Sarcopenia, a condition shared by various diseases: can we alleviate or delay the progression?

Prophylactic effects of nutrition, dietary strategies, exercise, lifestyle and environment on nonalcoholic fatty liver disease

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease and its prevalence has risen sharply. However, whether nutrition, dietary strategies, exercise, lifestyle and environment have preventive value for NAFLD remains unclear.

METHODS

Through searching 4 databases (PubMed, Web of Science, Embase and the Cochrane Library) from inception to January 2025, we selected studies about nutrition, dietary strategies, exercise, lifestyle and environment in the prevention of NAFLD and conducted a narrative review on this topic.

RESULTS

Reasonable nutrient intake encompassing macronutrients and micronutrients have an independent protective relationship with NAFLD. Besides, proper dietary strategies including mediterranean diet, intermittent fasting diet, ketogenic diet, and dietary approaches to stop hypertension diet have their inhibitory effects on the developmental process of NAFLD. Moreover, right exercises including walking, jogging, bicycling, and swimming are recommended for the prevention of NAFLD because they could effectively reduce weight, which is an important risk factor for NAFLD, and improve liver function. In addition, embracing a healthy lifestyle including reducing sedentary behavior, not smoking, sleeping well and brushing teeth regularly is integral since it not only could reduce the risk of NAFLD but also significantly contribute to overall prevention and control. Finally, the environment, including the social and natural environments, plays a potential role in NAFLD prevention.

CONCLUSION

Nutrition, dietary strategies, exercise, lifestyle and environment play an important role in the prevention of NAFLD. Moreover, this review offers comprehensive prevention recommendations for people at high risk of NAFLD.

Microdroplet-Engineered Skeletal Muscle Organoids from Primary Tissue Recapitulate Parental Physiology with High Reproducibility

Achieving high maturity and functionality in in vitro skeletal muscle models is essential for advancing our understanding of muscle biology, disease mechanisms, and drug discovery. However, current models struggle to fully recapitulate key features such as sarcomere structure, muscle fiber composition, and contractile function while also ensuring consistency and rapid production. Adult stem cells residing in muscle tissue are known for their powerful regenerative potential, yet tissue-derived skeletal muscle organoids have not been established. In this study, we introduce droplet-engineered skeletal muscle organoids derived from primary tissue using cascade-tubing microfluidics. These droplet-engineered organoids (DEOs) exhibit high maturity, including well-developed striated sarcomeres, spontaneous and stimulated contractions, and recapitulation of parental muscle fiber types. Notably, DEOs are produced in just 8 d without the need for primary cell culture-substantially accelerating the 50- to 60-d process required by classical organoid models. Additionally, the cascade-tubing microfluidics platform enables high-throughput production of hundreds of uniform DEO replicates from a small tissue sample, providing a scalable and reproducible solution for skeletal muscle research and drug screening.

Towards Precision in Sarcopenia Assessment: The Challenges of Multimodal Data Analysis in the Era of AI

Sarcopenia, a condition characterised by the progressive decline in skeletal muscle mass and function, presents significant challenges in geriatric healthcare. Despite advances in its management, complex etiopathogenesis and the heterogeneity of diagnostic criteria underlie the limited precision of existing assessment methods. Therefore, efforts are needed to improve the knowledge and pave the way for more effective management and a more precise diagnosis. To this purpose, emerging technologies such as artificial intelligence (AI) can facilitate the identification of novel and accurate biomarkers by modelling complex data resulting from high-throughput technologies, fostering the setting up of a more precise approach. Based on such considerations, this review explores AI's transformative potential, illustrating studies that integrate AI, especially machine learning and deep learning, with heterogeneous data such as clinical, anthropometric and molecular data. Overall, the present review will highlight the relevance of large-scale, standardised studies to validate biomarker signatures using AI-driven approaches.

TSG attenuated NAFLD and facilitated weight loss in HFD-fed mice via activating the RUNX1/FGF21 signaling axis

Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease characterized by steatosis in hepatocytes and is now becoming the major cause of liver-related mortality. Fibroblast growth factor 21 (FGF21) is an endocrine hormone mainly secreted by the liver, which can bind to its receptor (FGFR) and co-receptor beta klotho (KLB) to form a receptor complex, exerting its lipid-lowering function. 2,3,5,4'-Tetrahydroxy-stilbene-2-O-β-D-glucoside (TSG), a natural compound isolated from Polygonum multiflorum Thunb, has shown excellent activity in lowering lipid content and efficacy in improving NAFLD. In this study we investigated whether FGF21 was implicated in the therapeutic effect of TSG in NAFLD mice. NAFLD was induced in mice by feeding with a high-fat diet (HFD) for 12 weeks, and treated with TSG (20, 40 mg·kg-1·d-1, i.g.) during the last 4 weeks. We showed that TSG treatment significantly alleviated NAFLD in HFD-fed mice evidenced by reduced hepatic triglyceride (TG) and non-esterified fatty acids (NEFA), diminished lipid droplets and decreased NAFLD activity score (NAS) in liver tissues. We demonstrated that TSG treatment significantly increased the mRNA and protein levels of FGF21 in vitro and in vivo, and reduced lipid accumulation in both the liver and adipose tissues. Transcriptomics analysis revealed that TSG treatment significantly increased the nuclear translocation of a transcription factor RUNX1. Knockdown of Runx1 in HFD-fed mice eliminated the efficacy of TSG in alleviating NAFLD, reducing hepatic lipid accumulation and regulating FGF21 signaling pathway in liver and adipose tissues. In conclusion, TSG alleviates NAFLD by enhancing the FGF21-mediated lipid metabolism in a RUNX1-dependent manner.

Metabolic dysfunction-associated steaotic liver disease self-management among the Hispanic/Latino population

Introduction

Hispanic/Latino populations in the U.S. have the highest prevalence of Metabolic Dysfunction-Associated Steaotic Liver Disease (MASLD), and diet and exercise management are crucial for controlling the disease. While quantitative research on general diet and physical activity within this population exists, studies specifically addressing the quantitative analysis of self-management behaviors in Hispanic/Latino individuals with MASLD are notably scarce. This gap underscores the need for our focused investigation into these specific behaviors under the framework of self-management.

Objectives

Our study aims to investigate how various factors such as age, gender, socioeconomic status, and cultural influences are associated with diet and exercise self-management behaviors in Hispanic/Latino individuals with MASLD. We specifically explore the impact of these demographic and cultural factors as independent variables on the dependent variables of diet and exercise self-management behaviors.

Methods

This study involved 94 participants who were recruited from the Fresno Clinical Research Center to participate in a cross-sectional analysis designed to explore diet and exercise self-management behaviors among Hispanic/Latino people with MASLD. Data were collected from January 2023 to February 2023 using a 54-item Qualtrics survey.

Results

The average age of the participants was 53 years. Among the participants, 68.1% self- identified as female, and 80.9% had an annual income of at least $35,000. Age b = 0.074, p ≤ 0.001, gender b = 1.242, p ≤ 0.05, and financial stress b = 1.887 p ≤ 0.01 were predictors for poor exercise self-management behaviors. Disease-related knowledge b = -2.264 p ≤ 0.001, and familism b = -0.344 p ≤ 0.05 were predictors for healthy exercise self-management behaviors. There were no significant predictors for diet self-management behaviors among the variables observed in this study.

Conclusion

Age, gender, and financial stress predicted poor exercise self-management behaviors, while disease-related knowledge and familism predicted healthy exercise self-management behaviors.

Association of ultrasound signs of sarcopenia with serum ferritin levels and hepatic indices like NFS and FIB-4 in NAFLD patients

INTRODUCTION

Non-alcoholic fatty liver disease is one of the most common chronic diseases all around the world, which significantly correlates with metabolic disorders and inflammatory cycles. Sarcopenia is a decrease in the mass of skeletal muscles interacting with factors such as inflammatory processes and chronic diseases. It can also lead to the aggravation of chronic diseases.

METHOD

The study population was randomly selected and entered into the research based on exclusion and inclusion criteria. Non-alcoholic fatty liver disease was confirmed in all members of the study population by ultrasound. Patients' serum ferritin level was assessed, and their NFS and Fib 4 scores were calculated. Sarcopenia was diagnosed by measuring the thickness of the rectus femoris by ultrasonography. The correlation between these variables was evaluated and analyzed by statistical software.

RESULTS

According to statistical analysis, there is a significant association between the serum ferritin level and sarcopenia (P-value < 0.001). Besides, there is a significant association between NFS, Fib4, and sarcopenia (P-value = 0.024, 0.000).

CONCLUSION

This research's results reflect the correlation between serum ferritin and sarcopenia; however, it cannot conclude a cause-and-effect relationship between these variables.

Association of Dietary Antioxidant Potential with Sarcopenia in Hypertension

Background

The high prevalence of sarcopenia among hypertensive adults is a global health issue. Growing literature demonstrates that a high antioxidant diet can protect against sarcopenia. However, little attention has been paid to the association between the dietary composite antioxidant intake and sarcopenia in hypertension. To investigate the potential efficacy of the composite dietary antioxidant index (CDAI) on sarcopenia among hypertensive adults.

Methods

This study included 6995 hypertensive adults from the National Health and Nutrition Examination Survey (NHANES) 2001-2006 and 2013-2018, with 3212 (45.92%) females and 3783 (54.08%) males. Appendicular lean mass (ALM) and sarcopenia were assessed by dual-energy X-ray absorptiometry (DEXA). All hypertensive adults participating in NHANES were eligible to participate in dietary interviews, and the average intake of six antioxidants over two days was used to calculate the CDAI. Logistic regression was conducted to determine odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup analyses and restricted cubic spline (RCS) regressions were additionally utilized.

Results

The mean age was 48.47 ± 0.27 years old, and 1059 (15.14%) were considered to have sarcopenia. The highest quartile had a 61% decreased risk of sarcopenia (OR = 0.39, 95% CI: 0.25, 0.60) compared with the lowest quartile of CDAI. RCS revealed a linear association between CDAI with sarcopenia and ALM. Subgroup analyses demonstrated a more pronounced inverse correlation between CDAI and sarcopenia in females.

Conclusions

In summary, our results indicated a reverse correlation between CDAI and sarcopenia in hypertension. These findings highlighted the beneficial role of an antioxidant-rich diet in prevention and provided a valid method for managing sarcopenia in hypertensive adults.

Real-world cross-sectional study evaluating patient characteristics, disease burden, and treatment approaches in people with obesity disease in Japan

AIM

To describe clinical characteristics, disease burden, and treatment patterns among people with obesity disease (PwOD) in Japan, using data from the Adelphi Real World Obesity Disease Specific Programme™ (DSP).

METHODS

Secondary data from the Japanese DSP cohort (July to December 2022) were analyzed. PwOD had a BMI ≥25 kg/m2 and ≥1 obesity-related complications (ORCs). Outcomes were summarized for all PwOD or stratified by obesity class (BMI ≥25-<35 or ≥35 kg/m2 [high-degree obesity disease]) and use of anti-obesity medications (AOMs).

RESULTS

The study included 442 PwOD (mean age: 52.8 years; 54.8% males; BMI ≥25-<35 kg/m2: 64.5%; BMI ≥35 kg/m2: 35.5%; AOM users: n = 228; non-AOM users: n = 214). High-degree obesity disease was associated with worsened SF-36v2 scores (Physical Component Summary, Physical Functioning, Bodily Pain, and General Health), greater activity impairment, and reduced work productivity. Common weight management approaches were diet (79.9%) and exercise (51.1%). Common prescription AOMs included traditional herbal medicine (67.5%) and mazindol (21.1%). People with high-degree obesity disease (BMI ≥35 vs. ≥25-<35 kg/m2) used more prescription AOMs (57.3 vs. 48.4%), behavioral therapy (9.6 vs. 1.8%), and weight loss surgery (2.6 vs. 0.4%). The difference in weight reduction between AOM and non-AOM users was modest.

CONCLUSIONS

People with high-degree obesity disease experienced greater disease burden. Diet and exercise are common for weight management, while behavioral therapy is less frequently implemented. These findings highlight the challenges and unmet medical needs in treating obesity in Japan and could inform better treatment strategies in Japan and globally among the Asian population.

Sarcopenia and the management of spinal disease in the elderly

Sarcopenia, generally defined by the loss of skeletal mass and function, may disproportionately affect elderly individuals and heavily influence spinal disease. Muscle atrophy is associated with myriad clinical problems, including thoracic kyphosis, increased sagittal vertical axis (SVA), spinal implant failures, and postoperative complications. As such, the aim of this narrative review is to synthesize pertinent literature detailing the intersection between sarcopenia and the impact of sarcopenia on the management of spine disease. Specifically, we focus on the domains of etiology, diagnosis and assessment, impact on the cervical and lumbar spine, spinal augmentation procedures, neoplastic disease, whiplash injury, and recovery/prevention. A narrative review was conducted by searching the PubMed and Google Scholar databases from inception to July 12, 2024, for any cohort studies, systematic reviews, or randomized controlled trials. Case studies and conference abstracts were excluded. Diagnosis of sarcopenia relies on the assessment of muscle strength and quantity/quality. Strength may be assessed using clinical tools such as gait speed, timed up and go (TUG) test, or hand grip strength, whereas muscle quantity/quality may be assessed via computed tomography (CT scan), magnetic resonance imaging (MRI), and dual-energy X-ray absorptiometry (DXA scan). Sarcopenia has a generally negative impact on the clinical course of those undergoing cervical and lumbar surgery, and may be predictive of mortality in those with neoplastic spinal disease. In addition, severe acceleration-deceleration (whiplash) injuries may result in cervical extensor muscle atrophy. Intervention and recovery measures include nutrition or exercise therapy, although the evidence for nutritional intervention is lacking. Sarcopenia is a widely prevalent pathology in the advanced-age population, in which the diagnostic criteria, impact on spinal pathology, and recovery/prevention measures remain understudied. However, further understanding of this therapeutically challenging pathology is paramount, as surgical outcome may be heavily influenced by sarcopenia status.

Resmetirom: the first approved therapy for treating metabolic dysfunction associated steatohepatitis

INTRODUCTION

Metabolic dysfunction associated steatohepatitis (MASH), previously referred to as nonalcoholic steatohepatitis (NASH), has emerged as one of the leading indications for liver transplantation in the United States. The disease is associated with increased cardiovascular mortality in patients with early-stage liver fibrosis and a heightened risk of hepatic complications in those with advanced fibrosis. Despite its growing prevalence and significant healthcare burden, there were no approved drugs to treat this chronic disease. In March 2024, Resmetirom, a selective thyroid hormone receptor-beta agonist, became the first drug to receive FDA approval for the treatment of patients with MASH and fibrosis stages F2/F3. This accelerated approval was granted based on significantly higher rates of MASH resolution and fibrosis.

AREAS COVERED

This review summarizes the current literature on the mechanism of action, preclinical data, pharmacokinetics, clinical efficacy, indications, and contraindications of resmetirom in the management of patients with MASH.

EXPERT OPINION

The approval of resmetirom for patients with MASH and moderate to advanced hepatic fibrosis is a major advance in the management of MASH. The recent positive results of the ESSENCE trial of semaglutide, if associated with conditional approval, may offer clinicians two options to treat MASH in patients with moderate to advanced fibrosis.

Polysaccharides Extracted from Old Stalks of Asparagus officinalis L. Improve Nonalcoholic Fatty Liver by Increasing the Gut Butyric Acid Content and Improving Gut Barrier Function

Nonalcoholic fatty liver disease (NAFLD) ranks among the most prevalent chronic liver diseases worldwide, yet effective treatments remain scarce. Old stalks of Asparagus officinalis L. are rich in polysaccharides. The anti-NAFLD mechanism of polysaccharides from old stalks of A. officinalis (AP) requires further study. Here, we studied the effects of AP on NAFLD mice and its impact on the gut microbiota. AP intervention reduces blood lipids and liver lipids and reduces liver injury and inflammation in mice with NAFLD. Moreover, AP intervention changed gut microbiota composition and increased the abundances of butyric acid-producing bacteria, thereby increasing plasma concentration of butyric acid. Furthermore, AP intervention regulated the AMPK/SREBPs signaling pathway, thereby affecting hepatic lipid synthesis. Additionally, AP intervention improved gut barrier function and reduced plasma LPS levels, which subsequently inhibited the LPS/TLR4/NF-κB signaling pathway, thereby alleviating inflammation in NAFLD model mice. Importantly, fecal microbiota transplant (FMT) outcomes demonstrated that AP-induced changes in the gut microbiota impact the AMPK/SREBPs and LPS/TLR4/NF-κB pathways. These data suggest that AP intervention ameliorates NAFLD by regulating the gut microbiota. These research provides a scientific foundation for the use of the stalks of A. officinalis in the treatment of NAFLD.

Clinical and pathological characteristics of metabolic dysfunction-associated steatotic liver disease and the key role of epigenetic regulation: implications for molecular mechanism and treatment

Nonalcoholic fatty liver disease (NAFLD), also called metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent syndrome marked by liver fat accumulation in the absence of significant alcohol consumption, encompassing simple fatty liver, nonalcoholic steatohepatitis (NASH), and advanced stages such as fibrosis and cirrhosis. Its incidence has surged globally, impacting up to 40% of the population, with a doubling of cases in China over a decade. NASH, a severe form, can progress to liver cirrhosis and cancer, posing a substantial health burden, especially among individuals with type 2 diabetes. Projections indicate a steep rise in NASH cases, necessitating urgent interventions beyond lifestyle modifications, such as innovative pharmaceuticals. Early diagnosis is crucial, yet current tools have limitations, highlighting the need for noninvasive, scalable diagnostic approaches. Advances in imaging and biomarker identification offer hope for early detection. Epigenetic factors play a significant role in MASLD pathogenesis, regulating key molecular mechanisms. Addressing MASLD requires a multifaceted approach, integrating lifestyle interventions, pharmacotherapy, and emerging therapeutics, against the backdrop of an evolving landscape in disease management.

Diagnostic accuracy of two-dimensional shear wave elastography and point shear wave elastography in identifying different stages of liver fibrosis in patients with metabolic dysfunction-associated steatotic liver disease: A meta-analysis

To assess the diagnostic accuracy of two-dimensional shear wave elastography (2-D SWE) and point shear wave elastography (pSWE) in detecting liver fibrosis stages in patients with metabolic dysfunction-associated steatotic liver disease (MASLD), a comprehensive search was conducted across four databases up to February 9, 2024. A bivariate random-effects model was used to analyze the diagnostic accuracy of the methods. After screening, 13 studies involving pSWE included 1527 patients, while nine studies involving 2-D SWE included 1088 patients. The areas under the summary receiver operating characteristic (SROC) curves for diagnosing significant fibrosis (F ≥ 2), advanced fibrosis (F ≥ 3), and cirrhosis (F = 4) using pSWE and 2-D SWE were as follows: 0.84 (95% CI 0.80-0.87), 0.91 (95% CI 0.88-0.93), and 0.94 (95% CI 0.91-0.95) for pSWE; 0.83 (95% CI 0.79-0.86) 0.85 (95% CI 0.82-0.88), and 0.89 (95% CI 0.86-0.91) for 2-D SWE, respectively. The pooled sensitivity for pSWE and 2-D SWE for stages F ≥ 2, F ≥ 3, and F = 4 were 0.71 (95% CI 0.63-0.78), 0.81 (95% CI 0.72-0.88), and 0.81 (95% CI 0.63-0.91) for pSWE, and 0.77 (95% CI 0.68-0.84), 0.80 (95% CI 0.72-0.87), and 0.92 (95% CI 0.75-0.98) for 2-D SWE, respectively. The pooled specificity of pSWE and 2-D SWE for these stages were 0.83 (95% CI 0.76-0.88), 0.87 (95% Cl: 0.81-0.92), and 0.91 (95% CI 0.86-0.94) for pSWE, and 0.76 (95% CI 0.66-0.84), 0.76 (95% CI 0.69-0.82), and 0.83 (95% CI 0.78-0.85) for 2-D SWE, respectively. In conclusion, both 2-D SWE and pSWE demonstrated high diagnostic performance in identifying various stages of liver fibrosis in MASLD patients.

Aqueous extract of Atractylodes macrocephala Koidz. improves dexamethasone-induced skeletal muscle atrophy in mice by enhancing mitochondrial biological function

PURPOSE

The study aims to investigate the therapeutic effects of the aqueous extract of Atractylodes macrocephala Koidz. (AEA) on dexamethasone (Dex) -induced sarcopenia in mice and to explore its possible mechanisms of action.

METHODS

This study utilized bioinformatics analysis to explore the primary pathogenic mechanisms of age-related sarcopenia and Dex-induced muscle atrophy. In animal experiments, a mouse model of muscle atrophy was established using Dex, and different doses of AEA were administered for treatment. The therapeutic effects of AEA were evaluated through tests of motor ability and histological analysis, and the molecular mechanisms predicted by bioinformatics were verified by measuring the expression levels of related genes.

RESULTS

Bioinformatics analysis suggests that there may be shared pathogenic mechanisms related to mitochondrial function and structure between age-related sarcopenia and Dex-induced muscle atrophy. Dex significantly reduced the mass, function, and cross-sectional area of muscle fibers in mice, and also induced changes in muscle fiber types. In contrast, AEA significantly ameliorated the aforementioned atrophic effects caused by Dex. The modulation of mitochondrial biogenesis and dynamics may be a crucial mechanism by which AEA exerts its anti-sarcopenia effects.

CONCLUSION

AEA can significantly alleviate the symptoms of Dex-induced skeletal muscle atrophy in mice by improving mitochondrial function, indicating its potential for clinical application in the prevention and treatment of age-related sarcopenia.

Hypothyroidism/subclinical hypothyroidism and metabolic dysfunction-associated steatotic liver disease: advances in mechanism and treatment

Hypothyroidism is a risk factor for metabolic dysfunction-associated steatotic liver disease (MASLD) but it is not clear whether subclinical hypothyroidism (SCH) increases the risk of MASLD and whether SCH patients with MASLD require treatment. In this study, we reviewed articles published in PubMed from 2013 to 2024 with SCH/hypothyroidism and MASLD as keywords. According to the studies retrieved, SCH increases the likelihood of developing MASLD. Thyroid hormones influence energy metabolism and storage in adipose tissues, as well as fatty acid and cholesterol metabolism and transport in the liver. L-T4 replacement therapy reduces the prevalence of MASLD, especially in patients with severe SCH or mild SCH with dyslipidemia. Recent studies showed that thyroid hormone analogues and thyroid hormone β receptor agonists obtained positive results in the treatment of MASLD in animal models and clinical trials, and Resmetirom has been approved by the US. Food and Drug Administration (FDA) under the name Rezdiffra for use in conjunction with dietary and exercise regimens for managing non-cirrhotic NASH in adults with moderate to advanced fibrosis.

Age Difference in the Connection Between Systemic Inflammatory Response and Metabolic Syndrome

BACKGROUND

This research aims to investigate the connection between systemic inflammatory response and metabolic syndrome (MetS) across different age groups, with the aim of proposing more targeted recommendations.

METHODS

This study enrolled 15 959 adults from the 2001-2018 National Health and Nutrition Examination Survey of whom 6739 were diagnosed with MetS. After dividing the systemic immune-inflammation index (SII) into 4 quartiles, the Kruskal-Wallis test and weighted chi-square test were employed to assess statistical differences. Weighted multivariable logistic regression analysis, subgroup analysis, sensitivity analysis, and restricted cubic spline were employed to examine the relationship between SII and MetS.

RESULTS

Our study revealed that SII exhibits a quantitative association with MetS [odds ratio (OR) = 1.56; 95% confidence interval (CI): 1.37-1.79; P < .001]. Elevated SII is an independent risk factor for the 5 components of MetS. Different age groups and alcohol consumption status could modify the connection between SII and MetS. This connection was statistically significant in the 18 to 65 age group but not in the elderly subgroup (OR = 1.08; 95% CI, .95-1.23; P = .248). Multiple imputation confirmed the robustness of our results. Moreover, the connection exhibits an inverted U-shaped curve.

CONCLUSION

Our research highlights the predictive significance of SII in forecasting the incidence of MetS in young and middle-aged populations. The differences in inflammatory mechanisms across various age groups necessitate further research for exploration.

What is normal age-related thigh muscle composition among 45- to 84-year-old adults from the UK Biobank study

A loss of skeletal muscle mass and an increase in intramuscular fat are known to occur as we enter middle and older age, but the expected changes or normative values have remained unknown. The primary reason for this is that imaging studies are difficult and expensive to conduct, and consequently, the sample sizes have remained small. The development of the UK Biobank which provides access to a large magnetic resonance imaging (MRI) data set of more than 50,000 participants provides an opportunity to finally address this question of normative values for each age group. The study's primary aim was to determine the age-related changes in thigh muscle composition (e.g., thigh fat-free muscle volume and intramuscular fat) between the ages of 45 and 84 years. The second aim was to analyse associations between thigh fat-free muscle volume and intramuscular fat with lifestyle behaviours (smoking, alcohol consumption, and physical activity), leg pain, and bone mineral density. Fifty thousand three hundred thirty-two participants were included in the study. Total fat-free thigh muscle declined between the ages of 45 and 84 years, while intramuscular fat of the thigh continued to increase. The changes were stable between these age groups. The mean volume of fat-free muscle ranged from 11.16 (SD: 1.40) to 13.26 L (SD: 1.85) in adult males and 7.60 (SD: 0.97) to 8.80 L (SD 1.29) in females between the ages of 45 and 84 years. For intramuscular fat, the change among women was from 6.94% (SD: 1.59) in the 45 to 54 years age bracket to 8.83% (SD: 1.92) in the 75 to 84 age bracket, while for men, it was 5.83% (SD: 1.30) in the 45 to 54 age bracket to 7.85% (SD 1.89) in the 75 to 84 age bracket. The total fat-free muscle volume and intramuscular fat percentage provided can be used for the purpose of reference standards or normative values for adults in the age groups provided. Fat-free muscle and intramuscular fat were found to be associated with a range of health, activity, and leg pain outcomes, and these should be investigated in a follow-up longitudinal imaging study.

Effects of exercise and nutrition in improving sarcopenia in liver cirrhosis patients: a systematic review and meta-analysis

Background

Sarcopenia is highly prevalent in patients with liver cirrhosis (LC), adversely affecting their quality of life and life expectancy. Exercise and nutrition represent common interventions to ameliorate sarcopenia in these patients, although there exists inconsistency in the reported effectiveness of these strategies. This study seeks to assess the impact of exercise and nutrition on sarcopenia in LC patients through a systematic review and meta-analysis.

Methods

The research protocol was preregistered on PROSPERO, and adherence to PRISMA reporting guidelines was maintained throughout the systematic review process. Controlled vocabularies via Emtree, MeSH, and CINAHL Subject Heading were searched in five databases without any language limitation. The final analysis included only studies with a randomized controlled trial (RCT) design published by December 2021. The quality of these studies was assessed by the Cochrane ROB 2.0 version, and the meta-analysis was conducted using Review Manager 5.4 version.

Results

A total of 262 studies were screened, and seven RCT studies involving 206 subjects were included in the meta-analysis. Exercise interventions encompassed muscle-strengthening, cardiopulmonary enhancement, and increased walking steps, while nutrition interventions included protein, branched-chain amino acids (BCAAs), carbohydrates, and vitamins. Most interventions had a duration of 8-12 weeks. Significant improvements in skeletal muscle index [mean difference (MD): 0.53, P=0.01, 95% confidence interval (CI): -0.10, 0.96, I2=0%] and albumin (MD: 0.16, P=0.04, 95% CI: 0.01, 0.31, I2=0%) were observed in the experimental group when interventions extended for 12 months. Various indicators, such as thigh circumference, midarm circumference, and sit-to-stand, showed significant improvements within the experimental groups following interventions.

Conclusions

Exercise and nutrition interventions demonstrate efficacy in improving sarcopenia in LC patients, with more pronounced effects observed with interventions lasting 12 months or longer. Skeletal muscle index and albumin levels in patients with LC can be positively influenced by exercise and nutrition strategies. Emphasizing a healthy diet and regular exercise is crucial for preventing sarcopenia in patients with LC.

The systemic immune inflammation index is a reliable and novel risk factor for metabolic dysfunction-associated fatty liver disease

BACKGROUND

Metabolic dysfunction-associated fatty liver disease (MAFLD) can trigger inflammation, hepatocellular damage, cirrhosis, and hepatocellular carcinoma. There is a need for non-invasive, cost-effective diagnostic markers for MAFLD, as current methods like liver biopsy are invasive. This study investigates the potential of the systemic immune inflammation index (SII) as a useful tool in diagnosis of MAFLD.

METHODS

A cohort of 806 individuals, including 426 with MAFLD and 380 controls, was analyzed. SII values, along with various biochemical and inflammatory markers, were compared between groups.

RESULTS

The MAFLD group exhibited significantly higher SII values, which correlated with key markers of liver inflammation and function. Median SII levels of the MAFLD patients (581 (45-4553)) were significantly higher than that of the control group (423 (112-2595)) (p <0.001). SII showed moderate sensitivity (72%) and specificity (56%) in detecting MAFLD. Logistic regression analysis identified SII as an independent risk factor for MAFLD, with a unit increase in SII increasing the risk by 1.21 times.

CONCLUSIONS

These findings suggest that SII could serve as a useful, noninvasive marker for diagnosing and monitoring MAFLD, warranting further longitudinal studies to explore its role in disease progression and treatment response.

Association of exposure to multiple volatile organic compounds with ultrasound-defined hepatic steatosis and fibrosis in the adult US population: NHANES 2017-2020

Objective

Volatile organic compounds (VOCs) are pervasive environmental pollutants known to impact human health, but their role in liver steatosis or fibrosis is not fully understood. This study investigates the association of urinary VOC mixtures with the risk of liver steatosis and fibrosis in U.S. adult population.

Methods

Data of 1854 adults from the National Health and Nutrition Examination Survey (NHANES) from 2017.01 to 2020.03 were collected. Vibration Controlled Transient Elastography (VCTE) assessed hepatic steatosis and liver fibrosis via the controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), respectively. The study examined the relationship between urinary exposure biomarkers for 20 VOCs and liver health outcomes using multivariate logistic regression and Bayesian Kernel Machine Regression (BKMR) to evaluate the effects of both individual and mixed VOC exposures.

Results

Multivariate logistic regression analysis revealed that exposure biomarkers for acrolein and crotonaldehyde were positively associated with hepatic steatosis. Conversely, biomarkers for styrene, ethylbenzene, and propylene oxide were negatively associated with hepatic steatosis. Furthermore, biomarkers for 1,3-butadiene and xylene were positively associated with liver fibrosis, while ethylbenzene was negatively associated with this condition. BKMR analysis identified a significant positive joint effect of VOC biomarkers on CAP. Notably, when other VOC-EBs were held at median levels, biomarkers for acrolein and 1,3-butadiene exhibited linear correlations with Ln CAP and hepatic Ln LSM, respectively.

Conclusion

The study highlights the potential hepatotoxic effects of VOC mixtures, particularly noting the roles of acrolein and 1,3-butadiene in exacerbating liver steatosis and fibrosis. These findings advocate for further research to explore the mechanistic pathways and conduct longitudinal studies to establish causality and enhance understanding of VOCs' impact on liver health.

Ginsenoside, a potential natural product against liver diseases: a comprehensive review from molecular mechanisms to application

Liver disease constitutes a significant cause of global mortality, with its pathogenesis being multifaceted. Identifying effective pharmacological and preventive strategies is imperative for liver protection. Ginsenosides, the major bioactive compounds found in ginseng, exhibit multiple pharmacological activities including protection against liver-related diseases by mitigating liver fat accumulation and inflammation, preventing hepatic fibrosis, and exerting anti-hepatocarcinogenic effects. However, a comprehensive overview elucidating the regulatory pathways associated with ginsenosides in liver disease remains elusive. This review aims to consolidate the molecular mechanisms through which different ginsenosides ameliorate distinct liver diseases, alongside the pathogenic factors underlying liver ailments. Notably, ginsenosides Rb1 and Rg1 demonstrate significantly effective in treating fatty liver, hepatitis, and liver fibrosis, and ginsenosides CK and Rh2 exhibit potent anti-hepatocellular carcinogenic effects. Their molecular mechanisms underlying these effects primarily involve the modulation of AMPK, NF-κB, TGF-β, NFR2, JNK, and other pathways, thereby attenuating hepatic fat accumulation, inflammation, inhibition of hepatic stellate cell activation, and promoting apoptosis in hepatocellular carcinoma cells. Furthermore, it provides insights into the safety profile and current applications of ginsenosides, thereby facilitating their clinical development. Consequently, ginsenosides present promising prospects for liver disease management, underscoring their potential as valuable therapeutic agents in this context.

Triterpenoids from Chios Mastiha Resin Against MASLD-A Molecular Docking Survey

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease without an approved pharmacological approach for its prevention/treatment. Based on the modified Delphi process, NAFLD was redefined as metabolic dysfunction-associated steatotic liver disease (MASLD) to highlight the metabolic aspect of liver pathogenesis. Chios mastiha (Pistacia lentiscus var. Chia, Anacardiaceae) resin demonstrated promising results in MASLD treatment. In this paper, molecular docking was applied to test 16 compounds from Chios mastiha as potential ligands for the receptors GR, LXRα, LXRβ, PPARα PPARγ, MC4R, AMPK, and VEGFR2, whose up- and down-regulation interfere with MASLD development and progression. The observed compounds had moderate and high affinity for LXR, GR, MC4R, and PPARγ in comparison to proven ligands, while their affinity for PPARα, AMPK, and VEGFR was less pronounced. The combination of active compounds from Chios mastiha rather than a single molecule may have a superior ability to control the intertwined MASLD metabolic pathways.

Miniaturized Liver Disease Mimics to Gain Insights into MMP Expression during Disease Progression

Nonalcoholic fatty liver disease (NAFLD) encompasses a spectrum of liver conditions, ranging from hepatic steatosis to steatohepatitis, fibrosis, and severe outcomes such as cirrhosis or cancer. The progression from hepatic steatosis to fibrosis involves significant extracellular matrix (ECM) remodeling, characterized by increased collagen deposition and cross-linking of ECM proteins, causing increased tissue stiffness and altered MMP expression patterns. Dysregulated MMP expression and extracellular acidosis are key contributors to NAFLD progression. Unlike other MMPs, which may be relevant only at specific disease stages, MMP-9 serves as a universal marker, allowing for monitoring of its expression in relation to disease states and ECM parameters. Understanding dysregulated MMP-9 expression across different NAFLD stages can provide crucial insights into disease progression and serve as both a diagnostic and a prognostic biomarker, identifying potential therapeutic targets. This study introduces a three-dimensional (3D) collagen/alginate-based liver disease model designed to investigate how matrix collagen content, elasticity, and diseased cell conditions influence MMP expression and pH levels in situ using nanoprobes. The platform offered an understanding of the relationships between these factors and their role in NAFLD progression, offering valuable insights into disease progression and potential resolution. To examine how various physicochemical and biological factors, particularly MMP expression and collagen deposition, drive NAFLD progression, three 3D NAFLD models were developed, simulating healthy (HL), steatotic (SL), and fibrotic (FL) liver matrices. Additionally, the role of collagenase treatment in the FL matrix in enhancing MMP expression and potentially mitigating fibrosis was also explored. By employing dual-sensitive fluorescent nanoprobes to monitor real-time in situ changes in MMP-9 expression and pH levels, this platform offers a novel approach to understanding the in vitro roles of matrix stiffness, collagen deposition, and diseased cell conditions in NAFLD pathogenesis.

Extracellular vesicle-mediated approaches for the diagnosis and therapy of MASLD: current advances and future prospective

Metabolic dysfunction-associated steatotic liver disease (MASLD) is an asymptomatic, multifaceted condition often associated with various risk factors, including fatigue, obesity, insulin resistance, metabolic syndrome, and sleep apnea. The increasing burden of MASLD underscores the critical need for early diagnosis and effective therapies. Owing to the lack of efficient therapies for MASLD, early diagnosis is crucial. Consequently, noninvasive biomarkers and imaging techniques are essential for analyzing disease risk and play a pivotal role in the global diagnostic process. The use of extracellular vesicles has emerged as promising for early diagnosis and therapy of various liver ailments. Herein, a comprehensive summary of the current diagnostic modalities for MASLD is presented, highlighting their advantages and limitations while exploring the potential of extracellular vesicles (EVs) as innovative diagnostic and therapeutic tools for MASLD. With this aim, this review emphasizes an in-depth understanding of the origin of EVs and the pathophysiological alterations of these ectosomes and exosomes in various liver diseases. This review also explores the therapeutic potential of EVs as key components in the future management of liver disease. The dual role of EVs as biomarkers and their therapeutic utility in MASLD essentially highlights their clinical integration to improve MASLD diagnosis and treatment. While EV-based therapies are still in their early stages of development and require substantial research to increase their therapeutic value before they can be used clinically, the diagnostic application of EVs has been extensively explored. Moving forward, developing diagnostic devices leveraging EVs will be crucial in advancing MASLD diagnosis. Thus, the literature summarized provides suitable grounds for clinicians and researchers to explore EVs for devising diagnostic and treatment strategies for MASLD.

The effect of gut microbiome-targeted therapies in nonalcoholic fatty liver disease: a systematic review and network meta-analysis

Background

The incidence of NAFLD is increasing. Preclinical evidences indicate that modulation of the gut microbiome could be a promising target in nonalcoholic fatty liver disease.

Method

A systematic review and network meta-analysis was conducted to compare the effect of probiotics, synbiotics, prebiotics, fecal microbiota transplant, and antibiotics on the liver-enzyme, metabolic effects and liver-specific in patients with NAFLD. The randomized controlled trails (RCTs), limited to English language were searched from database such as Pubmed, Embase, Web of science and Cochrane Library from inception to November 2024. Review Manager 5.3 was used to to draw a Cochrane bias risk. Inconsistency test and publication-bias were assessed by Stata 14.0. Random effect model was used to assemble direct and indirect evidences. The effects of the intervention were presented as mean differences with 95% confidence interval.

Results

A total of 1921 patients from 37 RCTs were eventually included in our study. 23 RCTs evaluated probiotics, 10 RCTs evaluated synbiotics, 4 RCTs evaluated prebiotics, 3 RCTs evaluated FMT and one RCT evaluated antibiotics. Probiotics and synbiotics were associated with a significantly reduction in alanine aminotransferase [ALT, (MD: -5.09; 95%CI: -9.79, -0.39), (MD: -7.38, 95CI%: -11.94, -2.82)] and liver stiffness measurement by elastograph [LSM, (MD: -0.37;95%CI: -0.49, -0.25), (MD: -1.00;95%CI: -1.59, -0.41)]. In addition to, synbiotics was superior to probiotics in reducing LSM. Synbiotics was associated with a significant reduction of Controlled Attenuation Parameter [CAP, (MD: -39.34; 95%CI: -74.73, -3.95)]. Both probiotics and synbiotics were associated with a significant reduction of aspartate transaminase [AST, (MD: -7.81; 95%CI: -15.49, -0.12), (MD: -13.32; 95%CI: -23, -3.64)]. Probiotics and Allogenic FMT was associated with a significant reduction of Homeostatic Model Assessment for Insulin Resistance [HOMA-IR, (MD: -0.7, 95%CI: -1.26, -0.15), (MD: -1.8, 95%CI: -3.53, - 0.07)]. Probiotics was associated with a significant reduction of body mass index [BMI, MD: -1.84, 95%CI: -3.35, -0.33].

Conclusion

The supplement of synbiotics and probiotics maybe a promising way to improve liver-enzyme, LSM, and steatosis in patients with NAFLD. More randomized controlled trials are needed to determine the efficacy of FMT and antibiotics on NAFLD. And the incidence of adverse events of MTTs should be further explored.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, CRD42023450093.

Elevated GGT to HDL ratio as a marker for the risk of NAFLD and liver fibrosis

This study investigated the association between NAFLD and liver fibrosis and the ratio of gamma-glutamyl transferase to high-density lipoprotein cholesterol (GGT/HDL-C). In this cross-sectional study, we included 4764 subjects who participated in the National Health and Nutrition Examination Survey (NHANES) during 2017-2018. Adjusted multivariate logistic regression analysis was utilized to evaluate the relationships between GGT/HDL-C levels and NAFLD, fatty liver degree, and liver fibrosis. The non-linear link between NAFLD and the GGT/HDL-C ratio was examined using generalized additive models. There was a non-linear association between GGT/HDL-C and the risk of NAFLD, and all regression models demonstrated a strong relationship between GGT/HDL-C levels and the risk of liver fibrosis, the degree of hepatic steatosis, and the prevalence of NAFLD. Subgroup analyses revealed a significant correlation between the risk of NAFLD and the GGT/HDL-C ratio among Mexican Americans and young people in the 20-40 age range. The receiver operating characteristic (ROC) study showed that GGT/HDL-C was a more accurate predictor of NAFLD than GGT or HDL-C alone. In the U.S. population, an increased risk of NAFLD, the severity of hepatic steatosis, and the risk of liver fibrosis are independently correlated with an elevated GGT/HDL-C ratio.

Herbal Treatments for Obesity: A Review

Obesity is the most pervasive metabolic disorder, further linked with many other diseases, including diabetes, hypertension, cardiovascular disorders, and sleep apnea. To control the increasing weight of obese individuals, experts usually recommend exercise and lifestyle alterations, but medication and surgeries are also advised in severe cases. FDA-approved obesity-controlling drugs are effective but possess certain adverse effects, including dry mouth, drug abuse, dysregulation in monoamine neurotransmitters, insomnia, and many more. Medication processes are expensive; researchers have focused on safer and more effective alternative approaches than pharmaceutical drugs. Historically, a diverse array of herbal plants has been used due to their therapeutic effect, as invitro and in vivo experimentations have proved the effectiveness of herbal plants without associated mortality. In this review, we present various herbs with their metabolically active secondary metabolites, including Berberis vulgaris L, Rhizoma Coptidis, Radix Lithospermi, Aloe vera, Clerodendrum multiflorum Burm f., Astragalus membranaceus (Fisch), Boerhaavia diffusa, Achyranthes aspera L., etc. All of these herbs are responsible for anti-obesity, anti-diabetic, and anti-inflammatory effects. Most previously published clinical trials and animal studies have confirmed the significant potential of these herbal plants and their active ingredients to reduce weight by decreasing the accumulated fats in the body have also been discussed in this review. Thus, it is concluded that scientists must consider and utilize these natural treasures for safe, effective, and cost-effective treatment. It will open new and novel ways for treatment regimes.

The Relationship Between Remnant Cholesterol and Visceral Adipose Tissue: A National Cross-Sectional Study

The aim of our study is to explore the relationship between remnant cholesterol (RC) levels and visceral adipose tissue (VAT) in the US adult population. This cross-sectional study utilized data from 5301 participants aged 20 to 59 years gathered by the National Health and Nutrition Examination Survey (NHANES). RC was determined by deducting both high-density lipoprotein cholesterol (HDL-c) and low-density lipoprotein cholesterol (LDL-c) from total cholesterol (TC), and VAT was measured using dual-energy X-ray absorptiometry. Visceral obesity is defined as a VAT area ≥ 100 cm2. With increasing quartiles of RC levels, the prevalence of visceral obesity rises (16.51% vs. 36.11% vs. 55.66% vs. 74.48%, p<0.001). After adjusting for confounders, RC levels positively correlate with visceral obesity risk (OR=1.039, 95% CI 1.031-1.048, p<0.001). Additionally, individuals with low LDL-c/high RC and those with high LDL-c/low RC showed 2.908-fold (95% CI 1.995-4.241) and 1.310-fold (95% CI 1.022-1.680) higher risk of visceral obesity, respectively, compared to those with low LDL-c/low RC. Receiver Operating Characteristic (ROC) and Decision Curve Analysis (DCA) show RC's superior predictive ability over other lipid markers. Subgroup analysis showed that the relationship between RC and visceral obesity was more ronounced in those with cardiovascular disease. Smooth curve fitting indicated a nonlinear relationship between RC levels and VAT area. Our study highlights that elevated levels of RC are associated with adverse accumulation of VAT. However, the causal relationship between RC and visceral obesity requires additional investigation.

Tirzepatide for overweight and obesity management

INTRODUCTION

Tirzepatide is a once-weekly dual agonist, acting on glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptors. It is approved at the same doses (5, 10 and 15 mg) for both type 2 diabetes (T2D) and chronic weight management.

AREAS COVERED

Following a search in PubMed, clinicaltrials.gov, conference abstracts and Lilly website, we review herein the global phase 3 SURMOUNT program on tirzepatide's safety and efficacy for chronic weight management. Additionally, we discuss findings from the regional SURMOUNT-CN and SURMOUNT-J trials (in East-Asian populations) and the phase 2 SYNERGY-NASH, phase 3 SURMOUNT-OSA and SUMMIT studies on tirzepatide's impact on obesity-related complications. We also explore the clinical implications of SURMOUNT program results, considerations for tirzepatide prescribing for overweight/obesity, ongoing research and evidence gaps.

EXPERT OPINION

Tirzepatide marks a new era in overweight/obesity treatment, enabling many to achieve ≥ 20% weight loss. It is well-tolerated with a safety profile similar to GLP-1 receptor agonists. Tirzepatide also results in clinically important improvements in multiple obesity-related complications including sleep apnea, metabolic-dysfunction associated steatohepatitis, heart failure with preserved ejection fraction and diabetes prevention. Ongoing trials will provide further data on tirzepatide's long-term safety, efficacy (including cardiovascular outcomes) and potential cost-effectiveness for managing overweight/obesity and/or T2D.

Statin Monotherapy Not Inferior to Aspirin or Combined Aspirin and Statins Reducing the Incidences of Cirrhosis, HCC, and Mortality in MAFLD/MASH Patients: A Population Cohort Study

Purpose

Metabolic dysfunction-associated fatty liver disease (MAFLD) and metabolic dysfunction-associated steatohepatitis (MASH) pose significant risks for liver cirrhosis and hepatocellular carcinoma (HCC). Daily aspirin and statins could reduce HCC in patients with MAFLD/MASH. We aimed to clarify whether combined aspirin and statins exert a synergistic effect on prevention of cirrhosis and HCC in patients with MAFLD/MASH.

Patients and Methods

Patients and their clinical data were collected from the National Health Insurance Research Database (NHIRD), encompassing about 20 million population. A total of 735,574 MAFLD/MASH patients between January 1, 2009, and December 31, 2020 were identified. After applying exclusion criteria, 662,004 cases were enrolled, with a follow-up period of 3 years. Propensity score matching was employed for comparative analysis.

Results

Our findings indicate that combined statin and aspirin use significantly reduced the incidence of liver cirrhosis (p < 0.001) compared to statin or aspirin alone, or non-use of both drugs. However, the combined therapy did not confer additional benefits in reducing mortality rates and HCC. Furthermore, statin monotherapy exhibited a more pronounced effect in reducing mortality and HCC compared to aspirin alone or combined therapy.

Conclusion

Our study underscores that statin monotherapy was not inferior to aspirin or aspirin-statin combined therapies in terms of chemoprevention of cirrhosis, HCC, and overall mortality in MAFLD/MASH patients.

Effects of nocturnal snacks on body composition in patients with liver cirrhosis

BACKGROUND

Patients with liver cirrhosis are universally malnourished and the nocturnal snacks intervention is the currently recommended nutritional intervention for patients with liver cirrhosis. Body composition is an important indicator for the assessment of nutritional conditions. We investigated the effects of nocturnal snacks (200 kcal/day) for 3 months on body composition in patients with liver cirrhosis.

AIM

To investigate the effect of nocturnal snacks on body composition in patients with cirrhosis.

METHODS

Seventy patients with liver cirrhosis and 30 healthy controls were enrolled, and differences in body composition were detected using InBody 720, a body composition analyzer. The patients were further randomized into a normal diet group (three meals a day) and nocturnal snacks group (three meals a day + nocturnal snacks). The effect of nocturnal snacks on the body composition of patients with cirrhosis was assessed after 3 months of intervention.

RESULTS

Body fat mass (BFM), skeletal muscle mass (SMM), fat free mass, visceral fat area (VFA), and body cell mass (BCM) were significantly lower in the liver cirrhosis patients than in the healthy controls. After 3 months’ intervention, BFM, VFA and BCM were significantly higher in the nocturnal snacks group than in the normal diet group, with no significant differences in total caloric intake and daily activity. However, there was no significant difference in SMM between the nocturnal snacks and normal diet groups.

CONCLUSION

Long-term nocturnal snacks may improve body composition indices such as BFM, VFA and BCM in patients with cirrhosis. However, the improvement was minor for SMM.

The Putative Antilipogenic Role of NRG4 and ERBB4: First Expression Study on Human Liver Samples

BACKGROUND

Epidermal growth factor receptor 4 (ERBB4) and neuregulin 4 (NRG4) have been shown to reduce steatosis and prevent the development of non-alcoholic steatohepatitis in mouse models, but little to nothing is known about their role in non-alcoholic fatty liver disease (NAFLD) in humans. This study is the first to investigate the expression of ERBB4 and NRG4 mRNAs and their role in lipid metabolism in the livers of individuals with obesity, type 2 diabetes and biopsy-proven NAFLD.

METHODS

Liver biospecimens were obtained intraoperatively from 80 individuals. Quantitative reverse transcription polymerase chain reaction was used to measure the expression levels of mRNAs ERBB4 and NRG4, as well as key lipogenesis genes in the liver tissue of the donors. Histological analysis was conducted on liver biopsies from 36 subjects, and the levels of the examined transcripts were compared with the stage of NAFLD.

RESULTS

In individuals with elevated body mass index (BMI), ERBB4 and NRG4 levels decreased, while ACACA levels increased. A strong negative correlation was observed between NRG4 and ACACA levels. No deregulation of the analyzed transcripts was detected in NAFLD.

CONCLUSIONS

The study demonstrates a decrease in ERBB4 and NRG4 mRNA expression in the livers of subjects with high BMI but not in those with NAFLD. The correlation of the studied transcripts with major lipogenesis genes was assessed, and on this basis a putative scheme for NRG4-mediated suppression of hepatic de novo lipogenesis was hypothesised, offering new research vectors in this field.

Association between triglyceride glucose-body mass index and the staging of non-alcoholic steatohepatitis and fibrosis in patients with non-alcoholic fatty liver disease

OBJECTIVE

The objective of this study was to thoroughly investigate the clinical value of triglyceride glucose-body mass index (TyG-BMI) in patients diagnosed with non-alcoholic fatty liver disease (NAFLD). Specifically, we aimed to determine its association with non-alcoholic steatohepatitis (NASH) and the progression of liver fibrosis.

METHODS

The study included 393 patients diagnosed with NAFLD after liver biopsy. The patients were divided into two distinct cohorts: a training cohort (N = 320) and a validation cohort (N = 73). The training cohort was further divided into four groups based on TyG-BMI quartiles. The clinical characteristics of the patients in each group were compared in detail, and the association between TyG-BMI and NASH, NAFLD Activity Score (NAS) ≥ 4, at-risk NASH, significant fibrosis, advanced fibrosis, and cirrhosis was analyzed using multiple models. Additionally, we generated receiver operating characteristic (ROC) curves to evaluate the predictive ability of TyG-BMI for NASH and fibrosis staging in patients with NAFLD.

RESULTS

Patients with higher TyG-BMI values had a significantly higher prevalence of NASH, NAS ≥ 4, at-risk NASH, significant fibrosis, advanced fibrosis, and cirrhosis (all p < .05). TyG-BMI was an independent predictor of these diseases in both unadjusted and adjusted models (all p < .05). ROC curve analysis further revealed the excellent performance of TyG-BMI in predicting NASH, NAS ≥ 4, at-risk NASH, significant fibrosis, advanced fibrosis, and cirrhosis. The validation cohort yielded analogous results. Furthermore, we constructed three multivariate models of TyG-BMI in conjunction with elastography metrics, which demonstrated elevated diagnostic AUC values of 0.782, 0.792, 0.794, 0.785, 0.834, and 0.845, respectively.

CONCLUSION

This study confirms a significant association between insulin resistance and NAFLD, including at-risk NASH and fibrosis staging, as assessed using the TyG-BMI index. TyG-BMI and its associated multivariate models can be valuable noninvasive indicators for NAFLD diagnosis, risk stratification, and disease course monitoring.

Association Between Remnant Cholesterol and Risk of Hyperuricemia: A Cross-Sectional Study

Remnant cholesterol (RC) is closely related to metabolic diseases. Our study aims to explore the relationship between RC and hyperuricemia. This cross-sectional study included 14 568 adults aged 20 years or older from the National Health and Nutrition Examination Survey (NHANES) conducted between 2007 and 2018 in the United States. RC is calculated by subtracting high-density lipoprotein cholesterol (HDL-c) and low-density lipoprotein cholesterol (LDL-c) from total cholesterol (TC). Hyperuricemia is defined by serum uric acid (SUA) levels≥7 mg/dl in men and≥6 mg/dl in women. The independent association between RC and hyperuricemia was evaluated. As the quartile range of RC levels increases, the prevalence of hyperuricemia also rises (7.84% vs. 13.71% vs. 18.61% vs. 26.24%, p<0.001). After adjusting for confounding factors, the fourth quartile of RC was associated with an increased risk of hyperuricemia compared with the first quartile (OR=2.942, 95% CI 2.473-3.502, p<0.001). Receiver Operating Characteristic (ROC) analysis shows that RC outperforms other single lipid indices in hyperuricemia. Further Restricted Cubic Splines (RCS) analysis suggests a nonlinear relationship between RC levels and hyperuricemia. Elevated RC levels were found to be linked to hyperuricemia. Further studies on RC hold promise for both preventing and addressing hyperuricemia.

Psoas Muscle Volume as an Indicator of Sarcopenia and Disposition in Traumatic Hip Fracture Patients

INTRODUCTION

Sarcopenia, or the loss of lean muscle mass, is associated with increased morbidity and mortality as well as poor surgical outcomes. The aim of our study was to utilize computed tomography imaging to obtain the total psoas volume (TPV) as a potential marker of sarcopenia. We then investigated the relationship between TPV and outcomes in surgically managed hip fracture patients, particularly their discharge disposition.

METHODS

A retrospective review of surgically managed hip fracture patients at a single institution level one American College of Surgeons verified trauma center between 2017 and 2022 was performed. The primary endpoint was patient disposition after hospitalization. TPV was collected via three dimension reconstruction of computed tomography images. Student's t-test was used to assess for association between TPV and demographic variables. Binary logistic regressions were performed to examine variables that could predict patient disposition among the patients.

RESULTS

We identified 64 surgically managed hip fracture patients, 57.8% of whom were males, with a median age of 74 (IQR: 62, 88). Black race (244.4 vs. 190.3, P = 0.032) and younger age (252.2 vs. 181.8, P = 0.004) were associated with higher TPV. Male patients with higher TPV had a higher likelihood of being discharged home as opposed to a skilled nursing or rehabilitation facility (251.3 vs. 191.1, P = 0.02). In multivariable analysis adjusting for sex, race, body mass index, and age, males with a higher TPV were more likely to be discharged home (odds ratio: 1.012; 95% confidence interval: 1.004 1.020; P = 0.028).

CONCLUSIONS

Psoas muscle volume can be used to predict which male patients are likely to be discharged home postoperatively after surgically managed traumatic hip fracture.

Therapeutic potential of Parabacteroides distasonis in gastrointestinal and hepatic disease

Increasing evidences indicate that the gut microbiota is involved in the development and therapy of gastrointestinal and hepatic disease. Imbalance of gut microbiota occurs in the early stages of diseases, and maintaining the balance of the gut microbiota provides a new strategy for the treatment of diseases. It has been reported that Parabacteroides distasonis is associated with multiple diseases. As the next-generation probiotics, several studies have demonstrated its positive regulation on the gastrointestinal and hepatic disease, including inflammatory bowel disease, colorectal cancer, hepatic fibrosis, and fatty liver. The function of P. distasonis and its metabolites mainly affect host immune system, intestinal barrier function, and metabolic networks. Manipulation of P. distasonis with natural components lead to the protective effect on enterohepatic disease. In this review, the metabolic pathways regulated by P. distasonis are summarized to illustrate its active metabolites and their impact on host metabolism, the role and action mechanism in gastrointestinal and hepatic disease are discussed. More importantly, the natural components can be used to manipulate P. distasonis as treatment strategies, and the challenges and perspectives of P. distasonis in clinical applications are discussed.

Obesity and risk for liver disease: a two-sample Mendelian randomisation study

The associations between obesity and liver diseases are complex and diverse. To explore the causal relationships between obesity and liver diseases, we applied two-sample Mendelian randomisation (MR) and multivariable MR analysis. The data of exposures (BMI and WHRadjBMI) and outcomes (liver diseases and liver function biomarker) were obtained from the open genome-wide association study database. A two-sample MR study revealed that the genetically predicted BMI and WHRadjBMI were associated with non-alcoholic fatty liver disease, liver fibrosis and autoimmune hepatitis. Obesity was not associated with primary biliary cholangitis, liver failure, liver cell carcinoma, viral hepatitis and secondary malignant neoplasm of liver. A higher WHRadjBMI was associated with higher levels of biomarkers of lipid accumulation and metabolic disorders. These findings indicated independent causal roles of obesity in non-alcoholic fatty liver disease, liver fibrosis and impaired liver metabolic function rather than in viral or autoimmune liver disease.

Qinlian Hongqu Decoction Modulates FXR/TGR5/GLP-1 Pathway to Improve Insulin Resistance in NAFLD Mice: Bioinformatics and Experimental Study

Background: Qinglian Hongqu decoction (QLHQD), a traditional Chinese herbal remedy, shows potential in alleviating metabolic issues related to nonalcoholic fatty liver disease (NAFLD). However, its precise mode of action remains uncertain. Objective: This study aims to evaluate the efficacy and mechanisms of QLHQD in treating NAFLD. Methods: This study utilized a NAFLD mouse model to assess the effects of QLHQD on lipid metabolism, including blood lipids and hepatic steatosis, as well as glucose metabolism, including blood glucose levels, OGTT results, and serum insulin. Network pharmacology, bioinformatics, and molecular docking were used to explore how QLHQD may improve NAFLD treatment. Key proteins involved in these mechanisms were validated via WB and immunohistochemistry. Additionally, the expression of downstream pathway targets was examined to further validate the insulin resistance mechanism by which QLHQD improves NAFLD. Results: Animal studies demonstrated that QLHQD alleviated lipid abnormalities, hepatic steatosis, blood glucose levels, the insulin resistance index, and the OGTT results in NAFLD mice (P < 0.05 or 0.01). Network pharmacology and bioinformatics analyses indicated that the effects of QLHQD on NAFLD might involve bile acid secretion pathways. Subsequent validation through Western blotting, immunohistochemistry, and qPCR demonstrated that QLHQD may influence fat metabolism and insulin sensitivity in NAFLD mice via the FXR/TGR5/GLP-1 signaling pathway. Conclusion: QLHQD significantly alleviates glucose and lipid metabolism disorders in a high-fat diet-induced NAFLD mouse model. Its mechanism of action may involve the activation of the FXR/TGR5/GLP-1 signaling pathway in the gut, which reduces lipid accumulation and insulin resistance.

Combined Bone Mineral Density (BMD) and Monocyte-to-Lymphocyte Ratio (MLR) Predicts Recurrence and Prognosis in Hepatocellular Carcinoma Patients Following Liver Resection

Background

Bone mineral density (BMD) and monocyte-to-lymphocyte ratio (MLR) were recently identified as novel risk factors for patients with several malignancies. The objective of this study was to validate the role of preoperative BMD/MLR as a potential prognostic biomarker in patients with hepatocellular carcinoma (HCC) undergoing liver resection.

Methods

This investigation enrolled 442 adult patients diagnosed with HCC who underwent liver resection. The patients were classified into high- and low-BMD/MLR groups based on the median, and forward stepwise logistic regression was employed to identify independent predictors for early HCC recurrence. To mitigate the impact of confounding factors, a propensity score matching (PSM) analysis was conducted between patients in the high- and low-BMD/MLR groups. The Kaplan-Meier method was employed to assess and compare the disease-free survival (DFS) and overall survival (OS) between the two cohorts.

Results

The study categorized patients into high-BMD/MLR and low-BMD/MLR groups. Forward stepwise logistic regression analysis revealed that low BMD/MLR (P < 0.001), tumor size > 50 mm (P < 0.001), and AFP > 200 ug/L (P = 0.001) were significantly associated with the early recurrence of HCC. Moreover, the results suggested that DFS and OS were significantly shorter in the low-BMD/MLR group compared to the high-BMD/MLR group, both before and after PSM (P < 0.05).

Conclusion

Preoperative BMD/MLR held promise as a prognostic biomarker for early recurrence and prognosis in patients with HCC who underwent liver resection. Furthermore, the integration of tumor size, AFP level, and BMD/MLR demonstrated a robust predictive capacity for early recurrence within this patient population.

Crosstalk Between the Spleen and Other Organs/Systems: Downstream Signaling Events

The aim of this review was to gather pieces of information from available critically evaluated published articles concerning any interplay in which the spleen could be involved. For many years, the spleen has been alleged as an unnecessary biological structure, even though splenomegaly is an objective finding of many illnesses. Indeed, the previous opinion has been completely changed. In fact, the spleen is not a passive participant in or a simple bystander to a relationship that exists between the immune system and other organs. Recently, it has been evidenced in many preclinical and clinical studies that there are close associations between the spleen and other parts of the body, leading to various spleen–organ axes. Among them, the gut–spleen axis, the liver–spleen axis, the gut–spleen–skin axis, the brain–spleen axis, and the cardio-splenic axis are the most explored and present in the medical literature. Such recent sources of evidence have led to revolutionary new ideas being developed about the spleen. What is more, these observations may enable the identification of novel therapeutic strategies targeted at various current diseases. The time has come to make clear that the spleen is not a superfluous body part, while health system operators and physicians should pay more attention to this organ. Indeed, much work remains to be performed to assess further roles that this biological structure could play.

The Interaction of Apical Periodontitis, Cigarette Smoke, and Alcohol Consumption on Liver Antioxidant Status in Rats

This study aimed to investigate the impact of alcohol (A), secondhand cigarette smoking (ShS), and their combined effect on liver antioxidant activity and hepatic damage in rats with induced apical periodontitis (AP). Thirty-five female Wistar rats were randomly allocated into five groups (n = 7): (1) control (rats without ShS, alcoholic diet, or AP), (2) control-AP (induced AP only), (3) ShS-AP (ShS exposure and induced AP), (4) A-AP (alcoholic diet and induced AP), and (5) A+ShS-AP (alcoholic diet, ShS exposure, and induced AP). Alcohol was administered through semi-voluntary intake, while ShS exposure involved the daily inhalation of cigarette smoke. The experimental period lasted 8 weeks, with AP induction occurring in the 4th week following molar pulp exposure. Liver samples were collected post-euthanasia for histomorphometric and antioxidant marker analyses. All AP-induced groups exhibited increased liver sinusoidal dilation compared to the control group (p < 0.05). AP significantly reduced total antioxidant capacity (FRAP) across all groups (p < 0.05). In AP-induced groups, FRAP levels were further decreased in ShS-AP and A+ShS-AP compared to control-AP (p < 0.05). AP also led to a decrease in the glutathione defense system (p < 0.05). Rats with alcohol exposure (A-AP and A+ShS-AP) showed reduced glutathione peroxidase activity (p < 0.05). Glutathione reductase activity was comparable in the control and control-AP groups (p > 0.05), but significantly decreased in the alcohol and ShS-exposed groups (p < 0.05). Apical periodontitis can relate to morphological changes in the liver's sinusoidal spaces and impairment of liver's antioxidant capacity of rats, particularly when combined with chronic alcohol consumption and exposure to cigarette smoke.

The NRF-2/HO-1 Signaling Pathway: A Promising Therapeutic Target for Metabolic Dysfunction-Associated Steatotic Liver Disease

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a progressive liver disorder with a rising prevalence. It begins with lipid accumulation in hepatocytes and gradually progresses to Metabolic-associated steatohepatitis (MASH), fibrosis, cirrhosis, and potentially hepatocellular carcinoma (HCC). The pathophysiology of MASLD is complex and involves multiple factors, with oxidative stress playing a crucial role. Oxidative stress drives the progression of MASLD by causing cellular damage, inflammatory responses, and fibrosis, making it a key pathogenic mechanism. The Nuclear Factor Erythroid 2-Related Factor 2 / Heme Oxygenase-1 (Nrf2/HO-1) signaling axis provides robust multi-organ protection against a spectrum of endogenous and exogenous insults, particularly oxidative stress. It plays a pivotal role in mediating antioxidant, anti-inflammatory, and anti-apoptotic responses. Many studies indicate that activating the Nrf2/HO-1 signaling pathway can significantly mitigate the progression of MASLD. This article examines the role of the Nrf2/HO-1 signaling pathway in MASLD and highlights natural compounds that protect against MASLD by targeting Nrf2/HO-1 activation. The findings indicate that the Nrf2/HO-1 signaling pathway holds great promise as a therapeutic target for MASLD.

Sedentary behavior and associated factors on admissions to internal medicine wards

The relationship between sedentary lifestyle and chronic diseases is well known. This study examined the prevalence and factors associated with reduced physical activity (PA) among internal medicine inpatients on admission. In this single-center, cross-sectional study, inpatients aged 50 years or older were prospectively enrolled at a tertiary care facility in Ankara, Türkiye. PA was assessed using the International Physical Activity Questionnaire (IPAQ). Care and performance indicators, quality of life (EQ-5D 3L), nutritional status, timed up-and-go test, muscle strength, and cognitive status were assessed. Participants were classified into 3 groups of PA levels as low, moderate, and high. Study end points were the prevalence of low PA level and associated factors. Of the 240 participants (mean age: 62.7 ± 8.0 years; women: 50%), 47.1% (n = 113), 40.8% (n = 98) and 12.1% (n = 29) had low, moderate, and high PA, respectively. Type 2 diabetes mellitus (45.1%), hypertension (66.4%), coronary artery disease (41.6%), dementia (8.8%), and multimorbidity (53.1%) were more common in the low PA group. Outdoor walking < 3 days per week (OR: 4.44, 95% CI 1.55 to 12.74, p = 0.006, functional dependence in and outside home (OR: 4.25, 95% CI 1.13 to 15.92, p = 0.032) and EQ-5D VAS score (OR: 0.97, 95% CI 0.95 to 0.99, p = 0.011) were independently associated with low PA level on multivariable logistic regression analysis. This study found low or medium levels of PA in almost nine out of ten admissions to an internal medicine clinic. On the other hand, low PA level was not associated with most classical comorbidities but with altered performance and care indicators.

Oleuropein mitigates non-alcoholic fatty liver disease (NAFLD) and modulates liver metabolites in high-fat diet-induced obese mice via activating PPARα

BACKGROUND

This study aimed to elucidate the mechanism of oleuropein (OLE) ameliorates non-alcoholic fatty liver disease (NAFLD) and its underlying mechanisms.

RESULTS

Male C57BL/6J mice were fed either a low-fat diet (LFD), a high-fat diet (HFD), or a HFD supplemented with 0.03% (w/w) OLE for 16 weeks. OLE supplementation decreased body weight and liver weight, improved serum lipid profiles, and ameliorated HFD-induced hepatic dysfunction. Liver metabolomics analysis revealed that OLE increased the levels of nicotinamide, tauroursodeoxycholic acid, taurine, and docosahexaenoic acid, which were beneficial for lipid homeostasis and inflammation regulation. OLE exerted its protective effects by activating peroxisome proliferator-activated receptor alpha (PPARα), a key transcription factor that regulates fibroblast growth factor 21 (FGF21) expression and modulates lipid oxidation, lipogenesis and inflammation pathways. Importantly, OLE supplementation did not significantly affect body weight or liver weight in PPARα knockout (PPARα KO) mice, indicating that PPARα is essential for OLE-mediated NAFLD prevention.

CONCLUSION

Our results suggest that OLE alleviates NAFLD in mice by activating PPARα and modulating liver metabolites. © 2024 Society of Chemical Industry.

Chondroitin Sulfate from Halaelurus burgeri Skin Inhibits Hepatic Endoplasmic Reticulum Stress and Inflammation, and Regulates Gut Microbiota

SCOPE

Previous study has demonstrated the chemical structure of chondroitin sulfate (CHS) from Halaelurus burgeri skin and its effects on insulin resistance. However, the precise impact of this phenomenon on endoplasmic reticulum (ER) stress and inflammation, which contribute to insulin resistance, remains unclear. This study is to investigate the impact of CHS on ER stress, inflammatory response and signaling, and gut microbiota in high-fat diet (HFD)-fed mice.

METHODS AND RESULTS

HFD-fed C57BL/6J mice receive dietary gavage intervention of CHS for 18 weeks. Blood, liver tissue, and feces are harvested for further investigation. Results show that CHS inhibits ER stress, accompanied by lowered blood glucose, nitric oxide (NO), reactive oxygen (ROS), and free fatty acids (FFA) levels, and increases hepatic glycogen accumulation. Moreover, hepatic inflammation is improved by CHS treatment via inactivation of Toll-like receptor 4 (TLR4) signaling and its downstream c-jun N-terminal kinase (JNK) and nuclear factor kappa B (NFκB) pathways. Additionally, CHS regulates gut microbiota, particularly the decline in the Firmicutes to Bacteroidetes ratio. CHS also lowers fecal lipopolysaccharide and elevates several fecal short chain fatty acids.

CONCLUSION

These findings suggest that CHS from H. burgeri skin may be an alternative functional food supplement for anti-ER stress, anti-inflammtion, and regulation of gut microbiota.

Economic Impact of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) in Italy. Analysis and Perspectives

Background

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a multisystem condition destined to become pandemic in the coming decades. This study aimed at evaluating the economic impact of MASLD in the Italian population from the Italian National Healthcare Service (NHS) perspective.

Methods

The economic impact of the MASLD was assessed by developing a calculation model in Microsoft Excel® from the Italian NHS perspective, considering healthcare resources and direct costs. The target population was based on the prevalence data. Through a literature search, complications of MASLD were identified, including MASH, with relative risk of evolution into CC, DCC, HCC, T2DM, cardiovascular diseases, in particular AMI and stroke, CKD, and CRC. The differential impact between complication development in the population with MASLD and the same sample size population without-MASLD was evaluated. Differential risk data, mortality rates, and event unit costs were drawn from the published international literature. Frequency and cost data were applied to the total target population, the total annual costs and mortality data, referring to the two arms, were then calculated, and the differential value was obtained.

Results

Based on an estimated 11,546,370 MASLD target population, an annual illness impact of €12,251,631,822 was calculated, corresponding to a difference of €7,731,674,054 compared with the same sample size without MASLD. Moreover, the MASLD population is expected to experience 13,438 additional deaths annually.

Conclusion

The growing epidemiological impact of MASLD and its complications represent a huge economic burden for healthcare services worldwide. An integrated approach, including changes in lifestyle behaviors, will be the first step. Specific drugs for MASLD are not yet available; however, studies are underway, and combined pharmaceutical therapies may be an inevitable choice to achieve adequate control of MASLD and its complications.

The Different Predictive Effects of Multiple Body Fat Indexes on Metabolic Dysfunction-Associated Fatty Liver Disease

Purpose

The aim of this study was to comprehensively compare the predictive effect of 10 body fat indexes on MAFLD in different sex, age and BMI subgroups.

Patients and Methods

A total of 5403 physical examination data were included and divided into the MAFLD group (N=2632) and non-MAFLD group (N=2771). The differences and correlation of 10 promising indicators between the two groups were compared, including fatty liver index (FLI), hepatic steatosis index (HSI), lipid accumulation product (LAP), visceral fat index (VAI), cardiometabolic index (CMI), body adiposity index (BAI), and triglyceride-glucose index (TyG), waist circumference index (WC), body mass index (BMI), waist to height ratio (WHtR). Logistic regression was used to analyze the risk of MAFLD under different adjustment conditions. The operating characteristic curve of different genders, BMI levels and age subgroups was plotted.

Results

Male gender, smoking, alcohol drinking, and higher age are risk factors for MAFLD. In addition to BAI, the other 9 indicators had a high correlation with MAFLD, the area under the curve (AUC) value was >0.7, and the prediction effect was better in females, BMI<24 kg/m2, age <35 years subgroup, among which FLI (AUC: 0.912, 95% CI: 0.905-0.920), LAP (AUC: 0.894, 95% CI: 0.8866-0.903), and HSI (AUC: 0.881, 95% CI: 0.872-0.890) have better prediction effects.

Conclusion

Our study confirmed the accuracy of body fat-related indexes in predicting MAFLD in people of different sexes, ages, and BMI levels. Among them, FLI, LAP and HSI have high predictive value and can be utilized as simple and cost-effective tools for screening MAFLD in clinical settings.

Rodent model intervention for prevention and optimal management of sarcopenia: A systematic review on the beneficial effects of nutrients & non-nutrients and exercise to improve skeletal muscle health

Sarcopenia is a common musculoskeletal disorder characterized by degenerative processes and is strongly linked to an increased susceptibility to falls, fractures, physical limitations, and mortality. Several models have been used to explore therapeutic and preventative measures as well as to gain insight into the molecular mechanisms behind sarcopenia. With novel experimental methodologies emerging to design foods or novel versions of conventional foods, understanding the impact of nutrition on the prevention and management of sarcopenia has become important. This review provides a thorough assessment of the use of rodent models of sarcopenia for understanding the aging process, focusing the effects of nutrients, plant extracts, exercise, and combined interventions on skeletal muscle health. According to empirical research, nutraceuticals and functional foods have demonstrated potential benefits in enhancing physical performance. In preclinical investigations, the administration of herbal extracts and naturally occurring bioactive compounds yielded advantageous outcomes such as augmented muscle mass and strength generation. Furthermore, herbal treatments exhibited inhibitory effects on muscle atrophy and sarcopenia. A substantial body of information establishes a connection between diet and the muscle mass, strength, and functionality of older individuals. This suggests that nutrition has a major impact in both the prevention and treatment of sarcopenia.

The Role of Gut Microbiota Modification in Nonalcoholic Fatty Liver Disease Treatment Strategies

One of the most common chronic liver diseases is nonalcoholic fatty liver disease (NAFLD), which affects many people around the world. Gut microbiota (GM) dysbiosis seems to be an influential factor in the pathophysiology of NAFLD because changes in GM lead to fundamental changes in host metabolism. Therefore, the study of the effect of dysbiosis on the pathogenicity of NAFLD is important. European clinical guidelines state that the best advice for people with NAFLD is to lose weight and improve their lifestyle, but only 40% of people can achieve this goal. Accordingly, it is necessary to provide new treatment approaches for prevention and treatment. In addition to dietary interventions and lifestyle modifications, GM modification-based therapies are of interest. These therapies include probiotics, synbiotics, fecal microbiota transplantation (FMT), and next-generation probiotics. All of these treatments have had promising results in animal studies, and it can be imagined that acceptable results will be obtained in human studies as well. However, further investigations are required to generalize the outcomes of animal studies to humans.