Effect of quercetin on the clinical course of non-alcoholic steatohepatitis and diabetic kidney disease against comprehensive treatment of type 2 diabetes patients

Main Article Content

O.S. Khukhlina
A.A. Antoniv
Z.Ya. Kotsiubiichuk

Abstract

Background. The purpose of the study was to determine the probable effect of a complex of metformin, rosuvastatin, essential phospholipids, and quercetin on the clinical course of non-alcoholic steatohepatitis, diabetic kidney disease, type 2 diabetes mellitus, as well as on the state of blood lipid spectrum, parameters of carbohydrate metabolism compensation which are the factors of the progression of non-alcoholic steatohepatitis and diabetic kidney disease. Materials and methods. The dynamic of treatment was studied in 60 patients with non-alcoholic steatohepatitis with type 2 diabetes mellitus and stage I–III diabetic kidney disease, among whom 48 patients were diagnosed with mild non-alcoholic steatohepatitis and 12 with moderate activity. The comorbid disease in all patients with non-alcoholic steatohepatitis was type 2 diabetes mellitus of moderate severity, among which 15 people were at the stage of compensation, 45 were subcompensated. The state of carbohydrate metabolism was determined by fasting blood glucose and 2 hours after a meal by glucose oxidase method, fasting insulin content (DRG System) by enzyme-linked immunosorbent assay, blood glycosylated hemoglobin content ­using standard sets of reagents “Simko Ltd”. Results. One month after the start of therapy, asthenic syndrome of much lower intensity persisted only in 1 person (3.13 %) of the second group, while in the first group, it remained in 9 patients (32.1 %). At the same time in the majority of patients of the second group, the feeling of heaviness and pain in the right hypochondrium disappeared (in 31 (96.9 %) against 16 (57.1 %) in the first group (p < 0.05), respectively, and almost no dyspeptic symptoms disturbed (in 24 patients of group 2 (75.0 %) against 11 people (39.3 %) in group 1). A month after the start of treatment, no clinical manifestations of cholestasis were registered in 20 (62.5 %) patients of group 2 and only in 10 patients (35.7 %) in group 1 (p < 0.05). Quercetin in a complex treatment was found to have a positive effect on hepatomegaly regression, which remained in 5 patients (15.6 %) in group 2. Conclusions. The complex therapy with essential phospholipids, rosuvastatin, metformin in combination with quercetin in patients with comorbid non-alcoholic steatohepatitis, type 2 diabetes mellitus, and diabetic renal disease helps to eliminate the main clinical and laboratory symptoms of exacerbation of non-alcoholic steatohepatitis, helps to normalize blood glucose. The complex therapy with the addition of quercetin probably helped to increase the effectiveness of treatment of diabetic kidney di­sease against the background of type 2 diabetes mellitus, reduced the incidence of proteinuria, increased glomerular filtration rate, reduced hypercreatininemia.

Article Details

How to Cite
Khukhlina, O., A. Antoniv, and Z. Kotsiubiichuk. “Effect of Quercetin on the Clinical Course of Non-Alcoholic Steatohepatitis and Diabetic Kidney Disease Against Comprehensive Treatment of Type 2 Diabetes Patients”. INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine), vol. 16, no. 8, Aug. 2021, pp. 622-9, doi:10.22141/2224-0721.16.8.2020.222883.
Section
Original Researches

References

Hazlehurst JM, Woods C, Marjot T, Cobbold JF, Tomlinson JW. Non-alcoholic fatty liver disease and diabetes. Metabolism. 2016 Aug;65(8):1096-1108. doi:10.1016/j.metabol.2016.01.001.

Khukhlina OS, Antoniv AA, Mandryk OY, Smandych VS, Matushchak MR. The role of endothelial dysfunction in the progression mechanisms of non-alcoholic steatohepatitis in patients with obesity and chronic kidney disease. Wiad Lek. 2019;72(4):523-526.

Dharmalingam M, Yamasandhi PG. Nonalcoholic Fatty Liver Disease and Type 2 Diabetes Mellitus. Indian J Endocrinol Metab. 2018 May-Jun;22(3):421-428. doi:10.4103/ijem.IJEM_585_17.

European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016 Jun;64(6):1388-1402. doi:10.1016/j.jhep.2015.11.004.

Sberna AL, Bouillet B, Rouland A, et al. European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD) and European Association for the Study of Obesity (EASO) clinical practice recommendations for the management of non-alcoholic fatty liver disease: evaluation of their application in people with Type 2 diabetes. Diabet Med. 2018 Mar;35(3):368-375. doi:10.1111/dme.13565.

Angulo P, Kleiner DE, Dam-Larsen S, et al. Liver Fibrosis, but No Other Histologic Features, Is Associated With Long-term Outcomes of Patients With Nonalcoholic Fatty Liver Disease. Gastroenterology. 2015 Aug;149(2):389-97.e10. doi:10.1053/j.gastro.2015.04.043.

EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA). Scientific Opinion on the substantiation of health claims related to quercetin and protection of DNA, proteins and lipids from oxidative damage (ID 1647), “cardiovascular system” (ID 1844), “mental state and performance” (ID 1845), and “liver, kidneys” (ID 1846) pursuant to Article 13(1) of Regulation (EC) No 1924/2006. EFSA Journal. 2011;9(4):2067. doi:10.2903/j.efsa.2011.2067.

Salehi B, Machin L, Monzote L, et al. Therapeutic Potential of Quercetin: New Insights and Perspectives for Human Health. ACS Omega. 2020 May 14;5(20):11849-11872. doi:10.1021/acsomega.0c01818.

Kaşıkcı MB, Bağdatlıoğlu N. Bioavailability of Quercetin. Curr Res Nutr Food Sci. 2016;(4):146-151. doi:10.12944/CRNFSJ.4.

Anand David AV, Arulmoli R, Parasuraman S. Overviews of Biological Importance of Quercetin: A Bioactive Flavonoid. Pharmacogn Rev. 2016 Jul-Dec;10(20):84-89. doi:10.4103/0973-7847.194044.

Son HY, Lee MS, Chang E, et al. Formulation and Characterization of Quercetin-loaded Oil in Water Nanoemulsion and Evaluation of Hypocholesterolemic Activity in Rats. Nutrients. 2019 Jan 22;11(2):244. doi:10.3390/nu11020244.

Miltonprabu S, Tomczyk M, Skalicka-Woźniak K, et al. Hepatoprotective effect of quercetin: From chemistry to medicine. Food Chem Toxicol. 2017 Oct;108(Pt B):365-374. doi:10.1016/j.fct.2016.08.034.

Vovkun TV, Yanchuk PI, Shtanova LY, et al. Exocrine function of the liver in rats exposed to cоrvitin. Int J Physiol Pathophysiol. 2017;8(3):207-217. doi:10.1615/IntJPhysPathophys.v8.i3.20.

Sytar O, Kosyan A, Taran N, Smetanska I. Anthocyanin’s as marker for selection of buckwheat plants with high rutin content. Gesunde Pflanzen. 2014;66:165-169. doi:165.10.1007/s10343-014-0331-z.

Miles SL, McFarland M, Niles RM. Molecular and physiological actions of quercetin: need for clinical trials to assess its benefits in human disease. Nutr Rev. 2014 Nov;72(11):720-734. doi:10.1111/nure.12152.

Guo Y, Bruno RS. Endogenous and exogenous mediators of quercetin bioavailability. J Nutr Biochem. 2015 Mar;26(3):201-210. doi:10.1016/j.jnutbio.2014.10.008.

Mouradov A, Spangenberg G. Flavonoids: a metabolic network mediating plants adaptation to their real estate. Front Plant Sci. 2014 Nov 10;5:620. doi:10.3389/fpls.2014.00620.

Zhang M, Xie Z, Gao W, Pu L, Wei J, Guo C. Quercetin regulates hepatic cholesterol metabolism by promoting cholesterol-to-bile acid conversion and cholesterol efflux in rats. Nutr Res. 2016 Mar;36(3):271-279. doi:10.1016/j.nutres.2015.11.019.