Fibrotic NASH in Individuals with Obesity: a Cross-sectional Analysis of the Prevalence of this Significant Milestone of Disease Progression and Accuracy of a Non-invasive Marker for its Screening

Short-Term Evolution of MASLD Following Roux-en-Y Gastric Bypass: A Focus on Fibrotic MASH

BACKGROUND

Metabolic dysfunction-associated steatotic liver disease (MASLD) includes simple steatosis and metabolic dysfuncion-associated steatohepatitis (MASH), with fibrosis in MASH serving as a critical prognostic marker. This study investigates the effects of Roux-en-Y gastric bypass (RYGB) on fibrotic MASH, assessed using the fibrotic NASH index (FNI) and the non-invasive NASH detection score (NI-NASH-DS), as well as provides further data on the diagnostic accuracy of both scores.

METHODS

A retrospective cohort study was conducted involving 104 individuals (91.3% female, mean age 39.4 ± 8.6 years) who underwent RYGB. Histopathological evaluations during surgery identified fibrotic MASH, and FNI and NI-NASH-DS values were calculated at baseline and 1 year post-surgery.

RESULTS

At the time of surgery, participants had a mean BMI of 35.3 ± 2.8 kg/m2, which decreased to 27.1 ± 4.0 kg/m2 1 year after surgery. The mean % total weight loss (%TWL) was 23.8 ± 10.1%, and the mean % excess weight loss (%EWL) was 82.4 ± 37.3%. Fibrotic MASH was present in 17.3% of participants pre-operatively. The mean FNI score significantly decreased after surgery (p < 0.0001). Female gender (p < 0.001) and histological evidence of lobular inflammation (p < 0.001) were independently associated with the improvement of FNI. The FNI demonstrated high diagnostic accuracy (sensitivity: 61.1%, specificity: 96.4%, overall accuracy: 90.2%). NI-NASH-DS had a 60% accuracy in detecting MASH, alongside an 85.9% specificity.

CONCLUSIONS

RYGB seemingly promotes improvement of fibrotic MASH as evaluated by FNI, highlighting its potential as a therapeutic intervention to mitigate MASLD progression. Both FNI and NI-NASH-DS are helpful and inexpensive tools for assessing MASH.

Ultrasound radiomics-based logistic regression model for fibrotic NASH

BACKGROUND

Those who have severe fibrosis (F2 ≥ 2 stage) are at the greatest risk for the advancement of the illness among non-alcoholic fatty liver patients. To forecast the non-alcoholic steatohepatitis (NASH) probability accompanied by significant fibrosis, we propose to develop and validate a nomogram liver imaging reporting and data system, providing robust evidence for preventing and treating clinical liver diseases.

METHODS

The study used SD rats to create a model of hepatic steatosis and fibrosis by feeding them a high-fat diet and injecting Ccl4 subcutaneously. Radiomics characteristics were derived from two-dimensional liver ultrasound images of the rats, and a radiomics model was constructed, with rad-scores calculated accordingly. Univariate and multivariate logistic regression was employed to ascertain the clinical characteristics of rats and liver elasticity values, aiming to establish a clinical model. Ultimately, a clinical radiomics model was created by integrating the rad-score from the radiomics model with independent clinical characteristics from the clinical model. A forest plot was generated to depict this integration. The forest plot's performance was assessed by the use of the area under the receiver operating characteristic (ROC) curve (AUC), decision curve analysis, and calibration curve.

RESULTS

The areas under the receiver operating characteristic curve (AUC) for the training set and validation set of the clinical radiomics model were 0.986 and 0.971, respectively. Decision curve analysis showed that the clinical radiomics model had the highest net benefit across most threshold probability ranges.

CONCLUSION

The nomogram and clinical radiomics model, which consists of clinical characteristics, real-time shear wave elastography, and radiomics, provide excellent predictive capability in assessing the likelihood of fibrotic NASH.

From adiposity to steatosis: metabolic dysfunction-associated steatotic liver disease, a hepatic expression of metabolic syndrome - current insights and future directions

BACKGROUND

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing health concern and the risk of its development is connected with the increasing prevalence of metabolic syndrome (MetS) which occurs as a result of some complex obesity-induced metabolic changes. It is a common chronic liver disease characterized by excessive fat accumulation in the liver, the tendency to progress to more severe forms, and a corresponding increase in morbidity and mortality. Thus, effectively addressing the rising burden of the disease requires a thorough understanding of its complex interrelationship with obesity and MetS.

MAIN BODY

MASLD results from complex interactions involving obesity, insulin resistance, and dyslipidaemia, leading to hepatic lipid accumulation, and is influenced by several genetic and environmental factors such as diet and gut microbiota dysbiosis. It has extensive metabolic and non-metabolic implications, including links to MetS components like hyperglycaemia, hypertension, and dyslipidaemia, and progresses to significant liver damage and other extra-hepatic risks like cardiovascular disease and certain cancers. Diagnosis often relies on imaging and histology, with non-invasive methods preferred over liver biopsies. Emerging biomarkers and OMIC technologies offer improved diagnostic capabilities but face practical challenges. Advancements in artificial intelligence (AI), lifestyle interventions, and pharmacological treatments show promise, with future efforts focusing on precision medicine and novel diagnostic tools to improve patient outcome.

CONCLUSION

Understanding the pathogenic mechanisms underlying the development of MASLD within the context of metabolic syndrome (MetS) is essential for identifying potential therapeutic targets. Advancements in non-invasive diagnostic tools and novel pharmacological treatments, hold promise for improving the management of MASLD. Future research should focus on precision medicine and innovative therapies to effectively address the disease and its consequences.

Association of Histopathological and Biochemical Aspects of NAFLD With the Severity of Liver Fibrosis in Individuals With Obesity: Cross-sectional Study

BACKGROUND

Given the importance of fibrosis in the progression of non-alcoholic fatty liver disease (NAFLD), identifying biochemical and histopathological aspects associated with its severity is important to determine the course of disease in high-risk populations.

OBJECTIVES

The study aims to investigate correlations between biochemical and histopathological variables associated with the occurrence and severity of NAFLD-related liver fibrosis in individuals with obesity.

METHODS

This is a cross-sectional study which enrolled 171 individuals who underwent bariatric surgery at a tertiary university hospital. Clinical, laboratory, and histopathological hepatic characteristics were analyzed. Univariate and multivariate analyses were carried out to identify factors associated with the outcomes studied (severity of fibrosis staging) through simple and multiple regression models.

RESULTS

Female were 87.7%, and the mean age was 38.4 ± 9.3 years. The most common histopathological abnormalities were macrovesicular steatosis (74.9%) and hepatocellular ballooning (40.4%). In the histopathological univariate analysis, liver fibrosis significantly correlated with severities of microvesicular steatosis (p = 0.003), lobular inflammation (p = 0.001), and NAS (p < 0.001). In the multivariate analysis, the degrees of microvesicular steatosis (p < 0.001) and NAS (p < 0.001) independently correlated with fibrosis severity. In the univariate biochemical analysis, fibrosis severity significantly correlated with levels of hemoglobin A1c (p = 0.004) and glucose (p = 0.01). In the multivariate analysis, glucose levels independently correlated with liver fibrosis degree (p = 0.007).

CONCLUSION

Significant and independent associations were observed between the intensities of microvesicular steatosis, NAS, and glucose levels and the severity degree of liver fibrosis in individuals with obesity.