Non-alcoholic Fatty Liver Disease in South Asians: A Review of the Literature.

Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are national and global epidemics. The disease is characterized by a spectrum of liver steatosis (fat deposition), inflammation (in NASH) and fibrosis. NAFLD and specifically NASH can lead to cirrhosis, which carry risks of progression to portal hypertension and hepatocellular carcinoma (HCC). NASH is also associated with higher mortality from cardiovascular causes. Most of the data for NAFLD has been obtained from the perspective of developed nations, although the disease is increasing and threatening to reach epidemic proportions across the world. Emerging data is notable for high prevalence of NAFLD in South Asian populations, presumably resulting from a combination of underlying genetic polymorphisms and changes in socio-economic status. It is also notable that an 'Asian Paradox' has been defined for NAFLD based upon the observation of lower than pre-defined body mass index (BMI), otherwise termed as "lean NAFLD", among this population. Yet, data remains limited in regards to the characteristics of NAFLD/NASH in this population. In this article, we present a review of the literature and discuss the prevalence, associated risk factors and burden of HCC in South Asians with NAFLD.

Effects of Aloe vera supplementation in subjects with prediabetes/metabolic syndrome.

BACKGROUND: Metabolic syndrome affects 1 in 3 U.S. adults. The primary target of treatment of patients with metabolic syndrome is therapeutic lifestyle change. Numerous animal trials have reported positive effects of Aloe vera in in vivo models of diabetes, but there is a paucity of controlled clinical trials in patients with prediabetes. Thus, the objective of this pilot study was to examine the effect of aloe compared to placebo on fasting blood glucose, lipid profile, and oxidative stress in subjects with prediabetes/metabolic syndrome. METHODS: This was a double-blind, placebo-controlled Institutional Review Board (IRB)-approved pilot study of two aloe products (UP780 and AC952) in patients with prediabetes over an 8-week period. A total of 45 subjects with impaired fasting glucose or impaired glucose tolerance and having two other features of metabolic syndrome were recruited (n=15/group). Parameters of glycemia [fasting glucose, insulin, homeostasis model assessment (HOMA), glycosylated hemoglobin (HbA1c), fructosamine, and oral glucose tolerance test (OGTT)] and oxidative stress (urinary F2-isoprostanes) were measured along with lipid profile and high-sensitivity C-reactive protein (hsCRP) levels before and after supplementation. RESULTS: There were no significant baseline differences between groups. Compared to placebo, only the AC952 Aloe vera inner leaf gel powder resulted in significant reduction in total and low-density lipoprotein cholesterol (LDL-C) levels, glucose, and fructosamine. In the UP780 Aloe vera inner leaf gel powder standardized with 2% aloesin group, there were significant reductions in HbA1c, fructosamine, fasting glucose, insulin, and HOMA. Only the UP780 aloe group had a significant reduction in the F2-isoprostanes compared to placebo. CONCLUSIONS: Standardized aloe preparations offer an attractive adjunctive strategy to revert the impaired fasting glucose and impaired glucose tolerance observed in conditions of prediabetes/metabolic syndrome.

A randomized placebo-controlled crossover trial of aloe vera on bioavailability of vitamins C and B(12), blood glucose, and lipid profile in healthy human subjects.

Several factors limit the absorption and bioavailability of vitamins. Vitamin C, a commonly used water-soluble supplement reduces the risk of disease. Vitamin B(12) is necessary for the development of RBC, growth, and nervous system. Vitamin B(12) deficiency is common among elderly. Thus, agents that improve bioavailability of vitamin C and B(12), especially in older individuals would be important. Aloe Vera is a botanical with immunomodulatory properties. Aloe is processed using the hand-filleted technique or whole leaf procedure. The aim of this study is to examine the effect of two different aloe vera preparations (aloe inner leaf gel, [AG] and aloe whole leaf decolorized gel, [AL]) compared to placebo on the bioavailability of vitamins, C and B(12), in healthy human volunteers in a randomized crossover trial. Subjects (n = 15) received in a random fashion either aloe whole leaf extract (AL with vitamins B(12), 1 mg and vitamin C 500 mg) or aloe fillet gel (AG with B(12) 1 mg and vitamin C 500 mg) or water (with vitamin B(12) 1 mg and vitamin C 500 mg). Blood was obtained fasting, followed by 1, 2, 4, 6, 8, and 24 hours postingestion of aloe/water. When given with vitamins C and B(12), AG significantly increased plasma oxygen radical absorbance capacity (ORAC) at both 4 and 24 hours and AL at 4 hours compared to baseline and placebo. AG significantly increased plasma vitamin C at 4, 6, 8, and 24 hours and AL at 4 and 6 hours compared to baseline and placebo (p <.01). Also, both aloes significantly increased serum vitamin B(12) levels at 1 and 2 hours compared to baseline and placebo (p <.01). Thus, AG and AL preparations are safe, well tolerated, and enhance the bioavailability of vitamins C and B(12) and antioxidant potential.