Metabolic effects of ramipril and indapamide in hypertensive patients with non-alcoholic fatty liver disease

Objective. To assess the effects of combined antihypertensive therapy with ramipril and indapamide on insulin resistance, carbohydrate, lipid and purine metabolism, as well as the structure and function of the liver in hypertensive patients with non-alcoholic fatty liver disease (NAFLD).Design and methods. In a pre-post study, we included 30 patients with hypertension (HTN) 1–2 degrees in combination with NAFLD (Fatty Liver Index (FLI) > 60) aged 45 to 65 years. Patients discontinued antihypertensive therapy 5–7 days before the initial examination. After that one of the fixed combinations of ramipril (2,5/5 mg/day) and indapamide (0,625/1,25 mg) were prescribed along with the lifestyle and weight reduction recommendations (the Mediterranean type of diet, a decrease in calorie intake by 500–1000 kcal from baseline, and physical aerobic exercise at least 150 minutes per week). All patients underwent clinical examination, measurement of office blood pressure (BP), ambulatory BP monitoring (ABPM), anthropometric parameters, assessment of the visceral obesity index (VAI), anthropometric parameters, VAI, the degree of adipose tissue dysfunction (ATD), the percentage of visceral and subcutaneous fat by the bioelectrical impedance method. We also assessed lipid, carbohydrate, purine metabolism and the structural and functional state of the liver before and after the treatment.Results. After 24-week therapy with a fixed combination of ramipril and indapamide (average dosage of 4,04 ± 1,24 and 1,01 ± 0,31 mg, respectively) HTN patients with NAFLD achieved target BP. There was a decrease in both office systolic BP (SBP) (p < 0,001) and office diastolic BP (DBP) (p = 0,007) in 100 % of patients, as well as in ABPM indices. We observed a decrease in waist and hip circumferences (p ≤ 0,001 and p ≤ 0,001, respectively), the proportion of subcutaneous (p = 0,0134) and visceral (p = 0,002) fat. The number of patients with normal ATD increased (p = 0,030), while the proportion of patients with dysfunction decreased (p = 0,039). There was also a significant increase in high-density lipoprotein cholesterol (p = 0,027) and a decrease in insulin resistance (p = 0,002) and metabolic index (p = 0,030). We also found an improvement in carbohydrate metabolism with no change in purine metabolism. There was a favorable effect on the liver structure and function, and the number of patients with high alaninaminotransferase > 40 U/L decreased (5 (16,7 %) vs 0, p = 0,026).Conclusions. Twenty-fourweek treatment with a fixed combination of ramipril and indapamide, together with recommendations for lifestyle changes and weight loss, led to a significant decrease in BP levels, the severity of insulin resistance, and visceral obesity. In addition, the treatment had a beneficial effect on the parameters of carbohydrate and lipid metabolism, as well as liver structure and function (decreased severity of steatosis and fibrosis).

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Longitudinal Association of Non‐Alcoholic Fatty Liver Disease With Changes in Myocardial Structure and Function: The CARDIA Study

Journal of the American Heart Association ◽

10.1161/jaha.119.014279 ◽

2020 ◽

Vol 9 (4) ◽

Cited By ~ 8

Author(s):

Lisa B. VanWagner ◽

Jane E. Wilcox ◽

Hongyan Ning ◽

Cora E. Lewis ◽

John Jeffrey Carr ◽

...

Keyword(s):

Liver Disease ◽

Fatty Liver ◽

Fatty Liver Disease ◽

Structure And Function ◽

Alcoholic Fatty Liver ◽

Longitudinal Association ◽

Myocardial Structure ◽

And Function ◽

Alcoholic Fatty Liver Disease

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Cardiac structure and function are altered in adults with non-alcoholic fatty liver disease

Journal of Hepatology ◽

10.1016/j.jhep.2012.11.015 ◽

2013 ◽

Vol 58 (4) ◽

pp. 757-762 ◽

Cited By ~ 72

Author(s):

Kate Hallsworth ◽

Kieren G. Hollingsworth ◽

Christian Thoma ◽

Djordje Jakovljevic ◽

Guy A. MacGowan ◽

...

Keyword(s):

Liver Disease ◽

Fatty Liver ◽

Fatty Liver Disease ◽

Structure And Function ◽

Cardiac Structure ◽

Alcoholic Fatty Liver ◽

Cardiac Structure And Function ◽

And Function ◽

Alcoholic Fatty Liver Disease

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1289 CARDIAC STRUCTURE AND FUNCTION ARE ALTERED IN ADULTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE

Journal of Hepatology ◽

10.1016/s0168-8278(12)61301-4 ◽

2012 ◽

Vol 56 ◽

pp. S509 ◽

Cited By ~ 2

Author(s):

K. Hallsworth ◽

K.G. Hollingsworth ◽

C. Thoma ◽

R. Taylor ◽

C.P. Day ◽

...

Keyword(s):

Liver Disease ◽

Fatty Liver ◽

Fatty Liver Disease ◽

Structure And Function ◽

Cardiac Structure ◽

Alcoholic Fatty Liver ◽

Cardiac Structure And Function ◽

And Function ◽

Alcoholic Fatty Liver Disease

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Su1513 - The Association of Non-Alcoholic Fatty Liver Disease and Altered Cardiac Structure and Function

Gastroenterology ◽

10.1016/s0016-5085(18)33854-x ◽

2018 ◽

Vol 154 (6) ◽

pp. S-1163

Author(s):

Laura S. Chiu ◽

Alison Pedley ◽

Joseph Massaro ◽

Gary F. Mitchell ◽

Ramachandran Vasan ◽

...

Keyword(s):

Liver Disease ◽

Fatty Liver ◽

Fatty Liver Disease ◽

Structure And Function ◽

Cardiac Structure ◽

Alcoholic Fatty Liver ◽

Cardiac Structure And Function ◽

And Function ◽

Alcoholic Fatty Liver Disease

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Vitamin D and non-alcoholic fatty liver disease in children

Gastroenterologie a hepatologie ◽

10.48095/ccgh2021335 ◽

2021 ◽

Vol 75 (4) ◽

pp. 335-343

Author(s):

Terezia Kráľová ◽

Marek Pršo ◽

Daniel Čierny ◽

Zuzana Michnová ◽

Zuzana Havlíčeková ◽

...

Keyword(s):

Insulin Resistance ◽

Vitamin D ◽

Liver Disease ◽

Fatty Liver ◽

Hepatic Steatosis ◽

Fatty Liver Disease ◽

Hypovitaminosis D ◽

Anthropometric Parameters ◽

Alcoholic Fatty Liver ◽

Alcoholic Fatty Liver Disease

Background: Insulin resistance (IR) plays a key role in the pathogenesis of non-alcoholic fatty liver disease (NAFLD). Hypovitaminosis D is associated with several diseases, including hepatic steatosis and obesity. Vitamin D (VD) affects insulin secretion and improves tissue sensitivity to insulin, suggesting that hypovitaminosis D is also associated with IR. The leptin-to-adiponectin ratio (LAR) was investigated as a new marker of IR. Aim: The aim of our study was to determine the association between the VD status, NAFLD and IR in paediatric overweight or obese patients. Methods: The study ran from January 2018 to August 2020 and included 100 subjects. We measured their anthropometric parameters, determined their basic laboratory parameters and the level of leptin and adiponectin, calculated BMI, WHR, WHtR, LAR and HOMA-IR. We measured the degree of hepatic steatosis by obtaining the hepatorenal index (HRI) using ultrasonography, and used real-time elastography to determine the elasticity of the liver parenchyma (LFI). Subsequently, we compared the groups of patients with and without hepatic steatosis and looked for correlations in relation to the level of VD and IR. Results: 4.4% of patients had a severe VD deficiency, 55% of the children had hypovitaminosis D, 28.6% had VD insufficiency and 12% of patients had sufficient VD levels. Patients with significant hepatic steatosis (HRI 1.5 and more) had the lowest level of VD (16.61 ±5.62 μg/l, P = 0.015). The level of VD in patients with hepatic steatosis was inversely correlated with waist circumference, hip circumference, height, weight, triacylglycerols, GMT, C-peptide, insulin, HOMA-IR, HRI and LFI. Leptin levels were highest in patients with hepatic pre-steatosis. LAR was highest in the group with hepatic steatosis, but we did not observe significant correlations in relation to other parameters. Conclusion: VD levels are inversely associated with the degree of hepatic steatosis in overweight or obese paediatric patients. HOMA-IR inversely correlates with VD levels and positively with LFI. The LAR value was highest in the group of patients with steatosis, although we did not find out any significant correlations in relation to VD status and HRI. Key words: vitamin D – non-alcoholic fatty liver disease – insulin resistance – leptin – adiponectin – obesity – childhood

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Therapeutic Effect of Metformin and Vitamin E Versus Prescriptive Diet in Obese Adolescents with Fatty Liver

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000086 ◽

2011 ◽

Vol 81 (6) ◽

pp. 398-406 ◽

Cited By ~ 17

Author(s):

Akcam ◽

Boyaci ◽

Pirgon ◽

Kaya ◽

Uysal ◽

...

Keyword(s):

Insulin Resistance ◽

Vitamin E ◽

Fatty Liver ◽

Liver Steatosis ◽

Tnf Alpha ◽

Dietary Advice ◽

Model Assessment ◽

Fasting Insulin ◽

Alcoholic Fatty Liver ◽

Obese Adolescents

Objective: The aim of the study was to determine whether metformin or vitamin E treatment for six months is effective in reducing body weight, blood pressure, and also ameliorating insulin resistance, adiponectin, and tumor necrosis factor (TNF)-alpha in obese adolescents with non-alcoholic fatty liver disease (NAFLD). Methods: Sixty-seven obese adolescents with liver steatosis (age range, 9 - 17 years) were included in the study. The metformin group received an 850-mg dose of metformin daily and the vitamin E group received 400 U vitamin E /daily, in capsule form for 6 months, plus an individually tailored diet, exercise, and behavioral therapy. Results: After 6 months later, there was a significant decline in body mass index, and fasting insulin and homeostatic model assessment (HOMA) values in all three groups. Moreover, in comparingson of changes in HOMA among the groups, the metformin- treated group showed significantly improved metabolic control and insulin sensitivity (HOMA) at the end of the study. There were no significant differences for changes of adiponectin, TNF-alpha, in all three groups after 6 months study. Conclusion: These data suggest that metformin treatment is more effective than dietary advice and vitamin E treatment in reducing insulin resistance, and also in ameliorating metabolic parameters such as fasting insulin and lipid levels, in obese adolescents having NAFLD.

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Non-Alcoholic Fatty Liver Disease in Overweight Children and its Relationship with Retinol Serum Levels

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831.78.1.27 ◽

2008 ◽

Vol 78 (1) ◽

pp. 27-32 ◽

Cited By ~ 15

Author(s):

Suano de Souza ◽

Silverio Amancio ◽

Saccardo Sarni ◽

Sacchi Pitta ◽

Fernandes ◽

...

Keyword(s):

Insulin Resistance ◽

Liver Disease ◽

Fatty Liver ◽

Lipid Profile ◽

Fatty Liver Disease ◽

Thiobarbituric Acid ◽

Serum Levels ◽

Control Group ◽

Alcoholic Fatty Liver ◽

Alcoholic Fatty Liver Disease

Objectives: To evaluate the frequency of non-alcoholic fatty liver disease, the retinol serum levels, lipid profile, and insulin resistance in overweight/obese children. To relate these biochemical variables with the risk of this disease in the population studied. Methods: The study was cross-sectional and prospective, with 46 overweight/obese school children (28 female, 18 male; mean age 8.6 years). The control group consisted of 45 children, paired by age and gender. Hepatic steatosis, evaluated by ultrasound, was classified as normal, mild, moderate, or severe. Also evaluated were serum retinol levels; thiobarbituric acid reactive substances; lipid profile; and fasting glucose and serum insulin levels, used for the calculation of the Homeostasis Model Assessment. Results: Hepatic ultrasound alterations were found in 56.5% and 48,9% of the overweight/obese and control group children, respectively. Presence of obesity was associated with high levels of triglycerides (OR = 4.6; P = 0.002). In the studied children, the risk of steatosis was related to a trend to a higher percentage of retinol inadequacy (OR = 2.8; p = 0.051); there was no association with thiobarbituric acid reactive substances, lipid profile, or insulin resistance. Conclusions: The high frequency of non-alcoholic fatty liver disease in both groups, evaluated by hepatic ultrasound, in low-socioeconomic level children, independent of nutritional condition and without significant association with insulin resistance, emphasizes that especially in developing countries, other risk factors such as micronutrient deficiencies (e.g. vitamin A) are involved.

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