Essential phospholipids as a supportive adjunct in the management of patients with NAFLD

Dajani, Asad Izziddin; Hammour, Adnan M. Abu; Zakaria, Mohammed; Jaberi, Mazen R. Al; Nounou, Mohamed Ismail; Semrin, Abdul Ilah M.

doi:10.1016/j.ajg.2015.09.001

Cited by 29 publications

(43 citation statements)

References 44 publications

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“…This is line with the findings of previous clinical studies evaluating PPC in patients with NAFLD with metabolic comorbidities. 5 33 35 In one study conducted in 28 patients with NAFLD with T2DM who received 2.1 g/day of PPC as an adjuvant treatment, a significant reduction in liver function tests was observed after EPL treatment. 33 ALT, AST and GGT levels, respectively, decreased by a mean of 17.4, 10.4 and 9.1 U/L after 6 months of treatment with PPC adjunctive therapy, and this decrease was observed from the beginning of PPC therapy (p<0.05 compared with baseline for all three liver enzymes at months 2, 4, and 6 of treatment).…”

Section: Discussionmentioning

confidence: 99%

“…5 EPL led to notable symptomatic improvement and a mean reduction of ALT of 50.8 U/L and AST of 46.1 U/L per patient (p<0.01 compared with baseline for both liver enzymes); liver transaminases levels were reduced after the first 6 months of EPL treatment in 80.5% of patients with lone NAFLD, 84.1% of patients with NAFLD with T2DM, and 87.5% of patients with NAFLD with hyperlipidaemia. 5 In a double-blind trial also from Russia conducted in 215 copyright.…”

Section: Discussionmentioning

confidence: 99%

“…2 3 NAFLD is recognised as the hepatic manifestation of the metabolic syndrome, which includes obesity, dyslipidaemia, hypertension and type 2 diabetes mellitus (T2DM). [3][4][5] Obesity, in particular, is often associated with NAFLD, as the degree of steatosis was found to be correlated with body mass index (BMI). 6 7 The World Gastroenterology Organisation recommends a hierarchical resource-sensitive approach to the diagnosis of NAFLD.…”

Section: Open Access Summary Boxmentioning

confidence: 99%

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Effectiveness of phosphatidylcholine as adjunctive therapy in improving liver function tests in patients with non-alcoholic fatty liver disease and metabolic comorbidities: real-life observational study from Russia

Маев

Самсонов

Пальгова

et al. 2020

BMJ Open Gastroenterol

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ObjectiveNon-alcoholic fatty liver disease (NAFLD) is the most common cause of abnormal results of liver function tests. Earlier research showed that polyenylphosphatidylcholine (PPC) has hepatoprotective effects and thus can be used for the treatment of NAFLD and the prevention of its progression. Accordingly, the aim of this observational study was to evaluate if PPC administered as adjunctive therapy in routine clinical practice can effectively improve liver function tests of NAFLD in Russian patients with associated metabolic comorbidities.DesignA total of 2843 adult patients with newly diagnosed NAFLD, who had a least one of four comorbidities, namely, overweight/obesity, hypertension, type 2 diabetes mellitus, and hypercholesterolaemia, and who were prescribed 1.8 g/day of PPC as an adjunctive treatment to standard care, were enrolled during 2015–2016. Laboratory data were collected at baseline and 12 and 24 weeks of the study, and included liver function tests (aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT)), fasting plasma glucose, and lipid profile.ResultsOverall, 2263 patients (79.6%) had at least two metabolic comorbidities associated with NAFLD, and overweight/obesity was the most common comorbidity reported in 2298 (80.8%) patients. At 24 weeks, there was a significant decrease in liver enzyme levels (all p<0.001 compared with baseline). Across the four comorbidity subgroups, there was a mean drop of ALT levels ranging from 19.7 to 22.0 U/L, AST from 16.9 to 18.4 U/L, and GGT from 17.2 to 18.7 U/L. Similar findings were reported in subgroups with either one, two, three, or four comorbidities, with a significant decrease in liver enzyme levels ranging from 18.4 to 22.4 U/L for ALT, 14.8 to 18.7 U/L for AST, and 15.5 to 19.5 U/L for GGT.ConclusionsAdjuvant treatment with PPC resulted in consistent improvements in liver enzymes in patients with newly diagnosed NAFLD and associated metabolic comorbidities.Trial registration numberNCT00063622.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Open Access Summary Boxmentioning

confidence: 99%

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Effectiveness of phosphatidylcholine as adjunctive therapy in improving liver function tests in patients with non-alcoholic fatty liver disease and metabolic comorbidities: real-life observational study from Russia

Маев

Самсонов

Пальгова

et al. 2020

BMJ Open Gastroenterol

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“…Hence, in this study, we explored the effect of GP on NAFLD (HFD induced) rats using dilinoleoyl phosphatidylcholine (DLPC) as a contrast [23,24].…”

Section: Introductionmentioning

confidence: 99%

Structural modulation of gut microbiota during alleviation of non-alcoholic fatty liver disease with Gynostemma pentaphyllum in rats

Shen

Zhong

Peng

et al. 2020

BMC Complement Med Ther

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Background: The current work aimed to assess whether Gynostemma pentaphyllum (GP), a Chinese herbal medicine, structurally modifies the gut microbiota in rats during non-alcoholic fatty liver disease (NAFLD) treatment. Methods: High-fat diet (HFD)-induced NAFLD rats were orally administered water decoction of GP or equal amounts of distilled water per day for 4 weeks. Liver tissues were examined by histopathological observation, while intestinal tissues were examined by both histopathological and ultrastructural observations. The levels of fasting blood glucose (FBG), fasting serum insulin (FINS), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), alanine transaminase (ALT) and aspartate transaminase (AST) were measured by enzymatic method. The levels of toll-like receptor 4 (TLR-4), tumor necrosis factor-alpha (TNF-α), interleukin-1-beta (IL-1β) and interleukin-6 (IL-6) in both serum and hepatic tissues were measured by RT-qPCR. The protein expression level of TLR-4 in hepatic tissues was detected by western blot. The gut microbiota was assessed by 16S rRNA-based microbiota analysis. Results: GP maintained intestinal integrity and reversed gut dysbiosis in high-fat diet (HFD)-induced NAFLD rats. This also reduced the ratio of Firmicutes to Bacteroidetes, enriching the abundance of beneficial bacteria (Lactococcus spp.) and inhibiting the abundance of pathogenic bacteria (Ruminococcus spp.) in the gut. The levels of pro-inflammatory cytokines (TNF-α, IL-1β and IL-6) and the expression of TLR4 were downregulated (P < 0.05), while the insulin resistance index, HOMA-IR showed improvement by GP treatment (P < 0.05). Liver function indicators (ALT and AST) were remarkably decreased (P < 0.01). Besides, GP treatment reduced TG and LDL-C levels (P < 0.05), and increased HDL-C level (P < 0.05) compared with NAFLD group. Conclusion: The structural alterations of gut microbiota induced by GP are associated with NAFLD alleviation.

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“…Результатом явилось достоверное уменьшение уровня АСТ и АЛТ, при этом отмечено умеренное улучшение ультразвуковой картины, а также уменьшение плотности печени по данным ультразвуковой эластометрии (в сред-нем на 3,1 кПа). Эффективность ЭФ продемонстрирована не только в группе пациентов с НАЖБП, но и при ее соче-тании с сахарным диабетом 2-го типа и смешанной гипер-липидемией [59].…”

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Fatty Liver Disease. Modern Pathogenetic Approach to Therapy

Махов¹,

Володина²,

Панферов³

2016

Med. sov.

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В патогенезе НАЖБП традиционно рассматривают два этапа -два «толчка». Первый обусловлен нарушением углеводного и липидного обмена. При этом отмечают высокую роль инсулинорезистентности в генезе НАЖБП и НАСГ. НАЖБП весьма часто сопровождает метаболиче-ский синдром (МС), при котором инсулинорезистентность является ведущим звеном [3].В соответствии с этапами патогенеза выделяют пер-вичную и вторичную НАЖБП. При первичной НАЖБП, когда этиологическими факторами являются ожирение, сахарный диабет II типа, дисгиперлипидемии, выявляют высокое содержание триглицеридов (ТГ), липопротеинов (ЛП) и свободных жирных кислот (СЖК) в крови и в пече-ни. Накопление СЖК в печени способствует высокому уровню инсулина в крови. Гиперинсулинизм, сопровожда-ющий ожирение, СД 2-го типа и МС являются патогенети-ческими факторами, поскольку инсулин стимулирует син-тез СЖК, ТГ, а также снижает β-окисление СЖК и эвакуа-цию липидов из печени. Такой патогенез соответствует первичному варианту НАЖБП.Предполагается, что «первым толчком» при первич-ном варианте НАСГ является накопление СЖК в гепатоци-те. СЖК являются высокореактивным субстратом пере-кисного окисления липидов (ПОЛ). Этот процесс с обра-зованием активных радикалов приводит к повреждению митохондрий и клеточных мембран.Возникло понимание, что только избыточное накопле-ние в печени СЖК является необходимым, но недостаточ-ным для возникновения «оксидантного стресса». Появи-лось представление о «втором толчке», приводящем к НАСГ. Индукторами, дополнительными факторами «второ-го толчка» рассматривают воздействие лекарств, дефицит в пище антиоксидантов, гормональный дисбаланс. Со «вторым толчком» возникло положение о вторичном варианте НАЖБП.Список заболеваний и ситуаций, при котором возни-кают «вторичные» НАЖБП и НАСГ, весьма широк и вклю-чает: синдром нарушенного всасывания, особенно при операциях по поводу ожирения, интенсивное снижение массы тела, длительное, несбалансированное паренте-ральное питание, болезни накопления [4].Морфологическим критерием НАЖБП являются резуль-таты пункционной биопсии печени (ПБП): стеатоз или сте-атогепатит, фиброз и цирроз [4]. Показано, что ПБП, прово-димая по поводу верификации причины диффузной пато-логии печени, выявляет НАЖБП в 7-9% [5].Исследование биоптата позволяет определить сте-пень фиброза (от F 1 до F 3 ), наличие ЦП (F 4 ), характер вос-паления, степень стеатоза. При этом количество жира, главным образом ТГ, составляет более 5% сухого веще-ства органа [5]. ЖДП определяют также как стеатоз пече-ни, гепатостеатоз, жировой гепатоз, жирная печень (fat liver). Представлена такая градация: при вовлечении в стеатоз менее 30% гепатоцитов -легкая, средняя -до 60% и тяжелая -более 60% [6].Клиническая практика показывает, что ⅓ пациентов отказывается от процедуры. Следует учитывать, что воз-можности исследования не безграничны и во многом зависят от диагностической ценности биоптата, представ-ляющего лишь определенный участок паренхимы органа

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Essential phospholipids as a supportive adjunct in the management of patients with NAFLD

Cited by 29 publications

References 44 publications

Effectiveness of phosphatidylcholine as adjunctive therapy in improving liver function tests in patients with non-alcoholic fatty liver disease and metabolic comorbidities: real-life observational study from Russia

Effectiveness of phosphatidylcholine as adjunctive therapy in improving liver function tests in patients with non-alcoholic fatty liver disease and metabolic comorbidities: real-life observational study from Russia

Structural modulation of gut microbiota during alleviation of non-alcoholic fatty liver disease with Gynostemma pentaphyllum in rats

Fatty Liver Disease. Modern Pathogenetic Approach to Therapy

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