Hirsch Sandra, Poniachick Jaime, Avendaño Maritza, Csendes Atila, Burdiles Patricio, Smok Gladys, Diaz Juan C, de la Maza María Pía
Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile.
Nutrition. 2005 Feb;21(2):137-41. doi: 10.1016/j.nut.2004.03.022.
Folate depletion and hyperhomocysteinemia increase the risk for hepatic alcoholic damage and promote oxidative stress in animals. In addition, some investigators have reported an inverse association between serum folate and body mass index and a positive correlation between total homocysteine and fat mass. We investigated whether there is an association between serum folate and total homocysteine concentrations with the presence of non-alcoholic fatty liver disease (NAFLD) in obese subjects.
Forty-three obese (body mass index > or =35 kg/m2) patients who underwent bariatric surgery and hepatic biopsy were included. Serum total homocyteine, folate and vitamin B12 concentrations and hepatic enzymes were measured. Liver biopsies were graded for the presence of fat, inflammation, and fibrosis on a scale from 0 to 3. A total histologic score was calculated based on the sum of partial scores. Severe NAFLD was defined as a total score of at least 4 or severe steatosis (partial score for fat = 3).
Severe NAFLD was present in 17 patients. Serum folate concentration was significantly lower in obese patients with NAFLD than in those with normal liver or minimal alterations (9.3 +/- 3.5 versus 12.2 +/- 3.1 ng/mL, P = 0.005). Serum total homocysteine and vitamin B12 concentrations were similar in both groups. An inverse correlation between serum folate concentration and body mass index was observed (r = -0.31, P = 0.046).
In this study, severe NAFLD in obese subjects was associated with lower serum folate concentrations and serum homocysteine and vitamin B12 concentrations were not associated with liver damage in obese subjects.
叶酸缺乏和高同型半胱氨酸血症会增加动物肝脏酒精性损伤的风险，并促进氧化应激。此外，一些研究人员报告血清叶酸与体重指数呈负相关，总同型半胱氨酸与脂肪量呈正相关。我们调查了肥胖受试者血清叶酸和总同型半胱氨酸浓度与非酒精性脂肪性肝病（NAFLD）之间是否存在关联。
纳入43例接受减肥手术和肝脏活检的肥胖患者（体重指数≥35kg/m²）。检测血清总同型半胱氨酸、叶酸和维生素B12浓度以及肝酶。肝脏活检根据脂肪、炎症和纤维化的存在情况从0到3进行分级。根据部分评分的总和计算总组织学评分。严重NAFLD定义为总评分至少为4或严重脂肪变性（脂肪部分评分为3）。
17例患者存在严重NAFLD。患有NAFLD的肥胖患者血清叶酸浓度显著低于肝脏正常或仅有轻微改变的患者（9.3±3.5对12.2±3.1ng/mL，P=0.005）。两组血清总同型半胱氨酸和维生素B12浓度相似。观察到血清叶酸浓度与体重指数呈负相关（r=-0.31，P=0.046）。
在本研究中，肥胖受试者的严重NAFLD与较低的血清叶酸浓度相关，而血清同型半胱氨酸和维生素B12浓度与肥胖受试者的肝损伤无关。
