title: Alterations in lipid, carbohydrate and iron metabolism in patients with non-alcoholic steatohepatitis (NASH) and metabolic syndrome.
abstract: BACKGROUND
  NASH (non-alcoholic steatohepatitis) is considered the hepatic manifestation of the metabolic syndrome (MS). We aimed to analyze lipid, carbohydrate, and iron metabolism in NASH.
  
  
  METHODS
  37 patients with MS (17 M/20 F, 51+/-15 years), elevated transaminases; 25 patients had histologically proven NASH (NAS score≥5), 12 patients had toxic background (nonNASH). 37 age, sex, BMI-matched healthy controls. Lipid variables, LDL-subfractions, iron, ferritin, transferrin (T), transferrin saturation (TS), and hepcidin (H) were measured in patients/controls. Oral glucose tolerance tests were performed.
  
  
  RESULTS
  NASH patients with steatosis gr. 2 and 3 (>33% hepatic fat) had higher sd-LDL (mg/dl) concentrations than patients with steatosis gr. 1 (<33%) (p=0.002), nonNASH patients (p=0.03) and controls (p=0.001). Sd absolute (mg/dl) correlated directly with the steatosis grade only in patients with NASH and steatosis >33% (p=0.04). NASH-patients showed higher insulin, C-peptide and IRI values than nonNASH patients (p=0.034; 0.032; 0.04). H was increased in patients versus controls (p<0.001). H correlated with ferritin in MS-patients (p=0.01), correlated directly with sd-LDL (mg/dl) (p=0.017) and IRI (p<0.001) and indirectly with HDL (p=0.05) in NASH. No associations between hepatic inflammation/iron content on liver biopsy and variables of lipid metabolism were found but hepcidin correlated with hepatic inflammation in all patients and with NAS scores in NASH.
  
  
  CONCLUSIONS
  NASH-patients show insulin resistance and increased sd-LDL subfractions, suggesting an atherogenic profile. The correlation of H with sd-LDL and IRI, without relation to hepatic iron content suggests a putative link between inflammation, carbohydrate and lipid metabolism in NASH.
authors.affiliation: 1st Medical Clinic, Dept. of Endocrinology and Metabolic Diseases, Johannes Gutenberg University of Mainz, Germany. zimmeran@uni-mainz.de
authors.forename: Anca
authors.initials: A
authors.lastname: Zimmermann
authors.forename: Tim
authors.initials: T
authors.lastname: Zimmermann
authors.forename: Jörn
authors.initials: J
authors.lastname: Schattenberg
authors.forename: Sebastian
authors.initials: S
authors.lastname: Pöttgen
authors.forename: Johannes
authors.initials: J
authors.lastname: Lotz
authors.forename: Heidi
authors.initials: H
authors.lastname: Rossmann
authors.forename: Ralf
authors.initials: R
authors.lastname: Roeddiger
authors.forename: Stefan
authors.initials: S
authors.lastname: Biesterfeld
authors.forename: Hans-Christian
authors.initials: HC
authors.lastname: Geiss
authors.forename: Marcus
authors.initials: M
authors.lastname: Schuchmann
authors.forename: Peter R
authors.initials: PR
authors.lastname: Galle
authors.forename: Matthias M
authors.initials: MM
authors.lastname: Weber
mesh_terms: D000328:Adult; D000368:Aged; D023181:Antimicrobial Cationic Peptides / Q000097:blood; D002096:C-Peptide / Q000097:blood; D050260:Carbohydrate Metabolism / Q000502:physiology*; D008078:Cholesterol, LDL / Q000097:blood; D005234:Fatty Liver / Q000209:etiology / Q000378:metabolism*; D005260:Female; D005293:Ferritins / Q000097:blood; D005951:Glucose Tolerance Test; D064451:Hepcidins; D006801:Humans; D007328:Insulin / Q000097:blood; D007501:Iron / Q000378:metabolism*; D050356:Lipid Metabolism / Q000502:physiology*; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000378:metabolism*; D055442:Metabolome / Q000502:physiology; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D014168:Transferrin / Q000378:metabolism
chemical_list: D023181:Antimicrobial Cationic Peptides; D002096:C-Peptide; D008078:Cholesterol, LDL; C578702:HAMP protein, human; D064451:Hepcidins; D007328:Insulin; D014168:Transferrin; D005293:Ferritins; D007501:Iron