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Can Diabetes Affect Liver Enzymes

Glycogenic Hepatopathy In Type 1 Diabetes Mellitus

Glycogenic Hepatopathy In Type 1 Diabetes Mellitus

Copyright © 2015 Murat Atmaca et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Glycogenic hepatopathy is a rare cause of high transaminase levels in type 1 diabetes mellitus. This condition, characterized by elevated liver enzymes and hepatomegaly, is caused by irreversible and excessive accumulation of glycogen in hepatocytes. This is a case report on a 19-year-old male case, diagnosed with glycogenic hepatopathy. After the diagnosis was documented by liver biopsy, the case was put on glycemic control which led to significant decline in hepatomegaly and liver enzymes. It was emphasized that, in type 1 diabetes mellitus cases, hepatopathy should also be considered in the differential diagnoses of elevated liver enzyme and hepatomegaly. 1. Introduction Liver enzyme elevation is more common among diabetic patients compared to the general population. This condition is often associated with nonalcoholic hepatosteatosis [1, 2]. Another very rare cause of elevated liver enzymes, especially among type 1 diabetic patients, is glycogenic hepatopathy (GH). GH develops due to excessive and irreversible accumulation of glycogen in the hepatocytes and causes liver function disorders and hepatomegaly [3, 4]. Mauriac first defined GH in a child with brittle diabetes, as a component of Mauriac syndrome, characterized by delayed development, hepatomegaly, cushingoid appearance, and delayed puberty [5]. Additionally, GH can also be observed in adult type 1 diabetic individuals without other components of Mauriac syndrome [6–8]. Hyperglycemia and overinsulinization (poor glycemic control) are believed to be Continue reading >>

10 Causes Of Elevated Liver Enzymes

10 Causes Of Elevated Liver Enzymes

Home Your Health 10 Causes of Elevated Liver Enzymes By: Dr. Gerald Morris on Tuesday, July 5th Elevated liver enzymes are a marker of inflammation or damage to liver cells. Inflamed or injured liver cells cause the liver enzymes alanine transaminase (ALT) and aspartate transaminase (AST) to leak into the bloodstream. Mild elevations of ALT and AST are commonly discovered in individuals with no symptoms during routine blood work. In general, normal ranges for ALT are 7 to 56-units per liter, while normal ranges for AST are 10 to 40-units per liter. Mild elevations of both liver enzymes are 2 to 3-times higher than normal range. Ten causes of elevated liver enzymes include Nonalcoholic fatty liver disease (NAFLD) is the diagnosis used to describe an abnormal accumulation of fat in the liver of individuals who drink little or no alcohol. The disease is common and most individuals with the diagnosis show no signs or symptoms and have no complications. It is the most common cause of elevated liver enzymes. Risk factors for the development of NAFLD include obesity and type 2 diabetes. Nonalcoholic fatty liver disease has two forms: hepatic steatosis and nonalcoholic steatohepatitis. It is estimated that 30-percent of adults in the United States have nonalcoholic fatty liver disease. Physicians expect more than 5 to 10-percent of the livers weight to be fat at the time of diagnosis of the disease. No standard treatment exists for NAFLD. The emphasis is on minimizing the contribution of risk factors commonly associated with NAFLD. Losing weight if obese and tight control of type 2 diabetes is highly recommended to decrease the odds of developing NAFLD. Regardless of whether it takes place over many years or a few weeks, liver failure is an absolutely devastating health develo Continue reading >>

Association Between Liver Enzymes And Incident Type 2 Diabetes In Singapore Chinese Men And Women

Association Between Liver Enzymes And Incident Type 2 Diabetes In Singapore Chinese Men And Women

Aims To assess the association between liver enzymes and the risk of type 2 diabetes (T2D) in a Chinese population. Methods A nested case–control study comprising 571 T2D cases and 571 matched controls was conducted within the Singapore Chinese Health Study. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and lactate dehydrogenase (LDH) were quantified in baseline plasma collected from them, while γ-glutamyltransferase (GGT) was assayed among 255 T2D cases with baseline hemoglobin A1c <6.5% and 255 matched controls. Participants were free of diagnosed diabetes, cardiovascular disease, and cancer at blood collections (1999–2004). Incident self-reported T2D cases were identified at follow-up II interview (2006–2010). Controls were matched to cases on age, sex, dialect group, and date of blood collection. Results Higher levels of ALT and GGT were significantly associated with increased risk of T2D (p for trend <0.001 for ALT, p for trend=0.03 for GGT), and the ORs (95% CIs) comparing highest versus lowest tertiles of ALT and GGT were 2.00 (1.01 to 3.96) and 2.38 (1.21 to 4.66), respectively. A null association was observed for AST, ALP, and LDH with T2D risk. Adding GGT (<23 vs ≥23 IU/L) or ALT (<21 vs ≥21 IU/L) to a prediction model resulted in significant gain in net reclassification improvement and integrated discrimination improvement of T2D prediction (all p<0.001). Conclusions Higher levels of GGT and ALT are associated with increased T2D risk. GGT ≥23 IU/L and ALT ≥21 IU/L may identify people at higher risk of developing T2D in this Chinese population. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others t Continue reading >>

The Association Between Liver Enzymes And Risk Of Type 2 Diabetes: The Namwon Study

The Association Between Liver Enzymes And Risk Of Type 2 Diabetes: The Namwon Study

Abstract We examined the association between liver enzymes and development of type 2 diabetes in a general Korean population. A total of 10,667 subjects (4,201 males and 6,466 females) aged 45 to 74 years participated in a baseline examination between 2004 and 2007. Among the subjects, 8,157 (3,231 males and 4,926 females) underwent follow-up examination from 2007 to 2011, for a median follow-up period of 4.2 years. Type 2 diabetes was defined as intake of anti-diabetic agents, insulin treatment, fasting glucose concentration of more than 126 mg/dl, or hemoglobin A1c of more than 6.5% at re-examination. Associations of liver enzymes with incidence of type 2 diabetes were analyzed using logistic regression models. During the follow-up period, 548 subjects (235 males, 313 females) developed type 2 diabetes. After adjusting for comprehensive diabetes risk factor, the risk of type 2 diabetes was significantly higher in the highest alanine aminotransferase (ALT) quartile than in the lowest quartile (odds ratio (OR): 1.95, 95% confidence interval (CI): 1.18-3.21 in males; OR: 1.49, 95% CI: 1.03-2.16 in females). Similar results were observed for gamma-glutamyltransferase (GGT) quartiles, but in the fully adjusted analysis, the OR for the highest versus lowest quartiles was significant only for females (OR: 1.58, 95% CI: 0.95-2.63 in males; OR: 1.85, 95% CI: 1.23-2.79 in females). Our results suggest that serum ALT concentrations were independently associated with type 2 diabetes in both sexes, and that GGT was also independently associated but only in females. Background The liver plays an important role in maintenance of normal glucose levels during fasting as well as in the postprandial period [1], and its role in the pathogenesis of type 2 diabetes has attracted much inter Continue reading >>

Liver Blood Tests (normal, Low, And High Ranges & Results

Liver Blood Tests (normal, Low, And High Ranges & Results

What are the basic functions of the liver? The liver is located in the right upper portion of the abdominal cavity just beneath the rib cage. The liver has many functions that are vital to life. Briefly, some of the important functions of the human liver are: Detoxification of blood Production of important clotting factors, albumin, and many other important proteins Metabolizing (processing) medications and nutrients Production of glucose (gluconeogenesis or glucose synthesis/release during starvation) What are common liver blood function tests? Liver blood tests are some of the most commonly performed blood tests. These tests can be used to assess liver functions or liver injury. An initial step in detecting liver damage is a simple blood test to determine the level of certain liver enzymes (proteins) in the blood. Under normal circumstances, these enzymes mostly reside within the cells of the liver. But when the liver is injured for any reason, these enzymes are spilled into the blood stream. Enzymes are proteins that are present throughout the body, each with a unique function. Enzymes help to speed up (catalyze) routine and vital chemical reactions in the body. Among the most sensitive and widely used liver enzymes are the aminotransferases. They include aspartate aminotransferase (AST or SGOT) and alanine aminotransferase (ALT or SGPT). These enzymes are normally predominantly contained within liver cells and to a lesser degree in the muscle cells. If the liver is injured or damaged, the liver cells spill these enzymes into the blood, raising the AST and ALT enzyme blood levels and signaling liver disease. Other blood tests pertaining to the liver are measurements of some of the other enzymes found the liver. In addition to AST and ALT, alkaline phosphatase, 5' nuc Continue reading >>

Metformin, The Liver, And Diabetes

Metformin, The Liver, And Diabetes

Most people think diabetes comes from pancreas damage, due to autoimmune problems or insulin resistance. But for many people diagnosed “Type 2,” the big problems are in the liver. What are these problems, and what can we do about them? First, some basic physiology you may already know. The liver is one of the most complicated organs in the body, and possibly the least understood. It plays a huge role in handling sugars and starches, making sure our bodies have enough fuel to function. When there’s a lot of sugar in the system, it stores some of the excess in a storage form of carbohydrate called glycogen. When blood sugar levels get low, as in times of hunger or at night, it converts some of the glycogen to glucose and makes it available for the body to use. Easy to say, but how does the liver know what to do and when to do it? Scientists have found a “molecular switch” called CRTC2 that controls this process. When the CRTC2 switch is on, the liver pours sugar into the system. When there’s enough sugar circulating, CRTC2 should be turned off. The turnoff signal is thought to be insulin. This may be an oversimplification, though. According to Salk Institute researchers quoted on RxPG news, “In many patients with type II diabetes, CRTC2 no longer responds to rising insulin levels, and as a result, the liver acts like a sugar factory on overtime, churning out glucose [day and night], even when blood sugar levels are high.” Because of this, the “average” person with Type 2 diabetes has three times the normal rate of glucose production by the liver, according to a Diabetes Care article. Diabetes Self-Management reader Jim Snell brought the whole “leaky liver” phenomenon to my attention. He has frequently posted here about his own struggles with soarin Continue reading >>

What Every Diabetic Should Know About Liver Disease

What Every Diabetic Should Know About Liver Disease

What Every Diabetic Should Know About Liver Disease Did you know that diabetics are 50% more likely to develop liver disease? Particularly fatty liver disease. Fatty liver disease is incredibly common in overweight people; nearly everyone with excess weight on their abdomen has some degree of fatty liver. Type 2 diabetics are prone to carrying excess weight on their abdomen, but even slim diabetics often have a fatty liver. It is well known that diabetes increases the risk of kidney disease, nerve damage, blood vessel damage, infections, blindness, erectile problems and heart disease, but you may not realise diabetes has terrible effects on the liver. You can’t see or feel the effects it’s having on your liver until liver cells become damaged. According to Gillian Booth, MD, MSc, of St. Michael’s Hospital in Toronto, in a population-based study, newly diagnosed diabetes was linked with a near doubling in the rate of cirrhosis, liver failure or liver transplant compared with non-diabetics. Clearly these are significant findings that should be taken seriously. Insulin resistance (syndrome X) is the driving force behind the development of fatty liver. Insulin resistance is a forerunner to type 2 diabetes. If the insulin resistance becomes severe enough, a person usually develops type 2 diabetes. Type 1 diabetes usually develops in childhood, although by the time they are in their mid 30s, most type 1 diabetics have developed insulin resistance as well, and they face the same risks as type 2 diabetics when they get older. People with insulin resistance have high levels of insulin in their bloodstream. Insulin signals to your liver to manufacture fat, especially triglycerides and cholesterol. This promotes the accumulation of fat inside the liver, inside other organs, Continue reading >>

High Liver Enzymes & High Blood Sugar

High Liver Enzymes & High Blood Sugar

A simple blood test can check liver enzyme levels. Elevated levels can indicate liver damage; liver function is usually tightly regulated, but a damaged liver can "leak" extra enzymes into the bloodstream because its function is compromised. This liver damage can be acute or chronic. With either type of liver damage, many physiological functions, including blood sugar control, can be affected. It is important to correct the underlying cause of the liver dysfunction to prevent serious, long-term consequences. Video of the Day The pancreas and liver regulate blood sugar. During digestion, all carbohydrates are eventually broken down into glucose, which is released into the bloodstream. The pancreas senses this increase in blood sugar and signals the secretion of insulin to the surface of cells throughout the body; insulin helps pull glucose from the blood and into the cell where it can be used for energy. Excess glucose is sent to the liver, where it is stored as glycogen; glycogen is used for energy during a state of starvation. Functions of the Liver The liver is located in the upper right portion of the abdomen, and plays a very important and diverse role in the body. It has many functions, including creating bile to digest fat, regulating blood clotting and blood sugar, and producing and regulating proteins, cholesterol and fat transporters. Additionally, all drugs and chemicals that enter the body are first filtered by the liver; harmful substances are broken down and excreted by the kidneys. Liver and Blood Sugar The liver is where excess glucose is brought and stored as glycogen, and it works closely with other organ systems to regulate blood sugar. In a healthy person, the pancreas senses when blood sugar is low, and releases glucagon -- a hormone that signals to Continue reading >>

Diabetes: How Do I Help Protect My Liver?

Diabetes: How Do I Help Protect My Liver?

If I have diabetes, is there anything special I need to do to take care of my liver? Answers from M. Regina Castro, M.D. You're wise to wonder about steps to protect your liver. Diabetes raises your risk of nonalcoholic fatty liver disease, a condition in which excess fat builds up in your liver even if you drink little or no alcohol. This condition occurs in at least half of those with type 2 diabetes. It isn't clear whether the condition appears more often in people with type 1 diabetes than in the general population because obesity, which is a risk factor, occurs with similar frequency in both groups. Other medical conditions, such as high cholesterol and high blood pressure, also raise your risk of nonalcoholic fatty liver disease. Fatty liver disease itself usually causes no symptoms. But it raises your risk of developing liver inflammation or scarring (cirrhosis). It's also linked to an increased risk of liver cancer, heart disease and kidney disease. Fatty liver disease may even play a role in the development of type 2 diabetes. Once you have both conditions, poorly managed type 2 diabetes can make fatty liver disease worse. Your best defense against fatty liver disease includes these strategies: Work with your health care team to achieve good control of your blood sugar. Lose weight if you need to, and try to maintain a healthy weight. Take steps to reduce high blood pressure. Keep your low-density lipoprotein (LDL, or "bad") cholesterol and triglycerides — a type of blood fat — within recommended limits. Don't drink too much alcohol. If you have diabetes, your doctor may recommend an ultrasound examination of your liver when you're first diagnosed and regular follow-up blood tests to monitor your liver function. Continue reading >>

A Telltale Sign Of Type 2 Diabetes

A Telltale Sign Of Type 2 Diabetes

Elevated serum liver markers may be disease indicator…. Type 2 diabetes and liver disease seem to have a connection; the liver is one of the targets of some common diabetic medications. The body needs the liver to help maintain normal glucose levels. But when the cells in the body become resistant to insulin, the liver produces more and more glucose and tends to get overworked, eventually no longer working properly. Insulin resistance that leads to liver dysfunction usually results in type 2 diabetes. In this study, researchers investigated the possible link between certain disease states or abnormalities (abnormal fasting glucose levels, cardiovascular disease, metabolic syndrome, type 2 diabetes) and elevated liver enzymes (aspartate aminotransferase [AST], alanine aminotransferase [ALT], gamma-glutamyltransferase [GGT]). Although there is some evidence that lead researchers to believe that the detection of elevated liver enzymes is a reliable sign that these individuals are at a higher risk for developing type 2 diabetes, they would like to identify which enzyme is the best indicator and which increases the prevalence of type 2 diabetes. There were 8,863 study participants, all of which were over the age of 30, with no history of malignancy, hepatitis B or C, or liver cirrhosis. None of the participants were pregnant or consumed more than 30 grams of alcohol per day. There were 3,408 men and 5,455 women who participated in the study. Liver enzymes and their correlation with type 2 diabetes were evaluated utilizing logistic regression models. Based on liver marker levels and gender, individuals were placed into specific quartiles. Liver marker combinations revealed that individuals who had at least two liver enzymes levels in the highest quartile were at a higher ri Continue reading >>

Liver Disease And Diabetes Mellitus

Liver Disease And Diabetes Mellitus

CLINICAL DIABETES VOL. 17 NO. 2 1999 These pages are best viewed with Netscape version 3.0 or higher or Internet Explorer version 3.0 or higher. When viewed with other browsers, some characters or attributes may not be rendered correctly. FEATURE ARTICLE Gavin N. Levinthal, MD, and Anthony S. Tavill, MD, FRCP, FACP IN BRIEF Liver disease may cause or contribute to, be coincident with, or occur as a result of diabetes mellitus. This article addresses these associations. This article addresses the role of the liver in normal glucose homeostasis and discusses a variety of liver conditions associated with abnormal glucose homeostasis. This association may explain the pathogenesis of the liver disease or of the abnormal glucose homeostasis, or may be purely coincidental (Table 1). Table 1. Liver Disease and Diabetes Mellitus 1. Liver disease occurring as a consequence of diabetes mellitus Glycogen deposition Steatosis and nonalcoholic steatohepatitis (NASH) Fibrosis and cirrhosis Biliary disease, cholelithiasis, cholecystitis Complications of therapy of diabetes (cholestatic and necroinflammatory) 2 . Diabetes mellitus and abnormalities of glucose homeostasis occurring as a complication of liver disease Hepatitis Cirrhosis Hepatocellular carcinoma Fulminant hepatic failure Postorthotopic liver transplantation 3 . Liver disease occurring coincidentally with diabetes mellitus and abnormalities of glucose homeostasis Hemochromatosis Glycogen storage diseases Autoimmunebiliary disease The prevalence of type 1 diabetes in the United States is ~0.26%. The prevalence of type 2 diabetes is far higher, ~1–2% in Caucasian Americans and up to 40% in Pima Indians. According to the Centers for Disease Control and Prevention, hepatitis C alone chronically infects more than 1.8% of the A Continue reading >>

Type 2 Diabetes And Fatty Liver Disease

Type 2 Diabetes And Fatty Liver Disease

Non-alcoholic fatty liver disease is a group of conditions in which fat builds up in the liver, leading to inflammation of the cells where it is stored and causing the liver to get bigger. It can progress to more serious conditions, including fibrosis and cirrhosis of the liver. Fatty liver disease "is so common. It’s present arguably in a majority of type 2 diabetics,” says Daniel Einhorn, MD, clinical professor of medicine at the University of California, San Diego and the medical director of the Scripps Whittier Diabetes Institute. “None of us thought about it more than about 10 years ago, then all of a sudden we discovered it and see it all the time.” Fatty Liver Disease and Type 2 Diabetes: The Connection Diabetes does not cause fatty liver disease. Instead, the two diseases tend to occur in the same people because the same conditions cause both problems. “So, it’s not the diabetes per se. People with diabetes also have obesity and insulin resistance, and so the fatty liver is thought to be part of that,” Dr. Einhorn explains. Einhorn says that most cases of fatty liver disease do not cause any harm. However, since type 2 diabetes and obesity are so common in the United States, fatty liver disease is now a leading cause of end-stage (fatal) liver disease requiring a liver transplant, along with alcohol abuse and hepatitis. Fatty Liver Disease Diagnosis Fatty liver disease has no symptoms. People who are being treated for diabetes will have liver enzyme tests as part of their routine blood work during medical exams. Ninety-nine percent of the cases of fatty liver disease are detected by this test, says Einhorn. In some cases it will be picked up during the physical exam or in imaging studies, like a computed tomography scan of the abdomen or a liver ul Continue reading >>

The Liver And Diabetes

The Liver And Diabetes

Tweet The liver is one of the most important organs in our bodies, playing a central role in a number of important processes. One of these is to help control glucose concentration in the blood (i.e. regulating blood glucose levels). A healthy liver helps keep blood glucose within the ‘normal range’ and protects against excessive fluctuations, which is vital as high blood sugar (hyperglycemia) and low blood sugar (hypoglycemia) can both be dangerous for the human body. What is the liver? The liver is the largest internal organ of the human body, weighing approximately 1.4 kg (3 lb) in the average adult. Located under your diaphragm (more to the right side of your body), it is a wedge-shaped, spongy organ that performs a number of key functions, including regulating blood sugar levels, getting rid of toxins (body detoxification) and bile production. It also acts as a major filter of the blood travelling from the digestive tract to the rest of the body. The liver’s response to stress The body responds to stress by releasing hormones from the adrenal glands within the kidneys. These hormones travel within the blood to the liver and trigger the liver to release some of its stored glycogen. Release of glucose into the blood is part of the body’s ‘fight or flight’ response, preparing the body with energy to be able to quickly respond to a threat or stressful situation. Read more on stress and blood glucose levels The liver’s response to exercise During exercise, or other forms of physical activity, the liver plays a part in regulating blood glucose levels. When you begin physical activity, glycogen from the muscles are mobilised to be used as a source of fuel. As glucose is taken up by the muscles, the liver releases glucose into the blood. The liver can only sto Continue reading >>

Liver Fat, Hepatic Enzymes, Alkaline Phosphatase And The Risk Of Incident Type 2 Diabetes: A Prospective Study Of 132,377 Adults

Liver Fat, Hepatic Enzymes, Alkaline Phosphatase And The Risk Of Incident Type 2 Diabetes: A Prospective Study Of 132,377 Adults

Article | Open Liver Fat, Hepatic Enzymes, Alkaline Phosphatase and the Risk of Incident Type 2 Diabetes: A Prospective Study of 132,377 Adults Scientific Reportsvolume7, Articlenumber:4649 (2017) Previous studies have reported inconsistent results of the associations of alanine transaminase (ALT), aspartate transaminase (AST), gamma-glutamyltransferase (GGT) and alkaline phosphatase (ALP) with incident type 2 diabetes (diabetes hereafter). We aimed to resolve the controversy by taking nonalcoholic fatty liver disease (NAFLD) into account. The study population comprised 132,377 non-diabetic individuals (64,875 men and 67,502 women) aged 3579 who had two or more health examinations during 19962014. A total of 6,555 incident diabetes (3,734 men and 2,821 women) were identified, on average, over 5.8 years of follow-up. Cox regression was used to calculate the hazard ratio (HR) for incident diabetes, adjusting for classical confounders. The risk of incident diabetes was significantly associated with NAFLD [HR = 2.08 (men) and 2.65 (women)]. Elevated ALT, AST, GGT and ALP were also significantly associated with the increased risk of diabetes, with HRs of 1.27, 1.23, 1.58 and 1.37, respectively, in men, and 1.56, 1.18, 1.48 and 1.44, respectively in women. Our results suggest that NAFLD, ALT, AST, GGT and ALP are independent predictors for incident diabetes in both men and women. The prevalence and incidence of type 2 diabetes (diabetes hereafter) are rising rapidly worldwide, especially in Asia 1 . Diabetes has been linked to a shorter life expectancy mainly because of its complications, including heart disease, strokes, eye disease, kidney failure and bone disease 2 . Lifestyle changes and medications are shown to reduce the incidence of diabetes 3 . Therefore, identificat Continue reading >>

Raised Liver Enzymes In Newly Diagnosed Type 2 Diabetes Are Associated With Weight And Lipids, But Not Glycaemic Control

Raised Liver Enzymes In Newly Diagnosed Type 2 Diabetes Are Associated With Weight And Lipids, But Not Glycaemic Control

Go to: Our study shows a high incidence of elevated ALT in a well-defined population of newly diagnosed people with T2DM. Elevated ALT was used as a surrogate marker of NAFLD, which whilst both insensitive and non-specific, does suggest that this condition may be common within people with T2DM. Elevated ALT was found to have a statistically significant association with increasing age, obesity, elevated triglyceride levels, and low HDL cholesterol levels, but was not significantly associated with glycemic control. Manifestations of the metabolic syndrome, which often precedes T2DM, such as obesity, hyperinsulinemia, peripheral insulin resistance, hypertriglyceridemia, and hypertension, have been previously suggested as a cause of NAFLD.[5] This study is in keeping with the current understanding of the pathogenesis of NAFLD as a hepatic manifestation of the metabolic syndrome itself, as elevated ALT was commonly elevated in people with diagnosis of T2DM, suggesting that development of NAFLD may precede the diagnosis of T2DM. Strong epidemiological, biochemical, and therapeutic evidence support the premise that the primary pathophysiogical derangement, in most patients with NAFLD, is insulin resistance.[6] Insulin resistance leads to increased lipolysis, triglyceride synthesis, increased hepatic uptake of free fatty acids, and accumulation of hepatic triglyceride.[5,7–12] Our data, demonstrating higher serum triglycerides and lower HDL cholesterol in the raised ALT group, support this hypothesis. There are weaknesses of our study particularly the lack of comprehensive alcohol and drug history, although our cohort comes from a center where all newly diagnosed patients from a defined geographical area attended a well-recognized education program. We can therefore use our d Continue reading >>

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