FIB-4, APRI, and AST/ALT ratio compared to FibroScan for the assessment of hepatic fibrosis in patients with non-alcoholic fatty liver disease in Bandar Abbas, Iran

The Sub-Acute Potential Risk of Oxamyl in Male Albino Rats

The current study aimed to investigate the sub-acute effects of oxamyl on male Albino rats following oral administration of either 0.031 or 0.31 mg/kg/day for 14 consecutive days. The findings demonstrated that oxamyl produced a significant impact on most of the examined blood profile and biomarkers, along with a significant progressive and discernible alterations in the histology of organs. According to the results obtained, the potential mechanisms by which oxamyl causes its toxic effects on rats are identified as the inflammation indices, the inhibition of transaminases, alkaline phosphatase, and antioxidant enzymes, as well as the production of thiobarbituric acid reactive substances (TBARs) in organs following oxamyl treatment based on histopathological examinations. Due to the substantial genetic similarities between rats and humans, it is therefore anticipated that oxamyl will have comparable detrimental effects on humans.

The Effect of Exenatide on Platelets Ratio Index and Fibrosis-4 Index in Obese Patients With Diabetes Mellitus

Many studies have shown a close relationship between type 2 diabetes mellitus and obesity. Glucagon-like peptide-1 (GLP-1) agonists are particularly preferred as antidiabetic medications for obese patients with type 2 diabetes because they not only help with glycemic control but also promote weight loss by slowing gastric emptying. Fatty liver disease, a significant complication of obesity, can progress to hepatic fibrosis and cirrhosis in later stages. Platelets ratio index (APRI), fibrosis-4 index (FIB-4), indices are two of the most studied indirect markers of hepatic fibrosis. Our study aimed to investigate the effect of exenatide, a GLP-1 agonist, on the APRI and FIB-4 indices in obese patients with type 2 diabetes mellitus. We included obese patients with type 2 diabetes treated with exenatide at the endocrinology and metabolism outpatient clinics of Bakırköy Dr. Sadi Konuk Training and Research Hospital between January 2015 and May 2018. We calculated the APRI and FIB-4 indexes retrospectively using data on aspartate aminotransferase, alanine aminotransferase, platelet counts, and ages. The study included 170 patients, with an average age of 48.27 ± 11 years. We compared the APRI and FIB-4 indices at the third and sixth months after the onset of exenatide and before the treatment. While there was no significant change in the FIB-4 index with treatment, the APRI index showed a significant decrease. In conclusion, our study observed a significant decrease in the APRI index with exenatide treatment, while the FIB-4 index remained unchanged. More research is needed on liver fibrosis indices in the obese population.

Associations between non-insulin-based insulin resistance surrogate markers and liver-related outcomes in metabolic dysfunction-associated steatotic liver disease: a nationwide cohort study in South Korea

BACKGROUND

Insulin resistance (IR) is a crucial mechanism in the pathogenesis and clinical progression of metabolic dysfunction-associated steatotic liver disease (MASLD). This study aimed to examine the relationship between non-insulin-based IR surrogate markers and the incidence of liver-related outcomes in individuals with MASLD in a nationwide Korean cohort.

METHODS

A total of 66,334 individuals with MASLD who underwent a health examination between 1 January 2009 and 31 December 2010 were included in the study and followed until 31 December 2019, with a median follow-up period of 9.4 years. Hepatic steatosis was defined as a fatty liver index ≥ 30. The triglyceride-glucose (TyG) index, triglyceride-to-high-density lipoprotein cholesterol (TG/HDL) ratio, and metabolic score of IR (METS-IR) were employed as non-insulin-based IR surrogate markers. The MASLD groups were divided into four groups based on the non-insulin-based IR surrogate markers quartiles. The primary outcome was liver-related outcomes, as a composite of hepatocellular carcinoma and decompensated liver cirrhosis.

RESULTS

The MASLD group was 64.4% male (average age, 59.0 years). Using the lowest quartile (Q1) of the three non-insulin-based IR surrogate markers as a reference, a decrease in the adjusted hazard ratio for liver-related outcomes was observed from Q2 to Q4: (TyG: Q2 0.90 [95% confidence interval [CI]: 0.79-1.02], Q3 0.80 [95% CI: 0.70-0.91], Q4 0.80 [95% CI: 0.69-0.92]; TG/HDL: Q2 0.85 [95% CI: 0.75-0.97], Q3 0.81 [95% CI: 0.71-0.92], Q4 0.81 [95% CI: 0.71-0.93]; METS-IR: Q2 0.83 [95% CI: 0.73-0.95], Q3 0.80 [95% CI: 0.70-0.91], Q4 0.80 [95% CI: 0.70-0.92]).

CONCLUSIONS

A lower non-insulin-based IR surrogate marker in the MASLD group may be associated with an increased risk of liver-related outcomes. In the course of monitoring MASLD, metabolic alterations must be meticulously observed.

The role of autophagy in fibrosis: Mechanisms, progression and therapeutic potential (Review)

Various forms of tissue damage can lead to fibrosis, an abnormal reparative reaction. In the industrialized countries, 45% of deaths are attributable to fibrotic disorders. Autophagy is a highly preserved process. Lysosomes break down organelles and cytoplasmic components during autophagy. The cytoplasm is cleared of pathogens and dysfunctional organelles, and its constituent components are recycled. With the growing body of research on autophagy, it is becoming clear that autophagy and its associated mechanisms may have a role in the development of numerous fibrotic disorders. However, a comprehensive understanding of autophagy in fibrosis is still lacking and the progression of fibrotic disease has not yet been thoroughly investigated in relation to autophagy‑associated processes. The present review focused on the latest findings and most comprehensive understanding of macrophage autophagy, endoplasmic reticulum stress‑mediated autophagy and autophagy‑mediated endothelial‑to‑mesenchymal transition in the initiation, progression and treatment of fibrosis. The article also discusses treatment strategies for fibrotic diseases and highlights recent developments in autophagy‑targeted therapies.

Metabolic-Dysfunction-Associated Steatotic Liver Disease: Molecular Mechanisms, Clinical Implications, and Emerging Therapeutic Strategies

Metabolic-dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease (NAFLD), is a highly prevalent metabolic disorder characterized by hepatic steatosis in conjunction with at least one cardiometabolic risk factor, such as obesity, type 2 diabetes, hypertension, or dyslipidemia. As global rates of obesity and metabolic syndrome continue to rise, MASLD is becoming a major public health concern, with projections indicating a substantial increase in prevalence over the coming decades. The disease spectrum ranges from simple steatosis to metabolic-dysfunction-associated steatohepatitis (MASH), fibrosis, cirrhosis, and hepatocellular carcinoma, contributing to significant morbidity and mortality worldwide. This review delves into the molecular mechanisms driving MASLD pathogenesis, including dysregulation of lipid metabolism, chronic inflammation, oxidative stress, mitochondrial dysfunction, and gut microbiota alterations. Recent advances in research have highlighted the role of genetic and epigenetic factors in disease progression, as well as novel therapeutic targets such as peroxisome proliferator-activated receptors (PPARs), fibroblast growth factors, and thyroid hormone receptor beta agonists. Given the multifaceted nature of MASLD, a multidisciplinary approach integrating early diagnosis, molecular insights, lifestyle interventions, and personalized therapies is critical. This review underscores the urgent need for continued research into innovative treatment strategies and precision medicine approaches to halt MASLD progression and improve patient outcomes.

Non-linear relationship between triglyceride glucose index and new-onset diabetes among individuals with non-alcoholic fatty liver disease: a cohort study

BACKGROUND

The relationship between the triglyceride glucose (TyG) values and the development of diabetes in non-alcoholic fatty liver disease (NAFLD) patients is not yet well researched. This study aims to examine how the baseline TyG levels correlate with the incidence of new-onset diabetes in this specific cohort.

METHODS

This cohort included 2,506 normoglycemic Japanese adults with NAFLD who underwent routine health check-ups at Murakami Memorial Hospital between 2004 and 2015. Several statistical approaches, including restricted cubic splines and two-piecewise linear regression, were utilized to assess the relation between the TyG levels and diabetes risk.

RESULTS

Among the 2,506 participants (mean age: 44.78 ± 8.32 years; 81.09% male), 203 individuals (8.10%) developed diabetes over the course of the 11-year follow-up period. A U-shaped relationship was observed between the levels of TyG and the onset of diabetes, with an inflection point identified at a TyG value of 7.82 (95% CI: 7.72-8.00). Below this threshold, each one-unit elevation in TyG values reduced the probability of diabetes by 93% (HR = 0.07, 95% CI: 0.01-0.32, P = 0.001). Conversely, above this threshold, each one-unit elevation increased the probability of diabetes by 70% (HR = 1.70, 95% CI: 1.19-2.44, P = 0.004).

CONCLUSIONS

The findings validate a U-shaped association between TyG levels and new-onset diabetes in adults with NAFLD. Both low and high TyG levels increase diabetes probability in such a group.

Association between cardiovascular health and markers of liver function: a cross-sectional study from NHANES 2005-2018

Background

Cardiovascular health (CVH) has been associated with various systemic diseases. However, the relationship between CVH, as measured by Life's Essential 8 (LE8), and liver function markers in the general population remains poorly understood.

Methods

This study analyzed data from 21,156 participants (aged ≥ 20) from the NHANES 2005-2018 to investigate the associations between CVH and liver function markers [alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), albumin and AST/ALT ratio]. Linear regression models were used, along with a restricted cubic spline (RCS) to assess dose-response. Weighted quantile sum (WQS) regression and quantile g-computation (QGC) analyses were employed to evaluate the association between CVH and liver function markers.

Results

Linear regression analysis showed that each 1-point increase in CVH score was significantly associated with decreased levels of liver enzymes [ALT: -0.200 U/L (95% CI: -0.223, -0.176), AST: -0.043 U/L (-0.062, -0.024), GGT: -0.453 U/L (-0.509, -0.397), ALP: -0.310 U/L (-0.340, -0.281)] and increased levels of albumin [0.040 g/dL (0.036, 0.045)] and AST/ALT ratio [0.0056 (0.0051, 0.0061)]. Notably, CVH score demonstrated non-linear dose-response relationships with ALT, ALP, and AST/ALT ratio. Age significantly modified these associations, while nicotine exposure, BMI, and blood lipids were identified as primary contributors through WQS and QGC analyses. E-value analysis suggested robustness to unmeasured confounding.

Conclusion

This study demonstrates robust associations between CVH and liver function markers in United States adults, with nicotine exposure, BMI, and blood lipids identified as significant contributors. These findings suggest that maintaining optimal cardiovascular health may have beneficial effects on liver function, highlighting potential targets for integrated prevention strategies.

Noninvasive Assessment of the Severity of Liver Fibrosis in MASLD Patients with Long-Standing Type 2 Diabetes

BACKGROUND

Type 2 diabetes mellitus (T2DM) and metabolic dysfunction-associated steatotic liver disease (MASLD), which have a reciprocal relationship compounded by obesity, are highly prevalent in the Middle East affecting morbidity, mortality, and healthcare costs.

OBJECTIVE

This study aimed to assess the severity of MASLD and liver fibrosis among adult Emirati patients with long-standing T2DM.

DESIGN AND PARTICIPANTS

This cross-sectional study used noninvasive methods to assess the severity of MASLD and fibrosis progression in an adult cohort of Emirati patients (N = 546) with a mean T2DM duration of 16 years.

MAIN MEASURES

Fatty liver infiltration was assessed by hepatic steatosis index (HSI), while fibrosis was assessed by the fibrosis-4 (FIB-4) index and aspartate aminotransferase/platelet ratio index (APRI). Of those, 108 patients were randomly subjected to ultrasound-based FibroScan® to assess controlled attenuation parameter (CAP) and liver stiffness measurement (LSM).

KEY RESULTS

All patients had fatty liver with ~ 83% being categorized as having severe steatosis. Serum-based fibrosis biomarker panels detected significant liver fibrosis in ~ 2.5% of these patients. The APRI appeared to be more restrictive in detecting moderate fibrosis (1.5%) than the FIB-4 index (25.5%). CAP significantly correlated with the LSM, indicating that the two methods contributed to the same underlying pathophysiology. Liver steatosis was more severe in female patients, who were older and had a higher body mass index (BMI) than those with moderate or no significant fibrosis. They also had higher serum liver enzymes and were more likely to have age-related changes in kidney function. Interestingly, severity of both steatosis and fibrosis remained unaffected by age and duration of T2D except for fibrosis severity detected by FibroScan®.

CONCLUSIONS

This study highlights the critical need for routine screening of MASLD among Emirati patients with long-standing T2DM, given the high point prevalence of severe steatosis (~ 83%), predominantly among women in this population.

Predictive factors for clinical cure in the treatment of HBeAg(-) chronic hepatitis B or compensated cirrhosis: a prospective observational study

Background

Sequential or combined treatment with nucleos(t)ide analogs (NAs) and pegylated interferon alpha-2b (Peg-IFN-α-2b) can improve the clinical cure rate. However, its clinical application is limited due to the adverse reactions associated with IFN.

Methods

A multi-center prospective observational study was conducted involving 59 NAs-treated chronic hepatitis B (CHB) patients who were treated with a combination therapy of NAs and Peg-IFN-α-2b for 48 weeks. Another 327 NAs-treated patients received NAs monotherapy for 48 weeks. At the end of the treatment, patients were classified into either the clinically cured group or the non-clinically cured group based on clinical efficacy. The study aimed to analyze the clinical cure rate and the predictive factors.

Results

After propensity score matching (PSM), a total of 104 patients were included in the exposure and the control groups. After 48 weeks of treatment, 13 patients in the exposed group achieved clinical cure, with a cure rate of 25%. In contrast, in the control group was 1.92%. The clinical cure rate was greater in the population with CHB or compensated cirrhosis treated with sequential or combined Peg-IFN-α-2b and NAs than in the control group (p < 0.001). Patients treated with Peg-IFN-α-2b were divided into a clinical cure group and a non-clinical cure group for single-factor regression and multi-factor binary logistic regression. The results showed that baseline qHBsAg [relative ratio (RR) = 0.997, 95%CI: [0.995, 0.999], p = 0.031] and △TBiL (RR = 0.698, 95%CI: [0.555, 0.879], p = 0.002) were independent influencing factors for achieving clinical cure in patients with CHB or compensated cirrhosis.

Conclusion

A lower baseline qHBsAg and decrease in TBiL at 24 weeks of treatment are independent influencing factors for achieving clinical cure. The lower the baseline qHBsAg and the higher the △TBiL levels after 24 weeks of treatment, the higher the probability of patients achieving clinical cure.

Effects of rosemary extract and its residue on production, immune performance, and gut microbiota in geese

Introduction

To explore the effects of rosemary extract (RE) and its residue (RR) on the production, immune performance, and gut microbiota of geese.

Methods

We treat 28-day-old Sichuan white geese (n = 180) with three diets: (1) basal diet (control), (2) basal diet supplemented with 0.02% RE, and (3) basal diet supplemented with 15% RR for 42 days.

Results and discussion

On day 70, compared with control treatment, the final body weight, average daily gain and lysozyme levels in the RE treatment increased significantly (p < 0.05). In the RE and RR treatments, there was a significant decrease in alkaline phosphatase, globulin, and high-density lipoprotein levels compared to the control treatment, and there was also a significant increase in aspartate aminotransferase/alanine aminotransferase (p < 0.05). Moreover, for both RE and RR treatments, semi-eviscerated, eviscerated weights, and calcium apparent digestibility increased significantly, along with a decrease in the duodenal index (p < 0.05). Compared with RE treatment, those in the RR treatment had significantly higher duodenal and jejunum relative lengths, aspartate aminotransferase, uric acid, total cholesterol, and low-density lipoprotein levels, and decreased chest depth, chest angle, neck length, semi-eviscerated and eviscerated weights, crude protein digestibility, and levels of globulin, triglyceride, and lysozyme (p < 0.05). There were no differences in gut microbiota α or β diversities among treatments (p > 0.05). Compared to the control treatment, the relative abundance of Turicibacter significantly increased in the RR and RE treatments, and the relative abundance of Sporobacter, Alistipes, and Barnesiella significantly increased in the RR treatment (p < 0.05). Rikenellaceae, Succinivibrionaceae, and Aeromonadales were enriched in the RR treatment, and Lachnospiraceae, Turicibacteraceae, Fusobacteriaceae, and Enterobacteriaceae were enriched in the RE treatment. While we demonstrate the RR diet to be less effective than the RE diet, it did improve production and the gut microbiota of geese to a certain extent.

Role of waist circumference, body mass index and high-sensitivity C-reactive protein in pediatric steatotic liver disease: A cross-sectional study

INTRODUCTION AND OBJECTIVES

Relationships and interactions among waist circumference (WC), body mass index (BMI) and high-sensitivity C-reactive protein (hs-CRP) with steatotic liver disease (SLD) in children have rarely been studied as a whole. We aimed to investigate the association among WC, BMI and hs-CRP with SLD and its related metabolic indictors.

MATERIALS AND METHODS

A total of 10,776 children aged 10-15 years were screened in our study. Anthropometric data, biochemical parameters and ultrasound assessments were collected. Metabolic indictors between children with and without SLD were compared. The correlation of waist circumference Z score (ZWC), body mass index Z score (ZBMI) and hs-CRP with SLD and its related metabolic indictors, and the interactive effect between ZWC with hs-CRP and ZBMI with hs-CRP upon SLD, respectively, was tested.

RESULTS

A total of 543 children with normal BMI (n = 287) and high BMI (n = 256) were examined. Hs-CRP, ZWC and ZBMI were all found to significantly correlate with SLD and its related metabolic indexes. The interaction effect analysis showed that ZWC and male was independent risk factor of SLD with OR (95 %CI) of 23.431 (7.253, 75.697) and 7.927 (2.766,22.713), respectively, whereas the same effect wasn't found in ZBMI. The cut-off value of ZWC for the prediction of SLD was 1.494 and 1.541 in boys and girls, respectively.

CONCLUSIONS

Increased WC, BMI and hs-CRP exerts adverse effect in pediatric SLD and its related metabolic indictors. WC and male gender could be independent risk factors for SLD, and WC was a powerful index for the prediction of SLD in children aged 10-15 years.

Prediction of hepatic fibrosis using the aspartate transaminase-to-platelet ratio index in children and adolescents with metabolic dysfunction-associated steatotic liver disease

BACKGROUND

Aspartate transaminase-to-platelet ratio index (APRI) is an easy and useful predictor of hepatic fibrosis in patients with chronic hepatic disease, and it significantly correlates with the degree of hepatic fibrosis in adult patients with metabolic dysfunction-associated steatotic liver disease (MASLD). This study aimed to evaluate the use of APRI in assessing the severity of MASLD in children and adolescents.

METHODS

Medical records of 115 patients (males: 78; females: 37) with MASLD were retrospectively reviewed. The correlations between the APRI and clinical parameters that indicate the severity of MASLD were analyzed. Their ages ranged between 7.3 and 18.8 years old. Patients with hepatitis B or C infections were excluded from the study. The APRI score was calculated, and transient elastography for liver stiffness measurement (LSM) was performed for all the patients.

RESULTS

The mean APRI score was 0.46 ± 0.26, ranging between 0.16 and 1.57. The LSM values ranged between 2.94 and 7.72 kPa. Body mass index-standard deviation score, transaminase levels, and HbA1c levels were higher in a group with abnormal LSM when divided into two groups according to LSM. The APRI score was greater in the group with abnormal LSM (0.40 ± 0.17 vs. 0.64 ± 0.40, P < 0.001). The APRI score was associated with LSM (r = 0.354, P < 0.001). Area under the curve of APRI for predicting abnormal LSM was 0.650 (95% confidence interval, 0.517-0.784) with a cutoff value of 0.74.

CONCLUSIONS

APRI score showed weak correlation with LSM. Further study encompassing various severity of hepatic fibrosis is needed for identifying better and sensitive non-invasive indicators in pediatric MASLD.

Predictors of Hepatic Fibrosis in Type 2 Diabetes Patients with Metabolic-Dysfunction-Associated Steatotic Liver Disease

BACKGROUND/OBJECTIVES

Approximately 25% of the world's population and more than 60% of patients with type 2 diabetes (T2D) have metabolic-dysfunction-associated steatotic liver disease (MASLD). The association between these pathologies is an important cause of morbidity and mortality in Brazil and worldwide due to the high frequency of advanced fibrosis and cirrhosis. The objective of this study was to determine the epidemiologic and clinical-laboratory profile of patients with T2D and MASLD treated at an endocrinology reference service in a state in northeastern Brazil, and to investigate the association of liver fibrosis with anthropometric and laboratory measurements.

METHODS

A cross-sectional study was performed in a specialized outpatient clinic with 240 patients evaluated from July 2022 to February 2024, using a questionnaire, physical examination, laboratory tests, and liver elastography with FibroScan®.

RESULTS

Estimates showed that women (adjusted OR = 2.69, 95% CI = 1.35-5.35, p = 0.005), obesity (adjusted OR = 2.23, 95% CI = 1.22-4.07, p = 0.009), high GGT (adjusted OR = 3.78, 95% CI = 2.01-7.14, p < 0. 001), high AST (adjusted OR = 6.07, 95% CI = 2.27-16.2, p < 0.001), and high ALT (adjusted OR = 3.83, 95% CI = 1.80-8.11, p < 0.001) were associated with the risk of liver fibrosis even after adjusted analysis.

CONCLUSIONS

The study findings suggested that female sex and BMI were associated with an increased risk of liver fibrosis, highlighting the importance of comprehensive evaluation of these patients. In addition, FIB-4 and MAF-5 provided a good estimate of liver fibrosis in our population and may serve as a useful tool in a public health setting with limited resources.

Association between secondhand smoke and liver injury among US non-smoking adults: Mediation analysis of body mass index in the NHANES

INTRODUCTION

Liver injury is a primary factor in the pathogenesis of most liver diseases, which can lead to liver failure. Secondhand smoke (SHS) is a serious public problem. This research explored the correlation between SHS and the indicators of liver injury.

METHODS

This cross-sectional study was based on the National Health and Nutrition Examination Survey (NHANES) 2011-2016. The relationship between SHS and indicators of liver injury was explored by the weighted linear regression model and smooth curve fitting. The weighted threshold saturation effect model tested the relationship and inflection point between them. Mediation analyses were used to explore whether body mass index (BMI) mediates the correlation between SHS and liver injury indicators.

RESULTS

Our cross-sectional study included 3811 non-smoking participants (aged 20-80 years). The full covariate adjustment model (β= -0.05; 95% CI: -0.08 - -0.02) showed a significant and negative correlation between log cotinine and albumin (ALB). Compared to the unexposed group, the ALB, and total protein (TP) were decreased by 0.16 g/dL, 0.26 g/dL in the heavy exposure group [ALB: -0.16 (-0.26 - -0.05), TP: -0.26 (-0.38 - -0.13)], respectively. Smoothed curve fitting revealed a nonlinear relationship between log cotinine and fibrosis-4 index (FIB-4 score), with the inflection point of log cotinine at -1.72. When log cotinine was < -1.72, the log cotinine significantly and positively correlated with the FIB-4 score (β=0.27; 95% CI: 0.06-0.49). BMI partially mediated the effect of SHS exposure on ALB or TP.

CONCLUSIONS

SHS has harmful effects on the liver in never-smoking adults. BMI partially mediated the effect of SHS exposure on ALB or TP. More prospective and basic research in the future is necessary to focus on validating our results.

Comparative evaluation of APRI, FIB-4, HFS, and NFS: Scoring tools for liver fibrosis in a Mexican population with MASLD

INTRODUCTION AND AIM

Liver fibrosis is a complication of metabolic dysfunction-associated steatotic liver disease (MASLD). Given the limitations and risks of liver biopsy, examining noninvasive scoring systems that are affordable for the population is necessary. Our aim was to evaluate and compare the diagnostic yield of the APRI, FIB-4, NAFLD score, and Hepamet fibrosis score instruments for detecting liver fibrosis in Mexican subjects with MASLD.

MATERIAL AND METHODS

A retrospective study was conducted on a sample of subjects with MASLD. Liver fibrosis was calculated through transient liver elastography. Sociodemographic, epidemiologic, and biochemical variables were evaluated. Scores were calculated utilizing the fibrosis-4 (FIB-4) index, the aspartate aminotransaminase-to-platelet ratio index (APRI), the Hepamet fibrosis score (HFS), and the NAFLD score (NFS), and then compared. ROC curves were constructed, and the optimum cutoff points were determined utilizing the Youden index. Sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratio were calculated.

RESULTS

The study included 194 subjects (63% women), of whom 150 (77.3%) were classified with MASLD and 44 (22.7%) as controls with no liver disease. There was a 15.3% prevalence of advanced fibrosis. The cutoff points of 0.57 for APRI, 1.85 for FIB-4, 0.08 for HFS, and -0.058 for NFS showed diagnostic yields with areas under the ROC curves of 0.79, 0.80, 0.70, and 0.68, respectively.

CONCLUSION

The APRI, FIB-4, NFS, and HFS scores are useful for evaluating liver fibrosis in Mexican subjects with MASLD. Better diagnostic yield was found with the FIB-4 and APRI scores.

High-density lipoprotein cholesterol trajectory and new-onset metabolic dysfunction-associated fatty liver disease incidence: a longitudinal study

BACKGROUND

Although high-density lipoprotein cholesterol (HDL-C) exerts a significant influence on the development of metabolic dysfunction-associated fatty liver disease (MAFLD), the association of dynamic changes in HDL-C levels with the risk of MAFLD remains unclear. Thus, the aim of the current study was to explore the association between the changing trajectories of HDL-C and new-onset MAFLD. The findings of this study may provide a theoretical basis for future personalized intervention and prevention targeting MAFLD.

METHODS

A total of 1507 participants who met the inclusion criteria were recruited from a community-based physical examination population in Nanjing, China from 2017 to 2021. Group-based trajectory models were constructed to determine the heterogeneous HDL-C trajectories. The incidence of MAFLD in each group in 2022 was followed up, and the Cox proportional hazards regression model was applied to investigate the associations between different HDL-C trajectories and the risk of new-onset MAFLD.

RESULTS

The incidences of MAFLD in the low-stable, moderate-stable, moderate-high-stable, and high-stable groups of HDL-C trajectory were 26.5%, 13.8%, 7.2% and 2.6%, respectively. The incidence rate of MAFLD in the order of the above trajectory groups exhibited a decreasing trend (χ2 = 72.55, Ptrend<0.001). After adjusting for confounders, the risk of MAFLD onset in HDL-C low-stable group was still 5.421 times (95%CI: 1.303-22.554, P = 0.020) higher than that in the high-stable group. Subgroup analyses of the combined (moderate high-stable and high-stable groups combined), moderate-stable and low-stable groups showed that sex, age, and overweight/obesity did not affect the association between HDL-C trajectory and MAFLD risk.

CONCLUSIONS

Persistently low HDL-C level is a risk factor for the onset of MAFLD. Long-term monitoring of HDL-C levels and timely intervention for those experiencing persistent declines are crucial for early prevention of MAFLD.

New Biomarkers in Liver Fibrosis: A Pass through the Quicksand?

Chronic liver diseases (CLD) stem from various causes and lead to a gradual progression that ultimately may result in fibrosis and eventually cirrhosis. This process is typically prolonged and asymptomatic, characterized by the complex interplay among various cell types, signaling pathways, extracellular matrix components, and immune responses. With the prevalence of CLD increasing, diagnoses are often delayed, which leads to poor prognoses and in some cases, the need for liver transplants. Consequently, there is an urgent need for the development of novel, non-invasive methods for the diagnosis and monitoring of CLD. In this context, serum biomarkers-safer, repeatable, and more acceptable alternatives to tissue biopsies-are attracting significant research interest, although their clinical implementation is not yet widespread. This review summarizes the latest advancements in serum biomarkers for detecting hepatic fibrogenesis and advocates for concerted efforts to consolidate current knowledge, thereby providing patients with early, effective, and accessible diagnoses that facilitate personalized therapeutic strategies.

Associations of exposure to bisphenol-A or parabens with markers of liver injury/function among US adults in NHANES 2011-2016

BACKGROUND

Bisphenol-A (BPA) and parabens are common endocrine-disrupting compounds (EDCs) that are used extensively in consumer products worldwide and are widely found in the environment.

OBJECTIVE

The purpose of this study was to comprehensively explore the correlations between urinary BPA/parabens levels and liver injury/function markers.

METHODS

In this cross-sectional study, we used National Health and Nutrition Examination Survey (NHANES) data from 2011 to 2016. The exposure variables were urinary BPA and four urinary parabens [methylparaben (MPB), ethylparaben (EPB), propylparaben (PPB), and butylparaben (BPB)], while the outcome variables were indicators of liver function/injury [alanine aminotransferase (ALT), aspartate aminotransferase (AST), AST/ ALT, albumin (ALB), total protein (TP), total bilirubin (TBIL), alkaline phosphatase (ALP), and the fibrosis-4 index (FIB-4)]. Multiple linear regression and weighted quantile sum (WQS) regression analyses were applied to explore the relationships between the individual/combined exposure variables and the liver injury/function indicators, respectively. Furthermore, stratified analysis was employed to detect the associations influenced by age and sex.

RESULTS

A total of 2,179 adults were eligible for the present analysis. Multivariate linear regression analysis revealed positive associations of EPB with AST, ALT, TP, and FIB-4 scores and negative associations of BPA with TP and ALB. The effects of urinary parabens on adverse outcomes in the liver (AST and ALT) were significant in the female and middle-aged subgroups. In addition, the WQS analysis revealed that the mixture of four compounds was negatively associated with ALB. BPA had the greatest effect on the serum ALB concentration (weight = 0.688).

IMPACT

Our present study provided novel evidence of significant associations between BPA or certain parabens and numerous markers of liver injury/function indicators. We found that higher urinary BPA concentrations were associated with worse liver function. Exposure to high EPB/PPB ratios was significantly associated with biomarkers of liver injury.

Assessing Liver Fibrosis in Type 2 Diabetes Mellitus Patients With Metabolic Dysfunction-Associated Steatotic Liver Disease: The Role of Non-invasive Scoring Systems and Associated Factors

Background Metabolic dysfunction-associated steatotic liver disease (MASLD) constitutes a significant cause of chronic liver disease globally. Type 2 diabetes mellitus (T2DM) is a crucial risk factor for MASLD. This investigation is aimed at assessing hepatic fibrosis in T2DM patients with MASLD. Methods This cross-sectional study focused on T2DM patients with MASLD attending a tertiary care center in eastern India. Exclusion criteria were chronic alcohol intake (more than 21 units/week for males and more than 14 units/week for females), other chronic liver diseases, and pregnancy. The study utilized abdominal ultrasonography and transient elastography, complemented by calculating the BARD score, nonalcoholic fatty liver disease (NAFLD) fibrosis score, aspartate aminotransferase to platelet ratio index (APRI) score, and fibrosis 4 (FIB-4) index. The prevalence of advanced fibrosis in patients with T2DM and MASLD was assessed using transient elastography. Results Among the 149 T2DM patients with MASLD studied, 59.7% were female, with an average age of 49.09 years and a T2DM duration of 7.3 years. Transaminitis was detected in 9.4% of the subjects. The risk assessment of hepatic fibrosis revealed that 14.1% of patients had a high risk of hepatic fibrosis on BARD scoring, the NAFLD fibrosis score was in the range of F3-F4 in 8.7% of patients, the FIB-4 index showed a high risk of fibrosis in 5.4% of patients, and the APRI scoring showed severe fibrosis in 3.4% of patients. The prevalence of advanced fibrosis in patients with T2DM and MASLD was 7.4% (95% confidence interval (CI) 3.7 to 12.8), while 75.8% (95% CI 68.2 to 82.5) of participants had at least some level of hepatic fibrosis as measured by transient elastography. Notably, there was a significant positive correlation between these scores and the duration of diabetes and serum bilirubin levels, as corroborated by concordant transient elastography findings. On multivariate logistic regression, systolic blood pressure, serum total bilirubin level, and serum aspartate aminotransferase level had significant predictive value for advanced hepatic fibrosis. Conclusion The significant predictive value of systolic blood pressure, serum total bilirubin level, and serum aspartate aminotransferase level for hepatic fibrosis emphasizes the importance of integrated monitoring for these patients.

A prediction model for the progression from gestational hypertension to pre-eclampsia complicated with HELLP syndrome

OBJECTIVE

HELLP syndrome is a severe complication of hypertensive disorders of pregnancy that can cause multiple organ dysfunction and maternal death in a short period of time. Although HELLP syndrome is more common in patients with pre-eclampsia (PE), there is currently no effective way to identify high-risk individuals who may progress from gestational hypertension (GH) to PE complicated with HELLP syndrome. This study aimed to establish and validate a prediction model for PE complicated with HELLP syndrome, providing a basis for early detection and identification of high-risk individuals in clinical practice.

METHODS

This retrospective case-control study collected data on 326 patients with GH and 139 patients with PE complicated with HELLP syndrome from January 2015 to December 2019. An additional 206 patients with GH and 70 patients with PE complicated with HELLP syndrome who were treated from January 2020 to December 2022 were collected for external validation. General and clinical data were collected, and single-and multiple-factor logistic regression analyses were used to screen for independent factors affecting PE complicated with HELLP syndrome. The diagnostic performance of different indicators was evaluated using ROC curves. A prediction model for PE complicated with HELLP syndrome was constructed, and its efficacy was verified using ROC curves.

RESULTS

The results of single-factor analysis showed that age, SBP, DBP, MAP, hemoglobin, AST, ALT, cholinesterase, alkaline phosphatase, gamma-glutamyl transferase, total protein, total bilirubin, direct bilirubin, indirect bilirubin, BUN, UA, creatinine, APTT, international normalized ratio of prothrombin, D-dimer, fibrinogen, fibrinogen degradation products, Ca, and aspartate-aminotransferase to platelet ratio index (APRI) were factors influencing PE with HELLP syndrome. The results of multiple-factor logistic regression analysis showed that MAP, APRI, CHE, FDP, and Ca were independent factors affecting PE complicated with HELLP syndrome. Based on these results, a prediction model was established, with Y = 9.861 + 2.998APRI + 0.055MAP + 0.014FDP - 0.005CHE - 7.452*Ca.

CONCLUSIONS

The predictive model for PE complicated with HELLP syndrome includes APRI, MAP, FDP, CHE, and Ca. This model can be used as a quantitative tool for predicting and evaluating the development of GH into PE complicated with HELLP syndrome.

Aspartate Aminotransferase-to-Platelet Ratio Index (APRI) as a Novel Score in Early Detection of Complicated Dengue Fever

INTRODUCTION

The occurrence of dengue fever presents a considerable burden for public health care in developing countries. This study aims to validate APRI as predictor score for severity of dengue fever so that catastrophic events could be prevented, and early triage can save lives.

METHODS

The retrospective cross-sectional study was done on dengue positive patients from August to November 2023. APRI score was calculated for every patient at the time of admission. The primary end-point was non-complicated disease (Simple dengue fever) vs complicated disease (dengue hemorrhagic fever and dengue shock syndrome). ROC curve was used to identify the role of APRI in prediction of dengue complication. Youden index was used to find the cut-off value of APRI along with sensitivity, specificity, positive and negative likelihood ratios. To further evaluate the role of APRI score, patients were divided into two groups, patients with APRI score greater and lesser than cut-off value. The qualitative variables among two groups were compared by chi-square testing. The predictors of complicated dengue were first determined by univariate regression analysis and then confirmed by multivariate regression analysis.

RESULTS

The mean APRI score of 135 patients was 20.06 ± 6.31. AUC for APRI score was 0.93 (p < 0.0001) indicating that APRI score calculated at the time of admission is an excellent marker in determining the complicated dengue. The cut-off value for APRI score was 9.04 (sensitivity 84.91%, specificity 89.02%, p < 0.0001). The patients with APRI <9.04 mostly developed simple dengue fever (54.1%) vs DHF (4.4%) and DSS (1.5%), while patients with APRI >9.04 had more DHF (20.7%) and DSS (12.6%) vs simple dengue fever (6.7%). None of the patient died with APRI <9.04 while the mortality rate was 3.7% in patients with APRI >9.04.

CONCLUSION

The APRI score, calculated at the time of admission, is an excellent marker in determining the severe dengue.

Association of preoperative aspartate aminotransferase to platelet ratio index with outcomes and tumour microenvironment among colorectal cancer with liver metastases

This study aims to investigate applicable robust biomarkers that can improve prognostic predictions for colorectal liver metastasis (CRLM) patients receiving simultaneous resection. A total of 1323 CRLM patients from multiple centres were included. The preoperative aspartate aminotransferase to platelet ratio index (APRI) level from blood of patients were obtained. Patients were stratified into a high APRI group and a low APRI group, and comparisons were conducted by analyzing progression-free survival (PFS), overall survival (OS) and postoperative early recurrence. Tumour samples of CRLM were collected to perform single-cell RNA sequencing and multiplex immunohistochemistry/immunofluorescence (mIHC/IF) to investigate the association of APRI levels and the tumour microenvironment of CRLM. Compared with APRI <0.33, PFS disadvantage (IPTW-adjusted HR = 1.240, P = 0.015) and OS disadvantage (IPTW- adjusted HR = 1.507, P = 0.002) of APRI ≥0.33 were preserved in the IPTW-adjusted Cox hazards regression analyses. An APRI ≥0.25 was associated with a significantly increased risk of postoperative early recurrence after adjustment (IPTW-adjusted OR = 1.486, P = 0.001). The external validation showed consistent results with the training cohort. In the high APRI group, the single-cell RNA sequencing results revealed a heightened malignancy of epithelial cells, the enrichment of inflammatory-like cancer-associated fibroblasts and SPP1+ macrophages associated with activation of malignant cells and fibrotic microenvironment, and a more suppressed-function T cells; mIHC/IF showed that PD1+ CD4+ T cells, FOXP3+ CD4+ T cells, PD1+ CD8+ T cells, FOXP3+ CD8+ T cells, SPP1+ macrophages and iCAFs were significantly increased in the intratumoral region and peritumoral region. This study contributed valuable evidence regarding preoperative APRI for predicting prognoses among CRLM patients receiving simultaneous resection and provided underlying clues supporting the association between APRI and clinical outcomes by single-cell sequencing bioinformatics analysis and mIHC/IF.

Neutrophil to albumin ratio: a biomarker in non-alcoholic fatty liver disease and with liver fibrosis

Objective

Given the high prevalence of non-alcoholic fatty liver disease (NAFLD) and its potential to progress to liver fibrosis, it is crucial to identify the presence of NAFLD in patients to guide their subsequent management. However, the current availability of non-invasive biomarkers for NAFLD remains limited. Therefore, further investigation is needed to identify and develop non-invasive biomarkers for NAFLD.

Methods

A retrospective analysis was conducted on 11,883 patients admitted to the Healthcare Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, from January 2016 to December 2019 and divided into NAFLD and non-NAFLD groups. Anthropometric and laboratory examination data were collected. The correlations between variables and NAFLD were evaluated using the student's t-test or Mann-Whitney U test and binary logistic regression analysis. The predictive ability of these variables for NAFLD was assessed using the areas under the curves (AUCs) of receiver operating characteristics.

Results

Among the included patients, 3,872 (32.58%) were diagnosed with NAFLD, with 386 (9.97%) individuals having liver fibrosis. Patients with NAFLD exhibited a higher proportion of males, elevated body mass index (BMI), and increased likelihood of hypertension, diabetes mellitus, and atherosclerosis. Logistic regression analysis identified the neutrophil to albumin ratio (NAR) as the most promising novel inflammation biomarkers, with the highest AUC value of 0.701, a cut-off value of 0.797, sensitivity of 69.40%, and specificity of 66.00% in identifying the risk of NAFLD. Moreover, NAR demonstrated superior predictive value in identifying NAFLD patients at risk of liver fibrosis, with an AUC value of 0.795, sensitivity of 71.30%, and specificity of 73.60% when NAR reached 1.285.

Conclusion

These findings highlight that the novel inflammatory biomarker, NAR, is a convenient and easily accessible non-invasive predictor for NAFLD and NAFLD with liver fibrosis.

Pegbelfermin for reducing transaminase levels in patients with non-alcoholic steatohepatitis: a dose-response meta-analysis of randomized controlled trials

Background

The efficacy of Pegbelfermin (PGBF) in treating non-alcoholic steatohepatitis (NASH) remains controversial. Therefore, we conducted a dose-response meta-analysis to explore the effect and pattern of PGBF at different dosages and treatment durations on transaminase reduction in NASH patients.

Methods

We conducted searches on PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov, and supplemented the search with gray literature and manual searches. Randomized controlled trials (RCTs) evaluating the efficacy of PGBF in NASH patients were included. Risk of bias was assessed by Cochrane Risk of Bias Tool 2.0. We used random-effects models, generalized least squares regression, constrained maximum likelihood, and restricted cubic splines to explore the dose-response relationship. Egger's linear regression was employed to assess publication bias. The study is registered with PROSPERO, CRD42023448024.

Results

Four RCT studies from the period 2018-2023, involving 546 participants, were included. No participants discontinued PGBF treatment due to adverse events. High-dose PGBF treatment significantly reduced transaminase levels in NASH patients compared to the low-dose group (ALT %: MD = 14.94, 95% CI = 2.11-27.77; AST %: MD = 9.05, 95% CI = 3.17-14.92). Longer treatment duration further decreased transaminase levels (ALT%: MD = 8.81, 95% CI = 4.07-13.56; AST%: MD = 6.72, 95% CI = 2.62-10.81). Egger's test did not reveal significant publication bias (p > 0.05). Further investigation indicated a ceiling effect of PGBF dosage on transaminase reduction at 30 mg/week, and NASH patients experienced a rebound in transaminase levels after 28 weeks of continuous treatment.

Conclusion

There is a positive correlation between PGBF dosage and transaminase reduction within a certain range, showing an overall non-linear dose-response relationship. This finding provides guidance for the clinical application of PGBF. Clinicians should be mindful of the dosage ceiling at 30 mg/week and monitor changes in transaminase levels after 28 weeks for timely adjustments in PGBF dosage.

Systematic review registration

PROSPERO, CRD42023448024. https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=448024.

TyG-GGT is a Reliable Non-Invasive Predictor of Advanced Liver Fibrosis in Overweight or Obese Individuals

BACKGROUND

Liver fibrosis is a predisposing factor for liver cancer. This study will investigate the predictive role of the Triglyceride-glucose and Gamma-glutamyl transferase index (TyG-GGT) as a non-invasive indicator of advanced liver fibrosis in individuals with obesity or overweight.

METHOD

We enrolled patients who underwent metabolic and bariatric surgery as well as intraoperative liver biopsies at Zhejiang provincial people's hospital from August 2020 to March 2023. Clinical characteristics, comorbidities, laboratory data, and pathological variables of patients were collected and analysed. Then, we conducted logistics regression model to compare the performance of the TyG-GGT index with other 4 non-invasive models.

RESULTS

A total of 65 patients were included in this study. 43(66.2%) of them were female, with the mean body mass index (BMI) of 39.0 ± 7.3 kg/m2. Meanwhile, 24(36.9%) patients were diagnosed with diabetes. Advanced liver fibrosis were observed in 16.9% of patients, while liver cirrhosis was found in 4.6% of patients. The multivariable logistics regression showed that TyG-GGT was an independent risk factor of advanced liver fibrosis (OR = 6.989, P = 0.049). Additionally, compared to another 4 non-invasive liver fibrosis models (NFS = 0.66, FIB4 = 0.65, METS-IR = 0.68, APRI = 0.65), TyG-GGT exhibits the highest AUC value of 0.75.

CONCLUSIONS

More than one-third of patients undergoing metabolic and bariatric surgery are afflicted with nonalcoholic steatohepatitis (NASH), and a significant proportion exhibit advanced fibrosis. TyG-GGT was a potentially reliable predictor for screening individuals with overweight or obesity at high risk of advanced liver fibrosis, thus providing clinical guidance for early intervention in this targeted group.

Effect of different exercise modalities on nonalcoholic fatty liver disease: a systematic review and network meta-analysis

Physical exercise intervention can significantly improve the liver of patients with Non-alcoholic fatty liver disease (NAFLD), but it is unknown which exercise mode has the best effect on liver improvement in NAFLD patients. Therefore, we systematically evaluated the effect of exercise therapy on liver and blood index function of NAFLD patients through network meta-analysis (NMA). Through systematic retrieval of PubMed, Cochrane Library, Web of Science, EBSCO, and CNKI (National Knowledge Infrastructure), two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies by means of databases from inception to January 2023. The NMA was performed using the inconsistency model. A total of 43 studies, 2070 NAFLD patients were included: aerobic training (n = 779), resistance training (n = 159), high-intensity interval training (n = 160), aerobic training + resistance training (n = 96). The results indicate that aerobic training + resistance training could significantly improve serum total cholesterol (TC) (Surface under the cumulative ranking curve (SUCRA) = 71.7), triglyceride (TG) (SUCRA = 96.8), low-density lipoprotein cholesterol (LDL-C) (SUCRA = 86.1) in patients with NAFLD including triglycerides. Aerobic training is the best mode to improve ALT (SUCRA = 83.9) and high-density lipoprotein cholesterol (HDL-C) (SUCRA = 72.3). Resistance training is the best mode to improve aspartate transaminase (AST) (SUCRA = 81.7). Taking various benefits into account, we believe that the best modality of exercise for NAFLD patients is aerobic training + resistance training. In our current network meta-analysis, these exercise methods have different effects on the six indicators of NAFLD, which provides some reference for further formulating exercise prescription for NAFLD patients.

AST to ALT ratio as a prospective risk predictor for liver cirrhosis in patients with chronic HBV infection

BACKGROUND

Serum aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AAR) is one of the most frequent indicators to discriminate fibrosis and cirrhosis. However, the results remained controversial. The aim of this study was to evaluate the predictive effect of AAR on hepatitis B virus (HBV)-related cirrhosis development.

METHOD

A retrospective cohort study was conducted based on 1754 chronic HBV-infected patients. Clinical variables at their initial visit and follow-up data were collected. Cox proportional hazards model was constructed to evaluate the predictive value of AAR on cirrhosis risk, and its discrimination accuracy was determined by receiver operating characteristic (ROC). The time-dependent effect was assessed by a Fine and Gray competing risk model.

RESULTS

Compared to patients with lower AAR, those with elevated AAR level had higher risk of cirrhosis development by adjusting for host characteristics (dichotomized analyses: hazard ratio = 2.77, P = 8.25 × 10 -4 ; tertile analyses: hazard ratio = 2.95, P = 1.61 × 10 -3 ), with an increasing risk trend ( Ptrend = 4.56 × 10 -4 ). The effect remained prominent when ALT or AST was abnormal, while no significant risk was observed when AST and ALT were simultaneously normal. Time-dependent effect analysis demonstrated a persistently higher risk, with the average hazard ratio equivalent to 1.92. AAR level could improve the discrimination efficacy of host variables with area under the curve increased from 0.684 to 0.711 ( P  =  0.039 ).

CONCLUSION

Higher AAR was significantly associated with increased risk of HBV-related cirrhosis, and might be a potential predictor of cirrhosis development.

Accuracy of prognostic serological biomarkers in predicting liver fibrosis severity in people with metabolic dysfunction-associated steatotic liver disease: a meta-analysis of over 40,000 participants

Introduction

A prognostic model to predict liver severity in people with metabolic dysfunction-associated steatotic liver disease (MASLD) is very important, but the accuracy of the most commonly used tools is not yet well established.

Objective

The meta-analysis aimed to assess the accuracy of different prognostic serological biomarkers in predicting liver fibrosis severity in people with MASLD.

Methods

Adults ≥18 years of age with MASLD were included, with the following: liver biopsy and aspartate aminotransferase-to-platelet ratio (APRI), fibrosis index-4 (FIB-4), non-alcoholic fatty liver disease fibrosis score (NFS), body mass index, aspartate aminotransferase/alanine aminotransferase ratio, diabetes score (BARD score), FibroMeter, FibroTest, enhanced liver fibrosis (ELF), Forns score, and Hepascore. Meta-analyses were performed using a random effects model based on the DerSimonian and Laird methods. The study's risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2.

Results

In total, 138 articles were included, of which 86 studies with 46,514 participants met the criteria for the meta-analysis. The results for the summary area under the receiver operating characteristic (sAUROC) curve, according to the prognostic models, were as follows: APRI: advanced fibrosis (AF): 0.78, any fibrosis (AnF): 0.76, significant fibrosis (SF): 0.76, cirrhosis: 0.72; FIB-4: cirrhosis: 0.83, AF: 0.81, AnF: 0.77, SF: 0.75; NFS: SF: 0.81, AF: 0.81, AnF: 0.71, cirrhosis: 0.69; BARD score: SF: 0.77, AF: 0.73; FibroMeter: SF: 0.88, AF: 0.84; FibroTest: SF: 0.86, AF: 0.78; and ELF: AF: 0.87.

Conclusion

The results of this meta-analysis suggest that, when comparing the scores of serological biomarkers with liver biopsies, the following models showed better diagnostic accuracy in predicting liver fibrosis severity in people with MASLD: FIB-4 for any fibrosis, FibroMeter for significant fibrosis, ELF for advanced fibrosis, and FIB-4 for cirrhosis.Clinical trial registration: [https://clinicaltrials.gov/], identifier [CRD 42020180525].

Circulating microRNA expression and nonalcoholic fatty liver disease in adolescents with severe obesity

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases in children and adolescents. NAFLD ranges in severity from isolated hepatic steatosis to nonalcoholic steatohepatitis (NASH), wherein hepatocellular inflammation and/or fibrosis coexist with steatosis. Circulating microRNA (miRNA) levels have been suggested to be altered in NAFLD, but the extent to which miRNA are related to NAFLD features remains unknown. This analysis tested the hypothesis that plasma miRNAs are significantly associated with histological features of NAFLD in adolescents.

AIM

To investigate the relationship between plasma miRNA expression and NAFLD features among adolescents with NAFLD.

METHODS

This study included 81 adolescents diagnosed with NAFLD and 54 adolescents without NAFLD from the Teen-Longitudinal Assessment of Bariatric Surgery study. Intra-operative core liver biopsies were collected from participants and used to characterize histological features of NAFLD. Plasma samples were collected during surgery for miRNA profiling. A total of 843 plasma miRNAs were profiled using the HTG EdgeSeq platform. We examined associations of plasma miRNAs and NAFLD features using logistic regression after adjusting for age, sex, race, and other key covariates. Ingenuity Pathways Analysis was used to identify biological functions of miRNAs that were associated with multiple histological features of NAFLD.

RESULTS

We identified 16 upregulated plasma miRNAs, including miR-193a-5p and miR-193b-5p, and 22 downregulated plasma miRNAs, including miR-1282 and miR-6734-5p, in adolescents with NAFLD. Moreover, 52, 16, 15, and 9 plasma miRNAs were associated with NASH, fibrosis, ballooning degeneration, and lobular inflammation, respectively. Collectively, 16 miRNAs were associated with two or more histological features of NAFLD. Among those miRNAs, miR-411-5p was downregulated in NASH, ballooning, and fibrosis, while miR-122-5p, miR-1343-5p, miR-193a-5p, miR-193b-5p, and miR-7845-5p were consistently and positively associated with all histological features of NAFLD. Pathway analysis revealed that most common pathways of miRNAs associated with multiple NAFLD features have been associated with tumor progression, while we also identified linkages between miR-122-5p and hepatitis C virus and between miR-199b-5p and chronic hepatitis B.

CONCLUSION

Plasma miRNAs were associated with NAFLD features in adolescent with severe obesity. Larger studies with more heterogeneous NAFLD phenotypes are needed to evaluate miRNAs as potential biomarkers of NAFLD.

Reference intervals of biochemical parameters in Chilean adults

Background

Establishing reference intervals (RIs) in clinical laboratories is essential, as these can vary due to inter-individual variability as well as the analytical methods used. The purpose of this study was to determine RIs for markers and ratios biochemical in apparently healthy Chilean adults.

Methods

A sample of 1,143 data was selected from the Universidad Católica de Temuco, Clinical Laboratory database, La Araucanía Region, Chile, which were analysed by sex. The Tukey's Fences was used to detect outliers and the RIs were established using the non-parametric method.

"Yajieshaba" prevents acute alcoholic liver injury and repairs the intestinal mucosal barrier

ETHNOPHARMACOLOGICAL RELEVANCE

An essential factor related to the acute alcoholic liver injury is damage to the intestinal mucosal barrier. Yajieshaba (YJSB) is a commonly used formulation of Dai people in China and protects the liver.

AIM OF THE STUDY

This study investigated whether YJSB can prevent acute alcoholic liver injury by regulating the intestinal mucosal barrier.

MATERIALS AND METHODS

The mice received 0.39 g/kg, 1.17 g/kg, and 3.51 g/kg dose YJSB for 7 days, a mouse model of acute alcoholic liver injury was established by a single instillation of 56% alcohol. Plasma biochemical markers were analyzed, liver injury was identified by histopathology, lipopolysaccharide (LPS), nuclear factor-k-gene binding (NF-κB), hepatic inflammatory factors, oxidative stress factors and reactive oxygen species (ROS) content was analyzed. The morphological changes of intestinal histology were observed by H&E staining, and the ultrastructure of ileal cells was observed by transmission electron microscopy. Immunofluorescence and Western blot was used to determine the expression levels of transporters and enzymes involved in Claudin 1, Occludin and zona occludens 1 (ZO-1) homeostasis in the liver and intestine.

RESULTS

The findings showed that YJSB reduced the levels of aspartate aminotr ansferase (AST), alanine aminotransferase (ALT) and total bile acid (TBA), both of which are indicators of liver function and had a protective effect against liver injury. In the liver homogenate, YJSB reduced the level of LPS, NF-κB, tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and interleukin-6 (IL-6), decreased the level of superoxide dismutase (SOD), malondialdehyde (MDA), glutathione peroxidase (GSH-PX) and catalase (CAT) and ROS. The results of hematoxylin and eosin (H&E) staining and transmission electron microscopy analysis revealed that YJSB reduced the degree of damage to intestinal tissue and intracellular organelles, implying that YJSB can reduce the "attack factor" that causes intestinal barrier damage, increase the "defense factor" that protects the intestinal barrier. The results of immunohistochemistry and Western blotting analysis showed that YJSB could increase the expression of claudin 1, occludin, and ZO-1 proteins, suggesting that the mechanism of action of YJSB against acute alcohol liver injury involves the upregulation of the expression of the intestinal barrier-related proteins and the repair of the damaged intestinal barrier.

CONCLUSIONS

YJSB can block LPS, oxidative stress factors, and other harmful substances in the blood and protect the liver resisting acute alcoholic liver injury.

A convenient nomogram for predicting early death or liver transplantation after the Kasai procedure in patients with biliary atresia

PURPOSE

Many patients with biliary atresia (BA) after the Kasai procedure (KP) progress to death or require liver transplantation to achieve long-term survival; however, most cases of death/liver transplantation (D/LT) occur in the early period after KP (usually within 1 year). This study was designed to construct a convenient nomogram for predicting early D/LT in patients with BA after KP.

METHODS

A BA cohort was established in May 2017, and up to May 2023, 112 patients with 1-5 years of follow-up were enrolled in the study and randomly (ratio, 3:1) divided into a training cohort for constructing a nomogram (n = 84) and a validation cohort (n = 28) for externally validating the discrimination and calibration. The training cohort was divided into two groups: the early D/LT group (patients who died or had undergone LT within 1 year after KP [n = 35]) and the control group (patients who survived through the native liver more than 1 year after KP [n = 49]). Multivariate logistic regression and stepwise regression were applied to detect variables with the best predictive ability for the construction of the nomogram. The discrimination and calibration of the nomogram were internally and externally validated.

RESULTS

The Kaplan-Meier (K-M) curve showed an actual 1-year native liver transplantation (NLS) rate of 57.1% and an estimated 2-year NLS rate of 55.2%. By multivariate regression and stepwise regression, age at KP, jaundice clearance (JC) speed 1 month after KP, early-onset PC (initial time < 36.5 days) after KP, sex, aspartate aminotransferase-to-platelet ratio index (APRI), and weight at KP were identified as the independent variables with the best ability to predict early D/LT and were used to construct a nomogram. The developed nomogram based on these independent variables showed relatively good discrimination and calibration according to internal and external validation.

CONCLUSION

Most D/LTs were early D/LTs that occurred within 1 year after KP. The established nomogram based on predictors, including sex, weight at the KP, the APRI, age at the KP, JC speed 1 month after the KP, and early PC, may be useful for predicting early D/LT and may be helpful for counseling BA patients about patient prognosis after KP. This study was retrospectively registered at ClinicalTrials.gov (NCT05909033) in June 2023.

Sex Differences in the Association Between AST/ALT and Incidence of Type 2 Diabetes in Japanese Patients with Nonalcoholic Fatty Liver Disease: A Retrospective Cohort Study

OBJECTIVES/INTRODUCTION

The purpose of the current study was to investigate the association between Aspartate Transaminase (AST)/Alanine transaminase(ALT) and type 2 diabetes (T2DM) in nonalcoholic fatty liver disease (NAFLD) patients and to determine whether there were sex differences.

METHODS

In the retrospective study, we collected data on NAFLD patients (1, 896 men and 465 women) at Murakami Memorial Hospital from 2004 to 2015. Data were stratified by sex to investigate the association between AST/ALT and T2DM incidence by sex. Multiple regression analysis, smooth curve fitting model and subgroup analysis were used to determine the correlation, non-linear relationship and threshold effect between AST/ALT and T2DM.

RESULTS

In our study, 157 men and 40 women developed T2DM at follow-up. After adjusting for risk factors, AST/ALT was significantly associated with T2DM in men with NAFLD but not in women with NAFLD. The risk of T2DM increased as the AST/ALT ratio decreased. Besides, in male NAFLD patients, AST/ALT showed a non-linear relationship with T2DM, with an inflection point value of 0.964. When the AST to ALT ratio was below the threshold (AST/ALT <0.964), AST/ALT was significantly negatively associated with T2DM (HR = 0.177, 95% CI 0.055-0.568; P = 0.0036). In contrast, when AST/ALT >0.964, no significant association was found (HR = 3.174, 95% CI 0.345-29.167; P = 0.3074). Moreover, subgroup analysis showed that GGT could alter the relationship between AST/ALT and T2DM. In the group with GGT ≤ 40, AST/ALT was strongly associated with T2DM (HR = 0.24, 95% CI 0.09-0.66; P = 0.0059).

CONCLUSIONS

These results suggested that there were sex differences in the association between AST/ALT and T2DM in NAFLD participants. A non-linear association between AST/ALT and T2DM was observed in males. AST/ALT in the normal GGT group (GGT ≤40) might better facilitate the early screening of T2DM.

Is Aspartate Aminotransferase to Platelet Ratio Index a Better Noninvasive Score for Predicting Advanced Fibrosis in Nonalcoholic Fatty Liver Disease Patients?

Background

In the 21st century, nonalcoholic fatty liver disease (NAFLD) is the most prevalent liver disorder. The prevalence of NAFLD within the general population in India ranges from 9 to 53%. The gold standard for assessing the severity of liver fibrosis is liver biopsy. However, due to various difficulties involved with liver biopsy, it is imperative to identify different non-invasive tools that can replace liver biopsy.

Methodology

A prospective observational study of 130 patients meeting the inclusion criteria for NAFLD was done for a period of 18 months. We aimed to compare the performance characteristics of different noninvasive scores [fibrosis-4 (FIB-4) score, nonalcoholic fatty liver disease fibrosis score (NFS), and aspartate aminotransferase to platelet ratio index (APRI)] in predicting advanced fibrosis as assessed by FibroScan.

Results

In the study, 76.9% of patients were male. Advanced fibrosis was seen in 12.3% of the patients. Majority of the patients with advanced fibrosis had metabolic syndrome. Based on the area under the receiver operating characteristic curve (AUROC), the new cut-off for ruling out advanced fibrosis for FIB-4, NFS, and APRI were 1.18, -0.9, and 0.65, respectively, and APRI had the best AUROC (0.768).

Conclusion

Abnormal glycemic status and metabolic syndrome were risk factors for advanced fibrosis. The newly derived cut-offs for the FIB-4 score, NFS score, and APRI score had a better Negative predictive value compared to the original cut-offs.

How to cite this article

Bhayani PD, Parameswaran SA, Palaniswamy KR, et al. Is Aspartate Aminotransferase to Platelet Ratio Index a Better Noninvasive Score for Predicting Advanced Fibrosis in Nonalcoholic Fatty Liver Disease Patients? Euroasian J Hepato-Gastroenterol 2024;14(1):35-39.

Galectin-3 and Severity of Liver Fibrosis in Metabolic Dysfunction-Associated Fatty Liver Disease

Metabolic dysfunction-associated Fatty Liver Disease (MAFLD) is a chronic liver disease characterized by the accumulation of fat in the liver and hepatic steatosis, which can progress to critical conditions, including Metabolic dysfunction-associated Steatohepatitis (MASH), liver fibrosis, hepatic cirrhosis, and hepatocellular carcinoma. Galectin-3, a member of the galectin family of proteins, has been involved in cascades that are responsible for the pathogenesis and progression of liver fibrosis in MAFLD. This review summarizes the present understanding of the role of galectin-3 in the severity of MAFLD and its associated liver fibrosis. The article assesses the underlying role of galectin-3-mediated fibrogenesis, including the triggering of hepatic stellate cells, the regulation of extracellular degradation, and the modulation of immune reactions and responses. It also highlights the assessments of the potential diagnostic and therapeutic implications of galectin-3 in liver fibrosis during MAFLD. Overall, this review provides insights into the multifaceted interaction between galectin-3 and liver fibrosis in MAFLD, which could lead to the development of novel strategies for diagnosis and treatment of this prevalent liver disease.

Thrombospondin-2 as a potential noninvasive biomarker of hepatocyte injury but not liver fibrosis in children with MAFLD: A preliminary study

Aim of the study

Metabolic-associated fatty liver disease (MAFLD) requires close monitoring due to its increased incidence and progression to fibrosis, cirrhosis and even hepatocellular carcinoma. The search for non-invasive markers to diagnose liver fibrosis is ongoing. The aim of our study was to evaluate the serum levels of growth differentiation factor-15 (GDF-15), thrombospondin-2 (TSP2), pentraxin 3 (PTX3) and angiopoietin-like protein 8 (ANGPTL8) in children with MAFLD.

Material and methods

Fifty-six overweight/obese children with suspected liver disease were included in this prospective study. MAFLD was diagnosed according to the latest consensus. Vibration-controlled transient elastography (TE) was performed to detect clinically significant liver fibrosis. Serum concentrations of GDF-15, TSP2, PTX3 and ANGPTL8 were measured by enzyme-linked immunosorbent assay (ELISA).

Results

Liver steatosis was diagnosed in abdominal ultrasound in 31 (55.36%) overweight/obese patients who were classified as the MAFLD group. Aspartate aminotransferase (AST)/platelet ratio (APRI) and liver stiffness measurement (LSM) values and TSP2 concentrations showed significantly higher values in patients in MAFLD than in the non-MAFLD group. TSP2 was significantly positively correlated with alanine transaminase (ALT), AST, γ-glutamyltransferase (GGT) and APRI in the study group. The receiver operating characteristics (ROC) analysis showed that the area under the curve (AUC) of LSM, APRI and serum TSP2 was significant for predicting MAFLD in obese children. In the multivariable regression model, LSM was the only significant parameter associated with the diagnosis of MAFLD in children.

Conclusions

TSP2 may be a potential biomarker of hepatocyte injury in pediatric patients with MAFLD. None of the examined biomarkers were found to be effective non-invasive markers of liver fibrosis in children.

Liver biopsy-based validation, confirmation and comparison of the diagnostic performance of established and novel non-invasive steatotic liver disease indexes: Results from a large multi-center study

BACKGROUND

Non-invasive tools (NIT) for metabolic-dysfunction associated liver disease (MASLD) screening or diagnosis need to be thoroughly validated using liver biopsies.

PURPOSE

To externally validate NITs designed to differentiate the presence or absence of liver steatosis as well as more advanced disease stages, to confirm fully validated indexes (n = 7 NITs), to fully validate partially validated indexes (n = 5 NITs), and to validate for the first time one new index (n = 1 NIT).

METHODS

This is a multi-center study from two Gastroenterology-Hepatology Departments (Greece and Australia) and one Bariatric-Metabolic Surgery Department (Italy). Overall, n = 455 serum samples of patients with biopsy-proven MASLD (n = 374, including 237 patients with metabolic-dysfunction associated steatohepatitis (MASH)) and Controls (n = 81) were recruited. A complete validation analysis was performed to differentiate the presence of MASLD vs. Controls, MASH vs. metabolic-dysfunction associated steatotic liver (MASL), histological features of MASH, and fibrosis stages.

RESULTS

The index of NASH (ION) demonstrated the highest differentiation ability for the presence of MASLD vs. Controls, with the area under the curve (AUC) being 0.894. For specific histological characterization of MASH, no NIT demonstrated adequate performance, while in the case of specific features of MASH, such as hepatocellular ballooning and lobular inflammation, ION demonstrated the best performance with AUC being close to or above 0.850. For fibrosis (F) classification, the highest AUC was reached by the aspartate aminotransferase to platelet ratio index (APRI) being ~0.850 yet only with the potential to differentiate the severe fibrosis stages (F3, F4) vs. mild or moderate fibrosis (F0-2) with an AUC > 0.900 in patients without T2DM. When we excluded patients with morbid obesity, the differentiation ability of APRI was improved, reaching AUC = 0.802 for differentiating the presence of fibrosis F2-4 vs. F0-1. The recommended by current guidelines index FIB-4 seemed to differentiate adequately between severe (i.e., F3-4) and mild or moderate fibrosis (F0-2) with an AUC = 0.820, yet this was not the case when FIB-4 was used to classify patients with fibrosis F2-4 vs. F0-1. Trying to improve the predictive value of all NITs, using Youden's methodology, to optimize the suggested cut-off points did not materially improve the results.

CONCLUSIONS

The validation of currently available NITs using biopsy-proven samples provides new evidence for their ability to differentiate between specific disease stages, histological features, and, most importantly, fibrosis grading. The overall performance of the examined NITs needs to be further improved for applications in the clinic.

Association of AST/ALT (De Ritis) ratio with sarcopenia in a Chinese population of community-dwelling elderly

Background

The aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio, also known as De Ritis ratio, has been reportedly associated with malnutrition which plays a crucial role in sarcopenia. The aim of this study was to examine the relationship between AST/ALT ratio and sarcopenia in the Chinese community-dwelling elderly.

Methods

A cross-sectional study with 2751 participants (1343 men and 1408 women) aged ≥60 years was performed. Appendicular skeletal muscle mass index (ASMI), grip strength, and gait speed were measured to diagnose sarcopenia according to the latest Asian Working Group for Sarcopenia (AWGS) consensus. The association of AST/ALT ratio with sarcopenia was examined using logistic regression analysis.

Results

The prevalence of sarcopenia in the present study was 4.4%. AST/ALT ratio was higher in the sarcopenia group than in the non-sarcopenia group (1.30 ± 0.33 vs. 1.16 ± 0.62, P = 0.010). AST/ALT ratio was negatively correlated with the components of sarcopenia, including ASMI, grip strength, and gait speed. Logistic regression analysis indicated that high AST/ALT ratio (>1.20) was associated with increased risk of sarcopenia even after adjustment for potential confounders (adjusted OR = 2.33, 95%CI = 1.48-3.68, P < 0.001). Stratification analyses indicated that the association of high AST/ALT ratio with high risk of sarcopenia was more significant in males and the elderly with ≥70 years.

Conclusions

Our findings demonstrate that high AST/ALT ratio is associated with increased risk of sarcopenia in a Chinese population of community-dwelling elderly.

Factors related to the presence of nonalcoholic fatty liver disease in patients with type 2 diabetes: a single center study

Aim of the study

There is a close relationship between the development of diabetes and nonalcoholic fatty liver disease (NAFLD). The aim of the study was to determine the frequency and associated factors of NAFLD in type 2 diabetes mellitus (T2DM) patients according to the ultrasound examination and noninvasive hepatic fibrosis indices.

Material and methods

316 patients who were followed up in the Internal Medicine Diabetes clinic, over the age of 18, diagnosed with T2DM were included retrospectively. NAFLD was noted using ultrasound. NAFLD fibrosis score (NFS), fibrosis-4 index (FIB-4) and AST to platelet ratio index (APRI) were used as non-invasive hepatic fibrosis indices.

Results

The prevalence of NAFLD with hepatic ultrasound was 89.7% in T2DM patients. Among non-invasive fibrosis indices, NFS and FIB-4 were similar, but APRI was significantly higher in moderate-severe hepatosteatosis group (p values = 0.355, 0.246 and 0.003 respectively). In logistic regression analysis, while mild hepatosteatosis was associated with BMI and NFS (p = 0.004, p = 0.008), moderate to severe hepatosteatosis as associated with BMI and serum triglycerides (p < 0.001, p = 0.019).

Conclusions

The prevalence of NAFLD is high in patients with T2DM. The frequency and degree of NAFLD is associated with the NFS, BMI and hypertriglyceridemia. While NFS is associated with mild hepatosteatosis; moderate to severe hepatosteatosis is associated with BMI and serum triglycerides.

Comparison of Guidelines for the Screening, Diagnosis, and Noninvasive Assessment of Nonalcoholic Fatty Liver Disease

Background

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide. However, there is no clear consensus on optimal screening strategies and risk stratification. We conducted a systematic review of society guidelines to identify differences in recommendations regarding the screening, diagnosis, and assessment of NAFLD.

Methods

We searched PubMed, Web of Science, and Embase databases from January 1, 2015, to August 2, 2022. Two researchers independently extracted information from the guidelines about screening strategies, risk stratification, use of noninvasive tests (NITs) to assess hepatic fibrosis, and indications for liver biopsy.

Results

Twenty clinical practice guidelines and consensus statements were identified in our search. No guidelines recommended routine screening for NAFLD, while 14 guidelines recommended case finding in high-risk groups. Of the simple risk stratification models to assess for fibrosis, the fibrosis-4 score was the most frequently recommended, followed by the NAFLD fibrosis score. However, guidelines differed on which cutoffs to use and the interpretation of "high-risk" results.

Conclusion

Multiple guidelines exist with varying recommendations on the benefits of screening and interpretation of NIT results. Despite their differences, all guidelines recognize the utility of NITs and recommend their incorporation into the clinical assessment of NAFLD.

FIB-4 is closer to FibroScan screen results to detecting advanced liver fibrosis and maybe facilitates NAFLD warning

To assess the relationship between clinical biochemical characteristics and steatosis or fibrosis by Fibroscan in non-alcoholic fatty liver disease (NAFLD) patients in order to seek the simple effective screening method closed to the results of the fibroScan measurement. A cross-sectional study was conducted on 188 patients with NAFLD who underwent FibroScan examinations. Demographic data and clinical biochemical characteristics were collected and analyzed. The result showed elevated serum uric acid (SUA) (P = .023, odds ratio [OR = 1.005, 95% CI (1.001-1.009) and metabolic syndrome (MetS) (P = .000, OR = 4.549, 95%CI (1.974-10.484) were associated with severe steatosis (controlled attenuation parameter, CAP ≥ 300 dB/m). The magnitude of liver stiffness measured using FibroScan was positively correlated with aspartate transaminase/alanine aminotransferase (AST/ALT) ratio (R = 0.419, P = .000), AST to platelet ratio index (APRI) score (R = 0.309, P = .000), and Fibrosis-4 score (FIB-4) (R = 0.507, P = .000). The areas under the receiver operating curve (ROC) of AST/ALT, APRI, and FIB-4 for mild or severe fibrosis were 0.563, 0.696, and 0.728, respectively, and those for advanced fibrosis were 0.648, 0.750, and 0.821, respectively. The FIB-4 index cutoff value was 1.65 with a sensitivity of 68.3% and specificity of 89.8% during the diagnosis of advanced fibrosis. MetS and elevated SUA are associated with severe steatosis according to the CAP value screen, whereas FIB-4, as the fibrosis score method, is closer to the liver stiffness measurement results from FibroScan, which may facilitate early warning of NAFLD in the community or in remote areas.

Gentiopicroside improves high-fat diet-induced NAFLD in association with modulation of host serum metabolome and gut microbiome in mice

Objective

The incidence of non-alcoholic fatty liver disease is increasing every year, and there is growing evidence that metabolites and intestinal bacteria play a causal role in NAFLD. Gentiopicroside, a major iridoids compound in gentian, has been reported to reduce hepatic lipid accumulation. However to date, no studies have confirmed whether the predominance of Gentiopicroside is related to metabolites and intestinal bacteria. Therefore, we sought to study whether the hypolipidemic effect of Gentiopicroside is related to metabolic function and intestinal flora regulation.

Methods

In the present study, C57BL/6J mice were fed a high-fat diet for 12 weeks, followed by a high-fat diet with or without Gentiopicroside for 8 weeks, respectively. The Gentiopicroside intervention reduced body weight gain, liver index, and decreased serum biochemical parameters such as alanine aminotransferase, aspartate aminotransferase, and triglycerides in high-fat fed mice. The effect of Gentiopicroside on non-alcoholic fatty liver disease was studied using serum untargeted metabolomics and 16S rDNA assay.

Results

Metabolomic analysis showed that the addition of Gentiopicroside significantly altered the levels of amino acids, unmetabolized Gentiopicroside after administration, and metabolites such as Cinnoline, Galabiosylceramide, and Tryptophyl-Tyrosine, which are involved in the pathways regulating bile secretion, tryptophan metabolism, and lipid metabolism. Analysis of intestinal bacteria showed that Gentiopicrosides altered the community composition structure of intestinal bacteria, characterized by an increase and a decrease in beneficial and harmful bacteria, respectively. In addition, correlation analysis showed that the effect of Gentiopicroside on metabolites was positively correlated with intestinal flora Bacteroides, Lactobacillus, Muribaculum, and Prevotellaceae_UCG_001. Finally, the combined analysis revealed that metabolites were associated with the regulation of Firmicutes and Actinobacteria and positively correlated with lipid levels.

Conclusion

These results suggest that Gentiopicroside may be a potential agent for the prevention of intestinal disorders and the alleviation of non-alcoholic fatty liver disease.

Non-alcoholic fatty liver disease and incidence of microvascular complications of diabetes in patients with type 2 diabetes: a prospective cohort study

Objective

To investigate the association between non-alcoholic fatty liver disease (NAFLD) and liver enzymes with the incidence of microvascular complications (neuropathy, retinopathy, and nephropathy) in a cohort of Iranian patients with type 2 diabetes.

Methods

For a total population of 3123 patients with type 2 diabetes, a prospective study was designed for 1215 patients with NAFLD and 1908 gender and age-matched control patients without NAFLD. The two groups were followed for a median duration of 5 years for the incidence of microvascular complications. The association between having NAFLD, the level of liver enzymes, aspartate aminotransferase to platelet ratio index (APRI), Fibrosis-4 (FIB-4) value, and the incidence risk of diabetic retinopathy, neuropathy, and nephropathy were assessed through logistic regression analysis.

Results

NAFLD was found to be associated with incidence of diabetic neuropathy and nephropathy (Odds ratio: 1.338 (95% confidence interval: 1.091-1.640) and 1.333 (1.007-1.764), respectively). Alkaline-phosphatase enzyme was found to be associated with higher risks of diabetic neuropathy and nephropathy ((Risk estimate: 1.002 (95% CI: 1.001-1.003) and 1.002 (1.001-1.004), respectively)). Moreover, gamma-glutamyl transferase was associated with a higher risk of diabetic nephropathy (1.006 (1.002-1.009). Aspartate aminotransferase and alanine aminotransferase were inversely associated with the risk of diabetic retinopathy (0.989 (0.979-0.998) and 0.990 (0.983-0.996), respectively). Furthermore, ARPI_T (1), ARPI_T (2), and ARPI_T (3) were shown to be associated with NAFLD (1.440 (1.061-1.954), 1.589 (1.163-2.171), and 2.673 (1.925, 3.710), respectively). However, FIB-4 score was not significantly associated with risk of microvascular complications.

Conclusion

Despite the benign nature of NAFLD, patients with type 2 diabetes should be always assessed for NAFLD to ensure early diagnosis and entry into proper medical care. Regular screenings of microvascular complications of diabetes is also suggested for these patients.

Precision Medicine in Fatty Liver Disease/Non-Alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease, and is related to fatal and non-fatal liver, metabolic, and cardiovascular complications. Its non-invasive diagnosis and effective treatment remain an unmet clinical need. NAFLD is a heterogeneous disease that is most commonly present in the context of metabolic syndrome and obesity, but not uncommonly, may also be present without metabolic abnormalities and in subjects with normal body mass index. Therefore, a more specific pathophysiology-based subcategorization of fatty liver disease (FLD) is needed to better understand, diagnose, and treat patients with FLD. A precision medicine approach for FLD is expected to improve patient care, decrease long-term disease outcomes, and develop better-targeted, more effective treatments. We present herein a precision medicine approach for FLD based on our recently proposed subcategorization, which includes the metabolic-associated FLD (MAFLD) (i.e., obesity-associated FLD (OAFLD), sarcopenia-associated FLD (SAFLD, and lipodystrophy-associated FLD (LAFLD)), genetics-associated FLD (GAFLD), FLD of multiple/unknown causes (XAFLD), and combined causes of FLD (CAFLD) as well as advanced stage fibrotic FLD (FAFLD) and end-stage FLD (ESFLD) subcategories. These and other related advances, as a whole, are expected to enable not only improved patient care, quality of life, and long-term disease outcomes, but also a considerable reduction in healthcare system costs associated with FLD, along with more options for better-targeted, more effective treatments in the near future.

AST/ALT ratio, APRI, and FIB-4 compared to FibroScan for the assessment of liver fibrosis in patients with chronic hepatitis B in Bandar Abbas, Hormozgan, Iran

BACKGROUND

Chronic hepatitis B (CHB) is a significant risk factor for liver-related disorders. Hepatic fibrosis staging by liver biopsy in these patients can lead to complications. This study aimed to compare aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio, AST to platelet ratio index (APRI), and fibrosis-4 (FIB-4) with FibroScan results for the evaluation of hepatic fibrosis in CHB patients.

METHODS

This cross-sectional study included patients with CHB referred to the outpatient clinics of Bandar Abbas, Hormozgan, Iran, in 2021. The age and sex of the participants were noted. FibroScan evaluation was done for all subjects. Moreover, AST, ALT, and platelet counts were measured in their blood samples within one month of the FibroScan evaluation.

RESULTS

Of the 267 CHB patients evaluated in the present study (mean age: 45.45 ± 18.16 years), 173 (64.8%) were male. According to FibroScan results, 65 CHB patients (24.3%) had F1, 53 (19.9%) F2, 38 (14.2%) F3, and 20 (7.5%) F4 liver fibrosis. There was a significant correlation between FibroScan results and the three indices of AST/ALT ratio, APRI, and FIB-4 (P < 0.001), with the strongest correlation between FibroScan results and APRI (r = 0.682). With an area under the receiver operating characteristic (AUROC) curve of 0.852 (95% confidence interval [CI] 0.807; 0.897, P < 0.001), APRI ≥ 0.527 had the best diagnostic accuracy (77.15%) for the detection of any grade of liver fibrosis. Although the AUROC curve of APRI and FIB-4 was similar (0.864) for distinguishing between F3/F4 and F0-F2 of liver fibrosis, FIB-4 had the best diagnostic accuracy (82.02%).

CONCLUSIONS

APRI can rule out 95.4% of F3/F4 of liver fibrosis and rule in any grade of liver fibrosis in CHB patients by 90.78%. Therefore, APRI appears to be the best substitute for FibroScan in the assessment of liver fibrosis in patients with CHB.

Mechanisms of Yajieshaba in the treatment of liver fibrosis through the Keap1-Nrf2 signaling pathway

Yajieshaba (YJSB), a traditional Dai medicine formula containing botanical drugs, is commonly employed in Yunnan due to its significant therapeutic effects on liver protection. Consequently, to determine the efficacy of YJSB and the mechanism of action of Kelch-like ECH-associated protein 1 (Keap1)-nuclear factor erythroid 2-related factor 2 (Nrf2) pathway against liver fibrosis. We wanted to see if YJSB could treat CCl₄-induced liver fibrosis by regulating the Keap1-Nrf2 signaling pathway. YJSB significantly improved liver function biochemical indices, liver fibrosis quadruple, hydroxyproline (Hyp), and transforming growth factor-β1 (TGF-β1) levels. The staining results demonstrated that the degree of liver fibrosis was significantly reduced. YJSB reduced the content of malondialdehyde (MDA) and elevated the content of superoxide dismutase (SOD) in the liver, exhibiting antioxidant effects; meanwhile, it regulated the expression of Keap1-Nrf2 pathway protein, increased the expression of NAD(P)H: Quinone oxidoreductase (NQO1), Heme Oxygenase 1 (HO-1), Glutamate cysteine ligase modifier subunit (GCLM), and Glutamate cysteine ligase catalytic subunit (GCLC) expression in the liver decreased while Nrf2 expression increased. Fluorescence immunoassay studies demonstrated that YJSB promoted the trans-nuclearization of Nrf2. YJSB possesses anti-liver fibrosis pharmacological effects that improve liver function and effectively counteract CCl₄-induced liver fibrosis damage. The mechanism of action might be related to the regulation of protein expression of the Keap1-Nrf2 pathway, increasing the ability of the body to resist oxidative stress and reduce oxidative stress injury.

Silymarin for treatment of adults with nonalcoholic fatty liver disease

This is a protocol for a Cochrane Review (intervention). The objectives are as follows:

To evaluate the benefits and harms of silymarin in adults with nonalcoholic fatty liver disease (NAFLD).

Influence of ursodeoxycholic acid on blood glucose, insulin and GLP-1 in rats with liver fibrosis induced by bile duct ligation

BACKGROUND

The prevalence of impaired glucose tolerance and diabetes is much higher in people with cirrhosis than that in the general population. However, there are inadequate concrete guidelines for the management of diabetes in these patients, particularly in the early stage. Bile aids (BAs) have been found to exert hormone-like functions in the control of lipid and glucose metabolism. We studied the effect of ursodeoxycholic acid (UDCA) on glucose levels in rats with cirrhosis induced by bile duct ligation (BDL).

METHODS

SD rats were divided into three groups: sham operation (Group A); BDL (Group B), and UDCA plus BDL (Group C). After 4 weeks, oral glucose tolerance tests were performed. Serum biochemical parameters and the levels of glucose, insulin, and glucagon-like peptide 1 (GLP-1) were measured. Histopathology of the liver and islet was observed. The gene expression of cholesterol 7α-hydroylase (CYP7A1), microsomal oxysterol 7a-hydroxylase (CYP7B1) in the liver, and Takeda G-protein-coupled receptor-5 (TGR5) in the intestine was determined by real-time PCR.

RESULTS

Compared with Group A, fasting glucose and 1-h and 2-h postprandial glucose levels increased slightly (all P > 0.05), 2-h postprandial insulin levels increased significantly (P < 0.05), 15 min postprandial GLP-1 levels decreased (P < 0.05) in Group B. Compared with Group B, fasting glucose and 1-h postprandial glucose levels decreased (all P < 0.05), 2-h postprandial insulin levels decreased (P < 0.01), and 15 min postprandial GLP-1 levels increased (P < 0.05) in Group C. After UDCA intervention, liver fibrosis induced by BDL was alleviated, and the islet areas were increased (P < 0.05). Compared with Group A, the mRNA expression of CYP7A1 and CYP7B1 in the liver increased, and the mRNA expression of TGR5 in the intestine decreased in Group B (all P < 0.05). Compared with Group B, the mRNA expression of CYP7A1 and CYP7B1 in the liver decreased, and TGR5 in the intestine increased in Group C (P < 0.05).

CONCLUSIONS

After 4 weeks of BDL, the rats developed liver fibrosis and abnormal glucose metabolism. UDCA administration improved liver fibrosis, increased islet area, decreased glucose levels, inhibited genes in BA synthesis, enhanced TGR5 gene expression in the intestine, and further improved islet function.

Liver fat accumulation more than fibrosis causes early liver dynamic dysfunction in patients with non-alcoholic fatty liver disease

INTRODUCTION

In Non-Alcoholic Fatty Liver Disease (NAFLD), events driving early hepatic dysfunction with respect to specific metabolic pathways are still poorly known.

METHODS

We enrolled 84 subjects with obesity and/or type 2 diabetes (T2D). FibroScan® served to assess NAFLD by controlled attenuation parameter (CAP), and fibrosis by liver stiffness (LS). Patients with LS above 7 kPa were excluded. APRI and FIB-4 were used as additional serum biomarkers of fibrosis. The stable-isotope dynamic breath test was used to assess the hepatic efficiency of portal extraction (as DOB15) and microsomal metabolization (as cPDR30) of orally-administered (13C)-methacetin.

RESULTS

NAFLD occurred in 45%, 65.9%, and 91.3% of normal weight, overweight, and obese subjects, respectively. Biomarkers of liver fibrosis were comparable across subgroups, and LS was higher in obese, than in normal weight subjects. DOB15 was 23.2 ± 1.5‰ in normal weight subjects, tended to decrease in overweight (19.9 ± 1.0‰) and decreased significantly in obese subjects (16.9 ± 1.3, P = 0.008 vs. normal weight). Subjects with NAFLD had lower DOB15 (18.7 ± 0.9 vs. 22.1 ± 1.2, P = 0.03) but higher LS (4.7 ± 0.1 vs. 4.0 ± 0.2 kPa, P = 0.0003) than subjects without NAFLD, irrespective of fibrosis. DOB15 (but not cPDR30) decreased with increasing degree of NAFLD (R = -0.26; P = 0.01) and LS (R = -0.23, P = 0.03). Patients with T2D showed increased rate of NAFLD than those without T2D but similar LS, DOB15 and cPDR30.

CONCLUSIONS

Overweight, obesity and liver fat accumulation manifest with deranged portal extraction efficiency of methacetin into the steatotic hepatocyte. This functional alteration occurs early, and irrespective of significant fibrosis and presence of T2D.