nach oben

Erschienen in:

23.11.2018 | Article

Non-alcoholic fatty liver disease in the first trimester and subsequent development of gestational diabetes mellitus

verfasst von: Seung Mi Lee, Soo Heon Kwak, Ja Nam Koo, Ig Hwan Oh, Jeong Eun Kwon, Byoung Jae Kim, Sun Min Kim, Sang Youn Kim, Gyoung Min Kim, Sae Kyung Joo, Bo Kyung Koo, Sue Shin, Chanthalakeo Vixay, Errol R. Norwitz, Chan-Wook Park, Jong Kwan Jun, Won Kim, Joong Shin Park

Erschienen in: Diabetologia | Ausgabe 2/2019

Einloggen, um Zugang zu erhalten

Abstract

Aims/hypothesis

Although there is substantial evidence that non-alcoholic fatty liver disease (NAFLD) is associated with impaired glucose homeostasis, the clinical significance of NAFLD in pregnant women has not been well determined. This study investigates the relationship between NAFLD in the first trimester and the subsequent development of gestational diabetes mellitus (GDM).

Methods

A multicentre, prospective cohort study was conducted in which singleton pregnant Korean women were assessed for NAFLD at 10–14 weeks using liver ultrasound, fatty liver index (FLI) and hepatic steatosis index (HSI). Maternal plasma adiponectin and selenoprotein P concentrations were measured. Participants were screened for GDM using the two-step approach at 24–28 weeks.

Results

Six hundred and eight women were included in the final analysis. The prevalence of NAFLD was 18.4% (112/608) and 5.9% (36/608) developed GDM. Participants who developed GDM had a higher prevalence of radiological steatosis (55.6% vs 16.1%; p < 0.001) and higher FLI (40.0 vs 10.7; p < 0.001) and HSI (35.5 vs 29.0; p < 0.001). The risk of developing GDM was significantly increased in participants with NAFLD and was positively correlated with the severity of steatosis. This relationship between NAFLD and GDM remained significant after adjustment for metabolic risk factors, including measures of insulin resistance. Maternal plasma adiponectin and selenoprotein P levels were also correlated with both NAFLD severity and the risk of developing GDM.

Conclusions/interpretation

NAFLD in early pregnancy is an independent risk factor for GDM. Adiponectin may be a useful biomarker for predicting GDM in pregnant women.

Nur mit Berechtigung zugänglich

Cho HC (2016) Prevalence and factors associated with nonalcoholic fatty liver disease in a nonobese Korean population. Gut Liver 10(1):117–125. https://doi.org/10.5009/gnl14444 CrossRefPubMedPubMedCentral

Choi SY, Kim D, Kim HJ et al (2009) The relation between non-alcoholic fatty liver disease and the risk of coronary heart disease in Koreans. Am J Gastroenterol 104(8):1953–1960. https://doi.org/10.1038/ajg.2009.238 CrossRefPubMed

Vernon G, Baranova A, Younossi ZM (2011) Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther 34(3):274–285. https://doi.org/10.1111/j.1365-2036.2011.04724.x CrossRefPubMed

Loomba R, Sanyal AJ (2013) The global NAFLD epidemic. Nat Rev Gastroenterol Hepatol 10(11):686–690. https://doi.org/10.1038/nrgastro.2013.171 CrossRefPubMed

Ramesh S, Sanyal AJ (2005) Evaluation and management of non-alcoholic steatohepatitis. J Hepatol 42 Suppl(1):S2–12. https://doi.org/10.1016/j.jhep.2004.11.022

Targher G, Bertolini L, Padovani R et al (2007) Prevalence of nonalcoholic fatty liver disease and its association with cardiovascular disease among type 2 diabetic patients. Diabetes Care 30(5):1212–1218. https://doi.org/10.2337/dc06-2247 CrossRefPubMed

Marchesini G, Brizi M, Bianchi G et al (2001) Nonalcoholic fatty liver disease: a feature of the metabolic syndrome. Diabetes 50(8):1844–1850. https://doi.org/10.2337/diabetes.50.8.1844 CrossRefPubMed

Das K, Das K, Mukherjee PS et al (2010) Nonobese population in a developing country has a high prevalence of nonalcoholic fatty liver and significant liver disease. Hepatology 51(5):1593–1602. https://doi.org/10.1002/hep.23567 CrossRefPubMed

Amarapurkar D, Kamani P, Patel N et al (2007) Prevalence of non-alcoholic fatty liver disease: population based study. Ann Hepatol 6(3):161–163PubMed

10.

Singh SP, Nayak S, Swain M et al (2004) Prevalence of nonalcoholic fatty liver disease in coastal eastern India: a preliminary ultrasonographic survey. Tropical gastroenterology : official journal of the Digestive Diseases Foundation 25(2):76–79

11.

Koo BK, Joo SK, Kim D et al (2018) Additive effects of PNPLA3 and TM6SF2 on the histological severity of non-alcoholic fatty liver disease. J Gastroenterol Hepatol 33(6):1277–1285. https://doi.org/10.1111/jgh.14056 CrossRefPubMed

12.

Tiikkainen M, Tamminen M, Hakkinen AM et al (2002) Liver-fat accumulation and insulin resistance in obese women with previous gestational diabetes. Obes Res 10(9):859–867. https://doi.org/10.1038/oby.2002.118 CrossRefPubMed

13.

Forbes S, Taylor-Robinson SD, Patel N, Allan P, Walker BR, Johnston DG (2011) Increased prevalence of non-alcoholic fatty liver disease in European women with a history of gestational diabetes. Diabetologia 54(3):641–647. https://doi.org/10.1007/s00125-010-2009-0 CrossRefPubMed

14.

Foghsgaard S, Andreasen C, Vedtofte L et al (2017) Nonalcoholic fatty liver disease is prevalent in women with prior gestational diabetes mellitus and independently associated with insulin resistance and waist circumference. Diabetes Care 40(1):109–116. https://doi.org/10.2337/dc16-1017 CrossRefPubMed

15.

Ajmera VH, Gunderson EP, Vanwagner LB, Lewis CE, Carr JJ, Terrault NA (2016) Gestational diabetes mellitus is strongly associated with non-alcoholic fatty liver disease. Am J Gastroenterol 111(5):658–664. https://doi.org/10.1038/ajg.2016.57 CrossRefPubMedPubMedCentral

16.

Page LM, Girling JC (2011) A novel cause for abnormal liver function tests in pregnancy and the puerperium: non-alcoholic fatty liver disease. BJOG 118(12):1532–1535. https://doi.org/10.1111/j.1471-0528.2011.03070.x CrossRefPubMed

17.

Sharma DL, Lakhani HV, Klug RL et al (2017) Investigating molecular connections of non-alcoholic fatty liver disease with associated pathological conditions in West Virginia for biomarker analysis. J Clin Cell Immunol 8(5). https://doi.org/10.4172/2155-9899.1000523

18.

Misu H, Takamura T, Takayama H et al (2010) A liver-derived secretory protein, selenoprotein P, causes insulin resistance. Cell Metab 12(5):483–495. https://doi.org/10.1016/j.cmet.2010.09.015 CrossRefPubMed

19.

Ewing JA (1984) Detecting alcoholism. The CAGE questionnaire. JAMA 252(14):1905–1907. https://doi.org/10.1001/jama.1984.03350140051025 CrossRefPubMed

20.

Saadeh S, Younossi ZM, Remer EM et al (2002) The utility of radiological imaging in nonalcoholic fatty liver disease. Gastroenterology 123(3):745–750. https://doi.org/10.1053/gast.2002.35354 CrossRefPubMed

21.

Taylor KJ, Riely CA, Hammers L et al (1986) Quantitative US attenuation in normal liver and in patients with diffuse liver disease: importance of fat. Radiology 160(1):65–71. https://doi.org/10.1148/radiology.160.1.3520657 CrossRefPubMed

22.

Bedogni G, Bellentani S, Miglioli L et al (2006) The fatty liver index: a simple and accurate predictor of hepatic steatosis in the general population. BMC Gastroenterol 6(1):33. https://doi.org/10.1186/1471-230X-6-33 CrossRefPubMedPubMedCentral

23.

Gastaldelli A, Kozakova M, Hojlund K et al (2009) Fatty liver is associated with insulin resistance, risk of coronary heart disease, and early atherosclerosis in a large European population. Hepatology 49(5):1537–1544. https://doi.org/10.1002/hep.22845 CrossRefPubMed

24.

Bozkurt L, Gobl CS, Tura A et al (2012) Fatty liver index predicts further metabolic deteriorations in women with previous gestational diabetes. PLoS One 7(2):e32710. https://doi.org/10.1371/journal.pone.0032710 CrossRefPubMedPubMedCentral

25.

Lee JH, Kim D, Kim HJ et al (2010) Hepatic steatosis index: a simple screening tool reflecting nonalcoholic fatty liver disease. Dig Liver Dis 42(7):503–508. https://doi.org/10.1016/j.dld.2009.08.002 CrossRefPubMed

26.

Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC (1985) Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28(7):412–419. https://doi.org/10.1007/BF00280883 CrossRefPubMed

27.

Committee on Practice B-O (2013) Practice Bulletin No. 137: gestational diabetes mellitus. Obstet Gynecol 122:406–416CrossRef

28.

Carpenter MW, Coustan DR (1982) Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 144(7):768–773. https://doi.org/10.1016/0002-9378(82)90349-0 CrossRefPubMed

29.

Firth D (1993) Bias reduction of maximum likelihood estimates. Biometrika 80(1):27–38. https://doi.org/10.1093/biomet/80.1.27 CrossRef

30.

Ryu S, Suh BS, Chang Y et al (2015) Menopausal stages and non-alcoholic fatty liver disease in middle-aged women. Eur J Obstet Gynecol Reprod Biol 190:65–70. https://doi.org/10.1016/j.ejogrb.2015.04.017 CrossRefPubMed

31.

Lee JY, Shin DW, Oh JW et al (2017) Non-alcoholic fatty liver disease as a risk factor for female sexual dysfunction in premenopausal women. PLoS One 12(8):e0182708. https://doi.org/10.1371/journal.pone.0182708 CrossRefPubMedPubMedCentral

32.

De Souza LR, Berger H, Retnakaran R et al (2016) Non-alcoholic fatty liver disease in early pregnancy predicts dysglycemia in mid-pregnancy: prospective study. Am J Gastroenterol 111(5):665–670. https://doi.org/10.1038/ajg.2016.43 CrossRefPubMed

33.

Hagstrom H, Hoijer J, Ludvigsson JF et al (2016) Adverse outcomes of pregnancy in women with non-alcoholic fatty liver disease. Liver Int 36(2):268–274. https://doi.org/10.1111/liv.12902 CrossRefPubMed

34.

Mousa N, Abdel-Razik A, Shams M et al (2018) Impact of non-alcoholic fatty liver disease on pregnancy. Br J Biomed Sci 75:197–199

35.

Mccullough AJ (2004) The clinical features, diagnosis and natural history of nonalcoholic fatty liver disease. Clin Liver Dis 8:521–533 viiiCrossRef

36.

Porepa L, Ray JG, Sanchez-Romeu P, Booth GL (2010) Newly diagnosed diabetes mellitus as a risk factor for serious liver disease. CMAJ 182(11):E526–E531. https://doi.org/10.1503/cmaj.092144 CrossRefPubMedPubMedCentral

37.

Despres JP (1993) Abdominal obesity as important component of insulin-resistance syndrome. Nutrition 9(5):452–459PubMed

38.

Meng K, Lee CH, Saremi F (2010) Metabolic syndrome and ectopic fat deposition: what can CT and MR provide? Acad Radiol 17(10):1302–1312. https://doi.org/10.1016/j.acra.2010.03.019 CrossRefPubMed

39.

Larter CZ, Chitturi S, Heydet D, Farrell GC (2010) A fresh look at NASH pathogenesis. Part 1: the metabolic movers. J Gastroenterol Hepatol 25(4):672–690. https://doi.org/10.1111/j.1440-1746.2010.06253.x CrossRefPubMed

40.

Lebensztejn DM, Flisiak-Jackiewicz M, Bialokoz-Kalinowska I, Bobrus-Chociej A, Kowalska I (2016) Hepatokines and non-alcoholic fatty liver disease. Acta Biochim Pol 63(3):459–467. https://doi.org/10.18388/abp.2016_1252 CrossRefPubMed

41.

Kim JY, Park KJ, Hwang JY et al (2017) Activating transcription factor 3 is a target molecule linking hepatic steatosis to impaired glucose homeostasis. J Hepatol 67(2):349–359. https://doi.org/10.1016/j.jhep.2017.03.023 CrossRefPubMed

42.

Misu H, Ishikura K, Kurita S et al (2012) Inverse correlation between serum levels of selenoprotein P and adiponectin in patients with type 2 diabetes. PLoS One 7(4):e34952. https://doi.org/10.1371/journal.pone.0034952 CrossRefPubMedPubMedCentral

43.

Metzger BE, Buchanan TA, Coustan DR et al (2007) Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care 30 (Suppl 2):S251–S260. https://doi.org/10.2337/dc07-s225

44.

Committee on Practice B-O (2018) ACOG Practice Bulletin No. 190: gestational diabetes mellitus. Obstet Gynecol 131:e49–e64CrossRef

45.

Bril F, Ortiz-Lopez C, Lomonaco R et al (2015) Clinical value of liver ultrasound for the diagnosis of nonalcoholic fatty liver disease in overweight and obese patients. Liver Int 35(9):2139–2146. https://doi.org/10.1111/liv.12840 CrossRefPubMed

Titel: Non-alcoholic fatty liver disease in the first trimester and subsequent development of gestational diabetes mellitus
verfasst von: Seung Mi Lee
Soo Heon Kwak
Ja Nam Koo
Ig Hwan Oh
Jeong Eun Kwon
Byoung Jae Kim
Sun Min Kim
Sang Youn Kim
Gyoung Min Kim
Sae Kyung Joo
Bo Kyung Koo
Sue Shin
Chanthalakeo Vixay
Errol R. Norwitz
Chan-Wook Park
Jong Kwan Jun
Won Kim
Joong Shin Park
Publikationsdatum: 23.11.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Diabetologia / Ausgabe 2/2019
Print ISSN: 0012-186X
Elektronische ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-018-4779-8

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

„Überwältigende“ Evidenz für Tripeltherapie beim metastasierten Prostata-Ca.

22.05.2024 Prostatakarzinom Nachrichten

Patienten mit metastasiertem hormonsensitivem Prostatakarzinom sollten nicht mehr mit einer alleinigen Androgendeprivationstherapie (ADT) behandelt werden, mahnt ein US-Team nach Sichtung der aktuellen Datenlage. Mit einer Tripeltherapie haben die Betroffenen offenbar die besten Überlebenschancen.

So sicher sind Tattoos: Neue Daten zur Risikobewertung

22.05.2024 Melanom Nachrichten

Das größte medizinische Problem bei Tattoos bleiben allergische Reaktionen. Melanome werden dadurch offensichtlich nicht gefördert, die Farbpigmente könnten aber andere Tumoren begünstigen.

CAR-M-Zellen: Warten auf das große Fressen

22.05.2024 Onkologische Immuntherapie Nachrichten

Auch myeloide Immunzellen lassen sich mit chimären Antigenrezeptoren gegen Tumoren ausstatten. Solche CAR-Fresszell-Therapien werden jetzt für solide Tumoren entwickelt. Künftig soll dieser Prozess nicht mehr ex vivo, sondern per mRNA im Körper der Betroffenen erfolgen.

Frühzeitige HbA1c-Kontrolle macht sich lebenslang bemerkbar

22.05.2024 Typ-2-Diabetes Nachrichten

Menschen mit Typ-2-Diabetes von Anfang an intensiv BZ-senkend zu behandeln, wirkt sich positiv auf Komplikationen und Mortalität aus – und das offenbar lebenslang, wie eine weitere Nachfolgeuntersuchung der UKPD-Studie nahelegt.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Abstract

Aims/hypothesis

Methods

Results

Conclusions/interpretation

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 2/2019

Association between maternal diabetes, being large for gestational age and breast-feeding on being overweight or obese in childhood

Prostaglandin E2/EP2 receptor signalling pathway promotes diabetic retinopathy in a rat model of diabetes

Afternoon exercise is more efficacious than morning exercise at improving blood glucose levels in individuals with type 2 diabetes: a randomised crossover trial

Type 2 diabetes and the risk of incident hearing loss

Gestational diabetes in young women predicts future risk of serious liver disease