Effect of tauroursodeoxycholic acid on cardiometabolic health indicators in patients with metabolically associated steatotic liver disease

Objective — to evaluate the effectiveness of taurodeoxycholic acid (TUDC) therapy as a tool for improving cardiometabolic health, namely improving metabolic status and reducing the age of onset of age‑associated diseases (aging rates), in patients with metabolically associated steatotic liver disease (MASLD) depending on age, obesity and prediabetes. Materials and methods. The study included 30 patients with MASLD aged 54.0 [51.0; 59.0] years (70% men). The control group consisted of 20 healthy individuals, matched for age and sex. Patients received TUDC at a dose of 250 mg 3 times per day for 3 months in addition to standard therapy for concomitant diseases. Anthropometric indicators, biochemical profile according to the results of traditional indicators, pro‑inflammatory status according to the results of assessing the levels of C‑reactive protein, tumor necrosis factor alpha, aging rates — according to the level of 5‑methylcytosine (5‑mC), telomere length (TL) were assessed. Results. After treatment, a significant decrease in waist circumference (WC) (p=0.001), alkaline phosphatase (ALP) (p<0.001), urea (p<0.001), liver fibrosis index FIB‑4 (p=0.023), 5‑mC (p=0.006) and an increase in TL in the blood (p=0.005) were observed among all examined patients. The frequency of detection of bile stasis according to ultrasound data decreased (20% vs. 90%, p=0.025). After treatment significant differences were found in hip circumference (p=0.043), ALP (p=0.046), urea (p=0.027) in patients of the younger age group (< 50 years). In the group of patients ≥50 years, significant changes after treatment were observed in the levels of WC (p=0.003), ALP (p=0.004), triglycerides (p=0.049), very low density lipoprotein cholesterol (p=0.049), urea (p=0.003), FIB‑4 (p=0.005), 5‑mC (p=0.014) and TL (p=0.011). In patients without obesity, the treatment significantly reduced WC (p=0.018), aspartate aminotransferase (p=0.036), ALP (p=0.011), urea (p=0.012) and increased TL (p=0.028). In patients with OB, the treatment significantly reduced WC (p=0.017), ALP (p=0.021), urea (p=0.013) and 5‑mc (p=0.028). In normoglycemic patients, significant changes in WC (p=0.005), ALP (p=0.003), urea (p=0.002), FIB‑4 (p=0.039), 5‑mC (p=0.037), and TL (p=0.012) levels were observed as a result of treatment. In prediabetic patients, significant changes in WC (p=0.08), ALP (p=0.046), glucose (p=0.018), and 5‑mC (p=0.08) levels were observed as a result of treatment. In all groups, a significant decrease in the frequency of biliary stasis according to ultrasound examination was observed (p<0.05). Conclusions. The use of TUDC in patients with MASLD demonstrated a positive effect on metabolic status and aging rates: a decrease in WC, ALP levels, urea, FIB‑4, 5‑mC, and an increase in TL. The changes detected in groups of patients indicate the possibility of individualizing therapy to improve treatment outcomes. TUDC therapy may be an effective tool for improving metabolic status and slowing aging in patients with MASLD.