Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Napoli, Italy.
Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Endocrinology Unit, Department of Clinical Medicine and Surgery, University Medical School of Naples, Naples, Italy.
Front Endocrinol (Lausanne). 2021 Mar 18;12:649496. doi: 10.3389/fendo.2021.649496. eCollection 2021.
Obesity, mainly visceral obesity, and metabolic syndrome (MetS) are major risk factors for the development of type 2 diabetes, cardiovascular diseases, and cancer. Data analyzing the association of obesity and MetS with gastroenteropancreatic neuroendocrine neoplasms (GEP-NEN) are lacking. Fatty liver index (FLI) is a non-invasive tool for identifying individuals with non-alcoholic fatty liver disease (NAFLD). Visceral adiposity index (VAI) has been suggested as a gender-specific indicator of adipose dysfunction. Both indexes have been proposed as early predictors of MetS. This study aimed to investigate the association of FLI VAI as early predictors of MetS with gastroenteropancreatic neuroendocrine tumors (GEP-NETs).
A cross-sectional, case-control, observational study was carried out at the ENETS Centers of Excellence Multidisciplinary Group for Neuroendocrine Tumors, University "Federico II". VAI and FLI were calculated.
We enrolled 109 patients with histologically confirmed G1/G2 GEP-NET (53 M; 57.06 ± 15.96 years), as well as 109 healthy subjects, age, sex- and body mass index-matched. Forty-four GEP-NET patients were G2, of which 21 were with progressive disease, and 27 patients had metastases. GEP-NET patients had a higher value of VAI ( < 0.001) and FLI ( = 0.049) and higher MetS presence ( < 0.001) compared with controls. VAI and FLI values and MetS presence were higher in G2 than in G1 patients ( < 0.001), in patients with progressive disease, and in metastatic non-metastatic patients ( < 0.001). In addition, higher values of VAI and FLI and higher MetS presence were significantly correlated with the worst clinical severity of NENs. The cut-off values for the FLI and MetS to predict high grading of GEP-NETs and the presence of metastasis were also provided.
This is the first study investigating an association between VAI and FLI as early predictors of MetS and GEP-NET. Our findings report that the worsening of clinicopathological characteristics in GEP-NET is associated with higher presence of MetS, NAFLD, evaluated by FLI, and visceral adiposity dysfunction, evaluated by VAI. Addressing the clinical evaluation of MetS presence, NAFLD, and visceral adiposity dysfunction might be of crucial relevance to establish targeted preventive and treatment interventions of NEN-related metabolic comorbidities.
肥胖，主要是内脏肥胖和代谢综合征（MetS），是 2 型糖尿病、心血管疾病和癌症发展的主要危险因素。缺乏分析肥胖和 MetS 与胃肠胰神经内分泌肿瘤（GEP-NEN）之间关系的数据。脂肪性肝病指数（FLI）是一种识别非酒精性脂肪性肝病（NAFLD）患者的非侵入性工具。内脏脂肪指数（VAI）已被提议作为脂肪功能障碍的性别特异性指标。这两个指标都被提出作为 MetS 的早期预测指标。本研究旨在探讨 FLI 和 VAI 作为 MetS 的早期预测指标与胃肠胰神经内分泌肿瘤（GEP-NET）之间的关系。
在 ENETS 卓越中心多学科神经内分泌肿瘤小组，在意大利那不勒斯 Federico II 大学进行了一项横断面、病例对照、观察性研究。计算了 VAI 和 FLI。
我们纳入了 109 名经组织学证实的 G1/G2 GEP-NET 患者（53 名男性；57.06±15.96 岁），以及 109 名年龄、性别和体重指数匹配的健康对照者。44 名 GEP-NET 患者为 G2 级，其中 21 名患者疾病进展，27 名患者发生转移。与对照组相比，GEP-NET 患者的 VAI（<0.001）和 FLI（=0.049）值更高，MetS 阳性率更高（<0.001）。与 G1 级患者相比，G2 级患者的 VAI 和 FLI 值以及 MetS 阳性率更高（<0.001），疾病进展患者和转移性非转移性患者的 VAI 和 FLI 值以及 MetS 阳性率更高（<0.001）。此外，较高的 VAI 和 FLI 值和较高的 MetS 阳性率与 NENs 的最严重临床严重程度显著相关。还提供了用于预测 GEP-NETs 高级别和转移的 FLI 和 MetS 的截断值。
这是第一项研究 VAI 和 FLI 作为 MetS 的早期预测指标与 GEP-NET 之间关系的研究。我们的研究结果表明，GEP-NET 临床病理特征的恶化与更高的 MetS 阳性率、FLI 评估的非酒精性脂肪性肝病（NAFLD）和 VAI 评估的内脏脂肪功能障碍有关。评估 MetS 阳性率、NAFLD 和内脏脂肪功能障碍的临床评估可能对确定 NEN 相关代谢合并症的靶向预防和治疗干预措施至关重要。
