- Email: [email protected]
Non-Alcoholic Fatty Liver Disease is Associated with an Excessive Calorie intake Rather than a Distinctive Dietary Pattern
POSTER PRESENTATIONS FRI-314 SPLEEN DIMENSIONS EVALUATED BY ULTRASOUND ARE INVERSELY ASSOCIATED WITH LYSOSOMAL ACID LIPASE ACTIVITY IN PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE L. Polimeni1, F. Baratta1, D. Pastori1, G. Tozzi2, G. Labbadia1, F. Violi1, M. Del Ben1, F. Angelico1. 1Sapienza University of Rome; 2Children’s Hospital and Research Institute “Bambino Gesù”, Rome, Italy E-mail: [email protected] Background and Aims: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease. Lysosomal Acid Lipase (LAL) is a key enzyme in lipid metabolism and a reduction of its activity may contribute to intracellular lipid accumulation in adult NAFLD. Splenomegaly is a typical feature of both Wolman Syndrome and Cholesterol Ester Storage Disease, the two genetic forms of LAL deficiency. A less severe reduction of LAL activity has been suggested as an under-recognized cause of NAFLD. Ultrasonography (US) determination of spleen dimensions is accurate. The aim of this study was to determine if spleen biometry evaluated by US is associated with LAL activity in a population of NAFLD patients. Methods: The study has been performed in 252 consecutive patients with a liver US positive for NAFLD. Spleen longitudinal diameter and area were measured during US. Splenomegaly was defined as a spleen area >45 cm2 and/or longitudinal diameter >12 cm. LAL activity was measured with dried blood spot method (Lalistat2, nmol/spot/h). Results: Mean age was 55.1 ± 10.8 years and 38.1% of patients were women. US showed splenomegaly in 33 patients (13,1%). From the lower to the highest quartile of spleen area a significant decrease of LAL activity (0.95 vs 0.87 vs 0.77 vs 0.78 nmol/spot/h; p < 0.05), age (57.9 vs 56.2 vs 55.9 vs 55.1 years; p = 0.001) and prevalence of statin users (42.9 vs 41.4 vs 25.9 vs 19.6%; p < 0.05) were found; on the contrary, BMI (28.3 vs 30.2 vs 31.2 vs 31.3 kg/ m2; p < 0.01) and waist circumference (103.0 vs 105.0 vs 109.0 vs 107.0 cm; p < 0.01) significantly increased. LAL activity was significantly reduced in subjects with splenomegaly than in those with normal spleen (0.71 vs 0.88 nmol/spot/h; p < 0.05). Linear bivariate regression analysis showed an inverse correlation between LAL activity and spleen diameter (r = −0.16; p = 0.01) and between LAL activity and spleen area (r = −0.21; p = 0.002). Multivariable linear regression analysis showed that age ( p = 0.002) and LAL activity ( p = 0.01) were inversely associated with spleen area. In the same model, BMI was directly associated to spleen area ( p = 0.003). Conclusions: Our data show an inverse correlation between spleen dimensions evaluated by US and LAL activity in a population of NAFLD patients. LAL activity is significantly reduced in patients with splenomegaly than in those without. Our findings suggest that spleen enlargement may be a feature of NAFLD patients with reduced LAL activity. FRI-315 NON-ALCOHOLIC FATTY LIVER DISEASE IS ASSOCIATED WITH AN EXCESSIVE CALORIE INTAKE RATHER THAN A DISTINCTIVE DIETARY PATTERN M.H. Wehmeyer1, B. Jagemann1, B.-C. Zyriax2, E. Windler2, A.W. Lohse1, J.S. zur Wiesch1, J. Kluwe1. 1I. Department of Medicine, University Medical Center Hamburg-Eppendorf; 2Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany E-mail: [email protected] Background and Aims: Varying and partly contradictory dietary patterns were identified as being associated with non-alcoholic fatty liver disease (NAFLD) by different authors. Our study aimed to assess the dietary patterns associated with NAFLD and the efficacy of dietary interventions in a “real-life” setting in a German tertiary medical center.
Methods: Clinical and laboratory data, as well as data obtained by a semi-quantitative food frequency questionnaire (FFQ) of NAFLD patients were compared to an age and gender-matched cohort of healthy controls. The macronutritional components of the diet were normalized for the daily energy intake ( per 1000 kcal). All NAFLD patients received an in-depth dietary counselling and the efficacy of the dietary intervention was assessed in a subgroup of the NAFLD patients six months later. Results: In total, 55 NAFLD patients (37 males, 18 females, mean age 45.2 years) and 88 healthy controls (59 males, 29 females, mean age 45.9 years) were included in the study. NAFLD patients consumed more calories per day as compared to the controls (median 2739 kcal/ day, range 1009–5941 vs. 2173 kcal/day, 1199–4320; p < 0.001). The absolute amounts of most nutritional components ingested by NAFLD patients were higher than those in the controls. However, there were no significant differences with regard to the relative consumption of carbohydrates/1000 kcal (median 104.1 g vs. 102.7 g; p = 0.359), fat/1000 kcal (median 43.3 g vs. 45.0 g; p = 0.416) and fructose/1000 kcal (10.5 g vs. 10.3 g; p = 0.353). NAFLD patients had a higher intake of glucose/1000 kcal (median 8.8 g vs. 7.7 g; p = 0.041) and protein/1000 kcal (median 36.1 g vs. 34.8 g; p = 0.009) but a lower intake of fibres/1000 kcal (median 8.6 g vs. 10.4 g; p < 0.001) and mineral nutrients/1000 kcal (median 7.3 g vs. 7.7 g; p = 0.001) as compared to the controls. 24 NAFLD patients completed a second FFQ 6 months after the dietary counselling. The mean weight reduction was 3.4% of the baseline weight and the median calorie consumption/ day was significantly lower as compared to baseline (2756 kcal vs. 2074 kcal; p < 0.001). The ALT levels improved at the follow-up visit, too (median 75 U/l vs. 45.5 U/l; p < 0.001). Detailed clinical, demographical and nutritional data will be available at the meeting. Conclusions: Our data from a German “real-life” cohort suggest reduction of energy intake rather than changes of dietary composition as the therapeutic priority in dietary counselling of NAFLD patients. FRI-316 THE COMMON PROSTEATOTIC PNPLA3 (ADIPONUTRIN) P.I148M VARIANT MIGHT PROTECT AGAINST GALLSTONE DISEASE M. Krawczyk1,2, R. Jiménez-Agüero3, M.J. Perugorria4, L. Gallego3, L. Bujanda3, F. Lammert1, J.M. Banales3. 1Department of Medicine II, Saarland University Medical Center, Homburg, Germany; 2Laboratory of Metabolic Liver Diseases, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland; 3Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute – Donostia University Hospital (HUD), University of the Basque Country (UPV/EHU), CIBERehd, Ikerbasque, San Sebastian, Spain; 4 Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute – Donostia University Hospital (HUD), University of the Basque Country (UPV/EHU), CIBERehd, Ikerbasque, San Sebastian, Germany E-mail: [email protected] Background and Aims: Gallstone disease (GD) is believed to be more frequent in patients with fatty liver (NAFL). Indeed, GD and NAFL share the same environmental risk factors like metabolic syndrome, obesity and diabetes mellitus. The risk of NAFL is further increased in carriers of the PNPLA3 variant p.I148M. Here, we investigate the potential association between PNPLA3 p.I148M polymorphism and development of GD. Moreover, the association between this polymorphism and GD was evaluated in obese patients after bariatric surgery (BS). Methods: We prospectively recruited a cohort of 115 individuals (39 males, BMI range 26–64 kg/m2) and 106 were obese (i.e. BMI > 35 kg/ m2) scheduled for BS. Fat contents were quantified using biochemical determination of hepatic triglyceride contents (Folch) and a MRIbased equation [Jiménez-Agüero, BMC Med 2014;12:137]. At the inclusion we collected data on the prevalence of gallstones and cholecystectomies (CHE). One year after BS we measured the hepatic
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Methods: Clinical and laboratory data, as well as data obtained by a semi-quantitative food frequency questionnaire (FFQ) of NAFLD patients were compared to an age and gender-matched cohort of healthy controls. The macronutritional components of the diet were normalized for the daily energy intake ( per 1000 kcal). All NAFLD patients received an in-depth dietary counselling and the efficacy of the dietary intervention was assessed in a subgroup of the NAFLD patients six months later. Results: In total, 55 NAFLD patients (37 males, 18 females, mean age 45.2 years) and 88 healthy controls (59 males, 29 females, mean age 45.9 years) were included in the study. NAFLD patients consumed more calories per day as compared to the controls (median 2739 kcal/ day, range 1009–5941 vs. 2173 kcal/day, 1199–4320; p < 0.001). The absolute amounts of most nutritional components ingested by NAFLD patients were higher than those in the controls. However, there were no significant differences with regard to the relative consumption of carbohydrates/1000 kcal (median 104.1 g vs. 102.7 g; p = 0.359), fat/1000 kcal (median 43.3 g vs. 45.0 g; p = 0.416) and fructose/1000 kcal (10.5 g vs. 10.3 g; p = 0.353). NAFLD patients had a higher intake of glucose/1000 kcal (median 8.8 g vs. 7.7 g; p = 0.041) and protein/1000 kcal (median 36.1 g vs. 34.8 g; p = 0.009) but a lower intake of fibres/1000 kcal (median 8.6 g vs. 10.4 g; p < 0.001) and mineral nutrients/1000 kcal (median 7.3 g vs. 7.7 g; p = 0.001) as compared to the controls. 24 NAFLD patients completed a second FFQ 6 months after the dietary counselling. The mean weight reduction was 3.4% of the baseline weight and the median calorie consumption/ day was significantly lower as compared to baseline (2756 kcal vs. 2074 kcal; p < 0.001). The ALT levels improved at the follow-up visit, too (median 75 U/l vs. 45.5 U/l; p < 0.001). Detailed clinical, demographical and nutritional data will be available at the meeting. Conclusions: Our data from a German “real-life” cohort suggest reduction of energy intake rather than changes of dietary composition as the therapeutic priority in dietary counselling of NAFLD patients. FRI-316 THE COMMON PROSTEATOTIC PNPLA3 (ADIPONUTRIN) P.I148M VARIANT MIGHT PROTECT AGAINST GALLSTONE DISEASE M. Krawczyk1,2, R. Jiménez-Agüero3, M.J. Perugorria4, L. Gallego3, L. Bujanda3, F. Lammert1, J.M. Banales3. 1Department of Medicine II, Saarland University Medical Center, Homburg, Germany; 2Laboratory of Metabolic Liver Diseases, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland; 3Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute – Donostia University Hospital (HUD), University of the Basque Country (UPV/EHU), CIBERehd, Ikerbasque, San Sebastian, Spain; 4 Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute – Donostia University Hospital (HUD), University of the Basque Country (UPV/EHU), CIBERehd, Ikerbasque, San Sebastian, Germany E-mail: [email protected] Background and Aims: Gallstone disease (GD) is believed to be more frequent in patients with fatty liver (NAFL). Indeed, GD and NAFL share the same environmental risk factors like metabolic syndrome, obesity and diabetes mellitus. The risk of NAFL is further increased in carriers of the PNPLA3 variant p.I148M. Here, we investigate the potential association between PNPLA3 p.I148M polymorphism and development of GD. Moreover, the association between this polymorphism and GD was evaluated in obese patients after bariatric surgery (BS). Methods: We prospectively recruited a cohort of 115 individuals (39 males, BMI range 26–64 kg/m2) and 106 were obese (i.e. BMI > 35 kg/ m2) scheduled for BS. Fat contents were quantified using biochemical determination of hepatic triglyceride contents (Folch) and a MRIbased equation [Jiménez-Agüero, BMC Med 2014;12:137]. At the inclusion we collected data on the prevalence of gallstones and cholecystectomies (CHE). One year after BS we measured the hepatic
Journal of Hepatology 2016 vol. 64 | S425–S630
S489