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Chen P, Li Y, Dai Y, Wang Z, Zhou Y, Wang Y, Li G. Advances in the Pathogenesis of Metabolic Liver Disease-Related Hepatocellular Carcinoma. J Hepatocell Carcinoma 2024; 11:581-594. [PMID: 38525158 PMCID: PMC10960512 DOI: 10.2147/jhc.s450460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/13/2024] [Indexed: 03/26/2024] Open
Abstract
Hepatocellular carcinoma (HCC) is the sixth most common cancer globally and the primary cause of death in cancer cases, with significant public health concern worldwide. Despite the overall decline in the incidence and mortality rates of HCC in recent years in recent years, the emergence of metabolic liver disease-related HCC is causing heightened concern, especially in countries like the United States, the United Kingdom, and P.R. China. The escalation of metabolic liver disease-related HCC is attributed to a combination of factors, including genetic predisposition, lifestyle choices, and changes in the living environment. However, the pathogenesis of metabolic liver disease-associated HCC remains imperfect. In this review, we encapsulate the latest advances and essential aspects of the pathogenesis of metabolic liver disease-associated HCC, including alcoholic liver disease (ALD), metabolic dysfunction-associated steatotic liver disease (MASLD), and inherited metabolic liver diseases.
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Affiliation(s)
- Pinggui Chen
- Department of Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, Shanxi, People’s Republic of China
| | - Yaoxuan Li
- Department of School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Yunyan Dai
- Department of Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, Shanxi, People’s Republic of China
| | - Zhiming Wang
- Department of Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, Shanxi, People’s Republic of China
| | - Yunpeng Zhou
- Department of Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, Shanxi, People’s Republic of China
| | - Yi Wang
- Department of Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, Shanxi, People’s Republic of China
| | - Gaopeng Li
- Department of Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, Shanxi, People’s Republic of China
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Huang Q, Tan X, Wu Q, Zhao H, Chen H, Yu X, Wang J, Huang X, Huang Y, Wei J, Wu F, Zhu H, Wang L. Lipid accumulation product is a valid predictor of hepatic steatosis and nonalcoholic fatty liver disease. Biomark Med 2024; 18:123-135. [PMID: 38456353 DOI: 10.2217/bmm-2023-0725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
Aims: To evaluate and compare lipid accumulation product (LAP) with alanine aminotransferase (ALT), aspartate aminotransferase (AST), visceral adiposity index (VAI) and triglyceride-glucose index (TyG) as biomarkers for hepatic steatosis and nonalcoholic fatty liver disease (NAFLD). Methods: LAP, ALT, AST, VAI and TyG were measured in 52 biopsy-proven NAFLD patients and 21 control subjects. Additionally, LAP was also measured in 448 ultrasound-proven NAFLD patients and 1009 control subjects. Results: LAP was positively associated with hepatic steatosis and inflammation in biopsy-proven NAFLD. The risk of NAFLD was positively related to LAP and TyG, but LAP showed a better area under the receiver operating characteristic curve for hepatic steatosis and NAFLD. LAP also performed well in recognizing ultrasound-proven NAFLD. Conclusion: LAP is an ideal biomarker of hepatic steatosis and NAFLD.
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Affiliation(s)
- Qiaoli Huang
- Department of Nutrition, School of Medicine, Jinan University, Guangzhou, 510632, People's Republic of China
| | - Xuying Tan
- Department of Children Healthcare, Guangzhou Women & Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, People's Republic of China
| | - Qiongmei Wu
- Department of Nutrition, School of Medicine, Jinan University, Guangzhou, 510632, People's Republic of China
| | - Hanqing Zhao
- Department of Nutrition, School of Medicine, Jinan University, Guangzhou, 510632, People's Republic of China
| | - Hangjun Chen
- Department of Nutrition, School of Medicine, Jinan University, Guangzhou, 510632, People's Republic of China
| | - Xinxue Yu
- Department of Nutrition, School of Medicine, Jinan University, Guangzhou, 510632, People's Republic of China
| | - Jinting Wang
- Department of Nutrition, School of Medicine, Jinan University, Guangzhou, 510632, People's Republic of China
| | - Xueyi Huang
- Department of Nutrition, School of Medicine, Jinan University, Guangzhou, 510632, People's Republic of China
| | - Yurong Huang
- Department of Nutrition, School of Medicine, Jinan University, Guangzhou, 510632, People's Republic of China
| | - Jun Wei
- Department of Science & Technology, Guangzhou Customs, Guangzhou, 510623, People's Republic of China
| | - Feng Wu
- Department of Science & Technology, Guangzhou Customs, Guangzhou, 510623, People's Republic of China
| | - Huilian Zhu
- Department of Nutrition, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, People's Re-public of China
| | - Lijun Wang
- Department of Nutrition, School of Medicine, Jinan University, Guangzhou, 510632, People's Republic of China
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Peng HY, Duan SJ, Pan L, Wang MY, Chen JL, Wang YC, Yao SK. Development and validation of machine learning models for nonalcoholic fatty liver disease. Hepatobiliary Pancreat Dis Int 2023; 22:615-621. [PMID: 37005147 DOI: 10.1016/j.hbpd.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 03/20/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) had become the most prevalent liver disease worldwide. Early diagnosis could effectively reduce NAFLD-related morbidity and mortality. This study aimed to combine the risk factors to develop and validate a novel model for predicting NAFLD. METHODS We enrolled 578 participants completing abdominal ultrasound into the training set. The least absolute shrinkage and selection operator (LASSO) regression combined with random forest (RF) was conducted to screen significant predictors for NAFLD risk. Five machine learning models including logistic regression (LR), RF, extreme gradient boosting (XGBoost), gradient boosting machine (GBM), and support vector machine (SVM) were developed. To further improve model performance, we conducted hyperparameter tuning with train function in Python package 'sklearn'. We included 131 participants completing magnetic resonance imaging into the testing set for external validation. RESULTS There were 329 participants with NAFLD and 249 without in the training set, while 96 with NAFLD and 35 without were in the testing set. Visceral adiposity index, abdominal circumference, body mass index, alanine aminotransferase (ALT), ALT/AST (aspartate aminotransferase), age, high-density lipoprotein cholesterol (HDL-C) and elevated triglyceride (TG) were important predictors for NAFLD risk. The area under curve (AUC) of LR, RF, XGBoost, GBM, SVM were 0.915 [95% confidence interval (CI): 0.886-0.937], 0.907 (95% CI: 0.856-0.938), 0.928 (95% CI: 0.873-0.944), 0.924 (95% CI: 0.875-0.939), and 0.900 (95% CI: 0.883-0.913), respectively. XGBoost model presented the best predictive performance, and its AUC was enhanced to 0.938 (95% CI: 0.870-0.950) with further parameter tuning. CONCLUSIONS This study developed and validated five novel machine learning models for NAFLD prediction, among which XGBoost presented the best performance and was considered a reliable reference for early identification of high-risk patients with NAFLD in clinical practice.
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Affiliation(s)
- Hong-Ye Peng
- Graduate School of Beijing University of Chinese Medicine, Beijing 100029, China; Department of Gastroenterology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Shao-Jie Duan
- Graduate School of Beijing University of Chinese Medicine, Beijing 100029, China; Department of Gastroenterology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Liang Pan
- Phase 1 Clinical Trial Center, Deyang People's Hospital, Deyang 618000, China
| | - Mi-Yuan Wang
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jia-Liang Chen
- Center of Integrated Traditional Chinese and Western Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100102, China
| | - Yi-Chong Wang
- Graduate School of Beijing University of Chinese Medicine, Beijing 100029, China
| | - Shu-Kun Yao
- Department of Gastroenterology, China-Japan Friendship Hospital, Beijing 100029, China.
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Ha J, Yim SY, Karagozian R. Mortality and Liver-Related Events in Lean Versus Non-Lean Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2023; 21:2496-2507.e5. [PMID: 36442727 DOI: 10.1016/j.cgh.2022.11.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND & AIMS Although approximately 40% of patients with nonalcoholic fatty liver disease (NAFLD) are nonobese or lean, little is known about the long-term clinical outcomes of lean NAFLD. We aimed to estimate the risk of mortality and adverse liver-related events in patients with lean NAFLD compared with those with non-lean NAFLD. METHODS We searched the PubMed, Embase, and Cochrane Library databases through May 2022 for articles reporting mortality and/or development of cirrhosis among lean and non-lean NAFLD patients. The relative risks (RRs) of all-cause mortality, cardiovascular mortality, liver-related mortality, and occurrence of decompensated cirrhosis or hepatocellular carcinoma were pooled using the random-effects model. We also performed subgroup analysis according to characteristics of the study population, methods of NAFLD diagnosis, study design, study region, and length of follow-up. RESULTS We analyzed 10 cohort studies involving 109,151 NAFLD patients. Patients with lean NAFLD had comparable risks for all-cause mortality (RR, 1.09; 95% confidence interval [CI], 0.66-1.90), cardiovascular mortality (RR, 1.12; 95% CI, 0.66-1.90), and adverse liver events including decompensated cirrhosis and hepatocellular carcinoma (RR, 0.81; 95% CI, 0.50-1.30). However, the risk of liver-related mortality was higher in patients with lean than non-lean NAFLD (RR, 1.88; 95% CI, 1.02-3.45). CONCLUSIONS This study highlights a higher risk of liver-related mortality in patients with lean NAFLD than those with non-lean NAFLD. This finding indicates that further understanding of the pathophysiology, risk factors of adverse outcomes, and genetic and ethnic variabilities of lean NAFLD phenotype is warranted for individualized treatment strategies in lean NAFLD patients.
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Affiliation(s)
- Jane Ha
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sun Young Yim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Raffi Karagozian
- Department of Gastroenterology and Hepatology, Tufts Medical Center, Boston, Massachusetts.
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Li R, Liu J, Han P, Shi R, Zhao L, Li J. Associations between abdominal obesity indices and pathological features of non-alcoholic fatty liver disease: Chinese visceral adiposity index. J Gastroenterol Hepatol 2023; 38:1316-1324. [PMID: 37102199 DOI: 10.1111/jgh.16196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/26/2023] [Accepted: 04/09/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND AND AIM Many abdominal obesity indices such as waist circumference (WC), lipid accumulation product (LAP), visceral obesity index (VAI), and Chinese VAI (CVAI) have been considered to be associated with the risk of non-alcoholic fatty liver disease (NAFLD), but the association between abdominal obesity indices and the pathological features of NAFLD is uncertain. This study aims to explore the associations between these indices and the pathological features of NAFLD. METHODS A total of 147 patients with biopsy-confirmed NAFLD were enrolled in the final analysis. General information, biochemical tests, and pathological information of patients were collected. VAI, LAP, and CVAI were calculated. Spearman's correlation analysis and logistics regression analysis were applied to assess the relationship between abdominal obesity indices and the pathological features of NAFLD. Receiver operating characteristic curve analyses were used to assess the value of abdominal obesity indices in predicting liver fibrosis and non-alcoholic steatohepatitis. RESULTS Non-alcoholic fatty liver disease activity score (NAS) ≥ 5 significantly correlated with WC, LAP, VAI, and CVAI both in univariate and multivariate analyses (P < 0.05). Fibrosis was significantly and positively correlated with WC, LAP, and CVAI (P < 0.05). After adjustment for potential confounders, fibrosis remained associated with CVAI (P < 0.05). CONCLUSION CVAI is significantly associated with the pathological features of NAFLD, and CVAI shows the most superior efficacy in diagnosing fibrosis among these indices.
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Affiliation(s)
- Ruifang Li
- School of Medicine, Nankai University, Tianjin, China
| | - Jie Liu
- Department of Gastroenterology and Hepatology, Tianjin Second People's Hospital, Tianjin, China
| | - Ping Han
- Clinical School of the Second People's Hospital, Tianjin Medical University, Tianjin, China
| | - Ruifang Shi
- Department of Pathology, Tianjin Second People's Hospital, Tianjin, China
| | - Lili Zhao
- Department of Gastroenterology and Hepatology, Tianjin Second People's Hospital, Tianjin, China
| | - Jia Li
- Department of Gastroenterology and Hepatology, Tianjin Second People's Hospital, Tianjin, China, and School of Medicine, Nankai University, Tianjin, China
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Shen S, Huang H, Wang J, Tang Z, Shen C, Xu C. Positive Association Between the Chinese Visceral Adiposity Index and Nonalcoholic Fatty Liver Disease in Lean Adults. Dig Dis Sci 2023; 68:656-664. [PMID: 36512267 DOI: 10.1007/s10620-022-07787-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/05/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Chinese visceral adiposity index (CVAI) is a novel indicator that precisely evaluates visceral obesity and has been shown to be significantly associated with nonalcoholic fatty liver disease (NAFLD) in the general population. However, the relationship between CVAI and NAFLD in lean adults remains unclear. AIMS This study aimed to explore the association of CVAI with NAFLD in a lean population and evaluate the diagnostic capability of CVAI for lean NAFLD. METHODS A cross-sectional study was conducted among 9,607 lean adults (body mass index < 24 kg/m2), who underwent their annual health examinations at the First Affiliated Hospital, Zhejiang University School of Medicine in 2021. NAFLD was determined by ultrasonography to the exclusion of other known etiologies. RESULTS The prevalence of NAFLD was 16.4% in this lean population. CVAI values were significantly higher in participants with NAFLD than those without NAFLD and the CVAI quartile was positively associated with the prevalence of NAFLD, which was 0.4%, 6.0%, 19.4%, and 39.8% among the participants with CVAI in quartile 1 to 4, respectively (P for trend < 0.001). Logistic regression analysis found that CVAI was positively associated with the risk of NAFLD (adjusted odds ratio: 1.025, 95% confidence interval: 1.021-1.028; P < 0.001). Furthermore, CVAI had a significantly higher area under curve value for detecting NAFLD than other visceral obesity indices. CONCLUSION Our study showed that CVAI was positively associated with the prevalence and risk of NAFLD in lean adults, and CVAI showed the highest diagnostic ability for lean NAFLD.
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Affiliation(s)
- Shuxia Shen
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China
- Zhejiang Provincial Clinical Research Center for Digestive Diseases, Hangzhou, China
| | - Hangkai Huang
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China
- Zhejiang Provincial Clinical Research Center for Digestive Diseases, Hangzhou, China
| | - Jinghua Wang
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China
- Zhejiang Provincial Clinical Research Center for Digestive Diseases, Hangzhou, China
| | - Zexi Tang
- School of Science, Hong Kong University of Science and Technology, Hong Kong, China
| | - Chao Shen
- Health Management Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chengfu Xu
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China.
- Zhejiang Provincial Clinical Research Center for Digestive Diseases, Hangzhou, China.
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Lu Y, Xia Q, Wu L, Xie Z. Gender difference in association between low muscle mass and risk of non-alcoholic fatty liver disease among Chinese adults with visceral obesity. Front Nutr 2023; 10:1026054. [PMID: 36713086 PMCID: PMC9880268 DOI: 10.3389/fnut.2023.1026054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/02/2023] [Indexed: 01/15/2023] Open
Abstract
Background and aims Although the association between low muscle mass and the risk of non-alcoholic fatty liver disease is well-known, it has not been explored in viscerally obese populations by gender. Besides, whether low muscle mass still increases the NAFLD risk in subjects with visceral obesity, independent of obesity, is still unknown. The aim of this study was to explore the gender-specific association between low muscle mass and the risk of non-alcoholic fatty liver disease (NAFLD) in subjects with visceral obesity. Methods Overall, 1,114 participants aged 19-89 years were recruited in this retrospective study. Liver disease was diagnosed by hepatic ultrasound. Skeletal muscle mass was estimated by bioimpedance analysis and defined by the appendicular skeletal muscle index (ASMI). Gender-specific differences in the ASMI value were compared between NAFLD and control groups. Restricted cubic spline and multivariate logistic regression were performed to analyze the association (stratified by gender and age) between the ASMI and the risk of NAFLD, respectively. Results Middle-aged females (40-60 years) and males (of any age) with NAFLD had a significantly lower ASMI compared with controls (P-value < 0.05). An inverse linear association was found between the ASMI and risk of NAFLD (all P fornon-linearity > 0.05). Lower quartiles of the ASMI conferred independent risk of NAFLD compared to higher quartiles (all P for trend < 0.001). Low muscle mass conferred a higher risk of NAFLD in middle-aged females (adjusted odds ratio = 2.43, 95% confidence interval: 1.19-4.95) and males [18-39 years: 3.76 (1.79-7.91); 40-60 years: 4.50 (2.16-9.39); and >60 years: 4.10 (1.13-14.84)]. Besides, Low muscle mass and low muscle mass with obesity increase the risk of developing NAFLD, independent of obesity. Conclusion Among those with visceral obesity, low muscle mass increased the risk of NAFLD in males of any age, and middle-aged females, this may be explained by the postmenopausal decline in estrogen.
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Reduction of Obesity and Insulin Resistance through Dual Targeting of VAT and BAT by a Novel Combination of Metabolic Cofactors. Int J Mol Sci 2022; 23:ijms232314923. [PMID: 36499250 PMCID: PMC9738317 DOI: 10.3390/ijms232314923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/24/2022] [Accepted: 11/26/2022] [Indexed: 12/02/2022] Open
Abstract
Obesity is an epidemic disease worldwide, characterized by excessive fat accumulation associated with several metabolic perturbations, such as metabolic syndrome, insulin resistance, hypertension, and dyslipidemia. To improve this situation, a specific combination of metabolic cofactors (MC) (betaine, N-acetylcysteine, L-carnitine, and nicotinamide riboside) was assessed as a promising treatment in a high-fat diet (HFD) mouse model. Obese animals were distributed into two groups, orally treated with the vehicle (obese + vehicle) or with the combination of metabolic cofactors (obese + MC) for 4 weeks. Body and adipose depots weights; insulin and glucose tolerance tests; indirect calorimetry; and thermography assays were performed at the end of the intervention. Histological analysis of epidydimal white adipose tissue (EWAT) and brown adipose tissue (BAT) was carried out, and the expression of key genes involved in both fat depots was characterized by qPCR. We demonstrated that MC supplementation conferred a moderate reduction of obesity and adiposity, an improvement in serum glucose and lipid metabolic parameters, an important improvement in lipid oxidation, and a decrease in adipocyte hypertrophy. Moreover, MC-treated animals presented increased adipose gene expression in EWAT related to lipolysis and fatty acid oxidation. Furthermore, MC supplementation reduced glucose intolerance and insulin resistance, with an increased expression of the glucose transporter Glut4; and decreased fat accumulation in BAT, raising non-shivering thermogenesis. This treatment based on a specific combination of metabolic cofactors mitigates important pathophysiological characteristics of obesity, representing a promising clinical approach to this metabolic disease.
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Klang E, Soffer S, Alper L, Shimon O, Barash Y, Davidov Y, Likhter M, Cohen‐Ezra O, Ben Yakov G, Ben‐Ari Z. Research trends analysis of chronic hepatitis C versus nonalcoholic fatty liver disease: A literature review text‐mining analysis of publications. Health Sci Rep 2022; 5:e805. [DOI: 10.1002/hsr2.805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/11/2022] [Accepted: 08/01/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Eyal Klang
- Diagnositc Imaging Department Chaim Sheba Medical Center Tel Hashomer Israel
- The Sheba Talpiot Medical Leadership Program Chaim Sheba Medical Center Tel Hashomer Israel
- DeepVision Lab Chaim Sheba Medical Center Tel Hashomer Israel
| | - Shelly Soffer
- DeepVision Lab Chaim Sheba Medical Center Tel Hashomer Israel
- Internal Medicine B Assuta Medical Center Ashdod Israel
- Ben‐Gurion University of the Negev Be'er Sheva Israel
| | - Lee Alper
- DeepVision Lab Chaim Sheba Medical Center Tel Hashomer Israel
- The Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Orit Shimon
- Department of Anesthesia, Rabin Medical Center Beilinson Hospital Petach Tikvah Israel
| | - Yiftach Barash
- Diagnositc Imaging Department Chaim Sheba Medical Center Tel Hashomer Israel
- DeepVision Lab Chaim Sheba Medical Center Tel Hashomer Israel
| | - Yana Davidov
- The Liver Diseases Center Chaim Sheba Medical Center Tel Hashomer Israel
| | - Mariya Likhter
- The Liver Diseases Center Chaim Sheba Medical Center Tel Hashomer Israel
| | - Oranit Cohen‐Ezra
- The Liver Diseases Center Chaim Sheba Medical Center Tel Hashomer Israel
| | - Gil Ben Yakov
- The Liver Diseases Center Chaim Sheba Medical Center Tel Hashomer Israel
| | - Ziv Ben‐Ari
- The Sackler School of Medicine Tel Aviv University Tel Aviv Israel
- The Liver Diseases Center Chaim Sheba Medical Center Tel Hashomer Israel
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Kim B, Kim GM, Oh S. Use of the Visceral Adiposity Index as an Indicator of Chronic Kidney Disease in Older Adults: Comparison with Body Mass Index. J Clin Med 2022; 11:6297. [PMID: 36362525 PMCID: PMC9659218 DOI: 10.3390/jcm11216297] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/14/2022] [Accepted: 10/21/2022] [Indexed: 12/27/2023] Open
Abstract
The visceral adiposity index (VAI) was recently introduced to quantify visceral fat accumulation and dysfunction. This cross-sectional study explored whether the VAI is associated with chronic kidney disease (CKD) in older adults and compared its utility with that of body mass index (BMI) for predicting CKD. In total, 7736 older adults (3479 men and 4257 women) aged ≥ 60 years were divided into normal, mild, and moderate-to-severe CKD groups. Associations of the VAI and BMI with CKD were compared among the groups, and cut-off points for moderate-to-severe CKD (MSCKD) were established. While the VAI could discriminate among all of the groups, the BMI could not. The severity of CKD was more strongly associated with the VAI than BMI. The odds ratios indicated that, in the fully adjusted model, the VAI was a significant predictor of MSCKD in both men and women, while the BMI was a significant predictor only in men. For the VAI, the area under the receiver operating characteristic curve values for men and women were 0.631 (cut-off point: ≥2.993) and 0.588 (≥4.001), compared with 0.555 (≥25.335) and 0.533 (≥24.096) for BMI, respectively. Taken together, the findings suggest that the VAI is associated with CKD and represents a better indicator for the disease than BMI.
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Affiliation(s)
- Bokun Kim
- Department of Anti-Ageing Health Care, Changwon National University, Changwon 51140, Korea
- Future Convergence Research Institute, Changwon National University, Changwon 51140, Korea
- Department of Sports Healthcare, In-Je University, Gimhae 50834, Korea
| | - Gwon-Min Kim
- Medical Research Institute, Pusan National University, Busan 46241, Korea
| | - Sechang Oh
- Faculty of Rehabilitation, R Professional University of Rehabilitation, Tsuchiura 300-0032, Japan
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Kahn D, Macias E, Zarini S, Garfield A, Zemski Berry K, MacLean P, Gerszten RE, Libby A, Solt C, Schoen J, Bergman BC. Exploring Visceral and Subcutaneous Adipose Tissue Secretomes in Human Obesity: Implications for Metabolic Disease. Endocrinology 2022; 163:6678177. [PMID: 36036084 PMCID: PMC9761573 DOI: 10.1210/endocr/bqac140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Indexed: 11/19/2022]
Abstract
Adipose tissue secretions are depot-specific and vary based on anatomical location. Considerable attention has been focused on visceral (VAT) and subcutaneous (SAT) adipose tissue with regard to metabolic disease, yet our knowledge of the secretome from these depots is incomplete. We conducted a comprehensive analysis of VAT and SAT secretomes in the context of metabolic function. Conditioned media generated using SAT and VAT explants from individuals with obesity were analyzed using proteomics, mass spectrometry, and multiplex assays. Conditioned media were administered in vitro to rat hepatocytes and myotubes to assess the functional impact of adipose tissue signaling on insulin responsiveness. VAT secreted more cytokines (IL-12p70, IL-13, TNF-α, IL-6, and IL-8), adipokines (matrix metalloproteinase-1, PAI-1), and prostanoids (TBX2, PGE2) compared with SAT. Secretome proteomics revealed differences in immune/inflammatory response and extracellular matrix components. In vitro, VAT-conditioned media decreased hepatocyte and myotube insulin sensitivity, hepatocyte glucose handling, and increased basal activation of inflammatory signaling in myotubes compared with SAT. Depot-specific differences in adipose tissue secretome composition alter paracrine and endocrine signaling. The unique secretome of VAT has distinct and negative impact on hepatocyte and muscle insulin action.
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Affiliation(s)
- Darcy Kahn
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Emily Macias
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Simona Zarini
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Amanda Garfield
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Karin Zemski Berry
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Paul MacLean
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Robert E Gerszten
- The Cardiovascular Research Center and Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Andrew Libby
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Claudia Solt
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Jonathan Schoen
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Bryan C Bergman
- Correspondence: Bryan Bergman, PhD, Division of Endocrinology, Diabetes, and Metabolism, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
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Heterogeneity of non-alcoholic fatty liver disease (NAFLD): Implication for cardiovascular risk stratification. Atherosclerosis 2022; 357:51-59. [PMID: 36058083 DOI: 10.1016/j.atherosclerosis.2022.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/27/2022] [Accepted: 08/11/2022] [Indexed: 12/17/2022]
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Zhang L, Zhang M, Wang M, Wang M, Zhang R, Wang H, Zhang W, Ding Y, Wang J. External validation and comparison of simple tools to screen for nonalcoholic fatty liver disease in Chinese community population. Eur J Gastroenterol Hepatol 2022; 34:865-872. [PMID: 35802528 PMCID: PMC9273302 DOI: 10.1097/meg.0000000000002399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/12/2022] [Indexed: 12/21/2022]
Abstract
BACKGROUND Various noninvasive tools based on anthropometric indicators, blood lipids, and liver enzymes, etc. have been developed to screen for nonalcoholic fatty liver disease (NAFLD), with different diagnostic performance and cutoff values among studies. We aimed to validate and compare eight NAFLD-related models developed by simple indicators and to define their cutoff values in Chinese community population. METHODS A cross-sectional study was conducted in a health examination cohort of 3259 people. NAFLD was diagnosed by ultrasonography. General, anthropometric and biochemical data were collected. Fatty liver index (FLI), fatty liver disease index (FLD), Zhejiang University index (ZJU), lipid accumulation product (LAP), regression formula of controlled attenuation parameter (CAP), waist-to-height ratio (WHtR), triglyceride and glucose index (TyG), and visceral adiposity index (VAI) were calculated. The accuracy and cutoff points to detect NAFLD were evaluated by area under the receiver operator characteristic curve and the maximum Youden index analysis, respectively. A head-to-head comparison between these models and Decision Curve Analysis (DCA) was conducted. RESULTS In eight noninvasive diagnostic models of NAFLD, AUCs of FLI and FLD for NAFLD were higher than those of other models in the whole (0.852 and 0.852), male (0.826 and 0.824), and female (0.897 and 0.888) population, respectively. DCA showed that FLI, FLD, and ZJU have higher net benefit to screen for NAFLD compared to other models. CONCLUSIONS FLI and FLD could be the most accurate and applicable of eight models for the noninvasive diagnosis of NAFLD in both male and female groups.
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Affiliation(s)
- Liuxin Zhang
- Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University
| | - Mengting Zhang
- Department of Fundamental and Community Nursing, School of Nursing, Nanjing Medical University
| | - Min Wang
- Department of Fundamental and Community Nursing, School of Nursing, Nanjing Medical University
| | - Minxian Wang
- Department of Fundamental and Community Nursing, School of Nursing, Nanjing Medical University
| | - Ru Zhang
- Department of Fundamental and Community Nursing, School of Nursing, Nanjing Medical University
| | - Hongliang Wang
- Department of General Practice, Ninghai Road Community Health Service Center of Nanjing, Nanjing
| | - Wei Zhang
- Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China
| | - Yajie Ding
- Department of Fundamental and Community Nursing, School of Nursing, Nanjing Medical University
| | - Jie Wang
- Department of Fundamental and Community Nursing, School of Nursing, Nanjing Medical University
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Vicente-Herrero MT, Ramírez-Iñiguez de la Torre MV, López González ÁA. Obesidad, hábitos de vida y valoración FLI en la población laboral española durante la pandemia. REVISTA CLÍNICA DE MEDICINA DE FAMILIA 2022. [DOI: 10.55783/rcmf.150205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Antecedentes: el hígado graso no alcohólico es la enfermedad hepática más común en el mundo, habitualmente asintomática y manifestación hepática del síndrome metabólico.
Objetivo: estimar el riesgo de hígado graso mediante el índice de hígado graso (FLI, Fatty Liver Index) y su relación con el índice de masa corporal (IMC), indicadores de adiposidad, hábitos de vida y variables sociodemográficas.
Material y métodos: estudio descriptivo transversal realizado con 815 trabajadores de entre 18-66 años, durante la vigilancia de la salud de las empresas participantes, desde marzo de 2020 hasta junio de 2021.
Se utiliza la calculadora FLI y se establecen relaciones con variables sociodemográficas, índices de adiposidad, hábitos de alimentación y actividad física con el uso de los cuestionarios PREDIMED e IPAQ.
Resultados: el FLI > 60 se relaciona significativamente con el IMC, el perímetro de la cintura y el índice cintura-cadera. El IMC incrementa el riesgo casi 20 veces (odds ratio 19,87; IC 95% 10,84-36,44) de sufrir la enfermedad. Los valores altos son más perjudiciales en hombres y el riesgo aumenta con la edad. Un FLI en rango medio/alto (> 30) muestra una relación significativa con la adherencia a MedDiet y con la actividad física realizada, con diferencias entre géneros (p < 0,0001).
Conclusión: el riesgo de hígado graso aumenta con la obesidad y con los hábitos de vida no saludables, con valores más desfavorables entre los hombres. Destaca la importancia de valorar, junto con el IMC, los indicadores de adiposidad.
Palabras clave: hígado graso, enfermedad del hígado graso no alcohólico, obesidad, salud laboral.
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Affiliation(s)
- M.ª Teófila Vicente-Herrero
- Especialista en Medicina del Trabajo. Grupo Obesidad y Trabajo-Asociación Española de Especialistas en Medicina del Trabajo (AEEMT)
| | - M.ª Victoria Ramírez-Iñiguez de la Torre
- Especialista en Medicina del Trabajo. SPP Grupo Correos-SEPI-Albacete y Cuenca. Grupo Obesidad y Trabajo-Asociación Española de Especialistas en Medicina del Trabajo (AEEMT)
| | - Ángel Arturo López González
- Especialista en Medicina del Trabajo. Servei de Salut de les Illes Balears. Escuela Universitaria ADEMA. Grupo Obesidad y Trabajo-Asociación Española de Especialistas en Medicina del Trabajo (AEEMT)
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Vicente Herrero MT, Ramírez-Iñiguez de la Torre MV, López González ÁA. Obesidad, hábitos de vida y valoración FLI en la población laboral española durante la pandemia. REVISTA CLÍNICA DE MEDICINA DE FAMILIA 2022. [DOI: 10.55783/150205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Antecedentes: el hígado graso no alcohólico es la enfermedad hepática más común en el mundo, habitualmente asintomática y manifestación hepática del síndrome metabólico.
Objetivo: estimar el riesgo de hígado graso mediante el índice de hígado graso (FLI, Fatty Liver Index) y su relación con el índice de masa corporal (IMC), indicadores de adiposidad, hábitos de vida y variables sociodemográficas.
Material y métodos: estudio descriptivo transversal realizado con 815 trabajadores de entre 18-66 años, durante la vigilancia de la salud de las empresas participantes, desde marzo de 2020 hasta junio de 2021.
Se utiliza la calculadora FLI y se establecen relaciones con variables sociodemográficas, índices de adiposidad, hábitos de alimentación y actividad física con el uso de los cuestionarios PREDIMED e IPAQ.
Resultados: el FLI > 60 se relaciona significativamente con el IMC, el perímetro de la cintura y el índice cintura-cadera. El IMC incrementa el riesgo casi 20 veces (odds ratio 19,87; IC 95% 10,84-36,44) de sufrir la enfermedad. Los valores altos son más perjudiciales en hombres y el riesgo aumenta con la edad. Un FLI en rango medio/alto (> 30) muestra una relación significativa con la adherencia a MedDiet y con la actividad física realizada, con diferencias entre géneros (p < 0,0001).
Conclusión: el riesgo de hígado graso aumenta con la obesidad y con los hábitos de vida no saludables, con valores más desfavorables entre los hombres. Destaca la importancia de valorar, junto con el IMC, los indicadores de adiposidad.
Palabras clave: hígado graso, enfermedad del hígado graso no alcohólico, obesidad, salud laboral.
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Affiliation(s)
- M.ª Teófila Vicente Herrero
- Especialista en Medicina del Trabajo. Grupo Obesidad y Trabajo-Asociación Española de Especialistas en Medicina del Trabajo (AEEMT)
| | - M.ª Victoria Ramírez-Iñiguez de la Torre
- Especialista en Medicina del Trabajo. SPP Grupo Correos-SEPI-Albacete y Cuenca. Grupo Obesidad y Trabajo-Asociación Española de Especialistas en Medicina del Trabajo (AEEMT)
| | - Ángel Arturo López González
- Especialista en Medicina del Trabajo. Servei de Salut de les Illes Balears. Escuela Universitaria ADEMA. Grupo Obesidad y Trabajo-Asociación Española de Especialistas en Medicina del Trabajo (AEEMT)
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Rojano-Toimil A, Rivera-Esteban J, Manzano-Nuñez R, Bañares J, Martinez Selva D, Gabriel-Medina P, Ferrer R, Pericàs JM, Ciudin A. When Sugar Reaches the Liver: Phenotypes of Patients with Diabetes and NAFLD. J Clin Med 2022; 11:jcm11123286. [PMID: 35743358 PMCID: PMC9225139 DOI: 10.3390/jcm11123286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 01/27/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD) have been traditionally linked to one another. Recent studies suggest that NAFLD may be increasingly common in other types of diabetes such as type 1 diabetes (T1DM) and less frequently ketone-prone and Maturity-onset Diabetes of the Young (MODY) diabetes. In this review, we address the relationship between hyperglycemia and insulin resistance and the onset and progression of NAFLD. In addition, despite the high rate of patients with T2DM and other diabetes phenotypes that can alter liver metabolism and consequently develop steatosis, fibrosis, and cirrhosis, NALFD screening is not still implemented in the daily care routine. Incorporating a clinical algorithm created around a simple, non-invasive, cost-effective model would identify high-risk patients. The principle behind managing these patients is to improve insulin resistance and hyperglycemia states with lifestyle changes, weight loss, and new drug therapies.
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Affiliation(s)
- Alba Rojano-Toimil
- Endocrinology Department, Vall d’Hebron University Hospital, 08035 Barcelona, Spain;
- Vall d’Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain; (J.R.-E.); (R.M.-N.); (J.B.); (D.M.S.)
| | - Jesús Rivera-Esteban
- Vall d’Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain; (J.R.-E.); (R.M.-N.); (J.B.); (D.M.S.)
- Medicine Department Bellaterra, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- Liver Unit, Vall d’Hebron University Hospital, 08035 Barcelona, Spain
| | - Ramiro Manzano-Nuñez
- Vall d’Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain; (J.R.-E.); (R.M.-N.); (J.B.); (D.M.S.)
- Liver Unit, Vall d’Hebron University Hospital, 08035 Barcelona, Spain
| | - Juan Bañares
- Vall d’Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain; (J.R.-E.); (R.M.-N.); (J.B.); (D.M.S.)
- Liver Unit, Vall d’Hebron University Hospital, 08035 Barcelona, Spain
| | - David Martinez Selva
- Vall d’Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain; (J.R.-E.); (R.M.-N.); (J.B.); (D.M.S.)
- Spanish Network of Biomedical Research Centers, Diabetes and Metabolic Associated Disorders (CIBERdem), 28029 Madrid, Spain
| | - Pablo Gabriel-Medina
- Biochemistry Department, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (P.G.-M.); (R.F.)
- Biochemistry and Molecular Biology Department, Universitat Autònoma de Barcelona (UAB), Bellaterra, 08193 Barcelona, Spain
| | - Roser Ferrer
- Biochemistry Department, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (P.G.-M.); (R.F.)
| | - Juan M Pericàs
- Vall d’Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain; (J.R.-E.); (R.M.-N.); (J.B.); (D.M.S.)
- Liver Unit, Vall d’Hebron University Hospital, 08035 Barcelona, Spain
- Spanish Network of Biomedical Research Centers, Liver and Digestive Diseases (CIBERehd), 28801 Madrid, Spain
- Correspondence: (J.M.P.); (A.C.)
| | - Andreea Ciudin
- Endocrinology Department, Vall d’Hebron University Hospital, 08035 Barcelona, Spain;
- Vall d’Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain; (J.R.-E.); (R.M.-N.); (J.B.); (D.M.S.)
- Medicine Department Bellaterra, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- Spanish Network of Biomedical Research Centers, Diabetes and Metabolic Associated Disorders (CIBERdem), 28029 Madrid, Spain
- Correspondence: (J.M.P.); (A.C.)
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Huong NTC, Karimzadeh S, Thanh NT, Thuan TM, Sabbah GM, Ismaeil K, An DNT, Huong LT, Huy NT, Thi Le Hoa P. Updated upper limit of normal for serum alanine aminotransferase value in Vietnamese population. BMJ Open Gastroenterol 2022; 9:e000870. [PMID: 35613736 PMCID: PMC9134171 DOI: 10.1136/bmjgast-2022-000870] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 01/31/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Alanine aminotransferase (ALT) is a marker of hepatic damage and its range can be affected by viral hepatitis, alcoholic hepatitis and non-alcoholic fatty liver diseases. We aimed to study the factors associated with higher ALT level and update the upper limit of normal (ULN) in the Vietnamese population. METHODS This cross-sectional study enrolled 8383 adults, aged 18 years and older who visited the Medical Center at Ho Chi Minh City for a health check-up. Following the exclusion criteria, 6677 subjects were included in the analysis. RESULTS Age ≤40 years, male gender, body mass index >23 kg/m2, diastolic blood pressure >85 mm Hg, cholesterol >5.2 mmol/L, triglyceride >1.7 mmol/L, positivity, anti-hepatitis C virus positivity and fatty liver (p<0.05) were associated with higher ALT level (>40 U/L). Without considering age and gender, healthy group is defined after exclusion of participants with one of the mentioned contributing factors. The median ALT level in the healthy group was 18 in men and 13 in women. The ULN at the 95th percentile of the healthy group was 40 U/L in men and 28 U/L in women. CONCLUSION The ULN for ALT in healthy women was lower than in healthy men. Updated ULN for ALT level can promote the identification of unhealthy subjects. More studies that involve ethnicity and lifestyle factors are needed to confirm the new ULN in the Vietnamese population.
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Affiliation(s)
- Nguyen Thi Cam Huong
- Department of Infectious diseases, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Sedighe Karimzadeh
- School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Nguyen Thi Thanh
- University of Medicine and Pharmacy at Ho Chi Minh city, Ho Chi Minh City, Viet Nam
| | - Tieu Minh Thuan
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | | | | | - Dang Nguyen Trung An
- Imaging Diagnostic Department, University of Medicine and Pharmacy at Ho Chi Minh city, Ho Chi Minh City, Viet Nam
| | - Lai To Huong
- Health Screening Department, University Medical Center, Ho Chi Minh City, Viet Nam
| | - Nguyen Tien Huy
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Pham Thi Le Hoa
- Department of Infectious Disease, University of Medicine and Pharmacy at Ho Chi Minh city, Ho Chi Minh City, Viet Nam
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Berberine remodels adipose tissue to attenuate metabolic disorders by activating sirtuin 3. Acta Pharmacol Sin 2022; 43:1285-1298. [PMID: 34417576 PMCID: PMC9061715 DOI: 10.1038/s41401-021-00736-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 06/29/2021] [Indexed: 12/19/2022] Open
Abstract
Adipose tissue remodelling is considered a critical pathophysiological hallmark of obesity and related metabolic diseases. Berberine (BBR), a natural isoquinoline alkaloid, has potent anti-hyperlipidaemic and anti-hyperglycaemic effects. This study aimed to explore the role of BBR in modulating adipose tissue remodelling and the underlying mechanisms. BBR protected high fat diet (HFD)-fed mice against adiposity, insulin resistance and hyperlipidemia. BBR alleviated adipose tissue inflammation and fibrosis by inhibiting macrophage infiltration, pro-inflammatory macrophage polarization and the abnormal deposition of extracellular matrix, and the effect was mediated by BBR directly binding and activating the deacetylase Sirtuin 3 (SIRT3) and suppressing the activation of the mitogen-activated protein kinases and nuclear factor-κB signalling pathways. Furthermore, BBR decreased microRNA-155-5p secretion by macrophages, which in turn ameliorated liver injury. Moreover, BBR mitigated inflammatory responses in both LPS-stimulated macrophages and TNF-α-treated adipocytes and suppressed macrophage migration towards adipocytes by activating SIRT3. Collectively, this study revealed that BBR improved adipose tissue remodelling, and subsequently inhibited the secretion of microRNA-155-5p by macrophages, which alleviated adiposity, insulin resistance and liver injury in obese mice. The modulation of adipose tissue remodelling by activating SIRT3 could contribute to the anti-hyperlipidemic and anti-hyperglycemic effects of BBR.
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Li Q, Wang L, Wu J, Wang J, Wang Y, Zeng X. Role of age, gender and ethnicity in the association between visceral adiposity index and non-alcoholic fatty liver disease among US adults (NHANES 2003-2018): cross-sectional study. BMJ Open 2022; 12:e058517. [PMID: 35314476 PMCID: PMC8938699 DOI: 10.1136/bmjopen-2021-058517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES The association between visceral adiposity index (VAI) and the prevalence of non-alcoholic fatty liver disease (NAFLD) has not been fully determined. Here, we aimed to explore the association between VAI and NAFLD in the general US population, and further investigate whether the association involves population differences. DESIGN Cross-sectional population-based study. SETTING The National Health and Nutrition Examination Survey (2003-2018). PARTICIPANTS A total of 7522 participants aged 20 years or older who have complete information for NAFLD assessment test were included in this study. PRIMARY AND SECONDARY OUTCOME MEASURES NAFLD was assessed by the modified fatty liver index for the US population (USFLI) using a cut-off point of 30. Correlation between VAI and NAFLD prediction scores was calculated using the partial correlation analysis. Logistic regression models were further used to estimate ORs and 95% CIs. RESULTS Insulin resistance (IR), inflammation and waist circumference-adjusted partial correlation analysis indicated that VAI scores were positively correlated with USFLI (r=0.404 for men, and r=0.395 for women; p<0.001). In a comparison of the highest versus the lowest quartiles of VAI, multivariable logistic regression analysis demonstrated a positive association between VAI and NAFLD (OR (95% CI)=1.97 (1.12 to 3.47) for men, OR (95% CI)=4.03 (1.98 to 8.20) for women). The stratified analyses revealed that the positive association involves age/gender-specific and ethnic differences. As for the impact of metabolic disorders, our results revealed that the association was independent of IR and diabetes, but it would be confounded by other metabolic disorders. However, no significant association was found between VAI and hepatic fibrosis. CONCLUSION VAI is positively associated with the prevalence of NAFLD, but not hepatic fibrosis among US adults, and the association involves age/gender-specific and ethnic differences. The results reported here have important public health implications in NAFLD screening in the future.
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Affiliation(s)
- Qianwen Li
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Ling Wang
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
- Faculty of Medicine, Macau University of Science and Technology, Macau SAR, People's Republic of China
| | - Jian Wu
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Jing Wang
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Yanjie Wang
- School of Management, Xinxiang Medical University, Xinxiang, China
| | - Xin Zeng
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
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Yi X, Zhu S, Zhu L. Diagnostic accuracy of the visceral adiposity index in patients with metabolic-associated fatty liver disease: a meta-analysis. Lipids Health Dis 2022; 21:28. [PMID: 35249545 PMCID: PMC8898453 DOI: 10.1186/s12944-022-01636-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/15/2022] [Indexed: 01/26/2023] Open
Abstract
Background Conflicting results on the prognostic value of the visceral adiposity index (VAI) in patients with metabolic-associated fatty liver disease (MAFLD) have been reported. This study aimed to assess the diagnostic value of the VAI in MAFLD patients. Methods The Cochrane Library, PubMed, Embase, and other databases were searched to collect all documents that met the inclusion criteria from the establishment of the database to September 2021. The methodological quality of the included studies was assessed using the Newcastle–Ottawa Scale. The heterogeneity among the studies was analysed by the Cochran Q test and I2 test, and the appropriate model was selected according to the heterogeneity results. The diagnostic efficacy of the VAI was evaluated by sensitivity, specificity, and area under the curve, and a Fagan diagram was generated to evaluate the diagnostic ability of the VAI. Results A total of 9 studies were included. The overall quality of the included studies was good. Meta-analysis showed that the combined sensitivity of the VAI for the diagnosis of MAFLD was 0.70 [95% CI (0.69–0.71)], the combined specificity was 0.67 [95% CI (0.67–0.68)], the combined positive likelihood ratio was 2.08 [95% CI (1.87–2.31)], the combined negative likelihood ratio was 0.39 [95% CI (0.34–0.44)], and the combined diagnostic odds ratio was 5.81 [95% CI (4.73–7.14)]. The corresponding area under the curve was 0.79 [95% CI (0.75–0.82)]. Meta-regression analysis showed that the diagnostic method was a potential source of heterogeneity (P < 0.05). The Fagan diagram showed that the precision of MAFLD diagnosis was 70% when the pretest probability was set to 50% and then supplemented by the VAI. Conclusions The VAI is an independent predictor in the diagnosis of MAFLD and may be helpful in the detection of MAFLD. A VAI > 2.33 suggests that patients have a high probability of having MAFLD. Supplementary Information The online version contains supplementary material available at 10.1186/s12944-022-01636-8.
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Khayyat YM. Determination of “indeterminate score” measurements in lean nonalcoholic fatty liver disease patients from western Saudi Arabia. World J Hepatol 2021; 13:2150-2160. [PMID: 35070015 PMCID: PMC8727213 DOI: 10.4254/wjh.v13.i12.2150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/24/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Noninvasive measures to estimate liver fibrosis in lieu of biopsy in nonalcoholic liver disease (NAFLD) can broadly differentiate high vs low degrees of condition extent. However, an “indeterminate score” necessitates further clinical investigation and biopsy becomes essential, highlighting the need for identification of other noninvasive factors with accuracy for this midlevel extent and its prognosis. Lean NAFLD cases are of particular interest regarding this issue, as they present as otherwise healthy, and will benefit greatly from the less invasive assessment.
AIM To estimate the agreement of two noninvasive assessment tools in lean NAFLD patients, and assess factors related to indeterminate scores.
METHODS Ultrasound-diagnosed NAFLD patients, without sign of other chronic liver disease (n = 1262), were enrolled from a tertiary private medical centre between 2016-2019. After grouping by body mass index (obese, overweight, and lean), each participant underwent FibroScan. NAFLD fibrosis score (NFS) was used for subclassification (lower, higher, and indeterminate). No patient underwent liver biopsy. The kappa statistic was used to assess inter-rater agreement between the three groups on liver fibrosis degree assessed via FibroScan and NFS. Indeterminate score among the three groups was assessed to identify factors that predict its determination.
RESULTS The NAFLD study cohort was composed of lean (159/1262, 12.6%), overweight (365/1262, 29%) and obese (737/1262, 58.4%) individuals. The lean patients were significantly younger (49.95 ± 15.3 years, P < 0.05), with higher serum high density lipoprotein (52.56 ± 16.27 mg/dL, P < 0.001) and lower prevalences of type 2 diabetes mellitus, hypertension and hyperlipidaemia. All groups showed a predominance of lower fibrosis degree. The lean NAFLD patients showed a significantly lower NFS (P < 0.001). Degree of agreement between FibroScan and NFS was fair between the lean and obese NAFLD categories, and moderate in the overweight category. NFS was predictive of indeterminate score. Age was a factor among all the body mass index (BMI) categories; other associated factors, but with less strength, were serum alanine aminotransferase in the overweight category and BMI in the obese category.
CONCLUSION Lean NAFLD patients showed lower degree and prevalence of liver fibrosis by NFS; however, follow-up biopsy is still needed.
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Affiliation(s)
- Yasir Mohammed Khayyat
- Department of Medicine, Umm Al Qura University, Makkah 13578, Saudi Arabia
- Department of Medicine, International Medical Centre, Jeddah 21451, Saudi Arabia
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Ismaiel A, Jaaouani A, Leucuta DC, Popa SL, Dumitrascu DL. The Visceral Adiposity Index in Non-Alcoholic Fatty Liver Disease and Liver Fibrosis-Systematic Review and Meta-Analysis. Biomedicines 2021; 9:1890. [PMID: 34944706 PMCID: PMC8698356 DOI: 10.3390/biomedicines9121890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 11/28/2021] [Accepted: 11/29/2021] [Indexed: 12/19/2022] Open
Abstract
(1) Background: In order to avoid a liver biopsy in non-alcoholic fatty liver disease (NAFLD), several noninvasive biomarkers have been studied lately. Therefore, we aimed to evaluate the visceral adiposity index (VAI) in NAFLD and liver fibrosis, in addition to its accuracy in predicting NAFLD and NASH. (2) Methods: We searched PubMed, Embase, Scopus, and Cochrane Library, identifying observational studies assessing the VAI in NAFLD and liver fibrosis. QUADAS-2 was used to evaluate the quality of included studies. The principal summary outcomes were mean difference (MD) and area under the curve (AUC). (3) Results: A total of 24 studies were included in our review. VAI levels were significantly increased in NAFLD (biopsy-proven and ultrasound-diagnosed), simple steatosis vs. controls, and severe steatosis vs. simple steatosis. However, no significant MD was found according to sex, liver fibrosis severity, simple vs. moderate and moderate vs. severe steatosis, pediatric NAFLD, and NASH patients. The VAI predicted NAFLD (AUC 0.767) and NASH (AUC 0.732). (4) Conclusions: The VAI has a predictive value in diagnosing NAFLD and NASH, with significantly increased values in adult NAFLD patients, simple steatosis compared to controls, and severe steatosis compared to simple steatosis.
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Affiliation(s)
- Abdulrahman Ismaiel
- 2nd Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (A.I.); (S.-L.P.); (D.L.D.)
| | - Ayman Jaaouani
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania;
| | - Daniel-Corneliu Leucuta
- Department of Medical Informatics and Biostatistics, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Stefan-Lucian Popa
- 2nd Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (A.I.); (S.-L.P.); (D.L.D.)
| | - Dan L. Dumitrascu
- 2nd Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (A.I.); (S.-L.P.); (D.L.D.)
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23
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Progressive Liver Fibrosis in Non-Alcoholic Fatty Liver Disease. Cells 2021; 10:cells10123401. [PMID: 34943908 PMCID: PMC8699709 DOI: 10.3390/cells10123401] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/29/2021] [Accepted: 11/29/2021] [Indexed: 12/11/2022] Open
Abstract
Non-alcoholic steatohepatitis (NASH) is a chronic and progressive form of non-alcoholic fatty liver disease. Its global incidence is increasing and makes NASH an epidemic and a public health threat. Non-alcoholic fatty liver disease is associated with major morbidity and mortality, with a heavy burden on quality of life and liver transplant requirements. Due to repeated insults to the liver, patients are at risk for developing hepatocellular carcinoma. The progression of NASH was initially defined according to a two-hit model involving an initial development of steatosis, followed by a process of lipid peroxidation and inflammation. In contrast, current evidence proposes a “multi-hit” or “multi-parallel hit” model that includes multiple pathways promoting progressive fibrosis and oncogenesis. This model includes multiple cellular, genetic, immunological, metabolic, and endocrine pathways leading to hepatocellular carcinoma development, underscoring the complexity of this disease.
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24
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Cai J, Lin C, Lai S, Liu Y, Liang M, Qin Y, Liang X, Tan A, Gao Y, Lu Z, Wu C, Huang S, Yang X, Zhang H, Kuang J, Mo Z. Waist-to-height ratio, an optimal anthropometric indicator for metabolic dysfunction associated fatty liver disease in the Western Chinese male population. Lipids Health Dis 2021; 20:145. [PMID: 34706716 PMCID: PMC8549212 DOI: 10.1186/s12944-021-01568-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/23/2021] [Indexed: 12/24/2022] Open
Abstract
Background Non-alcoholic fatty liver disease (NAFLD) has been entitled as metabolic-dysfunction associated fatty liver disease (MAFLD). Therefore anthropometric indicators of adiposity may provide a non-invasive predictive and diagnostic tool for this disease. This study intended to validate and compare the MAFLD predictive and diagnostic capability of eight anthropometric indicators. Methods The study involved a population-based retrospective cross-sectional design. The Fangchenggang area male health and examination survey (FAMHES) was used to collect data of eight anthropometric indicators, involving body mass index (BMI), waist-to-height ratio (WHtR), waist-hip ratio (WHR), body adiposity index (BAI), cardiometabolic index (CMI), lipid accumulation product (LAP), visceral adiposity index (VAI), and abdominal volume index (AVI). Receiver operating characteristics (ROC) curves and the respective areas under the curves (AUCs) were utilized to compare the diagnostic capacity of each indicator for MAFLD and to determine the optimal cutoff points. Binary logistic regression analysis was applied to identify the odds ratios (OR) with 95% confidence intervals (95% CI) for all anthropometric indicators and MAFLD. The Spearman rank correlation coefficients of anthropometric indicators, sex hormones, and MAFLD were also calculated. Results All selected anthropometric indicators were significantly associated with MAFLD (P < 0.001), with an AUC above 0.79. LAP had the highest AUC [0.868 (95% CI, 0.853–0.883)], followed by WHtR [0.863 (95% CI, 0.848–0.879)] and AVI [0.859 (95% CI, 0.843–0.874)]. The cutoff values for WHtR, LAP and AVI were 0.49, 24.29, and 13.61, respectively. WHtR [OR 22.181 (95% CI, 16.216–30.340)] had the strongest association with MAFLD, regardless of potential confounders. Among all the anthropometric indicators, the strongest association was seen between LAP and sex hormones. Conclusion All anthropometric indicators were associated with MAFLD. WHtR was identified as the strongest predictor of MAFLD in young Chinese males, followed by LAP and AVI. The strongest association was found between LAP and sex hormones. Supplementary Information The online version contains supplementary material available at 10.1186/s12944-021-01568-9.
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Affiliation(s)
- Jinwei Cai
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China.,Department of Endocrinology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.,Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Cuiting Lin
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, Guangdong, China.,Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Shuiqing Lai
- Department of Endocrinology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Yingshan Liu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China.,Department of Endocrinology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Min Liang
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Yingfen Qin
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Xinghuan Liang
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Aihua Tan
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Yong Gao
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Zheng Lu
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Chunlei Wu
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Shengzhu Huang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China.,Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China.,Institute of Urology and Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Xiaobo Yang
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Haiying Zhang
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Jian Kuang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China. .,Department of Endocrinology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.
| | - Zengnan Mo
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China.,Institute of Urology and Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China.,Guangxi Key Laboratory of Genomic and Personalized Medicine, Nanning, Guangxi Zhuang Autonomous Region, China.,Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, Guangxi Zhuang Autonomous Region, China
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25
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Kuchay MS, Martínez-Montoro JI, Choudhary NS, Fernández-García JC, Ramos-Molina B. Non-Alcoholic Fatty Liver Disease in Lean and Non-Obese Individuals: Current and Future Challenges. Biomedicines 2021; 9:biomedicines9101346. [PMID: 34680463 PMCID: PMC8533092 DOI: 10.3390/biomedicines9101346] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/23/2021] [Accepted: 09/27/2021] [Indexed: 12/12/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD), which approximately affects a quarter of the world’s population, has become a major public health concern. Although usually associated with excess body weight, it may also affect normal-weight individuals, a condition termed as lean/non-obese NAFLD. The prevalence of lean/non-obese NAFLD is around 20% within the NAFLD population, and 5% within the general population. Recent data suggest that individuals with lean NAFLD, despite the absence of obesity, exhibit similar cardiovascular- and cancer-related mortality compared to obese NAFLD individuals and increased all-cause mortality risk. Lean and obese NAFLD individuals share several metabolic abnormalities, but present dissimilarities in genetic predisposition, body composition, gut microbiota, and susceptibility to environmental factors. Current treatment of lean NAFLD is aimed at improving overall fitness and decreasing visceral adiposity, with weight loss strategies being the cornerstone of treatment. Moreover, several drugs including PPAR agonists, SGLT2 inhibitors, or GLP-1 receptor agonists could also be useful in the management of lean NAFLD. Although there has been an increase in research regarding lean NAFLD, there are still more questions than answers. There are several potential drugs for NAFLD therapy, but clinical trials are needed to evaluate their efficacy in lean individuals.
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Affiliation(s)
- Mohammad Shafi Kuchay
- Division of Endocrinology and Diabetes, Medanta The Medicity Hospital, Gurugram 122001, Haryana, India;
| | - José Ignacio Martínez-Montoro
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Institute of Biomedical Research in Malaga (IBIMA), Faculty of Medicine, University of Malaga, 29010 Malaga, Spain;
| | | | - José Carlos Fernández-García
- Department of Endocrinology and Nutrition, Regional University Hospital of Malaga, Institute of Biomedical Research in Malaga (IBIMA), Faculty of Medicine, University of Malaga, 29010 Malaga, Spain
- Correspondence: (J.C.F.-G.); (B.R.-M.)
| | - Bruno Ramos-Molina
- Obesity and Metabolism Laboratory, Biomedical Research Institute of Murcia (IMIB-Arrixaca), 30120 Murcia, Spain
- Correspondence: (J.C.F.-G.); (B.R.-M.)
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26
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Wang X, Liu D, Wang Z, Cai C, Jiang H, Yu G. Porphyran-derived oligosaccharides alleviate NAFLD and related cecal microbiota dysbiosis in mice. FASEB J 2021; 35:e21458. [PMID: 33948987 DOI: 10.1096/fj.202000763rrr] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 12/18/2022]
Abstract
Porphyran and its derivatives possess a variety of biological activities, such as ameliorations of oxidative stress, inflammation, hyperlipemia, and immune deficiencies. In this study, we evaluated the potential efficacy of porphyran-derived oligosaccharides from Porphyra yezoensis (PYOs) in alleviating nonalcoholic fatty liver disease (NAFLD) and preliminarily clarified the underlying mechanism. NAFLD was induced by a high-fat diet for six months in C57BL/6J mice, followed by treatment with PYOs (100 or 300 mg/kg/d) for another six weeks. We found that PYOs reduced hepatic oxidative stress in mice with NAFLD, which plays a critical role in the occurrence and development of NAFLD. In addition, PYOs could markedly decrease lipid accumulation in liver by activating the IRS-1/AKT/GSK-3β signaling pathway and the AMPK signaling pathway in mice with NAFLD. PYOs also apparently relieved the hepatic fibrosis induced by oxidative stress via downregulation of TGF-β and its related proteins, so that liver injury was markedly alleviated. Furthermore, PYOs treatment relieved cecal microbiota dysbiosis (such as increasing the relative abundance of Akkermansia, while decreasing the Helicobacter abundance), which could alleviate oxidative stress, inflammation, and lipid metabolism, and protect the liver to a certain degree. In summary, PYOs treatment remarkably improved NAFLD via a specific molecular mechanism and reshaped the cecal microbiota.
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Affiliation(s)
- Xueliang Wang
- Key Laboratory of Marine Drugs of Ministry of Education, Shandong Provincial Key Laboratory of Glycoscience and Glycotechnology, School of Medicine and Pharmacy, Ocean University of China, Qingdao, China.,Laboratory for Marine Drugs and Bioproducts, Pilot National Laboratory for Marine Science and Technology (Qingdao), Qingdao, China
| | - Di Liu
- Key Laboratory of Marine Drugs of Ministry of Education, Shandong Provincial Key Laboratory of Glycoscience and Glycotechnology, School of Medicine and Pharmacy, Ocean University of China, Qingdao, China.,Laboratory for Marine Drugs and Bioproducts, Pilot National Laboratory for Marine Science and Technology (Qingdao), Qingdao, China
| | - Zhe Wang
- Key Laboratory of Marine Drugs of Ministry of Education, Shandong Provincial Key Laboratory of Glycoscience and Glycotechnology, School of Medicine and Pharmacy, Ocean University of China, Qingdao, China.,Laboratory for Marine Drugs and Bioproducts, Pilot National Laboratory for Marine Science and Technology (Qingdao), Qingdao, China
| | - Chao Cai
- Key Laboratory of Marine Drugs of Ministry of Education, Shandong Provincial Key Laboratory of Glycoscience and Glycotechnology, School of Medicine and Pharmacy, Ocean University of China, Qingdao, China.,Laboratory for Marine Drugs and Bioproducts, Pilot National Laboratory for Marine Science and Technology (Qingdao), Qingdao, China
| | - Hao Jiang
- Key Laboratory of Marine Drugs of Ministry of Education, Shandong Provincial Key Laboratory of Glycoscience and Glycotechnology, School of Medicine and Pharmacy, Ocean University of China, Qingdao, China.,Laboratory for Marine Drugs and Bioproducts, Pilot National Laboratory for Marine Science and Technology (Qingdao), Qingdao, China
| | - Guangli Yu
- Key Laboratory of Marine Drugs of Ministry of Education, Shandong Provincial Key Laboratory of Glycoscience and Glycotechnology, School of Medicine and Pharmacy, Ocean University of China, Qingdao, China.,Laboratory for Marine Drugs and Bioproducts, Pilot National Laboratory for Marine Science and Technology (Qingdao), Qingdao, China
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27
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Kang MK, Baek JH, Kweon YO, Tak WY, Jang SY, Lee YR, Hur K, Kim G, Lee HW, Han MH, Choi JH, Park SY, Park JG. Association of Skeletal Muscle and Adipose Tissue Distribution with Histologic Severity of Non-Alcoholic Fatty Liver. Diagnostics (Basel) 2021; 11:diagnostics11061061. [PMID: 34207587 PMCID: PMC8227703 DOI: 10.3390/diagnostics11061061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 12/18/2022] Open
Abstract
Adipose tissue and skeletal muscle is associated with non-alcoholic fatty liver disease (NAFLD). This study evaluates the association between body composition and histologic severity in patients with NAFLD. Using the cross-sectional CT images at the level of L3 vertebra and the histologic findings of 178 patients with biopsy-proven NAFLD, we analyzed the correlation of the histologic findings to the skeletal muscle index (SMI), subcutaneous adipose tissue index (SATI), and visceral adipose tissue index (VATI), which is defined as the body composition area (cm2) by height squared (m2). The clinical and laboratory features with body composition were analyzed to determine the risk factors for advanced fibrosis. The VATI significantly increased in severe non-alcoholic steatohepatitis (NASH) or advanced fibrosis. In addition, the VATI was correlated with the NAFLD activity score (NAS) and the fibrosis stage. In multivariate analyses, age (odds ratio (OR), 1.09; 95% confidence interval (CI), 1.02–1.19; p = 0.025), severe NASH (OR, 8.66; 95% CI, 2.13–46.40; p = 0.005), and visceral adiposity (OR, 6.77; 95% CI, 1.81–29.90; p = 0.007) were independently associated with advanced fibrosis in patients with NAFLD. Visceral adiposity is correlated with the histologic severity of NAFLD, which is independently associated with advanced fibrosis.
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Affiliation(s)
- Min-Kyu Kang
- Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu 42415, Korea; (M.-K.K.); (J.-H.B.)
| | - Jung-Hun Baek
- Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu 42415, Korea; (M.-K.K.); (J.-H.B.)
| | - Young-Oh Kweon
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Korea; (Y.-O.K.); (W.-Y.T.); (S.-Y.J.); (Y.-R.L.)
| | - Won-Young Tak
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Korea; (Y.-O.K.); (W.-Y.T.); (S.-Y.J.); (Y.-R.L.)
| | - Se-Young Jang
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Korea; (Y.-O.K.); (W.-Y.T.); (S.-Y.J.); (Y.-R.L.)
| | - Yu-Rim Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Korea; (Y.-O.K.); (W.-Y.T.); (S.-Y.J.); (Y.-R.L.)
| | - Keun Hur
- Department of Biochemistry and Cell Biology, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (K.H.); (G.K.)
| | - Gyeonghwa Kim
- Department of Biochemistry and Cell Biology, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (K.H.); (G.K.)
| | - Hye-Won Lee
- Department of Pathology, School of Medicine, Keimyung University Dongsan Hospital, Daegu 42601, Korea;
| | - Man-Hoon Han
- Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Korea;
| | - Joon-Hyuk Choi
- Department of Pathology, College of Medicine, Yeungnam University, Daegu 42415, Korea;
| | - Soo-Young Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Korea; (Y.-O.K.); (W.-Y.T.); (S.-Y.J.); (Y.-R.L.)
- Correspondence: (S.-Y.P.); (J.-G.P.); Tel.: +82-53-200-5516 or +82-9205-3619 (S.-Y.P.); +82-53-620-3837 or +82-10-2957-1798 (J.-G.P.); Fax: +82-53-426-8773 (S.-Y.P.); +82-53-654-8386 (J.-G.P.)
| | - Jung-Gil Park
- Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu 42415, Korea; (M.-K.K.); (J.-H.B.)
- Correspondence: (S.-Y.P.); (J.-G.P.); Tel.: +82-53-200-5516 or +82-9205-3619 (S.-Y.P.); +82-53-620-3837 or +82-10-2957-1798 (J.-G.P.); Fax: +82-53-426-8773 (S.-Y.P.); +82-53-654-8386 (J.-G.P.)
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28
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Chao HC, Lin HY. Comparison of Body Mass Index and Fat Indices in Predicting the Severity of Nonalcoholic Fatty Liver Disease Among Children Who Are Overweight and Obese. Front Pediatr 2021; 9:724426. [PMID: 34513769 PMCID: PMC8432615 DOI: 10.3389/fped.2021.724426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 07/26/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Information of the relationships between body mass parameters and the severity of fatty liver is deficient in pediatric nonalcoholic fatty liver disease (NAFLD). Methods: The relationships between body mass parameters (waist circumference [WC], body mass index [BMI], and abdominal subcutaneous fat thickness [ASFT]) and the severity of fatty liver were prospectively evaluated in pediatric patients who are overweight or obese, suffering from NAFLD. Ultrasonography was performed to assess fatty liver and its severity on a three-grade scale (low-grade fatty liver [LGFL], grade 1 or 2; high-grade fatty liver [HGFL], grade 3). Results: A total of 110 subjects (55 LGFL and 55 HGFL) aged 6.2-17.9 years were included. The WC, BMI, and ASFT values were significantly higher in the HGFL group compared to those in the LGFL group (p = 0.00004, 0.01, and 0.04, respectively). WC had the greatest power to predict HGFL under receiver-operating characteristic curve analyses and was positively correlated with the severity of fatty liver in subjects aged 6-12-year old and 13-17-year old (p = 0.007, and 0.0039, respectively). ASFT showed a positive correlation with the severity of fatty liver in subjects aged 13-17-year old (p = 0.04). Conclusions: WC, BMI, and ASFT are predictive of severe NAFLD among children who are overweight and obese; particularly, WC has the most predictive accuracy. Among the parameters, WC and ASFT are predictive in specific age groups.
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Affiliation(s)
- Hsun-Chin Chao
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Hsin-Yeh Lin
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
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29
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Vural Keskinler M, Mutlu HH, Sirin A, Erkalma Senates B, Colak Y, Tuncer I, Oguz A. Visceral Adiposity Index As a Practical Tool in Patients with Biopsy-Proven Nonalcoholic Fatty Liver Disease/Nonalcoholic Steatohepatitis. Metab Syndr Relat Disord 2020; 19:26-31. [PMID: 32898457 DOI: 10.1089/met.2020.0054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Aim: Our study aimed to examine the relationship of the visceral adiposity index (VAI) with clinical and histological parameters in biopsy-proven nonalcoholic fatty liver disease (NAFLD) cases and evaluate its place in clinical practice. Materials and Methods: The study included 57 biopsy-proven NAFLD cases and 57 healthy controls. The VAI values of the cases were calculated with the formula based on body mass index, waist circumference, triglycerides, and high-density lipoprotein cholesterol levels. The relationships between VAI values and clinical and histological parameters were examined. Results: While the VAI was significantly higher in the NAFLD cases in comparison to the control group (3.5 ± 3.09 vs. 1.60 ± 0.98, respectively, P < 0.001), this difference was more noticeable in the nonalcoholic steatohepatitis (NASH) group (3.60 ± 3.35) (P < 0.001). In distinguishing the NAFLD group and the healthy group in VAI, it was determined that VAI had a sensitivity of 72%, specificity of 68%, and an area under the receiver operating characteristic curve value of 76.9%. No significant relationship was found between the histological parameters and VAI scores. Conclusions: Our study showed that VAI was increased in the NAFLD cases. This increase was observed to be more noticeable in especially the NASH cases. It is possible for this index to be a practical modality that could be used in clinical practice in prediction of especially NASH cases, which constitute the progressive form of the disease, but in this sense, there is a need for further studies.
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Affiliation(s)
- Mirac Vural Keskinler
- Department of Internal Medicine and Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Hacer Hicran Mutlu
- Department of Family Physician, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Abdullatif Sirin
- Department of Gastroenterology, Duzce State Hospital, Duzce, Turkey
| | - Banu Erkalma Senates
- Department of Nephrology and Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Yasar Colak
- Department of Gastroenterology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ilyas Tuncer
- Department of Gastroenterology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Aytekin Oguz
- Department of Internal Medicine and Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
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30
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Anisonyan AV, Sandler YG, Khaimenova TY, Keyan VA, Saliev KG, Sbikina ES, Vinnitskaya EV. [Non-alcoholic fatty liver disease and type 2 diabetes mellitus: issues of the liver fibrosis diagnostics]. TERAPEVT ARKH 2020; 92:73-78. [PMID: 33346465 DOI: 10.26442/00403660.2020.08.000770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Indexed: 12/20/2022]
Abstract
AIM To evaluate the frequency of liver fibrosis progression to stage 34 among patients with non-alcoholic fatty liver disease (NAFLD), type 2 diabetes and obesity, to identify predictors of severe liver fibrosis, to propose an algorithm for diagnosing fibrosis in this category of patients. MATERIALS AND METHODS 160 patients with NAFLD, type 2 diabetes mellitus (DM) and obesity and 50 patients with NAFLD without diabetes were comprehensively examined. Patients underwent laboratory examination (clinical blood test, biochemical analysis, immunoglobulins G, M, autoantibody assay, coagulogram), liver ultrasound. All patients underwent determination of the liver fibrosis stage by two methods: the serological test FibroMax and indirect ultrasound elastometry of the liver; 40 patients underwent a liver biopsy. Statistical data processing was performed using the programming language and statistical calculations R: we used correlation analysis, multiple logistic regression method, one-way analysis of variance, multi-factor analysis, the Kruskal-Wallis method, and comparison of the number of patients using the Fisher test. RESULTS DM is a risk factor for the liver fibrosis progression in patients with NAFLD. Significant markers of severe fibrosis in this category of patients are increased levels of GGTP, haptoglobin and alpha-2-macroglobulin, lower platelet and prothrombin levels. Obesity and isolated steatosis without steatohepatitis are not markers of severe liver fibrosis at present, but obesity can be considered a risk factor for the progression of fibrosis in the future. CONCLUSION All patients with NAFLD in combination with diabetes need screening to detect advanced liver fibrosis: it is advisable to determine the levels of GGTP, haptoglobin and alpha-2-macroglobulin.
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Affiliation(s)
- A V Anisonyan
- Loginov Moscow Clinical Scientific and Practical Center
| | - Y G Sandler
- Loginov Moscow Clinical Scientific and Practical Center
| | | | - V A Keyan
- Loginov Moscow Clinical Scientific and Practical Center
| | - K G Saliev
- Loginov Moscow Clinical Scientific and Practical Center
| | - E S Sbikina
- Loginov Moscow Clinical Scientific and Practical Center
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Okamura T, Hashimoto Y, Hamaguchi M, Obora A, Kojima T, Fukui M. The visceral adiposity index is a predictor of incident nonalcoholic fatty liver disease: A population-based longitudinal study. Clin Res Hepatol Gastroenterol 2020; 44:375-383. [PMID: 32434704 DOI: 10.1016/j.clinre.2019.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 03/30/2019] [Accepted: 04/05/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Visceral adiposity index (VAI), calculated with body mass index, high-density lipoprotein cholesterol, triglyceride and waist circumference, has been proposed as a marker of visceral fat accumulation and dysfunction. METHODS The impact of VAI on incident nonalcoholic fatty liver disease (NAFLD) in a historical cohort study of 8399 (3773 men and 4626 women) participants. NAFLD was defined as having fatty liver diagnosed by abdominal ultrasonography. We divided the participants into two groups according to sex and into quartiles according to VAI (Q1-4). We calculated VAI using the formulas. Men: VAI = [waist circumference (WC)/39.68 + (1.88 × body mass index [BMI])] × [triglycerides (TG)/1.03] × [1.31/high-density lipoprotein cholesterol (HDL)]; women: VAI = [WC/36.58 + (1.89 × BMI)] × (TG/0.81) × (1.52/HDL). We performed Cox proportional hazard models, adjusting for age, alanine aminotransferase, fasting plasma glucose, systolic blood pressure, alcohol consumption, smoking status and exercise. RESULTS During the median 4.5-year follow-up for men and 4.9-year follow-up for women, 1078 participants (737 men and 341 women) developed NAFLD. The 4000 days cumulative incidence rate of NAFLD for men and women were 7.5% and 2.2% in Q1, 14.5% and 4.0% in Q2, 22.3% and 6.7% in Q3 and 33.8% and 16.7% in Q4. The hazard ratios of incident NAFLD in Q4 (VAI: men, > 1.13; women, > 0.83) were 3.69 (95% confidence interval 2.84-4.86, P < 0.001) in men and 4.93 (3.28-7.73, P < 0.001) in women, compared to Q1 (VAI: men, < 0.44; women, < 0.36). CONCLUSIONS The visceral adiposity index can be a predictor of incident NAFLD.
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Affiliation(s)
- Takuro Okamura
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Yoshitaka Hashimoto
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Masahide Hamaguchi
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Akihiro Obora
- Department of Gastroenterology, Asahi University Hospital, Gifu, Japan
| | - Takao Kojima
- Department of Gastroenterology, Asahi University Hospital, Gifu, Japan
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
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Simon TG, Kim MN, Luo X, Yang W, Ma Y, Chong DQ, Fuchs CS, Meyerhardt JA, Corey KE, Chung RT, Stampfer M, Zhang X, Giovannucci EL, Chan AT. Physical activity compared to adiposity and risk of liver-related mortality: Results from two prospective, nationwide cohorts. J Hepatol 2020; 72:1062-1069. [PMID: 31954204 PMCID: PMC8162838 DOI: 10.1016/j.jhep.2019.12.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/06/2019] [Accepted: 12/16/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND & AIMS Obesity in adulthood has been associated with increased risk of liver-related mortality. Whether higher levels of physical activity counteract the excess risk conferred by obesity remains unknown. We simultaneously evaluated the long-term impact of physical activity and adiposity on liver-related mortality, within 2 nationwide populations. METHODS We conducted a prospective cohort study of 77,238 women and 48,026 men, with detailed, validated assessments of weekly physical activity (metabolic equivalent task [MET]-hours]), adiposity (body mass index [BMI], waist circumference), and diet, alcohol use and clinical comorbidities, biennially from 1986 through 2012. Using Cox proportional hazards regression models, we calculated multivariable-adjusted hazard ratios (aHRs) and 95% CIs for liver-related mortality, including death from hepatocellular carcinoma (HCC) and other complications of cirrhosis. RESULTS Over 1,856,226 person-years, we recorded 295 liver-related deaths (108 HCC; 187 cirrhosis). Risk of liver-related mortality increased monotonically with higher BMI during adulthood (ptrend<0.0001) and with weight gain during early adulthood (ptrend <0.0001). The risk of liver-related mortality also declined progressively, with increasing physical activity (ptrend = 0.0003); the aHRs across increasing physical activity quintiles were: 1.0, 0.70 (95% CI 0.51-0.96), 0.59 (95% CI 0.42-0.84), 0.52 (95% CI 0.36-0.74) and 0.46 (95% CI 0.31-0.66). Compared to lean-active adults (BMI <25; ≥18 MET-hours/week), the aHRs for obese-active, lean-sedentary, and obese-sedentary adults were: 1.04 (95% CI 0.73-1.37), 2.08 (95% CI 1.21-3.33) and 3.40 (95% CI 2.06-5.56), respectively. Findings were similar for HCC-specific and cirrhosis-specific mortality. Overall, engaging in average-pace walking for >3 hours/week could have prevented 25% of liver-related deaths (95% CI 0.12-0.38). CONCLUSIONS In 2 prospective, nationwide cohorts, both excess adiposity and reduced physical activity were significant predictors of liver-related mortality. Achieving higher physical activity levels counteracted the excess liver-related risks associated with obesity. LAY SUMMARY This is the first large, prospective cohort study to simultaneously evaluate the impact of obesity and physical activity on the long-term risk of liver-related mortality in 2 nationwide populations of American men and women. The study demonstrated that obesity predicted significantly increased risk of liver-related mortality, while physical activity predicted significantly lower risk of liver-related mortality. Importantly, the excess risk of liver-related mortality observed with obesity was no longer statistically significant among adults who engaged in the equivalent of average-pace walking for 3 hours or more, per week.
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Affiliation(s)
- Tracey G Simon
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA; Clinical and Translational Epidemiology Unit (CTEU), Massachusetts General Hospital, Boston, MA
| | - Mi Na Kim
- Clinical and Translational Epidemiology Unit (CTEU), Massachusetts General Hospital, Boston, MA; Division of Gastroenterology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Xiao Luo
- Harvard Medical School, Boston, MA; School of Public Health, China Medical University, Shenyang, Liaoning, P.R. China; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Wanshui Yang
- Harvard Medical School, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Yanan Ma
- Harvard Medical School, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | | | | | | | - Kathleen E Corey
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA; Clinical and Translational Epidemiology Unit (CTEU), Massachusetts General Hospital, Boston, MA
| | - Raymond T Chung
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Meir Stampfer
- Harvard Medical School, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Xuehong Zhang
- Harvard Medical School, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Edward L Giovannucci
- Harvard Medical School, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Andrew T Chan
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA; Clinical and Translational Epidemiology Unit (CTEU), Massachusetts General Hospital, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Broad Institute, Boston, MA; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA.
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Azzu V, Vacca M, Virtue S, Allison M, Vidal-Puig A. Adipose Tissue-Liver Cross Talk in the Control of Whole-Body Metabolism: Implications in Nonalcoholic Fatty Liver Disease. Gastroenterology 2020; 158:1899-1912. [PMID: 32061598 DOI: 10.1053/j.gastro.2019.12.054] [Citation(s) in RCA: 146] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/20/2019] [Accepted: 12/04/2019] [Indexed: 02/06/2023]
Abstract
Adipose tissue and the liver play significant roles in the regulation of whole-body energy homeostasis, but they have not evolved to cope with the continuous, chronic, nutrient surplus seen in obesity. In this review, we detail how prolonged metabolic stress leads to adipose tissue dysfunction, inflammation, and adipokine release that results in increased lipid flux to the liver. Overall, the upshot of hepatic fat accumulation alongside an insulin-resistant state is that hepatic lipid enzymatic pathways are modulated and overwhelmed, resulting in the selective buildup of toxic lipid species, which worsens the pro-inflammatory and pro-fibrotic shift observed in nonalcoholic steatohepatitis.
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Affiliation(s)
- Vian Azzu
- Wellcome Trust-Medical Research Council Institute of Metabolic Science-Metabolic Research Laboratories, Addenbrooke's Hospital; The Liver Unit, Department of Medicine, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge.
| | - Michele Vacca
- Wellcome Trust-Medical Research Council Institute of Metabolic Science-Metabolic Research Laboratories, Addenbrooke's Hospital
| | - Samuel Virtue
- Wellcome Trust-Medical Research Council Institute of Metabolic Science-Metabolic Research Laboratories, Addenbrooke's Hospital
| | - Michael Allison
- The Liver Unit, Department of Medicine, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge
| | - Antonio Vidal-Puig
- Wellcome Trust-Medical Research Council Institute of Metabolic Science-Metabolic Research Laboratories, Addenbrooke's Hospital; Wellcome Trust Sanger Institute, Hinxton, United Kingdom
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Soldevila L, Tenesa M, Horneros J, Bechini J, López JJ, Pérez R, Martínez MÀ, Ouchi D, Franco S, Perez-Àlvarez N, Buccione D, Clotet B, Tural C. Association Between Visceral Abdominal Fat Accumulation and Severity of Liver Fibrosis in Nondiabetic Individuals Coinfected by Human Immunodeficiency Virus and Hepatitis C Virus. AIDS Res Hum Retroviruses 2020; 36:205-213. [PMID: 31564109 DOI: 10.1089/aid.2019.0097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Our primary objective was to assess the independent association between liver fibrosis (LF) and abdominal fat accumulation (AFA) and fatty liver disease (FLD). We also aimed to determine the diagnostic accuracy of AFA and FLD for the prediction of cirrhosis measured using unenhanced low-dose computed tomography (CT). This is a cross-sectional study in stable human immunodeficiency virus (HIV)/hepatitis C virus (HCV)-coinfected patients with active HCV replication. CT was used to quantify fat content in segments III and VI of the liver and AFA. Transient elastometry was used to stage LF. Multivariate logistic regression, receiver operating characteristic curve analysis, and linear mixed model analysis were applied. One hundred fifteen HIV/HCV-coinfected patients were included. Cirrhosis was detected in 20.8% (24 patients). There was a high correlation between anthropometric characteristics and radiological variables. The factors independently associated with cirrhosis were albumin concentration [odds ratio (OR), 0.69; 95% confidence interval (CI), 0.58-0.83; p < .0001] and visceral fat accumulation (OR, 1.02; 95% CI, 1.01-1.04; p = .0003). Multinomial analysis showed that visceral fat area (VFA) was the factor independently associated with stage F2 (OR, 1.02; 95% CI, 1.0-1.03; p < .005) and albumin concentration with stage F3 (OR, 0.75; 95% CI, 0.64-0.89; p < .001). VFA was the only radiological variable with an area under the curve >0.7 for the prediction of cirrhosis. There was no inter- or intraobserver variability in the measurement of AFA; however, high interobserver variability was recorded in the measurement of FLD. The association of VFA with cirrhosis, the high reproducibility of CT for the measurement of VFA, and the ability of VFA to predict cirrhosis make CT a suitable technique for identifying HIV/HCV-coinfected patients for closer surveillance.
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Affiliation(s)
- Laura Soldevila
- Internal Medicine Department, University Hospital Germans Trias I Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Montserrat Tenesa
- Radiology Department, University Hospital Germans Trias I Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Judith Horneros
- Radiology Department, University Hospital Germans Trias I Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Bechini
- Radiology Department, University Hospital Germans Trias I Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan José López
- Internal Medicine Department, University Hospital Germans Trias I Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ricardo Pérez
- Radiology Department, University Hospital Germans Trias I Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Dan Ouchi
- IrsiCaixa Laboratory, University Hospital Germans Trias I Pujol, Barcelona, Spain
| | - Sandra Franco
- IrsiCaixa Laboratory, University Hospital Germans Trias I Pujol, Barcelona, Spain
| | - Nuria Perez-Àlvarez
- Statistics and Operations Research Department, Technical University of Catalonia, Barcelona, Spain
| | - Daniela Buccione
- Internal Medicine Department, University Hospital Germans Trias I Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Bonaventura Clotet
- IrsiCaixa Laboratory, University Hospital Germans Trias I Pujol, Barcelona, Spain
- Infectious Diseases Department, University Hospital Germans Trias I Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Tural
- Internal Medicine Department, University Hospital Germans Trias I Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
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Hegazy M, Saleh SA, Ezzat A, Behiry ME. Novel Application of the Traditional Lipid Ratios as Strong Risk Predictors of NASH. Diabetes Metab Syndr Obes 2020; 13:297-305. [PMID: 32104026 PMCID: PMC7021917 DOI: 10.2147/dmso.s229590] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 11/27/2019] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Limited data are available regarding the role of triglycerides, cholesterol and lipoproteins ratios as risk factors for nonalcoholic fatty liver disease (NAFLD) progression. In the present study, the investigators aimed to investigate the value of cardiovascular risk ratios of triglycerides, cholesterol, and lipoproteins as predictors of nonalcoholic steatohepatitis (NASH) and the correlation of such ratios with disease severity. PATIENTS AND METHODS This study included 131 overweight and obese patients with NAFLD who were divided into NASH, borderline NASH, and non-NASH fatty liver (NNFL) subgroups according to NAFLD activity score (NAS) in liver biopsy, and 60 healthy participants as a control group. Lipid profile and lipid ratios including triglycerides/HDL (TGs/HDL), low-density lipoprotein/high-density lipoprotein (LDL/HDL) and total cholesterol/HDL (TC/HDL) ratios were measured. RESULTS Significantly higher triglycerides/HDL ratio was found in NASH and borderline NASH, while higher cholesterol/HDL ratio was found in borderline NASH in comparison to controls. There were positive correlations between TGs/HDL and steatosis, ballooning, inflammation, BMI, and NAS; between LDL/HDL and inflammation; and between cholesterol/HDL and BMI, steatosis, and NAS. The highest AUC was that of TG/HDL (0.744), at a cut-off point of 3, with 71.8% sensitivity and 76.8% specificity. CONCLUSION Triglycerides, cholesterol and lipoprotein ratios showed higher levels in NASH and correlated with NAFLD severity, and above these cut-off ratios, we can rule in the NASH cases which confer also the cardiovascular morbidities. Structured lipid ratios could serve as markers to screen NASH progression from simple steatosis cases and clarify the link of NASH with the cardiovascular risk prediction in overweight and obese patients.
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Affiliation(s)
- Mona Hegazy
- Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
- Correspondence: Mona Hegazy Internal Medicine, Faculty of Medicine, Cairo University, Villa 22A, Compound First Heights, 6th of October City, Cairo14651, EgyptTel +20 1001421551 Email
| | - Shereen A Saleh
- Internal Medicine, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Ahmed Ezzat
- Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mervat E Behiry
- Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
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Ebrahimi S, Gargari BP, Aliasghari F, Asjodi F, Izadi A. Ramadan fasting improves liver function and total cholesterol in patients with nonalcoholic fatty liver disease. INT J VITAM NUTR RES 2020; 90:95-102. [DOI: 10.1024/0300-9831/a000442] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Abstract. Background: Nonalcoholic fatty liver disease (NAFLD) is a serious global health problem, thus the prevention and management of the disease is necessary. This study aimed to determine the effects of Ramadan Fasting (RF) on liver function, Visceral Adiposity Index (VAI) and Atherogenic Index of Plasma (AIP) in these patients. Methods: Eighty-three NAFLD patients (57 males and 26 females) were enrolled in the study, 42 patients who practiced RF, between Jun 18 through July 17, 2015 and 41 patients in non-fasting groups. Anthropometric parameters and Ultrasound grading were measured before and after Ramadan. The biochemical parameters including lipid profiles (total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides), liver enzymes (Aspartate aminotransferase, SGOT and Alanine aminotransferase, SGPT) were evaluated before and after Ramadan. AIP and VAI were calculated based on formula. Results: The mean decreases in anthropometric indices were significantly different between groups. Similarly, the mean decrease in the total cholesterol values in the fasting group was remarkably greater than in the control group (p = 0.02). The values of AIP and VAI decreased at the end of the study in both group and the mean of changes showed no differences between groups (p = 0.79 and p = 0.65 for AIP and VAI, respectively). The changes in the concentrations of liver enzymes, as well as the severity of hepatic steatosis, showed remarkable differences between groups (p = 0.03, p = 0.05, and p = 0.02 for SGOT and SGPT, and Liver steatosis, respectively). Conclusion: RF improved liver steatosis in NAFLD patients and might be useful in the management of NAFLD.
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Affiliation(s)
- Sara Ebrahimi
- Master of Nutrition, Jahrom University of Medical Sciences, Motahari Hospital, Jahrom, Iran
| | - Bahram Pourghassem Gargari
- Department of Biochemistry and Diet Therapy, Nutrition Research Center, Faculty of Nutrition and Food Science, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fereshteh Aliasghari
- Department of Biochemistry and Diet Therapy, Nutrition Research Center, Faculty of Nutrition and Food Science, Tabriz University of Medical Sciences, Tabriz, Iran
- Student Research Committee, Tabriz University of Medical Sciences, Iran
| | - Foad Asjodi
- Board member of Sport Nutrition in IFMARC (Iran Football Medical Assessment and Research Center), Tehran, Iran
| | - Azimeh Izadi
- Department of Biochemistry and Diet Therapy, Nutrition Research Center, Faculty of Nutrition and Food Science, Tabriz University of Medical Sciences, Tabriz, Iran
- Student Research Committee, Tabriz University of Medical Sciences, Iran
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Haghgoo SM, Sharafi H, Alavian SM. Serum cytokines, adipokines and ferritin for non-invasive assessment of liver fibrosis in chronic liver disease: a systematic review. Clin Chem Lab Med 2019; 57:577-610. [PMID: 30231008 DOI: 10.1515/cclm-2018-0357] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 07/27/2018] [Indexed: 02/06/2023]
Abstract
Chronic liver disease (CLD) is a major health problem worldwide. Non-alcoholic fatty liver disease (NAFLD), chronic hepatitis C (CHC), chronic hepatitis B (CHB), and alcoholic liver disease (ALD) are the most common etiologies of CLD. Liver biopsy is the gold standard for assessment of liver fibrosis, however, it is an invasive method. This review attempts to evaluate the usefulness of serum adiponectin, serum leptin, serum ferritin, serum transforming growth factor-β1 (TGF-β1), and serum platelet derived growth factor-BB (PDGF-BB) as non-invasive markers in the diagnosis of liver fibrosis/cirrhosis. A systematic search in MEDLINE, Web of Science, Scopus, and local databases was performed to identify articles published in English or Persian as of November 2017. Studies conducted among CLD patients, with biopsy proven fibrosis/cirrhosis, and providing sufficient details of patients' clinicopathological characteristics were included. In the 95 studies included, there were a total of 15,548 CLD patients. More than 83% of studies were carried out in Asia and Europe. The relationship between liver fibrosis/cirrhosis and serum levels of ferritin, adiponectin, leptin, TGF-β1, and PDGF-BB was assessed in 42, 33, 27, nine, and three studies, respectively. Serum levels of the markers, particularly ferritin, could successfully predict liver fibrosis/cirrhosis, however, these data might not be clinically replicated and further studies are needed.
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Affiliation(s)
- Seyyed Mortaza Haghgoo
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Department of Clinical Biochemistry, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Heidar Sharafi
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Middle East Liver Diseases (MELD) Center, Tehran, Iran
| | - Seyed Moayed Alavian
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Middle East Liver Diseases (MELD) Center, Tehran, Iran
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Chen VL, Wright AP, Halligan B, Chen Y, Du X, Handelman SK, Long MT, Kiel DP, Speliotes EK. Body Composition and Genetic Lipodystrophy Risk Score Associate With Nonalcoholic Fatty Liver Disease and Liver Fibrosis. Hepatol Commun 2019; 3:1073-1084. [PMID: 31388628 PMCID: PMC6671828 DOI: 10.1002/hep4.1391] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/21/2019] [Indexed: 12/20/2022] Open
Abstract
Up to 25% of patients with nonalcoholic fatty liver disease (NAFLD) are not obese but may have a fat or muscle composition that predisposes them to NAFLD. Our aim was to determine whether body composition parameters associate with NAFLD and to identify genetic contributors to this association. This study included two cohorts. The first included 2,249 participants from the Framingham Heart Study who underwent a computed tomography scan to evaluate hepatic steatosis, dual-energy x-ray absorptiometry testing to assess body composition, and clinical examination. Body composition parameters were normalized to total body weight. A subset of participants underwent genotyping with an Affymetrix 550K single-nucleotide polymorphism array. The second cohort, Michigan Genomics Initiative, included 19,239 individuals with genotyping on the Illumina HumanCoreExome v.12.1 array and full electronic health record data. Using sex-stratified multivariable linear regression, greater central body fat associated with increased hepatic steatosis while greater lower extremity body fat associated with decreased hepatic steatosis. Greater appendicular lean mass was associated with decreased hepatic steatosis in men but not in women. A polygenic risk score for lipodystrophy (regional or global loss of adipose tissue) was associated with increased hepatic steatosis, increased liver fibrosis, and decreased lower extremity fat mass. Conclusion: Greater central body fat associated with increased hepatic steatosis, while greater lower extremity body fat and, in men, greater appendicular lean mass were associated with decreased hepatic steatosis. A genetic risk score for lipodystrophy was associated with NAFLD and liver fibrosis. Our results suggest that buffering of excess energy by peripheral fat and muscle may protect against NAFLD and liver fibrosis in the general population.
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Affiliation(s)
- Vincent L. Chen
- Division of Gastroenterology and Hepatology, Department of MedicineUniversity of Michigan Health SystemAnn ArborMI
- Department of Computational Medicine and BioinformaticsUniversity of Michigan Medical SchoolAnn ArborMI
| | - Andrew P. Wright
- Division of Gastroenterology and Hepatology, Department of MedicineUniversity of Michigan Health SystemAnn ArborMI
- Division of GastroenterologyLoma Linda University HealthLoma LindaCA
| | - Brian Halligan
- Division of Gastroenterology and Hepatology, Department of MedicineUniversity of Michigan Health SystemAnn ArborMI
| | - Yanhua Chen
- Division of Gastroenterology and Hepatology, Department of MedicineUniversity of Michigan Health SystemAnn ArborMI
| | - Xiaomeng Du
- Division of Gastroenterology and Hepatology, Department of MedicineUniversity of Michigan Health SystemAnn ArborMI
| | - Samuel K. Handelman
- Division of Gastroenterology and Hepatology, Department of MedicineUniversity of Michigan Health SystemAnn ArborMI
- Department of Computational Medicine and BioinformaticsUniversity of Michigan Medical SchoolAnn ArborMI
| | - Michelle T. Long
- Section of GastroenterologyBoston Medical Center, Boston University School of MedicineBostonMA
| | - Douglas P. Kiel
- Hebrew SeniorLifeInstitute for Aging Research, Department of MedicineBeth Israel Deaconess Medical CenterBostonMA
- Harvard Medical SchoolBostonMA
| | - Elizabeth K. Speliotes
- Division of Gastroenterology and Hepatology, Department of MedicineUniversity of Michigan Health SystemAnn ArborMI
- Department of Computational Medicine and BioinformaticsUniversity of Michigan Medical SchoolAnn ArborMI
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Wong RJ, Tran T, Kaufman H, Niles J, Gish R. Increasing metabolic co-morbidities are associated with higher risk of advanced fibrosis in nonalcoholic steatohepatitis. PLoS One 2019; 14:e0220612. [PMID: 31369606 PMCID: PMC6675045 DOI: 10.1371/journal.pone.0220612] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 07/21/2019] [Indexed: 12/12/2022] Open
Abstract
Hepatic fibrosis and advanced fibrosis in particular is the strongest predictor of liver-related outcomes and mortality among nonalcoholic steatohepatitis (NASH) patients. Understanding prevalence and predictors of NASH with advanced fibrosis is critical for healthcare resource planning. Using a large U.S. clinical laboratory database from 10/1/2017-9/30/2018, adults negative for hepatitis B and hepatitis C and after excluding for alcoholic liver disease and pregnancy were evaluated for prevalence of F3 and F4 fibrosis using a systematic algorithm of five fibrosis-4 (FIB-4) criteria: Criteria 1 (≥F3: >2.67), Criteria 2 (2.67<F3≤4.12 and F4>4.12), Criteria 3 (2.67<F3≤3.15, F4>3.15), Criteria 4 (3.25<F3≤3.5, F4>3.5), Criteria 5 (3.25<F3≤4.12, F4>4.12). Metabolic co-morbidities evaluated included decreased high density lipoprotein (<40 mg/dL men, <50 mg/dL women), high triglycerides (≥150 mg/dL), elevated hemoglobin A1C (≥6.5%). Parallel analyses of patients with specific NAFLD/NASH ICD-9/10 codes from 10/1/2013-9/30/2018 were performed. Multivariate logistic regression models evaluated for predictors of ≥F3 fibrosis. Among patients with NAFLD/NASH ICD-9/10 codes, ≥F3 prevalence ranged from 4.35% - 6.90%, and F4 prevalence ranged from 2.52%– 3.67%. Increasing metabolic co-morbidities was associated with higher risk of ≥F3 fibrosis. Compared to NASH patients without metabolic co-morbidities, NASH with four concurrent metabolic co-morbidities had higher risk of ≥F3 (OR 1.56, 95% CI 1.40–1.73, p<0.001). In summary, prevalence of NASH with advanced fibrosis among U.S. adults was as high as 6.90% and prevalence of NASH with cirrhosis was as high as 3.67%, representing 5.18 million and 2.75 million, respectively, when using an estimate of 75 million U.S. adults with NAFLD. Co-morbid metabolic abnormalities were associated with higher risk of advanced fibrosis among NASH patients.
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Affiliation(s)
- Robert J. Wong
- Division of Gastroenterology and Hepatology, Alameda Health System–Highland Hospital, Oakland, CA, United States of America
- * E-mail:
| | - Tram Tran
- Gilead Sciences, Foster City, CA, United States of America
| | - Harvey Kaufman
- Quest Diagnostics, Secaucus, NJ, United States of America
| | - Justin Niles
- Quest Diagnostics, Secaucus, NJ, United States of America
| | - Robert Gish
- Division of Gastroenterology and Hepatology, Stanford Health Care, Palo Alto, CA, United States of America
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Zhou YJ, Ye FZ, Li YY, Pan XY, Chen YX, Wu XX, Xiong JJ, Liu WY, Xu SH, Chen YP, Zheng MH. Individualized risk prediction of significant fibrosis in non-alcoholic fatty liver disease using a novel nomogram. United European Gastroenterol J 2019; 7:1124-1134. [PMID: 31662869 DOI: 10.1177/2050640619868352] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/08/2019] [Indexed: 12/17/2022] Open
Abstract
Background Fibrosis is deemed to be a pivotal determinant of the long-term prognosis in non-alcoholic fatty liver disease (NAFLD). Objective We aimed to develop a novel nomogram-based non-invasive model to accurately predict significant fibrosis in patients with NAFLD. Methods We designed a prospective cohort study including 207 patients with biopsy-proven NAFLD. Detailed anthropometric and fibrosis-related laboratory parameters were collected. A nomogram was established based on variables that were independently associated with significant fibrosis identified by the logistic regression model. Then it was compared with aspartate aminotransferase-to-platelet ratio index (APRI), NAFLD fibrosis score (NFS), FIB-4 and BARD score. Diagnostic accuracy was assessed according to area under the receiver operator characteristic curve (AUROC), sensitivity, specificity, positive and negative predictive values, and decision curve analysis. Results Variables included in the nomogram were: waist-to-height ratio, hyaluronic acid, procollagen-III-peptide, chitinase-3-like protein 1, and cytokeratine-18 neoepitope M65. The discrimination ability of the nomogram (AUROC = 0.829, 95%CI 0.755-0.904) was significantly superior to APRI (AUROC = 0.670, 95%CI 0.563-0.777), NFS (AUROC = 0.601, 95%CI 0.480-0.722), FIB-4 (AUROC = 0.624, 95%CI 0.511-0.736) and BARD (AUROC = 0.579, 95%CI 0.459-0.699) for significant fibrosis (all p < 0.05). The nomogram showed a larger net benefit to aid in decision-making as to whether biopsy is required. Conclusions This novel nomogram was more accurate, and achieved higher net benefit than APRI, NFS, FIB-4 and BARD to detect significant fibrosis. It can be useful as a non-invasive method to screen ≥F2 fibrosis in the overall population with NAFLD.
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Affiliation(s)
- Yu-Jie Zhou
- NAFLD Research Center, Department of Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease, Shanghai, China
| | - Fang-Zhou Ye
- NAFLD Research Center, Department of Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Yang-Yang Li
- Department of Pathology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiao-Yan Pan
- Department of Endocrinology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ying-Xiao Chen
- NAFLD Research Center, Department of Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xi-Xi Wu
- Department of Gastroenterology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jiao-Jiao Xiong
- NAFLD Research Center, Department of Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Wen-Yue Liu
- Department of Pathology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shi-Hao Xu
- Department of Ultrasonography, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yong-Ping Chen
- NAFLD Research Center, Department of Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Institute of Hepatology, Wenzhou Medical University, Wenzhou, China
| | - Ming-Hua Zheng
- NAFLD Research Center, Department of Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Institute of Hepatology, Wenzhou Medical University, Wenzhou, China
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Both WHR and FLI as Better Algorithms for Both Lean and Overweight/Obese NAFLD in a Chinese Population. J Clin Gastroenterol 2019; 53:e253-e260. [PMID: 30045169 DOI: 10.1097/mcg.0000000000001089] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
GOALS To compare current nonalcoholic fatty liver disease (NAFLD)-related algorithms to find suitable algorithms for NAFLD, especially lean NAFLD in middle-aged and elderly Chinese population. BACKGROUND NAFLD is the most common cause of chronic liver disease in the world today. Various algorithms based on obesity indicators, blood lipids, and liver enzymes, etc. have been developed to screen NAFLD. MATERIALS AND METHODS General, anthropometric and biochemical characteristics were collected. One-way analysis of variance and the χ test were applied to test the differences in continuous and categorical variables, respectively. Multivariable logistic regression analyses, adjusted by age, gender, body mass index, tobacco use, alcohol consumption, and physical activities, were used to investigate the associations between NAFLD-related algorithms and NAFLD. The accuracy and cut-off point of NAFLD-related algorithms to detect NAFLD were evaluated by area under the receiver operator characteristic curve and the maximum Youden index analysis, respectively. RESULTS In 8 NAFLD-related algorithms, the receiver operator characteristic of fatty liver index (FLI) and waist circumstance-to-height ratio (WHR) for NAFLD were in the whole (0.83 and 0.84), lean (0.74 and 0.74), and overweight/obese (0.71 and 0.72) population, respectively, which were higher than those of other algorithms. The cut-off points of WHR and FLI for NAFLD were different in the overall (0.50 and 20), lean (0.47 and 10), and overweight/obese (0.53 and 45) population. CONCLUSIONS WHR and FLI could be the most accurate of 8 algorithms for the noninvasive diagnosis of NAFLD in both lean and overweight/obese population.
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Pais R, Redheuil A, Cluzel P, Ratziu V, Giral P. Relationship Among Fatty Liver, Specific and Multiple-Site Atherosclerosis, and 10-Year Framingham Score. Hepatology 2019; 69:1453-1463. [PMID: 30125370 DOI: 10.1002/hep.30223] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 08/06/2018] [Indexed: 12/14/2022]
Abstract
Despite a well-documented increase in the prevalence of subclinical atherosclerosis in patients with steatosis, the relationship among steatosis and atherosclerosis, specific atherosclerotic sites, multiple-site atherosclerosis, and cardiovascular risk prediction is incompletely understood. We studied the relationship among steatosis, atherosclerosis site, multiple-site atherosclerosis, coronary artery calcification (CAC), and 10-year Framingham Risk Score (FRS) in 2,554 patients with one or more cardiovascular risk factors (CVRF), free of cardiovascular events and other chronic liver diseases, and drinking less than 50 g alcohol/day. All patients underwent arterial ultrasound (carotid [CP] and femoral [FP] plaques defined as intima-media thickness (IMT) > 1.5 mm), coronary computed tomography scan (severe CAC if ≥ 100), 10-year FRS calculation, and steatosis detection by the fatty liver index (FLI, present if score ≥ 60). Patients with steatosis (36% of total) had higher prevalence of CP (50% versus 45%, P = 0.004) and higher CAC (181 ± 423 versus 114 ± 284, P < 0.001) but similar prevalence of FP (53% versus 50%, P = 0.099) than patients without steatosis. Steatosis was associated with carotid IMT and CAC, but not with FP, independent of age, diabetes, hypertension, and tobacco use (P < 0.001). Fifty-three percent of patients had at least 2-site atherosclerosis and steatosis was associated with at least 2-site atherosclerosis independent of age and CVRF (odds ratio = 1.21, 95% confidence interval 1.01-1.45, P = 0.035). Sixty-four percent of patients with steatosis had a FRS score of 10% or more. FLI was associated with FRS beyond the CVRF or the number of atherosclerosis sites (P < 0.001). Adding FLI to CVRF predicted an FRS greater than or equal to 10% better than CVRF alone (area under the receiver operating characteristic curve = 0.848 versus 0.768, P < 0.001). Conclusion: Steatosis is associated with carotid and coronary, but not femoral atherosclerosis, and with cardiovascular mortality risk. The multiple-site involvement and quantitative tonic relationship could reinforce the prediction of cardiovascular mortality or events over classical CVRF or imaging-based detection of atherosclerosis.
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Affiliation(s)
- Raluca Pais
- Hepatogastroenterology Department, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière-Sorbonne Université, Paris, France.,Research Center, Paris, France.,Institute of Cardiometabolism and Nutrition, Paris, France
| | - Alban Redheuil
- Cardiovascular Imaging and Interventional Radiology Department, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière-Sorbonne Université, Paris, France
| | - Philippe Cluzel
- Cardiovascular Imaging and Interventional Radiology Department, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière-Sorbonne Université, Paris, France
| | - Vlad Ratziu
- Hepatogastroenterology Department, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière-Sorbonne Université, Paris, France.,Institute of Cardiometabolism and Nutrition, Paris, France.,INSERM UMRS 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Philippe Giral
- Institute of Cardiometabolism and Nutrition, Paris, France.,Nutrition and Endocrinology Department, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière-Sorbonne Université, Paris, France
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Bale G, Vishnubhotla RV, Mitnala S, Sharma M, Padaki RN, Pawar SC, Duvvur RN. Whole-Exome Sequencing Identifies a Variant in Phosphatidylethanolamine N-Methyltransferase Gene to be Associated With Lean-Nonalcoholic Fatty Liver Disease. J Clin Exp Hepatol 2019; 9:561-568. [PMID: 31695245 PMCID: PMC6823660 DOI: 10.1016/j.jceh.2019.02.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 02/03/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND AIM Nonalcoholic fatty liver disease (NAFLD) is a spectrum of liver diseases with simple steatosis on one end and hepatocellular carcinoma on the other. Although obesity is a known risk factor for NAFLD, individuals with normal body mass index (BMI) also have hepatic fatty infiltration, now termed "lean-NAFLD". It represents a distinct entity with a strong underlying genetic component. The present study aimed to sequence the complete exonic regions of individuals with lean-NAFLD to identify germline causative variants associated with disrupted hepatic fatty acid metabolism, thereby conferring susceptibility to NAFLD. METHODS Whole blood was collected from patients with lean-NAFLD (n = 6; BMI < 23.0 kg/m2) and matched lean controls (n = 2; discovery set). Liver fat was assessed using acoustic radiation force impulse (ARFI) imaging. Patients with ultrasound-detected NAFLD (n = 191) and controls (n = 105) were part of validation set. DNA was isolated, and whole-exome sequencing (WES) was performed in the discovery cohort (Ion Proton™; Ion AmpliSeq™ Exome RDY Kit). Data were analyzed (Ion Reporter software; Life Technologies), and variants identified. Validation of variants was carried out (Taqman probes; Real time-PCR). Student's t test and Fisher's exact test were used to analyze the statistical significance. RESULTS Although WES identified ∼74,000 variants in individual samples, using various pipelines. variants in genes namely phosphatidylethanolamine N-methyltransferase (PEMT) and oxysterol-binding protein-related protein10 (OSBPL10) that have roles in dietary choline intake and regulation of cholesterol homeostasis, respectively, were identified (discovery set). Furthermore, significant differences were noted in BMI (p = 0.006), waist/hip circumference (p > 0.001), waist/hip ratio (p > 0.001), aspartate aminotransferase (p > 0.001), alanine aminotransferase (p > 0.001), and triglycerides (p = 0.002) between patients and controls. Validation of variants (rs7946-PEMT and rs2290532-OSBPL10) revealed that variant in PEMT but not OSBPL10 gene was associated (p = 0.04) with threefold increased risk of NAFLD in lean individuals. CONCLUSION Our results demonstrate the association of rs7946 with lean-NAFLD. WES may be an effective strategy to identify causative variants underlying lean-NAFLD.
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Key Words
- ALT, alanine aminotransferase
- ARFI, Acoustic Radiation Force Impulse
- AST, aspartate aminotransferase
- BMI, Body mass index
- CI, confidence interval
- DNA, Deoxyribonucleic acid
- FFAs, free fatty acids
- GWAS, Genome-wide association studies
- HCC, Hepatocellular carcinoma
- HDL, high-density lipoproteins
- NAFLD, Nonalcoholic fatty Liver disease
- NASH, nonalcoholic steatohepatitis
- OSBPL10
- OSBPL10, Oxysterol-binding protein-related protein10
- PC, phosphatidylcholine
- PCR, Polymerase chain reaction
- PE, phosphatidylethanolamine
- PEMT
- PEMT, Phosphatidylethanolamine N-methyltransferase
- PHRED, Phil's Read Editor
- SIFT, Sorting Intoleratnt from Tolerant
- SNPs, Single-nucleotide polymorphisms
- SNVs, Single-nucleotide variants
- WC, Waist circumference
- WES, Whole-Exome Sequencing
- gDNA, genomic Deoxyribonucleic acid
- indel, insertion deletion
- lean-NAFLD
- ng, nano gram
- nonalcoholic fatty liver disease
- pM, pico mole
- whole-exome sequencing
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Affiliation(s)
- Govardhan Bale
- Institute of Basic Sciences and Translational Research, Asian Healthcare Foundation, Hyderabad 500082, Telangana, India
| | - Ravikanth V. Vishnubhotla
- Institute of Basic Sciences and Translational Research, Asian Healthcare Foundation, Hyderabad 500082, Telangana, India,Address for correspondence: Asian Healthcare Foundation, 6-3-661, Somajiguda, Hyderabad 500 082, India.
| | - Sasikala Mitnala
- Institute of Basic Sciences and Translational Research, Asian Healthcare Foundation, Hyderabad 500082, Telangana, India
| | - Mithun Sharma
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 500082, Telangana, India
| | - Rao N. Padaki
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 500082, Telangana, India
| | - Smita C. Pawar
- Department of Genetics, Osmania University, Hyderabad, Telangana, India
| | - Reddy N. Duvvur
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 500082, Telangana, India
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Vassilatou E, Lafoyianni S, Vassiliadi DA, Ioannidis D, Paschou SA, Mizamtsidi M, Panagou M, Vryonidou A. Visceral adiposity index for the diagnosis of nonalcoholic fatty liver disease in premenopausal women with and without polycystic ovary syndrome. Maturitas 2018; 116:1-7. [DOI: 10.1016/j.maturitas.2018.06.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/27/2018] [Accepted: 06/30/2018] [Indexed: 12/18/2022]
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Adherence to the Mediterranean Diet and Circulating Levels of Sirtuin 4 in Obese Patients: A Novel Association. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2017; 2017:6101254. [PMID: 28706576 PMCID: PMC5494780 DOI: 10.1155/2017/6101254] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 03/16/2017] [Indexed: 01/10/2023]
Abstract
Purpose This study was aimed at evaluating sirtuin 4 (Sirt4) levels in obese individuals, in relation to their adherence to the Mediterranean diet (MD), a healthy dietary pattern characterized by high antioxidant capacity, and markers of visceral fat storage. Subjects/Methods Forty-three obese patients (44% males; BMI: 36.7–58.8 kg/m2) were consecutively included. PREvención con DIeta MEDiterránea (PREDIMED) and the 7-day food records were used to assess the adherence to MD and dietary pattern, respectively. Visceral adiposity index (VAI) was calculated. Sirt4 levels were detected by ELISA method. Results The majority of the obese participants (62.8%) had an average adherence to MD. Compared with average adherers, low adherers had higher BMI, energy intake, and percentage of energy from lipids, mainly saturated fat and polyunsaturated fatty acids (PUFA), and lower Sirt4 levels. After adjusting for BMI, Sirt4 levels remained negatively correlated with VAI. After adjusting for total energy intake, Sirt4 levels remained negatively associated with PREDIMED and consumption of n-3 PUFA, vitamins C and E. The threshold value of PREDIMED predicting the lowest decrease in Sirt4 levels was found at a score of 6. Conclusions Less reduced Sirt4 levels in obese patients adhering to MD suggest a further aspect of the antioxidant advantage of MD.
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Engin A. Non-Alcoholic Fatty Liver Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 960:443-467. [DOI: 10.1007/978-3-319-48382-5_19] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Volkova NI, Porksheyan MI. Nonalcoholic fatty liver disease: What do we know and what will we have to learn? TERAPEVT ARKH 2017; 89:91-98. [DOI: 10.17116/terarkh201789291-98] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The article reviews relevant data on the prevalence, natural history, pathogenesis, diagnosis, and treatment of nonalcoholic fatty liver disease and critically assesses the fixed notion of this disease.
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Ji B, Qu H, Wang H, Wei H, Deng H. Association Between the Visceral Adiposity Index and Homeostatic Model Assessment of Insulin Resistance in Participants With Normal Waist Circumference. Angiology 2016; 68:716-721. [PMID: 28743220 DOI: 10.1177/0003319716682120] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We assessed the correlation between the visceral adiposity index (VAI; a useful indicator of adipose distribution and function) and homeostatic model assessment of insulin resistance (HOMA-IR) in participants with normal waist circumference. A cross-sectional study was conducted, which included 1834 Chinese adults. The blood pressure, anthropometric measurements, fasting and postprandial blood glucose, fasting insulin, and lipid profiles were measured. The VAI and HOMA-IR were calculated. Participants were divided into 4 groups according to the HOMA-IR level, and the correlation between the VAI and HOMA-IR was analyzed. The VAI gradually increased across the HOMA-IR quartiles ( P < .05), and a Pearson correlation analysis showed that VAI was positively related to the HOMA-IR ( P < .001) in males and females. After adjusting for the other covariates, VAI was independently correlated with the HOMA-IR. A logistic regression analysis indicated that VAI elevation was the main risk factor for the increased HOMA-IR in both genders. Overall, the VAI was closely correlated with the HOMA-IR in a population without central obesity.
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Affiliation(s)
- Baolan Ji
- 1 Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hua Qu
- 1 Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hang Wang
- 1 Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huili Wei
- 1 Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huacong Deng
- 1 Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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A indicator of visceral adipose dysfunction to evaluate metabolic health in adult Chinese. Sci Rep 2016; 6:38214. [PMID: 27905531 PMCID: PMC5131270 DOI: 10.1038/srep38214] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 11/07/2016] [Indexed: 12/18/2022] Open
Abstract
Visceral adipose dysfunction is a major cause of metabolic disorders. However, there is lack of a clinical index for prediction of visceral fat dysfunction in Asians. The present study aims to establish a visceral adiposity index for evaluation of metabolic health status in Chinese, the largest Asian ethnic group. 485 subjects were recruited from Lianqian Community, Xiamen and received abdominal computed tomography(CT) for visceral fat area. A Chinese visceral adiposity index (CVAI) was created using multivariate linear regression analyses, and was further validated in 6495 subjects recruited from Changfeng Community, Shanghai. CVAI was well associated with visceral obesity (r = 0.68, P < 0.001) and HOMA-IR (r = 0.60, P < 0.001). The AUROCs were 0.89(0.88–0.90), 0.72(0.71–0.73), 0.69(0.68–0.71) and 0.67(0.65–0.68) for determination of metabolic syndrome, hypertension, diabetes and prediabetes, respectively. CVAI was more valuable compared to BMI and waist circumference in evaluation of metabolic risks (all P < 0.001), even in subjects with metabolically unhealthy normal weight (MUNW) and metabolically healthy obese/overweight (MHO). This study demonstrates that CVAI is a reliable and applicable index for evaluation of visceral fat dysfunction in Chinese. It might be used to evaluate metabolic health status in Asians.
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