to 0.929 [0.869; 0.989] for the FIB-4 index. The absence of advanced fibrosis could be confirmed with excellent accuracy (99–100%). The positive predictive value of the FIB-4 index was higher (100% vs. 60%), however, the false negative rate was also high (33%). With a stepwise combination of both indices 82%–84% of biopsies would have been avoidable without a single misclassification. The AUROC for AST/ALT ratio, the NAFLD fibrosis score, and the BARD score were 0.81 (95% CI, 0.72–0.90), 0.96 (95% CI 0.92–0.99), and 0.67 (95% CI 0.55–0.78), respectively.ConclusionThe NIKEI can reliably exclude advanced fibrosis in subjects with NAFLD. In combination with the FIB-4 index misclassification with inadequate clinical management can be avoided while the need for liver biopsies can be reduced.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

NIKEI: A New Inexpensive and Non-Invasive Scoring System to Exclude Advanced Fibrosis in Patients with NAFLD

et al. 2013

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“…The decrease in the circulating amount of adiponectin correlates with the severity of liver histology in NAFLD patients (9). In a study, plasma adiponectin levels were found to be significantly associated with hepatic insulin sensitivity.…”

Section: Introductionmentioning

confidence: 98%

Relationship between the frequency of hepatitis B virus infections and levels of serum adipokines in patients with hepatosteatosis and insulin resistance

Balkan¹,

Gülşen²,

Balkan³

et al. 2017

Eur J Ther

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Objective:Although the steatogenic effect of hepatitis B virus (HBV) has been established in several studies, it is not yet known whether it leads to hepatosteatosis in anti-HBc IgG-positive patients. This study aimed to investigate the relationship between the frequency of HBV and levels of serum adipokines in patients with hepatosteatosis and insulin resistance. Methods: Eighty patients diagnosed with hepatosteatosis by ultrasonography, who were admitted to our polyclinic between July 2011 and June 2012 for various reasons, and who had insulin resistance were included. Homeostasis model assessment-insulin resistance of >2.7 was considered as insulin resistance, and these patients was investigated for anti-HBc IgG. The anti-HBc IgG level was analyzed by enzyme-linked immunosorbent assay. Levels of adiponectin, resistin, and leptin in serum samples were analyzed in anti-HBc IgG (+) and anti-HBc IgG (−) groups. Results: Anti-HBc IgG was positive in 29 (36.2%) patients and negative in 51 (63.8%). While the level of leptin in the anti-HBc IgG (+) group was 31569.72±14027.64 ng/mL, it was 25410.73±10978.26 ng/mL in the anti-HBc IgG (−) group. The levels of leptin in the anti-HBc IgG (+) and anti-HBc IgG (−) groups were statistically significant (p=0.047). However, levels of adiponectin and resistin were not different between the groups. Conclusion: These results suggest that anti-HBc IgG positivity is involved in the etiology of hepatosteatosis and insulin resistance as well.

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“…To the Editor: We appreciate the interest of Dogru and colleagues in our recent article on the association between adiponectin serum levels and liver fibrosis in morbidly obese patients [1]. In their letter, they raise some important questions on our work that we are delighted to clarify.…”

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confidence: 97%

The Relationship of Plasma Adiponectin with Liver Fibrosis in Morbid Obesity: Author’s Reply

Riquelme

Arrese

2010

OBES SURG

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We appreciate the interest of Dogru and colleagues in our recent article on the association between adiponectin serum levels and liver fibrosis in morbidly obese patients [1]. In their letter, they raise some important questions on our work that we are delighted to clarify. However, before we proceed, a word is in order regarding the main purpose of our study. This was conducted to explore the associations between plasma adiponectin concentrations and liver histology in morbidly obese patients and, for this reason, the main analysis related to patients with and without liver fibrosis within the group of obese subjects. It is important to note that the presence of fibrosis rather than inflammation is likely the major determinant of prognosis in nonalcoholic fatty liver disease (NAFLD) as shown in a recent publication [2] and that to non-invasively detect this feature is therefore clinically relevant. We included a control group in order to underscore the metabolic phenotype of morbid obese patients characterized by higher proportions of hypertension and type 2 diabetes mellitus as well as hyperleptinemia and hypodiponectinemia. Control subjects were selected from a population included in a previous epidemiological survey assessing the prevalence and natural history of cholelithiasis and NAFLD in Santiago, Chile [3,4]. For the purposes of the present study, controls were matched by sex and age and required to have a body mass index ≤25, serum alanine aminotransferase (ALT)≤ 30 IU/L in men and ALT≤19 IU/L in women, and an abdominal ultrasound without fatty liver. Based on their metabolic profile, these patients represent the opposite side of the metabolic syndrome spectrum. Therefore, nobody among them met the metabolic syndrome (MS) criteria and neither had an evidence of insulin resistance based on a HOMA-IR value >2.6 which is indicative of insulin resistance in non-diabetic subjects in a Chilean population according to Acosta et al. [5].In our study population, we did not perform glucose tolerance tests. Our patients were classified as diabetic or not from fasting glucose values as recommended. We agree that we cannot totally exclude impaired glucose-tolerant subjects in our study, but the presence of any impaired glucose-tolerant subjects in either of the two groups compared (obese patients with or without fibrosis) would have not changed the final results. Lower adiponectin serum levels were significantly associated with the presence of liver fibrosis and all the other variables highlighted by Dogru and colleagues such as body mass index, high density lipoprotein cholesterol and triglyceride levels, and also the proportions of subjects with hypertension and diabetes mellitus, although known to affect circulating adiponectin concentrations in other studies [6], did not show association with fibrosis in our study. In this regard, we are certain that multivariate analysis is the best way to assess a relationship between adipokines and hepatic fibrosis, in the setting of NAFLD, adjusted for major metabolic confoun...

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Hypoadiponectinemia and its Association with Liver Fibrosis in Morbidly Obese Patients

Abstract: NAFLD patients have lower plasma adiponectin concentrations than control subjects. Low adiponectin levels are associated with more severe liver histology. Serum adiponectin may be useful to estimate the severity of liver damage in obese patients with NAFLD.

Cited by 26 publications

References 52 publications

NIKEI: A New Inexpensive and Non-Invasive Scoring System to Exclude Advanced Fibrosis in Patients with NAFLD

NIKEI: A New Inexpensive and Non-Invasive Scoring System to Exclude Advanced Fibrosis in Patients with NAFLD

Relationship between the frequency of hepatitis B virus infections and levels of serum adipokines in patients with hepatosteatosis and insulin resistance

The Relationship of Plasma Adiponectin with Liver Fibrosis in Morbid Obesity: Author’s Reply

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