Prevalence of hepatic steatosis in apparently healthy medical students: a transient elastography study on the basis of a controlled attenuation parameter

Hepatic steatosis development as a long-term complication among testicular germ cell tumor survivors

BACKGROUND

Hepatic steatosis (HS) development and its risk factors in testicular germ cell tumor (TGCT) survivors have not been investigated.

METHODS

The study was designed as a retrospective observational study. Patients with existing HS at diagnosis were excluded. Serial imaging was utilized to detect HS.

RESULTS

A total of 106 TGCT survivors were included. HS developed in 57% (n = 61) during a median follow-up of 51.8 months (8.5-241.5); 77% (n = 47) of those had persistent HS. Patients who developed HS had a higher baseline body mass index (BMI) (median 26.5 vs. 23.6 kg/m2, p = 0.000). Higher baseline BMI [adjusted odds ratio (aOR): 1.35, (95% CI: 1.10-1.65) p = 0.004] and S0 stage [aOR: 3.87, (95% CI: 1.18-12.67), p = 0.025] were associated with a higher risk of HS development. The median time from the diagnosis of TGCT to the detection of HS was 44.7 months (29.5-59.8). Higher baseline BMI was associated with earlier development of HS both in all patients [hazard ratio (HR): 1.16, (95% CI: 1.04-1.30), p = 0.007] and patients treated with the BEP regimen [HR: 1.21, (95% CI: 1.01-1.47), p = 0.038].

CONCLUSION

HS may be considered a long-term complication in TGCT patients. The risk is associated with baseline BMI. Diagnosis and management of HS should be implemented in the survivorship care plan of TGCT survivors.

Geographical similarity and differences in the burden and genetic predisposition of NAFLD

NAFLD has become a major public health problem for more than 2 decades with a growing prevalence in parallel with the epidemic of obesity and type 2 diabetes (T2D). The disease burden of NAFLD differs across geographical regions and ethnicities. Variations in prevalence of metabolic diseases, extent of urban-rural divide, dietary habits, lifestyles, and the prevalence of NAFLD risk and protective alleles can contribute to such differences. The rise in NAFLD has led to a remarkable increase in the number of cases of cirrhosis, hepatocellular carcinoma, hepatic decompensation, and liver-related mortality related to NAFLD. Moreover, NAFLD is associated with multiple extrahepatic manifestations. Most of them are risk factors for the progression of liver fibrosis and thus worsen the prognosis of NAFLD. All these comorbidities and complications affect the quality of life in subjects with NAFLD. Given the huge and growing size of the population with NAFLD, it is expected that patients, healthcare systems, and the economy will suffer from the ongoing burden related to NAFLD. In this review, we examine the disease burden of NAFLD across geographical areas and ethnicities, together with the distribution of some well-known genetic variants for NAFLD. We also describe some special populations including patients with T2D, lean patients, the pediatric population, and patients with concomitant liver diseases. We discuss extrahepatic outcomes, patient-reported outcomes, and economic burden related to NAFLD.

The Prevalence of Liver Steatosis and Fibrosis Assessed by Vibration-Controlled Transient Elastography and Controlled Attenuation Parameter in Apparently Healthy Romanian Medical Students

Vibration-Controlled Transient Elastography (VCTE) with Controlled Attenuation Parameter (CAP) is used as a non-invasive method for evaluating liver steatosis and fibrosis simultaneously. In this prospective study, we aimed to assess the prevalence of liver steatosis and fibrosis, as well as the associated risk factors in Romanian medical students by VCTE and CAP score. We used a cut-off CAP score of ≥248 dB/m for the diagnosis of mild steatosis (S1), ≥268 dB/m for moderate steatosis (S2), and ≥280 dB/m to identify severe steatosis (S3). For liver fibrosis, the cut-off values were: ≤5.5 kPa, indicating no fibrosis (F0), 5.6 kPa for mild fibrosis (F1), 7.2 kPa for significant fibrosis (F2), 9.5 kPa for advanced fibrosis (F3), and 12.5 kPa for cirrhosis (F4). In total, 426 Romanian medical students (67.8% females, mean age of 22.22 ± 1.7 years) were evaluated. Among them, 352 (82.6%) had no steatosis (S0), 32 (7.5%) had mild steatosis (S1), 13 (3.1%) had a moderate degree of steatosis (S2), and 29 (6.8%) had severe steatosis (S3). Based on liver stiffness measurements (LSM), 277 (65%) medical students did not have any fibrosis (F0), 136 (31.9%) had mild fibrosis (F1), 10 (2.4%) participants were identified with significant fibrosis (F2), 3 (0.7%) with advanced fibrosis (F3), and none with cirrhosis (F4). In conclusion, the prevalence of liver steatosis and fibrosis is low among Romanian medical students.

Macro- and micronutrients in metabolic (dysfunction) associated fatty liver disease: association between advanced fibrosis and high dietary intake of cholesterol/saturated fatty acids

BACKGROUND AND AIM

There is still no approved pharmacotherapy for metabolic (dysfunction) associated fatty liver disease (MAFLD). Although dietary and lifestyle modifications for weight loss remain the mainstay for disease management, the association between macro- and micronutrients and fibrosis stage in patients with MAFLD remains unclear. This study was undertaken to address this issue.

METHODS

This is a retrospective analysis of prospectively collected data from patients in whom MAFLD was diagnosed with vibration controlled transient elastography. Steatosis was defined by a controlled attenuation parameter ≥238 dB/m, whereas a liver stiffness measurement ≥11 kPa was considered to indicate advanced fibrosis.

RESULTS

The study sample consisted of 106 patients with MAFLD (mean age 49 ± 10 years, 52 men and 54 women). Among the different micro- and macronutrients tested, only the dietary intake of cholesterol and saturated fatty acid (SFA) was independently associated with the presence of advanced fibrosis.

CONCLUSION

Our findings suggest that cholesterol/SFA-restricted dietary regimens - as exemplified by the traditional Mediterranean diet - may reduce the risk of advanced fibrosis in patients with MAFLD.

Role of intensive dietary and lifestyle interventions in the treatment of lean nonalcoholic fatty liver disease patients

BACKGROUND/AIM

Although weight loss is recommended for the treatment of nonalcoholic fatty liver disease (NAFLD) in overweight and obese individuals, this treatment modality remains questionable in lean individuals. In this study, we investigated the effects of medical nutrition therapy (MNT) and intensive lifestyle interventions (ILIs) for NAFLD in lean versus obese patients.

METHODS

In total, 35 patients (14 lean and 21 obese) were included in the study. All patients underwent transient elastography examinations, and controlled attenuation parameter (CAP) of >238 dB/m was indicative of hepatic steatosis. After 8 weeks of dietitian follow-up with MNT and ILI, the patients were compared with the baseline.

RESULTS

Significant weight loss was recorded in both lean (5.4%) and obese patients (5.7%) with NAFLD. The mean BMI decreased from 23.9 (20.5-24.8) to 22.4 (19.5-24.2) kg/m (P = 0.001) in lean patients and from 34.0 (30.0-42.0) to 31.6 (26.9-42.5) kg/m (P < 0.001) in obese patients. The alanine aminotransferase level significantly decreased from 56 (15-163) to 28 (13-98) U/L (P = 0.010) in lean patients and from 27 (13-81) to 22 (13-46) U/L (P = 0.018) in obese patients. The median CAP decreased from 299 (246-360) to 236 (169-318) dB/m (P = 0.002) in lean patients and from 325 (258-400) to 253 (202-383) dB/m (P < 0.001) in obese patients. Moreover, remission of hepatic steatosis was detected in eight lean patients (57.1%) and eight obese patients (38.1%).

CONCLUSION

These results indicate that 5% body weight loss in effective in both obese and lean patients resulting in a similar NAFLD remission.

Non-alcoholic fatty liver disease: A growing public health problem in Turkey

Non-alcoholic fatty liver disease (NAFLD) is histologically classified as either non-alcoholic fatty liver or non-alcoholic steatohepatitis (NASH). NASH is the progressive subtype of NAFLD. Individuals with NASH are at significant risk of developing hepatic fibrosis, cirrhosis, hepatocellular carcinoma, and liver-related and all-cause mortality. NAFLD is closely associated with obesity, type 2 diabetes mellitus (T2DM), metabolic syndrome, and cardiovascular events. Its prevalence is estimated to be above 30% in Turkey; and recent studies confirm this estimate. According to these studies, the prevalence of NAFLD in Turkey is between 48.3% and 60.1%. Currently, Turkey can be considered a risky region in terms of NAFLD burden as it is the most obese country in Europe with an obesity prevalence of 32.1% according to the 2016 World Health Organization data. Moreover, along with the increasing prevalence of obesity and T2DM in Turkey, the burden of NAFLD is estimated to increase in the upcoming decade. Despite the growing burden, we lack well-designed systemic studies that investigate NAFLD and its marked histological severity. In this review, we present studies on the burden of NAFLD and NASH, the natural history of NAFLD, and its association with other systemic diseases conducted with Turkish populations.

Growing burden of nonalcoholic fatty liver disease in Turkey: A single-center experience

BACKGROUND/AIMS

Nonalcoholic fatty liver disease (NAFLD), which consists of nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH), is a growing epidemic in Turkey, considering the recent alarming prevalence of 48.3%. Patients with NASH and/or liver fibrosis are more likely to progress to advanced liver disease. In this single-center study, we sought to describe the clinical and histological characteristics of a sample of Turkish patients with biopsy-proven NAFLD, who were enrolled over a 4-year period.

MATERIALS AND METHODS

This is a retrospective analysis of prospectively collected data from a total of 468 patients (224 males, 244 females; median age, 47 [18-71]. The study cohort consisted of patients with biopsy-proven NAFLD who were followed up at our outpatient clinic from 2009 to 2010 and from 2017 to 2018. Histological classification of the biopsies was performed according to the Steatosis, Activity and Fibrosis (SAF) scoring allowing the use of Fatty Liver Inhibition of Progression (FLIP) algorithm and the NAFLD Activity Score (NAS) scoring system.

RESULTS

Based on the SAF scoring, most patients (90.4%) had biopsy-proven NASH, whereas the NAFL was much rarer (9.6%). The prevalence of significant fibrosis (≥F2), advanced fibrosis (≥F3), and cirrhosis (F=4) was 35.0%, 17.5%, and 3.8%, respectively. The percentage of lean, overweight, and obese patients with NAFLD was 6.4%, 32.6%, and 61%, respectively. Metabolic syndrome was prevalent in 63% of the patients and Type 2 diabetes mellitus in 33.5%.

CONCLUSION

The growing burden of NAFLD as a public health problem in Turkey is underscored by its marked histological severity in terms of NASH and fibrosis. Well-conducted clinical trials will be essential for slowing down the NASH progression.

Screening for hepatic fibrosis and steatosis in Turkish patients with type 2 diabetes mellitus: A transient elastography study

BACKGROUND/AIMS

Non-alcoholic fatty liver disease is highly prevalent in patients with type 2 diabetes mellitus (T2DM). The aim of the present study was to investigate the potential usefulness of transient elastography (TE), which is a technique that allows measuring both fibrosis and liver fat content simultaneously, as a screening tool for hepatic involvement in Turkish patients with T2DM.

MATERIALS AND METHODS

We obtained liver stiffness measurements (LSMs, as a measure of fibrosis) and controlled attenuation parameter (CAP, as a marker of steatosis) in 124 (46 males and 78 females; mean body mass index (BMI): 33.2±6.6 kg/m2) Turkish patients with T2DM. The prevalence rates of overweight, obesity, and metabolic syndrome in our sample were 28.2%, 64.5%, and 77.4%, respectively. Probe-specific LSM cut-off values were used to define advanced fibrosis (>F3) and cirrhosis (F4) (M probe: F3=9.6-11.4 kPa, F4 >11.5 kPa and XL probe: F3=9.3-10.9 kPa, F4 >11.0 kPa). Mild, moderate, and severe steatosis were defined as CAP 222-232 dB/m, CAP 233-289 dB/m, and CAP >290 dB/m, respectively.

RESULTS

Advanced fibrosis and cirrhosis were identified in 21 (16.9%) and 10 (8.0%) patients, respectively. TE-defined hepatic steatosis (CAP>222 dB/m) was detected in 117 (94.3%) patients. Mild, moderate, and severe steatosis were identified in 0, 29, and 88 patients, respectively.

CONCLUSION

TE is a useful non-invasive imaging modality to screen for liver involvement in Turkish patients with T2DM. High rates of TE-defined fibrosis and steatosis in our sample reflect the presence of an elevated mean BMI.

Comparison of anthropometric measurements for prediction of the atherosclerosis and liver histology in young adults with nonalcoholic fatty liver disease

AIM

Anthropometry is a good evaluation tool that establishes the association between body fat distribution and metabolic risk factors precisely. The aim of this study was to test the association of anthropometric measurements with subclinical atherosclerosis and liver fibrosis.

METHODS

A total of 78 patients with nonalcoholic fatty liver disease (NAFLD) patients who had no known cardiovascular disease risk factors and 26 volunteered healthy controls were enrolled. Patients with suspected fatty liver underwent a liver biopsy. BMI, waist circumference (WC), hip circumference, and neck circumference (NC) were measured. To detect the presence of subclinical atherosclerosis, carotid intima-media thickness and carotid-femoral pulse wave velocity (cf-PWV) were examined.

RESULTS

NAFLD patients with fibrosis had higher NC, WC, and hip circumference levels, but no difference was observed between NAFLD patients without fibrosis and controls in these parameters. BMI was statistically different among the three groups (P < 0.05). After adjusting for confounding risk factors, the only significant parameter associated with histologic severity of NAFLD was WC, with odds ratio of 1.10. All anthropometric measurements were correlated positively with fibrosis, cf-PWV, and each other. While the association between BMI and cf-PWV remained significant, WC was found to be an independent risk factor for carotid intima-media thickness after adjustment of known cardiovascular risk factors.

CONCLUSION

WC is the strongest predictor of liver fibrosis as the anthropometric indexes in patients with NAFLD. NC can be used as an additional useful screening test for the primary evaluation of patients with NAFLD, even if it is not an independent risk factor.

The prevalence of non-alcoholic fatty liver disease in healthy young persons

OBJECTIVE

This aim of the present study was to determine prevalence of non-alcoholic fatty liver disease (NAFLD) in healthy young persons admitted for annual medical check-ups.

METHODS

A retrospective study was conducted in a military hospital. Total of 254 healthy males were included and participants were divided into 2 groups according to presence and grade of NAFLD. Demographic data, biochemical test results, and ultrasonography findings were collected from all patients. Statistical analyses were performed using SPSS software, version 22.0 (SPSS, Inc., Chicago, IL, USA).

RESULTS

Prevalence of NAFLD was 10.6%. Significant differences were found with regard to age; levels aspartate transaminase, alanine transaminase, gamma-glutamyl transferase, and alkaline phosphatase; body mass index (BMI); and presence of NAFLD (p=0.014, p=0.022, p=0.003, p≤0.001, p=0.004, and p≤0.001, respectively). When compared to those with grade 1 NAFLD, levels of alanine transaminase, fasting blood glucose, gamma-glutamyl transferase, triglycerides, total cholesterol and age variables were higher in those with grade 2 NAFLD. However, no statistically significant difference was noted when comparing grades of NAFLD.

CONCLUSION

Though this study included patients with normal BMI and normal laboratory test results, presence of NAFLD was not rare in these otherwise healthy young men. Liver enzyme levels were within normal limits; however, there was slight tendency to be high consistent with presence and grade of NAFLD.