Horm Metab Res 2020; 52(04): 236-245
DOI: 10.1055/a-1116-2333
Endocrine Care
© Georg Thieme Verlag KG Stuttgart · New York

Association of Apolipoprotein C3 Levels and Hepatic Steatosis: A Follow-Up Study

Patrick Heinz
1  Department of Internal Medicine I, University Hospital Ulm, Ulm, Germany
Bernhard Otto Boehm
2  Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
3  Imperial College London, London, United Kingdom
Julian Schmidberger
1  Department of Internal Medicine I, University Hospital Ulm, Ulm, Germany
Wolfgang Kratzer
1  Department of Internal Medicine I, University Hospital Ulm, Ulm, Germany
for the EMIL-Study Group› Author Affiliations
Funding Information Grants were received from the Baden-Württemberg State Health Office, the Stuttgart District Government, and the Ravensburg Regional Health Office. Further financial support was provided by the town council of Leutkirch, Germany. This work was supported by grants from the Deutsche Forschungsgemeinschaft (DFG; GrK1041), Baden-Wuerttemberg, Germany and B Boehm’s Ong Tiong Tat Chair Professorship of Diabetes Research. This study was initiated by the government of the Federal State of Baden-Württemberg, Germany.
Further Information

Publication History

received 14 November 2019

accepted 30 January 2020

Publication Date:
28 February 2020 (online)


Apolipoprotein C3 is a lipid-binding protein with a pivotal role in triglyceride metabolism and inflammation. This 11-year follow-up study aimed to evaluate apolipoprotein C3 levels and other parameters as markers of hepatic steatosis, in a random, population-based cohort in southern Germany. In 2013, we selected and re-examined 406 study participants (193 women, 213 men; average age 58.1±11.3 years) from the original “Echinococcus multilocularis and other internal diseases in Leutkirch I“ (EMIL I) cohort studied in 2002. All participants received upper abdominal sonography to grade potential hepatic steatosis, and blood tests to determine apolipoprotein C3 levels and other laboratory parameters. Body mass index, waist-to-hip ratio, and anthropometric measures were documented. The follow-up study conducted in 2013 included a partial correlation analysis. We found an association between hepatic steatosis and elevated apolipoprotein C3 levels (p<0.0001). Study participants with a novel diagnosis of hepatic steatosis had the highest apolipoprotein C3 serum levels (p=0.0002). Hepatic steatosis was associated with low levels of high density lipoprotein cholesterol (p=0.0374), high levels of total cholesterol (p=0.0117), increased homeostasis model assessment of insulin resistance (p=0.0002), elevated alanine transaminase (p<0.0001), elevated aspartate transaminase (p=0.0003), and elevated C-reactive protein (p=0.0446). Apolipoprotein C3 serum levels were associated with the presence, disease grade, and new development of hepatic steatosis likewise to biomarkers of the metabolic syndrome.

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