Role of micronutrients in staging of nonalcoholic fatty liver disease: A retrospective cross-sectional study

Abstract

BACKGROUND Nonalcoholic fatty liver disease (NAFLD) presents high incidence throughout the world and has been progressively increasing in prevalence. This disease has a heterogeneous natural history, including simple steatosis, nonalcoholic steatohepatitis (NASH), and cirrhosis. The factors that determine its evolution to more severe forms of the disease are still poorly understood, and micronutrients with antioxidant potential may be involved in the pathophysiology of the disease. AIM To evaluate the relationship between serum levels of micronutrients and the severity of NAFLD. METHODS A retrospective, observational and cross-sectional study was conducted. This study included all patients undergoing bariatric surgery who experienced liver biopsy during the procedure, and had serum levels of micronutrients (vitamin D, vitamin B12, zinc, iron, and magnesium), which was assessed in a preoperative evaluation conducted at a reference center in southern Brazil. RESULTS A total of 614 patients were analyzed, of which 93% had steatosis, 70.7% had NASH, and 49.3% had some degree of fibrosis. Serum levels of vitamin D were negatively correlated with the severity of steatosis and NASH, and serum levels of vitamin B12 were positively correlated with the severity of steatosis and fibrosis. The other micronutrients showed no association with NAFLD staging. CONCLUSION Serum levels of vitamin D are inversely related to the severity of steatosis and NASH, and serum levels of vitamin B12 are higher in more advanced stages of simple steatosis and liver fibrosis. Serum levels of zinc, iron, and magnesium were not associated with NAFLD severity.

Clinical Relevance of Vitamins and Carotenoids With Liver Steatosis and Fibrosis Detected by Transient Elastography in Adults

“…The potential mechanisms of vitamin B1 and vitamin B12 in NAFLD remains unclear, and findings from clinical studies are scarce ( 8 ). Higher serum levels of vitamin B12 were positively correlated with the severity of steatosis and fibrosis in 614 Brazilian patients ( 34 ). Dietary intakes of vitamin B1 and vitamin B12 were also found higher in patients with NAFLD patients than controls in 120 adult Jordanians ( 25 ) and 101 Canadians ( 27 ).…”

Histological and Immunohistochemical Study of the Effect of prenatal Zinc Deficiency on Postnatal Development of rat Liver

“…The current study declared remarkable vacuolation of hepatocytes at both light and electron microscopic levels; this was explained by Barabara and Mindigulo [45] , who reported that zinc deficiency results in lipid deposition in hepatocytes; a clinical condition known as nonalcoholic fatty liver diseases. They also added that dietary zinc deficiency results in endoplasmic reticulum stress with dysfunction of enzymes needed for hepatic lipid metabolism with subsequent fatty liver development, which may end to liver fibrosis [46] . In view of such findings, most light microscopic observations, including vacuolation and ultrastructural demonstration of lipid deposition within hepatocytes in all age groups suffering from zinc deficiency, could be explained.…”

Bi-directional causal effect between vitamin B12 and non-alcoholic fatty liver disease: Inferring from large population data

“…Therefore, the intake of vitamin B12 should be given great attention, especially its impact on NAFLD. Moreover, some study designs, including cross-sectional and case-control studies, have evaluated the association between vitamin B12 and NAFLD (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Several studies implicated positive association between vitamin B12 and NAFLD (12,16,20,21), whereas others indicated inverse association (10,13,19) or no association (11,14,15,17,18,22).…”

“…Moreover, some study designs, including cross-sectional and case-control studies, have evaluated the association between vitamin B12 and NAFLD (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Several studies implicated positive association between vitamin B12 and NAFLD (12,16,20,21), whereas others indicated inverse association (10,13,19) or no association (11,14,15,17,18,22). Notably, a latest systematic review and meta-analysis comprising 361 NAFLD subjects and 510 controls demonstrated no association of vitamin B12 concentrations with risk of NAFLD (23).…”