Lifestyle modifications, including calorie deficit diets targeting weight loss, are the first line treatment and prevention measures for the development and progression of the emerging cardiometabolic disease, nonalcoholic fatty liver disease (NAFLD), particularly early in the disease course when interventions may alter the natural history. However, the optimal composition of eating patterns to protect liver health is still under debate. High-quality diets with anti-inflammatory, antioxidant, and anti-obesity effects have the potential to play an important role in NAFLD occurrence; however, evidence is still limited. Dietary Approaches to Stop Hypertension (DASH) and a Mediterranean-style diet are two major healthy dietary patterns that have been extensively reported to prevent cardiometabolic outcomes such as hypertension (HTN) and cardiovascular disease (CVD), major concomitant diseases of NAFLD. A few indexes have been developed to measure adherence to both of these dietary patterns in observational studies. However, none of the DASH indexes have been updated with current evidence in more than a decade. Research suggests that greater reductions in cardiometabolic disorders are possible with more updated guidance. In addition to the impact of overall diet quality, the effects of specific foods on liver fat are still unknown, and some, such as eggs, are controversial. Until recently, eggs have been considered unhealthy due to concerns about dietary cholesterol intake, but evidence suggests these concerns may have been influenced by confounding. Eggs are rich in many important nutrients and bioactive compounds, including dietary choline and carotenoids, that may benefit cardiometabolic outcomes, including NAFLD. Choline deficiency has been shown to cause liver steatosis in preclinical studies, but little is known about the relations between egg consumption, egg-rich nutrients, and liver fat in humans. The objectives of this dissertation are to evaluate the association between adherence to different healthy dietary patterns, including a Mediterranean-style diet and the DASH diet, and NAFLD risk. To account for updated evidence, we also developed and tested the reliability and validity of a newly modified DASH (mDASH) eating pattern and evaluated its association with incident NAFLD risk as well as changes in liver fat over a 6-year follow-up period. Lastly, we evaluated the associations between eggs and selected egg-rich nutrients (i.e., choline, lutein, and zeaxanthin) and NAFLD risk and prevalence alone and in combination with other dietary habits. We used data from several cohorts in the Framingham Heart Study, including the Offspring, Third Generation, Omni Generation Cohort 1, and Omni Generation Cohort 2. Liver fat was assessed using a computed tomography (CT) scan using the average liver fat attenuation relative to a control phantom to create the liver phantom ratio (LPR) at two sequential CT scans (2002–2005 and 2008–2011) in the Offspring and Third Generation cohorts; measures were available at a single CT scan (2008–2011) in Omni cohorts. NAFLD was defined as a LPR ≤0.33 in the absence of heavy alcohol use (>14 drinks per week for females and >21 drinks per week for males). Prevalent NAFLD was determined on the follow-up CT scan, which all cohorts had available. Among those with no NAFLD at the first CT scan, incident NAFLD was determined on the follow-up CT scan. To determine changes in liver fat, we calculated the difference in LPR from one exam to the next by subtracting the 1st CT scan LPR measure from the 2nd CT LPR measure. Next, we calculated annualized changes by dividing LPR change values by the year difference between the 1st and 2nd CT scan dates for each participant. For the assessment of incident NAFLD and liver fat change, dietary data were derived from food frequency questionnaires (FFQs) administered as close as possible in time to the first liver fat measurement. For the analysis of prevalent liver fat, we used the FFQ as close as possible in time to the second liver fat measurement. The first specific aim of this dissertation is to evaluate whether adherence to the Mediterranean diet (MeDiet Index) or a DASH eating pattern (Fung DASH index) was associated with NAFLD risk. Modified Poisson regression models were used to compute incident NAFLD risk ratios (RR) and 95% confidence intervals (CI) associated with three score categories (low, moderate, and high) on each index adjusting for confounding in 1413 Framingham Offspring and Third Generation participants. Multivariable linear regression models were used to compute adjusted annualized means of liver fat change over a median of 6 years of median follow-up in 1691 participants. In the second specific aim, we aimed to evaluate the adherence to a mDASH eating pattern on NAFLD risk and changes in liver fat using a newly developed mDASH index. Firstly, we developed and evaluated the psychometric properties (reliability and validity) of the new mDASH index. To develop the index, we started with the components included in the original DASH eating pattern (fruits, vegetables, and low-fat dairy), and then proceeded to add components, one at a time, that have been suggested in the literature to protect against known DASH-related outcomes. The selection of the components included in the final mDASH index (total vegetables (including potatoes), total fruit, total dairy (including full-fat dairy), red and processed meat, whole grains, legumes, nuts and seeds, sugar-sweetened beverages, and fish) was based on two criteria: 1) factors found in previous literature to be associated with blood pressure and cardiovascular outcomes, and 2) the ability of possible components in the new mDASH to predict the risk of known DASH-related outcomes (i.e., HTN and atherosclerotic CVD (ASCVD)). Test-retest reliability analyses of the proposed mDASH index were performed with Pearson correlation coefficients over four sequential examination visits in 1339 Offspring Cohort individuals. To assess construct validity, we computed cross-sectional linear regression and correlation analyses between the proposed mDASH index against key DASH nutrients such as calcium, potassium, magnesium, and fiber in 2763 Offspring Cohort individuals. Next, we used Cox regression models to evaluate the predictive validity of the mDASH index, with one modification at a time, for incident HTN (n=1714) and then for ASCVD (n=2700) risks over 11 and 25 medians years of follow-up, respectively. Once the mDASH index was finalized, we used Cox models to determine whether our final mDASH index represents an improvement over three previously established DASH indexes (Fung, Dixon, and Günther) for predicting HTN and ASCVD in two Framingham cohorts, the Offspring and the younger Third Generation cohorts. Lastly, we aimed to evaluate the association between mDASH (vs. earlier DASH indexes) and the risk of incident NAFLD. Multivariable modified Poisson regression and general linear models were used to compute incident NAFLD RR (n=1406) and adjusted means of annualized liver fat change (n=1692) associated with the mDASH index and other prior DASH indexes in a combined sample from the Offspring and Third Generation cohorts. In the third specific aim, we evaluated the impact of egg and egg-rich nutrients (choline, lutein, and zeaxanthin) on NAFLD risk. Egg intake was classified into three categories based on the food frequency questionnaire categories (<1, 1, and ≥2 per week). Dietary choline was body weight adjusted based on the residual method while lutein and zeaxanthin were classified into tertiles, respectively. Multivariable logistic regression models were used to compute prevalent NAFLD odds ratios (OR) associated with egg intakes in 2644 participants from the Offspring, Third Generation, Omni 1, and Omni 2 cohorts. Multivariable modified Poisson regression and general linear models were used to compute NAFLD incident RR (n=1414) and adjusted means of annualized liver fat change (n=1690) associated with egg, choline, and lutein and zeaxanthin intakes in a combined sample from the Offspring and Third Generation cohorts which had repeated measures of liver fat. In our analyses related to the comparison of the DASH eating pattern with a Mediterranean-style diet (Aim 1, Chapter 2), in a combined sample from the Offspring and Third Generation cohorts 19% of participants (n=1413, mean age 51 years, 53% female) developed new onset of NAFLD during follow-up and liver fat increased for most participants. High score category (>28 vs. ≤23 scores) on the Fung DASH index were associated with a 40% lower risk of incident NAFLD (95% CI: 0.42–0.84) after adjusting for age, sex, alcohol intake, education status, current smoking status, multivitamin use, moderate-to-vigorous physical activity, and annualized waist-to-height ratio changes. These findings were stronger in women than men (RR for higher (vs. lower) DASH scores: 0.46, 95% CI: 0.26–0.84 in women; 0.69, 95% CI: 0.45–1.05 in men). DASH scores were also associated with statistically significantly less acquisition of liver fat over study follow-up (p-value<0.05). Further, the DASH diet was protective against NAFLD risk even among individuals with prevalent HTN or an elevated triglyceride:high density lipoprotein cholesterol (TG:HDL-C) ratio. We observed no association between adherence to a MeDiet index and NAFLD risk or liver fat change. The development and testing of the mDASH index are shown in Chapter 3. We found in the analyses for this second specific aim that there was strong evidence of test-retest reliability for the newly-developed mDASH index as supported by moderate to high correlations (r=0.59–0.71) in total mDASH scores between four sequential exams. The construct validity of the mDASH index was supported by its associations with selected nutrients in expected directions. Total mDASH scores were strongly positively associated with intakes of calcium, potassium, magnesium, and fiber (p-values<0.05). These associations were similar to or stronger than those observed with previous DASH indexes. The predictive validity of the new mDASH index was supported by the statistically significant 31% and 29% lower risks of incident HTN and ASCVD associated with score quintile 5 (vs. quintile 1) on the new index in the older Offspring Cohort. Similarly, strong inverse associations between the mDASH index and both HTN and ASCVD were also observed in the younger Third Generation Cohort. These associations were of a similar magnitude to those observed with the Fung index for both HTN and ASCVD but stronger than those seen with the Dixon or Günther indexes. In Chapter 3, we also examined the association between the new mDASH index and risk of incident NAFLD. We found that score tertile 3 (vs. tertile 1) on the mDASH index was associated with a 29% lower NAFLD risk (95% CI: 0.53–0.95) after adjusting for age, sex, energy, sodium intake, current smoking status, education level, multivitamin use, and alcohol intake. In addition, the highest scores on all DASH indexes (mDASH, Fung, Dixon, and Günther) were associated with substantially smaller annualized increases in liver fat over the study follow-up (p-value <0.05). In Chapter 4 of this dissertation, we first examined the association between egg consumption and prevalent and incident NAFLD. NAFLD prevalence was 29% among participants (n=2644) in a combined sample from the Offspring, Third Generation, Omni 1, and Omni 2 cohorts. In a sample from the Offspring and Third Generation cohorts with two measures of liver fat (n=1414), the cumulative incidence of NAFLD was 19% and liver fat was found to increase for most participants during follow-up. After adjusting for confounding by age, sex, energy, red meat and alcohol intakes, prevalent HTN, and body mass index (BMI), we found no association between egg intake and prevalent NAFLD (OR for ≥2 vs. <1 eggs per week (referent): 1.15, 95% CI: 0.92–1.45). Similarly, we observed no associations between egg intake and incident NAFLD risk (RR for ≥2 vs. <1 eggs per week (referent): 1.00, 95% CI: 0.77–1.30) or annualized change in liver fat. Our final specific aim in Chapter 4 was to examine the associations between selected egg-rich nutrients and NAFLD risk. Here, we found that dietary choline intake was strongly associated with a 31% lower risk of incident NAFLD (RR for highest vs. lowest tertile: 0.69, 95% CI: 0.51-0.94) after adjusting for age, sex, education level, and waist-to-height ratio. No associations were found between lutein and zeaxanthin intakes and NAFLD. In summary, the findings of this dissertation suggested that adherence to a DASH eating pattern is beneficially associated with a lower risk of incident NAFLD. Our new mDASH index supports other evidence suggesting that the DASH eating pattern should no longer be limited to the consumption of low-fat dairy and that total vegetable intake does not need to exclude white or sweet potatoes from the diet. The new mDASH is associated with a lower risk of traditional DASH-related outcomes, including HTN and ASCVD, as well as with the emerging cardiometabolic risk factor, NAFLD. Lastly, higher egg intake alone or combined with other eating patterns was not associated with NAFLD, while dietary choline intakes were inversely associated with NAFLD risk.

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Submitted by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2013-10-15T15:33:27Z No. of bitstreams: 1 Luana Palma. Doença esteatotica...2012.pdf: 6491139 bytes, checksum: 17714fa9ab206495fbf5e1aa05890deb (MD5) / Made available in DSpace on 2013-10-15T15:33:27Z (GMT). No. of bitstreams: 1 Luana Palma. Doença esteatotica...2012.pdf: 6491139 bytes, checksum: 17714fa9ab206495fbf5e1aa05890deb (MD5) Previous issue date: 2013 / Universidade Federal da Bahia. Salvador, BA, Brasil / Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, Brasil / A Doença Esteatótica Não Alcoólica do Fígado (do inglês Nonalcoholic Fatty Liver Disease – NAFLD) é uma doença crônica hepática de caráter espectral, que vai desde a esteatose simples até a esteato-hepatite não alcoólica. A progressão para cirrose e carcinoma hepatocelular têm sido descrita. A NAFLD apresenta aspectos histológicos semelhantes à doença hepática relacionada ao álcool (esteatose, inflamação lobular, corpúsculos de Mallory e fibrose), mas acomete indivíduos com história negativa de consumo excessivo de álcool. A NAFLD é uma das principais doenças crônicas hepáticas mundiais, e os indivíduos obesos representam a maioria dos casos da doença. Os mecanismos envolvidos na progressão da esteatose para esteato-hepatite não são bem compreendidos. Neste aspecto, modelos murinos da NAFLD têm sido frequentemente utilizados para elucidação destes mecanismos. A maioria dos modelos disponíveis é resultante de modificações genéticas e/ou nutricionais e, em geral, não simulam as alterações metabólicas e histológicas comumente vistas em pacientes com NAFLD. Em nosso grupo, foi proposto um novo modelo de NAFLD. Camundongos C57BL/6 alimentados com dieta rica em gordura (High Fat - HF) demonstraram alterações metabólicas e histológicas sugestivas de NAFLD. O objetivo do presente trabalho foi comparar alterações histológicas hepáticas presentes nestes camundongos com as alterações observadas em pacientes obesos. Amostras de fígados de pacientes obesos e de camundongos alimentados com a dieta HF foram utilizadas. Os tecidos hepáticos foram corados em Hematoxilina & Eosina e Picrossírius Red para avaliação das alterações hepáticas (esteatose, balonização, inflamação, corpúsculos de Mallory-Denk e fibrose). Além disso, foi realizada imunoistoquímica para avaliação da presença de células estrelares ativadas e de células progenitoras hepáticas, células envolvidas na fibrose e no desenvolvimento de carcinoma hepatocelular, respectivamente. Os resultados demonstraram que os fígados de todos os pacientes obesos exibiram esteatose macrovacuolar, balonização hepatocelular, inflamação lobular e fibrose perissinusoidal, o que caracterizou estes pacientes como portadores da NAFLD. As mesmas alterações foram observadas em fígados de camundongos alimentados com a dieta HF. As células estrelares ativadas foram observadas em todos os pacientes obesos, assim como em camundongos de dieta HF. As células progenitoras hepáticas foram observadas na maioria dos pacientes obesos. O fígado de todos os camundongos alimentados com dieta HF exibiram células progenitoras hepáticas. A partir dos dados obtidos, pode-se concluir que fígados de camundongos alimentados com dieta HF exibem alterações histológicas hepáticas similares às observadas em pacientes obesos. Isto abre perspectivas para a utilização do modelo proposto em estudos que busquem elucidar os mecanismos envolvidos na patogênese da NAFLD. / Nonalcoholic Fatty Liver Disease (NAFLD) is a chronic liver disease ranging from simple steatosis to nonalcoholic steatohepatitis. The progression to cirrhosis and hepatocellular carcinoma has been reported. The NAFLD shows histological features similar to alcohol-related liver disease (steatosis, lobular inflammation, fibrosis and Mallory-Denk bodies), but affects individuals with no history of excessive alcohol consumption. The NAFLD is a major chronic hepatic disease in the world, and obese individuals represent the majority of cases of the disease. The mechanisms involved in the progression of steatosis to steatohepatitis are not well understood. In this regard, murine models of NAFLD have been frequently used for elucidation of these mechanisms. Most available models are the result of genetic or nutritional modifications, and generally do not mimic metabolic and histologic changes commonly seen in patients with NAFLD. In our group, we have proposed a new model of NAFLD. Mice fed high fat diet (HF diet) demonstrated metabolic and histological features suggestive of NAFLD. The aim of this study was to compare liver histological alterations present in these mice with the changes observed in obese patients. Samples of livers of obese patients and mice fed HF diet were used. For assessment of liver alterations, such as steatosis, ballooning, inflammation, Mallory- Denk bodies and fibrosis, tissues were stained with hematoxylin & eosin and picrossirius red. In addition, the presence of activated stellate and progenitor liver cells was estimated using immunohistochemistry. The results show that the livers of all obese patients exhibited macrovesicular steatosis, hepatocellular ballooning, perisinusoidal fibrosis, and lobular inflammation, which characterized these patients with NAFLD. Similar changes were observed in livers of mice that fed the HF diet. Activated stellate cells were observed in all obese patients as well as in mice HF. Hepatic progenitor cells were observed in most obese patients. The liver of all animals fed the HF diet exhibited liver progenitor cells. From the data obtained, it can be concluded that livers of mice fed with HF diet exhibit liver abnormalities similar to those observed in obese patients. This opens perspectives for the use of the proposed model in studies that seek to elucidate the mechanisms involved in the pathogenesis of NAFLD.

C1q TNF Related Protein 3 (CTRP3) is a member of a family of secreted proteins that exert a multitude of biological effects. Our initial work identified CTRP3’s promise as an effective treatment for Nonalcoholic fatty liver disease (NAFLD). Specifically, we demonstrated that mice fed a high fat diet failed to develop NAFLD when treated with CTRP3. The purpose of this current project is to identify putative receptors which mediate the hepatic actions of CTRP3. Methods We used Ligand-receptor glycocapture technology with TriCEPS™-based ligand-receptor capture (LRC-TriCEPS; Dualsystems Biotech AG). The LRC-TriCEPS experiment with CTRP3-FLAG protein as ligand and insulin as a control ligand was performed on the H4IIE rat hepatoma cell line. Results Initial analysis demonstrated efficient coupling of TriCEPS to CTRP3. Further, flow cytometry analysis (FACS) demonstrated successful oxidation and crosslinking of CTRP3-TriCEPS and Insulin-TriCEPS complexes to cell surface glycans. Demonstrating the utility of TriCEPS under these conditions, the insulin receptor was identified in the control dataset. In the CTRP3 treated cells a total enrichment of 261 peptides was observed. From these experiments 5 putative receptors for CTRP3 were identified with two reaching statistically significance: Lysosomal-associated membrane protein 1 (LAMP-1) and Lysosome membrane protein 2 (LIMP II). Follow-up Co-immunoprecipitation analysis confirmed the association between LAMP1 and CTRP3 and further testing using a polyclonal antibody to block potential binding sites of LAMP1 prevented CTRP3 binding to the cells Conclusion The LRC-TriCEPS methodology was successful in identifying potential novel receptors for CTRP3. Relevance The identification of the receptors for CTRP3 are important prerequisites for the development of small molecule drug candidates, of which none currently exist, for the treatment NAFLD.

A Doença hepática gordurosa não alcoólica (DHGNA) é uma das formas mais comuns de doença hepática, acometendo cerca de 20 a 30% da população adulta, sendo mais frequente em indivíduos obesos (70 a 80%). Os principais fatores de risco associados à doença são os componentes da Síndrome metabólica. Até o momento, não há um tratamento farmacológico específico para a DHGNA e modificações no estilo de vida com redução de peso e exercício físico são sempre preconizados. Existem poucos dados sobre o impacto da atividade física e uma estratégia nutricional ideal no tratamento da DHGNA. Visto a necessidade de elucidar o impacto da atividade física e a busca por uma estratégia nutricional ideal no tratamento da DHGNA, propusemos um estudo randomizado controlado avaliando os efeitos de uma dieta hipocalórica e hiperproteica e do exercício físico aeróbio associado a esta dieta nos parâmetros metabólicos e antropométricos de mulheres sedentárias pós-menopausa. Foram incluídas 40 mulheres sedentárias pós-menopausa com DHGNA, que possuíam biópsia hepática em um período igual ou menor que 2 (dois) anos. Essas pacientes foram randomizadas em 2 grupos: grupo TREINO: treinamento aeróbio associado à dieta hipocalórica e hiperproteica e grupo DIETA: somente dieta hipocalórica e hiperproteica e, acompanhadas por um período de 6 meses. Na análise intra-grupo das variáveis antropométricas nos períodos pré e pós-intervenção dietética ou exercício físico aeróbio não foram observadas diferenças significativas em ambos os grupos. Na análise intra-grupo das variáveis bioquímicas, o HDL mostrou-se estatisticamente diferente (p= 0,004) no grupo TREINO. Na análise inter-grupos das variáveis bioquímicas observamos um aumento significativo para HDL-C (p= 0,036) no grupo TREINO. Na análise intra-grupo das variáveis ergoespirométricas observamos diferença significativa para as variáveis VO2máx Relativo (p= 0,04), Tempo LA (p= 0,001), Tempo PCR (p= 0,003) e Tempo Pico (p= 0,001) no grupo TREINO. Na análise inter-grupo das variáveis ergoespirométricas a análise das variáveis VO2máx Relativo (p= 0,042), Tempo LA (p= 0,011), Tempo PCR (p= 0,002) e Tempo Pico (p= 0,007) foram estatisticamente diferentes. Nossos dados mostram uma estreita relação entre a intervenção nutricional, exercício aeróbio e a melhora da DHGNA. Apesar do tempo proposto de exercício semanal ter sido relativamente pequeno, nossos dados mostram que tanto a dieta hipocalórica e hiperproteica quanto o tratamento com exercício aeróbio duas vezes por semana associado a esta dieta podem ser eficazes para o tratamento da DHGNA em mulheres sedentárias pós-menopausa. Salientamos a importância do exercício aeróbio associado à dieta hipocalórica e hiperproteica para o aumento do HDL-C sérico e melhora da aptidão cardiorrespiratória neste grupo de mulheres. Consideramos que ambos os tratamentos podem ser recomendados de acordo com a particularidade de cada indivíduo, respeitando suas dificuldades e limitações / The Nonalcoholic fatty liver disease (NAFLD) is the most common form of liver diseases, affecting approximately 20-30% of the adult population and is more common in obese individuals (70-80%). The main risk factors associated with the disease are the components of the Metabolic syndrome. To date, there is no specific pharmacological treatment for NAFLD and changes in lifestyle with weight reduction and exercise are always recommended. Few datas exist on the impact of physical activity and optimal nutritional strategy for the treatment of NAFLD. Seen the need to elucidate the impact of physical activity and the search for an ideal nutritional strategy in the treatment of NAFLD, we proposed a randomized controlled trial evaluating the effects of a hypocaloric high-protein diet and aerobic exercise associated with this diet on metabolic and anthropometric parameters in sedentary postmenopausal women. 40 sedentary postmenopausal women with NAFLD who had liver biopsy for a period equal to or less than 2 (two) years were included. These patients were randomized into 2 groups: TRAINING group: aerobic training with hypocaloric high-protein diet and DIET group: only hypocaloric high-protein diet, and followed for a period of six months. In intra-group anthropometric variables pre and post dietary intervention or aerobic exercise analysis, no significant differences were observed in both groups. In intra-group analysis of biochemical variables, HDL was statistically different (p= 0.004) on the TRAINING group. In inter-group analysis of biochemical variables observed a significant increase in HDL-C (p= 0.036) on TRAINING group. In the analysis of intra-group ergospirometric variables significant differences were observed for the variables Relative VO2max (p= 0.04), Time at VAT (p= 0.001), Time at RCP (p= 0.003) and Time at peak (p= 0.001) in TRAINING group. In the analysis of inter-group ergospirometric variables Relative VO2máx (p= 0.042), Time at VAT (p= 0.011), Time at RCP (p= 0.002) and Time at peak (p= 0.007) were significantly different. Our data shows a close relationship between nutrition intervention, aerobic exercise and improvement of NAFLD. Although the proposed weekly exercise time was relatively small, our data show that both a low-calorie diet and protein levels as treatment with aerobic exercise twice a week associated with this diet may be effective for treating NAFLD in postmenopausal women sedentary. Stress the importance of aerobic exercise associated with low-calorie and high-protein diet for the increase in serum HDL-C and improves cardiorespiratory fitness in this group. We believe that both treatments may be recommended according to the particularity of each individual, respecting their difficulties and limitations

OBJETIVO: Avaliamos se a presença da síndrome dos ovários policísticos (SOP) altera múltiplos marcadores ultrassonográficos e laboratoriais de risco metabólico e doença cardiovascular em mulheres obesas sem outras condições que interferem com o critério de elegibilidade do contraceptivo oral combinado (COC). MÉTODOS: Estudo caso-controle avaliando 90 mulheres obesas ( 30,0 Kg/m² e < 40 Kg/m²), com idade entre 18 e 40 anos, sem outras condições de saúde que interferem com os critérios de elegibilidade de COC: 45 com SOP e 45 controles, pareadas por idade. Índice de massa corporal; circunferência da cintura e do quadril; pressão arterial sanguínea; insulina e glicemia de jejum; quantitative insulin sensitivity check index (QUICKI); HDL, LDL e colesterol total; triglicérides; testosterona; globulina carreadora de hormônios sexuais (SHBG); índice de androgênio livre (FAI); índice de rigidez da carótida e espessura íntimamédia (EIM); dilatação mediada por fluxo da artéria braquial (DMF) e doença hepática gordurosa não alcoólica (DHGNA) foram avaliados. RESULTADOS: Em mulheres obesas com SOP, observamos uma maior freqüência de DHGNA quando comparada a obesas sem SOP (73,4% vs. 46,6%, p<0,01). Embora não significativo, observamos uma tendência a aumento da insulina (10,06±6,66 UI/mL vs. 7,45±5,88 UI/mL, p=0,05), diminuição do QUICKI (0,36±0,06 vs. 0,39±0,07, p=0,05) e diminuição da DMF (7,00±3,87% vs. 8,41±3,79%, p=0,08). Nenhuma outra diferença significativa foi observada. CONCLUSÕES: DHGNA é freqüente em mulheres obesas sem outras condições que interferem com o critério de elegibilidade do COC, especialmente naquelas com SOP. Isto deveria ser considerado na escolha da melhor opção contraceptiva. / OBJECTIVE: To evaluate whether the presence of polycystic ovary syndrome (PCOS) alters multiple ultrasonographic and laboratorial markers of metabolic and cardiovascular disease risk in obese women without any other health condition that interferes with combined oral contraceptive (COC) eligibility criteria. METHOD: A case-control study evaluating 90 obese women ( 30.0kg/m² and <40kg/m²) aged between 18 and 40 years without any other health condition that interferes with COC eligibility criteria: 45 with PCOS and 45 age-matched controls. Body mass index; waist and hip circumference; arterial blood pressure; fasting insulin and glucose; quantitative insulin sensitivity check index (QUICKI); HDL, LDL and total cholesterol; triglycerides; testosterone; sex hormone-binding globulin (SHBG), free androgen index (FAI); carotid stiffness index and intima media thickness; flow-mediated dilatation of brachial artery; and nonalcoholic fatty liver disease (NAFLD) were assessed. Results: In PCOS women, we observed a higher frequency of NAFLD (73.4% vs. 46.6%, p<0.01) and higher FAI (10.43% vs. 6.84%, p<0.01). We also observe a trend of increased insulin (10.06±6.66IU/mL vs. 7.45±5.88IU/mL, p=0.05), decreased QUICKI (0.36±0.06 vs. 0.39±0.07, p = 0.05), and decreased FMD (7.00±3.87% vs. 8.41±3.79%, p=0.08). No other significant difference was observed. Conclusions: NAFLD is frequent in obese women without any other health condition that interferes with COC eligibility criteria, especially in those with PCOS. This should be considered when choosing the best contraceptive option.

La stéatose hépatique non alcoolique (NAFLD) est une manifestation du syndrome métabolique dont la prévalence est en constante évolution. Les stratégies thérapeutiques sont soit difficiles à mettre en œuvre soit d’une efficacité limitée. Nous avons étudié une approche nutritionnelle avec 3 acides aminés particuliers : la glutamine, l’arginine et la citrulline (Cit) pour leurs propriétés de pharmaconutriments azotés. Dans un modèle de NAFLD modérée induite par le fructose, seule la citrulline (1 g/kg/j) permettait une amélioration du métabolisme lipidique. Toutefois, l’étude de la cinétique de NAFLD suggérait un effet protecteur du simple apport azoté. L’effet spécifique de la Cit par rapport au simple apport azoté (AANE) a donc été déterminé dans un modèle de NAFLD induite par 8 semaines de régime enrichi en fructose. Ceci a permis de confirmer l’effet protecteur de la Cit et des AANE. Toutefois, la Cit exerce un effet plus spécifique sur l’expression de Srebp1c et de Fas et améliore la disponibilité périphérique en Arg, un élément important de l’insulino-sensibilité. La stéatose est associée à une perte de masse maigre, suggérant une oxydation des AA aux dépens de l’anabolisme musculaire, et une accumulation de lipides à l’origine de la stéatose et du gain de masse grasse viscérale ; la Cit et les AANE en agissant sur la NAFLD préviendraient cet effet du fructose. Nous avons ensuite évalué les effets de la Cit dans un modèle de stéatose plus sévère induite par le western diet. La Cit améliore la fonction hépatique (diminution des lipides et de l’inflammation hépatique) et préserve l’axe intestin-foie (restauration du groupe Bacteroides/Prevotella dans la muqueuse colique, diminution de l’inflammation intestinale et augmentation de l’expression de la Claudine 1) mais ne permet pas de prévenir l’ensemble des altérations liées au western diet. Il serait intéressant d’évaluer la relation effet/dose et l’efficacité de la Cit en association avec d’autres traitements. Par ailleurs, les mécanismes cellulaires restent à élucider. / Nonalcoholic fatty liver disease (NAFLD) is a manifestation of the metabolic syndrome whose prevalence is constantly growing. Therapeutic strategies are either difficult to implement or of limited effectiveness. We studied a nutritional approach with three specific amino acids: glutamine, arginine and citrulline (Cit) for their pharmaconutrient properties. In a model of moderate fructose-induced NAFLD, citrulline alone (1 g/kg/day) improved lipid metabolism. However, the study of the kinetics of NAFLD suggested a protective effect of nitrogen supply by itself. The specific effect of Cit compared to that of nitrogen (NEAAs) has been determined in a model of 8 week fructose diet-induced NAFLD. This has confirmed the protective effect of Cit and NEAAs. However, Cit exerted a specific effect on the expression of Fas and SREBP1c and improves peripheral Arg availability, an important component of insulin sensitivity. Steatosis was associated with loss of lean mass, suggesting AA oxidation at the expense of muscle anabolism, and lipid accumulation causing steatosis and visceral fat gain; Cit and NEAAs by acting on NAFLD would prevent this effect of fructose. We then evaluated the effects of Cit in a model of more severe steatosis induced by western diet. Cit improved liver function (reduced fat and liver inflammation) and protected the liver-gut axis (restoration of Bacteroides/Prevotella group in the colonic mucosa, decreased intestinal inflammation and increased expression of claudin 1) but did not prevent all western diet-induced alterations. It would be interesting to assess the dose/effect relationship and the effectiveness of Cit in combination with other treatments. Furthermore, the cellular mechanisms remain to be elucidated.

A doença hepática gordurosa não alcoólica (DHGNA) abrange alterações desde esteatose até esteato-hepatite não alcoólica (EHNA), podendo evoluir para fibrose, cirrose e carcinoma hepatocelular. A DHGNA é considerada a doença hepática mais comum na atualidade e com prevalência mundial alarmante. Esta doença caracteriza-se, basicamente, pela deposição de triglicérides nos hepatócitos, podendo evoluir com inflamação e fibrose, e está intimamente associada com resistência à insulina (RI), diabetes mellitus tipo 2 e obesidade. Os hepatócitos representam as principais células hepáticas e se comunicam através de junções do tipo gap, formadas principalmente por conexina 32 (Cx32). Esta proteína apresenta importante função no controle da homeostase tecidual, regulando processos fisiológicos e tem sido associada como agente protetor na hepatocarcinogênese e outros processos patológicos, porem pouco se sabe sobre sua participação na DHGNA. Sendo assim, o objetivo deste trabalho foi avaliar a participação da Cx32 na fisiopatogênese da DHGNA, utilizando camundongos knockout para Cx32 (Cx32-KO) submetidos a uma dieta hiperlipídica deficiente em colina. Foram analisados dados biométricos, histopatológicos, função hepática, RI, citocinas inflamatórias, adipocinas, estresse oxidativo, peroxidação lipídica e a expressão de genes envolvidos na DHGNA. Os animais Cx32-KO apresentaram maior acumulo de triglicérides hepáticos em relação aos animais selvagens e, consequentemente, maior peso absoluto e relativo do fígado. Adicionalmente, apresentaram maior inflamação hepática demonstrado pela exacerbação da citocina TNF-&#945; e supressão da IL-10, maior dano hepatocelular indicado pelo aumento das enzimas AST e ALT, aumento da peroxidação lipídica e alterações na expressão de genes chaves na fisiopatogênese da DHGNA, como SREBP1c. No entanto, não houve diferença nos marcadores histopatológicos, RI e estresse oxidativo hepático. Por fim, os animais Cx32-KO apresentaram maior produção de leptina e adiponectina no tecido adiposo. Todos esses resultados revelam que a Cx32 pode atuar como um agente protetor ao desenvolvimento da DHGNA, sugerindo seu potencial como novo alvo terapêutico / Nonalcoholic fatty liver disease (NAFLD) covers a spectrum of liver diseases ranging from steatosis to nonalcoholic steatohepatitis (NASH), liver fibrosis, cirrhosis and eventually hepatocellular carcinoma. NAFLD is currently the most common liver disease in the world with an alarming prevalence worldwide. This disease is characterized by the deposition of triglycerides in hepatocytes and can develop inflammation and fibrosis. NAFLD is closely associated with insulin resistance (IR), type 2 diabetes mellitus and obesity. The gap junctions mediate intercellular communication and are critical for maintaining integral cellular processes. In hepatocytes, the major type of liver cells, the gap junctions are formed mainly by connexin 32 (Cx32). This protein is important for the control of tissue homeostasis and for physiological processesregulation. It has been linked as a protective agent in hepatocarcinogenesis and other pathological processes. However, little is known about its role on NAFLD. Thus, the aim of this study was to evaluate the participation of Cx32 in the pathogenesis of NAFLD using WT and Cx32-knockout mice (Cx32-KO) subjected to a high-fat diet deficient in choline. NAFLD was evaluated based on a battery of clinically relevant read-outs, including histopathological examination, inflammatory citokines, liver damage markers, in-depth lipid analysis, assessment of oxidative stress, insulin and glucose tolerance and lipid-related biomarkers.The Cx32-KO animals showed higher accumulation of hepatic triglycerides, increased inflammation and lipid peroxidation and increased production of leptin and adiponectin in the adipose tissue when compared with WT. Moreover, there was no difference in histopathological markers, RI and hepatic oxidative stress. Taken together, all these results show that Cx32 is a protective agent to the development of the disease, suggesting its potential as a novel therapeutic target in NAFLD

A doença hepática gordurosa não alcoólica (DHGNA) abrange alterações desde esteatose até esteato-hepatite não alcoólica (EHNA), podendo evoluir para fibrose, cirrose e carcinoma hepatocelular. A DHGNA é considerada a doença hepática mais comum na atualidade e com prevalência mundial alarmante. Esta doença caracteriza-se, basicamente, pela deposição de triglicérides nos hepatócitos, podendo evoluir com inflamação e fibrose, e está intimamente associada com resistência à insulina (RI), diabetes mellitus tipo 2 e obesidade. Os hepatócitos representam as principais células hepáticas e se comunicam através de junções do tipo gap, formadas principalmente por conexina 32 (Cx32). Esta proteína apresenta importante função no controle da homeostase tecidual, regulando processos fisiológicos e tem sido associada como agente protetor na hepatocarcinogênese e outros processos patológicos, porem pouco se sabe sobre sua participação na DHGNA. Sendo assim, o objetivo deste trabalho foi avaliar a participação da Cx32 na fisiopatogênese da DHGNA, utilizando camundongos knockout para Cx32 (Cx32-KO) submetidos a uma dieta hiperlipídica deficiente em colina. Foram analisados dados biométricos, histopatológicos, função hepática, RI, citocinas inflamatórias, adipocinas, estresse oxidativo, peroxidação lipídica e a expressão de genes envolvidos na DHGNA. Os animais Cx32-KO apresentaram maior acumulo de triglicérides hepáticos em relação aos animais selvagens e, consequentemente, maior peso absoluto e relativo do fígado. Adicionalmente, apresentaram maior inflamação hepática demonstrado pela exacerbação da citocina TNF-&#945; e supressão da IL-10, maior dano hepatocelular indicado pelo aumento das enzimas AST e ALT, aumento da peroxidação lipídica e alterações na expressão de genes chaves na fisiopatogênese da DHGNA, como SREBP1c. No entanto, não houve diferença nos marcadores histopatológicos, RI e estresse oxidativo hepático. Por fim, os animais Cx32-KO apresentaram maior produção de leptina e adiponectina no tecido adiposo. Todos esses resultados revelam que a Cx32 pode atuar como um agente protetor ao desenvolvimento da DHGNA, sugerindo seu potencial como novo alvo terapêutico / Nonalcoholic fatty liver disease (NAFLD) covers a spectrum of liver diseases ranging from steatosis to nonalcoholic steatohepatitis (NASH), liver fibrosis, cirrhosis and eventually hepatocellular carcinoma. NAFLD is currently the most common liver disease in the world with an alarming prevalence worldwide. This disease is characterized by the deposition of triglycerides in hepatocytes and can develop inflammation and fibrosis. NAFLD is closely associated with insulin resistance (IR), type 2 diabetes mellitus and obesity. The gap junctions mediate intercellular communication and are critical for maintaining integral cellular processes. In hepatocytes, the major type of liver cells, the gap junctions are formed mainly by connexin 32 (Cx32). This protein is important for the control of tissue homeostasis and for physiological processesregulation. It has been linked as a protective agent in hepatocarcinogenesis and other pathological processes. However, little is known about its role on NAFLD. Thus, the aim of this study was to evaluate the participation of Cx32 in the pathogenesis of NAFLD using WT and Cx32-knockout mice (Cx32-KO) subjected to a high-fat diet deficient in choline. NAFLD was evaluated based on a battery of clinically relevant read-outs, including histopathological examination, inflammatory citokines, liver damage markers, in-depth lipid analysis, assessment of oxidative stress, insulin and glucose tolerance and lipid-related biomarkers.The Cx32-KO animals showed higher accumulation of hepatic triglycerides, increased inflammation and lipid peroxidation and increased production of leptin and adiponectin in the adipose tissue when compared with WT. Moreover, there was no difference in histopathological markers, RI and hepatic oxidative stress. Taken together, all these results show that Cx32 is a protective agent to the development of the disease, suggesting its potential as a novel therapeutic target in NAFLD