title: Diagnostic accuracy of acyl-ghrelin and it association with non-alcoholic fatty liver disease in type 2 diabetic patients.
abstract: BACKGROUND
  Ghrelin is a hormone produced mainly by the cells lining the fundus of the stomach, which is involved in regulation of lipid and glucose metabolism. Two major forms of ghrelin can be found in circulation: an acylated form, and non-acylated form. Serum acyl-ghrelin (AG) concentration is significantly increased in patients with visceral obesity and insulin resistance. This study was conducted to evaluate changes in serum AG levels, its diagnostic accuracy and association with NAFLD in patients with type two diabetes (T2D).
  
  
  METHODS
  In this cross-sectional study, 91 T2D patients, age of 40-80 years, were included. All patients were divided into 3 groups. The control group included 28 T2D patients without NAFLD. The main group included 63 T2D patients with NAFLD, which was divided in 2 subgroups depending on transaminase levels: normal (n = 37) and elevated (n = 26) transaminases group. To assess the diagnostic accuracy of AG for NAFLD we used ROC-analysis.
  
  
  RESULTS
  We observed 1.5 (p = 0.016) and 2.5 (p < 0.001) fold increasing of serum AG levels in patients with NAFLD and normal or elevated transaminases compared to control groups. In multivariate logistic regression analysis high AG level was an independent, from transaminases activity, triglycerides (OR 1.791; 95 % CI 1.162-2.759; p = 0.008) and degree of IR (OR 1.599; 95 % CI 1.019-2.508; p = 0.044) predictor that associated with NAFLD. When serum AG used as non-invasive marker for NAFLD detection AUROC was 0.835 (95 % CI 0.752-0.918, p < 0.001). The cut-off value was >0.52 ng/ml, with sensitivity, specificity, PPV and NPV - 60.3 %, 92.8 %, 95.0 %, 50.9 % respectively. For distinguishing patients with NAFLD and elevated transaminases from patients with NAFLD and normal values AG was less effective.
  
  
  CONCLUSIONS
  Our study has demonstrated that elevated AG level were associated with NAFLD. Patients with elevated transaminases had significantly higher AG levels. An increase of AG over 0.52 ng/ml can be used as a diagnostic marker for NAFLD detection in patients with T2D.
authors.affiliation: Bogomolets National Medical University, T. Shevchenko blvd, 13, 01601 Kyiv, Ukraine.
authors.forename: Galyna
authors.initials: G
authors.lastname: Mykhalchyshyn
authors.affiliation: Bogomolets National Medical University, T. Shevchenko blvd, 13, 01601 Kyiv, Ukraine.
authors.forename: Nazarii
authors.initials: N
authors.lastname: Kobyliak
authors.affiliation: Bogomolets National Medical University, T. Shevchenko blvd, 13, 01601 Kyiv, Ukraine.
authors.forename: Petro
authors.initials: P
authors.lastname: Bodnar
keywords: Acyl-ghrelin; Non-alcoholic fatty liver disease; Type 2 diabetes