THE ROLE OF POLYUNSATURATED FATTY ACIDS IN THE LIVER DISEASE PROGRESSION IN OBESE PATIENTS

Background and aim: In obesity NAFLD is associated with insulin resistance (IR), that may induce advanced liver fibrosis leading to cirrhosis, through NASH. BARD score (BMI, AST/ALT Ratio, Diabetes mellitus) is reported to predict accurately advanced liver fibrosis (score >= 2 points). Liver damage could be also affected by inadequate nutrient intakes in obese subjects. The aim was to investigate in obese patients the relationships between nutrient intakes and the markers of metabolic and liver dysfunction. Material and methods: From June 2010 to September 2014, 198 obese (BMI 40.4±6.5 kg/m2) inpatients (F 150, aged 42.5±11.4 yr) were admitted to the study, under their informed consent. HOMA-IR (values>2.5) and BARD score (>=2 points) were calculated. Patients with T1DM, HBV (+), HCV (+), alcohol abuse, and steatogenic drugs in the history, were excluded. Dietary habits were obtained by detailed questioning and the recommended dietary allowances (RDAs) for the Italian population were used as the reference range. To highlight the variation of each selected nutrient from the corresponding RDA, we calculated the rate of variance, as a percent value, over or below the RDA. Results: The following prevalences were observed, T2DM (11.1%), HOMAIR >2.5 (67.2%), AST/ALT ratio >0.8 (53.5%), BARD score >=2 points(42.4%). The rate of variances for each nutrient, as percent values, overor below the RDA, are reported in the table, expressed as 50th, 25th, 75th percentile. The logistic regression shows that BARD score >=2 points is significantly associated with the very low intake of PUFA which is, as median, 42% below the RDA (OR 5.3; 95% CI: 1.8–37.5). The inadequately low intake of PUFA is significantly associated with the HOMA-IR (OR 9.8; 95% CI:1.7–57.2). On the other hand the excessive -6 fatty acid intake, 60% over the RDA in the median value, is significantly associated with a positive BARD score (OR 8.2; 95% CI: 1.8–37,5). Conclusions: We observed that the highest variation rates were for fat and protein, and especially for animal protein, averaging 273% over the RDA, without significant association with the investigated markers. The low PUFA intake is associated with increased risk of IR and liver dysfunction. The excessive -6 fatty acid intake, highly associated with positive BARD score, suggests a close relation with liver inflammation and fibrosis, probably due to the increased levels of 6-derived pro-inflammatory eicosanoids