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Relationship between Oxidative Stress, Inflammation and Dyslipidemia with Fatty Liver Index in Patients with Type 2 Diabetes Mellitus
received 02 June 2017
revised 18 July 2017
accepted 21 August 2017
11 September 2017 (online)
Introduction/Aim Considering the high prevalence of non-alcoholic fatty liver disease (NAFLD) in individuals with type 2 diabetes mellitus (DM2), we aimed to investigate the potential benefit of determining markers of oxidative stress, inflammation and dyslipidemia for prediction of NAFLD, as estimated with fatty liver index (FLI) in individuals with DM2.
Methods A total of 139 individuals with DM2 (of them 49.9% females) were enrolled in cross-sectional study. Anthropometric and biochemical parameters, as well as blood pressure were obtained. A FLI was calculated.
Results Multivariate logistic regression analysis showed that high density lipoprotein cholesterol (HDL-c) and malondialdehyde (MDA) were independent predictors of higher FLI [Odds ratio (OR)=0.056, p=0.029; and OR=1.105, p=0.016, respectively]. In Receiver Operating Characteristic curve analysis, the addition of fatty liver risk factors (e. g., age, gender, body height, smoking status, diabetes duration and drugs metabolized in liver) to each analysed biochemical parameter [HDL-c, non-HDL-c, high sensitivity C-reactive protein (hsCRP), MDA and advanced oxidant protein products (AOPP)] in Model 1, increased the ability to discriminate patients with and without fatty liver [Area under the curve (AUC)=0.832, AUC=0.808, AUC=0.798, AUC=0.824 and AUC=0.743, respectively]. Model 2 (which included all five examined predictors, e. g., HDL-c, non-HDL-c, hsCRP, MDA, AOPP, and fatty liver risk factors) improved discriminative abilities for fatty liver status (AUC=0.909). Even more, Model 2 had the highest sensitivity and specificity (89.3% and 87.5%, respectively) together than each predictor in Model 1.
Conclusion Multimarker approach, including biomarkers of oxidative stress, dyslipidemia and inflammation, could be of benefit in identifying patients with diabetes being at high risk of fatty liver disease.
- 1 Amirkalali B, Sohrabi MR, Esrafily A. et al. Association between Nicotinamide Phosphoribosyltransferase and de novo Lipogenesis in Nonalcoholic Fatty Liver Disease. Med Princ Pract 2017; 26: 251-257
- 2 Klisic A, Kavaric N, Jovanovic M. et al. Bioavailable testosterone is independently associated with fatty liver index in postmenopausal women. Arch Med Sci 2017; 13: 1188-1196
- 3 Macut D, Tziomalos K, Božić-Antić I. et al. Non-alcoholic fatty liver disease is associated with insulin resistance and lipid accumulation productin women with polycystic ovary syndrome. Hum Reprod 2016; 31: 1347-1353
- 4 Hazlehurst JM, Woods C, Marjot T. et al. Non-alcoholic fatty liver disease and diabetes. Metabolism 2016; 65: 1096-1108
- 5 Giorda C, Forlani G, Manti R. et al. Occurrence over time and regression of nonalcholic fatty liver disease in type 2 diabetes. Diabetes Metab Res Rev 2017; e2878
- 6 Targher G, Bertolini L, Chonchol M. et al. Nonalcoholic fatty liver disease is independently associated with an increased prevalence of chronic kidney disease and retinopathy in type 1 diabetic patients. Diabetologia 2010; 53: 1341-1348
- 7 Targher G, Bertolini L, Rodella S. et al. Nonalcoholic fatty liver disease is independently associated with an increased incidence of cardiovascular events in type 2 diabetic patients. Diabetes Care 2007; 30: 2119-2121
- 8 Zoppini G, Fedeli U, Gennaro N. et al. Mortality from chronic liver diseases in diabetes. Am J Gastroenterol 2014; 109: 1020-1025
- 9 Reyes-Gordillo K, Shah R, Muriel P. Oxidative stress and inflammation in hepatic diseases: Current and future therapy. Oxid Med Cell Longev 2017; 2017: 3140673
- 10 de Andrade KQ, Moura FA, dos Santos JM. et al Oxidative stress and inflammation in hepatic diseases: Therapeutic possibilities of n-acetylcysteine. Int J Mol Sci 2015; 16: 30269-30308
- 11 Gaggini M, Morelli M, Buzzigoli E. et al. Non-alcoholic fatty liver disease (NAFLD) and its connection with insulin resistance, dyslipidemia, atherosclerosis and coronary heart disease. Nutrients 2013; 5: 1544-1560
- 12 Papaetis GS, Papakyriakou P, Panagiotou TN. Central obesity, type 2 diabetes and insulin: Exploring a pathway full of thorns. Arch Med Sci 2015; 11: 463-482
- 13 Klisic AN, Vasiljevic ND, Simic TP. et al. Association between C-reactive protein, anthropometric and lipid parameters among healthy normal weight and overweight postmenopausal women in Montenegro. Lab Med 2014; 45: 12-16
- 14 Klisic A, Kotur-Stevuljevic J, Kavaric N. et al. The association between follicle stimulating hormone and glutathione peroxidase activity is dependent on abdominal obesity in postmenopausal women. Eat Weight Disord – St 2016; DOI: 10.1007/s40519-016-0325-1.
- 15 Klisic A, Kavaric N, Soldatovic I. et al. Relationship between cardiovascular risk score and traditional and nontraditional cardiometabolic parameters in obese adolescent girls. J Med Biochem 2016; 35: 282-292
- 16 Ipsen DH, Tveden-Nyborg P, Lykkesfeldt L. Does vitamin c deficiency promote fatty liver disease development?. Nutrients 2014; 6: 5473-5499
- 17 Savini I, Catani MV, Evangelista D. et al. Obesity-associated oxidative stress: strategies finalized to improve redox state. Int J Mol Sci 2013; 14 (05) 10497-10538
- 18 Li S, Tan HY, Wang N. et al. The role of oxidative stress and antioxidants in liver diseases. Int J Mol Sci 2015; 16: 26087-26124
- 19 Kavaric N, Klisic A, Ninic A. Are visceral adiposity index and lipid accumulation product reliable indices for metabolic disturbances in patients with type 2 diabetes mellitus?. J Clin Lab Anal 2017; DOI: 10.1002/jcla.22283.
- 20 Bedogni G, Bellentani S, Miglioli L. et al. The Fatty Liver Index: a simple and accurate predictor of hepatic steatosis in the general population. BMC Gastroenterol 2006; 6: 33
- 21 Zelber-Sagi S, Webb M, Assy N. et al. Comparison of fatty liver index with noninvasive methods for steatosis detection and quantification. World J Gastroenterol 2013; 19: 57-64
- 22 Tasić D, Radenkovic S, Stojanovic D. et al. Crosstalk of various biomarkers that might provide prompt identification of acute or chronic cardiorenal syndromes. Cardiorenal Med 2016; 6: 99-107
- 23 Kocić R, Pavlović D, Kocić G. Impact of intensive insulin treatment on the development and consequences of oxidative stress in insulin dependent diabetes mellitus. Vojnosanit Pregl 2007; 64: 623-628
- 24 Cichoż-Lach H, Michalak A. Oxidative stress as a crucial factor in liver diseases. World J Gastroenterol 2014; 20: 8082-8091
- 25 Tiwari BK, Pandey KB, Abidi AB et al. Markers of oxidative stress during diabetes mellitus. J Biomark 2013; 2013: 378790.
- 26 Stefan N, Häring HU, Hu FB. et al. Divergent associations of height with cardiometabolic disease and cancer: Epidemiology, pathophysiology, and global implications. Lancet Diabetes Endocrinol 2016; 4: 457-467
- 27 Lee SM, Cho YH, Lee SY. et al. Urinary Malondialdehyde Is Associated with Visceral Abdominal Obesity in Middle-Aged Men. Mediators Inflamm 2015; 2015; 524291
- 28 Kumar A, Sharma A, Duseja A. et al. Patients with nonalcoholic fatty liver disease (NAFLD) have higher oxidative stress in comparison to chronic viral hepatitis. J Clin Exp Hepatol 2013; 3: 12-18
- 29 Samy W, Hassanian MA. Paraoxonase-1 activity, malondialdehyde and glutathione peroxidase in non-alcoholic fatty liver disease and the effect of atorvastatin. Arab J Gastroenterol 2011; 12: 80-85
- 30 Köroğlu E, Canbakan B, Atay K. et al. Role of oxidative stress and insulin resistance in disease severity of non-alcoholic fatty liver disease. Turk J Gastroenterol 2016; 27: 361-366
- 31 Kantartzis K, Rettig I, Staiger H. et al. An extended fatty liver index to predict non-alcoholic fatty liver disease. Diabetes Metab 2017; 43: 229-239