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Fatty liver changes after gastric cancer surgery
Poster Presentations / Diabetes Research and Clinical Practice 120S1 (2016) S65–S211
and ameliorated insulin resistance and glucose intolerance. Throughout six months both HFHS and HFHS + NAC groups showed a dramatic increase of mitochondrial bioenergetics, measured as oxygen consumption rate by the Seahorse XF24 Extracellular Flux Analyzer. Compared to CD group at six month, HFHS group exhibited a significant increase of mitochondrial biogenesis associated with induced mitochondrial ROS, which was not observed in HFHS + NAC group. In light of this study, we suggest that anti-oxidative NAC reduces obesity and mitigates insulin resistance and glucose intolerance through reducing mitochondrial ROS, oxidative damage and changing mitochondrial bioenergetics of VF. Notably, our study shed light on the therapeutic effect of mitochondrial ROS-repressing anti-oxidant on obesity-prevention and development of diabetes. PI-39 Short leukocyte telomere length is associated with the FTO rs9939609 polymorphism in non-obese individuals Ji Hee YU1, Inkyung BAIK2, Kyoung Jin KIM1, Ji A SEO1, Sin Gon KIM1, Kyung Mook CHOI1, Sei Hyun BAIK1, Dong Seop CHOI1, Chol SHIN3, Nan Hee KIM1 *. 1Division of Endocrinology and Metabolism, Korea University Ansan Hospital, 2 Department of Foods and Nutrition, College of Natural Sciences, Kookmin University, 3Institute of Human Genomic Study, Korea University Ansan Hospital, Korea The fat mass and obesity-associated (FTO) gene polymorphism rs9939609 has been associated with body weight and adiposity in many studies. Obesity contributes to limited life expectancy and short telomere length, a cellular marker for biological age. Our study aimed to evaluate the association between FTO rs9939609 risk variant and leukocyte telomere length, and to investigate if this relationship is modified by the status of obesity. A total of 2,133 participants were recruited from the Korean Genome and Epidemiology Study. Leukocyte telomere length was determined using real-time quantitative polymerase chain reaction methodology. The FTO rs9939609 polymorphism was genotyped using DNA samples collected at baseline. The proportion of the TT, TA, and AA genotypes were shown as 76.7, 21.5, 1.8%, respectively. The mean body mass index (BMI) was significantly higher in carriers with the A-risk allele than in those with TT genotype (25.1 vs. 24.6 kg/m2, P = 0.002). In 1,184 subjects without obesity (BMI < 25 kg/m2), BMI, waist circumference and visceral fat area were higher in those with the FTO risk allele than in non-carriers. In contrast, none of them were associated with FTO risk allele in those with obesity. Leukocyte telomere length was significantly shorter in carriers with the FTO risk allele compared with non-carriers after controlling for age, sex, BMI, smoking, alcohol, exercise, hypertension, diabetes and cardiovascular disease (P < 0.01). In particular, such significant association between the FTO risk allele and telomere length appeared only in non-obese subjects (P = 0.03). In stepwise multivariate linear regression analyses, the independent risk factors affecting shorter leukocyte telomere length were higher age, lower highdensity lipoprotein cholesterol levels and the presence of the FTO risk allele. This finding was evident only in those without obesity. The FTO rs9939609 polymorphism is the independent risk factor not only for obesity but also for biological aging in nonobese population. PI-40 Fatty liver changes after gastric cancer surgery Soyoung OCK1, Shinjun LEE1, Sukyoung KWON1, Youngsik CHOI1, Bukyung KIM1 *. 1Kosin University School of Medicine, Korea Type 2 diabetes mellitus (T2DM) has been dramatically improved after bariatric surgery especially Roux-en-Y gastric
S193
bypass method. Immediate improvement of hepatic insulin sensitivity is suggested one of main mechanism. The procedures of gastric cancer surgeries are very similar with bariatric surgery. However, there is no study about the fatty liver change after gastric cancer surgery. Therefore we evaluated the fatty liver changes after gastrectomy for gastric cancer according to the types of surgery. From a total 374 patients who underwent gastric cancer surgery in Kosin University Gospel Hospital form 1 January to 31 December of 2013, 212 patients had early gastric cancer (EGC). We evaluated hepatic steatosis for only EGC patients using Hounsfield unit (HU) on non contrast computed tomography (CT) imaging. Spleen and liver ratio of HU was calculated at previous to operation, 6 months, 12 months and 24 months. We compared the preoperative results and postoperative results according to the types of surgery: Billroth I (B I), Billroth II (B II) and Roux-en-Y gastric bypass (RYGB). Among the total 212 EGC patients, 62.3% (132) underwent surgery with B I, 21.7% (46) with B II and 16% (34) with RYGB. Initial results of HU of liver, HU of spleen and spleen and liver ratio were not different among the three groups. After surgery, only patients with RYGB had significant changes of spleen and liver ratio at 6 months, 12 months and 24 months compared to the preoperative results (from −6.0 to −9.7, −9.2 and −10.4, p = 0.03). In 26 patients who had higher HU levels of spleen than liver initially, spleen and liver ratio also significantly decreased from 7.6 to −4.7 at 6 mo., −4.3 at 12 mo. and −4.2 at 24 mo. (p < 0.001). In this study we identified that even in normal patients who had high HU of liver than spleen had significant changes of hepatic steatosis after RYGB. The patients initially had fatty liver had also significant decrease of spleen and liver ratio. These results suggested that RYGB could be better choice for patients with gastric cancer and metabolic disease coincidentally. PI-41 Hypoglycemia occurred in one case after liver transplantation and bariatric surgery He-Jiun JIANG1, Wei-Wen HUNG1, Shyi-Jang SHIN1, Pi-Jung HSIAO1 *. 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan Secondary diabetes frequently occurs after liver transplantation under immunosuppression therapy. The accumulated incidence is reported around 50% after immunosuppression therapy, ex., tacrolimus. However, hypoglycemia is an important issue with emergent life-threatening risk more than hyperglycemia. It is so rare that hypoglycemia occurred in cases after successful liver transplantation. Here, we reported a case of severe hypoglycemia occurring one year after liver transplantation and treated by tacrolimus and mycophenolate mofetil. This 42 year-old man is a case with morbid obesity (126 kg, BMI 44.6 kg/m2) and he received the gastric bypass bariatric surgery in December, 2012. Then, he lost his body weight to 81 kg (BMI 28.7 kg/m2) one year later. This patient was also a heavy drinker and chronic hepatitis B complicated with liver cirrhosis and decompensated liver failure. Then, liver transplantation was performed successfully in April, 2015. Immunosuppression therapy was combined with tacrolimus and mycophenolate mofetil thereafter. However, frequent symptomatic hypoglycemia (<50 mg/dL) happened during admission for management of the rejection. The blood glucose was kept in the range of 55–90 mg/dL in fasting state and 60–130 mg/dL postprandially under dextrose infusion. The baseline evaluation revealed A1C 4.6%, ACTH 64.47 pg/mL, cortisol 3.55 μg/dL to exclude out adrenal insufficiency and organ failure. OGTT was performed and blood glucose was 78 mg/dL (baseline), 196 mg/dL (1st hour), dropped to 37 mg/dL (2nd hour) with C-peptide 7.97 ng/mL and insulin:
and ameliorated insulin resistance and glucose intolerance. Throughout six months both HFHS and HFHS + NAC groups showed a dramatic increase of mitochondrial bioenergetics, measured as oxygen consumption rate by the Seahorse XF24 Extracellular Flux Analyzer. Compared to CD group at six month, HFHS group exhibited a significant increase of mitochondrial biogenesis associated with induced mitochondrial ROS, which was not observed in HFHS + NAC group. In light of this study, we suggest that anti-oxidative NAC reduces obesity and mitigates insulin resistance and glucose intolerance through reducing mitochondrial ROS, oxidative damage and changing mitochondrial bioenergetics of VF. Notably, our study shed light on the therapeutic effect of mitochondrial ROS-repressing anti-oxidant on obesity-prevention and development of diabetes. PI-39 Short leukocyte telomere length is associated with the FTO rs9939609 polymorphism in non-obese individuals Ji Hee YU1, Inkyung BAIK2, Kyoung Jin KIM1, Ji A SEO1, Sin Gon KIM1, Kyung Mook CHOI1, Sei Hyun BAIK1, Dong Seop CHOI1, Chol SHIN3, Nan Hee KIM1 *. 1Division of Endocrinology and Metabolism, Korea University Ansan Hospital, 2 Department of Foods and Nutrition, College of Natural Sciences, Kookmin University, 3Institute of Human Genomic Study, Korea University Ansan Hospital, Korea The fat mass and obesity-associated (FTO) gene polymorphism rs9939609 has been associated with body weight and adiposity in many studies. Obesity contributes to limited life expectancy and short telomere length, a cellular marker for biological age. Our study aimed to evaluate the association between FTO rs9939609 risk variant and leukocyte telomere length, and to investigate if this relationship is modified by the status of obesity. A total of 2,133 participants were recruited from the Korean Genome and Epidemiology Study. Leukocyte telomere length was determined using real-time quantitative polymerase chain reaction methodology. The FTO rs9939609 polymorphism was genotyped using DNA samples collected at baseline. The proportion of the TT, TA, and AA genotypes were shown as 76.7, 21.5, 1.8%, respectively. The mean body mass index (BMI) was significantly higher in carriers with the A-risk allele than in those with TT genotype (25.1 vs. 24.6 kg/m2, P = 0.002). In 1,184 subjects without obesity (BMI < 25 kg/m2), BMI, waist circumference and visceral fat area were higher in those with the FTO risk allele than in non-carriers. In contrast, none of them were associated with FTO risk allele in those with obesity. Leukocyte telomere length was significantly shorter in carriers with the FTO risk allele compared with non-carriers after controlling for age, sex, BMI, smoking, alcohol, exercise, hypertension, diabetes and cardiovascular disease (P < 0.01). In particular, such significant association between the FTO risk allele and telomere length appeared only in non-obese subjects (P = 0.03). In stepwise multivariate linear regression analyses, the independent risk factors affecting shorter leukocyte telomere length were higher age, lower highdensity lipoprotein cholesterol levels and the presence of the FTO risk allele. This finding was evident only in those without obesity. The FTO rs9939609 polymorphism is the independent risk factor not only for obesity but also for biological aging in nonobese population. PI-40 Fatty liver changes after gastric cancer surgery Soyoung OCK1, Shinjun LEE1, Sukyoung KWON1, Youngsik CHOI1, Bukyung KIM1 *. 1Kosin University School of Medicine, Korea Type 2 diabetes mellitus (T2DM) has been dramatically improved after bariatric surgery especially Roux-en-Y gastric
S193
bypass method. Immediate improvement of hepatic insulin sensitivity is suggested one of main mechanism. The procedures of gastric cancer surgeries are very similar with bariatric surgery. However, there is no study about the fatty liver change after gastric cancer surgery. Therefore we evaluated the fatty liver changes after gastrectomy for gastric cancer according to the types of surgery. From a total 374 patients who underwent gastric cancer surgery in Kosin University Gospel Hospital form 1 January to 31 December of 2013, 212 patients had early gastric cancer (EGC). We evaluated hepatic steatosis for only EGC patients using Hounsfield unit (HU) on non contrast computed tomography (CT) imaging. Spleen and liver ratio of HU was calculated at previous to operation, 6 months, 12 months and 24 months. We compared the preoperative results and postoperative results according to the types of surgery: Billroth I (B I), Billroth II (B II) and Roux-en-Y gastric bypass (RYGB). Among the total 212 EGC patients, 62.3% (132) underwent surgery with B I, 21.7% (46) with B II and 16% (34) with RYGB. Initial results of HU of liver, HU of spleen and spleen and liver ratio were not different among the three groups. After surgery, only patients with RYGB had significant changes of spleen and liver ratio at 6 months, 12 months and 24 months compared to the preoperative results (from −6.0 to −9.7, −9.2 and −10.4, p = 0.03). In 26 patients who had higher HU levels of spleen than liver initially, spleen and liver ratio also significantly decreased from 7.6 to −4.7 at 6 mo., −4.3 at 12 mo. and −4.2 at 24 mo. (p < 0.001). In this study we identified that even in normal patients who had high HU of liver than spleen had significant changes of hepatic steatosis after RYGB. The patients initially had fatty liver had also significant decrease of spleen and liver ratio. These results suggested that RYGB could be better choice for patients with gastric cancer and metabolic disease coincidentally. PI-41 Hypoglycemia occurred in one case after liver transplantation and bariatric surgery He-Jiun JIANG1, Wei-Wen HUNG1, Shyi-Jang SHIN1, Pi-Jung HSIAO1 *. 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan Secondary diabetes frequently occurs after liver transplantation under immunosuppression therapy. The accumulated incidence is reported around 50% after immunosuppression therapy, ex., tacrolimus. However, hypoglycemia is an important issue with emergent life-threatening risk more than hyperglycemia. It is so rare that hypoglycemia occurred in cases after successful liver transplantation. Here, we reported a case of severe hypoglycemia occurring one year after liver transplantation and treated by tacrolimus and mycophenolate mofetil. This 42 year-old man is a case with morbid obesity (126 kg, BMI 44.6 kg/m2) and he received the gastric bypass bariatric surgery in December, 2012. Then, he lost his body weight to 81 kg (BMI 28.7 kg/m2) one year later. This patient was also a heavy drinker and chronic hepatitis B complicated with liver cirrhosis and decompensated liver failure. Then, liver transplantation was performed successfully in April, 2015. Immunosuppression therapy was combined with tacrolimus and mycophenolate mofetil thereafter. However, frequent symptomatic hypoglycemia (<50 mg/dL) happened during admission for management of the rejection. The blood glucose was kept in the range of 55–90 mg/dL in fasting state and 60–130 mg/dL postprandially under dextrose infusion. The baseline evaluation revealed A1C 4.6%, ACTH 64.47 pg/mL, cortisol 3.55 μg/dL to exclude out adrenal insufficiency and organ failure. OGTT was performed and blood glucose was 78 mg/dL (baseline), 196 mg/dL (1st hour), dropped to 37 mg/dL (2nd hour) with C-peptide 7.97 ng/mL and insulin: