Volume 7, Issue 5, October 2019, Page: 148-153
Effects of Zinc on Non-alcoholic Fatty Liver Disease After Pancreatoduodenectomy
Atsushi Miyosh, Department of Surgery, Saga-Ken Medical Centre Koseikan, Saga, Japan
Hiroki Koga, Department of Surgery, Saga-Ken Medical Centre Koseikan, Saga, Japan
Satomi Nakamura, Department of Surgery, Saga-Ken Medical Centre Koseikan, Saga, Japan
Hiroaki Nakamura, Department of Surgery, Saga-Ken Medical Centre Koseikan, Saga, Japan
Kohei Yamada, Department of Surgery, Saga-Ken Medical Centre Koseikan, Saga, Japan
Hiroshi Kubo, Department of Surgery, Saga-Ken Medical Centre Koseikan, Saga, Japan
Masatsugu Hiraki, Department of Surgery, Saga-Ken Medical Centre Koseikan, Saga, Japan
Osamu Ikeda, Department of Surgery, Saga-Ken Medical Centre Koseikan, Saga, Japan
Toshiya Tanaka, Department of Surgery, Saga-Ken Medical Centre Koseikan, Saga, Japan
Kenji Kitahara, Department of Surgery, Saga-Ken Medical Centre Koseikan, Saga, Japan
Seiji Sato, Department of Surgery, Saga-Ken Medical Centre Koseikan, Saga, Japan
Hirokazu Noshiro, Department of Surgery, Faculty of Medicine, Saga University, Saga, Japan
Received: Aug. 17, 2019;       Accepted: Sep. 12, 2019;       Published: Sep. 26, 2019
DOI: 10.11648/j.js.20190705.17      View  87      Downloads  24
Abstract
Background: The etiology, treatment and prevention of Nonalcoholic fatty liver disease (NAFLD) after pancreatoduodenectomy (PD) remain largely unknown. We aimed to elucidate the risk factors for NAFLD after PD and investigate the nutritional effects of zinc medication. Methods: We retrospectively examined 109 patients who underwent PD between 2013 and 2017. We diagnosed the postoperative NAFLD using CT attenuation at six months later. We identified the risk factors for postoperative NAFLD among perioperative factors and analyzed the nutritional effect of zinc medication at six months after surgery. Results: We diagnosed 27 patients with NAFLD after PD. A univariate analysis showed that pancreas cancer (p = 0.029), operative time (p = 0.008), blood loss (p = 0.034), postoperative diarrhea (p < 0.001) and zinc medication (p < 0.001) were associated with postoperative NAFLD. A multivariate analysis demonstrated that zinc medication was the most important factor for the prevention of NAFLD after PD. All patients who received zinc also took pancreatic enzyme simultaneously and showed a significantly lower rate of body weight loss than in patients without zinc at six months after PD (p = 0.041). These patients showed a significantly higher total cholesterol level (p = 0.006) and higher serum zinc level (p<0.001). Furthermore, significantly fewer cases of postoperative NAFLD were noted among the patients who received zinc than among those who did not receive it (5.7% vs 33.8%: p = 0.001). Conclusion: These results suggest that zinc administration might improve the postoperative nutritional status and prevent NAFLD after PD.
Keywords
Pancreatoduodenectomy, Nonalcoholic Fatty Liver Disease, Zinc
To cite this article
Atsushi Miyosh, Hiroki Koga, Satomi Nakamura, Hiroaki Nakamura, Kohei Yamada, Hiroshi Kubo, Masatsugu Hiraki, Osamu Ikeda, Toshiya Tanaka, Kenji Kitahara, Seiji Sato, Hirokazu Noshiro, Effects of Zinc on Non-alcoholic Fatty Liver Disease After Pancreatoduodenectomy, Journal of Surgery. Vol. 7, No. 5, 2019, pp. 148-153. doi: 10.11648/j.js.20190705.17
Copyright
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reference
[1]
Murakami Y, Uemura K, Hayashidani Y, Sudo T, Hashimoto Y, Nakagawara N, et al. No mortality after 150 consecutive pancreatoduodenectomies with duct-to-mucosa pancreaticogastrostomy. J Surg Oncol 2008; 97: 205-209.
[2]
Fish JC, Smith LB, Williams RD Digestive function after radical pancreaticoduodenectomy. Am J Surg 1969; 117: 40-45.
[3]
Nomura R, Ishizaki Y, Suzuki K, Kawasaki S. Development of hepatic steatosis after pancreatoduodenectomy. Am J Roentgenol 2007; 189: 1484-1488.
[4]
Yu HH, Shan YS, Lin PW Effect of pancreatticoduodenectomy on the course of hepatic steatosis. World J Surg 2010; 34: 2122-2127.
[5]
Kato H, Isaji S, Azumi Y, Kishiwada M, Hamada T Mizuno S, et al. Development of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) after pancreaticoduodenectomy: Proposal of a postoperative NAFLD scoring system. J Hepatobiliary Pancreat Sci 2010; 17: 296-304.
[6]
Tanaka N, Horiuchi A, Yokoyama T, Kaneko G, Horigome N, Yamura T, et al. Clinical characteristics of de novo nonalcoholic fatty liver disease following pancreaticoduodenectomy. J Gastroenterol 2011; 46: 758-768.
[7]
Sim EH, Kwon JH, Kim SY, Jung SM, Maeng LS, Jang JW, et al. Severe steatohepatitis with hepatic decompensation resulting from malnutrition after pancreaticoduodenectomy. Clin Mol Hepatol 2012; 18: 404-410.
[8]
Nakagawa N, Murakami Y, Uemura K, Sudo T, Hashimoto Y, Kondo N, et al. Nonalcoholic fatty liver disease after pancreatoduodenectomy is closely associated with postoperative pancreatic exocrine insufficiency. J Surg Oncol 2014; 110: 720-726.
[9]
Murata Y, Mizuno S, Kato H, Kishiwada M, Ohsawa I, Hamada T, et al. Nonalcoholic steatohepatitis (NASH) after pancreaticoduodenectomy: association of pancreatic exocrine deficiency and infection. Clin J Gastroenterol 2011; 4: 242-248.
[10]
Nagai M, Sho M, Satoi S, Toyokawa H, Akahori T, Yanagimoto H, et al. Effect of pancrelipase on nonalcoholic fatty liver disease after pancreaticoduodenectomy. J Hepatobililary Pancreat Sci 2014; 21: 186-192.
[11]
Kishi Y, Shimada K, Nara S, Esaki M, Kosuge T. Administration of pancrealipase as effective treatment for hepatic steatosis after pancreatectomy. Pancreas 2015; 44: 983-987.
[12]
Kato K, Isaji S, Kawarada Y, Hibasami H, Nakashima K. Effect of zinc administration on pancreatic regeneration after 80% pancreatectomy. Pancreas 1996; 14: 158-165.
[13]
Yu HH, Yang TM, Shan YS, Lin PW. Zinc deficiency in patients undergoing pancreatoduodenectomy for periampullary tumors is associated with pancreatic exocrine insufficiency. World J Surg 2011; 35: 2110-2117.
[14]
Sugino H, Kumagai N, Watanabe S, Toda K, Takeuchi O, Tsunematsu S, et al. Polaprezinc attenuates liver fibrosis in a mouse model of non-alcoholic steatohepatitis. J Gastroenterol Hepatol 2008; 23: 1909-1916.
[15]
Matsuoka S, Matsumura H, Nakamura H, Oshiro S, Arakawa Y, Hayashi J, et al. Zinc supplementation improves the outcome of chronic hepatitis C and liver cirrhosis. J Clin Biochem Nutr 2009; 45: 292-303.
[16]
Kawamoto S, Soyer PA, Fishman EK, Bluemke DA. Nonneoplatstic liver disease: Evaluation with CT and MRI imaging. Radiographics 1998; 18: 827-848.
[17]
Park SH, Kim PN, Kim KW, LEE SW, Yoon SE, Park SW, et al. Macrovesicular hepatic steatosis in living liver donors: Use of CT for quantitative and qualitative assessment. Radiology 2006; 239: 105-112.
[18]
Shrikhande SV, Sivasanker M, Vollmer CM, Friess H, Besselink MG, Fingerhut A, et al. International Study Group of Pancreatic Surgery (ISGPS) . Pancreatic anastomosis after pancreatoduodenectomy: A position statement by the International Study Group of Pancreatic Surgery (ISGPS) 2017; 161: 1221-1234.
[19]
Sato T, Matsuo Y, Shiga K, Morimoto M Miyai H, Takeyama H. Factors that predict the occurrence of and recovery from non-alcoholic fatty liver disease after pancreatoduodenectomy. Surgery 2016; 160: 318-330.
[20]
Satoi S, Sho M, Yanagimoto H, Yamamoto T, Akahori T, Kinoshita S, et al. Do pancrelipase delayed-release capsules have a protective role against nonalcoholic fattyliver disease after pancreatoduodenectomy in patients with pancreatic cancer? A randomized controlled trial. J Hepatobililary Pancreat Sci 2016; 23: 167-173.
[21]
Sturniolo Gc, Fries W, Mazzon E, Di Leo V, Barollo M, D’inca R. Effect of zinc supplementation on intestinal permeability in experimental colitis. J Lab Clin Med 2002; 139: 311-315.
[22]
Henning B, Wang Y, Ramasamy S, McClain CJ. Zinc deficiency alters barrier function of cultured porcine endothelial cells. J Nutr 1992; 122: 1242-1247.
[23]
Kim YJ, Kim MY, Kim HO, Lee MD, Park YM. Acrodematitis enteropathica-like eruption associated with combined nutritional deficiency. J Korean Med Sci2005; 20: 908-911.
[24]
Dutta SK, Procaccino F, Aamodt R Zinc metabolism in patienyts with exocrine pancreatic insufficiency. J Am Coll Nutr 1998; 17: 556-563.
[25]
Powell SR. The antioxidant properties of zinc. J Nutr 2000; 130: 1447S-1254S.
[26]
Yoshikawa T, Naito Y, Tanigawa T, Yoneta T, Kondo M. The antioxidant properties of a novel zinc-carnosine chelate compound, N- (3-aminopropionyl) -L-histidinato zinc. Biochem Biophys Acta 1991; 1115: 15-22.
[27]
Tilg H, Diehl AM. Cytokines in alcoholic and nonalcoholic steatohepatitis. N Engl J Med. 2000; 343: 1467-1476.
[28]
Kitade H, Chen G, Ni Y, Ota T. Nonalcoholic fatty liver disease and insulin resistance: New insights and potential new treatment. Nutrients 2017; 14: 9.
Browse journals by subject