Hypoadiponectinemia and its association with liver fibrosis in morbidly obese patients.
BACKGROUND
Reduced serum levels of adiponectin have been associated with insulin resistance and non-alcoholic fatty liver disease (NAFLD). However, the relationship between serum adiponectin levels and hepatic histology in NAFLD is controversial. The aim of this study was to explore associations between plasma adiponectin concentrations and liver histology in morbidly obese patients.


METHODS
We conducted a case-control study including obese patients undergoing bariatric surgery and normal controls. Anthropometric, standard biochemical variables as well as plasma adiponectin and leptin levels were determined. Liver biopsy was performed in all patients at the time of surgery.


RESULTS
Seventy morbidly obese patients (mean BMI, 40.6 ± 5.6 kg/m(2)) met the inclusion criteria and were compared with 69 controls (mean BMI, 22.8 ± 1.6 kg/m(2), p = 0.0001). Thirty patients (43%) had NAFLD and 20 (28%) of them fulfilled the histological criteria for steatohepatitis. Obesity was associated with increased leptin and decreased adiponectin levels. NAFLD patients exhibited decreased levels of serum adiponectin compared with matched controls [median (Q1-Q3), 3.9 (3.2-4.3) vs. 8.6 (6.5-9.2) μg/mL, p < 0.0001]. In univariate analysis, age, gender, type 2 diabetes mellitus, BMI, HOMA-IR, aspartate aminotransferase (AST), alanine aminotransferase, serum glucose, and adiponectin levels were independently associated with hepatic fibrosis. In multivariate analysis, AST [OR = 1.082 (1.000-1.170)], age [OR = 1.119 (1.023-1.225)], and serum adiponectin levels [OR = 0.529 (0.299-0.936)] were significantly associated with the presence of liver fibrosis.


CONCLUSIONS
NAFLD patients have lower plasma adiponectin concentrations than control subjects. Low adiponectin levels are associated with more severe liver histology. Serum adiponectin may be useful to estimate the severity of liver damage in obese patients with NAFLD.
Nazal
Leyla
L
Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 367, Santiago, Chile.
Riquelme
Arnoldo
A
Solís
Nancy
N
Pizarro
Margarita
M
Escalona
Alex
A
Burotto
Mauricio
M
Méndez
Juan Ignacio
JI
Saint-Jean
Catalina
C
Concha
María José
MJ
Giovanni
Stefano
S
Awruch
Diego
D
Morales
Arturo
A
Baudrand
Rene
R
Carrasco
Gonzalo
G
Domínguez
María Angélica
MA
Padilla
Oslando
O
Espinoza
Manuel
M
Miquel
Juan Francisco
JF
Nervi
Flavio
F
Arrese
Marco
M
D052242:Adiponectin / Q000097:blood*; D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015897:Comorbidity; D005234:Fatty Liver / Q000097:blood / Q000453:epidemiology / Q000473:pathology; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000097:blood* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D009767:Obesity, Morbid / Q000097:blood / Q000453:epidemiology*; D012372:ROC Curve; D055815:Young Adult
D052242:Adiponectin