Different Programs Nonalcoholic Fatty Liver Treatment Of Glucose Metabolism Abnormalities And Serum Fgf21 Changes

Partâ… Pioglitazone Versus Berberine for the Treatment of Non-Alcoholic Fatty Liver Disease Patients with Impaired Glucose Regulation or Type 2 Diabetes Mellitus- a randomized, open, controlled clinical trial.AIMSTo assess the effect and safety of Pioglitazone(PGZ) or Berberine(BBR) on treatment to Non-Alcoholic Fatty Liver Disease(NAFLD) patients with impaired glucose regulation(IGR) or Diabetes(DM).METHODSWe randomized 173 adults with NAFLD and with IGR or DM into 3 groups:Group A received lifestyle intervention(LI)without drugs(n=59); Group B received LI and PGZ (15 mg qd.) (n=56); Group C received LI and BBR(0.5g tid)(n=58); All of them were treated for 16 weeks. The primary outcome was an improvement in glucose(OGTT), HbAlc, lipid profile(TC, TG, HDL-c, LDL-c), liver enzymes (ALT, AST, GGT). The secondary outcome was a reduction in hepatic fat content(HFC) detected by proton magnetic resonance spectroscopy (1H MRS).RESULTS:1. There were no significant differences of baseline data in three group, including gender, age, BMI, waist circumference, WHR, blood Pressure;etc.2. Compared with pre-treatment, subjects after treatment have significant improvement in 2h glucose, HbAlc, liver enzyme, HFC, weight, waist, WHR, diastolic blood pressure(of the three group), in fasting glucose, systolic blood pressure of group B and C, in lipid profiles of group C(all paired t-test P<0.05).3. Although Group B(-15%)and Group C(-17%)have more obvious reduction in HFC than Group A(-11%), the differences of HFC after treatment are not significant among the three groups when baseline HFC, sex, BMI were adjusted(P=0.098). Other data changes such as fasting glucose, HbAlc, HDL-c, LDL-c, AST, GGT,WHR are similar (all ANOVA P>0.05).4. BBR therapy, as compared with LI, was associated with a significantly higher reduction in blood glucose, TC, TG, weight, waist, systolic and diastolic blood pressure(all P<0.05).5. Compared with PGZ, BBR therapy has a significantly higher reduction in TC,TG,, weight, waist, diastolic blood pressure(all P<0.05)while PGZ has a significantly higher reduction in ALT.6. PGZ therapy has a significantly higher reduction than LI in blood glucose, ALT, systolic blood pressure(all P<0.05).7.The major side effects related to the two drugs were different. Subjects who received PGZ felt muscular soreness(21.05%); palpitations(10.53%), fatigue(10.53%), subjects who received BBR appeared digestive symptoms such as anorexia(37.50%), diarrhea(21.88%), severe constipation(12.50%) etc. No severe adverse events were found about the two drugs.CONCLUSIONSFor NAFLD patients with IGR or DM, LI with or without PGZ or BBR are effective and safe methods to improve glucose and lipid and other metabolism, to lower HFC; BBR Showed stronger role for the treatment of serum glucose and lipid, weight, blood pressure. Partâ…¡Circulating Fibroblast Growth Factor 21 Levels and Hepatic Fat ContentBackground & Aims:Fibroblasts growth factor 21 (FGF21), a liver-secreted endocrine factor involved in regulating glucose and lipid metabolism, has been shown to be elevated in Patients with non-alcoholic fatty liver disease (NAFLD). This study aimed to evaluate the quantitative correlation between serum FGF21 level and hepatic fat content.Methods:Totally 138 subjects (72 male and 66 female) aged from 18 to 65 years with abnormal glucose metabolism and B-ultrasonograPhy diagnosed fatty liver were enrolled in the study. Serum FGF21 levels were determined by an in-house chemiluminescence immunoassay and hepatic fat contents were measured by proton magnetic resonance spectroscopy.Results:Serum FGF21 increased progressively with the increase of untreated hepatic fat content, but when hepatic fat content increased to the fourth quartile, FGF21 tended to decline. Serum FGF21 concentrations were positively correlated with untreated hepatic fat content especially in subjects with mild/moderate hepatic steatosis (r=0.276, P=0.009).Within the range of hepatic steatosis from the first to third quartile, FGF21 was superior to any other traditional clinical markers including ALT to reflect untreated hepatic fat content. When the patients with severe hepatic steatosis (the fourth quartile) were included, the quantitative correlation between FGF21 and untreated hepatic fat content was weakened. Unexpectedly, serum FGF21 increased while hepatic fat content decreased after treatment of lifestyle intervention and pioglitazone or berberine.Conclusions:Serum FGF21 can reflect the hepatic fat content only in untreated patients with mild or moderate NAFLD. In severe NAFLD or post-treatment patients, FGF21 concentration changes differently with hepatic fat content. The evidences are insufficient for taking serum FGF21 as a biomarker of hepatic fat content.