Early Research Reveals Key Player in Nonalcoholic Fatty Liver Disease Everyday Health
Early Research Reveals Key Player in Nonalcoholic Fatty Liver Disease Everyday Health MenuNewslettersSearch Liver Disease
Adobe Stock (2); CanvaNonalcoholic fatty liver disease (NAFLD), a condition in which excess fat builds up in the liver, affects nearly one in four Americans, according to the National Institute of Diabetes and Digestive and Kidney Diseases, and incidence has more than doubled over the past 20 years, according to the American Liver Foundation. The more severe form of NAFLD, when fat buildup in the liver is more than 5 to 10 percent, is known as nonalcoholic steatohepatitis (NASH). With NASH on the rise, researchers are pushing to understand more about the factors that influence the disease. Scientists at Duke-NUS Medical School in Singapore have zeroed in on an amino acid called homocysteine, which appears to cause inflammation in people with NASH. In a two-part study published July 8, 2022, in the Journal of Hepatology, researchers looked at whether supplementing the diet with folic acid and vitamin B12 could reverse inflammation. According to Madhulika Tripathi, MD, a senior research fellow with the laboratory of hormonal regulation in Duke-NUS Medical School's cardiovascular and metabolic program, who co-led the study, inflammation can cause NASH to progress into cirrhosis, which can lead to liver failure or liver cancer. Although scientists know that NASH is associated with elevated levels of homocysteine, they don’t know what role it plays in the disorder. In the first part of the study, researchers used mice and humans to determine how homocysteine levels correlated with NASH. They found that higher levels of homocysteine, called hyperhomocysteinemia, were associated with NASH progression. “It is very important to catch NASH at the beginning stages, when inflammation is just starting, because there are reversible and nonreversible stages. You have to catch it when the monster is first rearing its head,” says Dr. Tripathi. The key is to treat patients before they develop the advanced stages of NASH, which causes cirrhosis, or liver scarring, explains Justin Boike, MD, a hepatologist at Northwestern Medicine in Chicago, who was not involved with the research. While there are no drugs approved by the U.S. Food and Drug Administration (FDA) for the treatment of NAFLD, lifestyle changes, particularly diet and exercise aimed at weight loss, are the go-to for treatment. “If you lose weight, your liver health improves,” says Tripathi. According to the Mayo Clinic, people with NAFLD are usually advised to lose about 10 percent of their body fat, though improvement can be seen after a 3 to 5 percent weight loss. Weight loss surgery may also be an option for some people with NAFLD. In part two of the study, Tripathi and team began to explore whether dietary supplements may work in tandem with lifestyle changes to treat severe NAFLD. The team did this by adding folic acid and vitamin B12 to the mice's diet. They have not yet tested the supplements on humans, but the vitamins brought down liver inflammation in mice that had NASH. According to Tripathi, the inflammation reduction was significant, though she and her team could not quantify it with an exact number. Since exact data wasn’t collected on liver inflammation and the study was done on mice, not people, the results are preliminary and cannot be applied to human health. “Mice or mice models are designed to mimic humans as best as possible, but we know that it does not always end up being a one-to-one phenomenon. What works in mice models doesn’t always work in humans,” says Dr. Boike. “But it does set up the framework for those future studies in humans to be done.” Currently, NAFLD progression is evaluated using a sonogram and blood test. Judging by the study’s findings, it’s possible that in the future, measurement of homocysteine as a biomarker could indicate how someone’s NASH has progressed, says Tripathi.
Early Research Reveals Key Player in Nonalcoholic Fatty Liver Disease
A 2-part study mostly done in mice revealed that B vitamins may play a role in slowing the progression of nonalcoholic fatty liver disease. By Kaitlin SullivanMedically Reviewed by Ira Daniel Breite, MDReviewed: October 4, 2022Medically ReviewedVitamin B12 and folic acid may play a role in curbing inflammation related to liver disease.Adobe Stock (2); CanvaNonalcoholic fatty liver disease (NAFLD), a condition in which excess fat builds up in the liver, affects nearly one in four Americans, according to the National Institute of Diabetes and Digestive and Kidney Diseases, and incidence has more than doubled over the past 20 years, according to the American Liver Foundation. The more severe form of NAFLD, when fat buildup in the liver is more than 5 to 10 percent, is known as nonalcoholic steatohepatitis (NASH). With NASH on the rise, researchers are pushing to understand more about the factors that influence the disease. Scientists at Duke-NUS Medical School in Singapore have zeroed in on an amino acid called homocysteine, which appears to cause inflammation in people with NASH. In a two-part study published July 8, 2022, in the Journal of Hepatology, researchers looked at whether supplementing the diet with folic acid and vitamin B12 could reverse inflammation. According to Madhulika Tripathi, MD, a senior research fellow with the laboratory of hormonal regulation in Duke-NUS Medical School's cardiovascular and metabolic program, who co-led the study, inflammation can cause NASH to progress into cirrhosis, which can lead to liver failure or liver cancer. Although scientists know that NASH is associated with elevated levels of homocysteine, they don’t know what role it plays in the disorder. In the first part of the study, researchers used mice and humans to determine how homocysteine levels correlated with NASH. They found that higher levels of homocysteine, called hyperhomocysteinemia, were associated with NASH progression. “It is very important to catch NASH at the beginning stages, when inflammation is just starting, because there are reversible and nonreversible stages. You have to catch it when the monster is first rearing its head,” says Dr. Tripathi. The key is to treat patients before they develop the advanced stages of NASH, which causes cirrhosis, or liver scarring, explains Justin Boike, MD, a hepatologist at Northwestern Medicine in Chicago, who was not involved with the research. While there are no drugs approved by the U.S. Food and Drug Administration (FDA) for the treatment of NAFLD, lifestyle changes, particularly diet and exercise aimed at weight loss, are the go-to for treatment. “If you lose weight, your liver health improves,” says Tripathi. According to the Mayo Clinic, people with NAFLD are usually advised to lose about 10 percent of their body fat, though improvement can be seen after a 3 to 5 percent weight loss. Weight loss surgery may also be an option for some people with NAFLD. In part two of the study, Tripathi and team began to explore whether dietary supplements may work in tandem with lifestyle changes to treat severe NAFLD. The team did this by adding folic acid and vitamin B12 to the mice's diet. They have not yet tested the supplements on humans, but the vitamins brought down liver inflammation in mice that had NASH. According to Tripathi, the inflammation reduction was significant, though she and her team could not quantify it with an exact number. Since exact data wasn’t collected on liver inflammation and the study was done on mice, not people, the results are preliminary and cannot be applied to human health. “Mice or mice models are designed to mimic humans as best as possible, but we know that it does not always end up being a one-to-one phenomenon. What works in mice models doesn’t always work in humans,” says Dr. Boike. “But it does set up the framework for those future studies in humans to be done.” Currently, NAFLD progression is evaluated using a sonogram and blood test. Judging by the study’s findings, it’s possible that in the future, measurement of homocysteine as a biomarker could indicate how someone’s NASH has progressed, says Tripathi.