دانلود رایگان مقاله انگلیسی مکمل ویتامین D در درمان بیماری کبد چرب افراد غیر الکلی - الزویر 2018

ABSTRACT

Background: Low serum vitamin D has been associated with metabolic syndrome and Non-alcoholic fatty liver disease (NAFLD). This study aimed to investigate the impact of vitamin D supplementation in treatment of patients with NAFLD. Methods: In a double blind, randomized, placebo controlled trial patients with NAFLD were randomized to receive one weekly pearl of placebo, 50,000 U vitamin D3 (cholecalciferol) pearl per week and 0.25 mg calcitriol (1,25 dihydroxycholecalciferol) pearl per day for 3 months. Results: 106 NAFLD patients were randomized to receive calcitriol, vitamin D3 and placebo pearls for 12 weeks and data for 91 patients were analyzed. After 12 weeks of treatment, serum alkaline phosphatase levels was significantly decreased from baseline levels in vitamin D and calcitriol treated groups (P < 0.05). Serum and gamma glutamyl transferase (GGT) level was also significantly decreased compared to the baseline levels after 12 weeks of treatment with vitamin D. There was no statistically significant difference between placebo, calcitriol, vitamin D groups in terms of serum aminotransferase, alkaline phosphatase, serum GGT and lipid profile (P > 0.05). Conclusion: While significant reduction of serum alkaline phosphatase and GGT were seen with vitamin D and calcitriol supplementation from baseline levels, no beneficial effects was seen when comparing vitamin D, calcitriol and placebo groups at the end of trial.

Discussion

This study is the first randomized, double blind, placebo controlled trial investigating the effect of high dose oral vitamin D3 supplementation and calcitriol in non-diabetic, vitamin D deficient patients with NAFLD. Neither vitamin D3 nor calcitriol were capable of reducing serum aminotransferase, alkaline phosphatase and GGT in patients with NAFLD. Although mean serum fasting plasma glucose was decreased in calcitriol and vitamin D3 treated groups it was not statistically significant as compared to the placebo group. The alterations in serum level of TG, cholesterol and LDL were not statistically significant among these 3 groups. When compared to the baselines measures,12 weeks of calcitriol therapy significantly increased serum HDL level and decreased alkaline phosphatase from baseline levels. Serum alkaline phosphatase and GGT levels were also significantly deceased in vitamin D treated group when compared with baseline levels. No significant alterations in lipid profile, liver enzymes or blood sugar was observed in placebo treated group. Hepatic osteodystrophy is the term usually used to define abnormalities of bone in patients with chronic liver disease. Epidemiological evidences are now available that have proposed hypovitaminosis D as an independent risk factor for NAFLD [17,18]. It has been reported that low 25(OH) D is strongly and independently associated with NAFLD in adult normal population with normal liver enzymes [19]. Furthermore, the severity of vitamin D deficiency has been associated with NAFLD severity in histopathology and patients with lower vitamin D had more advanced liver steatosis and fibrosis [20,21]. NAFLD patients had 1.26 times higher likelihood to be vitamin D deficient in a recent meta-analysis [22].