Effects of N-3 Fatty Acids on Hepatic Triglyceride Content in Humans Orlistat for overweight subjects with nonalcoholic steatohepatitis: A randomized, prospective trial. Effects of n-3 polyunsaturated fatty acids in subjects with nonalcoholic fatty liver disease. Unsaturated fatty acids are inversely associated and n-6/n-3 ratios are positively related to inflammation and coagulation markers in plasma of apparently healthy adults. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. Prevalence of dyslipidemia and its associated factors among Jordanian adults. Effects of n-3 polyunsaturated fatty acids from seal oils on nonalcoholic fatty liver disease associated with hyperlipidemia. Highly Purified Eicosapentaenoic Acid Treatment Improves Nonalcoholic Steatohepatitis Quantification of hepatic steatosis with T1-independent, T2-corrected MR imaging with spectral modeling of fat: blinded comparison with MR spectroscopy. Randomized controlled trial testing the effects of weight loss on nonalcoholic steatohepatitis.
Background Because dietary N-3 fatty acids reduce plasma triglycerides , they may also decrease hepatic triglyceride content . If so , N-3 fatty acids might constitute a therapy for fatty liver . Methods Twenty-two subjects were recruited into a study design ed to test the effects of N-3 fatty acids on liver fat content . Seventeen completed the trial that had a sequential design of 4-week placebo followed by an 8-week treatment with 9 g/d of fish oil .  Liver fat was measured during placebo and treatment by magnetic resonance spectroscopy .  Compliance was assessed by capsule count at the end of each study phase and measurement of fatty acid composition in plasma triglyceride and phospholipid . Plasma lipoproteins and adiponectin were also measured . Results Treatment with fish oils reduced significantly levels of plasma triglyceride by 46 % ( P < .03 ) , very low-density lipoprotein + intermediate density lipoprotein cholesterol by 21 % ( P < .03 ) , total apolipoprotein B by 15 % ( P < .03 ) . In contrast to the changes in plasma triglycerides , hepatic triglyceride content was not significantly reduced by fish oil treatment . Conclusions N-3 fatty acids at high doses lower plasma triglyceride levels , but there are no significant decreases in hepatic content of triglyceride for the group as a whole . Whereas the triglyceride lowering is uniform , the liver response is more variable The aim of this study was to determine if orlistat , an inhibitor of fat absorption , combined with caloric restriction in overweight subjects with nonalcoholic steatohepatitis results in weight loss and improved liver histology .  Fifty overweight subjects ( body mass index = > or=27 ) with biopsy proven nonalcoholic steatohepatitis were r and omized to receive a 1,400 Kcal/day diet plus vitamin E ( 800 IU ) daily with or without orlistat ( 120 mg three times a day ) for 36 weeks . Liver biopsies were repeated at week 36 . Twenty-three subjects in the orlistat/diet/vitamin E group and 18 in the diet/vitamin E group completed the study . The mean age was 47 + /- 9.0 ( st and ard deviation ) years and mean body mass index was 36.4 + /- 6.3 kg/m(2 ) . Four subjects were diabetic . The orlistat group lost a mean of 8.3 % body weight compared to 6.0 % in the diet plus vitamin E group ( not significant ) . Both groups also had similarly improved serum aminotransferases , hepatic steatosis , necroinflammation , ballooning , and nonalcoholic fatty liver disease activity scores . Stratified according to weight loss instead of treatment group , a loss of > or=5 % body weight ( n = 24 ) compared to < 5 % body weight ( n = 17 ) correlated with improvement in insulin sensitivity ( P = 0.001 ) and steatosis ( P = 0.015 ) . Comparing subjects who lost > or=9 % of body weight ( n = 16 ) , to those that did not ( n = 25 ) , improved insulin sensitivity ( P < 0.001 ) , adiponectin ( P = 0.03 ) , steatosis ( P = 0.005 ) , ballooning ( P = 0.04 ) , inflammation ( P = 0.045 ) , and nonalcoholic fatty liver disease activity score ( P = 0.009 ) were seen . Increases in adiponectin strongly correlated with improved ballooning and nonalcoholic fatty liver disease activity score ( P = 0.03 ) . Orlistat did not enhance weight loss or improve liver enzymes , measures of insulin resistance , and histopathology . However , subjects who lost > or=5 % of body weight over 9 months improved insulin resistance and steatosis , and those subjects who lost > or=9 % also achieved improved hepatic histologic changes BACKGROUND Long-chain polyunsaturated fatty acid omega-3 levels are decreased in the hepatic tissue of patients with nonalcoholic fatty liver disease .  Polyunsaturated fatty acids are negative regulators of hepatic lipogenesis and attenuate the inflammatory response in mice . AIM To investigate whether polyunsaturated fatty acid may be effective in the treatment of nonalcoholic fatty liver disease . METHODS Forty patients with nonalcoholic fatty liver disease were r and omized into two groups for treatment of 6 months duration . Group DP ( n=20 ) received an AHA recommended diet and polyunsaturated fatty acid 2g/day ; Group D ( n=20 ) received only the AHA regular diet . Outcome measurements were fatty liver assessed by abdominal ultrasound , liver aminotransferase and tumour necrosis factor-alpha serum levels , and insulin resistance assessed by HOMA(IR ) . RESULTS After 6 months of treatment , the DP group displayed a decrease in alanine aminotransferase levels ( p<0.01 ) , as well as in triglyceride levels ( p<0.01 ) , serum tumour necrosis factor-alpha levels ( p<0.05 ) and in HOMA(IR ) ( p<0.05 ) . In the D group , no significant modification was observed . In the DP group , complete fatty liver regression was observed in 33.4 % of the patients , and an overall reduction in 50 % . In contrast , no patient achieved complete regression in the D group , whereas some amount of reduction occurred in 27.7 % of the patients ; the remaining 72.2 % did not change . CONCLUSION Our results indicate that alanine aminotransferase , triglyceride and serum tumour necrosis factor-alpha levels , as well as fatty liver improved after polyunsaturated fatty acid administration BACKGROUND Blood lipids and inflammatory markers levels have been associated with the development and progression of atherosclerosis . As the association of inflammatory markers with plasma fatty acids has not been extensively evaluated and understood , we sought to investigate the associations between dietary and plasma fatty acids with various inflammation and coagulation markers . METHODS High sensitivity C-reactive protein ( hsCRP ) , interleukin-6 ( IL-6 ) , tumor necrosis factor-alpha ( TNF-alpha ) , fibrinogen , and homocysteine were measured in serum of 374 free-living , healthy men and women , r and omly selected from the ATTICA 's study data base .  Total plasma fatty acids  were determined by gas chromatography . Dietary fatty acids  were assessed through a semi-quantitative FFQ . RESULTS Multi-adjusted regression analyses revealed that plasma n-3 fatty acids were inversely associated with CRP , IL-6 and TNF-alpha ; plasma n-6 fatty acids were inversely associated with CRP , IL-6 and fibrinogen ; monounsaturated fatty acids were inversely associated with CRP and IL-6 ( all p-values<0.05 ) . Interestingly , the n-6/n-3 ratios exhibited the strongest positive correlations with all the markers studied . No associations were observed between dietary fatty acids and the investigated markers . CONCLUSIONS Measurements of total plasma fatty acids could provide insights into the relationships between diet and atherosclerotic disease . Moreover , the n-6/n-3 ratio may constitute a predictor of low- grade inflammation and coagulation OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity BACKGROUND Dyslipidemia , which has been closely linked to pathophysiology of cardiovascular diseases , is a key independent modifiable risk factor for cardiovascular diseases . Estimation of the prevalence of dyslipidemia ensures proper planning of health actions for both primary and secondary prevention of cardiovascular diseases . OBJECTIVES To estimate the prevalence of various types of dyslipidemia and determine their associated factors among adults in north of Jordan . METHOD Data were analyzed from a cross-sectional study that included a r and om sample of 1121 Jordanians aged 25 years and older .  High total cholesterol ( TC ) was defined as TC ≥200 mg/dL and hypertriglyceridemia as serum triglycerides level ≥150 mg/dL. Low high-density lipoprotein cholesterol ( HDL-C ) was defined as serum HDL-C < 40 mg/dL. High low-density lipoprotein cholesterol ( LDL-C ) was defined as serum LDL-C ≥130 mg/dL. RESULTS Of a total of 1121 subjects , 48.8 % had high TC level , 40.7 % had high LDL-C  , 40.1 % had low HDL-C , 43.6 % had high triglyceride levels , and 75.7 % had at least one abnormal lipid level . Age was associated with high triglycerides , high LDL-C , and high TC . Men were more likely than women to have a high triglycerides level and low HDL-C. Compared with people with a body mass index < 25 , overweight and obese subjects had greater odds of having high triglycerides , high TC , and low HDL-C. Diabetes was associated with increased odds of high triglycerides only . CONCLUSION The prevalence dyslipidemia is high in Jordan , which necessitates appropriate the institution of community-based intervention strategies to prevent and manage cardiovascular risk factors AIM To investigate the efficacy and safety of n-3 polyunsaturated fatty acids ( PUFA ) from seal oils for patients with nonalcoholic fatty liver disease ( NAFLD ) associated with hyperlipidemia . METHODS One hundred and forty-four patients with NAFLD associated with hyperlipidemia were included in the 24-wk , r and omized , controlled trial . The patients were r and omized into two groups . Group A ( n=72 ) received recommended diet and 2 g n-3 PUFA from seal oils , three times a day . Group B ( n=72 ) received recommended diet and 2 g placebo , three times a day . Primary endpoints were fatty liver assessed by symptom scores , liver alanine aminotransferase ( ALT ) and serum lipid levels after 8 , 12 , 16 , and 24 wk . Hepatic fat infiltration was detected by ultrasonography at weeks 12 and 24 after treatment . RESULTS A total of 134 patients ( 66 in group A , 68 in group B ) were included in the study except for 10 patients who were excluded from the study . After 24 wk of treatment , no change was observed in body weight , fasting blood glucose ( FBG ) , renal function and blood cells of these patients . Total symptom scores , ALT and triglyceride ( TG ) levels decreased more significantly in group A than in group B ( P<0.05 ) . As expected , there was a tendency toward improvement in aspartate aminotransferase ( AST ) , gamma-glutamyltranspeptidase ( GGT ) , and total cholesterol ( TCHO ) and high-density lipoprotein ( HDL ) cholesterol levels ( P<0.05 ) after administration in the two groups . However , no significant differences were found between the two groups . The values of low-density lipoprotein ( LDL ) were significantly improved in group A ( P<0.05 ) , but no significant change was found in group B at different time points and after a 24-wk treatment . After treatment , complete fatty liver regression was observed in 19.70 % ( 13/66 ) of the patients , and an overall reduction was found in 53.03 % ( 35/66 ) of the patients in group A. In contrast , in group B , only five patients ( 7.35 % , 5/68 ) achieved complete fatty liver regression ( P=0.04 ) , whereas 24 patients ( 35.29 % , 24/68 ) had a certain improvement in fatty liver ( P=0.04 ) . No serious adverse events occurred in all the patients who completed the treatment . CONCLUSION Our results indicate that n-3 PUFA from seal oils is safe and efficacious for patients with NAFLD associated with hyperlipidemia and can improve their total symptom scores , ALT , serum lipid levels and normalization of ultrasonographic evidence . Further study is needed to confirm these results Recent studies have demonstrated that n-3 polyunsaturated fatty acids ameliorate  nonalcoholic fatty liver disease .  Although eicosapentaenoic acid ( EPA ) , one of the major components of n-3 polyunsaturated fatty acids , is widely used as an antilipidemic agent , its single efficacy for nonalcoholic steatohepatitis ( NASH ) remains unclear . As such , we aim ed to evaluate the efficacy and safety of EPA on 23 biopsy-proven NASH patients in a pilot trial . Highly purified EPA ( 2700 mg/d ) was administered for 12 months and efficacy was assessed by biochemical parameters and liver histology . All patients completed the treatment with no adverse events , indicating acceptable tolerance to the treatment . After 12 months , serum alanine aminotransferase levels were significantly improved ( from 79±36 to 50±20 U/L ) , and serum free fatty acids , plasma soluble tumor necrosis factor receptor 1 and 2 levels , and serum ferritin and thioredoxin levels , which may reflect hepatic oxidative stress , were significantly decreased . Body weight , blood glucose , insulin , and adiponectin concentrations remained unchanged . Seven of the 23 patients consented to undergo posttreatment liver biopsy , which showed improvement of hepatic steatosis and fibrosis , hepatocyte ballooning , and lobular inflammation in 6 patients . In conclusion , EPA treatment seems to be safe and efficacious for patients with NASH , largely due to its anti-inflammatory and antioxidative properties . To confirm these results , appropriately powered , controlled trials are needed PURPOSE To prospect ively compare an investigational version of a complex-based chemical shift-based fat fraction magnetic resonance ( MR ) imaging method with MR spectroscopy for the quantification of  hepatic steatosis . MATERIAL S AND METHODS This study was approved by the institutional review board and was HIPAA compliant . Written informed consent was obtained before all studies . Fifty-five patients ( 31 women , 24 men ; age range , 24 - 71 years ) were prospect ively imaged at 1.5 T with quantitative MR imaging and single-voxel MR spectroscopy , each within a single breath hold . The effects of T2 correction , spectral modeling of fat , and magnitude fitting for eddy current correction on fat quantification with MR imaging were investigated by reconstructing fat fraction images from the same source data with different combinations of error correction . Single-voxel T2-corrected MR spectroscopy was used to measure fat fraction and served as the reference st and ard . All MR spectroscopy data were postprocessed at a separate institution by an MR physicist who was blinded to MR imaging results . Fat fractions measured with MR imaging and MR spectroscopy were compared statistically to determine the correlation ( r(2 ) ) , and the slope and intercept as measures of agreement between MR imaging and MR spectroscopy fat fraction measurements , to determine whether MR imaging can help quantify fat , and examine the importance of T2 correction , spectral modeling of fat , and eddy current correction . Two-sided t tests ( significance level , P = .05 ) were used to determine whether estimated slopes and intercepts were significantly different from 1.0 and 0.0 , respectively . Sensitivity and specificity for the classification of clinical ly significant steatosis were evaluated . RESULTS Overall , there was excellent correlation between MR imaging and MR spectroscopy for all reconstruction combinations . However , agreement was only achieved when T2 correction , spectral modeling of fat , and magnitude fitting for eddy current correction were used ( r(2 ) = 0.99 ; slope ± st and ard deviation = 1.00 ± 0.01 , P = .77 ; intercept ± st and ard deviation = 0.2 % ± 0.1 , P = .19 ) . CONCLUSION T1-independent chemical shift-based water-fat separation MR imaging methods can accurately quantify fat over the entire liver , by using MR spectroscopy as the reference st and ard , when T2 correction , spectral modeling of fat , and eddy current correction methods are used UNLABELLED Nonalcoholic steatohepatitis ( NASH ) is a chronic progressive liver disease that is strongly associated with obesity . Currently , there is no approved therapy for NASH . Weight reduction is typically recommended , but efficacy data are lacking . We performed a r and omized controlled trial to examine the effects of lifestyle intervention using a combination of diet , exercise , and behavior modification , with a goal of 7 % to 10 % weight reduction , on clinical parameters of NASH . The primary outcome measure was the change in NASH histological activity score ( NAS ) after 48 weeks of intervention . Thirty-one overweight or obese individuals ( body mass index [ BMI ] , 25 - 40 kg/m(2 ) ) with biopsy-proven NASH were r and omized in a 2:1 ratio to receive intensive lifestyle intervention ( LS ) or structured education ( control ) . After 48 weeks of intervention , participants assigned to LS  lost an average of 9.3 % of their weight versus 0.2 % in the control group ( P = 0.003 ) . A higher proportion of participants in the LS group had a reduction of NAS of at least 3 points or had posttreatment NAS of 2 or less as compared with the control group ( 72 % versus 30 % , P = 0.03 ) . NAS improved significantly in the LS group ( from 4.4 to 2.0 ) in comparison with the control group ( from 4.9 to 3.5 ) ( P = 0.05 ) . Percent weight reduction correlated significantly with improvement in NAS ( r = 0.497 , P = 0.007 ) . Participants who achieved the study weight loss goal ( > or=7 % ) , compared with those who lost less than 7 % , had significant improvements in steatosis ( -1.36 versus -0.41 , P < 0.001 ) , lobular inflammation ( -0.82 versus -0.24 , P = 0.03 ) , ballooning injury ( -1.27 versus -0.53 , P = 0.03 ) and NAS ( -3.45 versus -1.18 , P < 0.001 ) . CONCLUSION Weight reduction achieved through lifestyle intervention leads to improvements in liver histology in NASH
Non-alcoholic fatty liver disease ( NAFLD ) is a frequent accompaniment of obesity and insulin resistance .
With the prevalence approaching 85 % in obese population s , new therapeutic approaches to manage NAFLD are warranted .