Schmid Andreas, Arians Miriam, Karrasch Thomas, Pons-Kühnemann Jörn, Schäffler Andreas, Roderfeld Martin, Roeb Elke
Department of Internal Medicine III, Justus Liebig University, 35392 Giessen, Germany.
Department of Gastroenterology, Internal Medicine II, Justus Liebig University, Klinikstr. 33, 35392 Giessen, Germany.
J Clin Med. 2022 Mar 22;11(7):1756. doi: 10.3390/jcm11071756.
Obesity and type 2 diabetes mellitus (T2D) represent important comorbidities of the metabolic syndrome, which are associated with non-alcoholic fatty liver disease (NAFLD)-related hepatic fibrosis. In total, 160 morbidly obese patients-81 following a low-calorie formula diet (LCD) program and 79 undergoing bariatric surgery (Roux-en-Y gastric bypass, RYGB)-were examined for anthropometric and metabolic parameters at base-line and during 12 months of weight loss, focusing on a putative co-regulation of T2D parameters and liver fibrosis risk. High NAFLD fibrosis scores (NFS) before intervention were associated with elevated HbA1c levels and T2D. Loss of weight and body fat percentage (BFL) were associated with improved glucose and lipid metabolism and reduced risk of NAFLD-related fibrosis, with particularly beneficial effects by RYGB. Both T2D improvement and NFS decrease were positively associated with high BFL. A highly significant correlation of NFS reduction with BFL was restricted to male patients while being absent in females, accompanied by generally higher BFL in men. Overall, the data display the relation of BFL, T2D improvement, and reduced NAFLD-related fibrosis risk during weight loss in morbidly obese individuals induced by diet or RYGB. Furthermore, our data suggest a considerable sexual dimorphism concerning the correlation of fat loss and improved risk of liver fibrosis.
肥胖和2型糖尿病（T2D）是代谢综合征的重要合并症，与非酒精性脂肪性肝病（NAFLD）相关的肝纤维化有关。总共对160例病态肥胖患者进行了研究，其中81例采用低热量配方饮食（LCD）方案，79例接受减肥手术（Roux-en-Y胃旁路术，RYGB），在基线和体重减轻的12个月期间检查了人体测量和代谢参数，重点关注T2D参数与肝纤维化风险的假定共同调节。干预前高NAFLD纤维化评分（NFS）与HbA1c水平升高和T2D相关。体重和体脂百分比（BFL）的降低与葡萄糖和脂质代谢改善以及NAFLD相关纤维化风险降低相关，RYGB具有特别有益的效果。T2D的改善和NFS的降低均与高BFL呈正相关。NFS降低与BFL的高度显著相关性仅限于男性患者，女性患者不存在这种相关性，男性的BFL通常更高。总体而言，数据显示了病态肥胖个体在饮食或RYGB诱导的体重减轻过程中BFL、T2D改善与NAFLD相关纤维化风险降低之间的关系。此外，我们的数据表明，在脂肪减少与肝纤维化风险改善的相关性方面存在明显的性别差异。
