Fernando Bril1, Maryann Maximos2, Paola Portillo-Sanchez1, Diane Biernacki1, Romina Lomonaco1, Sreevidya Subbarayan1, Mark Correa3, Margaret Lo4, Amitabh Suman5, Kenneth Cusi6. 1. Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL, USA; Malcom Randall Veterans Administration Medical Center (VAMC), Gainesville, FL, USA. 2. Malcom Randall Veterans Administration Medical Center (VAMC), Gainesville, FL, USA; Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL, USA. 3. Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL, USA. 4. Malcom Randall Veterans Administration Medical Center (VAMC), Gainesville, FL, USA; Division of Internal Medicine, University of Florida, Gainesville, FL, USA. 5. Malcom Randall Veterans Administration Medical Center (VAMC), Gainesville, FL, USA. 6. Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL, USA; Malcom Randall Veterans Administration Medical Center (VAMC), Gainesville, FL, USA; Division of Diabetes, University of Texas Health Science Center at San Antonio (UTHSCSA), USA; Audie L. Murphy Veterans Administration Medical Center (VAMC), San Antonio, TX, USA. Electronic address: Kenneth.Cusi@medicine.ufl.edu.
Abstract
BACKGROUND & AIMS: The role of plasma vitamin D deficiency in the development of non-alcoholic fatty liver disease (NAFLD) and steatohepatitis (NASH) remains poorly understood. Previous studies have suggested a role for vitamin D deficiency in the pathogenesis of NAFLD/NASH, but they have been rather small, and/or NAFLD was diagnosed using only aminotransferases or liver ultrasound. This study aimed to assess the role of vitamin D deficiency in relationship to liver fat accumulation and severity of NASH. METHODS: A total of 239 patients were recruited and state-of-the-art techniques were used to measure insulin resistance (euglycemic insulin clamp with 3-(3)H-glucose), liver fat accumulation (magnetic resonance spectroscopy or (1)H-MRS), total body fat (dual energy X-ray absorptiometry), and severity of liver disease (liver biopsy). RESULTS: Patients were divided into 3 groups according to plasma 25-hydroxyvitamin D levels (normal: >30 ng/ml; insufficiency: 20-30 ng/ml; deficiency: <20 ng/ml). When well-matched for clinical parameters (BMI, total adiposity, or prevalence of prediabetes/type 2 diabetes), no significant differences were observed among groups in terms of skeletal muscle, hepatic, or adipose tissue insulin sensitivity, the amount of liver fat by (1)H-MRS, or the severity of histological inflammation, ballooning, or fibrosis. Patients were then divided according to liver histology into those with definite NASH and those without NASH. Although patients with NASH had higher insulin resistance, plasma vitamin D concentrations were similar between both groups. CONCLUSIONS: Our results suggest that plasma vitamin D levels are not associated with insulin resistance, the amount of liver fat accumulation, or the severity of NASH.
BACKGROUND & AIMS: The role of plasma vitamin D deficiency in the development of non-alcoholic fatty liver disease (NAFLD) and steatohepatitis (NASH) remains poorly understood. Previous studies have suggested a role for vitamin D deficiency in the pathogenesis of NAFLD/NASH, but they have been rather small, and/or NAFLD was diagnosed using only aminotransferases or liver ultrasound. This study aimed to assess the role of vitamin D deficiency in relationship to liver fat accumulation and severity of NASH. METHODS: A total of 239 patients were recruited and state-of-the-art techniques were used to measure insulin resistance (euglycemic insulin clamp with 3-(3)H-glucose), liver fat accumulation (magnetic resonance spectroscopy or (1)H-MRS), total body fat (dual energy X-ray absorptiometry), and severity of liver disease (liver biopsy). RESULTS:Patients were divided into 3 groups according to plasma 25-hydroxyvitamin D levels (normal: >30 ng/ml; insufficiency: 20-30 ng/ml; deficiency: <20 ng/ml). When well-matched for clinical parameters (BMI, total adiposity, or prevalence of prediabetes/type 2 diabetes), no significant differences were observed among groups in terms of skeletal muscle, hepatic, or adipose tissue insulin sensitivity, the amount of liver fat by (1)H-MRS, or the severity of histological inflammation, ballooning, or fibrosis. Patients were then divided according to liver histology into those with definite NASH and those without NASH. Although patients with NASH had higher insulin resistance, plasma vitamin D concentrations were similar between both groups. CONCLUSIONS: Our results suggest that plasma vitamin D levels are not associated with insulin resistance, the amount of liver fat accumulation, or the severity of NASH.
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