Zhyzhneuskaya S V, Al-Mrabeh A H, Peters C, Barnes A C, Hollingsworth K G, Welsh P, Sattar N, Lean M E J, Taylor R
Magnetic Resonance Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
University Hospital of North Durham, County Durham and Darlington NHS Foundation Trust, Durham, UK.
Diabet Med. 2025 Mar;42(3):e15462. doi: 10.1111/dme.15462. Epub 2024 Dec 8.
Ectopic fat is reduced by effective weight management, but difficult to assess clinically.
We evaluated paired data on 42 participants in the intervention group of the Diabetes Remission Clinical Trial (DiRECT) at baseline, 12 and 24 months after weight loss as indicators of liver fat content measured by 3-point Dixon MRI.
Baseline liver fat was elevated at 13.0 [7.8-23.3]% with fasting plasma glucose 7.9 [7.1-10.1] mmol/L. Prevalence of baseline MASLD was 86.4%. After weight loss of 11.9 ± 1.2 kg (0-37 kg) at 12 months, remission of MASLD occurred in 74% and liver fat normalised for many (1.8 [1.2-5.2]%; p < 0.0001) as did fasting glucose (5.9 [5.5-7.2] mmol/L; p < 0.0001). Alanine aminotransferase (ALT) and gamma glutamyl transferase (GGT) decreased at 12 months by 38 [19-60]% (p < 0·0001) and 38 [16-53]% (p < 0.0001) respectively. The positive predictive value for decrease in liver fat, with baseline values of >40 IU/L, was 100% for ALT and 87.5% for GGT. As expected, change in liver fat correlated with change in ALT (r = 0.64; p < 0.0001), GGT (r = 0.38; p = 0.013), AST (r = 0.36; p = 0.018), fatty liver index (r = 0.50; p < 0.0001) and hepatic steatosis index (r = 0.44; p < 0.0001).
Metabolic dysfunction-associated steatotic liver disease, an important marker of ill-health is improved by intentional weight loss. If enzyme levels are raised at baseline, following weight loss, changes in ALT and GGT usefully reflect change in liver fat content, with high positive predictive value. Monitoring liver enzymes can provide a simple way to assess change in liver fat following weight loss in day-to-day clinical practice.
通过有效的体重管理可减少异位脂肪，但临床上难以评估。
我们评估了糖尿病缓解临床试验（DiRECT）干预组42名参与者在基线、体重减轻后12个月和24个月时的配对数据，这些数据作为通过三点狄克逊磁共振成像测量的肝脏脂肪含量指标。
基线时肝脏脂肪升高至13.0[7.8 - 23.3]%，空腹血糖为7.9[7.1 - 10.1]mmol/L。基线时代谢功能障碍相关脂肪性肝病（MASLD）的患病率为86.4%。在12个月时体重减轻11.9±1.2 kg（0 - 37 kg）后，74%的患者MASLD得到缓解，许多患者的肝脏脂肪恢复正常（1.8[1.2 - 5.2]%；p < 0.0001），空腹血糖也恢复正常（5.9[5.5 - 7.2]mmol/L；p < 0.0001）。12个月时丙氨酸氨基转移酶（ALT）和γ-谷氨酰转移酶（GGT）分别下降38[19 - 60]%（p < 0.0001）和38[16 - 53]%（p < 0.0001）。基线值>40 IU/L时，ALT降低对肝脏脂肪减少的阳性预测值为100%，GGT为87.5%。正如预期的那样，肝脏脂肪的变化与ALT（r = 0.64；p < 0.0001）、GGT（r = 0.38；p = 0.013）、AST（r = 0.36；p = 0.018）、脂肪肝指数（r = 0.50；p < 0.0001）和肝脂肪变性指数（r = 0.44；p < 0.0001）的变化相关。
代谢功能障碍相关脂肪性肝病是健康不良的重要标志物，通过有意减重可得到改善。如果基线时酶水平升高，减重后，ALT和GGT的变化可有效地反映肝脏脂肪含量的变化，具有较高的阳性预测值。在日常临床实践中，监测肝酶可提供一种简单的方法来评估减重后肝脏脂肪的变化。
