Elevated Concentrations of Liver Enzymes and Ferritin Identify a New Phenotype of Insulin Resistance: Effect of Weight Loss After Gastric Banding
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Several studies have associated elevated liver enzymes (LFTs), obesity, and type 2 diabetes (T2DM), and a link has been established between insulin resistance (IR) and elevated ferritin concentrations. We examined the relationship between LFTs, ferritin, and IR in morbid obese subjects and the effect of weight loss after bariatric surgery.
We measured liver enzymes, ferritin, insulin resistance, and glucose tolerance (by OGTT) in 159 morbid obese subjects (BMI = 44.4 ± 0.4 kg/m2) at baseline, 6 months and 1 year after laparoscopic-adjustable-gastric banding (LAGB). Subjects were divided in two groups: increased LFTs (ALT > 30; AST/ALT < 1) vs. normal LFTs.
A large proportion of morbid obese subjects had increased LFTs (44%) which were associated with increased IR and ferritin, suggesting potential liver disease. A majority of the morbidly obese with increased LFTs, IGT, and T2DM, were male and had almost double ferritin concentrations, strongly correlated with ALT (r = 0.43, p < 0.0001). Both ferritin and ALT correlated with waist circumference and IR. One year after, LAGB glucose tolerance improved, LFTs and IR were reduced; ferritin did not change significantly, but was still correlated with IR.
Ferritin may be an additional useful marker for more severe hepatic IR.
KeywordsInsulin Resistance Bariatric Surgery Waist Circumference Ferritin NASH
We acknowledge the expert technical assistance of Roberta Petz, Emma Buzzigoli, Emma Di Gregorio, and Demetrio Ciociaro.
Sources of Funding
The study has been partially supported by startup funds from the University of Texas Health Science Center (Franco Folli), funds from the Italian National Research Council (Amalia Gastaldelli) and MURST (Antonio Pontiroli).
There are no conflicts of interest for this paper.
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