Elevation of Alanine Transaminase and Markers of Liver Fibrosis After a Mixed Meal Challenge in Individuals with Type 2 Diabetes

Khoo, Eric Yin-Hao; Stevenson, Mary C.; Leverton, E; Cross, R; Eriksson, Jan W.; Poucher, Simon M.; Spendlove, Ian; Morris, Peter G.; Macdonald, I. A.; Mansell, Peter; Aithal, Guruprasad P.

doi:10.1007/s10620-012-2219-z

Cited by 8 publications

(9 citation statements)

References 27 publications

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“…The reduction in serum bilirubin in healthy participants is unlikely to represent clinical significance as all values are well below the upper limit of the normal range (approximately 30 μmol/L). The postprandial rise in serum HA in healthy participants has been attributed to a manifestation of a metabolic challenge leading to a stress response in the liver [ 38 ]. The postprandial increase in LSM at T = 30 min in our healthy participants has previously been observed in patients with varying stages of liver fibrosis [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…We did not specify the presence of diabetes mellitus in our inclusion/exclusion criteria. This may be of particular relevance in the two patients with non-alcoholic fatty liver disease, since significant changes in the postprandial ALT levels have been reported in participants with type 2 diabetes mellitus compared to healthy participants [ 38 , 39 ]. The age range of the patients with CC was significantly higher than that of the healthy participants, and two participants were scanned in the afternoon, rather than in the morning as were the other participants.…”

Section: Discussionmentioning

confidence: 99%

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MRI assessment of altered dynamic changes in liver haemodynamics following a meal challenge in compensated cirrhosis

et al. 2018

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BackgroundThe aim was to use magnetic resonance imaging (MRI) to dynamically assess postprandial changes in hepatic and collateral blood flow, liver perfusion and oxygenation in healthy participants and patients with liver disease with compensated cirrhosis (CC).MethodsWe evaluated blood flow in the portal vein, hepatic artery and azygos vein (using phase-contrast MRI), liver perfusion (using arterial spin labelling) and blood oxygenation (using transverse relaxation time [T2*] mapping). Measures were collected at baseline and at 6–7-min intervals from 20 to 65 min following a test meal (440 mL, 660 kcal) in 10 healthy participants and 10 patients with CC.ResultsIn healthy participants, we observed a significant postprandial increase in portal vein flow from baseline (+ 137 ± 26% (mean ± standard deviation), p < 0.001) coupled with a reduction in hepatic artery flow from baseline (− 30 ± 18%, p = 0.008), reflecting the hepatic artery buffer response. In patients with CC, a lower but still significant increase in portal vein flow (67 ± 50%, p = 0.014) was observed, without a clear hepatic artery buffer response. Healthy participants showed a significant increase in postprandial liver perfusion (138 ± 75%, p < 0.001), not observed in patients with CC. There was no change in liver T2* for either group.ConclusionsPostprandial changes in liver perfusion, oxygenation and hepatic and collateral circulation can be measured noninvasively using MRI. Differences between healthy participants and patients with CC were shown, which may help stratify liver cirrhosis in patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

MRI assessment of altered dynamic changes in liver haemodynamics following a meal challenge in compensated cirrhosis

et al. 2018

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“…However, HA was not correlated with steatosis grade or fibrosis grade in patients with biopsy-proven NAFLD without type 2 diabetes (85). Khoo et al (87) show that HA levels increase after a mixed meal challenge in type 2 diabetes patients as well as in healthy volunteers. Despite similar baseline serum HA levels, the rise was significantly higher in type 2 diabetes patients (87).…”

Section: Hyaluronic Acid In Autoimmune Hepatitismentioning

confidence: 99%

“…Khoo et al (87) show that HA levels increase after a mixed meal challenge in type 2 diabetes patients as well as in healthy volunteers. Despite similar baseline serum HA levels, the rise was significantly higher in type 2 diabetes patients (87). Serum HA levels were significantly higher in individuals with advanced fibrosis stages in a small sample of 127 morbidly obese patients (56 NASH and 71 NAFLD) (88).…”

Section: Hyaluronic Acid In Autoimmune Hepatitismentioning

confidence: 99%

Hyaluronic acid as a non-invasive biomarker of liver fibrosis

Neuman

Cohen

Nanau

2016

Clinical Biochemistry

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“…9 In Type 2 diabetes, a mixed meal challenge has been shown to result in the rise of serum markers of liver injury. 10 Portal vein flow measured using Doppler ultrasound has been shown to be blunted in patients with chronic liver disease compared with healthy volunteers, 11,12 but Doppler flow measures have been shown to have high variability and poor reproducibility. [12][13][14] Liver stiffness, as measured by transient elastography, has been shown to increase after a meal challenge, peaking 30 minutes postprandial.…”

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confidence: 99%

Using MRI to study the alterations in liver blood flow, perfusion, and oxygenation in response to physiological stress challenges: Meal, hyperoxia, and hypercapnia

Cox

Palaniyappan

Aithal

et al. 2018

Magnetic Resonance Imaging

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Background Noninvasive assessment of dynamic changes in liver blood flow, perfusion, and oxygenation using MRI may allow detection of subtle hemodynamic alterations in cirrhosis. Purpose To assess the feasibility of measuring dynamic liver blood flow, perfusion, and T2* alterations in response to meal, hypercapnia, and hyperoxia challenges. Study Type Prospective. Subjects Ten healthy volunteers (HV) and 10 patients with compensated cirrhosis (CC). Field Strength/Sequence 3T; phase contrast, arterial spin labeling, and normalT2* mapping. Assessment Dynamic changes in portal vein and hepatic artery blood flow (using phase contrast MRI), liver perfusion (using arterial spin labeling), and blood oxygenation (normalT2* mapping) following a meal challenge (660 kcal), hyperoxia (target PETO2 of 500 mmHg), and hypercapnia (target increase PETCO2 of ∼6 mmHg). Statistical Tests Tests between baseline and each challenge were performed using a paired two‐tailed t‐test (parametric) or Wilcoxon‐signed‐ranks test (nonparametric). Repeatability and reproducibility were determined by the coefficient of variation (CoV). Results Portal vein velocity increased following the meal (70 ± 9%, P < 0.001) and hypercapnic (7 (5–11)%, P = 0.029) challenge, while hepatic artery flow decreased (–30 ± 18%, P = 0.005) following the meal challenge in HV. In CC patients, portal vein velocity increased (37 ± 13%, P = 0.012) without the decrease in hepatic artery flow following the meal. In both groups, the meal increased liver perfusion (HV: 82 ± 50%, P < 0.0001; CC: 27 (16–42)%, P = 0.011) with faster arrival time of blood (HV: –54 (–56‐30)%, P = 0.074; CC: –42 ± 32%, P = 0.005). In HVs, normalT2* increased after the meal and in response to hyperoxia, with a decrease in hypercapnia (6 ± 8% P = 0.052; 3 ± 5%, P = 0.075; –5 ± 6%, P = 0.073, respectively), but no change in CC patients. Baseline between‐session CoV <15% for blood flow and <10% for normalT2* measures. Data Conclusion Dynamic changes in liver perfusion, blood flow, and oxygenation following a meal, hyperoxic, and hypercapnic challenges can be measured using noninvasive MRI and potentially be used to stratify patients with cirrhosis. Level of Evidence: 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:1577–1586.

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Elevation of Alanine Transaminase and Markers of Liver Fibrosis After a Mixed Meal Challenge in Individuals with Type 2 Diabetes

Abstract: In subjects with T2DM, a mixed meal challenge is associated with a significant elevation in the serum levels of ALT, HA and P3NP without significant changes in LFC. These markers should be performed in the fasted state.

Cited by 8 publications

References 27 publications

MRI assessment of altered dynamic changes in liver haemodynamics following a meal challenge in compensated cirrhosis

MRI assessment of altered dynamic changes in liver haemodynamics following a meal challenge in compensated cirrhosis

Hyaluronic acid as a non-invasive biomarker of liver fibrosis

Using MRI to study the alterations in liver blood flow, perfusion, and oxygenation in response to physiological stress challenges: Meal, hyperoxia, and hypercapnia

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