Hepatobiliary surgery and nutrition最新文献

Background: Metabolic regulation is critical during liver regeneration in rodents, but human data are limited. We investigated perioperative dynamics of circulating metabolites and plasma levels of glucagon-like peptide-1 (GLP-1) and GLP-2, in patients undergoing liver resections, exploring their associations with the histological phenotype of metabolic dysfunction-associated steatotic liver disease (MASLD) and posthepatectomy liver failure (PHLF).

Methods: Eighty-one and 75 patients from two centers between 2012 and 2023 were studied. Targeted quantitative metabolomic assay of 180 circulating metabolites, perioperative GLP-1, GLP-2, and standard lipid parameter level evaluation was employed. An exploratory PHLF prediction model was developed, including GLP-1 as a metabolic parameter.

Results: Significant alterations of 44 metabolites by postoperative day (POD) 1 and 40 by POD5 were observed, mainly among phospholipid species. Unsupervised clustering identified two metabolic clusters, with one encompassing 93% of PHLF patients by POD5 (P<0.001). Standard plasma lipid parameters displayed consistent decrease after hepatectomy, independent from MASLD phenotype, with the lowest levels in PHLF patients. Postoperative GLP-1 and GLP-2 dynamics displayed a reciprocal pattern, indicating adaptive change in secretion. Preoperative GLP-1 levels were significantly increased in PHLF (P=0.02). Furthermore, incorporation of GLP-1 into the established aspartate aminotransferase to platelet ratio index (APRI) + albumin-bilirubin (ALBI) score, improved PHLF prediction [area under the curve (AUC): 0.833, 95% confidence interval (CI): 0.660-0.964].

Conclusions: Significant metabolic changes occur during human liver resection, particularly in phospholipid metabolism, along with distinct perioperative dynamics of GLP-1 and GLP-2, closely linked to PHLF and independent of the histological phenotype of MASLD. Additionally, we provide exploratory results on the predictive value of GLP-1 for PHLF, emphasizing a holistic model of liver function assessment highlighting the metabolic component of human liver regeneration.

Background: Many studies have shown that carotenoids are beneficial to non-alcoholic fatty liver disease (NAFLD). Therefore, we explored potential biomarkers of gut microbiota and fecal and serum metabolites linking the association between serum carotenoids and NAFLD in adults.

Methods: This 7.8-year prospective study included 2921 participants with serum carotenoids at baseline and determined NAFLD by ultrasonography (ULS-NAFLD) every 3 years. A total of 828 subjects additionally underwent magnetic resonance imaging to identify NAFLD (MRI-NAFLD). Gut microbiota was analyzed by 16S rRNA sequencing in 1,661 participants, and targeted metabolomics profiling in 893 feces and 896 serum samples was performed by ultrahigh-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) in the middle term.

Results: A total of 2,522 participants finished follow-up visits. Of these participants, 770, 301, 474, and 977 were categorized into NAFLD-free, improved, new-onset, and persistent NAFLD groups based on their ULS-NAFLD status changes, respectively, and 342/828 were MRI-verified NALFD. Longitudinal analyses showed an inverse association between carotenoids and NALFD risk/presence (P_-trend <0.05). Multivariable-adjusted odds ratios (ORs)/hazard ratio (HR) [95% confidence intervals (CIs)] of NAFLD for quartile 4 (vs. quartile 1) of total carotenoids were 0.63 (0.50, 0.80) for incident ULS-NAFLD, 0.20 (0.15, 0.27) for persistent ULS-NAFLD, 1.53 (1.10, 2.12) for improved-NAFLD, and 0.58 (0.39, 0.87) for MRI-NAFLD. The biomarkers in the gut-liver axis significantly associated with both serum carotenoids and NAFLD included sixteen microbial genera mainly in Ruminococcaceae and Veillonellaceae family, nineteen fecal metabolites containing medium-chain fatty acids (MCFAs), bile acids, and carnitines, and sixteen serum metabolites belonging to organic acids and amino acids. The total carotenoids-related scores of significant microbial genera, fecal and serum metabolites mediated the carotenoids-NAFLD association by 8.72%, 12.30%, and 16.83% (all P<0.05) for persistent NAFLD and 9.46%, 8.74%, and 15.7% for incident-NAFLD, respectively.

Conclusions: Our study reveals a beneficial association of serum carotenoids and incident and persistent NAFLD. The identified gut-liver axis biomarkers provided mechanistic linkage for the epidemiological association.