الفهرس 
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Abstract
SUMMARY
T
ype 2 diabetes (T2DM) and its complications represent a major worldwide public health challenge, with high-rate morbidity and mortality. chronic hyperglycemia leads to oxidative stress that often associated with the development of microvascular diabetic complications and increases the risk of diabetic macrovascular disease. Hyperglycemia-induced cellular damage through several mechanisms including oxidative stress (i.e., increased superoxide production), increased advanced glycation end products formation, polyol pathway activity and protein kinase C activation.
Fatty liver is a clinical condition characterized by accumulation of lipids within hepatocytes so when hepatic fat content exceeding 5% of the liver weight this considered as fatty liver. It is commonly related to various components of metabolic syndrome including obesity, diabetes mellitus, and dyslipidemia. Non-alcoholic fatty liver disease (NAFLD) has a great focus worldwide, as it is expected to affect 75% of patients with type2 diabetes mellitus (T2DM).
Glutathione is a tripeptide that plays an essential role in serious physiological processes affecting the maintenance of redox balance, reduction of oxidative stress and enhancement of metabolic detoxification. Several studies reported that erythrocyte glutathione (GSH) concentration is decreased in patients with type 2 diabetes. However, the exact mechanisms accountable for glutathione deficiency in type 2 diabetes have not been fully well-known. It is seeming that enhancing dietary intake of glutathione precursors, co-factors, and whole foods could improve health by optimizing glutathione status in our body. These dietary sources include lean protein sources, brassica vegetables, polyphenol-rich fruits and vegetables, herbs and spices, green tea, and omega-3 fatty acid rich-foods such as fish.
The aim of the current study was to assess reduced glutathione plasma level then evaluate its correlation with the dietary factors, fasting blood glucose levels, HBA1c and lipid profile in type 2 diabetic patients with fatty liver. We specifically aimed at:
1- Assessing the dietary intake of the subjects enrolled in the study.
2- Measuring reduced glutathione plasma levels.
3- Correlating reduced glutathione plasma levels to dietary assessment results and to different biochemical parameters evaluated in the study.
This study was done at Faculty of Medicine, Ain Shams University during the period from 2020 – 2021.
A total of 40 individuals including 20 type 2 diabetic patients with fatty liver attending outpatient clinic Ain shams university and 20 healthy persons working in faculty of medicine, Ain Shams University. Cases and controls were matched for the variables: age and gender.
Informed consent and full clinical data were obtained from all participants.
The type2 DM patients and apparently healthy persons referred for diagnostic abdominal ultrasound and screened for fatty liver in the Radiology department of El-Demerdash hospital
Blood samples were collected from all participants and their dietary habits were assessed by means of Food Frequency Questionnaire and 24-hour recall followed by assessment of the different anthropometric measurement (Hight, weight, BMI, waist circumference, hip circumference, and waist /hip ratio).
Study groups:
group A (20): Healthy control subjects (BMI≤35)
group B (20): Type 2 diabetic patients with fatty liver (BMI≤35)
Blood Samples obtained were used as following:
Na2-EDTA tubes to assess for glycosylated hemoglobin HbA1c% determination.
Serum was then separated used to assess fasting blood sugar, lipid profile (Cholesterol, Triglycerides, HDL, and LDL), Liver enzymes (Aspartate aminotransferase (AST), Alanine aminotransferase (ALT)) and serum albumin
Plasma levels of reduced glutathione measured by ELISA.
All analyses were done using the statistical package for the social sciences version 20 (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.) on a personal computer.
The obtained results revealed the following:
There was no significant difference in total caloric intake, protein intake, carbohydrate intake, fat intake and fiber intake (P > 0.05) was found between control and diabetic groups.
There was no statistically significant difference between both groups regarding micronutrients’ intake (P > 0.05).
It was noted that there was no significant difference between control and diabetic subjects regarding the serving’s intake of the different food groups per week (P > 0.05). It was noticed that controls have significantly more starch servings/week than diabetics (P <0.05).
The fasting blood glucose and HbA1c (%) were significantly higher in diabetic patients compared to healthy control group (P < 0.01).
As regard lipid profile, Total cholesterol, TAG and LDL were significantly higher in diabetic patients as compared to healthy control group (P < 0.05). On the other hand, HDL levels were significantly reduced in diabetics as compared with controls (P < 0.05). There was non-significant difference between both groups regarding ALT, AST, and albumin serum levels (P > 0.05).
GSH plasma levels were found to be significantly higher in healthy control subjects as compared to diabetics with fatty liver patients (P<0.01).
Reduced glutathione plasma levels show no significant correlation with daily intake of any of the macronutrients. (P > 0.05). But there is a positive significant correlation with daily intake of proteins (gram/day) (P < 0.05) within the type 2 diabetic patients with fatty liver.
Reduced glutathione plasma levels showed no significant correlation with weekly servings intake of any of the food groups in food frequency questionnaire (P > 0.05). We noticed an inverse significant correlation with Fat servings /week intake (P < 0.05) within the type 2 diabetic patients with fatty liver group.
Reduced glutathione plasma levels showed high significant inverse correlation with fasting blood glucose and HBA1C (P < 0.01). There was non-significant correlation with lipid profile and liver function test parameters (P>0.05)