251
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Targher G, Lonardo A, Byrne CD. Nonalcoholic fatty liver disease and chronic vascular complications of diabetes mellitus. Nat Rev Endocrinol 2018; 14:99-114. [PMID: 29286050 DOI: 10.1038/nrendo.2017.173] [Citation(s) in RCA: 245] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) and diabetes mellitus are common diseases that often coexist and might act synergistically to increase the risk of hepatic and extra-hepatic clinical outcomes. NAFLD affects up to 70-80% of patients with type 2 diabetes mellitus and up to 30-40% of adults with type 1 diabetes mellitus. The coexistence of NAFLD and diabetes mellitus increases the risk of developing not only the more severe forms of NAFLD but also chronic vascular complications of diabetes mellitus. Indeed, substantial evidence links NAFLD with an increased risk of developing cardiovascular disease and other cardiac and arrhythmic complications in patients with type 1 diabetes mellitus or type 2 diabetes mellitus. NAFLD is also associated with an increased risk of developing microvascular diabetic complications, especially chronic kidney disease. This Review focuses on the strong association between NAFLD and the risk of chronic vascular complications in patients with type 1 diabetes mellitus or type 2 diabetes mellitus, thereby promoting an increased awareness of the extra-hepatic implications of this increasingly prevalent and burdensome liver disease. We also discuss the putative underlying mechanisms by which NAFLD contributes to vascular diseases, as well as the emerging role of changes in the gut microbiota (dysbiosis) in the pathogenesis of NAFLD and associated vascular diseases.
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Affiliation(s)
- Giovanni Targher
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Piazzale Stefani 1, 37126 Verona, Italy
| | - Amedeo Lonardo
- Azienda Ospedaliera Universitaria di Modena, Ospedale Civile Sant'Agostino Estense, Via Giardini 1355, 41126 Baggiovara, Modena, Italy
| | - Christopher D Byrne
- Nutrition and Metabolism, Faculty of Medicine, Institute of Developmental Sciences (IDS), MP887, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
- Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
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252
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Ooi GJ, Earnest A, Kemp WW, Burton PR, Laurie C, Majeed A, Johnson N, McLean C, Roberts SK, Brown WA. Evaluating feasibility and accuracy of non-invasive tests for nonalcoholic fatty liver disease in severe and morbid obesity. Int J Obes (Lond) 2018; 42:1900-1911. [PMID: 29463916 DOI: 10.1038/s41366-018-0007-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 12/13/2017] [Accepted: 12/21/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION In obese individuals, nonalcoholic fatty liver disease (NAFLD) is common but often goes undiagnosed, and therefore untreated. The presence of significant fibrosis is a key determinant of NAFLD progression, and liver steatosis has substantial cardiovascular implications. We aimed to determine the diagnostic accuracy of common noninvasive diagnostic tests for steatosis and fibrosis in the obese. METHODS We recruited 182 severely and morbidly obese individuals undergoing bariatric surgery (age 44 ± 12 years, body mass index 45.1 ± 8.3 kg/m2). Medical history, blood tests and liver biopsy were taken on the day of surgery. Serum steatosis and fibrosis scores were calculated. In a subgroup of patients, transient elastography with controlled attenuation parameter (TE/CAP) (n = 82) and proton magnetic resonance spectroscopy (1H-MRS) (n = 49) were performed. RESULTS 1H-MRS had excellent diagnostic accuracy for steatosis, with strong correlation to steatosis (r = 0.647, p < 0.001), good AUROC (0.852, p = 0.001), sensitivity (81.3%) and specificity (87.5%). However, due to low feasibility in this cohort (65.3% success), this was substantially decreased with intention-to-diagnose analysis (sensitivity 50.0%, specificity 60.9%). CAP had good feasibility (80.5%), and performed better in intention-to-diagnose analysis (AUROC 0.688, sensitivity 84.8%, specificity 47.2%). Serum steatosis scores performed poorly, with comparable accuracy to ALT. For significant fibrosis, TE had the best accuracy (AUROC 0.903, p = 0.007), which remained reasonable after intention-to-diagnose analysis (sensitivity 100%, specificity 59.0%). A combination approach using CAP with ALT for steatosis and TE with Forn index for fibrosis yielded reasonable overall accuracy. CONCLUSIONS 1H-MRS and TE/CAP had greatest accuracy for NAFLD-related steatosis and fibrosis. Failure rates in obesity significantly diminished diagnostic ability. Use of a combination of serum and imaging tests improved overall feasibility of assessment and diagnostic accuracy in obese individuals.
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Affiliation(s)
- Geraldine J Ooi
- Centre for Obesity Research and Education, Central Clinical School, Monash University, Melbourne, Australia. .,Department of General Surgery, The Alfred Hospital, Melbourne, Australia.
| | - Arul Earnest
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Clayton, VIC, Australia
| | - William W Kemp
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Australia
| | - Paul R Burton
- Centre for Obesity Research and Education, Central Clinical School, Monash University, Melbourne, Australia.,Department of General Surgery, The Alfred Hospital, Melbourne, Australia
| | - Cheryl Laurie
- Centre for Obesity Research and Education, Central Clinical School, Monash University, Melbourne, Australia
| | - Ammar Majeed
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Australia
| | - Nathan Johnson
- Faculty of Health Science, The University of Sydney, Sydney, Australia
| | - Catriona McLean
- Department of Pathology, The Alfred Hospital, Melbourne, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Australia
| | - Wendy A Brown
- Centre for Obesity Research and Education, Central Clinical School, Monash University, Melbourne, Australia.,Department of General Surgery, The Alfred Hospital, Melbourne, Australia
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253
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Ahn SH, Seo DH, Kim SH, Nam MS, Hong S. The relationship between fatty liver index and bone mineral density in Koreans: KNHANES 2010-2011. Osteoporos Int 2018; 29:181-190. [PMID: 29051986 DOI: 10.1007/s00198-017-4257-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 10/05/2017] [Indexed: 12/28/2022]
Abstract
UNLABELLED Analyses using a nationally representative cohort have revealed that high fatty liver index (FLI) is associated with low bone mineral density (BMD) regardless of insulin resistance in men, thereby supporting the deteriorated bone metabolism in nonalcoholic fatty liver disease (NAFLD). INTRODUCTION NAFLD is linked to deteriorated bone health. We investigated the association of FLI, a scoring model for NAFLD, with BMD. METHODS This was a population-based, cross-sectional study from the Korea National Health and Nutrition Examination Surveys including 4264 Koreans (1908 men and 2356 women). FLI was calculated using body mass index, waist circumference, serum triglyceride, and gamma-glutamyltranspeptidase level. Insulin resistance was evaluated using the homeostasis model assessment-estimated insulin resistance (HOMA-IR) index. BMD was measured using dual-energy X-ray absorptiometry at the lumbar spine, total hip, femoral neck, and whole body. RESULTS Men had a higher FLI than women, while the HOMA-IR index was similar between men and women. The significant association between FLI and BMD was observed only in men, but not in women. FLI was negatively correlated with total hip, femoral neck, and whole body BMD in men after adjusting for all potential confounders, including HOMA-IR (P < 0.001 to 0.010). Lumbar spine, total hip, femoral neck, and whole body BMD in men showed a decreasing trend as the FLI tertile increased after adjusting for all potential confounders, including HOMA-IR (P for trends < 0.001 to 0.034). In men aged 50 years or older, odds ratios for combined osteopenia and osteoporosis increased across increasing FLI tertiles after adjusting for confounders (P for trends < 0.011 to 0.029). CONCLUSION NAFLD is associated with low bone density regardless of insulin resistance in men. These findings suggest an undiscovered direct link between liver and bone that increases the risk of osteoporosis in men with NAFLD.
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Affiliation(s)
- S H Ahn
- Division of Endocrinology and Metabolism, Inha University Hospital, Inha University School of Medicine, Incheon, 22332, Republic of Korea
| | - D H Seo
- Division of Endocrinology and Metabolism, Inha University Hospital, Inha University School of Medicine, Incheon, 22332, Republic of Korea
| | - S H Kim
- Division of Endocrinology and Metabolism, Inha University Hospital, Inha University School of Medicine, Incheon, 22332, Republic of Korea
| | - M-S Nam
- Division of Endocrinology and Metabolism, Inha University Hospital, Inha University School of Medicine, Incheon, 22332, Republic of Korea
| | - S Hong
- Division of Endocrinology and Metabolism, Inha University Hospital, Inha University School of Medicine, Incheon, 22332, Republic of Korea.
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254
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Sviklāne L, Olmane E, Dzērve Z, Kupčs K, Pīrāgs V, Sokolovska J. Fatty liver index and hepatic steatosis index for prediction of non-alcoholic fatty liver disease in type 1 diabetes. J Gastroenterol Hepatol 2018; 33:270-276. [PMID: 28464337 DOI: 10.1111/jgh.13814] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 04/24/2017] [Accepted: 04/27/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIM Little is known about the diagnostic value of hepatic steatosis index (HSI) and fatty liver index (FLI), as well as their link to metabolic syndrome in type 1 diabetes mellitus. We have screened the effectiveness of FLI and HSI in an observational pilot study of 40 patients with type 1 diabetes. METHODS FLI and HSI were calculated for 201 patients with type 1 diabetes. Forty patients with FLI/HSI values corresponding to different risk of liver steatosis were invited for liver magnetic resonance study. In-phase/opposed-phase technique of magnetic resonance was used. Accuracy of indices was assessed from the area under the receiver operating characteristic curve. RESULTS Twelve (30.0%) patients had liver steatosis. For FLI, sensitivity was 90%; specificity, 74%; positive likelihood ratio, 3.46; negative likelihood ratio, 0.14; positive predictive value, 0.64; and negative predictive value, 0.93. For HSI, sensitivity was 86%; specificity, 66%; positive likelihood ratio, 1.95; negative likelihood ratio, 0.21; positive predictive value, 0.50; and negative predictive value, 0.92. Area under the receiver operating characteristic curve for FLI was 0.86 (95% confidence interval [0.72; 0.99]); for HSI 0.75 [0.58; 0.91]. Liver fat correlated with liver enzymes, waist circumference, triglycerides, and C-reactive protein. FLI correlated with C-reactive protein, liver enzymes, and blood pressure. HSI correlated with waist circumference and C-reactive protein. FLI ≥ 60 and HSI ≥ 36 were significantly associated with metabolic syndrome and nephropathy. CONCLUSIONS The tested indices, especially FLI, can serve as surrogate markers for liver fat content and metabolic syndrome in type 1 diabetes.
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Affiliation(s)
- Laura Sviklāne
- Faculty of Medicine, University of Latvia, Riga, Latvia.,Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Evija Olmane
- Pauls Stradins Clinical University Hospital, Riga, Latvia.,Magnetic Resonance Center DiaMed, Riga, Latvia
| | - Zane Dzērve
- Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Kārlis Kupčs
- Pauls Stradins Clinical University Hospital, Riga, Latvia.,Magnetic Resonance Center DiaMed, Riga, Latvia
| | - Valdis Pīrāgs
- Faculty of Medicine, University of Latvia, Riga, Latvia.,Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Jeļizaveta Sokolovska
- Faculty of Medicine, University of Latvia, Riga, Latvia.,Pauls Stradins Clinical University Hospital, Riga, Latvia
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255
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Keating SE, Parker HM, Hickman IJ, Gomersall SR, Wallen MP, Coombes JS, Macdonald GA, George J, Johnson NA. NAFLD in clinical practice: Can simple blood and anthropometric markers be used to detect change in liver fat measured by 1 H-MRS? Liver Int 2017; 37:1907-1915. [PMID: 28581252 DOI: 10.1111/liv.13488] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 05/30/2017] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Research in NAFLD management is commonly based on quantitative assessment of liver fat by proton-magnetic resonance spectroscopy (1 H-MRS), and translation of this into clinical practice is currently limited by availability and expense. Novel steatosis biomarkers have been proposed for the prediction of liver fatness; however, whether these are suitable for detecting changes in liver fat is unknown. We aimed to determine the accuracy of these indices, and waist circumference (WC), in quantifying longitudinal change in 1 H-MRS-quantified liver fat. METHODS We performed a secondary analysis using data from 97 overweight/obese adults (age: 39.7±11.5 years, body mass index: 30.7±4.4 kg/m2 , liver fat: 6.0±4.8%, 65% male) who completed either an 8-week exercise or 12-week nutraceutical intervention, with varying degrees of change in liver fat. Baseline and post-intervention measures were liver fat (1 H-MRS), NAFLD Liver Fat Score, Liver Fat Equation (LFE), Fatty Liver Index (FLI), Hepatic Steatosis Index (HSI), the Visceral Adiposity Index (VAI) and WC. RESULTS Only the change in HSI, FLI and WC was associated with change in liver fat; however, correlations were weak to moderate. There was no agreement between the LFE and 1 H-MRS for detecting liver fat change. Only change in WC significantly affected change in liver fat (P<.001), and WC AUROC for the presence of steatosis was 0.65 and 0.78 for men and women respectively. CONCLUSIONS Novel indices are limited in their ability to detect longitudinal change in liver fat. Waist circumference may offer modest utility as a surrogate to infer liver fat change with lifestyle interventions.
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Affiliation(s)
- Shelley E Keating
- Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia.,School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Helen M Parker
- Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
| | - Ingrid J Hickman
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Mater Research Institute, The University of Queensland, South Brisbane, QLD, Australia.,Translational Research Institute, Brisbane, QLD, Australia
| | - Sjaan R Gomersall
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Matthew P Wallen
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia.,Faculty of Health, Federation University Australia, Mount Helen, VIC, Australia
| | - Jeff S Coombes
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Graeme A Macdonald
- Translational Research Institute, Brisbane, QLD, Australia.,Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Department of Anaesthesia, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research and Westmead Hospital, University of Sydney, Westmead, NSW, Australia
| | - Nathan A Johnson
- Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia.,Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, NSW, Australia
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256
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Saokaew S, Kanchanasuwan S, Apisarnthanarak P, Charoensak A, Charatcharoenwitthaya P, Phisalprapa P, Chaiyakunapruk N. Clinical risk scoring for predicting non-alcoholic fatty liver disease in metabolic syndrome patients (NAFLD-MS score). Liver Int 2017; 37:1535-1543. [PMID: 28294515 DOI: 10.1111/liv.13413] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 03/06/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Non-alcoholic fatty liver disease (NAFLD) can progress from simple steatosis to hepatocellular carcinoma. None of tools have been developed specifically for high-risk patients. This study aimed to develop a simple risk scoring to predict NAFLD in patients with metabolic syndrome (MetS). METHODS A total of 509 patients with MetS were recruited. All were diagnosed by clinicians with ultrasonography-confirmed whether they were patients with NAFLD. Patients were randomly divided into derivation (n=400) and validation (n=109) cohort. To develop the risk score, clinical risk indicators measured at the time of recruitment were built by logistic regression. Regression coefficients were transformed into item scores and added up to a total score. A risk scoring scheme was developed from clinical predictors: BMI ≥25, AST/ALT ≥1, ALT ≥40, type 2 diabetes mellitus and central obesity. The scoring scheme was applied in validation cohort to test the performance. RESULTS The scheme explained, by area under the receiver operating characteristic curve (AuROC), 76.8% of being NAFLD with good calibration (Hosmer-Lemeshow χ2 =4.35; P=.629). The positive likelihood ratio of NAFLD in patients with low risk (scores below 3) and high risk (scores 5 and over) were 2.32 (95% CI: 1.90-2.82) and 7.77 (95% CI: 2.47-24.47) respectively. When applied in validation cohort, the score showed good performance with AuROC 76.7%, and illustrated 84%, and 100% certainty in low- and high-risk groups respectively. CONCLUSIONS A simple and non-invasive scoring scheme of five predictors provides good prediction indices for NAFLD in MetS patients. This scheme may help clinicians in order to take further appropriate action.
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Affiliation(s)
- Surasak Saokaew
- Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.,School of Pharmacy, Monash University Malaysia, Selangor, Malaysia.,Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Shada Kanchanasuwan
- Clinical and Administrative Pharmacy, The University of Georgia College of Pharmacy, Athens, GA, USA
| | - Piyaporn Apisarnthanarak
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Aphinya Charoensak
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Phunchai Charatcharoenwitthaya
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pochamana Phisalprapa
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia.,Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.,School of Pharmacy, University of Wisconsin, Madison, WI, USA.,School of Population Health, University of Queensland, Brisbane, Qld, Australia
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257
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Lonardo A, Nascimbeni F, Maurantonio M, Marrazzo A, Rinaldi L, Adinolfi LE. Nonalcoholic fatty liver disease: Evolving paradigms. World J Gastroenterol 2017; 23:6571-6592. [PMID: 29085206 PMCID: PMC5643282 DOI: 10.3748/wjg.v23.i36.6571] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 08/21/2017] [Accepted: 09/05/2017] [Indexed: 02/06/2023] Open
Abstract
In the last years new evidence has accumulated on nonalcoholic fatty liver disease (NAFLD) challenging the paradigms that had been holding the scene over the previous 30 years. NAFLD has such an epidemic prevalence as to make it impossible to screen general population looking for NAFLD cases. Conversely, focusing on those cohorts of individuals exposed to the highest risk of NAFLD could be a more rational approach. NAFLD, which can be diagnosed with either non-invasive strategies or through liver biopsy, is a pathogenically complex and clinically heterogeneous disease. The existence of metabolic as opposed to genetic-associated disease, notably including ”lean NAFLD” has recently been recognized. Moreover, NAFLD is a systemic condition, featuring metabolic, cardiovascular and (hepatic/extra-hepatic) cancer risk. Among the clinico-laboratory features of NAFLD we discuss hyperuricemia, insulin resistance, atherosclerosis, gallstones, psoriasis and selected endocrine derangements. NAFLD is a precursor of type 2 diabetes (T2D) and metabolic syndrome and progressive liver disease develops in T2D patients in whom the course of disease is worsened by NAFLD. Finally, lifestyle changes and drug treatment options to be implemented in the individual patient are also critically discussed. In conclusion, this review emphasizes the new concepts on clinical and pathogenic heterogeneity of NAFLD, a systemic disorder with a multifactorial pathogenesis and protean clinical manifestations. It is highly prevalent in certain cohorts of individuals who are thus potentially amenable to selective screening strategies, intensive follow-up schedules for early identification of liver-related and extrahepatic complications and in whom earlier and more aggressive treatment schedules should be carried out whenever possible.
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Affiliation(s)
- Amedeo Lonardo
- Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, 41126 Modena, Italy
| | - Fabio Nascimbeni
- Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, 41126 Modena, Italy
- University of Modena and Reggio Emilia, 41126 Modena, Italy
| | - Mauro Maurantonio
- Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, 41126 Modena, Italy
| | - Alessandra Marrazzo
- Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, 41126 Modena, Italy
- University of Modena and Reggio Emilia, 41126 Modena, Italy
| | - Luca Rinaldi
- Department of Medical, Surgical, Neurological, Geriatric, and Metabolic Sciences, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy
| | - Luigi Elio Adinolfi
- Department of Medical, Surgical, Neurological, Geriatric, and Metabolic Sciences, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy
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258
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Type 2 Diabetes Mellitus and Simple Glucose Metabolism Parameters may Reliably Predict Nonalcoholic Fatty Liver Disease Features. Obes Surg 2017; 28:187-194. [DOI: 10.1007/s11695-017-2829-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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259
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Wang SY, Lin J. Letter: the efficacy of oltipraz in patients with non-alcoholic fatty liver disease has not been confirmed. Aliment Pharmacol Ther 2017. [PMID: 28621072 DOI: 10.1111/apt.14122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- S Y Wang
- Department of Gastroenterology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - J Lin
- Department of Gastroenterology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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260
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Shen YN, Yu MX, Gao Q, Li YY, Huang JJ, Sun CM, Qiao N, Zhang HX, Wang H, Lu Q, Wang T. External validation of non-invasive prediction models for identifying ultrasonography-diagnosed fatty liver disease in a Chinese population. Medicine (Baltimore) 2017; 96:e7610. [PMID: 28746214 PMCID: PMC5627840 DOI: 10.1097/md.0000000000007610] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Several prediction models for fatty liver disease (FLD) are available with limited externally validation and less comprehensive evaluation. The aim was to perform external validation and direct comparison of 4 prediction models (the Fatty Liver Index, the Hepatic Steatosis Index, the ZJU index, and the Framingham Steatosis Index) for FLD both in the overall population and the obese subpopulation.This cross-sectional study included 4247 subjects aged 20 to 65 years recruited from the north of Shanxi Province in China. Anthropometric and biochemical features were collected using standard protocols. FLD was diagnosed by liver ultrasonography. We assessed all models in terms of discrimination, calibration, and decision curve analysis.The original models performed well in terms of discrimination for the overall population, with the area under the receiver operating characteristic curves (AUCs) around 0.85, while AUCs for obese individuals were around 0.68. Nevertheless, the predicted risks did not match well with the observed risks both in the overall population and the obese subpopulation. The FLI 2006 was 1 of the 2 best models in terms of discrimination (AUCs were 0.87 and 0.72 for the overall population and the obese subgroup, respectively) and had the best performance in terms of calibration, and attained the highest net benefit.The FLI 2006 is overall the best tool to identify high risk individuals and has great clinical utility. Nonetheless, it does not perform well enough to quantify the actual risk of FLD, which need to be (re)calibrated for clinical use.
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Affiliation(s)
- Ya-Nan Shen
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan
| | - Ming-Xing Yu
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan
| | - Qian Gao
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan
| | - Yan-Yan Li
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan
| | - Jian-Jun Huang
- Department of Neurosurgery, General Hospital of Datong Coal Mining Group, Datong, China
| | - Chen-Ming Sun
- Department of Neurosurgery, General Hospital of Datong Coal Mining Group, Datong, China
| | - Nan Qiao
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan
| | - Hai-Xia Zhang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan
| | - Hui Wang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan
| | - Qing Lu
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan
| | - Tong Wang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan
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261
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Ballestri S, Nascimbeni F, Baldelli E, Marrazzo A, Romagnoli D, Targher G, Lonardo A. Ultrasonographic fatty liver indicator detects mild steatosis and correlates with metabolic/histological parameters in various liver diseases. Metabolism 2017. [PMID: 28641784 DOI: 10.1016/j.metabol.2017.04.003] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Fatty liver is a common feature of different types of liver diseases. The sensitivity and specificity of ultrasonography for diagnosing fatty liver are variable. A semi-quantitative ultrasound score, i.e., the ultrasonographic fatty liver indicator (US-FLI), is closely associated with metabolic/histological variables in patients with nonalcoholic fatty liver disease (NAFLD). The main aims of this study were to assess the diagnostic performance of US-FLI in detecting varying degrees of histological steatosis, and to examine the association of US-FLI with metabolic/histological parameters in 352 biopsied patients with various chronic liver diseases (173 with hepatitis C [HCV], 23 with hepatitis B [HBV], 123 with NAFLD and 33 with other etiologies). RESULTS US-FLI accurately detected mild steatosis (minimum amount 10% on histology) with a cut-off value ≥2 (sensitivity 90.1%, specificity 90%), moderate steatosis (≥30%) with a cut-off value ≥3 (sensitivity 86.4%, specificity 92.5%) and severe steatosis (>66%) with a cut-off value ≥5 (sensitivity 88.5%, specificity 87%). US-FLI was correlated with steatosis percentage in each liver disease group as well as with lobular inflammation, ballooning, portal fibrosis, grading and staging in patients with NAFLD or HCV. US-FLI was also correlated with waist circumference, body mass index and insulin resistance both in the whole sample and in each liver disease group. CONCLUSIONS US-FLI accurately identifies histological severity and is correlated with metabolic parameters in patients with various steatogenic liver diseases. US-FLI is an easy and versatile tool for the screening of steatosis and the metabolic health of these patients.
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Affiliation(s)
| | - Fabio Nascimbeni
- Azienda USL, Nuovo Ospedale Sant'Agostino Estense di Baggiovara, Modena, Italy; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Enrica Baldelli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandra Marrazzo
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Dante Romagnoli
- Azienda USL, Nuovo Ospedale Sant'Agostino Estense di Baggiovara, Modena, Italy
| | - Giovanni Targher
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Italy
| | - Amedeo Lonardo
- Azienda USL, Nuovo Ospedale Sant'Agostino Estense di Baggiovara, Modena, Italy
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262
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Lonardo A, Nascimbeni F, Ponz de Leon M. Nonalcoholic fatty liver disease and COPD: is it time to cross the diaphragm? Eur Respir J 2017; 49:49/6/1700546. [PMID: 28596428 DOI: 10.1183/13993003.00546-2017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 04/16/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Amedeo Lonardo
- Operating Unit of Internal Medicine, OCSAE, Modena, Italy
| | - Fabio Nascimbeni
- Operating Unit of Internal Medicine, OCSAE, Modena, Italy
- University of Modena and Reggio Emilia, Modena, Italy
| | - Maurizio Ponz de Leon
- Operating Unit of Internal Medicine, OCSAE, Modena, Italy
- University of Modena and Reggio Emilia, Modena, Italy
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263
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Kantartzis K, Rettig I, Staiger H, Machann J, Schick F, Scheja L, Gastaldelli A, Bugianesi E, Peter A, Schulze M, Fritsche A, Häring HU, Stefan N. An extended fatty liver index to predict non-alcoholic fatty liver disease. DIABETES & METABOLISM 2017; 43:229-239. [DOI: 10.1016/j.diabet.2016.11.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/04/2016] [Accepted: 11/23/2016] [Indexed: 02/06/2023]
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Zhang S, Du T, Li M, Jia J, Lu H, Lin X, Yu X. Triglyceride glucose-body mass index is effective in identifying nonalcoholic fatty liver disease in nonobese subjects. Medicine (Baltimore) 2017; 96:e7041. [PMID: 28562560 PMCID: PMC5459725 DOI: 10.1097/md.0000000000007041] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is an increasingly common condition that is highly correlated with obesity; however, it is not uncommon among nonobese individuals. Triglyceride (TG) and glucose index combined with body mass index (TyG-BMI) has been proposed as a favorable marker of insulin resistance. We sought to investigate the effectiveness of TyG-BMI in identifying NAFLD in nonobese subjects.We conducted a cross-sectional study in a nonobese (BMI <25.0 kg/m) Chinese population (N = 6809) of adults who underwent health examinations, including abdominal ultrasonography.The prevalence of ultrasonography-detected NAFLD was 23.9% in nonobese subjects. After adjusting for potential confounders, every 1-standard deviation increase in TyG-BMI had an odds ratio (OR) of 3.4 [95% confidence interval (95% CI), 3.0-3.9] for NAFLD. Compared with the lowest quartile of TyG-BMI, multivariable-adjusted ORs were 2.4 (1.6-3.6), 6.4 (4.2-9.7), and 15.3 (9.8-23.9) for those in the second, third, and fourth quartile, respectively. According to the receiver operating characteristic curve analysis, TyG-BMI was effective in diagnosing patients with NAFLD with an area under the curve of 0.835 (95% CI, 0.824-0.845). In comparison, TyG-BMI was superior to its components, including TyG, BMI, TG, and fasting plasma glucose, for identifying nonobese subjects at risk for NAFLD.In this study, the prevalence of NAFLD was over one-fifth in the nonobese population. TyG-BMI was an effective marker to detect NAFLD in nonobese subjects.
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Affiliation(s)
- Shujun Zhang
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Tingting Du
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Mengni Li
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Jing Jia
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | | | - Xuan Lin
- Department of Endocrinology, Wuhan Iron and Steel Company (WISCO) General Hospital, Wuhan, Hubei Province, China
| | - Xuefeng Yu
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
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265
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AISF position paper on nonalcoholic fatty liver disease (NAFLD): Updates and future directions. Dig Liver Dis 2017; 49:471-483. [PMID: 28215516 DOI: 10.1016/j.dld.2017.01.147] [Citation(s) in RCA: 225] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 01/08/2017] [Accepted: 01/10/2017] [Indexed: 02/07/2023]
Abstract
This review summarizes our current understanding of nonalcoholic fatty liver disease (NAFLD), a multi-factorial systemic disease resulting from a complex interaction between a specific genetic background and multiple environmental/metabolic "hits". The role of gut microbiota, lipotoxicity, inflammation and their molecular pathways is reviewed in-depth. We also discuss the epidemiology and natural history of NAFLD by pinpointing the remarkably high prevalence of NAFLD worldwide and its inherent systemic complications: hepatic (steatohepatitis, advanced fibrosis and cirrhosis), cardio-metabolic (cardiovascular disease, cardiomyopathy, arrhythmias and type 2 diabetes) and neoplastic (primary liver cancers and extra-hepatic cancers). Moreover, we critically report on the diagnostic role of non-invasive biomarkers, imaging techniques and liver biopsy, which remains the reference standard for diagnosing the disease, but cannot be proposed to all patients with suspected NAFLD. Finally, the management of NAFLD is also reviewed, by highlighting the lifestyle changes and the pharmacological options, with a focus on the innovative drugs. We conclude that the results of ongoing studies are eagerly expected to lead to introduce into the clinical arena new diagnostic and prognostic biomarkers, prevention and surveillance strategies as well as to new drugs for a tailored approach to the management of NAFLD in the individual patient.
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266
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Cernea S, Cahn A, Raz I. Pharmacological management of nonalcoholic fatty liver disease in type 2 diabetes. Expert Rev Clin Pharmacol 2017; 10:535-547. [PMID: 28276774 DOI: 10.1080/17512433.2017.1300059] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The prevalence of nonalcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes (T2D) is high and it is associated with poor prognosis. Hepatic steatosis results as a consequence of excessive hepatic lipid accumulation which correlates with insulin resistance and lipotoxicity, with subsequent oxidative stress, inflammation, apoptosis and fibrosis. Areas covered: This article presents the main pathophysiologic mechanisms and currently available drugs evaluated for their therapeutic effects on NAFLD/nonalcoholic steatohepatitis (NASH) and drugs under development that target relevant pathogenetic pathways. However, to date there is no particular drug approved for treatment of NAFLD in patients with T2D. Expert commentary: Early recognition and intervention are essential to ameliorate disease progression. Specific recommendations are still needed for NAFLD/NASH screening and diagnosis and therapeutic algorithm in patients with T2D. Lifestyle optimization with significant weight loss is a key intervention in patients with NAFLD and T2D. Pioglitazone, liraglutide, vitamin E, OCA and pentoxifylline have proven some histological improvements in NASH and omega 3-PUFAs were shown to decrease liver fat, but no specific recommendation can be made for treatment of NASH. Perhaps a combination of agents that target different pathogenic pathways are needed to better control disease progression, but more robust evidence for these agents is still needed.
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Affiliation(s)
- Simona Cernea
- a Department M3/Internal Medicine IV , University of Medicine and Pharmacy , Târgu Mureş , Romania.,b Diabetes, Nutrition and Metabolic Diseases Outpatient Unit , Emergency County Clinical Hospital , Târgu Mureş , Romania
| | - Avivit Cahn
- c Diabetes Unit, Department of Internal Medicine , Hadassah Hebrew University Hospital , Jerusalem , Israel.,d Endocrinology and Metabolism Unit, Department of Internal Medicine , Hadassah University Hospital , Jerusalem , Israel
| | - Itamar Raz
- c Diabetes Unit, Department of Internal Medicine , Hadassah Hebrew University Hospital , Jerusalem , Israel
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267
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Zhang S, Du T, Li M, Lu H, Lin X, Yu X. Combined effect of obesity and uric acid on nonalcoholic fatty liver disease and hypertriglyceridemia. Medicine (Baltimore) 2017; 96:e6381. [PMID: 28328829 PMCID: PMC5371466 DOI: 10.1097/md.0000000000006381] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Hyperuricemia is associated with metabolic syndrome (MetS), but the association is often confounded by the shared background of obesity. We sought to explore the modifying effects of obesity on the association between uric acid (UA), MetS components, and nonalcoholic fatty liver disease (NAFLD).We conducted a cross-sectional study in a Chinese population of 10,069 participants aged ≥20 years. Multiplicative interaction between obesity (BMI ≥25 kg/m) and elevated UA was assessed using an interaction term in a logistic regression analysis. The presence of additive interaction was assessed based on the relative excess risk due to the interaction (RERI) and the attributable proportion due to the interaction (AP).There was no evidence of a multiplicative interaction between obesity and elevated UA on MetS components and NAFLD. However, there was a strong additive interaction between obesity and elevated UA with regard to NAFLD (RERI of 6.47 [95% CI 3.42-9.53] for men and 5.87 [1.55-10.19] for women) and hypertriglyceridemia (RERI of 1.38 [0.57-2.20] for men and 1.38 [0.08-2.67] for women). In addition, 42% and 36% of the increased odds of NAFLD for men and women, respectively, can be explained by an interaction between obesity and elevated UA (AP of 0.42 [95% CI (0.30-0.54)] for men and 0.36 [0.17-0.55] for women). Similarly, the interaction accounted for 27% and 26% of the increased risk of hypertriglyceridemia for men and women (AP of 0.27 [0.14-0.41] for men and 0.26 [0.06-0.47] for women).In this population, obesity and elevated UA synergistically interacted to increase the risk of NAFLD and hypertriglyceridemia.
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Affiliation(s)
- Shujun Zhang
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Tingting Du
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Mengni Li
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | | | - Xuan Lin
- Department of Endocrinology, Wuhan Iron and Steel Company (WISCO) General Hospital, Wuhan, Hubei province, China
| | - Xuefeng Yu
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
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268
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Bril F, Cusi K. Management of Nonalcoholic Fatty Liver Disease in Patients With Type 2 Diabetes: A Call to Action. Diabetes Care 2017; 40:419-430. [PMID: 28223446 DOI: 10.2337/dc16-1787] [Citation(s) in RCA: 220] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 12/08/2016] [Indexed: 02/03/2023]
Abstract
Traditionally a disease of hepatologists, nonalcoholic fatty liver disease (NAFLD) has recently become a major concern for a broad spectrum of health care providers. Endocrinologists and those caring for patients with type 2 diabetes mellitus (T2DM) are at center stage, as T2DM appears to worsen the course of NAFLD and the liver disease makes diabetes management more challenging. However, the nature of this relationship remains incompletely understood. Although the increasing prevalence of NAFLD is frequently attributed to the epidemic of obesity and is often oversimplified as the "hepatic manifestation of the metabolic syndrome," it is a much more complex disease process that may also be observed in nonobese individuals and in patients without clinical manifestations of the metabolic syndrome. It carries both metabolic and liver-specific complications that make its approach unique among medical conditions. Diabetes appears to promote the development of nonalcoholic steatohepatitis (NASH), the more severe form of the disease, and increases the risk of cirrhosis and hepatocellular carcinoma. Patients and physicians face many uncertainties, including fragmented information on the natural history of the disease, challenges in the diagnosis of NASH, and few pharmacological agents with proven efficacy. However, recent advances in diagnosis and treatment, combined with the risk of serious consequences from inaction, call for health care providers to be more proactive in the management of patients with T2DM and NASH.
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Affiliation(s)
- Fernando Bril
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, Florida
| | - Kenneth Cusi
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, Florida .,Malcom Randall Veterans Affairs Medical Center, Gainesville, Florida
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van den Berg EH, Amini M, Schreuder TCMA, Dullaart RPF, Faber KN, Alizadeh BZ, Blokzijl H. Prevalence and determinants of non-alcoholic fatty liver disease in lifelines: A large Dutch population cohort. PLoS One 2017; 12:e0171502. [PMID: 28152105 PMCID: PMC5289609 DOI: 10.1371/journal.pone.0171502] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 01/20/2017] [Indexed: 12/22/2022] Open
Abstract
Background & aims Non-alcoholic fatty liver disease is an increasing health issue that develops rather unnoticed with obesity, type 2 diabetes mellitus and metabolic syndrome. We investigated prevalence, determinants and associated metabolic abnormalities of non-alcoholic fatty liver disease in the largest population-based cohort to date. Methods Biochemical characteristics, type 2 diabetes mellitus and metabolic syndrome were determined in the Lifelines Cohort Study (N = 167,729), a population-based cohort in the North of the Netherlands. Non-alcoholic fatty liver disease was defined as Fatty Liver Index (FLI)≥60. Exclusion criteria were age <18 years, immigrants, missing data to assess FLI and metabolic syndrome, excessive alcohol use, previous-diagnosed hepatitis or cirrhosis and non-fasting blood sampling. Results Out of 37,496 included participants (median age 44 years, 62.1% female), 8,259 (22.0%) had a FLI≥60. Individuals with a FLI≥60 were more often male, older, obese, had higher levels of hemoglobinA1c, fasting glucose, liver enzymes, total cholesterol, low-density lipoprotein cholesterol, triglycerides, c-reactive protein and leucocytes and lower high-density lipoprotein cholesterol (all P<0.0001). Participants with a FLI≥60 showed higher prevalence of type 2 diabetes mellitus (9.3% vs. 1.4%), metabolic syndrome (54.2% vs. 6.2%), impaired renal function (20.1% vs. 8.7%) and cardiovascular disease (4.6% vs. 1.6%) (all P<0.0001). Multivariable logistic analysis showed that smoking, hemoglobin, leucocytes, c-reactive protein, platelets, alanine aminotransferase, alkaline phosphatase, albumin, impaired renal function (OR 1.27, 95%CI 1.15–1.41), metabolic syndrome (OR 11.89, 95%CI 11.03–12.82) and its individual components hyperglycemia (OR 2.53, 95%CI 2.34–2.72), hypertension (OR 1.89, 95%CI 1.77–2.01) and reduced high-density lipoprotein cholesterol (OR 3.44, 95%CI 3.22–3.68) were independently associated with suspected non-alcoholic fatty liver disease (all P<0.0001). Conclusion Twenty-two percent (22.0%) of the population in the North of the Netherlands is suspected to suffer from non-alcoholic fatty liver disease, coinciding with a significant increased risk of type 2 diabetes mellitus, metabolic syndrome, cardiovascular disease and impaired renal function.
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Affiliation(s)
- Eline H. van den Berg
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- * E-mail:
| | - Marzyeh Amini
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tim C. M. A. Schreuder
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robin P. F. Dullaart
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Klaas Nico Faber
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Behrooz Z. Alizadeh
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hans Blokzijl
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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270
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van den Berg EH, van Tienhoven-Wind LJN, Amini M, Schreuder TCMA, Faber KN, Blokzijl H, Dullaart RPF. Higher free triiodothyronine is associated with non-alcoholic fatty liver disease in euthyroid subjects: the Lifelines Cohort Study. Metabolism 2017; 67:62-71. [PMID: 28081779 DOI: 10.1016/j.metabol.2016.11.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 10/13/2016] [Accepted: 11/02/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Overt hypothyroidism confers an increased risk of non-alcoholic fatty liver disease (NAFLD). The liver plays a crucial role in the metabolism of cholesterol and triglycerides; thyroid hormones interact on hepatic lipid homeostasis. Thyroid function within the euthyroid range affects a number of health issues, including atherosclerosis development and biochemical markers of increased cardiovascular risk. However, the association of thyroid hormones with NAFLD in euthyroid subjects has not been unequivocally established. We therefore determined associations of thyroid hormone parameters with NAFLD among euthyroid subjects. METHODS The study was conducted in the Lifelines Cohort Study, a population-based cohort study of participants living in the North of the Netherlands. Only euthyroid subjects (thyroid-stimulating hormone (TSH) 0.5-4.0mU/L, free thyroxine (FT4) 11-19.5pmol/L and free triiodothyronine (FT3) 4.4-6.7pmol/L) older than 18years were included. Exclusion criteria were participants with excessive alcohol use, known hepatitis or cirrhosis, liver functions ≥ three times the upper limit, current cancer, non-white ancestry, previous or current use of thyroid medication and current use of lipid or glucose lowering medication. A priori defined liver biochemistry, thyroid function parameters and metabolic syndrome (MetS) were studied. NAFLD was defined by using the validated Fatty Liver Index (FLI); FLI≥60 was categorized as NAFLD. A P<0.01 was considered significant. RESULTS FLI≥60 was found in 4274 (21.1%) of 20,289 individuals (62.1% male, median age 46years) with increased prevalence of MetS (P<0.0001). In age- and sex-adjusted analysis FLI≥60 was independently associated with a higher FT3 (OR 1.34, 95% CI 1.29-1.39, per SD increment, P<0.0001) and a lower FT4 (OR 0.73, 95% CI 0.70-0.75, P<0.0001) but not by TSH. The strongest association was found for the FT3/FT4 ratio (OR 1.44, 95% CI 1.39-1.49, P<0.0001). These associations remained similar after additional adjustment for the presence of MetS. In subjects with enlarged waist circumference, TSH and FT4 were lower while FT3 was higher, resulting in an increased FT3/FT4 ratio (P<0.0001). CONCLUSIONS Euthyroid subjects with suspected NAFLD are characterized by higher FT3, lower FT4 and higher FT3/FT4 ratio, probably consequent to central obesity.
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Affiliation(s)
- Eline H van den Berg
- Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, The Netherlands.
| | | | - Marzyeh Amini
- Department of Epidemiology, University of Groningen, and University Medical Center Groningen, The Netherlands
| | - Tim C M A Schreuder
- Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, The Netherlands
| | - Klaas Nico Faber
- Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, The Netherlands
| | - Hans Blokzijl
- Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, The Netherlands
| | - Robin P F Dullaart
- Department of Endocrinology, University of Groningen and University Medical Center Groningen, The Netherlands
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271
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Zhang S, Du T, Zhang J, Lu H, Lin X, Xie J, Yang Y, Yu X. The triglyceride and glucose index (TyG) is an effective biomarker to identify nonalcoholic fatty liver disease. Lipids Health Dis 2017; 16:15. [PMID: 28103934 PMCID: PMC5248473 DOI: 10.1186/s12944-017-0409-6] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 01/05/2017] [Indexed: 12/19/2022] Open
Abstract
Background The triglyceride and glucose index (TyG) has been proposed as a marker of insulin resistance. We aimed to investigate the ability of TyG, through comparing with the predictive value of alanine aminotransferase (ALT), to identify individuals at risk for nonalcoholic fatty liver disease (NAFLD). Methods A cross-sectional study was conducted in a Chinese health examination cohort of 10 761 people aged above 20 years. NAFLD was diagnosed by ultrasonography. Results Compared with the participants in the lowest quartile of TyG, the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for NAFLD were 1.8 (1.5–2.1), 3.0 (2.5–3.5), and 6.3 (5.3–7.5) for those in the second, the third, and the fourth quartile of TyG, whereas the corresponding ORs (95% CI) for NAFLD were 1.5 (1.3–1.7), 1.9 (1.6–2.2), and 3.1 (2.6–3.7) for the upper three quartiles of ALT. These results suggested that TyG was superior to ALT in association with NAFLD risk. According to the ROC analysis, the optimal cut-off point of TyG for NAFLD was 8.5 and the area under the ROC curve (AUC) was 0.782 (95% CI 0.773–0.790), with 72.2 and 70.5% sensitivity and specificity, respectively. The AUC of TyG was larger than that of ALT (0.715 (95% CI 0.705–0.725), P for difference <0.0001), whereas the largest AUC was obtained when adding TyG to ALT (0.804 (95% CI 0.795–0.812), P for difference <0.0001). Conclusions TyG is effective to identify individuals at risk for NAFLD. A TyG threshold of 8.5 was highly sensitive for detecting NAFLD subjects and may be suitable as a diagnostic criterion for NAFLD in Chinese adults. Electronic supplementary material The online version of this article (doi:10.1186/s12944-017-0409-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shujun Zhang
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China
| | - Tingting Du
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China
| | - Jianhua Zhang
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China
| | - Huiming Lu
- Department of Health Examination, Wuhan Iron and Steel Company (WISCO) General Hospital, 29 Metallurgical Avenue, Wuhan, 430080, China
| | - Xuan Lin
- Department of Endocrinology, Wuhan Iron and Steel Company (WISCO) General Hospital, 29 Metallurgical Avenue, Wuhan, 430080, China
| | - Junhui Xie
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China
| | - Yan Yang
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China
| | - Xuefeng Yu
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China.
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272
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Fatty Liver Index and Lipid Accumulation Product Can Predict Metabolic Syndrome in Subjects without Fatty Liver Disease. Gastroenterol Res Pract 2017; 2017:9279836. [PMID: 28194177 PMCID: PMC5282434 DOI: 10.1155/2017/9279836] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 11/09/2016] [Accepted: 11/20/2016] [Indexed: 02/06/2023] Open
Abstract
Background. Fatty liver index (FLI) and lipid accumulation product (LAP) are indexes originally designed to assess the risk of fatty liver and cardiovascular disease, respectively. Both indexes have been proven to be reliable markers of subsequent metabolic syndrome; however, their ability to predict metabolic syndrome in subjects without fatty liver disease has not been clarified. Methods. We enrolled consecutive subjects who received health check-up services at Taipei Veterans General Hospital from 2002 to 2009. Fatty liver disease was diagnosed by abdominal ultrasonography. The ability of the FLI and LAP to predict metabolic syndrome was assessed by analyzing the area under the receiver operating characteristic (AUROC) curve. Results. Male sex was strongly associated with metabolic syndrome, and the LAP and FLI were better than other variables to predict metabolic syndrome among the 29,797 subjects. Both indexes were also better than other variables to detect metabolic syndrome in subjects without fatty liver disease (AUROC: 0.871 and 0.879, resp.), and the predictive power was greater among women. Conclusion. Metabolic syndrome increases the cardiovascular disease risk. The FLI and LAP could be used to recognize the syndrome in both subjects with and without fatty liver disease who require lifestyle modifications and counseling.
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273
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Seto WK, Fung J, Cheung KS, Mak LY, Hui RWH, Liu KSH, Lai CL, Yuen MF. Body-mass index is associated with fibrosis regression during long-term nucleoside analogue therapy in chronic hepatitis B. Aliment Pharmacol Ther 2016; 44:1071-1079. [PMID: 27659292 DOI: 10.1111/apt.13804] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 08/18/2016] [Accepted: 08/29/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Factors influencing changes in liver stiffness measurements during long-term nucleoside analogue therapy for chronic hepatitis B (CHB) have not been thoroughly investigated. AIM To identify determinants of on-treatment fibrosis regression in CHB. METHODS We performed follow-up liver stiffness and controlled attenuation parameter measurements on nucleoside analogue-treated CHB patients with severe liver fibrosis, according to EASL-ALEH criteria, diagnosed by transient elastography in 2006-2008. Anthropometric measurements and different metabolic parameters were recorded. RESULTS Among 257 patients with severe liver fibrosis by initial transient elastography, 123 (47.9%) were recruited for reassessment. Median treatment duration was 87.5 (interquartile range 75.3-102.2) months; 97.5% had undetectable HBV DNA. There was a significant reduction in median liver stiffness from 14.6 to 8.3 kPa (P < 0.001). A total of 29.3% had fibrosis regression, with lower rates of 17.9%, 14.9% and 11.5% noted in patients with body-mass index (BMI) ≥25 kg/m2 , metabolic syndrome and diabetes, respectively. Absence of BMI ≥25 kg/m2 , diabetes and metabolic syndrome, when compared with presence of any one of these three factors, was associated with increased fibrosis regression (43.1% vs. 16.9%, P = 0.001). Multivariate analysis found a lower BMI to be the only factor independently associated with fibrosis regression (P = 0.034, odds ratio 0.68, 95% CI 0.48-0.97). No association was noted between controlled attenuation parameter measurements and fibrosis regression (P > 0.05). CONCLUSION An increased BMI hindered fibrosis regression in patients with chronic hepatitis B during nucleoside analogue treatment, suggesting that control of metabolic risk factors, in addition to virologic suppression via antiviral therapy, might be needed to halt the fibrogenic process in chronic hepatitis B.
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Affiliation(s)
- W-K Seto
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong. .,State Key Laboratory for Liver Research, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
| | - J Fung
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.,State Key Laboratory for Liver Research, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - K-S Cheung
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - L-Y Mak
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - R W H Hui
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - K S H Liu
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - C-L Lai
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.,State Key Laboratory for Liver Research, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - M-F Yuen
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong. .,State Key Laboratory for Liver Research, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
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Abstract
Non-invasive diagnosis and quantification of hepatic steatosis rely on two different but complementary approaches: biomarkers or imaging techniques, either ultrasound-based such as liver ultrasonography and controlled attenuation parameter (CAP), or computed tomography (CT) and magnetic resonance imaging (MRI). Scores for the detection of steatosis have not gained much popularity in clinical practice so far. CAP, using the M probe, is the most promising technique but needs to be implemented with the XL probe and compared to ultrasound that, despite its limitations, remains the most widely used method. CT, owing to its low sensitivity and the fact that it involves a potential radiation hazard, is inappropriate. Finally, proton density fat fraction measurement by MRI is currently the most accurate and sensitive imaging method, simpler and more practical than magnetic resonance spectroscopy, but restricted, up to now, just to research and clinical trials.
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275
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Wei H, Qu H, Wang H, Deng H. Associations between sitting time and non-alcoholic fatty liver diseases in Chinese male workers: a cross-sectional study. BMJ Open 2016; 6:e011939. [PMID: 27609847 PMCID: PMC5020753 DOI: 10.1136/bmjopen-2016-011939] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Various studies have revealed a close association between sedentary behaviour and metabolic diseases, yet the association between sedentary time and non-alcoholic fatty liver disease (NAFLD) remains unclear. In this study, we investigated the association between sitting time and NAFLD in a Chinese male population and explored its underlying mechanism. STUDY DESIGN A cross-sectional study. SETTING Chongqing, China. PARTICIPANTS Our study included 2054 male participants; all of the participants were of Han nationality. PRIMARY OUTCOME MEASURES Sitting time was assessed using a self-reported questionnaire concerning the time devoted to sitting behaviour. Various clinical and demographic biomarkers were measured. Logistic regression analyses were used to investigate the ORs and the 95% CIs between sitting time and NAFLD. RESULTS We found a higher proportion of NAFLD across the tertiles of sitting time (p trend=0.003). Multivariate linear regression analyses showed sitting time independently correlated with homoeostasis model assessment for insulin resistance (HOMA-IR), alanine aminotransferase, γ-glutamyl transpeptidase, body mass index, triglyceride and the high-sensitive C reactive protein (hsCRP) (all p<0.05). Further logistic regression analyses showed that longer sitting time (>7.1 hours/day) was associated with a higher prevalence of NAFLD (OR 1.09; 95% CI (1.04 to 1.67)) after adjusting for confounders. However, this association was insignificant after further adjusting for hsCRP (OR 1.03; 95% CI (0.92 to 1.84)). CONCLUSIONS Sitting time was positively associated with the prevalence of NAFLD, and this association might be affected by inflammation.
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Affiliation(s)
- Huili Wei
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, 400016 Chongqing, China, Chongqing, China
| | - Hua Qu
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, 400016 Chongqing, China, Chongqing, China
| | - Hang Wang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, 400016 Chongqing, China, Chongqing, China
| | - Huacong Deng
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, 400016 Chongqing, China, Chongqing, China
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276
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Bugianesi E, Rosso C, Cortez-Pinto H. How to diagnose NAFLD in 2016. J Hepatol 2016; 65:643-4. [PMID: 27401791 DOI: 10.1016/j.jhep.2016.05.038] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/24/2016] [Accepted: 05/25/2016] [Indexed: 02/07/2023]
Affiliation(s)
- E Bugianesi
- Division of Gastroenterology, Department of Medical Sciences, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Italy
| | - C Rosso
- Division of Gastroenterology, Department of Medical Sciences, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Italy
| | - H Cortez-Pinto
- Department of Gastroenterology, Hospital de Santa Maria, CHLN, Laboratory of Nutrition, Faculty of Medicine of Lisbon, University of Lisbon, Portugal
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277
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Pais R, Giral P, Khan JF, Rosenbaum D, Housset C, Poynard T, Ratziu V. Fatty liver is an independent predictor of early carotid atherosclerosis. J Hepatol 2016; 65:95-102. [PMID: 27129836 DOI: 10.1016/j.jhep.2016.02.023] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 01/17/2016] [Accepted: 02/04/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Whether steatosis is incidentally or causally associated with carotid atherosclerosis is debated, and long-term follow-up data are missing. This study aims to examine the impact of steatosis on the presence and progression of carotid intima-media thickness (C-IMT) and carotid plaques (CP) in a large cohort with longitudinal follow-up. METHODS A retrospective single-center study between 1995 and 2012. Transversal cohort: patients with ⩾2 cardiovascular risk factors without previous cardiovascular events. Longitudinal cohort: patients with two consecutive C-IMT measurements more than 2years apart. Steatosis was defined by a surrogate marker, the fatty liver index (FLI). CP and C-IMT were assessed by carotid ultrasound. RESULTS In the transversal cohort (n=5671) both C-IMT and the Framingham risk score (FRS) increased across FLI quartiles (0.58±0.12, 0.61±0.14, 0.63±0.14, 0.64±0.14mm, and 5±5%, 9±7%, 12±8%, 15±9%, p<0.001 for both). Steatosis predicted C-IMT better than diabetes or dyslipidemia. Steatosis independently predicted C-IMT (p=0.002) and FRS (p<0.001) after adjustment for metabolic syndrome and cardiovascular risk factors. In the longitudinal cohort (n=1872, mean follow-up 8±4years), steatosis occurred in 12% and CP in 23% of patients. C-IMT increased in patients with steatosis occurrence (from 0.60±0.13mm to 0.66±0.14mm, p=0.001) whereas it did not change in those that stayed free of steatosis. Steatosis at baseline predicted CP occurrence (OR=1.63, 95% CI 1.10-2.41, p=0.014), independent of age, sex, type-2 diabetes, tobacco use, hsCRP, hypertension and C-IMT. CONCLUSIONS In patients with metabolic syndrome at risk for cardiovascular events, steatosis contributes to early atherosclerosis and progression thereof, independent of traditional cardiovascular risk factors.
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Affiliation(s)
- Raluca Pais
- Service Hépatogastroentérologie, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-salpêtrière - Université Pierre et Marie Curie, UMR_S 938, INSERM - CDR Saint Antoine, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Philippe Giral
- Service d'Endocrinologie-Métabolisme, Unités de Prévention Cardiovasculaire, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-salpêtrière - Université Pierre et Marie Curie, INSERM, UMR_S 939, Paris, France
| | - Jean-François Khan
- Service d'Endocrinologie-Métabolisme, Unités de Prévention Cardiovasculaire, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-salpêtrière - Université Pierre et Marie Curie, INSERM, UMR_S 939, Paris, France
| | - David Rosenbaum
- Service d'Endocrinologie-Métabolisme, Unités de Prévention Cardiovasculaire, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-salpêtrière - Université Pierre et Marie Curie, INSERM, UMR_S 939, Paris, France
| | - Chantal Housset
- Service Hépatogastroentérologie, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-salpêtrière - Université Pierre et Marie Curie, UMR_S 938, INSERM - CDR Saint Antoine, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Thierry Poynard
- Service Hépatogastroentérologie, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-salpêtrière - Université Pierre et Marie Curie, UMR_S 938, INSERM - CDR Saint Antoine, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Vlad Ratziu
- Service Hépatogastroentérologie, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-salpêtrière - Université Pierre et Marie Curie, UMR_S 938, INSERM - CDR Saint Antoine, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France.
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278
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EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol 2016; 64:1388-402. [PMID: 27062661 DOI: 10.1016/j.jhep.2015.11.004] [Citation(s) in RCA: 2767] [Impact Index Per Article: 345.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 11/04/2015] [Indexed: 02/07/2023]
Affiliation(s)
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- European Association for the Study of the Liver (EASL), The EASL Building – Home of European Hepatology, 7 rue Daubin, CH 1203 Geneva, Switzerland.
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279
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Jung CH, Kang YM, Jang JE, Hwang JY, Kim EH, Park JY, Kim HK, Lee WJ. Fatty liver index is a risk determinant of incident type 2 diabetes in a metabolically healthy population with obesity. Obesity (Silver Spring) 2016; 24:1373-9. [PMID: 27112320 DOI: 10.1002/oby.21483] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 01/19/2016] [Accepted: 01/20/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study investigated the effect of fatty liver disease (FLD) on the risk of incident type 2 diabetes in a population with metabolically healthy obesity (MHO). METHODS The study population comprised 34,258 Koreans without type 2 diabetes. Participants were stratified by BMI (cutoff value, 25.0 kg/m(2) ) and metabolic health state (using Wildman criteria). FLD was defined by the fatty liver index (FLI), a predictive algorithm to detect FLD. Subjects were classified into low and high FLI groups based on tertile. RESULTS At baseline, there were significant differences in FLI between four study groups. During a median follow-up of 36.5 months, 1.7% individuals developed type 2 diabetes. The risk of incident type 2 diabetes varied for the MHO group according to the level of FLI. The risk of type 2 diabetes in the MHO with low FLI was not significantly elevated compared with the metabolically healthy individuals without obesity (MHNO) with low FLI (multivariate-adjusted HR, 1.19 [95% CI 0.66-2.14]). However, the MHO with high FLI had an elevated risk of incident type 2 diabetes (multivariate-adjusted HR, 1.99 [95% CI 1.36-2.92]). CONCLUSIONS MHO subjects have a substantially higher risk of incident type 2 diabetes than MHNO subjects. The presence of FLD assessed by FLI partially explains this increased risk.
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Affiliation(s)
- Chang Hee Jung
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yu Mi Kang
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung Eun Jang
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jenie Yoonoo Hwang
- Department of Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eun Hee Kim
- Department of Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joong-Yeol Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hong-Kyu Kim
- Department of Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Woo Je Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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280
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281
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Patel V, Sanyal AJ, Sterling R. Clinical Presentation and Patient Evaluation in Nonalcoholic Fatty Liver Disease. Clin Liver Dis 2016; 20:277-92. [PMID: 27063269 DOI: 10.1016/j.cld.2015.10.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a diagnosis of exclusion. Most patients are asymptomatic and diagnosed incidentally. Most patients remain undiagnosed. A high index of suspicion and serologic work-up to rule out alternative causes of liver disease is required. In NALFD, fibrosis correlates with outcomes, including mortality. To diagnose, assess severity, and monitor fibrosis, 2 noninvasive methods can be used. However, noninvasive tests are more helpful at extremes of fibrosis: excluding it or diagnosing advanced fibrosis. Liver biopsy is usually reserved for cases whereby noninvasive tests fail to accurately determine the degree of fibrosis or the diagnosis is unclear.
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Affiliation(s)
- Vaishali Patel
- Section of Hepatology, Department of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, 1200 East Broad Street, West Hospital, Room 1478, Richmond, VA 23298-0341, USA
| | - Arun J Sanyal
- Section of Hepatology, Department of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, 1200 East Broad Street, West Hospital, Room 1478, Richmond, VA 23298-0341, USA
| | - Richard Sterling
- Section of Hepatology, Department of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, 1200 East Broad Street, West Hospital, Room 1478, Richmond, VA 23298-0341, USA.
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282
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Shih KL, Su WW, Chang CC, Kor CT, Chou CT, Chen TY, Wu HM. Comparisons of parallel potential biomarkers of 1H-MRS-measured hepatic lipid content in patients with non-alcoholic fatty liver disease. Sci Rep 2016; 6:24031. [PMID: 27079922 PMCID: PMC4832180 DOI: 10.1038/srep24031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 03/18/2016] [Indexed: 02/06/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the main cause of chronic liver disease. This cross-sectional study aimed to evaluate whether parallel clinical features and serum markers are related to the severity of NAFLD. We enrolled 111 participants with different metabolic syndrome (MetS) scores (zero, n = 22; one, n = 19; two, n = 22; and ≥ three, n = 48) and used 1H-MRS to measure liver fat content. Biochemical profiles and potential biomarkers of NAFLD were measured in fasting plasma. We found that 1H-MRS-measured fat content was significantly associated with MetS score ≥1, endotoxin, and hs-CRP. Ordinal logistic regression analysis revealed that MetS score ≥2 and endotoxin were predictive of NAFLD (1H-MRS > 5%) and that endotoxin, hs-CRP, and malondialdehyde (MDA) were predictive of NAFLD with liver injury (1H-MRS > 9.67%). Endotoxin plus MetS score was shown to be the most accurate predictor of overall NAFLD (AUC = 0.854; (95% CI: 0.785–0.924), P < 0.001), and endotoxin plus hs-CRP and MDA was found to be predictive of NAFLD with liver injury (0.868; (0.801–0.936), P < 0.001). These results suggest that MetS score plus certain serum biomarkers with 1H-MRS findings may hold promise for developing an effective model for monitoring the severity of NAFLD.
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Affiliation(s)
- Kai-Lun Shih
- Department of Gastroenterology, Changhua Christian Hospital, Changhua, Taiwan
| | - Wei-Wen Su
- Department of Gastroenterology, Changhua Christian Hospital, Changhua, Taiwan
| | - Chia-Chu Chang
- Department of Nephrology, Changhua Christian Hospital, Changhua, Taiwan.,School of Medicine, Chung-Shan Medical University, Taichung, Taiwan
| | - Chew-Teng Kor
- Internal Medicine Research Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Chen-Te Chou
- Department of Medical Imaging, Changhua Christian Hospital, Changhua, Taiwan
| | - Ting-Yu Chen
- Inflammation Research &Drug Development Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Hung-Ming Wu
- Inflammation Research &Drug Development Center, Changhua Christian Hospital, Changhua, Taiwan.,Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan.,Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan
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283
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de Lédinghen V, Wong GLH, Vergniol J, Chan HLY, Hiriart JB, Chan AWH, Chermak F, Choi PCL, Foucher J, Chan CKM, Merrouche W, Chim AML, Le Bail B, Wong VWS. Controlled attenuation parameter for the diagnosis of steatosis in non-alcoholic fatty liver disease. J Gastroenterol Hepatol 2016; 31:848-55. [PMID: 26514665 DOI: 10.1111/jgh.13219] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 10/12/2015] [Accepted: 10/18/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Controlled attenuation parameter (CAP) evaluated with transient elastography (FibroScan) is a recent method for non-invasive assessment of steatosis. Its usefulness in non-alcoholic fatty liver disease (NAFLD) is unknown. We prospectively investigated the performance of CAP for the diagnosis of steatosis in NAFLD, factors associated with discordances between CAP and steatosis grades, and relationships between CAP and clinical or biological parameters. METHODS All CAP examinations performed in NAFLD patients with a liver biopsy performed within 1 week of CAP measurement were included. Liver biopsies were assessed for activity and fibrosis stage, NAFLD activity score, and steatosis graded as follows: S0, steatosis < 5%; S1, 5-33%; S2, 34-66%; S3, >66%. RESULTS Two hundred sixty-one patients (59% male, age 56 years) from two ethnic groups were included. No patient had steatosis < 5%. The area under the receiver-operating characteristics curve of CAP for steatosis ≥S2 and S3 was 0.80 and 0.66, respectively. At a cut-off value of 310 dB/m, the sensitivity, specificity, and positive and negative predictive values for ≥S2 steatosis were 79%, 71%, 86%, and 71%, respectively. Discordance of at least one grade between CAP and steatosis was observed in 81 patients. By multivariate analysis, only steatosis S2S3 was associated with no discordance. By multivariate analysis, only BMI ≥ 30 kg/m(2) was significantly associated with CAP > 310 dB/m. CONCLUSION The association of CAP with steatosis, especially in patients with non-alcoholic steatohepatitis, and with elevated BMI could be useful for the diagnosis and follow-up of NAFLD patients.
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Affiliation(s)
- Victor de Lédinghen
- Investigation Center of Liver Fibrosis, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France.,INSERM U1053, Bordeaux University, Bordeaux, France
| | - Grace Lai-Hung Wong
- State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Julien Vergniol
- Investigation Center of Liver Fibrosis, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France
| | - Henry Lik-Yuen Chan
- State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Jean-Baptiste Hiriart
- Investigation Center of Liver Fibrosis, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France
| | - Anthony Wing-Hung Chan
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
| | - Faiza Chermak
- Investigation Center of Liver Fibrosis, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France
| | - Paul Cheung-Lung Choi
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
| | - Juliette Foucher
- Investigation Center of Liver Fibrosis, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France
| | - Carmen Ka-Man Chan
- Investigation Center of Liver Fibrosis, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France.,INSERM U1053, Bordeaux University, Bordeaux, France
| | - Wassil Merrouche
- Investigation Center of Liver Fibrosis, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France
| | - Angel Mei-Ling Chim
- Investigation Center of Liver Fibrosis, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France.,INSERM U1053, Bordeaux University, Bordeaux, France
| | - Brigitte Le Bail
- INSERM U1053, Bordeaux University, Bordeaux, France.,Department of Pathology, Pellegrin Hospital, Bordeaux University Hospital, Bordeaux, France
| | - Vincent Wai-Sun Wong
- State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
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284
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Additive Effect of Non-Alcoholic Fatty Liver Disease on Metabolic Syndrome-Related Endothelial Dysfunction in Hypertensive Patients. Int J Mol Sci 2016; 17:456. [PMID: 27023537 PMCID: PMC4848912 DOI: 10.3390/ijms17040456] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 03/16/2016] [Accepted: 03/22/2016] [Indexed: 12/20/2022] Open
Abstract
Metabolic syndrome (MS) is characterized by an increased risk of incident diabetes and cardiovascular (CV) events, identifying insulin resistance (IR) and endothelial dysfunction as key elements. Moreover, non-alcoholic fatty liver disease (NAFLD) is bidirectionally linked with MS as a consequence of metabolic and inflammatory abnormalities. We addressed the question if the evolution in NAFLD might worsen endothelium-dependent vasodilating response in MS hypertensives. We recruited 272 Caucasian newly-diagnosed never-treated hypertensive outpatients divided into three groups according to the presence/absence of MS alone or in combination with NAFLD. MS and NAFLD were defined according to the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII) and non-invasive fatty liver index, respectively. We determined IR by using the homeostasis model assessment (HOMA) index. Vascular function, as forearm blood flow (FBF), was determined through strain-gauge plethysmography after intra-arterial infusion of acetylcholine (ACh) and sodium nitroprusside. MS+NAFLD+ group showed worse metabolic, inflammatory and vascular profiles compared with MS−NAFLD− and MS+NAFLD−. HOMA resulted in being the strongest predictor of FBF both in the MS+NAFLD− and in the MS+NAFLD+ groups, accounting for 20.5% and 33.2% of its variation, respectively. In conclusion, we demonstrated that MS+NAFLD+ hypertensives show a worse endothelium-dependent vasodilation compared with MS+NAFLD−, allowing for consideration of NAFLD as an early marker of endothelial dysfunction in hypertensives.
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285
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Baeg MK, Yoon SK, Ko SH, Noh YS, Lee IS, Choi MG. Helicobacter pylori infection is not associated with nonalcoholic fatty liver disease. World J Gastroenterol 2016; 22:2592-2600. [PMID: 26937147 PMCID: PMC4768205 DOI: 10.3748/wjg.v22.i8.2592] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 11/22/2015] [Accepted: 12/14/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine whether Helicobacter pylori (H. pylori) infection confers a higher risk of Nonalcoholic fatty liver disease (NAFLD).
METHODS: Healthy people who underwent health screening were analyzed retrospectively. Inclusion criteria were age ≥ 20 years, history of H. pylori infection, and recorded insulin level. Participants were classified as H. pylori positive or negative according to 13C urea breath tests. NAFLD was defined using the hepatic steatosis index (HSI) and NAFLD liver fat score (NAFLD-LFS). Those with an HSI > 36 or NAFLD-LFS > -0.640 were considered to have NAFLD. Multivariable logistic regression was performed to identify risk factors for NAFLD.
RESULTS: Three thousand six hundred and sixty-three people were analyzed and 1636 (44.7%) were H. pylori positive. H. pylori infection was associated with older age, male gender, hypertension, higher body mass index, and a dyslipidemic profile. HSI differed significantly between H. pylori positive and negative subjects (median 33.2, interquartile range (IQR) 30.0-36.2 for H. pylori-positive vs median 32.6, IQR 29.8-36.0 for negative participants, P = 0.005), but NAFLD-LSF did not [median -1.7, IQR -2.4 - -0.7 vs median -1.8, IQR -2.4-(-0.7), respectively, P = 0.122]. The percentage of people with NAFLD did not differ between infected and uninfected groups: HIS, 26.9% vs 27.1%, P = 0.173; NAFLD-LFS, 23.5% vs 23.1%, P = 0.778. H. pylori infection was not a risk factor, but C-reactive protein concentration and smoking were significant risk factors for NAFLD.
CONCLUSION: H. pylori infection is not a risk factor for NAFLD as indicated by HSI or NAFLD-LFS. Prospective, large-scale studies involving liver biopsies should be considered.
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286
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Silaghi CA, Silaghi H, Colosi HA, Craciun AE, Farcas A, Cosma DT, Hancu N, Pais R, Georgescu CE. Prevalence and predictors of non-alcoholic fatty liver disease as defined by the fatty liver index in a type 2 diabetes population. ACTA ACUST UNITED AC 2016; 89:82-8. [PMID: 27004029 PMCID: PMC4777473 DOI: 10.15386/cjmed-544] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 09/09/2015] [Indexed: 02/06/2023]
Abstract
Background and aims We aimed to study the prevalence and the predictive factors of non-alcoholic fatty liver disease (NAFLD) defined by the fatty liver index (FLI) in type 2 diabetic patients (T2DM). Methods Three hundred and eighty-one T2DM outpatients who regularly attended a Consulting Clinic in Cluj were retrospectivelly included. FLI, a surrogate steatosis biomarker based on body mass index (BMI), waist circumference (WC), triglycerides (TGL) and gammaglutamyl-transferase (GGT) was used to assess NAFLD in all patients. Anthropometric and biochemical parameters were measured. Hepatic steatosis (HS) was evaluated by ultrasonography. Results NAFLD-FLI (defined as FLI>60) was correlated with HS evaluated by ultrasound (r=0.28; p<0.001). NAFLD-FLI was detected in 79% of T2DM. The prevalence of obesity in NAFLD-FLI patients was 80%. Of the patients with normal alanine aminotransferase (ALAT), 73.8 % had NAFLD. At univariate analysis, NAFLD-FLI was correlated with age (r= −0.14; p=0.007), sex (r=0.20; p<0.001), LDL cholesterol (r=0.12; p=0.032), HDL cholesterol (r = −0.13; p=0.015), ALAT (r=0.20; p<0.001) and ASAT (r=0.19; p<0.001). At multiple regression analysis, sex, ALAT and LDL-cholesterol were independent predictors of NAFLD-FLI. After logistic regression model, ALAT, LDL-cholesterol, HOMA-IR were good independent predictors of NAFLD-FLI. Conclusions NAFLD-FLI could be useful to identify NAFLD in T2DM patients. Subjects with T2DM had a high prevalence of NADLD-FLI even with normal ALAT levels. Our findings showed that sex, ALAT, LDL cholesterol and IR were significant and independent factors associated with the presence of NAFLD in T2DM subjects.
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Affiliation(s)
- Cristina Alina Silaghi
- County Emergency Hospital, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Endocrinology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Horatiu Silaghi
- 5th Surgery Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Horatiu Alexandru Colosi
- Medical Informatics and Biostatistics Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anca Elena Craciun
- Diabetes, Nutrition and Metabolic Diseases Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Diabetes, Nutrition and Metabolic Diseases Department, Regina Maria Clinic, Cluj-Napoca, Romania
| | - Anca Farcas
- 1st Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Daniel Tudor Cosma
- Diabetes, Nutrition and Metabolic Diseases Department, County Clinic Emergency Hospital, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Nicolae Hancu
- Diabetes, Nutrition and Metabolic Diseases Department, Regina Maria Clinic, Cluj-Napoca, Romania
| | - Raluca Pais
- Service Hépatogastroentérologie, Hôpital Pitié - Salpêtrière, Université Pierre et Marie Curie, INSERM UMRS 938, Paris, France
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287
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EASL-EASD-EASO Clinical Practice Guidelines for the Management of Non-Alcoholic Fatty Liver Disease. Obes Facts 2016; 9:65-90. [PMID: 27055256 PMCID: PMC5644799 DOI: 10.1159/000443344] [Citation(s) in RCA: 304] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 04/11/2016] [Indexed: 12/11/2022] Open
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288
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Doycheva I, Cui J, Nguyen P, Costa EA, Hooker J, Hofflich H, Bettencourt R, Brouha S, Sirlin CB, Loomba R. Non-invasive screening of diabetics in primary care for NAFLD and advanced fibrosis by MRI and MRE. Aliment Pharmacol Ther 2016; 43:83-95. [PMID: 26369383 PMCID: PMC4673036 DOI: 10.1111/apt.13405] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 07/29/2015] [Accepted: 08/26/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Current guidelines do not recommend screening for non-alcoholic fatty liver disease (NAFLD) or advanced fibrosis. Patients with type 2 diabetes mellitus (T2DM) are known to be at increased risk for NAFLD and advanced fibrosis. AIM To assess the feasibility in diabetics in a primary care setting of screening for NAFLD and advanced fibrosis, by using non-invasive magnetic resonance imaging (MRI) to estimate the hepatic proton density fat fraction (MRI-PDFF) and magnetic resonance elastography (MRE) to estimate hepatic stiffness. METHODS We performed a cross-sectional analysis of a prospective study that included 100 (53% men) consecutively enrolled diabetics who did not have any other aetiology of liver disease. All patients underwent a standardised research visit, laboratory tests, MRI-PDFF, and MRE. RESULTS Mean (±s.d.) age and body mass index (BMI) was 59.7 (±11.2) years and 30.8 (±6.5) kg/m(2) , respectively. The prevalence of NAFLD (defined as MRI-PDFF ≥5%) and advanced fibrosis (defined as MRE ≥3.6 kPa) was 65% and 7.1%, respectively. One patient with advanced fibrosis had definite hepatocellular carcinoma. When compared to those without NAFLD, patients with NAFLD were younger (P = 0.028) and had higher mean BMI (P = 0.0008), waist circumference (P < 0.0001) and prevalence of metabolic syndrome (84.6% vs. 40.0%, P < 0.0001). Only 26% of those with NAFLD had elevated alanine aminotransferase. CONCLUSIONS This proof-of-concept study demonstrates that T2DM has significant rates of both NAFLD and advanced fibrosis. Concomitant screening for NAFLD and advanced fibrosis by using MRI-proton density fat fraction and magnetic resonance elastography in T2DM is feasible and may be considered after validation in a larger cohort.
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Affiliation(s)
- Iliana Doycheva
- NAFLD Translational Research Unit, University of California, San Diego, La Jolla, CA
| | - Jeffrey Cui
- NAFLD Translational Research Unit, University of California, San Diego, La Jolla, CA
| | - Phirum Nguyen
- NAFLD Translational Research Unit, University of California, San Diego, La Jolla, CA,Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla, CA
| | - Eduardo A. Costa
- Liver Imaging Group, Department of Radiology, University of California, San Diego, La Jolla, CA
| | - Jonathan Hooker
- Liver Imaging Group, Department of Radiology, University of California, San Diego, La Jolla, CA
| | - Heather Hofflich
- Division of General Internal Medicine, Department of Medicine, University of California, San Diego, La Jolla, CA
| | - Ricki Bettencourt
- Division of Epidemiology, Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA
| | - Sharon Brouha
- Department of Radiology, University of California, San Diego, La Jolla, CA
| | - Claude B. Sirlin
- Liver Imaging Group, Department of Radiology, University of California, San Diego, La Jolla, CA
| | - Rohit Loomba
- NAFLD Translational Research Unit, University of California, San Diego, La Jolla, CA,Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla, CA,Division of Epidemiology, Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA
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289
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Abstract
Nonalcoholic fatty liver disease (NAFLD) is a disorder characterized by excess accumulation of fat in hepatocytes (nonalcoholic fatty liver (NAFL)); in up to 40% of individuals, there are additional findings of portal and lobular inflammation and hepatocyte injury (which characterize nonalcoholic steatohepatitis (NASH)). A subset of patients will develop progressive fibrosis, which can progress to cirrhosis. Hepatocellular carcinoma and cardiovascular complications are life-threatening co-morbidities of both NAFL and NASH. NAFLD is closely associated with insulin resistance; obesity and metabolic syndrome are common underlying factors. As a consequence, the prevalence of NAFLD is estimated to be 10-40% in adults worldwide, and it is the most common liver disease in children and adolescents in developed countries. Mechanistic insights into fat accumulation, subsequent hepatocyte injury, the role of the immune system and fibrosis as well as the role of the gut microbiota are unfolding. Furthermore, genetic and epigenetic factors might explain the considerable interindividual variation in disease phenotype, severity and progression. To date, no effective medical interventions exist that completely reverse the disease other than lifestyle changes, dietary alterations and, possibly, bariatric surgery. However, several strategies that target pathophysiological processes such as an oversupply of fatty acids to the liver, cell injury and inflammation are currently under investigation. Diagnosis of NAFLD can be established by imaging, but detection of the lesions of NASH still depend on the gold-standard but invasive liver biopsy. Several non-invasive strategies are being evaluated to replace or complement biopsies, especially for follow-up monitoring.
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290
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Sorrentino G, Crispino P, Coppola D, De Stefano G. Efficacy of lifestyle changes in subjects with non-alcoholic liver steatosis and metabolic syndrome may be improved with an antioxidant nutraceutical: a controlled clinical study. Drugs R D 2015; 15:21-5. [PMID: 25732561 PMCID: PMC4359182 DOI: 10.1007/s40268-015-0084-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction The prevalence of liver steatosis is particularly high in subjects with signs of the metabolic syndrome, and current therapeutic guidelines mostly rely on lifestyle changes alone, which rarely achieve significant objective improvements. In the present study, we evaluated the possibility of monitoring objective improvements in these subjects, before and after a dietary regimen. Methods Overall, 78 subjects with metabolic syndrome and ultrasound confirmation of liver steatosis were included in an open, controlled study; all of these subjects were treated for 90 days with the standard regimen of diet and exercise. One group of 43 subjects (Group A) also received a Eurosil 85®-based nutraceutical (silymarin + vitamin E) as a dietary adjunct, whereas the remaining 35 subjects (Group B) represented the control group. Changes from baseline values were recorded in biometric, biochemical, and ultrasound data. For assessments and monitoring of liver steatosis, two indexes were utilised—Hepatic Steatosis Index (HSI) and Lipid Accumulation Product (LAP) index. Results The absolute changes from baseline were significantly higher in Group A in biometric parameters (reduction of abdominal circumference, Body Mass Index, ultrasound measurement of right liver lobe) and in both the HSI and LAP indexes. Both treatments were well tolerated. Conclusion The results observed suggest that the use of a Eurosil 85®-based nutraceutical as a dietary adjunct with antioxidant properties potentially favours the efficacy of the dietary regimen alone and may possibly improve the subjects’ motivation to sustain such lifestyle changes over time.
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291
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Amarapurkar D, Amarapurkar A. Indications of Liver Biopsy in the Era of Noninvasive Assessment of Liver Fibrosis. J Clin Exp Hepatol 2015; 5:314-9. [PMID: 26900273 PMCID: PMC4723644 DOI: 10.1016/j.jceh.2015.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 08/24/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Liver biopsy (LB) has been used as diagnostic modality in liver diseases (LD). Over last two decades, there has been remarkable improvement in understanding of natural history, molecular diagnostics of viral hepatitis, genetic of LD, and also limitations of LB. There is current trend in avoiding LB in the management of various LDs. AIM To determine utility of LB in clinical practice. MATERIAL AND METHODS In a prospective study, 2413 patients of LD were followed up, 219 (9%) were acute, and remaining 2194 (90.9%) were chronic LD. Patients were evaluated by biochemical parameters, virological studies, and imaging endoscopy as and when required. LB was performed in 176 (7.2%) patients when no conclusion could be drawn from the noninvasive workup. Patients with platelet count <50,000/cm(2), ascites, and overt bleeding were excluded. Patients with international normalization ratio (INR) more than 1.5 were not excluded. No prophylactic use of fresh frozen plasma and platelet transfusion was done. There was no major complication related to the procedure. Indications for LB were as follows: cryptogenic LD 38 cases, hepatitis B infection 35, suspected autoimmune hepatitis 30, mass lesion in the liver and lymphoma 29, evaluation of portal hypertension 15, elevated liver enzymes 11, hepatitis C infection 9, and drug-induced LD 4, and miscellaneous 5 cases which were primary biliary cholangitis, primary sclerosing cholangitis, cholestatic LD, sarcoidosis, and amyloidosis. RESULTS LB changed the diagnosis in 55 (31.2%). These were cryptogenic LD in 24 cases, portal hypertension 15, elevated liver enzymes 11, and 5 others. In remaining, LB confirmed clinical diagnosis and helped in making management decisions. CONCLUSION LB was required in 7.2% of patients with chronic LD. In 31.2% cases, LB changed the diagnosis. LB was a safe procedure even in presence of low platelet count and abnormal INR.
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Key Words
- AIH, autoimmune hepatitis
- APRI, aspartate transaminases to platelet ratio index
- CMV, cytomegalovirus
- EBV, Epstein bar virus
- HCC, hepatocellular carcinoma
- HEV, hepatitis E virus
- INCPH, idiopathic noncirrhotic portal hypertension
- LB, liver biopsy
- LD, liver disease
- NAFLD, nonalcoholic fatty liver disease
- NASH, nonalcoholic steatohepatitis
- NRH, nodular regenerative hyperplasia
- autoimmune hepatitis
- cryptogenic cirrhosis
- noncirrhotic portal hypertension
- steatohepatitis
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292
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Gisondi P, Barba E, Girolomoni G. Non-alcoholic fatty liver disease fibrosis score in patients with psoriasis. J Eur Acad Dermatol Venereol 2015; 30:282-7. [PMID: 26537011 DOI: 10.1111/jdv.13456] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 09/04/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients with psoriasis are at risk of non-alcoholic fatty liver disease (NAFLD) and likely liver fibrosis. OBJECTIVE Investigate the prevalence of NAFLD in patients with psoriasis and measure their risk of liver fibrosis. METHOD One hundred and twenty-four patients with psoriasis and 79 healthy controls were included in this cross-sectional study. NAFLD was diagnosed in the presence of characteristic sonographic features of fatty liver after excluding other secondary causes of chronic liver disease. NAFLD fibrosis score (NAFLD-FS) was scored in those with NAFLD to measure the risk of advanced liver fibrosis. RESULTS Prevalence of NAFLD was greater in patients with psoriasis than in controls (44% vs. 26%, P < 0.001). NAFLD-FS was higher in patients with psoriasis than in controls, suggesting a higher risk of liver fibrosis in those with psoriasis (-1.57 ± 1.4 vs. -3.10 ± 1.5, mean ± SD, P < 0.0001). Psoriasis resulted in a significant predictor of advanced liver fibrosis independently of age, sex, BMI, hypertension and diabetes in the multivariate analysis. CONCLUSIONS Patients with psoriasis should be screened for common causes of liver disease, including NAFLD and liver fibrosis.
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Affiliation(s)
- P Gisondi
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - E Barba
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - G Girolomoni
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
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293
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Marino L, Jornayvaz FR. Endocrine causes of nonalcoholic fatty liver disease. World J Gastroenterol 2015; 21:11053-76. [PMID: 26494962 PMCID: PMC4607905 DOI: 10.3748/wjg.v21.i39.11053] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/11/2015] [Accepted: 08/28/2015] [Indexed: 02/06/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the industrialized world. The prevalence of NAFLD is increasing, becoming a substantial public health burden. NAFLD includes a broad spectrum of disorders, from simple conditions such as steatosis to severe manifestations such as fibrosis and cirrhosis. The relationship of NAFLD with metabolic alterations such as type 2 diabetes is well described and related to insulin resistance, with NAFLD being recognized as the hepatic manifestation of metabolic syndrome. However, NAFLD may also coincide with endocrine diseases such as polycystic ovary syndrome, hypothyroidism, growth hormone deficiency or hypercortisolism. It is therefore essential to remember, when discovering altered liver enzymes or hepatic steatosis on radiological exams, that endocrine diseases can cause NAFLD. Indeed, the overall prognosis of NAFLD may be modified by treatment of the underlying endocrine pathology. In this review, we will discuss endocrine diseases that can cause NALFD. Underlying pathophysiological mechanisms will be presented and specific treatments will be reviewed.
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294
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Cruz MAF, Cruz JF, Macena LB, de Santana DS, Oliveira CCDC, Lima SO, Franca AVC. Association of the Nonalcoholic Hepatic Steatosis and Its Degrees With the Values of Liver Enzymes and Homeostasis Model Assessment-Insulin Resistance Index. Gastroenterology Res 2015; 8:260-264. [PMID: 27785306 PMCID: PMC5051044 DOI: 10.14740/gr685w] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is among the most common chronic diseases of the modern world with a wide variety of factors including genetic, environmental and metabolic. The aim of this study was to verify the association between the degrees of hepatic steatosis at the abdominal ultrasound and the values of aminotransferases (aspartate aminotransferase (AST) and alanine transferase (ALT)), gamma glutamyl transpeptidase (GGT) and homeostasis model assessment-insulin resistance (HOMA-IR) index. METHODS A prospective, descriptive survey study, using a quantitative analytical examination, was conducted from July 2013 to July 2014. In the statistical analysis, values were expressed as median, first and third quartiles. We used the nonparametric Kruskal-Wallis test to compare the medians between the degrees of steatosis, adopted a statistical significance of 5% (P ≤ 0.05) and used the statistical program SPSS 22.0. RESULTS We diagnosed 233/800 (29.1%) patients with hepatic steatosis on routine ultrasound, and 65.7% were female. Regarding degrees, 119 had grade 1 (51.0%), 94 grade 2 (40.4%) and 20 grade 3 (8.6%). The median age of the patients with grade 1, 2 or 3 did not vary significantly (P > 0.05). The median body mass index (BMI), although clinically important because of its elevation, did not differ significantly (P > 0.05). ALT levels increased as the degree of hepatic steatosis has advanced as well as the levels of AST, GGT and HOMA-IR. AST values showed a greater association with the severity of fatty liver (P = 0.0001) than the ALT (P = 0.001). CONCLUSIONS ALT, AST, GGT and HOMA-IR are associated to the degrees of hepatic steatosis on ultrasound and can help in the selection of patients for the liver histological evaluation.
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Affiliation(s)
| | | | | | | | | | - Sonia Oliveira Lima
- Department of Medicine, Tiradentes University, Aracaju 49032-490, Sergipe, Brazil
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295
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Verna EC, Patel J, Bettencourt R, Nguyen P, Hernandez C, Valasek MA, Kisselva T, Brenner DA, Loomba R. Novel association between serum pentraxin-2 levels and advanced fibrosis in well-characterised patients with non-alcoholic fatty liver disease. Aliment Pharmacol Ther 2015; 42:582-90. [PMID: 26119353 PMCID: PMC7979413 DOI: 10.1111/apt.13292] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 04/28/2015] [Accepted: 06/02/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pentraxin-2 (PTX-2), a serum protein, inhibits inflammation and fibrosis, and recombinant PTX-2 is being tested as an anti-fibrotic agent. AIM To evaluate the association between serum PTX-2 levels and fibrosis stage in patients with non-alcoholic fatty liver disease (NAFLD). METHODS Serum pentraxin-2 levels were compared between four groups of well-characterised patients including NAFLD with no fibrosis, NAFLD with mild-moderate fibrosis (stage 1-2), NAFLD with advanced fibrosis (stage 3-4), and age-sex matched non-NAFLD controls. RESULTS Sixty subjects were included in the study. The mean age was 58.9 years, 68% were male and 58% were Caucasian. In univariate analysis, serum PTX-2 levels significantly decreased from non-NAFLD controls to mild NAFLD with no fibrosis, to NAFLD with mild-moderate fibrosis and were lowest in patients with NAFLD and advanced fibrosis, in a dose-dependent manner (P < 0.0001). In multivariable-adjusted analyses controlling for age, sex, albumin, and CRP, the results remained consistent and statistically significant. Serum PTX-2 level had an AUROC of 0.84 (95% CI: 0.71-0.97) for the diagnosis of NAFLD, and an AUROC of 0.77 (95% CI: 0.65-0.90) for the diagnosis of advanced fibrosis in NAFLD. Serum PTX-2 levels also decreased with increasing liver stiffness as estimated by magnetic resonance elastography (r = -0.31, P = 0.02). CONCLUSIONS PTX-2 levels are significantly lower in patients with NAFLD compared to non-NAFLD controls, and decline further in patients with advanced fibrosis. PTX-2 may therefore be both a biomarker of disease and a potential target for anti-fibrotic therapy with the recombinant pentraxin-2.
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Affiliation(s)
- E. C. Verna
- Center for Liver Disease and Transplantation, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - J. Patel
- Internal Medicine, Department of Medicine, University of California at San Diego, La Jolla, CA, USA
| | - R. Bettencourt
- NAFLD Translational Research Unit, University of California at San Diego, La Jolla, CA, USA,Division of Epidemiology, Department of Family and Preventive Medicine, University of California at San Diego, La Jolla, CA, USA
| | - P. Nguyen
- NAFLD Translational Research Unit, University of California at San Diego, La Jolla, CA, USA,Division of Gastroenterology, Department of Medicine, University of California at San Diego, La Jolla, CA, USA
| | - C. Hernandez
- NAFLD Translational Research Unit, University of California at San Diego, La Jolla, CA, USA,Division of Gastroenterology, Department of Medicine, University of California at San Diego, La Jolla, CA, USA
| | - M. A. Valasek
- Department of Pathology, University of California at San Diego, La Jolla, CA, USA
| | - T. Kisselva
- Division of Gastroenterology, Department of Medicine, University of California at San Diego, La Jolla, CA, USA
| | - D. A. Brenner
- Division of Gastroenterology, Department of Medicine, University of California at San Diego, La Jolla, CA, USA
| | - R. Loomba
- NAFLD Translational Research Unit, University of California at San Diego, La Jolla, CA, USA,Division of Gastroenterology, Department of Medicine, University of California at San Diego, La Jolla, CA, USA,Division of Epidemiology, Department of Family and Preventive Medicine, University of California at San Diego, La Jolla, CA, USA
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296
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Saponaro C, Gaggini M, Gastaldelli A. Nonalcoholic fatty liver disease and type 2 diabetes: common pathophysiologic mechanisms. Curr Diab Rep 2015; 15:607. [PMID: 25894944 DOI: 10.1007/s11892-015-0607-4] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is an independent risk factor for advanced liver disease, type 2 diabetes (T2DM), and cardiovascular diseases. The prevalence of NAFLD in the general population is around 30 %, but it is up to three times higher in those with T2DM. Among people with obesity and T2DM, the NAFLD epidemic also is worsening. Therefore, it is important to identify early metabolic alterations and to prevent these diseases and their progression. In this review, we analyze the pathophysiologic mechanisms leading to NAFLD, particularly, those common to T2DM, such as liver and muscle insulin resistance. However, it is mainly adipose tissue insulin resistance that results in increased hepatic de novo lipogenesis, inflammation, and lipotoxicity. Although genetics predispose to NAFLD, an unhealthy lifestyle, including high-fat/high-sugar diets and low physical activity, increases the risk. In addition, alterations in gut microbiota and environmental chemical agents, acting as endocrine disruptors, may play a role.
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Affiliation(s)
- Chiara Saponaro
- Cardiometabolic Risk Unit, Institute of Clinical Physiology, CNR, via Moruzzi 1, 56100, Pisa, Italy,
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297
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Ballestri S, Romagnoli D, Nascimbeni F, Francica G, Lonardo A. Role of ultrasound in the diagnosis and treatment of nonalcoholic fatty liver disease and its complications. Expert Rev Gastroenterol Hepatol 2015; 9:603-27. [PMID: 25694178 DOI: 10.1586/17474124.2015.1007955] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We review the role of liver ultrasonography (US) and related techniques as non-invasive tools in predicting metabolic derangements, liver histology, portal hypertension and cardiovascular risk as well as allowing early diagnosis and management of hepatocellular carcinoma in patients with nonalcoholic fatty liver disease. In this setting, US detects fatty changes as low as ≥20% and hepatic steatosis identified ultrasonographically, in its turn, closely mirrors coronary and carotid atherosclerosis burden. Semi-quantitative US indices (to exclude nonalcoholic steatohepatitis) and sonoelastography (to quantify fibrosis) help in predicting liver histology and selecting patients to submit to liver biopsy. Surveillance for hepatocellular carcinoma conducted through biannual US is mandatory and US has a role in guiding locoregional treatment and in evaluating the efficacy of treatment. High-intensity focused ultrasound can be delivered with precision resulting in coagulative necrosis of hepatocellular carcinoma without puncturing the liver. Costs and inconveniences have so far hampered its diffusion.
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Affiliation(s)
- Stefano Ballestri
- Division of Internal Medicine, Hospital of Pavullo - Department of Internal Medicine, Azienda USL, Pavullo, Modena 41126, Italy
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298
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Ruhl CE, Everhart JE. Fatty liver indices in the multiethnic United States National Health and Nutrition Examination Survey. Aliment Pharmacol Ther 2015; 41:65-76. [PMID: 25376360 DOI: 10.1111/apt.13012] [Citation(s) in RCA: 233] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 09/09/2014] [Accepted: 10/11/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Validated non-invasive measures of fatty liver are needed that can be applied across populations and over time. A fatty liver index (FLI) including body mass index, waist circumference, triglycerides and gamma glutamyltransferase (GGT) activity was developed in an Italian municipality, but has not been validated widely or examined in a multiethnic population. AIMS We evaluated this FLI in the multiethnic U.S. National Health and Nutrition Examination Survey (NHANES) and also to explore whether an improved index for the U.S. population (US FLI) could be derived. The US FLI would then used to examine U.S. time trends in fatty liver prevalence. METHODS We studied 5869 fasted, viral hepatitis negative adult participants with abdominal ultrasound data on fatty liver in the 1988-1994 NHANES. Time trend analyses included 21 712 NHANES 1988-1994 and 1999-2012 participants. RESULTS The prevalence of fatty liver was 20%. For the FLI, the area under the receiver operating characteristic curve [AUC; 95% confidence interval (CI)] was 0.78 (0.74-0.81). The US FLI included age, race-ethnicity, waist circumference, GGT activity, fasting insulin and fasting glucose and had an AUC (95% CI) of 0.80 (0.77-0.83). Defining fatty liver as a US FLI ≥ 30, the prevalence increased from 18% in 1988-1991 to 29% in 1999-2000 to 31% in 2011-2012. CONCLUSIONS For predicting fatty liver, the US FLI was a modest improvement over the FLI in the multiethnic U.S. population. Using this measure, the fatty liver prevalence in the U.S. population increased substantially over two decades.
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Affiliation(s)
- C E Ruhl
- Social & Scientific Systems, Inc., Silver Spring, MD, USA
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Wong VWS, Wong GLH. When and how to use steatosis biomarkers? Aliment Pharmacol Ther 2014; 40:1359-60. [PMID: 25376197 DOI: 10.1111/apt.12983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 09/15/2014] [Indexed: 01/02/2023]
Affiliation(s)
- V W-S Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong; Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong; State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
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