Dietary consumption and serum pattern of bioactive fatty acids in NAFLD patients

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"documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Ann Hepatol. 2020;19:489-96" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Mediterranean-like mix of fatty acids induces cellular protection on lipid-overloaded hepatocytes from western diet fed mice" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "489" "paginaFinal" => "496" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1607 "Ancho" => 2421 "Tamanyo" => 146433 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Cellular functionality by MTT assay. Control and western cells were treated or not with high mono and polyunsaturated fatty acids (HMPFA) or high saturated fatty acids (HSFA) according <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>, for 24 h. Each bar represents the mean ± SEM in at least four mice, *p < 0.05 vs control cells, # p < 0.05 vs western cells." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Lyssia Castellanos-Tapia, María Elizabeth Tejero-Barrera, Soraya Salas-Silva, Arturo Simoni-Nieves, Alejandro Escobedo-Calvario, Luis E. Gomez-Quiroz" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Lyssia" "apellidos" => "Castellanos-Tapia" ] 1 => array:2 [ "nombre" => "María Elizabeth" "apellidos" => "Tejero-Barrera" ] 2 => array:2 [ "nombre" => "Soraya" "apellidos" => "Salas-Silva" ] 3 => array:2 [ "nombre" => "Arturo" "apellidos" => "Simoni-Nieves" ] 4 => array:2 [ "nombre" => "Alejandro" "apellidos" => "Escobedo-Calvario" ] 5 => array:2 [ "nombre" => "Luis E." "apellidos" => "Gomez-Quiroz" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268120300661?idApp=UINPBA00004N" "url" => "/16652681/0000001900000005/v5_202012011817/S1665268120300661/v5_202012011817/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1665268120300703" "issn" => "16652681" "doi" => "10.1016/j.aohep.2020.06.009" "estado" => "S300" "fechaPublicacion" => "2020-09-01" "aid" => "223" "copyright" => "Fundación Clínica Médica Sur, A.C." "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Ann Hepatol. 2020;19:472-81" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Hepatic transcriptome signature correlated with HOMA-IR explains early nonalcoholic fatty liver disease pathogenesis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "472" "paginaFinal" => "481" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2390 "Ancho" => 2925 "Tamanyo" => 464831 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Differentially expressed genes between mild-NAFL and NASH. (A) Hierarchical clustering of the samples into two groups: mild-NAFL and NASH based on 5 genes with a fold change > 1.5. Blue indicates mild-NAFL samples and black indicates NASH samples. (B)Validation of the expressions of 5 DEGs on an independent cohort of 25 samples (12 mild-NAFL and 13 NASH samples). The p-values are indicated in boxes for expression of each gene. (C) Hierarchical clustering of the samples into study groups based on the identified DEGs in published datasets-GSE49541 (blue = mild fibrosis, red = advanced fibrosis samples), GSE48452 (yellow = healthy individuals, blue = simple steatosis and red = NASH patients) and GSE89632 (yellow = healthy individuals, blue = simple steatosis and red = NASH patients). Data is presented in heatmap format in which rows are the genes (probes) and columns are the samples. Red color corresponds to up-regulation and green color corresponds to down-regulation of gene expression." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ankita Chatterjee, Analabha Basu, Kausik Das, Pankaj Singh, Dipankar Mondal, Biswanath Bhattacharya, Shweta Roychoudhury, Partha P. Majumder, Abhijit Chowdhury, Priyadarshi Basu" "autores" => array:10 [ 0 => array:2 [ "nombre" => "Ankita" "apellidos" => "Chatterjee" ] 1 => array:2 [ "nombre" => "Analabha" "apellidos" => "Basu" ] 2 => array:2 [ "nombre" => "Kausik" "apellidos" => "Das" ] 3 => array:2 [ "nombre" => "Pankaj" "apellidos" => "Singh" ] 4 => array:2 [ "nombre" => "Dipankar" "apellidos" => "Mondal" ] 5 => array:2 [ "nombre" => "Biswanath" "apellidos" => "Bhattacharya" ] 6 => array:2 [ "nombre" => "Shweta" "apellidos" => "Roychoudhury" ] 7 => array:2 [ "nombre" => "Partha P." "apellidos" => "Majumder" ] 8 => array:2 [ "nombre" => "Abhijit" "apellidos" => "Chowdhury" ] 9 => array:2 [ "nombre" => "Priyadarshi" "apellidos" => "Basu" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268120300703?idApp=UINPBA00004N" "url" => "/16652681/0000001900000005/v5_202012011817/S1665268120300703/v5_202012011817/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Dietary consumption and serum pattern of bioactive fatty acids in NAFLD patients" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "482" "paginaFinal" => "488" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Fabiola López-Bautista, Varenka J. Barbero-Becerra, María Yolanda Ríos, M. Ángeles Ramírez-Cisneros, Cristell A. Sánchez-Pérez, Martha H. Ramos-Ostos, Misael Uribe, Norberto C. Chávez-Tapia, Eva Juárez-Hernández" "autores" => array:9 [ 0 => array:3 [ "nombre" => "Fabiola" "apellidos" => "López-Bautista" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Varenka J." "apellidos" => "Barbero-Becerra" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "María Yolanda" "apellidos" => "Ríos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "M. Ángeles" "apellidos" => "Ramírez-Cisneros" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "Cristell A." "apellidos" => "Sánchez-Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "Martha H." "apellidos" => "Ramos-Ostos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 6 => array:3 [ "nombre" => "Misael" "apellidos" => "Uribe" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 7 => array:3 [ "nombre" => "Norberto C." "apellidos" => "Chávez-Tapia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 8 => array:4 [ "nombre" => "Eva" "apellidos" => "Juárez-Hernández" "email" => array:2 [ 0 => "ejuarezh@medicasur.org.mx" 1 => "evajuarezh@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Molecular Biology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Translational Research Unit, Medica Sur Clinic and Foundation, Mexico City, Mexico" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Chemical Research Center, IICBA, UAEM, Morelos, Mexico" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Integral Diagnosis and Treatment Center, Medica Sur Clinic and Foundation, Mexico City, Mexico" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Gastroenterology and Obesity Department, Medica Sur Clinic and Foundation, Mexico City, Mexico" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2303 "Ancho" => 3167 "Tamanyo" => 246097 ] ] "descripcion" => array:1 [ "en" => "Correlation between liver fibrosis (skPa) and bioactive fatty acids consumption." ] ] ] "textoCompleto" => "1IntroductionNonalcoholic fatty liver disease (NAFLD) is one of the most frequent chronic hepatic conditions worldwide. It is characterized by the increase of fat deposits in hepatocytes in absence of high alcohol consumption, drug hepatotoxicity, or viral and autoimmune diseases <a class="elsevierStyleCrossRef" href="#bib0225">[1]</a>. NAFLD is associated with obesity, type 2 diabetes, hypertension, and dyslipidemia. This condition is considered the hepatic manifestation of metabolic syndrome. Genetic, metabolic, environmental, and nutritional factors are involved in NAFLD pathogenesis <a class="elsevierStyleCrossRefs" href="#bib0230">[2,3]</a>.Reports show a prevalence of NAFLD of 20 to 40% in general population; differences in prevalence are due to different diagnostic methods and population, with variable risk factors such as genetic predisposition, socioeconomic status, and anthropometric characteristics <a class="elsevierStyleCrossRefs" href="#bib0225">[1,4–6]</a>. In Mexico, the prevalence of NAFLD has been estimated in 14% to 50%. This prevalence derives from high rates of obesity and type 2 diabetes in which prevalence of NAFLD is 82% and 18%, respectively; genetic factors such as presence of PNPLA3 polymorphism in Mexican population are also related to high prevalence <a class="elsevierStyleCrossRefs" href="#bib0255">[7,8]</a>. In the last few years, a modification of dietary habits in Mexican population has been characterized by an increase in saturated fats consumption and low polyunsaturated fatty acids consumption <a class="elsevierStyleCrossRef" href="#bib0265">[9]</a>, which exert a direct effect in metabolic syndrome risk and chronic liver diseases development and increase.Despite the efforts in clinical trials for pharmacological treatments for NAFLD, only two options (pioglitazone and vitamin E) have been included in American and European guidelines for NAFLD treatment <a class="elsevierStyleCrossRef" href="#bib0270">[10]</a>. The main treatment for this hepatic condition is still based on lifestyle modifications, including dietary assessment, weight loss, and physical activity <a class="elsevierStyleCrossRefs" href="#bib0225">[1,11]</a>.In the last few years, dietary recommendations are focused in decreasing the total intake of dietary lipids, with special emphasis in lower consumption of saturated fatty acids (SFAs). However, some of the dietary lipids have shown different bioactive functions that depend on their molecular characteristics. These effects could mean whether a risk or a protective factor for different diseases, including those related to metabolic syndrome, like cardiovascular diseases <a class="elsevierStyleCrossRef" href="#bib0280">[12]</a>.Nowadays, a wide diversity of biological activities associated with bioactive fatty acids—including their metabolic derivatives and components—has been described that proves their role in energetic-metabolic homeostasis, cellular proliferation, inflammatory regulation, as well as the modulation of hepatocytes in obesity, NAFLD, and liver fibrosis development <a class="elsevierStyleCrossRef" href="#bib0285">[13]</a>. The saturation characteristics of fatty acids have also been related to an increased risk of metabolic diseases (SFAs), fatty acids oxidation, lipogenesis (monounsaturated fatty acids (MUFAs)), and anti/pro inflammatory properties (polyunsaturated fatty acids (PUFAs)) <a class="elsevierStyleCrossRefs" href="#bib0290">[14–17]</a>. It has been established that the bioactive function of some fatty acids could be beneficial, deleterious, or dual depending on individual characteristics, such as intestinal microbiota composition, genetics, and lifestyle. In NAFLD, saturated bioactive fatty acids have showed a beneficial effect through the regulation of cholesterol and triglycerides metabolism. Notably, monounsaturated fatty acids have shown a dual effect in lipid metabolism and inflammation. On the other hand, polyunsaturated fatty acids have different effects in each component of NAFLD physiopathology: a beneficial effect has been observed in insulin resistance and obesity; the deleterious effect is characteristic of lipids metabolism and deposition; and a dual effect could be observed in inflammation and in liver fibrosis related to obesity <a class="elsevierStyleCrossRef" href="#bib0285">[13]</a>.As far as we know, recent evidence which associates bioactive fatty acids with NAFLD is mainly supported by animal models <a class="elsevierStyleCrossRefs" href="#bib0310">[18–20]</a> and human studies with small samples <a class="elsevierStyleCrossRefs" href="#bib0325">[21–25]</a>.The aim of this study is to determine the dietary consumption patterns and serum percentage of bioactive fatty acids in NAFLD patients.2Material and methods2.1Patient populationThis is a cross-sectional study carried out at the Medica Sur Clinic and Foundation check-up unit. The study was approved by the Ethics Committee and it complies with the Helsinki Declaration. Patients signed an informed consent form to participate in this study.The study population was selected from a series of consecutive patients. Exclusion criteria included alcohol intake (>20g/day), diagnosed liver disease, and current use of medication. The absence of any viral, genetic, autoimmune, and drug-induced liver disease was confirmed in each patient by laboratory tests and by a questionnaire about medications taken at the time of the check-up.Sociodemographic data were collected. Body mass index (BMI) was calculated as [weight (kg)/height (m)2]. Complete blood counts, biochemical data including glycosylated hemoglobin (HbA1c), liver function tests, and lipid panel were performed.2.2NAFLD and liver fibrosis evaluationA transient elastography (Fibroscan™ 502 Touch, Echosens, Paris, France) was performed in each patient, M or XL probes were chosen according to the manufacturer and quality recommendations <a class="elsevierStyleCrossRef" href="#bib0350">[26]</a>. The presence of NAFLD was identified by Control Attenuation Parameter (CAP), classifying patients in four groups according to percentage of fat measured in decibels/meter (dB/m), as: non-steatosis (<232dB/m, <5% of fat in liver cells), mild steatosis (232–256dB/m, >5% of fat in liver cells), moderate steatosis (257–290dB/m, >33% of fat in liver cells), and severe steatosis (>290dB/m, >66% of fat in liver cells). Liver fibrosis were diagnosed by Wong cut-off points <a class="elsevierStyleCrossRef" href="#bib0355">[27]</a>: >6.2kPa, as liver fibrosis, and >12kPa as advanced liver fibrosis.2.3Bioactive fatty acids consumption analysisRecruited patients answered a food frequency questionnaire validated in Mexican population by the National Institute of Public Health software (SNUT) <a class="elsevierStyleCrossRef" href="#bib0360">[28]</a>. The SNUT software calculates the daily intake of calories, proteins, carbohydrates, fats, and micronutrients. In terms of the fat consumption analysis, the results of the questionnaire are presented as the daily intake of different nutrients and fatty acids.We analyzed the consumption of each bioactive fatty acid and classified them according to their molecular characteristics as non-saturated (myristic acid), saturated (palmitic and stearic acids), monounsaturated (palmitoleic and oleic acids), and polyunsaturated (linoleic, linolenic, arachidonic).2.4Bioactive fatty acids serum percentage analysisA representative sample of 40 individuals was analyzed by Gas Chromatography–Mass Spectrometry, through Mass Profiler Professional software and data extraction was completed by deconvolution on Mass Hunter Qualitative Analysis software. A peak area of ≥1% of the total chromatogram was established as criteria for exportation data for statistics. Compounds were retained for analysis by flags and frequency filtering.Peripheral blood samples were collected in sterile pyrogen-free tubes and serum was recovered after centrifugation and stored at −80°C until use. Serum was subjected to esterification to obtain FAME (Fatty Acid Methyl Ester) reaction with some modifications <a class="elsevierStyleCrossRef" href="#bib0365">[29]</a> as follows: 200μL of serum of 10 patients per group were individually evaporated at 40°C, dissolved in 400μL of anhydrous methanol (MeOH) and 20μL of acetyl chloride, hermetically stored under N2 atmospheres, and let react for 30minutes. The reaction was cold for 3minutes and then 500μL of potassium carbonate 6% were added or until any gas evolution was registered. The total volume was transferred into a conic tube, added with 400μL of hexane, vortexed, and centrifuged for 10min (10,000rpm). 200μL of organic phase were analyzed by GC-MS using a DB-23 0.25mm×0.25μm, 30m length column with the following conditions: 8°C/min-175°C–0min, 4°C/min–230°C–10min <a class="elsevierStyleCrossRef" href="#bib0370">[30]</a>. A 38 component FAME standard mix C4-C24 was analyzed.Compounds were identified by the correlation of their retention time and the fragmentation pattern with those of FAME standard components; additional peaks were compared with NIST library v2014.2.5Statistical analysisThe distribution of variables was determined by the Kolmogorov–Smirnov test, while data are presented as mean±S.D., median (interquartile range), or percentage.The comparison of dietary consumption patterns of bioactive fatty acids in patients with or without NAFLD, as well as the severity of liver diseases, was performed with ANOVA, Kruskal–Wallis, or Chi square statistical test, as needed. The Spearman correlation analysis was applied to observe the correlation of dietary consumption of bioactive fatty acids, as well as the serum percentage with biochemical data. Values of p≤0.05 were considered statistically significant. All statistical analyses were performed using the SPSS software (SPSS version 16.0, Inc., Chicago, Il, USA).3Results3.1General characteristics of populationA total of 299 patients were included, 109 without NAFLD and 190 with NAFLD; 63.9% (n=190) were men, whose median of age and BMI were 44.2±9.9 years and 25.9±3.8kg/m2, respectively. Clinical and biochemical characteristics are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. In NAFLD patients, the proportion of men was higher (70.5% (n=134) vs. 29.5% (n=56)). As expected, BMI was directly proportional to NAFLD severity, as well as glucose, uric acid, triglycerides, and HbA1c levels. In NAFLD patients, levels of liver function tests were higher, but high density lipoprotein (HDL) cholesterol was lower in severe NAFLD cases (p≤0.05). Clinical, biochemical and dietary characteristics of all study participants are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>3.2NAFLD and liver fibrosis evaluationThe mean of dB/m of each group was: 183.9±36 in the non-NAFLD group (n=109); 244.2±7.5 in the mild NAFLD group (n=49); 272.6±9.8 in the moderate NAFLD group (n=57); and 329±28.1 in the severe NAFLD group (n=84). The median liver stiffness was 4.2 (IQR 3.4–4.9) kPa, and the prevalence of liver fibrosis (>6kPa) was 11.7% (n=35). There were no patients with advanced liver fibrosis (≥12kPa).3.3Dietary consumption analysisRegarding the presence of NAFLD, significant differences were observed in dietary consumption of glucose (14.7g (IQR 10.0–19.4) vs. 12.4mg (IQR 8.2–18.9)) and fructose (20.4g (IQR 14.6–25.9) vs. 17.6mg (IQR 12.6–23.9)) (p=0.031); patients from the non-NAFLD group (n=109) showed lower consumption of these nutrients than NAFLD patients (n=190). It is important to mention that the total lipid consumption in all the population was higher (37–38.4% of total calories intake) than the daily recommended intake <a class="elsevierStyleCrossRefs" href="#bib0295">[15,31]</a>. The bioactive fatty acids dietary consumption did not show significant differences between NAFLD and non-NAFLD patients.3.4Dietary consumption patterns of bioactive fatty acids according to NAFLD severityIn patients with NAFLD diagnosis (n=190), we observed significant differences in stearic and linoleic bioactive fatty acids consumption, being higher in moderate NAFLD cases (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>The total calories intake was directly proportional to NAFLD severity (mild NAFLD 1404 (1232–1723) kcal/day; moderate NAFLD 1740(1424–2030) kcal/day and severe NAFLD 1739 (1217–1963) kcal/day, p<0.04) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>); however, carbohydrates, protein, and fat distribution were not different among groups.According to decibels of CAP, we observed positive but weak correlations with consumption of palmitic (r2=0.180, p=0.018), stearic (r2=0.200, p=0.009) and linoleic (r2=0.163, p=0.032) acids. On the other hand, in patients with severe NAFLD (n=84) decibels of CAP showed significant positive, and once again, weak correlation with consumption of stearic (r2=0.329, p=0.003) and palmitoleic acid (r2=0.304, p=0.006). (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>)<elsevierMultimedia ident="fig0005"></elsevierMultimedia>In a post hoc analysis we divided patients in groups according to severity (non-NAFLD+mild NAFLD and moderate NAFLD+severe NAFLD) to identify differences between these groups; only palmitoleic acid dietary consumption was significantly higher in moderate+severe NAFLD patients (1.4 (IQR 1.1–1.8) vs. 1.3 (IQR 1.0–1.7), p=0.044).3.5Dietary consumption pattern of bioactive fatty acids in patients with fibrosisIn patients with fibrosis we observed a significantly higher consumption of myristic acid (1.15 (IQR 0.96–1.62 g) vs. 0.99 (IQR 0.68–1.37) g, p=0.021). In correlation analysis of consumption of bioactive fatty acids with liver stiffness (kPa) we did not observed significant correlations; however, in severe NAFLD patients (n=84), analysis of correlation, showed a weak but significantly positive correlation between consumption of palmitic (r2=0.33; p=0.003), stearic (r2=0.32; p=0.005), palmitoleic (r2=0.29; 0.01), oleic (r2=0.29; p=0.01), and linoleic acid (r2=0.29; p=0.01) and liver stiffness (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>3.6Serum percentage of bioactive fatty acids analysisThe analysis of bioactive fatty acids serum percentage (n=40, ten patients per group) did not show differences in NAFLD patients versus non-NAFLD patients; also, we did not observe correlations between serum percentage and dietary consumption. In terms of severity, bioactive fatty acids serum percentage did not show significant correlations.4DiscussionBioactive fatty acids consumption is an important issue since it has been related to an increased or decreased risk of developing several diseases related to metabolic syndrome, such as NAFLD <a class="elsevierStyleCrossRef" href="#bib0380">[32]</a>. This study shows the relation between bioactive fatty acids consumption, NAFLD severity, and serum percentage. As far as we know, this is the first study that evaluates all these factors and their correlation with biochemical markers related to metabolic syndrome.We observed an increased stearic acid consumption related to NAFLD severity. Meanwhile, saturated (palmitic, stearic, and linolenic) bioactive fatty acids showed a positive correlation with NAFLD severity (dB/m), which has been related to an increase in the consumption of SFAs with hepatic fat fraction <a class="elsevierStyleCrossRef" href="#bib0385">[33]</a>. SFAs have been associated with inflammatory cytokine promotion and apoptosis induction in NAFLD <a class="elsevierStyleCrossRefs" href="#bib0300">[16,34]</a>. In our sample, we observed that bioactive SFAs (stearic and palmitic acid) were positively correlated with kPa in severe NAFLD.In our population, the higher consumption of bioactive SFAs corresponds to palmitic acid, which has been associated with increased lipotoxicity and inflammation; <a class="elsevierStyleCrossRefs" href="#bib0395">[35,36]</a> nevertheless, palmitic acid did not show significant differences regarding NAFLD severity.A balance between myristic acid and palmitic acid has been related to NAFLD and NASH (non-alcoholic steatohepatitis) <a class="elsevierStyleCrossRef" href="#bib0395">[35]</a>; apparently the inflammatory response and high cardiovascular risk are related to these two bioactive fatty acids <a class="elsevierStyleCrossRef" href="#bib0405">[37]</a>. SFAs induce apoptosis in hepatocytes, where specifically myristic acid has been proposed as a biomarker in NASH <a class="elsevierStyleCrossRef" href="#bib0410">[38]</a>. Moreover, we observed a higher consumption of myristic acid in patients with fibrosis.It has been described that traditional Mexican diet confers a high NAFLD risk, due to the low consumption of MUFAs and PUFAs and the high consumption of SFAs <a class="elsevierStyleCrossRef" href="#bib0305">[17]</a>. Despite the fact that patients with severe steatosis showed higher consumption of MUFAs and PUFAs, daily recommended requirements are not accomplished, which has also been observed in Brazilian population <a class="elsevierStyleCrossRef" href="#bib0415">[39]</a>.Imbalance of n−3/n−6 in favor to n−6 is associated with inflammatory promotion and eicosapentaenoic acid/arachidonic acid serum index, which has been related to NAFLD development <a class="elsevierStyleCrossRefs" href="#bib0420">[40,41]</a>. We observed a high consumption of linoleic acid in moderate and severe NAFLD patients, respect to mild NAFLD patients. This is a factor that may contribute to the progression from NAFLD to NASH, since the imbalance in favor to n-6 has an important role in the progression of NAFLD <a class="elsevierStyleCrossRef" href="#bib0300">[16]</a>. However, this bioactive fatty acid did also correlate with kPa in severe NAFLD patients.In severe NAFLD patients we observed a high consumption stearic and linoleic acids. This observation could be interpreted as a sign of imbalance between n−3/n−6; such imbalance could condition the effect direction of bioactive fatty acids in terms of their dual effect, thus increasing NAFLD severity instead of showing an anti-inflammatory effect <a class="elsevierStyleCrossRefs" href="#bib0300">[16,42]</a>. These results support the importance of maintaining an n−3/n−6 balance, especially in patients with evidence of fat deposition in liver tissue, thus avoiding an increase in the consumption of arachidonic acid.The aim of the study encompasses the evaluation of dietary consumption and serum percentage pattern in NAFLD patients; however, we did not observe a correlation between consumption and serum profile. Several studies of lipidomic profile of NAFLD have been published before; however, most of them focused in animal models, even less in human samples <a class="elsevierStyleCrossRef" href="#bib0435">[43]</a>. As far as we know, our work is the first to try to correlate consumption pattern and serum percentage of bioactive fatty acids in NAFLD patients. Regrettably, this aim was not properly accomplished. A direct correlation between consumption and serum content seems to be complicated to analyze, since multiple biochemical and metabolic mechanisms occurred in the process until the lipid reaches the blood stream and still in it. Recently, several bioactive lipids, more specifically free fatty acids, have been proposed as agonists of free fatty acids receptors, which have important roles in several cells and tissues and are involved in metabolic and inflammation mechanisms <a class="elsevierStyleCrossRef" href="#bib0440">[44]</a>. Then, this may be an alternative area of study that could lead us to meet the stated objective.The evaluation and modification of bioactive fatty acids consumption in NAFLD dietary treatment should focus on prioritizing the consumption of those that are characterized by anti-inflammatory and anti-fibrotic properties, but mainly maintaining an n−3/n−6 balance. These modifications, in combination with lifestyle modifications and physical activity, seem to be promising in the progression of liver disease prevention.Conclusively, the dietary consumption of bioactive fatty acids is different according to NAFLD severity, but not in the presence or absence of this liver disease. Individualized diets according to NAFLD severity could be successful in order to prevent outcomes related to augmentation of inflammation, development of NASH, and progression to cirrhosis and hepatocellular carcinoma.Author contributionsAll the authors have read and approved the final manuscript.FundingFunding for this study was provided by the CONACyT-FOSSIS-262216, and Medica Sur, Mexico.Conflict of interestThe authors declare no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1424238" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1301796" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patient population" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "NAFLD and liver fibrosis evaluation" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Bioactive fatty acids consumption analysis" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Bioactive fatty acids serum percentage analysis" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Statistical analysis" ] ] ] 4 => array:3 [ "identificador" => "sec0040" "titulo" => "Results" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "General characteristics of population" ] 1 => array:2 [ "identificador" => "sec0050" "titulo" => "NAFLD and liver fibrosis evaluation" ] 2 => array:2 [ "identificador" => "sec0055" "titulo" => "Dietary consumption analysis" ] 3 => array:2 [ "identificador" => "sec0060" "titulo" => "Dietary consumption patterns of bioactive fatty acids according to NAFLD severity" ] 4 => array:2 [ "identificador" => "sec0065" "titulo" => "Dietary consumption pattern of bioactive fatty acids in patients with fibrosis" ] 5 => array:2 [ "identificador" => "sec0070" "titulo" => "Serum percentage of bioactive fatty acids analysis" ] ] ] 5 => array:2 [ "identificador" => "sec0075" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0080" "titulo" => "Author contributions" ] 7 => array:2 [ "identificador" => "sec0085" "titulo" => "Funding" ] 8 => array:2 [ "identificador" => "sec0090" "titulo" => "Conflict of interest" ] 9 => array:2 [ "identificador" => "xack497213" "titulo" => "Acknowledgements" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-04-01" "fechaAceptado" => "2020-06-15" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1301796" "palabras" => array:5 [ 0 => "Body mass index" 1 => "Lipids" 2 => "Liver" 3 => "Nutrition" 4 => "NAFLD" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Introduction and objectivesNonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome. Some dietary fatty acids have showed different bioactive functions in metabolic syndrome. The aim of this study is to determine the dietary consumption patterns and serum percentage of bioactive fatty acids in NAFLD patients. Patients and methodsCross-sectional study with NAFLD patients and non-NAFLD patients. Dietary consumption of bioactive fatty acids was assessed by a food frequency questionnaire. NAFLD and liver fibrosis were diagnosed by transient elastography. The identification of serum bioactive fatty acids was achieved by gas chromatography–mass spectrometry (%). Bioactive fatty acids consumption was correlated with NAFLD clinical characteristics with the Spearman correlation analysis. ResultsA total of 299 patients were included, whose mean of age and body mass index were 44.2±9.9 years and 25.9±3.8kg/m2, respectively. The consumption of bioactive fatty acids was no different regarding the presence of NAFLD; however, the consumption of stearic and linoleic fatty acids was higher in relation with NAFLD severity (p≤0.05). The consumption of myristic acid was higher in patients with fibrosis (p=0.02). Serum percentage and dietary consumption did not show correlations. ConclusionDietary consumption of bioactive fatty acids is different according to NAFLD severity. Individualized diets according to NAFLD severity could be successful in order to prevent liver injury-related outcomes." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] ] "nomenclatura" => array:1 [ 0 => array:3 [ "identificador" => "nom0005" "titulo" => "Abbreviations" "listaDefinicion" => array:1 [ 0 => array:1 [ "definicion" => array:11 [ 0 => array:2 [ "termino" => "BMI" "descripcion" => "body mass index" ] 1 => array:2 [ "termino" => "CAP" "descripcion" => "controlled attenuated parameter" ] 2 => array:2 [ "termino" => "FAME" "descripcion" => "fatty acid methyl ester" ] 3 => array:2 [ "termino" => "HbA1c" "descripcion" => "glycosylated hemoglobin" ] 4 => array:2 [ "termino" => "HDL" "descripcion" => "high density lipoprotein" ] 5 => array:2 [ "termino" => "LDL" "descripcion" => "low density lipoprotein" ] 6 => array:2 [ "termino" => "MUFAs" "descripcion" => "monounsaturated fatty acids" ] 7 => array:2 [ "termino" => "NAFLD" "descripcion" => "non-alcoholic fatty liver disease" ] 8 => array:2 [ "termino" => "NASH" "descripcion" => "non-alcoholic steatohepatitis" ] 9 => array:2 [ "termino" => "PUFAs" "descripcion" => "polyunsaturated fatty acids" ] 10 => array:2 [ "termino" => "SFAs" "descripcion" => "saturated fatty acids" ] ] ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2303 "Ancho" => 3167 "Tamanyo" => 256115 ] ] "descripcion" => array:1 [ "en" => "Correlation between liver steatosis (dB) and bioactive fatty acids consumption." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2303 "Ancho" => 3167 "Tamanyo" => 246097 ] ] "descripcion" => array:1 [ "en" => "Correlation between liver fibrosis (skPa) and bioactive fatty acids consumption." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "Data are presented as mean±SD or median (IQR)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Non-steatosis \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Steatosis severity</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">n=109 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Mild \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Moderate \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Severe \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">p<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">49 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">57 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">84 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Men n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52 (54.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28 (68.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39 (78) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52 (71.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.008 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42.7±9.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46.1±9.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.5±10.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46.7±9.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.03 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Body mass index (kg/m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.9±3.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.6±2.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.4±3.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.4±3.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Decibels (dB/m) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">183.9±36.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">244.2±7.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">272.6±9.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">329.0±28.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Liver stiffiness (skPa) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.1±1.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.0±1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.0±0.84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.7±1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hemoglobin (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.3±1.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.5±1.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.3±1.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.8±1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.164 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Platelets (×103/μL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">241.3±69.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">226.6±38.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">235.8±60.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">230.0±69.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.438 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Glucose (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88 (84–94.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">92.0 (86.5–97.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91 (84–97) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">93 (87–100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.006 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BUN (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.5±3.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.0±3.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.9±3.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.4±3.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.052 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Creatinine (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.89 (0.74–0.99) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.86 (0.76–0.95) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.86 (0.75–0.97) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.94 (0.81–1.01) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.189 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Uric acid (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.2±1.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.5±1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.2±1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.8±1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.005 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Triglycerides (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">122 (91–167) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">126 (80–172) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">122 (94–170) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">173 (119–244) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.131 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TC (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">206.4±34.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">209.4±37.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">209.3±39.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">207.8±38.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.955 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HDL (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49.5±13.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48.4±13.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47.5±9.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43.9±13.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LDL (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">130.6±32.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">132.8±33.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">129.9±33.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">130.0±32.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.887 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">C-reactive protein (mg/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.2 (0.60–2.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.5 (0.9–2.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.4 (0.80–2.20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.8 (0.92–3.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.145 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Albumin (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.6±3.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.3±0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.2±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.3±0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.668 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total bilirubin (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.9±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.8±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.9±0.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.8±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.731 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Direct bilirubin (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.10 (0.09–0.12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.11 (0.10–0.15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.10 (0.09–0.13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.10 (0.09–0.14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.150 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HbA1C (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.2 (5.0–5.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.3 (5.0–5.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.3 (5.1–5.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.4 (5.2–5.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ALT (U/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.5 (18.0–30.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24.0 (19.5–31.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.5 (19.0–37.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 (22–50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AST (U/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 (19–29) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24.0 (21.5–29.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.0 (20.0–29.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 (22–32.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.006 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ALP (U/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61.2±17.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70.8±20.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69.6±19.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68.8±21.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.005 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GGT (U/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.5 (14–32) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.0 (14.2–28.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 (17–38) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.0 (17.5–44.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LDH (U/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">139.3±23.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">147.4±27.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">147.2±27.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">146.5±25.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diet</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total kcal/day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1466 (1218–2005) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1404 (1232–1723) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1740 (1424–2030) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1739 (1217–1963) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.040 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Protein (%)/day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16±3.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16±2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.7±3.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.8±3.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.401 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Carbohydrates (%)/day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.4±8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46.9±6.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.4±6.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46.4±8.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.675 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fructose (mg)/day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.8 (12.7–23.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.9 (13.1–24.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.4 (15.8–29.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.4 (15.2–25.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.087 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Glucose (mg)/day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.3 (8.5–18.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.6 (9.2–17.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.5 (10.4–19.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.6 (11–20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.060 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fiber (g)/day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (13.2–24.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.4 (13.2–22.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.3 (16.4–23.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.5 (14.7–23.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.509 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lipids (%)/day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38.4±7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37±5.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37.7±5.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37.7±7.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.714 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lipids (g)/day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62.7 (51.0–86.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58.2 (47.9–74.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72.1 (58.6–85.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67.9(49.8–86.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.166 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Saturated fats/day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 (14.3–27.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.1 (14.3 –20.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.1 (16.6–25.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.2 (15.3–28.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.126 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Monounsaturated/day fats \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.7 (22.2–41.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.7 (22.1–32.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31.4 (23.5–40.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.0 (22.3–41.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.395 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Polyunsaturated fats/day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.9 (7.9–15.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.9 (7.6–13.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.1 (9.8–15.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.9 (8.5–15.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.051 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2442733.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "Comparison of the 4 groups. BUN Blood urea nitrogen; TC Total Cholesterol; HDL High-density lipoprotein; LDL Low-density lipoprotein; ALT Alanine aminotransferase; AST Aspartate aminotransferase; ALP Alkaline phosphatase; GGT Gamma-Glutamyl transferase; LDH Lactate dehydrogenase." ] ] ] "descripcion" => array:1 [ "en" => "Clinical, biochemical and dietary characteristics in all study participants." ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Bioactive fatty acid \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Steatosis severity</th></tr><tr title="table-row"><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">n \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Mild \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Moderate \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Severe \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">49 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">57 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">84 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Saturated bioactive fatty acids</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Palmitic (g/day) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.43 (7.43–10.91) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.05 (8.69–13.89) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.57 (8.02–14.30) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.078 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stearic acid (g/day) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.99 (2.88–4.69) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.69 (3.43–5.77)<a class="elsevierStyleCrossRef" href="#tblfn0010">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.51 (3.38–6.01) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.022 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Monounsaturated bioactive fatty acids</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Palmitoleic (g/day) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.26 (0.86–1.58) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.58 (1.14–1.88) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.42 (1.02–1.66) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.111 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oleic (g/day) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.46 (15.6–24.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.40 (17.86–29.42) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.67 (16.15–31.66) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.216 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Polyunsaturated fatty acids</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Linoleic (g/day) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.53 (5.2–8.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.08 (6.19–10.75)<a class="elsevierStyleCrossRef" href="#tblfn0010">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.99 (5.62–11.09) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.008 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Linolenic acid (g/day) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.18 (0.86–1.49) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.22 (0.97–1.53) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.17 (0.90–1.53) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.776 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Arachidonic (g/day) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.14 (0.09–0.18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.16 (0.11–0.20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.14 (0.11–0.19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.288 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2442732.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "*" "nota" => "p≤0.05 differences between mild and moderate steatosis" ] ] ] "descripcion" => array:1 [ "en" => "Profile of bioactive fatty acids consumption according to NAFLD severity (n=190)." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:44 [ 0 => array:3 [ "identificador" => "bib0225" "etiqueta" => "[1]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obesity and nonalcoholic fatty liver disease: current perspectives" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. 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Fabiola López-Bautistaa, Varenka J. Barbero-Becerrab, María Yolanda Ríosc, M. Ángeles Ramírez-Cisnerosc, Cristell A. Sánchez-Pérezb, Martha H. Ramos-Ostosd, Misael Uribee, Norberto C. Chávez-Tapiab, Eva Juárez-Hernándezb,

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ejuarezh@medicasur.org.mx
evajuarezh@hotmail.com

Corresponding author.

a Molecular Biology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico

b Translational Research Unit, Medica Sur Clinic and Foundation, Mexico City, Mexico

c Chemical Research Center, IICBA, UAEM, Morelos, Mexico

d Integral Diagnosis and Treatment Center, Medica Sur Clinic and Foundation, Mexico City, Mexico

e Gastroenterology and Obesity Department, Medica Sur Clinic and Foundation, Mexico City, Mexico

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          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Correlation between liver fibrosis &#40;skPa&#41; and bioactive fatty acids consumption&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">1</span><span class="elsevierStyleSectionTitle" id="sect0040">Introduction</span><p id="par0060" class="elsevierStylePara elsevierViewall">Nonalcoholic fatty liver disease &#40;NAFLD&#41; is one of the most frequent chronic hepatic conditions worldwide&#46; It is characterized by the increase of fat deposits in hepatocytes in absence of high alcohol consumption&#44; drug hepatotoxicity&#44; or viral and autoimmune diseases <a class="elsevierStyleCrossRef" href="#bib0225">&#91;1&#93;</a>&#46; NAFLD is associated with obesity&#44; type 2 diabetes&#44; hypertension&#44; and dyslipidemia&#46; This condition is considered the hepatic manifestation of metabolic syndrome&#46; Genetic&#44; metabolic&#44; environmental&#44; and nutritional factors are involved in NAFLD pathogenesis <a class="elsevierStyleCrossRefs" href="#bib0230">&#91;2&#44;3&#93;</a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Reports show a prevalence of NAFLD of 20 to 40&#37; in general population&#59; differences in prevalence are due to different diagnostic methods and population&#44; with variable risk factors such as genetic predisposition&#44; socioeconomic status&#44; and anthropometric characteristics <a class="elsevierStyleCrossRefs" href="#bib0225">&#91;1&#44;4&#8211;6&#93;</a>&#46; In Mexico&#44; the prevalence of NAFLD has been estimated in 14&#37; to 50&#37;&#46; This prevalence derives from high rates of obesity and type 2 diabetes in which prevalence of NAFLD is 82&#37; and 18&#37;&#44; respectively&#59; genetic factors such as presence of PNPLA3 polymorphism in Mexican population are also related to high prevalence <a class="elsevierStyleCrossRefs" href="#bib0255">&#91;7&#44;8&#93;</a>&#46; In the last few years&#44; a modification of dietary habits in Mexican population has been characterized by an increase in saturated fats consumption and low polyunsaturated fatty acids consumption <a class="elsevierStyleCrossRef" href="#bib0265">&#91;9&#93;</a>&#44; which exert a direct effect in metabolic syndrome risk and chronic liver diseases development and increase&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Despite the efforts in clinical trials for pharmacological treatments for NAFLD&#44; only two options &#40;pioglitazone and vitamin E&#41; have been included in American and European guidelines for NAFLD treatment <a class="elsevierStyleCrossRef" href="#bib0270">&#91;10&#93;</a>&#46; The main treatment for this hepatic condition is still based on lifestyle modifications&#44; including dietary assessment&#44; weight loss&#44; and physical activity <a class="elsevierStyleCrossRefs" href="#bib0225">&#91;1&#44;11&#93;</a>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In the last few years&#44; dietary recommendations are focused in decreasing the total intake of dietary lipids&#44; with special emphasis in lower consumption of saturated fatty acids &#40;SFAs&#41;&#46; However&#44; some of the dietary lipids have shown different bioactive functions that depend on their molecular characteristics&#46; These effects could mean whether a risk or a protective factor for different diseases&#44; including those related to metabolic syndrome&#44; like cardiovascular diseases <a class="elsevierStyleCrossRef" href="#bib0280">&#91;12&#93;</a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Nowadays&#44; a wide diversity of biological activities associated with bioactive fatty acids&#8212;including their metabolic derivatives and components&#8212;has been described that proves their role in energetic-metabolic homeostasis&#44; cellular proliferation&#44; inflammatory regulation&#44; as well as the modulation of hepatocytes in obesity&#44; NAFLD&#44; and liver fibrosis development <a class="elsevierStyleCrossRef" href="#bib0285">&#91;13&#93;</a>&#46; The saturation characteristics of fatty acids have also been related to an increased risk of metabolic diseases &#40;SFAs&#41;&#44; fatty acids oxidation&#44; lipogenesis &#40;monounsaturated fatty acids &#40;MUFAs&#41;&#41;&#44; and anti&#47;pro inflammatory properties &#40;polyunsaturated fatty acids &#40;PUFAs&#41;&#41; <a class="elsevierStyleCrossRefs" href="#bib0290">&#91;14&#8211;17&#93;</a>&#46; It has been established that the bioactive function of some fatty acids could be beneficial&#44; deleterious&#44; or dual depending on individual characteristics&#44; such as intestinal microbiota composition&#44; genetics&#44; and lifestyle&#46; In NAFLD&#44; saturated bioactive fatty acids have showed a beneficial effect through the regulation of cholesterol and triglycerides metabolism&#46; Notably&#44; monounsaturated fatty acids have shown a dual effect in lipid metabolism and inflammation&#46; On the other hand&#44; polyunsaturated fatty acids have different effects in each component of NAFLD physiopathology&#58; a beneficial effect has been observed in insulin resistance and obesity&#59; the deleterious effect is characteristic of lipids metabolism and deposition&#59; and a dual effect could be observed in inflammation and in liver fibrosis related to obesity <a class="elsevierStyleCrossRef" href="#bib0285">&#91;13&#93;</a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">As far as we know&#44; recent evidence which associates bioactive fatty acids with NAFLD is mainly supported by animal models <a class="elsevierStyleCrossRefs" href="#bib0310">&#91;18&#8211;20&#93;</a> and human studies with small samples <a class="elsevierStyleCrossRefs" href="#bib0325">&#91;21&#8211;25&#93;</a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The aim of this study is to determine the dietary consumption patterns and serum percentage of bioactive fatty acids in NAFLD patients&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2</span><span class="elsevierStyleSectionTitle" id="sect0045">Material and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2&#46;1</span><span class="elsevierStyleSectionTitle" id="sect0050">Patient population</span><p id="par0095" class="elsevierStylePara elsevierViewall">This is a cross-sectional study carried out at the Medica Sur Clinic and Foundation check-up unit&#46; The study was approved by the Ethics Committee and it complies with the Helsinki Declaration&#46; Patients signed an informed consent form to participate in this study&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The study population was selected from a series of consecutive patients&#46; Exclusion criteria included alcohol intake &#40;&#62;20<span class="elsevierStyleHsp" style=""></span>g&#47;day&#41;&#44; diagnosed liver disease&#44; and current use of medication&#46; The absence of any viral&#44; genetic&#44; autoimmune&#44; and drug-induced liver disease was confirmed in each patient by laboratory tests and by a questionnaire about medications taken at the time of the check-up&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Sociodemographic data were collected&#46; Body mass index &#40;BMI&#41; was calculated as &#91;weight &#40;kg&#41;&#47;height &#40;m&#41;<span class="elsevierStyleSup">2</span>&#93;&#46; Complete blood counts&#44; biochemical data including glycosylated hemoglobin &#40;HbA1c&#41;&#44; liver function tests&#44; and lipid panel were performed&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2&#46;2</span><span class="elsevierStyleSectionTitle" id="sect0055">NAFLD and liver fibrosis evaluation</span><p id="par0110" class="elsevierStylePara elsevierViewall">A transient elastography &#40;Fibroscan&#8482; 502 Touch&#44; Echosens&#44; Paris&#44; France&#41; was performed in each patient&#44; M or XL probes were chosen according to the manufacturer and quality recommendations <a class="elsevierStyleCrossRef" href="#bib0350">&#91;26&#93;</a>&#46; The presence of NAFLD was identified by Control Attenuation Parameter &#40;CAP&#41;&#44; classifying patients in four groups according to percentage of fat measured in decibels&#47;meter &#40;dB&#47;m&#41;&#44; as&#58; non-steatosis &#40;&#60;232<span class="elsevierStyleHsp" style=""></span>dB&#47;m&#44; &#60;5&#37; of fat in liver cells&#41;&#44; mild steatosis &#40;232&#8211;256<span class="elsevierStyleHsp" style=""></span>dB&#47;m&#44; &#62;5&#37; of fat in liver cells&#41;&#44; moderate steatosis &#40;257&#8211;290<span class="elsevierStyleHsp" style=""></span>dB&#47;m&#44; &#62;33&#37; of fat in liver cells&#41;&#44; and severe steatosis &#40;&#62;290<span class="elsevierStyleHsp" style=""></span>dB&#47;m&#44; &#62;66&#37; of fat in liver cells&#41;&#46; Liver fibrosis were diagnosed by Wong cut-off points <a class="elsevierStyleCrossRef" href="#bib0355">&#91;27&#93;</a>&#58; &#62;6&#46;2<span class="elsevierStyleHsp" style=""></span>kPa&#44; as liver fibrosis&#44; and &#62;12<span class="elsevierStyleHsp" style=""></span>kPa as advanced liver fibrosis&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2&#46;3</span><span class="elsevierStyleSectionTitle" id="sect0060">Bioactive fatty acids consumption analysis</span><p id="par0115" class="elsevierStylePara elsevierViewall">Recruited patients answered a food frequency questionnaire validated in Mexican population by the National Institute of Public Health software &#40;SNUT&#41; <a class="elsevierStyleCrossRef" href="#bib0360">&#91;28&#93;</a>&#46; The SNUT software calculates the daily intake of calories&#44; proteins&#44; carbohydrates&#44; fats&#44; and micronutrients&#46; In terms of the fat consumption analysis&#44; the results of the questionnaire are presented as the daily intake of different nutrients and fatty acids&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">We analyzed the consumption of each bioactive fatty acid and classified them according to their molecular characteristics as non-saturated &#40;myristic acid&#41;&#44; saturated &#40;palmitic and stearic acids&#41;&#44; monounsaturated &#40;palmitoleic and oleic acids&#41;&#44; and polyunsaturated &#40;linoleic&#44; linolenic&#44; arachidonic&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2&#46;4</span><span class="elsevierStyleSectionTitle" id="sect0065">Bioactive fatty acids serum percentage analysis</span><p id="par0125" class="elsevierStylePara elsevierViewall">A representative sample of 40 individuals was analyzed by Gas Chromatography&#8211;Mass Spectrometry&#44; through Mass Profiler Professional software and data extraction was completed by deconvolution on Mass Hunter Qualitative Analysis software&#46; A peak area of &#8805;1&#37; of the total chromatogram was established as criteria for exportation data for statistics&#46; Compounds were retained for analysis by flags and frequency filtering&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Peripheral blood samples were collected in sterile pyrogen-free tubes and serum was recovered after centrifugation and stored at &#8722;80<span class="elsevierStyleHsp" style=""></span>&#176;C until use&#46; Serum was subjected to esterification to obtain FAME &#40;Fatty Acid Methyl Ester&#41; reaction with some modifications <a class="elsevierStyleCrossRef" href="#bib0365">&#91;29&#93;</a> as follows&#58; 200<span class="elsevierStyleHsp" style=""></span>&#956;L of serum of 10 patients per group were individually evaporated at 40<span class="elsevierStyleHsp" style=""></span>&#176;C&#44; dissolved in 400<span class="elsevierStyleHsp" style=""></span>&#956;L of anhydrous methanol &#40;MeOH&#41; and 20<span class="elsevierStyleHsp" style=""></span>&#956;L of acetyl chloride&#44; hermetically stored under N2 atmospheres&#44; and let react for 30<span class="elsevierStyleHsp" style=""></span>minutes&#46; The reaction was cold for 3<span class="elsevierStyleHsp" style=""></span>minutes and then 500<span class="elsevierStyleHsp" style=""></span>&#956;L of potassium carbonate 6&#37; were added or until any gas evolution was registered&#46; The total volume was transferred into a conic tube&#44; added with 400<span class="elsevierStyleHsp" style=""></span>&#956;L of hexane&#44; vortexed&#44; and centrifuged for 10<span class="elsevierStyleHsp" style=""></span>min &#40;10&#44;000<span class="elsevierStyleHsp" style=""></span>rpm&#41;&#46; 200<span class="elsevierStyleHsp" style=""></span>&#956;L of organic phase were analyzed by GC-MS using a DB-23 0&#46;25<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>0&#46;25<span class="elsevierStyleHsp" style=""></span>&#956;m&#44; 30<span class="elsevierStyleHsp" style=""></span>m length column with the following conditions&#58; 8<span class="elsevierStyleHsp" style=""></span>&#176;C&#47;min-175<span class="elsevierStyleHsp" style=""></span>&#176;C&#8211;0<span class="elsevierStyleHsp" style=""></span>min&#44; 4<span class="elsevierStyleHsp" style=""></span>&#176;C&#47;min&#8211;230<span class="elsevierStyleHsp" style=""></span>&#176;C&#8211;10<span class="elsevierStyleHsp" style=""></span>min <a class="elsevierStyleCrossRef" href="#bib0370">&#91;30&#93;</a>&#46; A 38 component FAME standard mix C4-C24 was analyzed&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Compounds were identified by the correlation of their retention time and the fragmentation pattern with those of FAME standard components&#59; additional peaks were compared with NIST library v2014&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2&#46;5</span><span class="elsevierStyleSectionTitle" id="sect0070">Statistical analysis</span><p id="par0140" class="elsevierStylePara elsevierViewall">The distribution of variables was determined by the Kolmogorov&#8211;Smirnov test&#44; while data are presented as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>S&#46;D&#46;&#44; median &#40;interquartile range&#41;&#44; or percentage&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The comparison of dietary consumption patterns of bioactive fatty acids in patients with or without NAFLD&#44; as well as the severity of liver diseases&#44; was performed with ANOVA&#44; Kruskal&#8211;Wallis&#44; or Chi square statistical test&#44; as needed&#46; The Spearman correlation analysis was applied to observe the correlation of dietary consumption of bioactive fatty acids&#44; as well as the serum percentage with biochemical data&#46; Values of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;05 were considered statistically significant&#46; All statistical analyses were performed using the SPSS software &#40;SPSS version 16&#46;0&#44; Inc&#46;&#44; Chicago&#44; Il&#44; USA&#41;&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">3</span><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">3&#46;1</span><span class="elsevierStyleSectionTitle" id="sect0080">General characteristics of population</span><p id="par0150" class="elsevierStylePara elsevierViewall">A total of 299 patients were included&#44; 109 without NAFLD and 190 with NAFLD&#59; 63&#46;9&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>190&#41; were men&#44; whose median of age and BMI were 44&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;9 years and 25&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;8<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; respectively&#46; Clinical and biochemical characteristics are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; In NAFLD patients&#44; the proportion of men was higher &#40;70&#46;5&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>134&#41; vs&#46; 29&#46;5&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>56&#41;&#41;&#46; As expected&#44; BMI was directly proportional to NAFLD severity&#44; as well as glucose&#44; uric acid&#44; triglycerides&#44; and HbA1c levels&#46; In NAFLD patients&#44; levels of liver function tests were higher&#44; but high density lipoprotein &#40;HDL&#41; cholesterol was lower in severe NAFLD cases &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; Clinical&#44; biochemical and dietary characteristics of all study participants are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">3&#46;2</span><span class="elsevierStyleSectionTitle" id="sect0085">NAFLD and liver fibrosis evaluation</span><p id="par0155" class="elsevierStylePara elsevierViewall">The mean of dB&#47;m of each group was&#58; 183&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>36 in the non-NAFLD group &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>109&#41;&#59; 244&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;5 in the mild NAFLD group &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>49&#41;&#59; 272&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;8 in the moderate NAFLD group &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>57&#41;&#59; and 329<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&#46;1 in the severe NAFLD group &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>84&#41;&#46; The median liver stiffness was 4&#46;2 &#40;IQR 3&#46;4&#8211;4&#46;9&#41; kPa&#44; and the prevalence of liver fibrosis &#40;&#62;6<span class="elsevierStyleHsp" style=""></span>kPa&#41; was 11&#46;7&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>35&#41;&#46; There were no patients with advanced liver fibrosis &#40;&#8805;12<span class="elsevierStyleHsp" style=""></span>kPa&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">3&#46;3</span><span class="elsevierStyleSectionTitle" id="sect0090">Dietary consumption analysis</span><p id="par0160" class="elsevierStylePara elsevierViewall">Regarding the presence of NAFLD&#44; significant differences were observed in dietary consumption of glucose &#40;14&#46;7<span class="elsevierStyleHsp" style=""></span>g &#40;IQR 10&#46;0&#8211;19&#46;4&#41; vs&#46; 12&#46;4<span class="elsevierStyleHsp" style=""></span>mg &#40;IQR 8&#46;2&#8211;18&#46;9&#41;&#41; and fructose &#40;20&#46;4<span class="elsevierStyleHsp" style=""></span>g &#40;IQR 14&#46;6&#8211;25&#46;9&#41; vs&#46; 17&#46;6<span class="elsevierStyleHsp" style=""></span>mg &#40;IQR 12&#46;6&#8211;23&#46;9&#41;&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;031&#41;&#59; patients from the non-NAFLD group &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>109&#41; showed lower consumption of these nutrients than NAFLD patients &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>190&#41;&#46; It is important to mention that the total lipid consumption in all the population was higher &#40;37&#8211;38&#46;4&#37; of total calories intake&#41; than the daily recommended intake <a class="elsevierStyleCrossRefs" href="#bib0295">&#91;15&#44;31&#93;</a>&#46; The bioactive fatty acids dietary consumption did not show significant differences between NAFLD and non-NAFLD patients&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">3&#46;4</span><span class="elsevierStyleSectionTitle" id="sect0095">Dietary consumption patterns of bioactive fatty acids according to NAFLD severity</span><p id="par0165" class="elsevierStylePara elsevierViewall">In patients with NAFLD diagnosis &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>190&#41;&#44; we observed significant differences in stearic and linoleic bioactive fatty acids consumption&#44; being higher in moderate NAFLD cases &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">The total calories intake was directly proportional to NAFLD severity &#40;mild NAFLD 1404 &#40;1232&#8211;1723&#41; kcal&#47;day&#59; moderate NAFLD 1740&#40;1424&#8211;2030&#41; kcal&#47;day and severe NAFLD 1739 &#40;1217&#8211;1963&#41; kcal&#47;day&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#59; however&#44; carbohydrates&#44; protein&#44; and fat distribution were not different among groups&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">According to decibels of CAP&#44; we observed positive but weak correlations with consumption of palmitic &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;180&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;018&#41;&#44; stearic &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;200&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;009&#41; and linoleic &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;163&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;032&#41; acids&#46; On the other hand&#44; in patients with severe NAFLD &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>84&#41; decibels of CAP showed significant positive&#44; and once again&#44; weak correlation with consumption of stearic &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;329&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#41; and palmitoleic acid &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;304&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;006&#41;&#46; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0180" class="elsevierStylePara elsevierViewall">In a post hoc analysis we divided patients in groups according to severity &#40;non-NAFLD<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>mild NAFLD and moderate NAFLD<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>severe NAFLD&#41; to identify differences between these groups&#59; only palmitoleic acid dietary consumption was significantly higher in moderate<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>severe NAFLD patients &#40;1&#46;4 &#40;IQR 1&#46;1&#8211;1&#46;8&#41; vs&#46; 1&#46;3 &#40;IQR 1&#46;0&#8211;1&#46;7&#41;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;044&#41;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">3&#46;5</span><span class="elsevierStyleSectionTitle" id="sect0100">Dietary consumption pattern of bioactive fatty acids in patients with fibrosis</span><p id="par0185" class="elsevierStylePara elsevierViewall">In patients with fibrosis we observed a significantly higher consumption of myristic acid &#40;1&#46;15 &#40;IQR 0&#46;96&#8211;1&#46;62 g&#41; vs&#46; 0&#46;99 &#40;IQR 0&#46;68&#8211;1&#46;37&#41; g&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;021&#41;&#46; In correlation analysis of consumption of bioactive fatty acids with liver stiffness &#40;kPa&#41; we did not observed significant correlations&#59; however&#44; in severe NAFLD patients &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>84&#41;&#44; analysis of correlation&#44; showed a weak but significantly positive correlation between consumption of palmitic &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;33&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#41;&#44; stearic &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;32&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#41;&#44; palmitoleic &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;29&#59; 0&#46;01&#41;&#44; oleic &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;29&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#44; and linoleic acid &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;29&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41; and liver stiffness &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">3&#46;6</span><span class="elsevierStyleSectionTitle" id="sect0105">Serum percentage of bioactive fatty acids analysis</span><p id="par0190" class="elsevierStylePara elsevierViewall">The analysis of bioactive fatty acids serum percentage &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#44; ten patients per group&#41; did not show differences in NAFLD patients versus non-NAFLD patients&#59; also&#44; we did not observe correlations between serum percentage and dietary consumption&#46; In terms of severity&#44; bioactive fatty acids serum percentage did not show significant correlations&#46;</p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">4</span><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0195" class="elsevierStylePara elsevierViewall">Bioactive fatty acids consumption is an important issue since it has been related to an increased or decreased risk of developing several diseases related to metabolic syndrome&#44; such as NAFLD <a class="elsevierStyleCrossRef" href="#bib0380">&#91;32&#93;</a>&#46; This study shows the relation between bioactive fatty acids consumption&#44; NAFLD severity&#44; and serum percentage&#46; As far as we know&#44; this is the first study that evaluates all these factors and their correlation with biochemical markers related to metabolic syndrome&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">We observed an increased stearic acid consumption related to NAFLD severity&#46; Meanwhile&#44; saturated &#40;palmitic&#44; stearic&#44; and linolenic&#41; bioactive fatty acids showed a positive correlation with NAFLD severity &#40;dB&#47;m&#41;&#44; which has been related to an increase in the consumption of SFAs with hepatic fat fraction <a class="elsevierStyleCrossRef" href="#bib0385">&#91;33&#93;</a>&#46; SFAs have been associated with inflammatory cytokine promotion and apoptosis induction in NAFLD <a class="elsevierStyleCrossRefs" href="#bib0300">&#91;16&#44;34&#93;</a>&#46; In our sample&#44; we observed that bioactive SFAs &#40;stearic and palmitic acid&#41; were positively correlated with kPa in severe NAFLD&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">In our population&#44; the higher consumption of bioactive SFAs corresponds to palmitic acid&#44; which has been associated with increased lipotoxicity and inflammation&#59; <a class="elsevierStyleCrossRefs" href="#bib0395">&#91;35&#44;36&#93;</a> nevertheless&#44; palmitic acid did not show significant differences regarding NAFLD severity&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">A balance between myristic acid and palmitic acid has been related to NAFLD and NASH &#40;non-alcoholic steatohepatitis&#41; <a class="elsevierStyleCrossRef" href="#bib0395">&#91;35&#93;</a>&#59; apparently the inflammatory response and high cardiovascular risk are related to these two bioactive fatty acids <a class="elsevierStyleCrossRef" href="#bib0405">&#91;37&#93;</a>&#46; SFAs induce apoptosis in hepatocytes&#44; where specifically myristic acid has been proposed as a biomarker in NASH <a class="elsevierStyleCrossRef" href="#bib0410">&#91;38&#93;</a>&#46; Moreover&#44; we observed a higher consumption of myristic acid in patients with fibrosis&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">It has been described that traditional Mexican diet confers a high NAFLD risk&#44; due to the low consumption of MUFAs and PUFAs and the high consumption of SFAs <a class="elsevierStyleCrossRef" href="#bib0305">&#91;17&#93;</a>&#46; Despite the fact that patients with severe steatosis showed higher consumption of MUFAs and PUFAs&#44; daily recommended requirements are not accomplished&#44; which has also been observed in Brazilian population <a class="elsevierStyleCrossRef" href="#bib0415">&#91;39&#93;</a>&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Imbalance of <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>3&#47;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>6 in favor to <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>6 is associated with inflammatory promotion and eicosapentaenoic acid&#47;arachidonic acid serum index&#44; which has been related to NAFLD development <a class="elsevierStyleCrossRefs" href="#bib0420">&#91;40&#44;41&#93;</a>&#46; We observed a high consumption of linoleic acid in moderate and severe NAFLD patients&#44; respect to mild NAFLD patients&#46; This is a factor that may contribute to the progression from NAFLD to NASH&#44; since the imbalance in favor to <span class="elsevierStyleItalic">n</span>-6 has an important role in the progression of NAFLD <a class="elsevierStyleCrossRef" href="#bib0300">&#91;16&#93;</a>&#46; However&#44; this bioactive fatty acid did also correlate with kPa in severe NAFLD patients&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">In severe NAFLD patients we observed a high consumption stearic and linoleic acids&#46; This observation could be interpreted as a sign of imbalance between <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>3&#47;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>6&#59; such imbalance could condition the effect direction of bioactive fatty acids in terms of their dual effect&#44; thus increasing NAFLD severity instead of showing an anti-inflammatory effect <a class="elsevierStyleCrossRefs" href="#bib0300">&#91;16&#44;42&#93;</a>&#46; These results support the importance of maintaining an <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>3&#47;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>6 balance&#44; especially in patients with evidence of fat deposition in liver tissue&#44; thus avoiding an increase in the consumption of arachidonic acid&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">The aim of the study encompasses the evaluation of dietary consumption and serum percentage pattern in NAFLD patients&#59; however&#44; we did not observe a correlation between consumption and serum profile&#46; Several studies of lipidomic profile of NAFLD have been published before&#59; however&#44; most of them focused in animal models&#44; even less in human samples <a class="elsevierStyleCrossRef" href="#bib0435">&#91;43&#93;</a>&#46; As far as we know&#44; our work is the first to try to correlate consumption pattern and serum percentage of bioactive fatty acids in NAFLD patients&#46; Regrettably&#44; this aim was not properly accomplished&#46; A direct correlation between consumption and serum content seems to be complicated to analyze&#44; since multiple biochemical and metabolic mechanisms occurred in the process until the lipid reaches the blood stream and still in it&#46; Recently&#44; several bioactive lipids&#44; more specifically free fatty acids&#44; have been proposed as agonists of free fatty acids receptors&#44; which have important roles in several cells and tissues and are involved in metabolic and inflammation mechanisms <a class="elsevierStyleCrossRef" href="#bib0440">&#91;44&#93;</a>&#46; Then&#44; this may be an alternative area of study that could lead us to meet the stated objective&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">The evaluation and modification of bioactive fatty acids consumption in NAFLD dietary treatment should focus on prioritizing the consumption of those that are characterized by anti-inflammatory and anti-fibrotic properties&#44; but mainly maintaining an <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>3&#47;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>6 balance&#46; These modifications&#44; in combination with lifestyle modifications and physical activity&#44; seem to be promising in the progression of liver disease prevention&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Conclusively&#44; the dietary consumption of bioactive fatty acids is different according to NAFLD severity&#44; but not in the presence or absence of this liver disease&#46; Individualized diets according to NAFLD severity could be successful in order to prevent outcomes related to augmentation of inflammation&#44; development of NASH&#44; and progression to cirrhosis and hepatocellular carcinoma&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Author contributions</span><p id="par0245" class="elsevierStylePara elsevierViewall">All the authors have read and approved the final manuscript&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Funding</span><p id="par0250" class="elsevierStylePara elsevierViewall">Funding for this study was provided by the <span class="elsevierStyleGrantSponsor" id="gs1">CONACyT-FOSSIS-262216</span>&#44; and <span class="elsevierStyleGrantSponsor" id="gs2">Medica Sur&#44; Mexico</span>&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflict of interest</span><p id="par0255" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
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        0 => array:3 [
          "identificador" => "xres1424238"
          "titulo" => "Abstract"
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              "identificador" => "abst0005"
              "titulo" => "Introduction and objectives"
            ]
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              "identificador" => "abst0010"
              "titulo" => "Patients and methods"
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              "titulo" => "Results"
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          "titulo" => "Keywords"
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        2 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        3 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Material and methods"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Patient population"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "NAFLD and liver fibrosis evaluation"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Bioactive fatty acids consumption analysis"
            ]
            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Bioactive fatty acids serum percentage analysis"
            ]
            4 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Statistical analysis"
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        4 => array:3 [
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          "titulo" => "Results"
          "secciones" => array:6 [
            0 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "General characteristics of population"
            ]
            1 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "NAFLD and liver fibrosis evaluation"
            ]
            2 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Dietary consumption analysis"
            ]
            3 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Dietary consumption patterns of bioactive fatty acids according to NAFLD severity"
            ]
            4 => array:2 [
              "identificador" => "sec0065"
              "titulo" => "Dietary consumption pattern of bioactive fatty acids in patients with fibrosis"
            ]
            5 => array:2 [
              "identificador" => "sec0070"
              "titulo" => "Serum percentage of bioactive fatty acids analysis"
            ]
          ]
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        5 => array:2 [
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          "titulo" => "Discussion"
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        6 => array:2 [
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          "titulo" => "Author contributions"
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        7 => array:2 [
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          "titulo" => "Funding"
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        8 => array:2 [
          "identificador" => "sec0090"
          "titulo" => "Conflict of interest"
        ]
        9 => array:2 [
          "identificador" => "xack497213"
          "titulo" => "Acknowledgements"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2020-04-01"
    "fechaAceptado" => "2020-06-15"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1301796"
          "palabras" => array:5 [
            0 => "Body mass index"
            1 => "Lipids"
            2 => "Liver"
            3 => "Nutrition"
            4 => "NAFLD"
          ]
        ]
      ]
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    "resumen" => array:1 [
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Nonalcoholic fatty liver disease &#40;NAFLD&#41; is the hepatic manifestation of metabolic syndrome&#46; Some dietary fatty acids have showed different bioactive functions in metabolic syndrome&#46; The aim of this study is to determine the dietary consumption patterns and serum percentage of bioactive fatty acids in NAFLD patients&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Cross-sectional study with NAFLD patients and non-NAFLD patients&#46; Dietary consumption of bioactive fatty acids was assessed by a food frequency questionnaire&#46; NAFLD and liver fibrosis were diagnosed by transient elastography&#46; The identification of serum bioactive fatty acids was achieved by gas chromatography&#8211;mass spectrometry &#40;&#37;&#41;&#46; Bioactive fatty acids consumption was correlated with NAFLD clinical characteristics with the Spearman correlation analysis&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 299 patients were included&#44; whose mean of age and body mass index were 44&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;9 years and 25&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;8<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; respectively&#46; The consumption of bioactive fatty acids was no different regarding the presence of NAFLD&#59; however&#44; the consumption of stearic and linoleic fatty acids was higher in relation with NAFLD severity &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; The consumption of myristic acid was higher in patients with fibrosis &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;02&#41;&#46; Serum percentage and dietary consumption did not show correlations&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Dietary consumption of bioactive fatty acids is different according to NAFLD severity&#46; Individualized diets according to NAFLD severity could be successful in order to prevent liver injury-related outcomes&#46;</p></span>"
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          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction and objectives"
          ]
          1 => array:2 [
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            "titulo" => "Patients and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
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        "identificador" => "nom0005"
        "titulo" => "<span class="elsevierStyleSectionTitle" id="sect0035">Abbreviations</span>"
        "listaDefinicion" => array:1 [
          0 => array:1 [
            "definicion" => array:11 [
              0 => array:2 [
                "termino" => "BMI"
                "descripcion" => "<p id="par0005" class="elsevierStylePara elsevierViewall">body mass index</p>"
              ]
              1 => array:2 [
                "termino" => "CAP"
                "descripcion" => "<p id="par0010" class="elsevierStylePara elsevierViewall">controlled attenuated parameter</p>"
              ]
              2 => array:2 [
                "termino" => "FAME"
                "descripcion" => "<p id="par0015" class="elsevierStylePara elsevierViewall">fatty acid methyl ester</p>"
              ]
              3 => array:2 [
                "termino" => "HbA1c"
                "descripcion" => "<p id="par0020" class="elsevierStylePara elsevierViewall">glycosylated hemoglobin</p>"
              ]
              4 => array:2 [
                "termino" => "HDL"
                "descripcion" => "<p id="par0025" class="elsevierStylePara elsevierViewall">high density lipoprotein</p>"
              ]
              5 => array:2 [
                "termino" => "LDL"
                "descripcion" => "<p id="par0030" class="elsevierStylePara elsevierViewall">low density lipoprotein</p>"
              ]
              6 => array:2 [
                "termino" => "MUFAs"
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                  \t\t\t\t">0&#46;145&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Albumin &#40;mg&#47;dL&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;668&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Total bilirubin &#40;mg&#47;dL&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;731&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Direct bilirubin &#40;mg&#47;dL&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;10 &#40;0&#46;09&#8211;0&#46;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;11 &#40;0&#46;10&#8211;0&#46;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;10 &#40;0&#46;09&#8211;0&#46;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;10 &#40;0&#46;09&#8211;0&#46;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">HbA1C &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5&#46;2 &#40;5&#46;0&#8211;5&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#46;3 &#40;5&#46;0&#8211;5&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#46;3 &#40;5&#46;1&#8211;5&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">5&#46;4 &#40;5&#46;2&#8211;5&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;002</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">ALT &#40;U&#47;L&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">22&#46;5 &#40;18&#46;0&#8211;30&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#46;0 &#40;19&#46;5&#8211;31&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">27&#46;5 &#40;19&#46;0&#8211;37&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;22&#8211;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">AST &#40;U&#47;L&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;19&#8211;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">24&#46;0 &#40;21&#46;5&#8211;29&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">23&#46;0 &#40;20&#46;0&#8211;29&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">27 &#40;22&#8211;32&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;006</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">ALP &#40;U&#47;L&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">61&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">70&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#46;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">69&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">68&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;005</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">GGT &#40;U&#47;L&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;5 &#40;14&#8211;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">21&#46;0 &#40;14&#46;2&#8211;28&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;17&#8211;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">26&#46;0 &#40;17&#46;5&#8211;44&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;05</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">LDH &#40;U&#47;L&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">139&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">147&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">147&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">146&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>25&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Diet</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Total kcal&#47;day</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1466 &#40;1218&#8211;2005&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1404 &#40;1232&#8211;1723&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1740 &#40;1424&#8211;2030&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">19 &#40;14&#46;3&#8211;27&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Monounsaturated&#47;day fats</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Polyunsaturated fats&#47;day</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12&#46;9 &#40;8&#46;5&#8211;15&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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Article information

ISSN: 16652681
Original language: English

DOI:10.1016/j.aohep.2020.06.008

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	2	2	4
2024 October	16	13	29
2024 September	20	9	29
2024 August	27	7	34
2024 July	12	8	20
2024 June	17	11	28
2024 May	18	9	27
2024 April	25	13	38
2024 March	59	12	71
2024 February	39	21	60
2024 January	47	17	64
2023 December	33	19	52
2023 November	28	25	53
2023 October	38	24	62
2023 September	17	9	26
2023 August	21	11	32
2023 July	20	15	35
2023 June	25	14	39
2023 May	55	9	64
2023 April	34	13	47
2023 March	18	16	34
2023 February	12	10	22
2023 January	16	10	26
2022 December	23	14	37
2022 November	29	13	42
2022 October	18	15	33
2022 September	20	9	29
2022 August	20	14	34
2022 July	23	12	35
2022 June	14	16	30
2022 May	21	12	33
2022 April	14	15	29
2022 March	34	21	55
2022 February	26	11	37
2022 January	43	11	54
2021 December	47	11	58
2021 November	21	9	30
2021 October	32	8	40
2021 September	10	19	29
2021 August	20	7	27
2021 July	30	7	37
2021 June	20	14	34
2021 May	15	13	28
2021 April	107	32	139
2021 March	41	17	58
2021 February	22	9	31
2021 January	26	7	33
2020 December	23	6	29
2020 November	18	6	24
2020 October	29	15	44
2020 September	81	13	94
2020 August	3	7	10

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