Copeptin and Nonalcoholic Fatty Liver Disease

Participants: As a pilot study, the investigators will recruit 30 obese adults with NAFLD
based upon ultrasound echogenicity within 6 months of enrollment, and 30 obese adults without
NAFLD based upon ultrasound (US) echogenicity for comparison.

Screening Visit/Study Visit: Patients in the investigator's Obesity clinic will be approached
about the study and consented if interested at the screening. Participants will have a chart
review for their history and physical Exam and medication review for inclusion and exclusion
criteria. Qualified participants will be invited for a screening visit to be scheduled in
conjunction with the labs and procedures performed as Standard of Care (SOC) in the obesity
clinic. At the screening visit, following consent, participants will have vitals (blood
pressure, Body Mass Index (BMI), waist circumference) and a physical examination performed.
Participants' Standard of Care (SOC) labs including fasting lipid panel, HbA1c (unless done
within last 3 months), comprehensive metabolic panel, titers for hepatitis b and c, and
complete blood count will be drawn, along with the following research labs: insulin,
glucagon, free fatty acids, adiponectin and a 24-hour urine cortisol collection. Those who
have not had an abdominal US will have a SOC US performed to delineate non-NAFLD or NAFLD
status. US will not be performed if already done within 6 months of enrollment. All
ultrasound studies will be interpreted by one University of Colorado Denver radiologist to
categorize the patient as NAFLD or non-NAFLD to limit inter-reader variability. Those with
NAFLD present on US will also have a SOC Fibroscan done to assess severity of steatosis
(based upon Controlled Attenuation Parameter or CAP Score) and fibrosis (based upon
elastography). Given limitations of ultrasound to accurately detect significant steatosis
unless >30%, the investigators will in addition perform Fibroscan (all particpants regardless
of US) to assess steatosis, so as to confirm if significant steatosis and compare copeptin
levels on a continuum of level of steatosis as part of research procedure. Fibroscan can
detect steatosis (based upon Controlled Attenuation Parameter or CAP Score) and fibrosis
(based upon elastography). FIbroscan with M probe has been found to have AUROC 0.823 for a
cutoff of value of 248 dB/m for no steatosis vs steatosis (with other cutoffs at 268 dB/m
between S1 and S2-S3 and 280 dB/m between S1-S2 and S3 disease).

Inclusion Criteria:

1. Patients age 30-75

2. BMI 30-40

3. Presence of fatty liver on ultrasound

Exclusion Criteria:

1. Diabetes mellitus (determined by prior HbA1c, fasting glucose, and/or random glucose
in the last three months according to ADA criteria),

2. Medication known to affect insulin sensitivity e.g. metformin, thiazolidinediones,
systemic steroids, atypical antipsychotics),

3. Fibrates,

4. eGFR <45 ml/min/1.73m2 by MDRD equation(11),

5. Pregnancy,

6. Breast feeding,

7. Sodium <135 mEq/L,

8. Diabetes insipidus,

9. Liver disease other than NAFLD (including obstructive liver disease),

10. ALT or AST>60 IU/L,

11. Hepatic steatosis on ultrasound for the non-NAFLD group,

12. Congestive heart failure,

13. Patients who consume >20g of ETOH a day,

14. Patients found to have Cushing's disease based upon 24 hour urine results (Urine Free
cortisol >2x upper limit of normal).

15. Patient's with pacemakers

16. Off of Coenzyme Q for 6 months.