title: Hypolactasia is associated with insulin resistance in nonalcoholic steatohepatitis.
abstract: OBJECTIVE
  To assess lactase gene (LCT)-13910C>T polymorphisms in Brazilian non-alcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) patients in comparison with healthy controls.
  
  
  METHODS
  This was a transverse observational clinical study with NAFLD patients who were followed at the Hepatology Outpatient Unit of the Hospital das Clínicas, São Paulo, Brazil. The polymorphism of lactase non-persistence/lactase persistence (LCT-13910C>T) was examined by PCR-restriction fragment length polymorphism technique in 102 liver biopsy-proven NAFLD patients (steatosis in 9 and NASH in 93) and compared to those of 501 unrelated healthy volunteers. Anthropometric, clinical, biochemical and liver histology data were analyzed. Continuous variables were compared using the t or Mann-Whitney tests, and categorical data were compared with the Fisher's exact test. Univariate logistic regression and multivariate logistic regression adjusted for gender and age were performed.
  
  
  RESULTS
  No differences in the LCT-13910 genotype frequencies were noted between the NAFLD patients (66.67% of the patients with steatosis were CC, 33.33% were CT, and none were TT; 55.91% of the patients with NASH were CC, 39.78% were CT, and 4.3% were TT; P = 0.941) and the healthy controls (59.12% were CC, 35.67% were CT, and 5.21% were TT) or between the steatosis and NASH patients. That is, the distribution of the lactase non-persistence/lactase persistence polymorphism (LCT-13910C>T) in the patients with NAFLD was equal to that in the general population. In the NASH patients, the univariate analysis revealed that the lactase non-persistence (low lactase activity or hypolactasia) phenotype was associated with higher insulin levels (23.47 ± 15.94 μU/mL vs 15.8 ± 8.33 μU/mL, P = 0.027) and a higher frequency of insulin resistance (91.84% vs 72.22%, P = 0.02) compared with the lactase persistence phenotype. There were no associations between the LCT genotypes and diabetes (P = 0.651), dyslipidaemia (P = 0.328), hypertension (P = 0.507) or liver histology in these patients. Moreover, in the NASH patients, hypolactasia was an independent risk factor for insulin resistance even after adjusting for gender and age [OR = 5.0 (95%CI: 1.35-20; P = 0.017)].
  
  
  CONCLUSIONS
  The LCT-13910 genotype distribution in Brazilian NAFLD patients was the same as that of the general population, but hypolactasia increased the risk of insulin resistance in the NASH patients.
authors.affiliation: Daniel Ferraz de Campos Mazo, Rejane Mattar, José Tadeu Stefano, Joyce Matie Kinoshita da Silva-Etto, Márcio Augusto Diniz, Sebastião Mauro Bezerra Duarte, Fabíola Rabelo, Rodrigo Vieira Costa Lima, Priscila Brizolla de Campos, Flair José Carrilho, Claudia P Oliveira, Division of Gastroenterology and Hepatology, Department of Gastroenterology (LIM 07), University of São Paulo School of Medicine, São Paulo 05403-000, Brazil.
authors.forename: Daniel Ferraz
authors.initials: DF
authors.lastname: de Campos Mazo
authors.affiliation: Daniel Ferraz de Campos Mazo, Rejane Mattar, José Tadeu Stefano, Joyce Matie Kinoshita da Silva-Etto, Márcio Augusto Diniz, Sebastião Mauro Bezerra Duarte, Fabíola Rabelo, Rodrigo Vieira Costa Lima, Priscila Brizolla de Campos, Flair José Carrilho, Claudia P Oliveira, Division of Gastroenterology and Hepatology, Department of Gastroenterology (LIM 07), University of São Paulo School of Medicine, São Paulo 05403-000, Brazil.
authors.forename: Rejane
authors.initials: R
authors.lastname: Mattar
authors.affiliation: Daniel Ferraz de Campos Mazo, Rejane Mattar, José Tadeu Stefano, Joyce Matie Kinoshita da Silva-Etto, Márcio Augusto Diniz, Sebastião Mauro Bezerra Duarte, Fabíola Rabelo, Rodrigo Vieira Costa Lima, Priscila Brizolla de Campos, Flair José Carrilho, Claudia P Oliveira, Division of Gastroenterology and Hepatology, Department of Gastroenterology (LIM 07), University of São Paulo School of Medicine, São Paulo 05403-000, Brazil.
authors.forename: José Tadeu
authors.initials: JT
authors.lastname: Stefano
authors.affiliation: Daniel Ferraz de Campos Mazo, Rejane Mattar, José Tadeu Stefano, Joyce Matie Kinoshita da Silva-Etto, Márcio Augusto Diniz, Sebastião Mauro Bezerra Duarte, Fabíola Rabelo, Rodrigo Vieira Costa Lima, Priscila Brizolla de Campos, Flair José Carrilho, Claudia P Oliveira, Division of Gastroenterology and Hepatology, Department of Gastroenterology (LIM 07), University of São Paulo School of Medicine, São Paulo 05403-000, Brazil.
authors.forename: Joyce Matie Kinoshita
authors.initials: JM
authors.lastname: da Silva-Etto
authors.affiliation: Daniel Ferraz de Campos Mazo, Rejane Mattar, José Tadeu Stefano, Joyce Matie Kinoshita da Silva-Etto, Márcio Augusto Diniz, Sebastião Mauro Bezerra Duarte, Fabíola Rabelo, Rodrigo Vieira Costa Lima, Priscila Brizolla de Campos, Flair José Carrilho, Claudia P Oliveira, Division of Gastroenterology and Hepatology, Department of Gastroenterology (LIM 07), University of São Paulo School of Medicine, São Paulo 05403-000, Brazil.
authors.forename: Márcio Augusto
authors.initials: MA
authors.lastname: Diniz
authors.affiliation: Daniel Ferraz de Campos Mazo, Rejane Mattar, José Tadeu Stefano, Joyce Matie Kinoshita da Silva-Etto, Márcio Augusto Diniz, Sebastião Mauro Bezerra Duarte, Fabíola Rabelo, Rodrigo Vieira Costa Lima, Priscila Brizolla de Campos, Flair José Carrilho, Claudia P Oliveira, Division of Gastroenterology and Hepatology, Department of Gastroenterology (LIM 07), University of São Paulo School of Medicine, São Paulo 05403-000, Brazil.
authors.forename: Sebastião Mauro Bezerra
authors.initials: SM
authors.lastname: Duarte
authors.affiliation: Daniel Ferraz de Campos Mazo, Rejane Mattar, José Tadeu Stefano, Joyce Matie Kinoshita da Silva-Etto, Márcio Augusto Diniz, Sebastião Mauro Bezerra Duarte, Fabíola Rabelo, Rodrigo Vieira Costa Lima, Priscila Brizolla de Campos, Flair José Carrilho, Claudia P Oliveira, Division of Gastroenterology and Hepatology, Department of Gastroenterology (LIM 07), University of São Paulo School of Medicine, São Paulo 05403-000, Brazil.
authors.forename: Fabíola
authors.initials: F
authors.lastname: Rabelo
authors.affiliation: Daniel Ferraz de Campos Mazo, Rejane Mattar, José Tadeu Stefano, Joyce Matie Kinoshita da Silva-Etto, Márcio Augusto Diniz, Sebastião Mauro Bezerra Duarte, Fabíola Rabelo, Rodrigo Vieira Costa Lima, Priscila Brizolla de Campos, Flair José Carrilho, Claudia P Oliveira, Division of Gastroenterology and Hepatology, Department of Gastroenterology (LIM 07), University of São Paulo School of Medicine, São Paulo 05403-000, Brazil.
authors.forename: Rodrigo Vieira Costa
authors.initials: RV
authors.lastname: Lima
authors.affiliation: Daniel Ferraz de Campos Mazo, Rejane Mattar, José Tadeu Stefano, Joyce Matie Kinoshita da Silva-Etto, Márcio Augusto Diniz, Sebastião Mauro Bezerra Duarte, Fabíola Rabelo, Rodrigo Vieira Costa Lima, Priscila Brizolla de Campos, Flair José Carrilho, Claudia P Oliveira, Division of Gastroenterology and Hepatology, Department of Gastroenterology (LIM 07), University of São Paulo School of Medicine, São Paulo 05403-000, Brazil.
authors.forename: Priscila Brizolla
authors.initials: PB
authors.lastname: de Campos
authors.affiliation: Daniel Ferraz de Campos Mazo, Rejane Mattar, José Tadeu Stefano, Joyce Matie Kinoshita da Silva-Etto, Márcio Augusto Diniz, Sebastião Mauro Bezerra Duarte, Fabíola Rabelo, Rodrigo Vieira Costa Lima, Priscila Brizolla de Campos, Flair José Carrilho, Claudia P Oliveira, Division of Gastroenterology and Hepatology, Department of Gastroenterology (LIM 07), University of São Paulo School of Medicine, São Paulo 05403-000, Brazil.
authors.forename: Flair José
authors.initials: FJ
authors.lastname: Carrilho
authors.affiliation: Daniel Ferraz de Campos Mazo, Rejane Mattar, José Tadeu Stefano, Joyce Matie Kinoshita da Silva-Etto, Márcio Augusto Diniz, Sebastião Mauro Bezerra Duarte, Fabíola Rabelo, Rodrigo Vieira Costa Lima, Priscila Brizolla de Campos, Flair José Carrilho, Claudia P Oliveira, Division of Gastroenterology and Hepatology, Department of Gastroenterology (LIM 07), University of São Paulo School of Medicine, São Paulo 05403-000, Brazil.
authors.forename: Claudia P
authors.initials: CP
authors.lastname: Oliveira
keywords: Genetic polymorphism; Insulin resistance; Lactose intolerance; Non-alcoholic fatty liver disease; Nonalcoholic steatohepatitis