Serum Selenium and Zinc Levels in Non-alcoholic Fatty Liver Disease Patients
Condition: NAFLD
MeSH terms: Liver Diseases; Fatty Liver; Non-alcoholic Fatty Liver Disease
Study type: Observational

Summary: 
      Non-alcoholic fatty liver disease (NAFLD) includes a wide range of disorders that consist of
      simple fatty infiltration, steatohepatitis (NASH), and end-stage liver disease (cirrhosis).
      NAFLD is the most common cause of chronic liver disease worldwide and increases the risk of
      end-stage liver disease and hepatocellular carcinoma (HCC) . While risk factors such as
      obesity, diabetes, and a sedentary lifestyle may increase the risk of NAFLD, studies have
      shown that environmental exposures may further contribute to the pathogenesis of NAFLD.
      Although the pathogenic role of macronutrients is well established in both NAFLD and obesity,
      the contribution of micronutrients to NAFLD pathogenesis has garnered less attention than
      with obesity.

      Selenium is an essential element in many biological functions and is an important component
      of human nutrition. Exposure to selenium can be found in nature, such as rocks and sediment,
      air, soil, fuel oil, drinking water and nutritional supplementation. It is a major component
      of many enzymes such as glutathione peroxidase and plays an important role in anti-oxidation,
      DNA synthesis, reproduction, muscle function, and thyroid metabolism. Selenium concentrations
      have been studied in many diseases and organ systems including the liver. However, the exact
      relationship between selenium in patients with NAFLD is unclear.

      Selenium is an essential element in many biological functions and is an important component
      of human nutrition. It is a major component of many enzymes such as glutathione peroxidase
      and plays an important role in anti-oxidation, DNA synthesis, reproduction, muscle function,
      and thyroid metabolism. Selenium concentrations have been studied in many diseases and organ
      systems including the liver. However, the exact relationship between selenium in patients
      with NAFLD is unclear.

      Despite data suggesting mineral deficiencies in NAFLD patients, most data do not support
      insufficient mineral consumption as a possible mechanism for these deficiencies, except in
      the case of zinc deficiency. Zinc is the second most prevalent trace element in the body. It
      is integrally involved in the normal life cycle and has many important regulatory, catalytic,
      and defensive functions. Zinc deficiency occurs in many types of liver disease, especially
      more advanced/decompensated disease.
    

Detailed description: 
      We aim firstly to assess the serum selenium and zinc level in NAFLD patients, secondly to
      detect the association between hepatic fibrosis, steatosis, and serum selenium level in NAFLD
      patients, thirdly to detect if there is a synergistic effect of both molecules.

      Patients and methods

      Study design:

      Case-control study.

      Studied population & locality:

      This study will be conducted on two groups: Group (1): include 70 patients diagnosed to has
      NAFLD by ultrasonography presented to the outpatient clinic of Tropical medicine and
      gastroenterology department, Sohag University Hospitals during the period from March 2021 to
      August 2021.

      Group (2): a control group of 30 healthy volunteers who looks normal on ultrasonographic
      examination.

      Exclusion criteria:

      Any patient with a chronic liver disease rather than NAFLD.

      Methods:

      All included patients will be subjected to:

        1. Detailed history, complete general and systemic examination.

        2. BMI will be calculated as follow

        3. Abdominal Ultrasonography.

        4. Laboratory investigations:

             -  Fasting blood sugar

             -  Serum lipogram.

             -  Liver function tests.

             -  CBC.

        5. Estimation of serum selenium and zinc level.

        6. Liver stiffness measurements to detect the degree of fibrosis and measurement of the
           degree of steatosis using (Fibroscan).

      Ethical considerations:

      The study will be approved by The Ethical committee of medical research, Sohag Faculty of
      Medicine, Sohag University.

      After an explanation about the nature of the procedures, possible complications, benefits,
      and steps of the study, all patients and controls will give written informed consent for
      participating in the study, performing the abdominal ultrasound, taking blood samples,
      performing fibroscan.

      Statistical analysis:

      Data will be analyzed using STATA version 12.1. Quantitative data were represented as mean,
      standard deviation, median, and range. Data will be analyzed using a student t-test to
      compare the means of the two groups. Qualitative data will be presented as numbers and
      percentages and will be compared using either the Chi-square test or Fisher exact test.
      P-value will be considered significant if it was less than 0.05.
    

Intervention name(s): Serum Zinc a level; serum selenium level; Fibroscan measurement
Intervention type(s): Diagnostic Test; Diagnostic Test; Diagnostic Test
Intervention description(s): Diagnostic test; Diagnostic test; Diagnostic test
Intervention MeSH terms: Selenium
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        group (1): patients diagnosed to have NAFLD by ultrasonography presented to the outpatient
        clinic of Tropical medicine and gastroenterology department, Sohag University Hospitals
        during the period from March 2021 to August 2021.

        Group (2): a control group of 30 healthy volunteers who looks normal on ultrasonographic
        examination
      
Keywords: NAFLD; Fibrosis; selenium; zinc