Ultrasonography (US) and non-invasive diagnostic methods for non-alcoholic fatty liver disease (NAFLD) and early vascular damage. Possible application in a population study on the metabolic syndrome (MS)

NAFLD does not increase the risk of incident dementia: A prospective study and meta-analysis

The association between nonalcoholic fatty liver disease (NAFLD) and incident dementia remains unclear. This study aimed to explore whether NAFLD was associated with the risk of incident dementia. We conducted a prospective analysis of 179,222 UK Biobank participants. NAFLD was diagnosed based on the fatty liver index. Cox proportional hazards models were used to estimate the adjusted hazard ratio (HR) and 95% confidence interval (CI) of NAFLD for incident dementia. The results from this and six previous prospective studies were combined in meta-analyses. During a median follow-up of 12.4 years (2,149,839 person-years), 4950 incident dementia cases, including 2318 Alzheimer's disease (AD) cases and 1135 vascular dementia (VD) cases, were identified. There was no significant association between NAFLD and the risks of all-cause dementia (HR: 0.97, 95% CI: 0.90-1.06; P = 0.528). NAFLD was also not significantly associated with AD or VD (HR: 0.95, 95% CI: 0.84-1.07, P = 0.401; HR: 1.03, 95% CI: 0.88-1.22, P = 0.689, respectively). Our meta-analyses of prospective studies included 879,749 subjects. The pooled HR of NAFLD for all-cause dementia was 1.01 (95% CI: 0.94-1.08), and that for VD was 0.99 (95% CI: 0.86-1.13). All included cohort studies were of high quality as assessed by the Newcastle‒Ottawa scale. We found no evidence of an association between NAFLD and incident dementia.

Improving data adequacy of ultrasonography reports for non-alcoholic fatty liver disease (NAFLD) through a national structured template

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is a prevalent disorder that increases due to lifestyle, the rising rate of obesity, and population ages worldwide. Diagnostic ways, including sonography, do not have an explicit reporting structure.

PURPOSE

To create a structure template for NAFLD reporting, investigate its completeness, and assess the specialist opinions of using it in clinical practice.

MATERIAL AND METHODS

A structured reporting template (SRT) was designed and implemented in four stages. At first, important features were extracted from a comprehensive literature review and were evaluated by 10 radiologists and gastroenterologists using the Likert scale. Finally, the usefulness of the SRT in comparison with the conventional reporting template (CRT) was judged by 10 gastroenterologists completing the questionnaire.

RESULTS

Demographic information and sonography of the liver, gallbladder, and spleen organs were the most critical features. The completeness scores of SRT reports were higher than CRT scores for almost all the factors studied. The difference in the scores was significant for most of the parameters. Moreover, the total completeness score increased from 42% in CRT to 92% in SRT. A comparison of the report adequacy of two reports was seen in all items. The SRT obtained more rates from specialists.

CONCLUSION

Introduction of the SRT for NAFLD significantly enhanced the completeness of reporting to reduce variability in the interpretation of the related reports by clinicians. Nevertheless, more studies are needed to generalize the results in real scales for patients with NAFLD.

One-year weight management lowers lipopolysaccharide-binding protein and its implication in metainflammation and liver fibrosis

Background

Studies showed that the endotoxemia-related biomarker, lipopolysaccharide-binding protein (LBP), is associated with obesity and fatty liver. The level of LBP is reduced after surgical weight loss. This study aimed to verify the change of serum LBP levels after one-year medical weight management in subjects with obesity.

Methods and findings

A total of 62 subjects with obesity, 39 subjects with overweight, and 21 subjects with normal body mass index were enrolled for a one-year weight management program. Basic information, body composition analysis, clinical data, serum LBP level, and abdominal ultrasonography findings were collected. At baseline, the serum LBP levels of the obese and overweight subjects were significantly higher than that of the normal group (30.9±7.4 and 29.6±6.3 versus 23.1±5.6 μg/mL, respectively, p<0.001). Serum LBP in subjects with obesity was significantly reduced to 26.5±7.1 μg/mL (p-value < 0.001) after one year. In the multivariate analyses, LBP was associated with high sensitive C-reactive protein (hs-CRP) and non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS) before weight management in the obese group. Moreover, the change of LBP in response to weight management was significantly related to the changes of hs-CRP, leukocyte count and NFS by multivariate linear regression analysis also in the obese group.

Conclusion

The serum level of the endotoxemia-related biomarker, LBP, decreases after one-year weight management in the obese subjects. In addition to serving as a metainflammatroy biomarker like hs-CRP, LBP may also be a potential biomarker as a non-invasive biomarker for the evaluation of liver fibrosis in NAFLD.

Characterization of spontaneously-developed non-alcoholic fatty liver disease in aged rhesus monkeys

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is a global epidemic afflicting 20-30% in the general population. The animal model of NAFLD available at the present are less clinically relevant. In this study. We aimed to establish a NAFLD model of rhesus monkeys and develop an ultrasonographic steatosis score (USS) system to grade hepatic steatosis in this model.

METHODS

We performed hepatic ultrasonography and blood biochemical tests on 86 rhesus monkeys with and without metabolic syndrome (MetS), among which 45 animals were further assessed by histopathological analysis.

RESULTS

The liver histological features of rhesus monkeys NAFLD were resemble to those of NAFLD patients. There was a close correlation between the histological steatosis grade and the USS (Spearman's coefficient, 0.705, p < 0.001). The USS sensitivity was 87.5% and the specificity was 94.6% when the cut-off was USS2. In addition, the prevalence of MetS was significantly higher in the USS2-3 group. Multiple risk factors of cardiometabolic disease, including obesity, insulin resistance and dyslipidemia were significantly correlated with the USS.

CONCLUSIONS

NAFLD was developed spontaneously among aging in rhesus monkeys (with increased prevalence in the MetS monkeys), which provided an ideal model for NAFLD. The newly developed USS system can be used to evaluate fatty liver in the rhesus monkey. The model as well as the noninvasive assessment methodology will provide a powerful tool for mechanistic studies and preclinical test of novel therapies for NAFLD.

The synergistic impact of nonalcoholic fatty liver disease and metabolic syndrome on subclinical atherosclerosis

OBJECTIVE

Nonalcoholic fatty liver disease (NAFLD) is a well-known contributor for the development of cardiovascular disease (CVD). We examined the influence of NAFLD and metabolic syndrome (MetS) on markers of subclinical atherosclerosis, including carotid intima-media thickness (CIMT), brachial-ankle pulse wave velocity (baPWV) and ankle-brachial pressure index (ABI), after adjusting for cardiometabolic risk factors.

DESIGN

A cross-sectional study.

PATIENTS AND MEASUREMENTS

The association between NAFLD, MetS and markers of subclinical atherosclerosis was assessed in 955 participants without CVD using multiple logistic regression analysis after adjusting for multiple cardiometabolic risk variables.

RESULTS

After adjusting for age and sex, CIMT and baPWV were found to be significantly correlated with multiple cardiometabolic risk variables, whereas ABI was only associated with obesity parameters. The prevalence of NAFLD differed significantly according to the presence of subclinical atherosclerosis as defined by both CIMT and baPWV (P = 0·004 and P = 0·007, respectively). After adjusting for potential confounding factors, NAFLD or MetS was not associated with subclinical atherosclerosis as defined by CIMT and baPWV. However, individuals with both NAFLD and MetS had a significantly higher risk of subclinical atherosclerosis as defined by CIMT (OR = 2·06, 95% CI = 1·13-3·74) or baPWV (OR = 2·64, 95% CI = 1·46-4·76) compared to normal subjects, even after adjusting for potential confounders.

CONCLUSIONS

The results show that NAFLD and MetS have a synergistic impact on the subclinical atherosclerosis, which suggests that individuals with both NAFLD and MetS should be strongly advised to engage in CVD prevention strategies.

Liuwei Dihuangwan protects against non-alcoholic fatty liver disease in rats

AIM: To explore whether Liuwei Dihuangwan has a protective effect against non-alcoholic fatty liver disease (NAFLD) in rats and the possible mechanisms involved.

METHODS: Forty-five rats were randomly divided into three groups: a normal control group, a model control group, and a Liuwei Dihuangwan treated group. The normal control group was fed a normal diet, the model control group was fed a high-fat diet, and the Liuwei Dihuangwan treated group was fed a high-fat diet + Liuwei Dihuangwan. Serum levels of high-density lipoproteincholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), aspartate transaminase (AST), alanine aminotransferase (ALT), albumin (ALB), total protein (TP), globulose (GLB), as well as hepatic levels of superoxide dismutase (SOD), malonaldehyde (MDA), triglyceride (TG), and total cholesterol (TC) were compared between different groups.

RESULTS: Serum levels of HDL-C (0.61 mmol/L ± 0.06 mmol/L vs 1.08 mmol/L ± 0.16 mmol/L) were significantly lower and those of LDL-C and ALT (0.75 U/L ± 0.23 U/L vs 0.16 U/L ± 0.05 U/L; 92.16 U/L ± 35.56 U/L vs 31.61 U/L ± 14.69 U/L) were significantly higher in the model control group than in the normal control group. Serum levels of LDL-C and ALT were significantly lower in the Liuwei Dihuangwan treated group than in the model control group (0.46 mmol/L ± 0.12 mmol/L vs 0.75 mmol/L ± 0.23 mmol/L; 41.88 U/L ± 12.27 U/L vs 92.16 U/L ± 35.56 U/L; P < 0.05 for both). Serum levels of ALB (18.84 g/L ± 1.95 g/L vs 20.16 g/L ± 0.95 g/L), TP (43.15 g/L ± 3.98 g/L vs 42.91 g/L ± 2.62 g/L) and GLB (24.34 g/L ± 1.65 g/L vs 22.75 g/L 2.19 g/L) had no significant differences between the model control group and the normal control group (P > 0.05 for all), and between the Liuwei Dihuangwan treated group and the model control group (ALB: 18.83 g/L ± 3.05 g/L vs 18.84 g/L ± 1.95 g/L; TP: 41.17 g/L ± 4.84 g/L vs 43.15 g/L ± 3.98 g/L; GLB: 22.33 g/L ± 2.41 g/L vs 24.34 g/L ± 1.65 g/L; P > 0.05 for all). Hepatic levels of SOD (196.22 U/mgprot ± 25.08 U/mgprot vs 361.25 U/mgprot ± 24.17 U/mgprot) were significantly lower and those of MDA (3.92 nmol/mgprot ± 1.21 nmol/mgprot vs 1.34 nmol/mgprot ± 0.32 nmol/mgprot), TG (3.75 mmol/L ± 0.52 mmol/L vs 1.62 mmol/L ± 0.44 mmol/L) and TC (1.75 mmol/L ± 0.65 mmol/L vs 1.05 mmol/L ± 0.28 mmol/L) were significantly higher in the model control group than in the normal control group (P < 0.05 for all). Hepatic levels of SOD (274.06 U/mgprot ± 52.11 U/mgprot vs 196.22 U/mgprot ± 25.08 U/mgprot) were significantly higher and those of MDA, TG and TC (1.77 nmol/mgprot ± 0.53 nmol/mgprot vs 3.92 nmol/mgprot ± 1.21 nmol/mgprot, 2.36 mmol/L ± 0.51 mmol/L vs 3.75 mmol/L ± 0.52 mmol/L, 1.45 mmol/L ± 0.44 mmol/L vs 1.75 mmol/L ± 0.65 mmol/L) were significantly lower in the Liuwei Dihuangwan treated group than in the model control group (P < 0.05 for all). Pathological changes observed by naked eyes and light microscopy were obvious in the model control group compared with the normal control group, and Liuwei Dihuangwan significantly improved these changes.

CONCLUSION: Liuwei Dihuangwan has positive therapeutic effects against experimental NAFLD in rats possibly by improving the levels of SOD, MDA, TG and TC.

Recent progress in research of nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is a common liver disease with a prevalence of 15%-30% in Western continues and about 15% in China. Nonalcoholic simple fatty liver (SFL) usually has a benign prognosis, whereas nonalcoholic steatohepatitis (NASH) may progress to cirrhosis and even hepatocellular carcinoma. Genetic studies show that a number of single nucleotide polymorphisms (SNPs) in the genes of tumor necrosis factor-α (TNF-α), leptin, and adiponectin are associated with susceptibility to NAFLD. Recently, genome-wide association studies (GWASs) reveal a more important relevant SNP (adiponutrin or PNPLA3), which is located on chromosome 22 and regulates phospholipase. Epigenetic studies demonstrate that down-expression of miR-122 is involved in the pathogenesis of NAFLD. Histology remains the gold standard for the diagnosis of NAFLD. In clinical practice, the diagnosis is usually made by imaging techniques (e.g. ultrasonography), as liver biopsy is usually difficult. However, imaging techniques cannot differentiate NASH from NAFL. Modification of lifestyle factors such as diet, exercise, and weight control is important for treatment and should be encouraged in all patients. Pharmacotherapy with weight reduction agents, insulin sensitizers, statins, or hepatoprotectors is helpful clinically, although their efficacy has not been well proved by evidence-based medicine.