The triglycerides and glucose index is highly associated with non-alcoholic fatty liver disease in overweight and obese women

BACKGROUND

Although some previous studies have indicated that the triglycerides and glucose (TyG) index is associated with an increased risk of non-alcoholic fatty liver disease (NAFLD), there are still few studies in this field.

AIMS

The goal of this study was to assess whether the TyG index is associated with the presence of non-alcoholic fatty liver disease NAFLD in overweight and obese women.

METHODS

Overweight and obese women aged 20 to 65 years were enrolled in a cross-sectional study and allocated into the groups with and without NAFLD. Alcohol consumption, pregnancy, normal-weight, positive markers of viral or autoimmune hepatitis, acute or chronic liver disease, renal disease, cardiovascular disease, neoplasia, and intake of hepatotoxic drugs were exclusion criteria. The diagnosis of NAFLD was established by liver ultrasound and the TyG index was calculated as the Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)]/2.

RESULTS

A total of 420 participants were enrolled and allocated into the groups with (n = 212) and without (n = 208) NAFLD. In the overall population, the frequency of NAFLD was 50.4%. The logistic regression analysis adjusted by body mass index, waist circumference, and total body fat showed that total cholesterol (OR = 1.004; 95% CI: 1.000-1.007), triglycerides (OR = 1.002; 95% CI: 1.000-1.004), AST (OR = 1.19; 95% CI: 1.15-1.23), ALT (OR = 1.20; 95% CI: 1.15-1.25), and TyG index (OR = 3.15; 95% CI: 1.64-6.06) are significantly associated with NAFLD.

CONCLUSIONS

The results show that the TyG index is highly associated with the presence of NAFLD in women with overweight and obesity.

Position statement on the use of albumin in liver cirrhosis

Cirrhosis is characterised by a prolonged asymptomatic period in which the inflammation persists, increasing as the disease progresses. Characteristic of this is the increase in pro-inflammatory cytokines and pro-oxidant molecules which are determining factors in the development of multiple organ dysfunction. In the early development of cirrhosis, splanchnic arterial vasodilation, activation of vasoconstrictor systems (renin-angiotensin-aldosterone) and the sympathetic nervous system (noradrenaline) bring about bacterial translocation and systemic dissemination via portal circulation of bacterial products, and molecular patterns associated with damage, which exacerbate the systemic inflammation present in the patient with cirrhosis. Albumin is a molecule that undergoes structural and functional changes as liver damage progresses, affecting its antioxidant, immunomodulatory, oncotic and endothelial stabilising properties. Our knowledge of the properties of albumin reveals a molecule with multiple treatment options in patients with cirrhosis, from the compensated then decompensated phases to multiple organ dysfunction. Its recognised uses in spontaneous bacterial peritonitis, post-paracentesis circulatory dysfunction, acute kidney injury and hepatorenal syndrome are fully validated, and a treatment option has opened up in decompensated cirrhosis and in acute-on-chronic liver disease.

Approach to the patient with cholestasis and jaundice syndrome. Joint AMH, AMG, and AMEG scientific position statement

The term cholestasis refers to bile acid retention, whether within the hepatocyte or in the bile ducts of any caliber. Biochemically, it is defined by a level of alkaline phosphatase that is 1.67-times higher than the upper limit of normal. Cholestatic diseases can be associated with an inflammatory process of the liver that destroys hepatocytes (hepatitis), withjaundice (yellowing of the skin and mucus membranes, associated with elevated serum bilirubin levels), or with both, albeit the three concepts should not be considered synonymous. Cholestatic diseases can be classified as intrahepatic or extrahepatic, depending on their etiology. Knowing the cause of the condition is important for choosing the adequate diagnostic studies and appropriate treatment in each case. A complete medical history, together with a thorough physical examination and basic initial studies, such as liver ultrasound and liver function tests, aid the clinician in deciding which path to follow, when managing the patient with cholestasis. In a joint effort, the Asociación Mexicana de Hepatología (AMH), the Asociación Mexicana de Gastroenterología (AMG) and the Asociación Mexicana de Endoscopia Gastrointestinal (AMEG) developed the first Mexican scientific position statement on said theme.

Dyslipidemia as a risk factor for liver fibrosis progression in a multicentric population with non-alcoholic steatohepatitis

Background: Nonalcoholic fatty liver disease (NAFLD) is a serious worldwide health problem, with an estimated global prevalence of 24%; it has a notable relationship with other metabolic disorders, like obesity and type 2 diabetes mellitus (T2DM). Nonalcoholic steatohepatitis (NASH) is one of the most important clinical entities of NAFLD, which is associated with an increased risk of progression to liver cirrhosis and hepatocellular carcinoma (HCC). Mexico is one of the countries with the highest prevalence of metabolic diseases; therefore, we sought to investigate the impact that these clinical entities have in the progression to advanced fibrosis in Mexican patients with NASH. Methods: We performed a multicenter retrospective cross-sectional study, from January 2012 to December 2017. A total of 215 patients with biopsy-proven NASH and fibrosis were enrolled. NASH was diagnosed according NAS score and liver fibrosis was staged by the Kleiner scoring system. For comparing the risk of liver fibrosis progression, we divided our sample into two groups. Those patients with stage F0-F2 liver fibrosis were included in the group with non-significant liver fibrosis (n=178) and those individuals with F3-F4 fibrosis were included in the significant fibrosis group (n=37). We carried out a multivariate analysis to find risk factors associated with liver fibrosis progression. Results: From the 215 patients included, 37 had significant liver fibrosis (F3-4). After logistic regression analysis T2DM (p=0.044), systemic arterial hypertension (p=0.014), cholesterol (p=0.041) and triglycerides (p=0.015) were the main predictor of advanced liver fibrosis. Conclusions: In a Mexican population, dyslipidemia was the most important risk factor associated with advanced liver fibrosis and cirrhosis.

The Mexican consensus on nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) affects nearly one third of the population worldwide. Mexico is one of the countries whose population has several risk factors for the disease and its prevalence could surpass 50%. If immediate action is not taken to counteract what is now considered a national health problem, the medium-term panorama will be very bleak. This serious situation prompted the Asociación Mexicana de Gastroenterología and the Asociación Mexicana de Hepatología to produce the Mexican Consensus on Fatty Liver Disease. It is an up-to-date and detailed review of the epidemiology, pathophysiology, clinical forms, diagnosis, and treatment of the disease, whose aim is to provide the Mexican physician with a useful tool for the prevention and management of nonalcoholic fatty liver disease.

Current trends of liver cirrhosis in Mexico: Similitudes and differences with other world regions

AIM

To investigate the main current etiologies of cirrhosis in Mexico.

METHODS

We performed a cross-sectional retrospective multicenter study that included eight hospitals in different areas of Mexico. These hospitals provide health care to people of diverse social classes. The inclusion criteria were a histological, clinical, biochemical, endoscopic, or imaging diagnosis of liver cirrhosis. Data were obtained during a 5-year period (January 2012-December 2017).

RESULTS

A total of 1210 patients were included. The mean age was 62.5 years (SD = 12.1), and the percentages of men and women were similar (52.0% vs 48.0%). The most frequent causes of liver cirrhosis were hepatitis C virus (HCV) (36.2%), alcoholic liver disease (ALD) (31.2%), and nonalcoholic steatohepatitis (23.2%), and the least frequent were hepatitis B virus (1.1%), autoimmune disorders (7.3%), and other conditions (1.0%).

CONCLUSION

HCV and ALD are the most frequent causes of cirrhosis in Mexico. However, we note that non-alcoholic fatty liver disease (NAFLD) as an etiology of cirrhosis increased by 100% compared with the rate noted previously. We conclude that NAFLD will soon become one of the most frequent etiologies of liver cirrhosis in Mexico.

The product of triglycerides and glucose as biomarker for screening simple steatosis and NASH in asymptomatic women

 Introduction and aim. Given that early identification of non-alcoholic fatty liver disease (NAFLD) is an important issue for primary prevention of hepatic disease, the objectives of this study were to evaluate the efficacy of the product of triglyceride and glucose levels (TyG) for screening simple steatosis and non-alcoholic steatohepatitis (NASH) in asymptomatic women, and to compare its efficacy vs. other biomarkers for recognizing NAFLD.

MATERIAL AND METHODS

Asymptomatic women aged 20 to 65 years were enrolled into a cross-sectional study. The optimal values of TyG, for screening simple steatosis and NASH were established on a Receiver Operating Characteristic scatter plot; the sensitivity, specificity, and likelihood ratios of TyG index were estimated versus liver biopsy. According sensitivity and specificity, the efficacy of TyG was compared versus the well-known clinical biomarkers for recognizing NAFLD.

RESULTS

A total of 50 asymptomatic women were enrolled. The best cutoff point of TyG for screening simple steatosis was 4.58 (sensitivity 0.94, specificity 0.69); in addition, the best cutoff point of TyG index for screening NASH was 4.59 (sensitivity 0.87, specificity 0.69). The positive and negative likelihood ratios were 3.03 and 0.08 for simple steatosis, and 2.80 and 0.18 for NASH. As compared versus SteatoTest, NashTest, Fatty liver index, and Algorithm, the TyG showed to be the best test for screening.

CONCLUSIONS

TyG has high sensitivity and low negative likelihood ratio; as compared with other clinical biomarkers, the TyG showed to be the best test for screening simple steatosis and NASH.

Obesity and inflammation: epidemiology, risk factors, and markers of inflammation

Obesity is a public health problem that has reached epidemic proportions with an increasing worldwide prevalence. The global emergence of obesity increases the risk of developing chronic metabolic disorders. Thus, it is an economic issue that increased the costs of the comorbidities associated. Moreover, in recent years, it has been demonstrated that obesity is associated with chronic systemic inflammation, this status is conditioned by the innate immune system activation in adipose tissue that promotes an increase in the production and release of pro-inflammatory cytokines that contribute to the triggering of the systemic acute-phase response which is characterized by elevation of acute-phase protein levels. On this regard, low-grade chronic inflammation is a characteristic of various chronic diseases such as metabolic syndrome, cardiovascular disease, diabetes, hypertension, non-alcoholic fatty liver disease, and some cancers, among others, which are also characterized by obesity condition. Thus, a growing body of evidence supports the important role that is played by the inflammatory response in obesity condition and the pathogenesis of chronic diseases related.

Decrease of aminotransferase levels in obese women is related to body weight reduction, irrespective of type of diet

OBJECTIVE

To evaluate the efficacy of low carbohydrate diet (LCD) as compared with low fat diet (LFD) to decrease aminotransferase levels in obese women with nonalcoholic fatty liver disease.

MATERIAL AND METHODS

A total of 59 women were randomly enrolled in a non-controlled clinical intervention study to receive either LCD or LFD during six months. Apparently healthy non-pregnant obese women aged 20 to 65 years were eligible to participate. Previous diagnosis of hepatic disease, serum creatinine level ≥ 1.5 mg/dL, severe life-limiting medical illness, pregnancy, active participation in other dietary program, use of weight loss drugs, or alcohol consumption ≥ 30 g per day were exclusion criteria.

RESULTS

A total of 31 obese women who received LCD were compared with 28 women allocated in the LFD group. There were 3 (LCD group) and 2 (LFD group) women with lost of follow-up. No differences in the proportion of type 2 diabetes, hypertension and hyperlipidemia were noted between women in the LCD and LFD groups. At end of follow-up, there were not significant statistical differences in the anthropometric and biochemical characteristics between women in both groups. The weight loss was 5.7 and 5.5% for women in the LCD LFD groups. Although the decrease of AST (31.7 and 22.4%) and ALT (41 and 33.3%) levels was more elevated in the women of LCD group, as compared with the LFD group, there were not significant statistical differences.

CONCLUSIONS

Our results show that weight loss, irrespective of the type of diet, reduces aminotransferase levels in obese women with NAFLD.

[Risk factors associated with upper gastrointestinal bleeding and with mortality]

OBJECTIVE

to determine the associated risk factors with upper gastrointestinal bleeding (UGIB) and mortality in subjects with peptic ulcer.

METHODS

a total of 345 subjects with peptic ulcer, < 60 years of age, were enrolled in a cross-sectional study. Subjects were allocated into one of two groups in accordance with the presence of UGIB. A logistic regression model, adjusted by age and sex, was used to compute the relationship between the risk factors and both UGIB and mortality.

RESULTS

smoking (OR = 2.6, CI 95 % = 1.2-8.7), alcohol consumption (OR = 4.8, CI 95 % = 1.4-10.5), and previous history of UGIB (OR = 1.8, CI 95 % = 1.1-9.7) were strongly and independently associated with UGIB; chronic obstructive pulmonary disease (OR = 1.9, CI 95 % = 1.2-11.4), and high blood pressure (OR = 1.4, CI 95 % = 1.1- 7.5) were associated with mortality in UGIB.

CONCLUSIONS

the associated risk factors with UGIB in patients with peptic ulcer were: age lower than 60 years; smoking; history of UGIB; and alcohol consumption. The chronic obstructive pulmonary disease and high blood pressure were associated with mortality in UGIB.

Hypomagnesemia, insulin resistance, and non-alcoholic steatohepatitis in obese subjects

BACKGROUND

Epidemiological evidence shows a strong relationship between decreased serum magnesium levels (DSML) and insulin resistance. As nonalcoholic steatohepatitis (NASH) seems to be related to insulin resistance, the aim of this study was to determine the potential relationship between DSML and NASH in obese subjects.

METHODS

We compared obese individuals with the diagnosis of diabetes, insulin-resistance, and non-insulin resistance to a control group of non-obese, non-insulin-resistant subjects. Participants were required to have negative viral markers and negligible alcohol intake. Other liver diseases and well-known causes for decreasing of magnesium were exclusion criteria. A liver biopsy was performed in subjects with aspartate aminotransferase (AST) and alanine aminotransferease (ALT) levels > or =40 IU/mL.

RESULTS

Of the 60 obese subjects, 20 were non-insulin resistant, 20 were insulin resistant, and 20 were type 2 diabetics. Twenty subjects were in the control group. Eleven (33.3%) diabetics, 14 (42.4%) insulin-resistant subjects, and 8 (24.2%) non-insulin-resistant subjects underwent liver biopsies. Diagnosis of NASH was established in 29 (36.2%) individuals. Subjects with the diagnosis of NASH exhibited lower serum magnesium levels of 1.7 +/- 0.2 mg/dL (0.70 +/- 0.08 mmol/L), and those with fibrosis showed the lowest serum magnesium concentration at 1.5 +/- 0.3 mg/dL (0.62 +/- 0.12 mmol/L). Multiple regression analysis adjusted by age showed that low serum magnesium concentration was independently related to a high HOMA-IR index (OR 7.6, CI 95% 2.1-11.2; p <0.0001) and that a high HOMA-IR index was related to NASH (OR 6.5, CI 95% 1.5-8.8; p <0.01). After adjusting for age and a high HOMA-IR index, hypomagnesemia remained independently related to NASH (OR 1.4, CI 95% 1.1-5.4; p <0.05).

CONCLUSIONS

The results of this study demonstrate an independent relationship between DSML and NASH.

Etiology of liver cirrhosis in Mexico

BACKGROUND

In the last decades it has been suggested that the main cause of liver cirrhosis in Mexico is alcohol. Currently in Western countries hepatitis C virus stage liver disease and liver transplantation. In Mexico, we have no data relative to the etiology of liver cirrhosis. The aim of this study was to investigate the main causes of liver cirrhosis in Mexico.

METHODS

Eight hospitals located in different areas of the country were invited to participate in this study. Those hospitals provide health care to different social classes of the country. The inclusion criteria were the presence of either an histological or a clinical and biochemical diagnosis of liver cirrhosis.

RESULTS

A total 1,486 cases were included in this study. The etiology of liver cirrhosis was alcohol in 587 (39.5%), HCV 544 (36.6%), cryptogenic 154 (10.4%), PBC 84 (5.7%), HBV 75 (5.0%) and other 42 (2.8%). There was no statistical difference between alcohol and HCV.

CONCLUSIONS

We conclude that the main causes of liver cirrhosis in Mexico are alcohol and HCV.

[Gastropathy caused by non-steroidal anti-inflammatory agents and its association with Helicobacter pylori]

BACKGROUND

Upper gastrointestinal bleeding that is related with older patients and NSAIDs use. The frequency of peptic ulcer bleeding varies of 15% to 30% of cases.

OBJECTIVE

To determine the gastropathy features of patients who receive nonsteroidal anti-inflammatory drug, and its relation with Helicobacter pylori (Hp).

METHODS

Men and women with GU or DU with or without haemorrhage, were included into two groups, NSAIDs users and non users. We determined the incidence rate of peptic ulcer and the frequencies of risk factors as tobacco use, previous peptic ulcer or haemorrhage, concomitant disease presence and its association with Hp infection.

RESULTS

We included 434 (67.5%) patients that used NSAIDs and 209 (32.5%) non NSAIDs users control subjects. The average was 62.5 +/- 17.2 years and 49.5 +/- 19.4 years respectively. The annual incidence rate of peptic ulcer in NSAIDs users was 17.5%. Gastrointestinal bleeding was more frequent in NSAIDs users and its relations with Hp infection (23.5%) was smaller than patients without NSAIDs user (47.7%) (OR 0.39 p = 0.0000).

CONCLUSIONS

The GU was highly frequent in the older people who using NSAIDs. The Hp infection shows lower incidence of gastrointestinal bleeding NSAIDs users.

[Survival in patients with liver cirrhosis at the Durango, IMSS Regional General Hospital]

INTRODUCTION

In Mexico, hepatic cirrhosis mortality exhibits important regional differences.

AIM

To analyze global survival of cirrhotic patients, according to etiology and functional status.

MATERIAL AND METHODS

Between March 1990 to August 1998, newly diagnosed patients with hepatic cirrhosis were included in a follow-up study. Subjects were analyzed monthly. Information on clinical evolution, complications, and dates of events (death) and complications were registered. Survival was estimated using Kaplan-Meier method.

RESULTS

Ninety nine subjects were included in the survival analysis, 66 with alcoholic and 33 with viral cirrhosis (HCV and HBV in 24 and nine patients, respectively). Ninety seven percent of patients were decompensated at diagnosis, and 81% had ascites. Probabilities for survival in the entire series were 69.7, 37.6 and 23.6% at 24, 48, and 60 months, respectively. There were no significant differences in the survival of patients grouped according to etiology. When survival was analyzed by Child-Pugh score, it was slightly higher in the alcoholic cirrhosis group.

CONCLUSIONS

In this study survival probability of patients with viral cirrhosis was lower than in patients with alcohol cirrhosis.

[Risk factors for peptic ulcer recurrence]

Prevalence of peptic ulcer (PU) and risk factors associated with its recurrence are unknown among the Mexican population.

OBJECTIVE

To determine clinical features and risk factors associated with peptic ulcer recurrence.

MATERIAL AND METHODS

Five-year follow-up study that included 211 men and 140 women 20 years age or older. PU diagnosis was made by clinical and endoscopic criteria. Associated risk factors such as NSAIDs use, smoking, alcohol consumption, and H. pylori infection were assessed. Clinical recurrence was defined as the time between basal diagnosis and the first PU clinical drop.

RESULTS

Diagnosis of duodenal ulcer (DU) and gastric ulcer (GU) was documented in 41.9 and 58.1% of subjects. Predominant risk factor for DU was smoking, and NSAID intake for GU. H. pylori were documented in 39.3%. Sixty-five years of age or older (61 and 33% for GU and DU, respectively), and three or more associated risk factors (70%) were the main associated causes for PU recurrence. PU recurrence associated with Hp was 34%.

CONCLUSIONS

GU frequency was the highest and associated risk factors for its recurrence were NSAID intake, 65 years of age or older, and Hp infection.

[Survival analysis in cirrhotic patients]

BACKGROUND

Hepatic cirrhosis (HC) is a chronic and progressive disease that, independently of its etiology, favors the presence of some complications that impair the survival of patients.

AIMS

To determine the frequency, etiology, and main decompensation factors, as well as analyse survival curves in HC of a population of Durango, México.

METHODS

Cirrhotic patients of both sexes from the Hospital General del IMSS in Durango were included. The etiology of cirrhosis, the factors of decompensation and the grade of portal hypertension (PHT) were determined. A 39 month follow-up was done, registering complications and cause of death.

STATISTICAL ANALYSIS

Fisher's exact test, Friedman's variance analysis, Mantel-Haenzsel chi-square test and Kaplan-Meier methods were used.

RESULTS

Fifty patients were studied, 30 female and 20 male. The mean age was 54.3 years old (range 32-74 years). The more frequent etiology was alcoholic in 42% patients (19 male and 2 female). Forty three patients (86%) had decompensation by ascitis; 19 (38%) had variceal bleeding, 18(36%) had encephalopathy and 16(32%) were icteric. Twenty six patients (52%) had PHT III, and 30 (60%) were Child-Pugh class B.

CONCLUSIONS

Survival in the decompensated group at 19.8 months follow-up was 62% and 73% in the total group, 20% died. Statistical significance (p < 0.05) was found between PHT grade and Child-Pugh functional class; hepatic reserve correlated inversely with bleeding (p < 0.05) and encephalopathy (p < 0.05) probability. The advanced grade of PHT directly correlated with bleeding encephalopathy and mortality (p < 0.05). We did not find any association between the etiology of cirrhosis and the incidence of complications.