title: The association between adipocytokines and biomarkers for nonalcoholic fatty liver disease-induced liver injury:  a study in the general population.
abstract: OBJECTIVE
  Leptin and adiponectin have been implicated in the development of nonalcoholic fatty liver disease (NAFLD). However, the usefulness of adipocytokines as a screening tool for nonalcoholic steatohepatitis (NASH) and fibrosis could not be evaluated in the general population due to the invasive nature of liver biopsy. The aim was to evaluate the association between adipocytokines and presumed liver injury in the general population using noninvasive biomarkers.
  
  
  METHODS
  A cross-sectional study of 375 individuals, sampled from the National Health Survey was conducted. The exclusion criterion was any known secondary etiology for liver disease. Anthropometrics, serum leptin, adiponectin, insulin, lipids, and FibroMax were measured.
  
  
  RESULTS
  Three hundred and thirty-eight individuals met the inclusion criteria and had valid FibroMax. Fibrosis diagnosed by the FibroTest was found in 25.7% of the patients, of whom 12.8% had significant fibrosis. Steatohepatitis was diagnosed by the NASH test in 0.9% and borderline NASH in 31.4% of the patients. Adiponectin was an independent negative correlate of borderline NASH [odds ratio (OR): 0.92; 95% confidence interval (CI): 0.86-0.98/1 µg/ml] together with high-density lipoprotein, and leptin was a positive correlate (OR: 1.03; CI: 1.01-1.06/1 ng/ml), together with abdominal obesity, serum triglycerides, and HbA1C. The OR for borderline NASH was 20.7 (CI: 7.5-57.5) when both high leptin (upper quartile) and suboptimal adiponectin were present, adjusting for age and sex. The FibroTest was not associated with leptin and adiponectin. The strongest predictors for fibrosis were age, sex, abdominal obesity, and insulin.
  
  
  CONCLUSIONS
  Low adiponectin and high leptin and the combination of both have a strong independent association with presumed early-stage NASH. However, early-stage fibrosis cannot be predicted by these adipocytokines.
authors.affiliation: Department Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. zelbersagi@bezeqint.net
authors.forename: Shira
authors.initials: S
authors.lastname: Zelber-Sagi
authors.forename: Vlad
authors.initials: V
authors.lastname: Ratziu
authors.forename: Izabel
authors.initials: I
authors.lastname: Zvibel
authors.forename: Ilana
authors.initials: I
authors.lastname: Goldiner
authors.forename: Laurie
authors.initials: L
authors.lastname: Blendis
authors.forename: Gilles
authors.initials: G
authors.lastname: Morali
authors.forename: Zamir
authors.initials: Z
authors.lastname: Halpern
authors.forename: Ran
authors.initials: R
authors.lastname: Oren
mesh_terms: D054392:Adipokines / Q000097:blood*; D052242:Adiponectin / Q000097:blood; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D004812:Epidemiologic Methods; D005234:Fatty Liver / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D020738:Leptin / Q000097:blood; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D009765:Obesity / Q000150:complications; D017678:Sex Distribution
chemical_list: D054392:Adipokines; D052242:Adiponectin; D015415:Biomarkers; D007328:Insulin; D020738:Leptin