Vitamin D Deficiency, A Noninvasive Marker of Steatohepatitis in Patients with Obesity and Biopsy Proven Nonalcoholic Fatty Liver Disease

Abstract

Context. Nonalcoholic fatty liver disease (NAFLD) includes simple steatosis, steatohepatitis (NASH) which can evolve with progressive fibrosis, cirrhosis and hepatocellular carcinoma. As liver biopsy cannot be used as a screening method, noninvasive markers are needed.Objective. The aim of this study was to test if there is a significant association between vitamin D deficit and the severity of NAFLD.Design. The patients were divided into two groups (vitamin D insufficiency/deficiency) and statistical analyses were performed on the correlation of clinical and biochemical characteristics with histopathological hepatic changes.Subjects and methods. We prospectively studied 64 obese patients referred for bariatric surgery between 2014 and 2016 to our Surgical Unit. Anthropometric, clinical measurements, general and specific biological balance were noted. NAFLD diagnosis and activity score (NAS) were evaluated on liver biopsies.Results. Increased serum fibrinogen was correlated with NASH (p=0.005) and higher NAS grade. T2DM was positively correlated with liver fibrosis (p=0.002). 84.37% of the patients had vitamin D deficit and 15.62% were vitamin D insufficient. Lobular inflammation correlated with vitamin D deficit (p=0.040). Fibrosis (p=0.050) and steatohepatitis (p=0.032) were independent predictors of low vitamin D concentration.Conclusions. Vitamin D status in conjunction with other parameters -such as T2DM -or serum biomarkersnamely fibrinogen level and PCR level -may point out the aggressive forms of NAFLD and the need for liver biopsy for appropriate management.

Non-invasive Assessment of Liver Steatosis and Fibrosis Using Transient Elastography and Controlled Attenuation Parameter in type 2 Diabetes Patients

“…Despite obtaining information only from a quite small number of patients, our data are consistent with other recently published results that showed that steatosis is present in an important number of T2DM patients and it was positively correlated with liver fibrosis (23)(24).…”

Vitamin D Deficiency During Development Permanently Alters Liver Cell Composition and Function

“…The association between vitamin D deficiency in adulthood and chronic liver diseases (CLD) ( 40 ), including cirrhosis ( 41 ), non-alcoholic fatty liver disease (NAFLD, recently been proposed to rename as metabolic-associated fatty liver disease [MAFLD) ( 42 )] ( 43 – 45 ), and non-alcoholic steatohepatitis (NASH) ( 44 , 45 ), have been identified in many cross-sectional studies. Stokes et al.…”

Effect of Bariatric Surgery on Metabolic Diseases and Underlying Mechanisms

“…While the liver is mainly affected, a large portion of the gastrointestinal system is inhibited by the presence of various biomarkers that disrupt chemical and endocrine functionality. These biomarkers consist of, but are not limited to, cholesteryl ester transfer protein (CETP) [ 55 ], neurotensin (NT) [ 56 ], and vitamin D [ 57 ]. CETP accompanies NAFLD progression through metabolic liver inflammation.…”

“…High levels of NT have been associated with high rates of NAFLD, cardiovascular disease, T2DM, and obesity. Insufficient or deficient vitamin D levels are indicative of NAFLD progression in association with fibrinogen levels, PCR levels, and T2DM [ 57 ].…”