RT info:eu-repo/semantics/doctoralThesis
T1 Estudio de las características fenotípicas y genotípicas en pacientes con hígado graso no alcohólico con sobrepeso vs.obesidad
A1 Burgueño Gómez, Beatriz
A2 Universidad de Valladolid. Escuela de Doctorado
K1 Medicina Interna
K1 Steatohepatitis
K1 Esteatohepatitis
K1 Obesity
K1 Obesidad
K1 Overweight
K1 Sobrepeso
K1 Mediterranean diet
K1 Dieta mediterránea
K1 32 Ciencias Médicas
AB INTRODUCTION: Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the developed world and the progression to NASH and, ultimately, cirrhosis represents an emerging public health problem. The prevalence of NAFLD is increasing in the Western world and varies between 20-30% in the adult population in Mediterranean countries and between 15-20% in Asian countries. The increase in prevalence is associated with the parallel increase in obesity and DM-2. Although obesity is a recognized risk factor for the development of NAFLD, it can also be seen in nonobese patients.OBJECTIVE: to analyze the clinical, anthropometric, biochemical, histological characteristics, dietary habits, adipocytokines and the effect of two single nucleotide polymorphisms (SNP): the genetic variant I148M of PNPLA3 and G308G of TNF-&#945; in a sample of patients with NAFLD with overweight and obesity, comparing these factors in both population subgroups.MATERIAL AND METHODS: This is an observational, cross-sectional and descriptive study on a prospective database of 203 patients diagnosed with NAFLD by liver biopsy. We define obesity as a BMI &#8805;30 kg/m2 and overweight BMI >25 kg/m² and < 30 kg/m². To assess adherence to the Mediterranean diet we used the MEDAS questionnaire. Anthropometric variables such as waist and hip circumference, triceps fold, lean mass and phase angle were measured. The calories in the diet, the proportion of proteins, lipids, carbohydrates and vitamin E consumed were calculated after analyzing the nutritional survey using the Dietsource® program. We measure basal glucose, C-reactive protein, insulin, insulin resistance index (HOMA-IR), total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, leptin, adiponectin and resistin. The I148M variant rs738409 of the PNPLA3 gene and rs180069 of the TNF&#945; gene were evaluated.RESULTS: in the group of overweight patients there was a greater proportion of men (76.2% vs 47.9%; p<0.01), and they had better compliance with the Mediterranean diet (9vs7; p<0.05). In overweight patients, adiponectin levels were higher (22.5&#61617;21.9; p<0.05) compared to obese patients. NASH was higher in the group of obese patients (59.3% vs 41.3%; p=0.02) without significant differences in the rest of the histopathological parameters. In overweight patients, the HOMA index was an independent factor associated with NASH (OR 2, 95%CI 1.119-3.682, p=0.02) and fibrosis (OR 1.8, 95%CI 1.1-2.8, p<0.01). Adherence to the Mediterranean diet was a protective factor for both NASH and fibrosis in overweight patients (OR0.7, 95%CI 0.5-0.8 p<0.01, OR0.09, 95%CI 0.02-0.55 p<0. 01 respectively). In the obese group, the HOMA index was a risk factor for NASH (OR 1.95, 95%CI 1.05-3.62, p<0.05), and age was identified for fibrosis (OR1.12 1.02 -1.22, p<0.02). Adherence to the Mediterranean diet was a protective factor for fibrosis in the group of obese patients (OR 0.132 95%CI 0.031-0.565, p<0.01).CONLUSIONS: NASH was significantly higher in the group of obese patients compared to those who were overweight. HOMA-IR was an independent factor associated with both NASH and liver fibrosis in the group of overweight patients. In the group of obese patients, HOMA-IR was an independent factor associated with the development of NASH, but it was not identified for the development of liver fibrosis. Age was an independent factor associated with liver fibrosis in obese patients. Adherence to the Mediterranean diet was an independent protective factor for both NASH and liver fibrosis in overweight and obese patients. The presence of PNPLA3 and TNF&#945; genetic polymorphisms did not show a significant independent association with NASH or liver fibrosis in both patient cohorts.
YR 2023
FD 2023
LK https://uvadoc.uva.es/handle/10324/65186
UL https://uvadoc.uva.es/handle/10324/65186
LA spa
NO Escuela de Doctorado
DS UVaDOC
RD 31-may-2024