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Arsoy HA, Kara Ö, Keskin M. The evaluation of non-alcoholic fatty liver disease in children with obesity with vibration-controlled transient elastography. J Clin Ultrasound 2024. [PMID: 38635340 DOI: 10.1002/jcu.23698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 04/07/2024] [Accepted: 04/08/2024] [Indexed: 04/20/2024]
Abstract
INTRODUCTION Parallel to the worldwide increase in obesity, the epidemic of chronic liver disease is increasing also in pediatric population. Our aim is to provide a different outlook on the current screening confusion in pediatric non-alcoholic fatty liver disease (NAFLD) with the non-invasive vibration-controlled transient elastography (VCTE) method. MATERIALS AND METHODS This single-center, cross-sectional, comparative study was performed at the tertiary center, included 95 patients with obesity and 116 controls, both groups were 9-18 years of ages. VCTE examinations performed in all patients. The cut-off values for controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) were established by comparing the study and control groups. RESULTS The cut-off for CAP was determined as >236 dB/m when comparing the two groups. The AUC was 0.900 (95% CI, 0.851-0.937) and the diagnostic accuracy was 77.9% and 91.4% for sensitivity and specificity, respectively. The cut-off value for LSM >5 kPa was determined by comparison of the two groups. The AUC was 0.794 (95% CI, 0.733-0.846) and the diagnostic accuracies were 50.5% and 90.5% for sensitivity and specificity, respectively. CONCLUSIONS There is no benchmark method for screening pediatric NAFLD. However, VCTE is a promising method for screening pediatric NAFLD. It is accessible, repeatable and practical.
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Affiliation(s)
- Hanife Ayşegül Arsoy
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, University of Health Sciences Bursa, YuksekIhtisas Training and Research Hospital, Bursa, Turkey
| | - Özlem Kara
- Department of Pediatric Endocrinology, University of Health Sciences Bursa, YuksekIhtisas Training and Research Hospital, Bursa, Turkey
| | - Murat Keskin
- Department of Gastroenterology, Hepatology and Nutrition, School of Medicine, KTO Karatay University, Konya, Turkey
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Bianco C, Pelusi S, Margarita S, Tavaglione F, Jamialahmadi O, Malvestiti F, Periti G, Rondena J, Tomasi M, Carpani R, Ronzoni L, Vidali M, Ceriotti F, Fraquelli M, Vespasiani‐Gentilucci U, Romeo S, Prati D, Valenti L. Predictors of controlled attenuation parameter in metabolic dysfunction. United European Gastroenterol J 2024; 12:364-373. [PMID: 38141028 PMCID: PMC11017762 DOI: 10.1002/ueg2.12513] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/26/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND & AIMS Hepatic fat content can be non-invasively estimated by controlled attenuation parameter (CAP) during transient elastography. The aim of this study was to examine the determinants and predictors of CAP values in individuals with metabolic dysfunction. METHODS We enrolled 1230 consecutive apparently healthy individuals (Liver-Bible-2022 cohort) with ≥3 metabolic dysfunction features. CAP was measured by Fibroscan. CAP determinants and predictors were identified using backward stepwise analysis and introduced in generalized linear models. RESULTS Participants were predominantly males (82.9%), mean age was 53.8 ± 6.4 years, 600 (48.8%) had steatosis (CAP ≥ 275 dB/m), and 27 had liver stiffness measurement (LSM) ≥ 8 kPa. CAP values correlated with LSM (p < 10-22). In multivariable analysis, fasting insulin and abdominal circumference (AC) were the main determinants of CAP (p < 10-6), together with body mass index (BMI; p < 10-4), age, diabetes, triglycerides, ferritin, and lower HDL and thyroid stimulating hormone (TSH; p < 0.05 for all). In a subset of 592 participants with thyroid hormone measurement, we found an association between higher free triiodothyronine levels, correlating with lower TSH, and CAP values, independent of TSH and of levothyroxine treatment (p = 0.0025). A clinical CAP score based on age, BMI, AC, HbA1c, ALT, and HDL predicted CAP ≥ 275 dB/m with moderate accuracy (AUROC = 0.73), which was better than that of the Fatty Liver Index and of ALT (AUROC = 0.70/0.61, respectively) and validated it in multiple cohorts. CONCLUSION Abdominal adiposity and insulin resistance severity were the main determinants of CAP in individuals with metabolic dysfunction and may improve steatotic liver disease risk stratification. CAP values were modulated by the hypophysis-thyroid axis.
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Affiliation(s)
- Cristiana Bianco
- Precision Medicine LabBiological Resource Center and Department of Transfusion MedicineFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Serena Pelusi
- Precision Medicine LabBiological Resource Center and Department of Transfusion MedicineFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Sara Margarita
- Precision Medicine LabBiological Resource Center and Department of Transfusion MedicineFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Federica Tavaglione
- Clinical Medicine and Hepatology UnitDepartment of Internal Medicine and GeriatricsFondazione Policlinico Campus Bio‐MedicoRomeItaly
- Department of Medicine and SurgeryUniversità Campus Bio‐Medico di RomaRomeItaly
| | - Oveis Jamialahmadi
- Department of Molecular and Clinical MedicineInstitute of MedicineSahlgrenska AcademyWallenberg LaboratoryUniversity of GothenburgGothenburgSweden
| | - Francesco Malvestiti
- Department of Pathophysiology and TransplantationUniversità degli Studi di MilanoMilanItaly
| | - Giulia Periti
- Precision Medicine LabBiological Resource Center and Department of Transfusion MedicineFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Jessica Rondena
- Precision Medicine LabBiological Resource Center and Department of Transfusion MedicineFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Melissa Tomasi
- Precision Medicine LabBiological Resource Center and Department of Transfusion MedicineFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Rossana Carpani
- Precision Medicine LabBiological Resource Center and Department of Transfusion MedicineFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Luisa Ronzoni
- Precision Medicine LabBiological Resource Center and Department of Transfusion MedicineFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Matteo Vidali
- Clinical Chemistry Unit and Laboratory MedicineFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Ferruccio Ceriotti
- Clinical Chemistry Unit and Laboratory MedicineFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Mirella Fraquelli
- Gastroenterology and Endoscopy UnitFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Umberto Vespasiani‐Gentilucci
- Clinical Medicine and Hepatology UnitDepartment of Internal Medicine and GeriatricsFondazione Policlinico Campus Bio‐MedicoRomeItaly
- Department of Medicine and SurgeryUniversità Campus Bio‐Medico di RomaRomeItaly
| | - Stefano Romeo
- Department of Molecular and Clinical MedicineInstitute of MedicineSahlgrenska AcademyWallenberg LaboratoryUniversity of GothenburgGothenburgSweden
- Clinical Nutrition UnitDepartment of Medical and Surgical SciencesUniversity Magna GraeciaCatanzaroItaly
- Cardiology DepartmentSahlgrenska University HospitalGothenburgSweden
| | - Daniele Prati
- Precision Medicine LabBiological Resource Center and Department of Transfusion MedicineFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Luca Valenti
- Precision Medicine LabBiological Resource Center and Department of Transfusion MedicineFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
- Department of Pathophysiology and TransplantationUniversità degli Studi di MilanoMilanItaly
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Hsieh RH, Chien YJ, Lan WY, Lin YK, Lin YH, Chiang CF, Yang MT. Bacillus coagulans TCI711 Supplementation Improved Nonalcoholic Fatty Liver by Modulating Gut Microbiota: A Randomized, Placebo-Controlled, Clinical Trial. Curr Dev Nutr 2024; 8:102083. [PMID: 38510931 PMCID: PMC10951533 DOI: 10.1016/j.cdnut.2024.102083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/21/2023] [Accepted: 01/10/2024] [Indexed: 03/22/2024] Open
Abstract
Background Nonalcoholic fatty liver disease (NAFLD) has become one of the major problems of chronic liver disease worldwide. It not only causes damage to the liver but also engenders chronic hepatitis and cirrhosis. Recent studies have shown that regulating Bacillus coagulans can improve NAFLD. Objectives This trial explores whether B. coagulans TCI711 (BCT) could ameliorate NAFLD. Methods A total of 57 patients with NAFLD were recruited through FibroScan liver fibrosis scanner and divided into placebo (n = 28) and BCT-supplemented groups (n = 29). Specifically, 1 BCT probiotic capsule was supplemented daily for 8 wk. Furthermore, the blood, stool, and fatty liver content were then examined. Results Parameters evaluated for liver and kidney indicators showed no side effects after supplementing BCT. A significant reduction of 8.7% in the fatty liver was achieved by effectively suppressing the grade of fatty liver as revealed by controlled attenuation parameter. BCT also regulated gut microbiota profiles, with significant increases observed in Bifidobacterium, Eubacterium, Ruminococcaceae, and Sellimonas compared with the baseline. Conclusions BCT may improve NAFLD by regulating gut microbiota, and parameters evaluated for liver and kidney indicate no side effects.
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Affiliation(s)
- Rong-Hong Hsieh
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
| | - Yu-Ju Chien
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
| | - Wen-Yi Lan
- Center for General Education, Taipei Medical University, Taipei, Taiwan
| | - Yung-Kai Lin
- Institute of Food Safety and Risk Management, National Taiwan Ocean University, Keelung, Taiwan
- Department of Food Science, National Taiwan Ocean University, Keelung, Taiwan
- Graduate Institute of Biomedical Engineering, National Chung Hsing University, Taichung, Taiwan
| | | | - Chi-Fu Chiang
- Research & Design Center, TCI Co., Ltd., Taipei, Taiwan
| | - Ming-Ta Yang
- Center for General Education, Taipei Medical University, Taipei, Taiwan
- Clinical Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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Tavaglione F, Flagiello V, Terracciani F, Gallo P, Capparelli E, Spiezia C, De Vincentis A, Palermo A, Scriccia S, Galati G, Napoli N, Daniels SJ, Blau JE, Carlsson B, Khazrai YM, Incalzi RA, Picardi A, Vespasiani-Gentilucci U. Non-invasive assessment of hepatic steatosis by ultrasound-derived fat fraction in individuals at high-risk for metabolic dysfunction-associated steatotic liver disease. Diabetes Metab Res Rev 2024; 40:e3787. [PMID: 38461408 DOI: 10.1002/dmrr.3787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/05/2024] [Accepted: 02/15/2024] [Indexed: 03/11/2024]
Abstract
AIMS Given the increasing number of individuals developing metabolic dysfunction-associated steatotic liver disease (MASLD) and the low rate of those with progressive liver disease, there is a pressing need to conceive affordable biomarkers to assess MASLD in general population settings. Herein, we aimed to investigate the performance of the ultrasound-derived fat fraction (UDFF) for hepatic steatosis in high-risk individuals. METHODS A total of 302 Europeans with obesity, type 2 diabetes, or a clinical history of hepatic steatosis were included in the analyses. Clinical, laboratory, and imaging data were collected using standardized procedures during a single screening visit in Rome, Italy. Hepatic steatosis was defined by controlled attenuation parameter (CAP) or ultrasound-based Hamaguchi's score. UDFF performance for hepatic steatosis was estimated by the area under the receiver operating characteristic curve (AUC). RESULTS Overall, median (IQR) UDFF was 12% (7-20). UDFF was positively correlated with CAP (ρ = 0.73, p < 0.0001) and Hamaguchi's score (ρ = 0.79, p < 0.0001). Independent predictors of UDFF were circulating triglycerides, alanine aminotransferase (ALT), and ultrasound-measured visceral adipose tissue (VAT). UDFF AUC was 0.89 (0.85-0.93) and 0.92 (0.88-0.95) for CAP- and ultrasound-diagnosed hepatic steatosis, respectively. UDFF AUC for hepatic steatosis was higher than those of fatty liver index (FLI), hepatic steatosis index (HSI), CAP-score (CAPS), and ALT (p < 0.0001). Lower age, ALT, and VAT were associated with discordance between UDFF and ultrasound. CONCLUSIONS UDFF may be a simple and accurate imaging biomarker to assess hepatic steatosis and monitor changes in hepatic fat content over time or in response to therapeutic interventions beyond clinical trials.
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Affiliation(s)
- Federica Tavaglione
- Research Unit of Clinical Medicine and Hepatology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Operative Unit of Clinical Medicine and Hepatology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Valentina Flagiello
- Research Unit of Clinical Medicine and Hepatology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Operative Unit of Clinical Medicine and Hepatology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Francesca Terracciani
- Research Unit of Clinical Medicine and Hepatology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Operative Unit of Clinical Medicine and Hepatology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Paolo Gallo
- Research Unit of Clinical Medicine and Hepatology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Operative Unit of Clinical Medicine and Hepatology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Emma Capparelli
- Research Unit of Clinical Medicine and Hepatology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Chiara Spiezia
- Research Unit of Food Science and Human Nutrition, Department of Science and Technology for Sustainable Development and One Health, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Antonio De Vincentis
- Research Unit of Internal Medicine, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Operative Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Andrea Palermo
- Research Unit of Metabolic Bone and Thyroid Disorders, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Operative Unit of Metabolic Bone and Thyroid Disorders, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Sara Scriccia
- Check-up Center, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Giovanni Galati
- Operative Unit of Clinical Medicine and Hepatology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Nicola Napoli
- Research Unit of Metabolic Bone and Thyroid Disorders, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Operative Unit of Metabolic Bone and Thyroid Disorders, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Samuel J Daniels
- Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Jenny E Blau
- Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Björn Carlsson
- Translational Science and Experimental Medicine, Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Yeganeh M Khazrai
- Research Unit of Food Science and Human Nutrition, Department of Science and Technology for Sustainable Development and One Health, Università Campus Bio-Medico di Roma, Rome, Italy
- Operative Research Unit of Nutrition and Prevention, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Raffaele Antonelli Incalzi
- Research Unit of Internal Medicine, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Operative Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Antonio Picardi
- Research Unit of Clinical Medicine and Hepatology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Operative Unit of Clinical Medicine and Hepatology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Umberto Vespasiani-Gentilucci
- Research Unit of Clinical Medicine and Hepatology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Operative Unit of Clinical Medicine and Hepatology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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An ZM, Liu QH, Ye XJ, Zhang Q, Pei HF, Xin X, Yuan J, Huang Q, Liu K, Lu F, Yan ZH, Zhao Y, Hu YY, Zheng MH, Feng Q. A Novel Score Based on Controlled Attenuation Parameter Accurately Predicts Hepatic Steatosis in Individuals With Metabolic Dysfunction Associated Steatotic Liver Disease: A Derivation and Independent Validation Study. Clin Transl Gastroenterol 2024; 15:e00680. [PMID: 38240390 PMCID: PMC10962889 DOI: 10.14309/ctg.0000000000000680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/10/2024] [Indexed: 03/27/2024] Open
Abstract
INTRODUCTION In metabolic dysfunction-associated steatotic liver disease, the diagnostic efficacy of controlled attenuation parameter (CAP) was not very accurate in evaluating liver fat content. The aim of this study was to develop a score, based on CAP and conventional clinical parameters, to improve the diagnostic performance of CAP regarding liver fat content. METHODS A total of 373 participants from 2 independent Chinese cohorts were included and divided into derivation (n = 191), internal validation (n = 75), and external validation (n = 107) cohorts. Based on the significant difference index between the 2 groups defined by the magnetic resonance imaging-proton density fat fraction (MRI-PDFF) in derivation cohort, the optimal model (CAP-BMI-AST score [CBST]) was screened by the number of parameters and the area under the receiver operating characteristic curve (AUROC). In the internal and external validation cohorts, the AUROC and corresponding 95% confidence intervals (CIs) were used to compare the diagnostic performance of CBST with that of CAP. RESULTS We constructed the CBST = -14.27962 + 0.05431 × CAP - 0.14266 × body mass index + 0.01715 × aspartate aminotransferase. When MRI-PDFF was ≥20%, ≥10%, and ≥5%, the AUROC for CBST was 0.77 (95% CI 0.70-0.83), 0.89 (95% CI 0.83-0.94), and 0.93 (95% CI 0.88-0.98), which was higher than that for CAP respectively. In the internal validation cohort, the AUROC for CBST was 0.80 (95% CI 0.70-0.90), 0.95 (95% CI 0.91-1.00), and 0.98 (95% CI 0.94-1.00). The optimal thresholds of CBST were -0.5345, -1.7404, and -1.9959 for detecting MRI-PDFF ≥20%, ≥10%, and ≥5%, respectively. DISCUSSION The CBST score can accurately evaluate liver steatosis and is superior to the CAP.
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Affiliation(s)
- Zi-Ming An
- Institute of Liver Diseases, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Shanghai Key Laboratory of Traditional Chinese Clinical Medicine, Shanghai, China
- Key Laboratory of Liver and Kidney Diseases, Shanghai University of Traditional Chinese Medicine, Ministry of Education, Shanghai, China
| | - Qiao-Hong Liu
- Institute of Liver Diseases, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xin-Jian Ye
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qian Zhang
- Institute of Liver Diseases, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hua-Fu Pei
- Institute of Liver Diseases, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xin Xin
- Institute of Liver Diseases, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jie Yuan
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qian Huang
- Institute of Liver Diseases, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Kun Liu
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Fang Lu
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhi-Han Yan
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yu Zhao
- Institute of Liver Diseases, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yi-Yang Hu
- Institute of Liver Diseases, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Shanghai Key Laboratory of Traditional Chinese Clinical Medicine, Shanghai, China
- Key Laboratory of Liver and Kidney Diseases, Shanghai University of Traditional Chinese Medicine, Ministry of Education, Shanghai, China
| | - Ming-Hua Zheng
- MAFLD Research Center, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Diagnosis and Treatment for the Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, China
| | - Qin Feng
- Institute of Liver Diseases, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Shanghai Key Laboratory of Traditional Chinese Clinical Medicine, Shanghai, China
- Key Laboratory of Liver and Kidney Diseases, Shanghai University of Traditional Chinese Medicine, Ministry of Education, Shanghai, China
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Atabieke F, Li XJ, Aierken A, Li J, Zhang Y, Aizezi Y, Gao HL, Zhang ZQ. Association between frailty and hepatic fibrosis in NAFLD among middle-aged and older adults: results from NHANES 2017-2020. Front Public Health 2024; 12:1330221. [PMID: 38389936 PMCID: PMC10883311 DOI: 10.3389/fpubh.2024.1330221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
Background Although previous studies found that frailty is prevalent in NAFLD patients with advanced liver fibrosis and cirrhosis, studies examining the relationship are spare. Aim Our study aspires to investigate the potential correlation between the Frailty Index (FI) and hepatic fibrosis among middle-aged and older adults with NAFLD. Methods Data from the 2017-2020.03 National Health and Nutrition Examination Survey (NHANES) were utilized for this study, with a final of 2,383 participants aged 50 years and older included. The quantification of frailty was executed employing a 49-item frailty index. The recognition of hepatic steatosis and fibrosis was accomplished through the utilization of the controlling attenuation parameter (CAP) and transient elastography (TE). The relationship between the FI and hepatic fibrosis were investigated employing univariable and multivariable-adjusted logistic regression analyses. A subgroup analysis was conducted, dividing the subjects based on gender, Body Mass Index (BMI), and the presence of hyperlipidemia. Results The findings demonstrated a positive correlation between the FI and significant hepatic fibrosis in NAFLD, even after using multivariate logistic regression models adjusting for potential confounding factors (OR = 1.022, 95% CI, 1.004-1.041) and in tertiles (Q3vs Q1: OR = 2.004, 95% CI, 1.162-3.455). In the subgroup analysis, the correlation was more statistically significant in male (OR = 1.046, 95% CI, 1.022-1.071), under/normal weight (OR = 1.077, 95% CI, 1.009-1.150), overweight (OR = 1.040, 95% CI, 1.010-1.071), and subjects without hyperlipidemia (OR = 1.054, 95% CI, 1.012-1.097). The area under the Receiver Operating Characteristic (ROC) curve for the FI in assessing the existence of substantial fibrosis in NAFLD was 0.612 (95% CI, 0.596-0.628). Conclusion This study demonstrated a positive correlation between significant hepatic fibrosis and frailty, particularly among males aged 50 years and older, who were non-obese and did not have hyperlipidemia with NAFLD. Additional studies are required to further validate these findings.
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Affiliation(s)
- Falide Atabieke
- The Second Department of Gastroenterology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Xiu-Juan Li
- Department of Pathophysiology, School of Basic Medical Sciences Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Ailikamu Aierken
- Xinjiang Medical University School of Clinical Medicine, Children's Hospital of the Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Jian Li
- The Second Department of Gastroenterology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Yu Zhang
- The Second Department of Gastroenterology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Yierzhati Aizezi
- Center of Critical Care Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Hong-Liang Gao
- The Second Department of Gastroenterology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Zhi-Qiang Zhang
- The Second Department of Gastroenterology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
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Shengir M, Lebouche B, Elgretli W, Saeed S, Ramanakumar AV, Giannakis A, De Pokomandy A, Cox J, Costiniuk C, Routy JP, Klein MB, Sebastiani G. Switch to a raltegravir-based antiretroviral regimen in people with HIV and non-alcoholic fatty liver disease: A randomized controlled trial. HIV Med 2024; 25:135-142. [PMID: 37641534 DOI: 10.1111/hiv.13531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/01/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION The effect of antiretroviral therapy (ART), particularly integrase strand transfer inhibitors (INSTIs), on non-alcoholic fatty liver disease (NAFLD) in people with HIV remains unclear. We evaluated the effect of switching non-INSTI backbone antiretroviral medications to raltegravir on NAFLD and metabolic parameters. MATERIALS AND METHODS This was a single-centre, phase IV, open-label, randomized controlled clinical trial. People living with HIV with NAFLD and undetectable viral load while receiving a non-INSTI were randomized 1:1 to the switch arm (raltegravir 400 mg twice daily) or the control arm (continuing ART regimens not containing INSTI). NAFLD was defined as hepatic steatosis by controlled attenuation parameter ≥238 dB/m in the absence of significant alcohol use and viral hepatitis co-infections. Cytokeratin 18 was used as a biomarker of non-alcoholic steatohepatitis. Changes over time in outcomes were quantified as standardized mean differences (SMDs), and a generalized linear mixed model was used to compare outcomes between study arms. RESULTS A total of 31 people with HIV (mean age 54 years, 74% male) were randomized and followed for 24 months. Hepatic steatosis improved between baseline and end of follow-up in both the switch (SMD -43.4 dB/m) and the control arm (-26.6 dB/m); the difference between arms was not significant. At the end of follow-up, aspartate aminotransferase significantly decreased in the switch arm compared with the control arm (SMD -9.4 vs. 5.5 IU/L). No changes in cytokeratin 18, body mass index, or lipids were observed between study arms. DISCUSSION Switching to a raltegravir-based regimen improved aspartate aminotransferase but seemed to have no effect on NAFLD, body weight, and lipids compared with remaining on any other ART.
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Affiliation(s)
- Mohamed Shengir
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Bertrand Lebouche
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Wesal Elgretli
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Sahar Saeed
- Queen's University, Kingston, Ontario, Canada
| | | | - Andreas Giannakis
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Alexandra De Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Joseph Cox
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Cecilia Costiniuk
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jean-Pierre Routy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marina B Klein
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Giada Sebastiani
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
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8
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Abstract
PURPOSE It has been discovered that a folate shortage may raise the risk of hepatic steatosis. We investigated the relationship between serum folate and controlled attenuation parameter (CAP) among 3606 participants over from the National Health and Nutrition Examination Survey (NHANES). MATERIALS AND METHODS Multivariate logistic regression studies were carried out to calculate the relationship between serum folate and CAP. Additionally, generalized additive models and fitted smoothing curves were carried out. RESULTS After adjusting for other variables, we discovered that serum folate had a negative correlation with CAP. Males and whites maintained a negative correlation of serum folate with CAP when subgroup analyses were stratified by sex and race/ethnicity. The relationship between blood folate levels and CAP in whites had an U-shaped curve (inflection point: 34 ng/ml). CONCLUSION According to our study, the majority of Americans, particularly men and whites, had a negative correlation between serum folate and CAP. Among white people, this connection followed an U-shaped pattern. These findings may provide guidance for monitoring serum folate level and controlling oral folate dosage in clinic, so as to prevent liver steatosis more effectively.Key MessagesThe size of the cohort in our study is large, and our findings come from a nationally representative database.Our study revealed a negative relationship between serum folate and CAP among most Americans, especially in male and whites, which may provide evidence for medications to treat hepatic steatosis.In whites, the association of serum folate with CAP was an U-shaped curve (inflection point: 34 ng/ml). This may provide guidance for monitoring serum folate level and controlling oral folate dosage in clinic, so as to prevent liver steatosis more effectively.
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Affiliation(s)
- Xingxing Chen
- Department of Ultrasound, The First People's Hospital of Xiaoshan District, Hangzhou, P.R. China
| | - Jiajia Lu
- Department of Ultrasound, The First People's Hospital of Xiaoshan District, Hangzhou, P.R. China
| | - Qi Xu
- Department of Ultrasound, The First People's Hospital of Xiaoshan District, Hangzhou, P.R. China
| | - Bin Chen
- Department of Ultrasound, The First People's Hospital of Xiaoshan District, Hangzhou, P.R. China
| | - Lijun Shen
- Department of Ultrasound, The First People's Hospital of Xiaoshan District, Hangzhou, P.R. China
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9
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Wang D, Nan N, Bing H, He B. Controlled attenuation parameters to assess liver steatosis in obese patients with polycystic ovary syndrome. Front Endocrinol (Lausanne) 2023; 14:1241734. [PMID: 37720537 PMCID: PMC10501797 DOI: 10.3389/fendo.2023.1241734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
Objectives This study was performed to investigate the changes and influencing factors of liver controlled attenuation parameter (CAP) in obese patients with polycystic ovary syndrome (PCOS), and to determine the prevalence and risk factors of nonalcoholic fatty liver disease (NAFLD) in PCOS patients with obesity. Methods Forty-one PCOS patients with obesity and twenty age- and body mass index (BMI)-matched control women without PCOS were enrolled in this study. General data, body composition, biochemical parameters, sex hormones, and liver CAP in the two groups were collected and compared. Liver CAP was measured using transient elastography. Results NAFLD was more common in the Obese PCOS group than in the control group (75.61% vs. 45.00%, P=0.018). Compared to the control group, the obese PCOS group showed apparent increases in alanine transaminase (ALT), aspartate transaminase (AST), CAP, triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), totle testosterone (TT), free androgen index (FAI), fasting insulin (FIns), and homeostasis model assessment-insulin resistance (HOMA-IR), along with lower high-density lipoprotein cholesterol (HDL-C) and sex hormone binding globulin (SHBG) levels. In addition, as shown by Spearman analysis, liver CAP in PCOS patients with obesity had a positive correlation with ALT, AST, TG, TT, FAI, FIns, and HOMA-IR, and a negative correlation with SHBG. Logistic regression analysis showed that TG, TT, FIns, and HOMA-IR were risk factors for NAFLD, while TT was an independent risk factor for NAFLD in PCOS patients with obesity. Conclusion PCOS patients with obesity had a significantly higher prevalence of NAFLD. Furthermore, in PCOS patients with obesity, liver CAP was associated with disorders of lipid metabolism, insulin resistance, and hyperandrogenemia, with elevated testosterone levels being an independent risk factor for NAFLD in PCOS patients with obesity.
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Affiliation(s)
- Dongxu Wang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Nan Nan
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hao Bing
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Bing He
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, China
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10
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Xiao Y, Pietzner A, Rohwer N, Jung A, Rothe M, Weylandt KH, Elbelt U. Bioactive oxylipins in type 2 diabetes mellitus patients with and without hypertriglyceridemia. Front Endocrinol (Lausanne) 2023; 14:1195247. [PMID: 37664847 PMCID: PMC10472135 DOI: 10.3389/fendo.2023.1195247] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/20/2023] [Indexed: 09/05/2023] Open
Abstract
Objective Dyslipidemia, in particular elevated triglycerides (TGs) contribute to increased cardiovascular risk in type 2 diabetes mellitus (T2DM). In this pilot study we aimed to assess how increased TGs affect hepatic fat as well as polyunsaturated fatty acid (PUFA) metabolism and oxylipin formation in T2DM patients. Methods 40 patients with T2DM were characterized analyzing routine lipid blood parameters, as well as medical history and clinical characteristics. Patients were divided into a hypertriglyceridemia (HTG) group (TG ≥ 1.7mmol/l) and a normal TG group with TGs within the reference range (TG < 1.7mmol/l). Profiles of PUFAs and their oxylipins in plasma were measured by gas chromatography and liquid chromatography/tandem mass spectrometry. Transient elastography (TE) was used to assess hepatic fat content measured as controlled attenuation parameter (CAP) (in dB/m) and the degree of liver fibrosis measured as stiffness (in kPa). Results Mean value of hepatic fat content measured as CAP as well as body mass index (BMI) were significantly higher in patients with high TGs as compared to those with normal TGs, and correlation analysis showed higher concentrations of TGs with increasing CAP and BMI scores in patients with T2DM. There were profound differences in plasma oxylipin levels between these two groups. Cytochrome P450 (CYP) and lipoxygenase (LOX) metabolites were generally more abundant in the HTG group, especially those derived from arachidonic acid (AA), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), γ-linolenic acid (γ-LA), and α-linolenic acid (α-LA), and a strong correlation between TG levels and plasma metabolites from different pathways was observed. Conclusions In adult patients with T2DM, elevated TGs were associated with increased liver fat and BMI. Furthermore, these patients also had significantly higher plasma levels of CYP- and LOX- oxylipins, which could be a novel indicator of increased inflammatory pathway activity, as well as a novel target to dampen this activity.
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Affiliation(s)
- Yanan Xiao
- Division of Medicine, Department of Gastroenterology, Metabolism and Oncology, University Hospital Ruppin-Brandenburg, Brandenburg Medical School, Neuruppin, Germany
- Medical Department, Division of Psychosomatic Medicine, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Anne Pietzner
- Division of Medicine, Department of Gastroenterology, Metabolism and Oncology, University Hospital Ruppin-Brandenburg, Brandenburg Medical School, Neuruppin, Germany
- Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology, Brandenburg Medical School and University of Potsdam, Potsdam, Germany
| | - Nadine Rohwer
- Division of Medicine, Department of Gastroenterology, Metabolism and Oncology, University Hospital Ruppin-Brandenburg, Brandenburg Medical School, Neuruppin, Germany
- Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology, Brandenburg Medical School and University of Potsdam, Potsdam, Germany
- Department of Molecular Toxicology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Adelheid Jung
- Division of Medicine, Department of Gastroenterology, Metabolism and Oncology, University Hospital Ruppin-Brandenburg, Brandenburg Medical School, Neuruppin, Germany
| | | | - Karsten H. Weylandt
- Division of Medicine, Department of Gastroenterology, Metabolism and Oncology, University Hospital Ruppin-Brandenburg, Brandenburg Medical School, Neuruppin, Germany
- Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology, Brandenburg Medical School and University of Potsdam, Potsdam, Germany
| | - Ulf Elbelt
- Division of Medicine, Department of Gastroenterology, Metabolism and Oncology, University Hospital Ruppin-Brandenburg, Brandenburg Medical School, Neuruppin, Germany
- Medical Department, Division of Psychosomatic Medicine, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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11
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Chiu KL, Chen YD, Wang ST, Chang TH, Wu JL, Shih CM, Yu CS. Exploring the Potential Performance of Fibroscan for Predicting and Evaluating Metabolic Syndrome using a Feature Selected Strategy of Machine Learning. Metabolites 2023; 13:822. [PMID: 37512529 PMCID: PMC10383149 DOI: 10.3390/metabo13070822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/29/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
Metabolic syndrome (MetS) includes several conditions that can increase an individual's predisposition to high-risk cardiovascular events, morbidity, and mortality. Non-alcoholic fatty liver disease (NAFLD) is a predominant cause of cirrhosis, which is a global indicator of liver transplantation and is considered the hepatic manifestation of MetS. FibroScan® provides an accurate and non-invasive method for assessing liver steatosis and fibrosis in patients with NAFLD, via a controlled attenuation parameter (CAP) and liver stiffness measurement (LSM or E) scores and has been widely used in current clinical practice. Several machine learning (ML) models with a recursive feature elimination (RFE) algorithm were applied to evaluate the importance of the CAP score. Analysis by ANOVA revealed that five symptoms at different CAP and E score levels were significant. All eight ML models had accuracy scores > 0.9, while treebags and random forest had the best kappa values (0.6439 and 0.6533, respectively). The CAP score was the most important variable in the seven ML models. Machine learning models with RFE demonstrated that using the CAP score to identify patients with MetS may be feasible. Thus, a combination of CAP scores and other significant biomarkers could be used for early detection in predicting MetS.
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Affiliation(s)
- Kuan-Lin Chiu
- Department of Family Medicine, Taipei Medical University Hospital, Taipei 110301, Taiwan
| | - Yu-Da Chen
- Department of Family Medicine, Taipei Medical University Hospital, Taipei 110301, Taiwan
| | - Sen-Te Wang
- Department of Family Medicine, Taipei Medical University Hospital, Taipei 110301, Taiwan
- Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Health Management Center, Taipei Medical University Hospital, Taipei 110301, Taiwan
| | - Tzu-Hao Chang
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei 235603, Taiwan
- Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei 110301, Taiwan
| | - Jenny L Wu
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei 235603, Taiwan
| | - Chun-Ming Shih
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Cardiovascular Research Center, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei 11031, Taiwan
| | - Cheng-Sheng Yu
- Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei 235603, Taiwan
- Clinical Data Center, Office of Data Science, Taipei Medical University, Taipei 106339, Taiwan
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12
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Zuarth-Vázquez J, Moreno-Castañeda L, Soriano-Márquez JP, Velázquez-Alemán A, Ramos-Ostos MH, Uribe M, López-Méndez I, Juárez-Hernández E. Low-Normal Thyroid Function Is Not Associated with Either Non-Alcoholic Fatty Liver Disease or with Metabolic Dysfunction-Associated Fatty Liver Disease. Life (Basel) 2023; 13:life13041048. [PMID: 37109577 PMCID: PMC10144109 DOI: 10.3390/life13041048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The association of low-normal thyroid function (LNTF) with non-alcoholic fatty liver disease (NAFLD) or metabolic dysfunction-associated fatty liver disease (MAFLD) is controversial; thus, the aim of this study is to determine this association. METHODS NAFLD was evaluated by controlled attenuation parameter of transient elastography. Patients were classified by MAFLD criteria. LNTF was defined as TSH levels of 2.5 to 4.5 mIU/L and were divided into three different cut-off points (>4.5 to 5.0, >3.1, and >2.5 mIU/L). Associations between LNTF, NAFLD, and MAFLD were evaluated by univariate and multivariate logistic regression analyses. RESULTS A total of 3697 patients were included; 59% (n = 2179) were male, and median age and body mass index were 48 (43-55) years and 25.9 (23.6-28.5) kg/m2, respectively, and 44% (n = 1632) were diagnosed with NAFLD. THS levels of 2.5 and 3.1 showed significant associations with the presence of NAFLD and MAFLD; however, LNTF did not show an independent association with the presence of NAFLD or MAFLD in multivariate analysis. According to different cut-off points, patients with LNTF presented similar risks for NAFLD as the general population. CONCLUSION LNTF is not associated with NAFLD or MAFLD. Patients with high LNTF are equally at risk for NAFLD as the general population.
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Affiliation(s)
- Julia Zuarth-Vázquez
- Internal Medicine Department, Medica Sur Clinic & Foundation, Mexico City 14050, Mexico
| | | | | | | | | | - Misael Uribe
- Gastroenterology and Obesity Unit, Medica Sur Clinic & Foundation, Mexico City 14050, Mexico
| | - Iván López-Méndez
- Hepatology and Transplants Unit, Medica Sur Clinic & Foundation, Mexico City 14050, Mexico
| | - Eva Juárez-Hernández
- Translational Research Unit, Medica Sur Clinic & Foundation, Mexico City 14050, Mexico
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13
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Kablawi D, Aljohani F, Palumbo CS, Restellini S, Bitton A, Wild G, Afif W, Lakatos PL, Bessissow T, Sebastiani G. Nonalcoholic Fatty Liver Disease Increases Cardiovascular Risk in Inflammatory Bowel Diseases. Crohns Colitis 360 2023; 5:otad004. [PMID: 36846097 PMCID: PMC9951742 DOI: 10.1093/crocol/otad004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Indexed: 02/05/2023] Open
Abstract
Background Nonalcoholic fatty liver disease (NAFLD) is strongly associated with cardiovascular disease in the general population. Both conditions seem more frequent in patients with inflammatory bowel disease (IBD). We aimed to assess the effect of NAFLD and liver fibrosis on intermediate-high cardiovascular risk in IBD. Methods We prospectively included IBD patients undergoing a routine screening program for NAFLD by transient elastography (TE) with associated controlled attenuation parameter (CAP). NAFLD and significant liver fibrosis were defined as CAP ≥275 dB m-1 and liver stiffness measurement by TE ≥8 kPa, respectively. Cardiovascular risk was assessed with the atherosclerotic cardiovascular disease (ASCVD) risk estimator and categorized as low if <5%, borderline if 5%-7.4%, intermediate if 7.5%-19.9%, and high if ≥20% or if previous cardiovascular event. Predictors of intermediate-high cardiovascular risk were investigated by multivariable logistic regression analysis. Results Of 405 patients with IBD included, 278 (68.6%), 23 (5.7%), 47 (11.6%), and 57 (14.1%) were categorized as at low, borderline, intermediate, and high ASCVD risk, respectively. NAFLD and significant liver fibrosis were found in 129 (31.9%) and 35 (8.6%) patients, respectively. After adjusting for disease activity, significant liver fibrosis and body mass index, predictors of intermediate-high ASCVD risk were NAFLD (adjusted odds ratio [aOR] 2.97, 95% CI, 1.56-5.68), IBD duration (aOR 1.55 per 10 years, 95% CI, 1.22-1.97), and ulcerative colitis (aOR 2.32, 95% CI, 1.35-3.98). Conclusions Assessment of cardiovascular risk should be targeted in IBD patients with NAFLD, particularly if they have longer IBD duration and ulcerative colitis.
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Affiliation(s)
| | | | | | - Sophie Restellini
- Gastroenterology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Alain Bitton
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Gary Wild
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Waqqas Afif
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Peter L Lakatos
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada,1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | | | - Giada Sebastiani
- Address correspondence to: Giada Sebastiani, MD, Division of Gastroenterology and Hepatology, Chronic Viral Illness Service, Royal Victoria Hospital, McGill University Health Centre, 1001 Blvd. Décarie, Montreal, QC H4A 3J1, Canada ()
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14
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Caturano A, Galiero R, Loffredo G, Vetrano E, Medicamento G, Acierno C, Rinaldi L, Marrone A, Salvatore T, Monda M, Sardu C, Marfella R, Sasso FC. Effects of a Combination of Empagliflozin Plus Metformin vs. Metformin Monotherapy on NAFLD Progression in Type 2 Diabetes: The IMAGIN Pilot Study. Biomedicines 2023; 11:biomedicines11020322. [PMID: 36830859 PMCID: PMC9952909 DOI: 10.3390/biomedicines11020322] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) comprises a heterogeneous group of metabolic liver diseases and is characterized by the presence of steatosis in at least 5% of hepatocytes. The aim of our study was to assess the effect of the combination therapy of empagliflozin + metformin vs. metformin monotherapy on NAFLD progression in type 2 diabetic (T2DM) patients. Sixty-three metformin-treated T2DM patients who were SGLT2i-naïve and had an ultrasound diagnosis of NAFLD (aged 60.95 ± 11.14 years; males, 57.1%) were included in the present analysis. Thirty-three started the combination therapy. All patients were observed for 6 months and routinely monitored with anthropometry, blood biochemistry, and FibroScan®/CAP. At the 6-month follow-up, the combination therapy group presented a significant reduction in BMI (30.83 ± 3.5 vs. 28.48 ± 3.25), glycated hemoglobin (8.2 (7.4-8.8)) vs. 7.2 (6.8-7.9), ALT (68.5 (41.5-88.0) vs. 45.00 (38.00, 48.00)), CAP parameter (293.5 (270.0-319.25) vs. 267.00 (259.50, 283.75)) and steatosis degree (p = 0.001) in comparison with the control group, whose parameters remained almost stable over time. In patients affected by T2DM, the combination of empagliflozin + metformin vs. metformin monotherapy ameliorated liver steatosis, ALT levels, body weight, and glycated hemoglobin after a 6-month follow-up.
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Affiliation(s)
- Alfredo Caturano
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I-80138 Naples, Italy
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, I-80138 Naples, Italy
| | - Raffaele Galiero
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I-80138 Naples, Italy
| | - Giuseppe Loffredo
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I-80138 Naples, Italy
| | - Erica Vetrano
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I-80138 Naples, Italy
| | - Giulia Medicamento
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I-80138 Naples, Italy
| | - Carlo Acierno
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I-80138 Naples, Italy
| | - Luca Rinaldi
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I-80138 Naples, Italy
| | - Aldo Marrone
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I-80138 Naples, Italy
| | - Teresa Salvatore
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, I-80138 Naples, Italy
| | - Marcellino Monda
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, I-80138 Naples, Italy
| | - Celestino Sardu
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I-80138 Naples, Italy
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I-80138 Naples, Italy
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I-80138 Naples, Italy
- Correspondence: ; Tel.: +39-(08)-15665010
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15
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Vilar-Gomez E, Vuppalanchi R, Mladenovic A, Samala N, Gawrieh S, Newsome PN, Chalasani N. Prevalence of High-risk Nonalcoholic Steatohepatitis (NASH) in the United States: Results From NHANES 2017-2018. Clin Gastroenterol Hepatol 2023; 21:115-124.e7. [PMID: 34958922 DOI: 10.1016/j.cgh.2021.12.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/05/2021] [Accepted: 12/16/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The population prevalence of high-risk non-alcoholic steatohepatitis (NASH), defined as nonalcoholic fatty liver disease activity score ≥4 and fibrosis stage ≥2, is unknown. The FibroScan-AST (FAST) score, calculated using liver stiffness measurement and controlled attenuation parameter values from FibroScan and aspartate aminotransferase levels, is a validated algorithm to identify individuals with high-risk NASH. We estimated the prevalence of high-risk NASH using the FAST score in the United States population. METHODS Data were derived from the National Health and Nutrition Examination Surveys 2017-2018, which included a total of 4218 adults with valid elastography measurements. FAST scores of ≥0.35 (sensitivity, 90%) and ≥0.67 (specificity, 90%) were used to identify adults with high-risk NASH in the general population. RESULTS At 90% sensitivity for the FAST score, the prevalence of age-adjusted high-risk NASH was 5.8% and was higher among men (8.2% vs 3.6% in women) and in Hispanics (9.2% vs. 5.8% non-Hispanic (N.H.) Asians, 5.2% in N.H. whites, and 3.8% in N.H. blacks). The prevalence of high-risk NASH was 11.7% in those with metabolic syndrome and 22.5% in individuals with type 2 diabetes mellitus (T2DM). At 90% specificity for the FAST score, the prevalence of age-adjusted high-risk NASH was 1.2% and was higher among men (1.7% vs 0.8% in women) and in Hispanics (2.2% vs 1.0% in N.H. Asians, 0.9% in N.H. whites, and 0.4% in N.H. blacks). The prevalence of high-risk NASH was 3.4% in those with metabolic syndrome and 8.7% in adults with T2DM. CONCLUSIONS We estimate at least 2 million adults have high-risk NASH in the United States. Moreover, the prevalence of high-risk NASH among individuals with T2DM is higher, ranging between 8.7% and 22.5%, supporting the case for coordinated case-finding and management.
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Affiliation(s)
- Eduardo Vilar-Gomez
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Raj Vuppalanchi
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
| | - Andrea Mladenovic
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Niharika Samala
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Samer Gawrieh
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Phil N Newsome
- National Institute for Health Research Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, United Kingdom; Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom; Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Naga Chalasani
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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16
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Fan H, Xu C, Li W, Huang Y, Hua R, Xiong Y, Yang Y, Feng X, Wang Z, Yuan Z, Zhou J. Ideal Cardiovascular Health Metrics Are Associated with Reduced Severity of Hepatic Steatosis and Liver Fibrosis Detected by Transient Elastography. Nutrients 2022; 14:nu14245344. [PMID: 36558503 PMCID: PMC9780817 DOI: 10.3390/nu14245344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Life's Simple 7 (LS7) is the American Heart Association's (AHA) proposal for a healthy lifestyle, also known as cardiovascular health (CVH) metrics. However, the association between CVH metrics and the severity of hepatic steatosis and liver fibrosis detected by transient elastography is unknown. We performed a cross-sectional study using the data from the 2017-2018 National Health and Nutrition Examination Survey (NHANES) cycle. The controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) were used to evaluate the severity of hepatic steatosis and liver fibrosis and to define NAFLD, advanced liver fibrosis, and cirrhosis. A total of 2679 participants were included. Multivariate linear regression analysis revealed that per 1-unit increase in the CVH metric, CAP and LSM decreased by 8.565 units and 0.274 units, respectively. In the multivariate logistic regression analysis, the risk of NAFLD, advanced liver fibrosis, and cirrhosis were 7, 10, and 6 times higher in the poor CVH group than in the ideal CVH group. Subgroup analysis indicated that CVD patients and non-Hispanic whites could benefit more from ideal CVH. In conclusion, adherence to ideal CVH metrics, as proposed by the AHA, can significantly reduce the risk of hepatic steatosis and liver fibrosis.
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Affiliation(s)
- Heze Fan
- Cardiovascular Department, First Affiliated Hospital of Xi’an Jiao Tong University, Xi’an 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi’an 710061, China
| | - Chenbo Xu
- Cardiovascular Department, First Affiliated Hospital of Xi’an Jiao Tong University, Xi’an 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi’an 710061, China
| | - Wenyuan Li
- Cardiovascular Department, First Affiliated Hospital of Xi’an Jiao Tong University, Xi’an 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi’an 710061, China
| | - Yuzhi Huang
- Cardiovascular Department, First Affiliated Hospital of Xi’an Jiao Tong University, Xi’an 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi’an 710061, China
| | - Rui Hua
- Cardiovascular Department, First Affiliated Hospital of Xi’an Jiao Tong University, Xi’an 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi’an 710061, China
| | - Ying Xiong
- Cardiovascular Department, First Affiliated Hospital of Xi’an Jiao Tong University, Xi’an 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi’an 710061, China
| | - Yuxuan Yang
- Cardiovascular Department, First Affiliated Hospital of Xi’an Jiao Tong University, Xi’an 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi’an 710061, China
| | - Xueying Feng
- Cardiovascular Department, First Affiliated Hospital of Xi’an Jiao Tong University, Xi’an 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi’an 710061, China
| | - Zihao Wang
- Cardiovascular Department, First Affiliated Hospital of Xi’an Jiao Tong University, Xi’an 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi’an 710061, China
| | - Zuyi Yuan
- Cardiovascular Department, First Affiliated Hospital of Xi’an Jiao Tong University, Xi’an 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi’an 710061, China
- Correspondence:
| | - Juan Zhou
- Cardiovascular Department, First Affiliated Hospital of Xi’an Jiao Tong University, Xi’an 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi’an 710061, China
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Liu P, Li M, Zhao L, Yu H, Zhao C, Chen J, Shi R, Zhou L, Zhou Q, Wu B, Li J. Impact of hepatic steatosis on treatment response of autoimmune hepatitis: A retrospective multicentre analysis. Front Immunol 2022; 13:1040029. [PMID: 36591223 PMCID: PMC9795183 DOI: 10.3389/fimmu.2022.1040029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022] Open
Abstract
Background There is a paucity of data on whether steatosis impacts autoimmune hepatitis (AIH) treatment response. We aimed to evaluate the influence of baseline steatosis on the biochemical response, fibrosis progression, and adverse longterm outcomes of AIH. Methods Steatosis was diagnosed by a controlled attenuation parameter (CAP) ≥ 248 dB / m. Only patients who underwent immunosuppressive therapy with available liver histological material at diagnosis and qualified CAP within seven days of the liver biopsy were included. Univariate and multivariate analyses were subsequently conducted. Results The multicentre and retrospective cohort enrolled 222 subjects (88.3% female, median age 54 years, median follow-up 48 months) in the final analysis, and 56 (25.2%) patients had hepatic steatosis. Diabetes, hypertension, and significant fibrosis at baseline were more common in the steatosis group than in the no steatosis group. After adjusting for confounding factors, hepatic steatosis was an independent predictor of insufficient biochemical response (OR: 8.07) and identified as an independent predictor of long-term adverse outcomes (HR: 4.07). By subgroup multivariate analysis (different degrees of steatosis, fibrosis, and prednisone dose), hepatic steatosis independently showed a relatively stable correlation with treatment response. Furthermore, in contrast to those without steatosis, a significant increase in liver stiffness (LS) was observed in patients with steatosis (4.1%/year vs. -16%/year, P < 0.001). Conclusions Concomitant hepatic steatosis was significantly associated with poor response to treatment in AIH patients. Routine CAP measurements are therefore essential to guide the management of AIH.
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Affiliation(s)
- Peiyan Liu
- Clinical School of the Second People’s Hospital, Tianjin Medical University, Tianjin, China,Department of Hepatology, Tianjin Second People’s Hospital, Tianjin, China
| | - Mingkai Li
- Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China,Guangdong Provincial Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Lili Zhao
- Clinical School of the Second People’s Hospital, Tianjin Medical University, Tianjin, China,Department of Hepatology, Tianjin Second People’s Hospital, Tianjin, China
| | - Hongsheng Yu
- Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Chang Zhao
- Department of Pathology, The Lingnan Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jianning Chen
- Department of Pathology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ruifang Shi
- Department of Pathology, Tianjin Second People’s Hospital, Tianjin, China
| | - Li Zhou
- Department of Hepatology, Tianjin Second People’s Hospital, Tianjin, China
| | - Qi Zhou
- Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China,Guangdong Provincial Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Bin Wu
- Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China,Guangdong Provincial Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China,*Correspondence: Bin Wu, ; Jia Li,
| | - Jia Li
- Department of Hepatology, Tianjin Second People’s Hospital, Tianjin, China,*Correspondence: Bin Wu, ; Jia Li,
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Choi JW, Yoo JJ, Kim SG, Kim YS. Bioelectrical Impedance Analysis Can Be an Effective Tool for Screening Fatty Liver in Patients with Suspected Liver Disease. Healthcare (Basel) 2022; 10. [PMID: 36421592 DOI: 10.3390/healthcare10112268] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/09/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background and study aims: Although abdominal ultrasound (USG) or controlled attenuation parameter (CAP) score of transient elastography (TE) is recommended for the diagnosis of fatty liver, issues regarding cost and accessibility still exist. The aim of this study was to evaluate if bioelectrical impedance analysis (BIA) can be used as a reliable screening tool for fatty liver. Patients and methods: A total of 249 patients who underwent all three tests including TE, BIA, and USG were enrolled. The correlation between fat mass measured by BIA, CAP score of TE, and fatty liver grade measured by USG was analyzed. In addition, the cut-off value of BIA which can predict the fatty liver grade was calculated. Results: Fat mass index (FMI) assessed by BIA increased significantly along with the rise in fatty liver grade measured by USG (normal: 6.2 ± 2.4, Gr I: 8.0 ± 3.7, Gr II: 10.6 ± 3.5, Gr III: 10.7 ± 3.7 kg/m2, p < 0.001). In addition, a positive correlation was found between the CAP score of TE and the FMI of BIA. Additionally, a total body fat mass increase by 24.3% or 29.8% in men and 34.8% or 35.1% in women increased the possibility of developing any grade of fatty liver or significant fatty liver (≥Gr II fatty liver), respectively. Conclusion: The total fat or fat mass index of BIA was related to fatty liver as assessed by ultrasound or CAP score, and area under the receiver operating characteristic (AUROC) was about 0.8. Thus, BIA can be used as a screening tool for fatty liver in patients with suspected liver disease.
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Nagaoki Y, Sugiyama A, Mino M, Kodama H, Abe K, Imada H, Ouoba S, E B, Ko K, Akita T, Sako T, Kumada T, Chayama K, Tanaka J. Prevalence of fatty liver and advanced fibrosis by ultrasonography and FibroScan in a general population random sample. Hepatol Res 2022; 52:908-918. [PMID: 35932166 DOI: 10.1111/hepr.13821] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 01/25/2023]
Abstract
AIM Fatty liver is the most common liver disease. This study examined fatty liver and advanced fibrosis prevalence in a random sample of the Japanese general population. METHODS A total of 6000 people randomly selected from two cities in Hiroshima Prefecture were invited to participate in this cross-sectional study originally carried out for hepatitis virus screening. Ultrasonography and FibroScan (controlled attenuation parameter [CAP] and liver stiffness measurement [LSM]) were provided as additional tests. RESULTS Of 6000 invited individuals, 1043 participated in hepatitis virus screening, of which 488 randomly selected individuals (median age, 56 years; interquartile range, 45-68 years; male participants, 49.8%) underwent ultrasonography, CAP, and LSM. Ultrasonography showed fatty liver in 24.6% and mild fatty liver in 32.8%. Controlled attenuation parameter showed severe steatosis in 27.5%, moderate steatosis in 12.5%, and mild steatosis in 11.1%. Overall, 62.1% were diagnosed with fatty liver based on ultrasonography or CAP. Nonalcoholic fatty liver disease (NAFLD) prevalence was 50.6%. Liver stiffness measurement found cirrhosis in 1.0% and severe fibrosis in 1.8%. Multivariate analysis of risk factors associated with ≥F2 or higher liver fibrosis showed that age ≥60 years and above (adjusted odds ratio [AOR], 3.2; 95% confidence interval [CI], 1.5-6.9; p = 0.0031), hepatitis C virus antibody positivity (AOR, 8.4; 95% CI, 1.0-68.4; p = 0.0467), and fatty liver (AOR, 2.3; 95% CI, 1.1-6.2; p = 0.0317) are independent risk factors. CONCLUSIONS In the general population, 62.1% had fatty liver, and NAFLD prevalence was twice as high as previously reported. Screening that is noninvasive, low-cost, and does not require special techniques or equipment is needed to detect advanced liver fibrosis.
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Affiliation(s)
- Yuko Nagaoki
- Department of Gastroenterology, Mazda Hospital, Mazda Motor Corporation, Hiroshima, Japan.,Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Aya Sugiyama
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Megumi Mino
- Health and Welfare Division, Hiroshima Prefectural Government Research Center, Hiroshima, Japan
| | - Hiroomi Kodama
- Health and Welfare Division, Hiroshima Prefectural Government Research Center, Hiroshima, Japan
| | - Kanon Abe
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hirohito Imada
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Serge Ouoba
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.,Clinical Research Unit of Nanoro, Institute for Health Science Research, Nanoro, Burkina Faso
| | - Bunthen E
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.,Payment Certification Agency (PCA), Ministry of Health, Phnom Penh, Cambodia
| | - Ko Ko
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomoyuki Akita
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Toru Sako
- General Affairs, Foundation for Community Health and Medicine Promotion in Hiroshima Prefecture, Hiroshima, Japan
| | - Takashi Kumada
- Department of Nursing, Faculty of Nursing, Gifu Kyoritsu University, Ogaki, Japan
| | - Kazuaki Chayama
- Collaborative Research Laboratory of Medical Innovation, Hiroshima University, Hiroshima, Japan
| | - Junko Tanaka
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Li X, Peng Z, Li M, Zeng X, Li H, Zhu Y, Chen H, Hu A, Zhao Q, Zhang Z, Wang H, Yuan C, Yang W. A Healthful Plant-Based Diet Is Associated with Lower Odds of Nonalcoholic Fatty Liver Disease. Nutrients 2022; 14. [PMID: 36235752 DOI: 10.3390/nu14194099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/28/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
There is little evidence for the associations of the overall plant-based diet index (PDI), the healthful PDI (hPDI), and the unhealthful PDI (uPDI) with the odds of nonalcoholic fatty liver disease (NAFLD). We present a nationwide cross-sectional study among US adults aged 18 years or older. Diet was assessed by 24-h recalls. Overall PDI, hPDI, and uPDI were constructed based on 18 food groups. NAFLD was defined based on controlled attenuation parameter derived via transient elastography (TE) in the absence of other causes of chronic liver disease. Among 3900 participants with eligible TE examination, 1686 were diagnosed with NAFLD. The overall PDI was not associated with NAFLD prevalence (comparing extreme tertiles of PDI score OR = 1.03, 95% CI 0.76, 1.38, ptrend = 0.609). However, hPDI was inversely (OR = 0.50, 95% CI 0.35, 0.72, ptrend < 0.001), while uPDI was positively associated with odds of NAFLD (OR = 1.37, 95% CI 0.93, 2.02, ptrend = 0.009) in the multivariable-adjusted models without body mass index (BMI). After further adjustment for BMI, only the association of hPDI with NAFLD remained statistically significant (OR = 0.64, 95% CI 0.46, 0.87, ptrend = 0.006). Such inverse association appeared stronger in non-Hispanic whites, but not in other racial/ethnic groups (pinteraction = 0.009). Our findings suggest that a plant-based diet rich in healthy plant foods might be associated with lower odds of NAFLD, particularly among US non-Hispanic whites. Clinical trials and cohort studies to validate our findings are needed.
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21
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Ferraioli G, Raimondi A, Maiocchi L, De Silvestri A, Filice C. Quantification of Liver Fat Content with the iATT Algorithm: Correlation with Controlled Attenuation Parameter. Diagnostics (Basel) 2022; 12. [PMID: 35892497 DOI: 10.3390/diagnostics12081787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background: The primary aim of our study was to assess the correlation between an improved version of the attenuation coefficient available on the Arietta 850 ultrasound system (iATT, Fujifilm Healthcare, Tokyo, Japan) and controlled attenuation parameter (CAP). The secondary aim was to assess whether focusing only on iATT acquisition without following the strict protocol for liver stiffness measurements would affect iATT measurement. Methods: Consecutive individuals were enrolled. Pearson’s r was used to test the correlation between ATT and CAP values. The concordance between iATT and CAP was tested using Lin’s concordance correlation coefficient (CCC). Results: 354 individuals (203 males, 151 females) were studied. The overall Pearson correlation between CAP and iATT values obtained following or not following the liver stiffness measurement protocol, respectively, were r = 0.73 and r = 0.71. The correlation was affected by the interquartile range/median (IQR/M) of the 10 measurements: it was r = 0.75 for IQR/M ≤ 15% and r = 0.60 for IQR/M > 15%. CCC showed that there was a moderate to good concordance between iATT and CAP values. Conclusion: iATT shows a strong correlation with CAP that does not decrease when the protocol for liver stiffness acquisition is not followed. The correlation between iATT and CAP values is higher when the IQR/M ≤ 15%.
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Abstract
OBJECTIVE This study aimed to investigate the association between serum vitamin C and liver fibrosis in patients with NAFLD in the US adults. METHODS We conducted a cross-sectional analysis of data from the 2017 to 2018 cycle of National Health and Nutrition Examination Survey (NHANES). Serum vitamin C and transient elastography (TE)-accessed liver stiffness was taken as independent and dependent variables, respectively. Liver steatosis and fibrosis were detected by controlling attenuation parameter (CAP) and TE. NAFLD was defined by a CAP score of ≥248 dB/m without any indication of other causes of chronic liver disease. The median liver stiffness of ≥8.2 kPa was used to identify significant fibrosis (≥F2) among NAFLD patients. We calculated the adjusted odds ratio (OR) and 95% confidential intervals (CIs) for associations with significant NAFLD fibrosis using multivariable logistic regression models. RESULTS Overall, 1926 individuals with NAFLD were included in the analysis and 267 subjects met the definition of significant fibrosis. Serum vitamin C was associated with lower odds of liver fibrosis in NAFLD after adjusting for potential confounders (OR = 0.60, 95% CI, 0.43-0.84), while in the subgroup analysis stratified by gender and body mass index (BMI), this association showed a difference after adjusting for confounders (males: OR = 0.43, 95% CI, 0.26-0.71; females: OR = 0.78, 95% CI, 0.49-1.24). There were no significant associations of serum vitamin C with liver fibrosis in NAFLD with underweight or normal (OR = 1.34, 95% CI, 0.19-9.34). CONCLUSIONS This cross-sectional study indicated an association of serum vitamin C with significant fibrosis in men and overweight or obese patients with NAFLD.
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Affiliation(s)
- Yipu Zhao
- Endoscopic Diagnosis and Treatment Center, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Hailu Li
- Department of Colorectal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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23
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Trifan A, Stratina E, Rotaru A, Stafie R, Zenovia S, Nastasa R, Huiban L, Sfarti C, Cojocariu C, Cuciureanu T, Muzica C, Chiriac S, Girleanu I, Singeap AM, Stanciu C. Changes in Liver Steatosis Using Controlled Attenuation Parameter among Patients with Chronic Hepatitis C Infection Treated with Direct-Acting Antivirals Therapy Who Achieved Sustained Virological Response. Diagnostics (Basel) 2022; 12:diagnostics12030702. [PMID: 35328255 PMCID: PMC8947513 DOI: 10.3390/diagnostics12030702] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 02/06/2023] Open
Abstract
Chronic hepatitis C virus (HCV) infection induces hepatic steatosis due to viral and host factors. However, information regarding the effects of direct-acting antivirals (DAAs) therapy on liver steatosis and fibrosis is limited. Vibration-controlled transient elastography (VCTE) with a controlled attenuation parameter (CAP) represents a non-invasive method, which has been used in the last few years for the detection of hepatic steatosis and fibrosis before and at a sustained virological response at 12 weeks (SVR12). The aim of this study was to assess the modifications of liver steatosis and fibrosis in HCV-infected patients who achieved SVR12. Consecutive patients with chronic HCV infection that were treated with DAAs in a tertiary gastroenterology center from Romania were included. Demographics, laboratory data, and VCTE evaluation were recorded in all patients. Patients with previous hepatic decompensation and those who did not achieve SVR were excluded. Two hundred and eighty patients (67.1% females) who achieved SVR12 were included. Regarding the changes in biological parameters, including liver enzymes such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST), reduced to normal levels at SVR12 compared to the baseline (28.72 ± 24.71 U/L vs. 40.72 ± 27.34 U/L for ALT, p < 0.013 and 27.21 ± 11.15 U/L vs. 33.35 ± 23.37 U/L for AST, p = 0.029). On the contrary, the levels of triglycerides increased significantly from the baseline to SVR12 (124.03 ± 113.49 mg/dL to 153.78 ± 94.53, p = 0.004). Regarding hepatic steatosis by CAP evaluation, at SVR12, 186 (66.4%) of the individuals had a CAP score of ≥248 dB/m, an increase of 4.6% from the baseline. After viral eradication with DAAs, we observed an increase in hepatic steatosis. Hence, a long-term follow-up is mandatory to identify HCV-infected patients with hepatic steatosis post-SVR and the risk factors for more severe outcomes.
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Affiliation(s)
- Anca Trifan
- Department of Gastroenterology, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iasi, Romania; (A.T.); (A.R.); (R.S.); (S.Z.); (L.H.); (C.S.); (C.C.); (T.C.); (C.M.); (S.C.); (I.G.); (A.-M.S.); (C.S.)
- Department of Gastroenterology and Hepatology, “St. Spiridon” University Hospital, 700115 Iasi, Romania
| | - Ermina Stratina
- Department of Gastroenterology, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iasi, Romania; (A.T.); (A.R.); (R.S.); (S.Z.); (L.H.); (C.S.); (C.C.); (T.C.); (C.M.); (S.C.); (I.G.); (A.-M.S.); (C.S.)
- Department of Gastroenterology and Hepatology, “St. Spiridon” University Hospital, 700115 Iasi, Romania
- Correspondence: (E.S.); (R.N.)
| | - Adrian Rotaru
- Department of Gastroenterology, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iasi, Romania; (A.T.); (A.R.); (R.S.); (S.Z.); (L.H.); (C.S.); (C.C.); (T.C.); (C.M.); (S.C.); (I.G.); (A.-M.S.); (C.S.)
- Department of Gastroenterology and Hepatology, “St. Spiridon” University Hospital, 700115 Iasi, Romania
| | - Remus Stafie
- Department of Gastroenterology, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iasi, Romania; (A.T.); (A.R.); (R.S.); (S.Z.); (L.H.); (C.S.); (C.C.); (T.C.); (C.M.); (S.C.); (I.G.); (A.-M.S.); (C.S.)
- Department of Gastroenterology and Hepatology, “St. Spiridon” University Hospital, 700115 Iasi, Romania
| | - Sebastian Zenovia
- Department of Gastroenterology, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iasi, Romania; (A.T.); (A.R.); (R.S.); (S.Z.); (L.H.); (C.S.); (C.C.); (T.C.); (C.M.); (S.C.); (I.G.); (A.-M.S.); (C.S.)
- Department of Gastroenterology and Hepatology, “St. Spiridon” University Hospital, 700115 Iasi, Romania
| | - Robert Nastasa
- Department of Gastroenterology, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iasi, Romania; (A.T.); (A.R.); (R.S.); (S.Z.); (L.H.); (C.S.); (C.C.); (T.C.); (C.M.); (S.C.); (I.G.); (A.-M.S.); (C.S.)
- Department of Gastroenterology and Hepatology, “St. Spiridon” University Hospital, 700115 Iasi, Romania
- Correspondence: (E.S.); (R.N.)
| | - Laura Huiban
- Department of Gastroenterology, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iasi, Romania; (A.T.); (A.R.); (R.S.); (S.Z.); (L.H.); (C.S.); (C.C.); (T.C.); (C.M.); (S.C.); (I.G.); (A.-M.S.); (C.S.)
- Department of Gastroenterology and Hepatology, “St. Spiridon” University Hospital, 700115 Iasi, Romania
| | - Catalin Sfarti
- Department of Gastroenterology, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iasi, Romania; (A.T.); (A.R.); (R.S.); (S.Z.); (L.H.); (C.S.); (C.C.); (T.C.); (C.M.); (S.C.); (I.G.); (A.-M.S.); (C.S.)
- Department of Gastroenterology and Hepatology, “St. Spiridon” University Hospital, 700115 Iasi, Romania
| | - Camelia Cojocariu
- Department of Gastroenterology, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iasi, Romania; (A.T.); (A.R.); (R.S.); (S.Z.); (L.H.); (C.S.); (C.C.); (T.C.); (C.M.); (S.C.); (I.G.); (A.-M.S.); (C.S.)
- Department of Gastroenterology and Hepatology, “St. Spiridon” University Hospital, 700115 Iasi, Romania
| | - Tudor Cuciureanu
- Department of Gastroenterology, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iasi, Romania; (A.T.); (A.R.); (R.S.); (S.Z.); (L.H.); (C.S.); (C.C.); (T.C.); (C.M.); (S.C.); (I.G.); (A.-M.S.); (C.S.)
- Department of Gastroenterology and Hepatology, “St. Spiridon” University Hospital, 700115 Iasi, Romania
| | - Cristina Muzica
- Department of Gastroenterology, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iasi, Romania; (A.T.); (A.R.); (R.S.); (S.Z.); (L.H.); (C.S.); (C.C.); (T.C.); (C.M.); (S.C.); (I.G.); (A.-M.S.); (C.S.)
- Department of Gastroenterology and Hepatology, “St. Spiridon” University Hospital, 700115 Iasi, Romania
| | - Stefan Chiriac
- Department of Gastroenterology, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iasi, Romania; (A.T.); (A.R.); (R.S.); (S.Z.); (L.H.); (C.S.); (C.C.); (T.C.); (C.M.); (S.C.); (I.G.); (A.-M.S.); (C.S.)
- Department of Gastroenterology and Hepatology, “St. Spiridon” University Hospital, 700115 Iasi, Romania
| | - Irina Girleanu
- Department of Gastroenterology, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iasi, Romania; (A.T.); (A.R.); (R.S.); (S.Z.); (L.H.); (C.S.); (C.C.); (T.C.); (C.M.); (S.C.); (I.G.); (A.-M.S.); (C.S.)
- Department of Gastroenterology and Hepatology, “St. Spiridon” University Hospital, 700115 Iasi, Romania
| | - Ana-Maria Singeap
- Department of Gastroenterology, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iasi, Romania; (A.T.); (A.R.); (R.S.); (S.Z.); (L.H.); (C.S.); (C.C.); (T.C.); (C.M.); (S.C.); (I.G.); (A.-M.S.); (C.S.)
- Department of Gastroenterology and Hepatology, “St. Spiridon” University Hospital, 700115 Iasi, Romania
| | - Carol Stanciu
- Department of Gastroenterology, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iasi, Romania; (A.T.); (A.R.); (R.S.); (S.Z.); (L.H.); (C.S.); (C.C.); (T.C.); (C.M.); (S.C.); (I.G.); (A.-M.S.); (C.S.)
- Department of Gastroenterology and Hepatology, “St. Spiridon” University Hospital, 700115 Iasi, Romania
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Padole P, Arora A, Sharma P, Chand P, Verma N, Kumar A. Saroglitazar for Nonalcoholic Fatty Liver Disease: A Single Centre Experience in 91 Patients. J Clin Exp Hepatol 2022; 12:435-439. [PMID: 35535066 PMCID: PMC9077151 DOI: 10.1016/j.jceh.2021.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/12/2021] [Indexed: 12/12/2022] Open
Abstract
Background Saroglitazar is a novel, dual peroxisome proliferator-activated receptors-α/γ agonist and is being investigated for the treatment of nonalcoholic fatty liver disease (NAFLD). Patients and methods Consecutive overweight (body mass index [BMI] >23 kg/m2) patients of NAFLD, diagnosed based on controlled attenuation parameter (CAP) >248 dB/m, and attending the outpatient department of a tertiary care centre in New Delhi, were enrolled. Patients with cirrhosis (liver stiffness measurement [LSM] >13.5 kPa) and those with concomitant liver disease due to other aetiologies (alcohol, viral, etc.) were excluded. All patients received saroglitazar 4 mg/day; in addition, they were advised to reduce weight and were counselled regarding diet and exercise. At 3-month follow-up, patients were categorized into those who were able to reduce ≥5% body weight and those who could n'ot, and both these groups were compared. Results A total of 91 patients (median age 45 years [range 18-66 years]; 81% men) were included in the study. The median BMI was 29.3 kg/m2 (range 23.6-42.2 kg/m2). The baseline median (range) aspartate transaminase, alanine transaminase, gamma glutamyl transferase, LSM and CAP values were 40 IU/dL (range 22-144 IU/dL), 48 IU/dL (range 13-164 IU/dL), 42 IU/dL (range 4-171 IU/dL), 6.7 kPa (range 3.6-13.1 kPa), and 308 dB/m (range 249-400 dB/m). All patients tolerated saroglitazar well. At 3-month, 57 patients (63%) were able to reduce ≥5% weight, whereas in the remaining 34 patients (37%), the weight reduction was <5% from baseline. Transaminases values improved in both the groups; however, LSM and CAP values improved only in patients who reduced weight. Conclusion In overweight patients with NAFLD, a 3-month therapy with saroglitazar is able to improve transaminases but not LSM and CAP values unless accompanied by weight reduction of at least 5%. Larger randomized controlled trials are needed to document the independent effect of saroglitazar in these patients.
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Key Words
- ALP, alkaline phosphatase
- ALT, alanine transaminase
- AST, aspartate transaminase
- BMI, body mass index
- CAP, controlled attenuation parameter
- DCGI, Drug Controller General of India
- FDA, Food and Drug Administration
- GGT, gamma glutamyl transferase
- HCV, hepatitis C virus
- IQR, interquartile range
- IU, international units
- LSM, liver stiffness measurement
- MAFLD, metabolic (dysfunction) associated fatty liver disease
- NAFLD
- NAFLD, nonalcoholic fatty liver disease
- NASH, nonalcoholic steatohepatitis
- PPAR, peroxisome proliferator-activated receptor
- controlled attenuation parameter
- dB, decibels
- kPa, kilopascal
- obesity
- pPAR agonist
- saroglitazar
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Affiliation(s)
- Prateek Padole
- Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Anil Arora
- Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Praveen Sharma
- Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Prakash Chand
- Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Nishant Verma
- Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Ashish Kumar
- Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
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Cervo A, Sebastiani G, Milic J, Krahn T, Mazzola S, Petta S, Cascio A, Guaraldi G, Mazzola G. "Dangerous liaisons: NAFLD and liver fibrosis increase cardiovascular risk in HIV". HIV Med 2022; 23:911-921. [PMID: 35199429 DOI: 10.1111/hiv.13274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/24/2022] [Accepted: 02/03/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Non-alcoholic fatty liver disease (NAFLD) is strongly associated with cardiovascular disease in the general population. We aimed to assess the impact of NAFLD and liver fibrosis on intermediate-high cardiovascular risk in people living with HIV. METHODS We included people living with HIV from three cohorts. NAFLD and significant liver fibrosis were defined using transient elastography: controlled attenuation parameter ≥288 dB/m and liver stiffness measurement ≥7.1 kPa, respectively. Cardiovascular risk was assessed with the atherosclerotic cardiovascular disease (ASCVD) risk estimator in patients aged between 40 and 75 years and categorised as low if <5%, borderline if 5%-7.4%, intermediate if 7.5%-19.9% and high if ≥20% or with the presence of a previous cardiovascular event. Patients with hepatitis B and/or hepatitis C virus co-infection, alcohol abuse and unreliable transient elastography measurements were excluded. Predictors of intermediate-high cardiovascular risk were investigated in multivariable analysis by logistic regression and also by stratifying according to body mass index (BMI; cut-offs of 25 and 30 kg/m2 ) and age (cut-off of 60 years). RESULTS Of 941 patients with HIV alone included, 423 (45%), 128 (13.6%), 260 (27.6%) and 130 (13.8%) were categorised as at low, borderline, intermediate and high ASCVD risk, respectively. Predictors of intermediate-high ASCVD risk were NAFLD (adjusted odds ratio [aOR] 2.11; 95% confidence interval [CI] 1.40-3.18; p < 0.001), liver fibrosis (aOR 1.64; 95% CI 1.03-2.59; p = 0.034), duration of HIV (aOR 1.04; 95% CI 1.02-1.06; p < 0.001), and previous exposure to thymidine analogues and/or didanosine (aOR 1.54; 95% CI 1.09-2.18; p = 0.014). NAFLD was also associated with higher cardiovascular risk in normoweight patients (aOR 2.97; 95% CI 1.43-6.16; p = 0.003), in those with BMI <30 kg/m2 (aOR 2.30; 95% CI 1.46-3.61; p < 0.001) and in those aged <60 years (aOR 2.19; 95% CI 1.36-3.54; p = 0.001). CONCLUSION Assessment of cardiovascular disease should be targeted in people living with HIV with NAFLD and/or significant liver fibrosis, even if they are normoweight and young.
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Affiliation(s)
- Adriana Cervo
- Infectious Diseases Unit, PROMISE, University Hospital of Palermo, Palermo, Italy
| | - Giada Sebastiani
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
| | - Jovana Milic
- University of Modena and Reggio Emilia, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Thomas Krahn
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
| | - Sergio Mazzola
- Clinical Epidemiology and Cancer Register Unit, University Hospital of Palermo, Palermo, Italy
| | - Salvatore Petta
- Service of Gastroenterology and Hepatology, PROMISE, University Hospital of Palermo, Palermo, Italy
| | - Antonio Cascio
- Infectious Diseases Unit, PROMISE, University Hospital of Palermo, Palermo, Italy
| | - Giovanni Guaraldi
- University of Modena and Reggio Emilia, Modena, Italy.,Infectious Diseases Unit, University Hospital of Modena, Modena, Italy
| | - Giovanni Mazzola
- Infectious Diseases Unit, PROMISE, University Hospital of Palermo, Palermo, Italy
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Marc L, Mihaescu A, Lupusoru R, Grosu I, Gadalean F, Bob F, Chisavu L, Olariu N, Tucicovschi V, Timar B, Sporea I, Timar R, Schiller A. Liver Steatosis: Better Predictor of CKD in MAFLD Than Liver Fibrosis as Determined by Transient Elastography With Controlled Attenuation Parameter. Front Med (Lausanne) 2022; 8:788881. [PMID: 35096879 PMCID: PMC8793847 DOI: 10.3389/fmed.2021.788881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/13/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Changing the term/concept of the non-alcoholic fatty liver disease (NAFLD) to metabolic dysfunction associated fatty liver disease (MAFLD) may broaden the pathological definition that can include chronic renal involvement, and, possibly, changes chronic kidney disease's (CKD's) epidemiological association with liver disease, because CKD is associated with metabolic disorders and almost all patients with CKD present some form of an atherogenic dyslipidemia. Our study explores the relationship between MAFLD and CKD using Transient Elastography (TE) with a Controlled Attenuated Parameter (CAP). Methods: We evaluated 335 patients with diabetes with MAFLD and with high CKD risk using TE with CAP (FibroScan®). The CKD was defined according to Kidney Disease Improving Global Outcomes (KDIGO) 2012 guidelines. Logistic regression and stepwise multiple logistic regression were used to evaluate the factors associated with CKD. In addition, a receiver operating characteristic curve (ROC) analysis was used to assess the performance of CAP and TE in predicting CKD and its optimal threshold. Results: The prevalence of CKD in our group was 60.8%. Patients with CKD had higher mean liver stiffness measurements (LSM) and CAP values than those without CKD. We found that hepatic steatosis was a better predictor of CKD than fibrosis. Univariate regression showed that CAP values >353 dB/m were predictive of CKD; while the multivariate regression analysis (after adjustment according to sex, body mass index (BMI), low-density lipoprotein cholesterol (LDLc), and high-density lipoprotein cholesterol (HDLc), and fasting glucose) showed that CAP values >353 dB/m were more strongly associated with the presence of CKD compared to the LSM (fibrosis) values. Conclusion: In patients with MAFLD, CAP-assessed steatosis appears to be a better predictor of CKD compared to LSM-assessed hepatic fibrosis.
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Affiliation(s)
- Luciana Marc
- Department of Internal Medicine II - Division of Nephrology, "Victor Babes" University of Medicine and Pharmacy, Timişoara, Romania.,Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, Timişoara, Romania.,Nephrology Clinic - County Emergency Hospital "Pius Brinzeu", Timişoara, Romania
| | - Adelina Mihaescu
- Department of Internal Medicine II - Division of Nephrology, "Victor Babes" University of Medicine and Pharmacy, Timişoara, Romania.,Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, Timişoara, Romania.,Nephrology Clinic - County Emergency Hospital "Pius Brinzeu", Timişoara, Romania
| | - Raluca Lupusoru
- Department of Functional Sciences, Center for Modeling Biological Systems and Data Analysis, "Victor Babes" University of Medicine and Pharmacy, Timişoara, Romania.,Department of Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy, Timişoara, Romania
| | - Iulia Grosu
- Department of Internal Medicine II - Division of Nephrology, "Victor Babes" University of Medicine and Pharmacy, Timişoara, Romania.,Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, Timişoara, Romania.,Nephrology Clinic - County Emergency Hospital "Pius Brinzeu", Timişoara, Romania
| | - Florica Gadalean
- Department of Internal Medicine II - Division of Nephrology, "Victor Babes" University of Medicine and Pharmacy, Timişoara, Romania.,Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, Timişoara, Romania.,Nephrology Clinic - County Emergency Hospital "Pius Brinzeu", Timişoara, Romania
| | - Flaviu Bob
- Department of Internal Medicine II - Division of Nephrology, "Victor Babes" University of Medicine and Pharmacy, Timişoara, Romania.,Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, Timişoara, Romania.,Nephrology Clinic - County Emergency Hospital "Pius Brinzeu", Timişoara, Romania
| | - Lazar Chisavu
- Department of Internal Medicine II - Division of Nephrology, "Victor Babes" University of Medicine and Pharmacy, Timişoara, Romania.,Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, Timişoara, Romania.,Nephrology Clinic - County Emergency Hospital "Pius Brinzeu", Timişoara, Romania
| | - Nicu Olariu
- Department of Internal Medicine II - Division of Nephrology, "Victor Babes" University of Medicine and Pharmacy, Timişoara, Romania
| | - Vlad Tucicovschi
- Department of Internal Medicine II - Division of Nephrology, "Victor Babes" University of Medicine and Pharmacy, Timişoara, Romania
| | - Bogdan Timar
- Department of Internal Medicine II - Division of Diabetes and Nutritional Disease, "Victor Babes" University of Medicine and Pharmacy, Timişoara, Romania.,Diabetes and Nutritional Disease Clinic - County Emergency Hospital "Pius Brinzeu", Timişoara, Romania
| | - Ioan Sporea
- Department of Internal Medicine II - Division of Gastroenterology and Hepatology, Advanced Regional Research Center in Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy, Timişoara, Romania
| | - Romulus Timar
- Department of Internal Medicine II - Division of Diabetes and Nutritional Disease, "Victor Babes" University of Medicine and Pharmacy, Timişoara, Romania.,Diabetes and Nutritional Disease Clinic - County Emergency Hospital "Pius Brinzeu", Timişoara, Romania
| | - Adalbert Schiller
- Department of Internal Medicine II - Division of Nephrology, "Victor Babes" University of Medicine and Pharmacy, Timişoara, Romania.,Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, Timişoara, Romania.,Nephrology Clinic - County Emergency Hospital "Pius Brinzeu", Timişoara, Romania
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27
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Matsumoto K, Miyaaki H, Fukushima M, Sasaki R, Haraguchi M, Miuma S, Nakao K. The impact of single-nucleotide polymorphisms on liver stiffness and controlled attenuation parameter in patients treated with direct-acting antiviral drugs for hepatitis C infection. Biomed Rep 2022; 16:9. [PMID: 34987793 PMCID: PMC8719319 DOI: 10.3892/br.2021.1492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/18/2021] [Indexed: 11/18/2022] Open
Abstract
Single-nucleotide polymorphisms (SNPs) of patatin-like phospholipase domain-containing 3 (PNPLA3), tolloid-like protein 1 (TLL1) and interleukin-28 (IL28) have been identified as susceptibility factors for liver steatosis, inflammation and fibrosis in patients with hepatitis C virus (HCV) infection. Here, whether these polymorphisms affected predispositions to changes in liver stiffness (LS) and controlled attenuation parameter (CAP) following direct-acting antiviral (DAA) therapy was assessed. The changes in LS and steatosis in 77 HCV-infected patients receiving DAA therapy were compared with PNPLA3, TLL1 and IL28 genotypes, using CAP, FibroScan and Virtual Touch tissue quantification (VTTQ) before treatment and 12 weeks after the end of the treatment. VTTQ results showed that LS significantly decreased in PNPLA3 CC (P=0.035), TLL1 AA (P=0.011) and IL28B TT (P=0.005) genotypes; no significant differences were observed in PNPLA3 CG/GG, TLL1 AT/TT and IL28B TG/GG. FibroScan results showed that LS significantly decreased in TLL1 AA (P=0.028) and IL28B TT (P=0.032), with no significant difference in PNPLA3 CC. No significant differences were observed in PNPLA3 CG/GG, TLL1 AT/TT and IL28B TG/GG groups. CAP was significantly increased in PNPLA3 CG/GG (P=0.039 and P<0.05) and IL28B TT (P=0.014); no significant difference was observed in PNPLA3 CC and all genotypes of TLL1 and IL28B TG/GG. Therefore, these results indicated that SNPs could predict changes in LS and steatosis after DAA therapy.
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Affiliation(s)
- Kosuke Matsumoto
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan
| | - Hisamitsu Miyaaki
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan
| | - Masanori Fukushima
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan
| | - Ryu Sasaki
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan
| | - Masafumi Haraguchi
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan
| | - Satoshi Miuma
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan
| | - Kazuhiko Nakao
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan
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28
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Correa-Rodríguez M, Izquierdo M, García-Hermoso A, Ramírez-Vélez R. Discriminatory capacity of obesity indicators as predictors of high liver fat in US adolescents. Eur J Clin Invest 2022; 52:e13654. [PMID: 34293184 DOI: 10.1111/eci.13654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/14/2021] [Accepted: 07/01/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aims of this study were to assess the potential of 16 anthropometric, body composition and endocrine indexes as predictors of high liver fat and determine the most appropriate cut-off points in US adolescents. METHODS A cross-sectional study was conducted on a population of 816 adolescents aged 12-17 years. The FibroScan® 502V2 device was used to estimate the controlled attenuation parameter (CAP). Body fat percentage, fat mass, trunk fat percentage and trunk fat mass were measured by dual-energy X-ray absorptiometry. Anthropometric data and metabolic parameters were determined. Receiver operating characteristic curves were analysed to estimate the optimal cut-off points that best identify adolescents with high liver fat (CAP ≥90th percentile). RESULTS In boys, triponderal mass index (TMI) had the highest area under curve (AUC) value (0.865) and the optimal cut-off score for TMI was 17.47 kg/m3 , which had 81.32 sensitivity and 82.99 specificity. In girls, trunk fat index (TFI) had the highest AUC value (0.826) and its optimal cut-off score in screening for high liver fat was 3.76 kg/m2 , which had 74.04 sensitivity and 88.03 specificity. Fat mass index (FMI) index had the second highest AUC values (0.863 in boys 0.812 in girls) in both sex; the cut-off point for the detection of high liver fat was <8.66 kg/m2 for girls and <7.45 kg/m2 for boys. CONCLUSION Assessment of TMI in boys, TFI in girls, and FMI in both sexes are low-cost and easy-to-use parameters that may be useful as early screening tools for possible high liver fat in adolescents.
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Affiliation(s)
- María Correa-Rodríguez
- Departament of Nursing, Health Sciences Faculty, University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Mikel Izquierdo
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IDISNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Institute of Health Carlos III, Madrid, Spain
| | - Antonio García-Hermoso
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IDISNA, Pamplona, Spain.,Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Universidad de Santiago de Chile (USACH), Santiago, Chile
| | - Robinson Ramírez-Vélez
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IDISNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Institute of Health Carlos III, Madrid, Spain
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29
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Duan H, Zhang R, Chen X, Yu G, Song C, Jiang Y, He Y, Wan H, Shen J. Associations of Uric Acid With Liver Steatosis and Fibrosis Applying Vibration Controlled Transient Elastography in the United States: A Nationwide Cross-Section Study. Front Endocrinol (Lausanne) 2022; 13:930224. [PMID: 35813625 PMCID: PMC9259838 DOI: 10.3389/fendo.2022.930224] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Serum uric acid (UA) is related to many metabolic diseases. However, the association of UA with liver diseases was not very clear. The objective of this study is to clarify the relationship of UA with liver steatosis and fibrosis. METHODS This is a cross-sectional study of 4364 people of National Health and Nutrition Examination Survey (NHANES) 2017-2018. Liver steatosis and fibrosis were assessed by controlled attenuation parameter (CAP) and liver stiffness measurements (LSM) using Vibration-controlled transient elastography (VCTE). Linear and logistic regressions were performed. RESULTS After adjusting for potential confounders, UA levels were associated with the prevalence of liver steatosis [OR=2.097 (95%CI: 1.245, 3.534)] and liver fibrosis [OR=2.983 (95%CI: 1.797, 4.952)]. Furthermore, the results were consistent in the subgroup analyses of males and females. CONCLUSIONS UA levels were positively associated with the prevalence of liver steatosis and fibrosis.
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Affiliation(s)
- Hualin Duan
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde Foshan), Foshan, China
| | - Rong Zhang
- Department of Endocinology & Metabolic Diseases, Affiliated Hospital of Xiangnan University, Chenzhou, China
| | - Xingying Chen
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde Foshan), Foshan, China
| | - Genfeng Yu
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde Foshan), Foshan, China
| | - Cheng Song
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde Foshan), Foshan, China
| | - Yuqi Jiang
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde Foshan), Foshan, China
| | - Yajun He
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde Foshan), Foshan, China
| | - Heng Wan
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde Foshan), Foshan, China
- Department of Endocrinology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
- *Correspondence: Jie Shen, ; Heng Wan,
| | - Jie Shen
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde Foshan), Foshan, China
- *Correspondence: Jie Shen, ; Heng Wan,
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30
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Zhu Y, Peng Z, Lu Y, Li H, Zeng X, Zhang Z, Li X, Hu C, Hu A, Zhao Q, Wang H, Yang W. Higher dietary insulinaemic potential is associated with increased risk of liver steatosis and fibrosis. Liver Int 2022; 42:69-79. [PMID: 34521152 DOI: 10.1111/liv.15057] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/17/2021] [Accepted: 09/07/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Hyperinsulinaemia and insulin resistance play a central role in the progression of hepatic steatosis and fibrosis, and diet can modulate insulin response. We thus hypothesised that diet with higher insulinaemic potential is associated with an increased risk of these conditions. METHODS Two empirically dietary indices for hyperinsulinaemia (EDIH) and insulin resistance (EDIR) were derived to identify food groups most predictive of fasting concentrations of C-peptide and insulin and homeostatic model assessment for insulin resistance respectively. Hepatic steatosis and fibrosis were defined by controlled attenuation parameter and liver stiffness measurement using transient elastography (TE). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by logistic regression. RESULTS Of the 4171 participants with TE examination, 1436 (age-standardised prevalence, 33.8%) were diagnosed with steatosis, 255 (5.6%) with advanced fibrosis and 101 (2.2%) with cirrhosis. The multivariable-adjusted ORs for participants comparing the highest to the lowest EDIH tertile were 1.17 (95% CI: 0.99-1.39, Ptrend = .005) for steatosis, 1.74 (95% CI: 1.24-2.44, Ptrend = .001) for advanced fibrosis and 2.05 (95% CI: 1.21-3.46, Ptrend = .004) for cirrhosis. Similar associations were observed for EDIR with ORs of 1.32 (95% CI: 1.11-1.55, Ptrend < .001) for steatosis and 1.43 (95% CI: 1.03-1.99, Ptrend = .006) for advance fibrosis. These positive associations remained among never drinkers and individuals who were free of hepatitis B and/or C. CONCLUSIONS Our findings suggest that hyperinsulinaemia and insulin resistance may partially underlie the influence of diet on hepatic steatosis and fibrosis, and highlight the importance of reducing or avoiding insulinaemic dietary pattern.
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Affiliation(s)
- Yu Zhu
- Department of Nutrition, School of Public Health, Anhui Medical University, Hefei, China.,Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Anhui, China.,NHC Key Laboratory of study on Abnormal Gametes and Reproductive Tract, Anhui, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics/Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Zhaohong Peng
- Department of Interventional Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yao Lu
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hairong Li
- Department of Nutrition, School of Public Health, Anhui Medical University, Hefei, China
| | - Xufen Zeng
- Department of Nutrition, School of Public Health, Anhui Medical University, Hefei, China
| | - Zhuang Zhang
- Department of Nutrition, School of Public Health, Anhui Medical University, Hefei, China
| | - Xiude Li
- Department of Nutrition, School of Public Health, Anhui Medical University, Hefei, China
| | - Chunqiu Hu
- Department of Nutrition, School of Public Health, Anhui Medical University, Hefei, China
| | - Anla Hu
- Department of Nutrition, School of Public Health, Anhui Medical University, Hefei, China
| | - Qihong Zhao
- Department of Nutrition, School of Public Health, Anhui Medical University, Hefei, China
| | - Hua Wang
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei, China
| | - Wanshui Yang
- Department of Nutrition, School of Public Health, Anhui Medical University, Hefei, China.,Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Anhui, China.,NHC Key Laboratory of study on Abnormal Gametes and Reproductive Tract, Anhui, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics/Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
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Chen J, Zhang B. [Research Progress of Quantitative Ultrasound Assessment of Liver Steatosis in Non-alcoholic Fatty Liver Disease]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2021; 43:827-832. [PMID: 34728047 DOI: 10.3881/j.issn.1000-503x.12688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The incidence of non-alcoholic fatty liver disease(NAFLD)keeps on rise.Without intervention,it may develop to steatohepatitis,cirrhosis,and even hepatocellular carcinoma.Liver biopsy,the gold standard for evaluating the steatosis severity of NAFLD,is invasive and unsuitable for large-scale screening.In recent years,magnetic resonance imaging(MRI)-related examinations have been used as a gold standard only second to liver biopsy,which still have disadvantages in large-scale application.Ultrasound has the advantages of simple operation,low cost,and safety,and may become an important method for accessing NALFD.This review summarizes the current studies about the diagnosis of liver steatosis by quantitative ultrasound assessment,including controlled attenuation parameters,attenuation imaging,ultrasonic liver/kidney intensity ratio and liver attenuation rate,and integrated backscatter.
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Affiliation(s)
- Jie Chen
- Department of Ultrasound,China-Japan Friendship Hospital,Beijing 100029,China
| | - Bo Zhang
- Department of Ultrasound,China-Japan Friendship Hospital,Beijing 100029,China
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Hirooka M, Tanaka T, Koizumi Y, Yukimoto A, Watanabe T, Yoshida O, Tokumoto Y, Abe M, Hiasa Y. Accurate reflection of hepatic venous pressure gradient by spleen stiffness measurement in patients with low controlled attenuation parameter values. JGH Open 2021; 5:1172-1178. [PMID: 34622004 PMCID: PMC8485403 DOI: 10.1002/jgh3.12647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/07/2021] [Accepted: 08/14/2021] [Indexed: 12/12/2022]
Abstract
Background and Aim Spleen stiffness measurement (SSM) is useful for assessing portal hypertension. It is unclear whether SSM values are appropriate because vibration‐controlled transient elastography (VCTE) does not generate B‐mode images. This study aimed to confirm whether the controlled attenuation parameter (CAP) measured in the spleen can predict the accuracy of SSM. Methods This retrospective study enrolled 349 patients who underwent SSM using VCTE from January 2012 to December 2020. Consecutive patients were classified into the pilot set (SSM and hepatic venous pressure gradient [HVPG] were measured) and the validation set (SSM was measured without HVPG). In the pilot set, scatter plots with a nonparametric contour line were created. Logistic regression analysis was performed to predict outliers outside the 50% contour line. Results The values of CAP could distinguish the outliers in scatter plots between the HPVG and SSM in both univariate and multivariate analyses (cutoff, 118 dB/m). The correlation of SSM with HVPG (r = 0.718; P < 0.001) was significantly better in the low CAP (≤118 dB/m) group than in the high CAP (>118 dB/m) group (r = 0.330; P < 0.001). The area under the receiver operating characteristic curve of SSM in predicting high‐risk varices was better in the low CAP group than in all patients or in the high CAP group in the pilot set (0.881, 0.854, and 0.843, respectively) and in the validation set (0.893, 0.821, and 0.814, respectively). Conclusion For patients with CAP <118 dB/m, SSM is a feasible predictor of HVPG.
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Affiliation(s)
- Masashi Hirooka
- Department of Gastroenterology and Metabiology Ehime University, Graduate School of Medicine Toon Japan
| | - Takaaki Tanaka
- Department of Gastroenterology and Metabiology Ehime University, Graduate School of Medicine Toon Japan
| | - Yohei Koizumi
- Department of Gastroenterology and Metabiology Ehime University, Graduate School of Medicine Toon Japan
| | - Atsushi Yukimoto
- Department of Gastroenterology and Metabiology Ehime University, Graduate School of Medicine Toon Japan
| | - Takao Watanabe
- Department of Gastroenterology and Metabiology Ehime University, Graduate School of Medicine Toon Japan
| | - Osamu Yoshida
- Department of Gastroenterology and Metabiology Ehime University, Graduate School of Medicine Toon Japan
| | - Yoshio Tokumoto
- Department of Gastroenterology and Metabiology Ehime University, Graduate School of Medicine Toon Japan
| | - Masanori Abe
- Department of Gastroenterology and Metabiology Ehime University, Graduate School of Medicine Toon Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabiology Ehime University, Graduate School of Medicine Toon Japan
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Pasta A, Borro P, Cremonini AL, Formisano E, Tozzi G, Cecchi S, Fresa R, Labanca S, Djahandideh A, Sukkar SG, Picciotto A, Pisciotta L. Effect of a common missense variant in LIPA gene on fatty liver disease and lipid phenotype: New perspectives from a single-center observational study. Pharmacol Res Perspect 2021; 9:e00820. [PMID: 34476902 PMCID: PMC8413903 DOI: 10.1002/prp2.820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 12/15/2022] Open
Abstract
Lysosomal acid lipase deficiency (LAL-D) is an autosomal recessive disease characterized by hypoalphalipoproteinemia, mixed hyperlipemia, and fatty liver (FL) due to mutations in LIPAse A, lysosomal acid type (LIPA) gene. The rs1051338 single-nucleotide polymorphism (SNP) in LIPA gene, in vitro, could adversely affect the LAL activity (LAL-A). Nonalcoholic fatty liver disease (NAFLD) is often associated with metabolic syndrome, and the diagnosis requires the exclusion of excess of alcohol intake and other causes of hepatic disease. The aim of the study was to evaluate the impact of rs1051338 rare allele on lipid phenotype, severity of FL, and LAL-A in patients suffering from dyslipidemia associated with NAFLD. We selected 74 subjects with hypoalphalipoproteinemia or mixed hyperlipemia and evaluated transaminases, liver assessment with controlled attenuation parameter (CAP), LAL-A, rs1051338 SNP genotype. The presence of rare allele caused higher levels of triglycerides and hepatic transaminase and lower levels of high-density lipoprotein cholesterol (HDL-C). Multivariate analysis highlighted independent association between rare allele and FL severity in subjects with NAFLD. The rs1051338 SNP may modulate FL severity and atherogenic dyslipidemia in patients suffering from NAFLD.
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Affiliation(s)
- Andrea Pasta
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Paolo Borro
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Anna Laura Cremonini
- Dietetics and Clinical Nutrition Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elena Formisano
- Nutritional Unit ASL-1 Imperiese, Giovanni Borea Civil Hospital, Sanremo, Italy
| | - Giulia Tozzi
- Division of Metabolism and Research Unit of Metabolic Biochemistry, Department of Pediatrics, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Stefano Cecchi
- Hepatology, Gastroenterology and Nutrition Unit, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy
| | - Raffaele Fresa
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Sara Labanca
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Afscin Djahandideh
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Samir Giuseppe Sukkar
- Dietetics and Clinical Nutrition Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonino Picciotto
- Department of Internal Medicine, University of Genoa, Genoa, Italy
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Livia Pisciotta
- Department of Internal Medicine, University of Genoa, Genoa, Italy
- Dietetics and Clinical Nutrition Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Shrestha R, Kc S, Thapa P, Pokharel A, Karki N, Jaishi B. Estimation of Liver Fat by FibroScan in Patients With Nonalcoholic Fatty Liver Disease. Cureus 2021; 13:e16414. [PMID: 34422459 PMCID: PMC8367388 DOI: 10.7759/cureus.16414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2021] [Indexed: 11/05/2022] Open
Abstract
Background Assessment of nonalcoholic fatty liver disease (NAFLD) includes estimation of liver fat (steatosis). Controlled attenuation parameter (CAP) value obtained by FibroScan® (Echosens, Paris, France) is an alternative to liver biopsy for diagnosing and estimating steatosis (S). This study aimed to estimate the liver fat by CAP in NAFLD patients. Methods An observational cross-sectional study was conducted at the Liver Unit of Bir Hospital, from January 2021 to May 2021 after ethical clearance from the Institutional Review Board of the National Academy of Medical Sciences. A convenient sampling method was used. Data were analyzed with descriptive and inferential statistics involving bivariate and multivariate analysis. Results A total of 127 NAFLD patients were enrolled. The mean (±SD) CAP value was 271.53 (±50.69) dB/m. Total cholesterol, triglyceride, and body mass index (BMI) correlated positively (p<0.05) while systolic blood pressure correlated negatively with CAP value (p=0.031). On multivariate analysis, patients with BMI ≥25 kg/m2 were found 3.7 times more likely to have CAP ≥291 dB/m (S3, severe steatosis) than those with BMI <25 kg/m2 (p=0.048, 95% CI 1.01, 13.50). The mean (±SD) CAP values were 276.19 (±49.93) and 246.60 (±48.50) dB/m among those with BMI ≥25 kg/m2 and <25 kg/m2, respectively (p=0.016, using independent t-test). CAP steatosis grading correlated positively with both the ultrasound grading (p<0.001) and fibrosis grading by liver stiffness measurement (p=0.004). Conclusion In this observational cross-sectional study of NAFLD patients, the mean (±SD) CAP value was 271.53 (±50.69) dB/m, which corresponds to moderate steatosis (S2). Obese NAFLD patients with ≥25 kg/m2 were 3.7 times more likely to have severe steatosis (S3) than nonobese NAFLD patients with BMI <25 kg/m2.
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Affiliation(s)
- Rupesh Shrestha
- Liver Unit, Bir Hospital, National Academy of Medical Sciences, Kathmandu, NPL
| | - Sudhamshu Kc
- Liver Unit, Bir Hospital, National Academy of Medical Sciences, Kathmandu, NPL
| | - Pukar Thapa
- Liver Unit, Bir Hospital, National Academy of Medical Sciences, Kathmandu, NPL
| | - Arbinda Pokharel
- Liver Unit, Bir Hospital, National Academy of Medical Sciences, Kathmandu, NPL
| | - Niyanta Karki
- Liver Unit, Bir Hospital, National Academy of Medical Sciences, Kathmandu, NPL
| | - Bikash Jaishi
- Liver Unit, Bir Hospital, National Academy of Medical Sciences, Kathmandu, NPL
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Shao CX, Ye J, Dong Z, Li F, Lin Y, Liao B, Feng S, Zhong B. Steatosis grading consistency between controlled attenuation parameter and MRI-PDFF in monitoring metabolic associated fatty liver disease. Ther Adv Chronic Dis 2021; 12:20406223211033119. [PMID: 34408822 PMCID: PMC8366131 DOI: 10.1177/20406223211033119] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/21/2021] [Indexed: 12/29/2022] Open
Abstract
Background The consistency in steatosis grading between magnetic resonance imaging-based proton density fat fraction (MRI-PDFF) and controlled attenuation parameter (CAP) before and after treatment remains unclear. This study aimed to compare the diagnostic accuracy of steatosis grading between MRI-PDFF and CAP using liver biopsy as standard and to evaluate the value of monitoring changes in steatosis grading with CAP during follow-up utilizing MRI-PDFF as a reference. Methods Consecutive patients from a biopsy cohort and a randomized controlled trial were included in this study and classified into 3 groups (the biopsy, orlistat treatment, and routine treatment subgroups). Hepatic steatosis was measured via MRI-PDFF and CAP at baseline and at the 6th month; the accuracy and cutoffs were assessed in the liver biopsy cohort at baseline. Results A total of 209 consecutive patients were enrolled. MRI-PDFF and CAP showed comparable diagnostic accuracy for detecting pathological steatosis [⩾S1, area under the receiver operating characteristic curve (AUC) = 0.984 and 0.972, respectively]; in contrast, CAP presented significantly lower AUCs in grades S2-3 and S3 (0.820 and 0.815, respectively). The CAP values correlated well with the MRI-PDFF values at baseline and at the 6th month (r = 0.809 and 0.762, respectively, both p < 0.001), whereas a moderate correlation in their changes (r = 0.612 and 0.524 for moderate-severe and mild steatosis, respectively; both p < 0.001) was observed. The AUC of CAP change was obtained to predict MRI-PDFF changes of ⩾5% and ⩾10% (0.685 and 0.704, p < 0.001 and p = 0.001, respectively). The diagnostic agreement of steatosis grade changes between MRI-PDFF and CAP was weak (κ = 0.181, p = 0.001). Conclusions CAP has decreased value for the initial screening of moderate-severe steatosis and is limited in monitoring changes in steatosis during treatment. The confirmation of steatosis grading with MRI-PDFF remains necessary.
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Affiliation(s)
- Cong Xiang Shao
- Department of Gastroenterology of the First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China
| | - Junzhao Ye
- Department of Gastroenterology of the First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China
| | - Zhi Dong
- Department of Radiology of the First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China
| | - Fuxi Li
- Department of Gastroenterology of the First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China
| | - Yansong Lin
- Department of Gastroenterology of the First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China
| | - Bing Liao
- Department of Pathology of the First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China
| | - Shiting Feng
- Department of Radiology of the First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China
| | - Bihui Zhong
- Department of Gastroenterology of the First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan II Road, Yuexiu District, Guangzhou, 510080, China
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Tada T, Nishimura T, Matono T, Yoshida M, Yuri M, Fujiwara A, Yuri Y, Takashima T, Aizawa N, Ikeda N, Enomoto H, Kumada T, Iijima H. Association of liver stiffness and steatosis with hepatocellular carcinoma development in patients with hepatitis C virus infection who received direct-acting antiviral therapy and achieved sustained virological response. Hepatol Res 2021; 51:860-869. [PMID: 34046970 DOI: 10.1111/hepr.13677] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/14/2021] [Accepted: 05/25/2021] [Indexed: 12/16/2022]
Abstract
AIM The pathogenic process underlying the development of hepatocellular carcinoma (HCC) is not yet clear in patients with chronic hepatitis C virus who receive direct-acting antiviral therapy and achieve sustained virological response. This study investigated two risk factors for HCC in these patients; specifically, hepatic fibrosis and steatosis. METHODS A total of 355 patients in whom hepatitis C virus was eradicated by direct-acting antiviral were evaluated. Fibrosis and steatosis were assessed using transient elastography (TE) and the controlled attenuation parameter (CAP). Inverse probability weighting was applied to patient age, sex, albumin-bilirubin, α-fetoprotein, history of HCC, TE, or CAP. RESULTS The 12-, 24-, and 36-month cumulative incidence rates of HCC were 0.9%, 2.4%, and 4.1%, respectively. Univariate analysis with the Cox proportional hazards model showed that whereas a high TE value (≥10 kPa) was significantly associated with HCC development (HR 7.861, 95% CI 2.126-29.070; p = 0.002), CAP was not. Additionally, univariate analysis with the Cox proportional hazards model adjusted by inverse probability weighting showed that a high TE value was significantly associated with HCC development (HR 3.980, 95% CI, 1.036-15.290; p = 0.044), whereas CAP was not. The cumulative inverse probability weighting-adjusted incidence of HCC rates at 12, 24, and 36 months were 0.0%, 0.5%, and 1.7%, respectively, in patients with a low TE value, and 2.5%, 5.1%, and 7.6%, respectively, in those with a high TE value. CONCLUSION A high TE value was a risk factor for HCC in hepatitis C virus patients who received direct-acting antiviral therapy and achieved sustained virological response.
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Affiliation(s)
- Toshifumi Tada
- Department of Internal Medicine, Japanese Red Cross Society Himeji Hospital, Himeji, Hyogo, Japan.,Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.,Ultrasound Imaging Center, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Takashi Nishimura
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.,Ultrasound Imaging Center, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Tomomitsu Matono
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.,Ultrasound Imaging Center, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.,Department of Internal Medicine, Himeji St. Mary's Hospital, Himeji, Hyogo, Japan
| | - Masahiro Yoshida
- Ultrasound Imaging Center, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Minako Yuri
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Aoi Fujiwara
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yukihisa Yuri
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Tomoyuki Takashima
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Nobuhiro Aizawa
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Naoto Ikeda
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hirayuki Enomoto
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Takashi Kumada
- Faculty of Nursing, Gifu Kyoritsu University, Ogaki, Japan
| | - Hiroko Iijima
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.,Ultrasound Imaging Center, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Ferraioli G, Maiocchi L, Savietto G, Tinelli C, Nichetti M, Rondanelli M, Calliada F, Preda L, Filice C. Performance of the Attenuation Imaging Technology in the Detection of Liver Steatosis. J Ultrasound Med 2021; 40:1325-1332. [PMID: 32960457 PMCID: PMC8246860 DOI: 10.1002/jum.15512] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 05/12/2023]
Abstract
OBJECTIVES The main aim was to assess the performance and cutoff value for the detection of liver steatosis (grade S > 0) with the Attenuation Imaging-Penetration (ATI-Pen) algorithm available on the Aplio i-series ultrasound systems (Canon Medical Systems, Otawara, Japan). The magnetic resonance imaging-derived proton density fat fraction (MRI-PDFF) was used as the reference standard. Secondary aims were to compare the results to those obtained with the previous ATI algorithm (Attenuation Imaging-General [ATI-Gen]) and with the controlled attenuation parameter (CAP) and to generate a regression equation between ATI-Pen and ATI-Gen values. METHODS Consecutive adult patients potentially at risk of liver steatosis were prospectively enrolled. Each patient underwent ultrasound quantification of liver steatosis with ATI-Pen and ATI-Gen and a CAP assessment with the FibroScan system (Echosens, Paris, France). The MRI-PDFF evaluation was performed within a week. The correlations between ATI-Pen, ATI-Gen, the CAP, and the MRI-PDFF were analyzed with the Pearson rank correlation coefficient. The diagnostic performance of ATI-Pen, ATI-Gen, and the CAP was assessed with receiver operating characteristic curves and an area under the receiver operating characteristic curve (AUROC) analysis. RESULTS Seventy-two individuals (31 male and 41 female) were enrolled. Correlation coefficients of ATI-Pen, ATI-Gen, and the CAP with the MRI-PDFF were 0.78, 0.83, and 0.58, respectively. The AUROCs of ATI-Pen, ATI-Gen, and the CAP for detecting steatosis (S > 0) were 0.90 (95% confidence interval, 0.81-0.96), 0.92 (0.82-0.98), and 0.85 (0.74-0.92), and the cutoffs were greater than 0.69 dB/cm/MHz, greater than 0.62 dB/cm/MHz, and greater than 273 dB/m. The regression equation between ATI-Pen and ATI-Gen was ATI-Pen = 0.88 ATI-Gen + 0.13. CONCLUSIONS Attenuation Imaging is a reliable tool for detecting liver steatosis, showing an excellent correlation with the MRI-PDFF and high performance with AUROCs of 0.90 or higher.
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Affiliation(s)
- Giovanna Ferraioli
- Department of Clinical, Surgical, Diagnostic, and Pediatric SciencesUniversity of PaviaPaviaItaly
| | - Laura Maiocchi
- Department of Clinical Sciences and Infectious DiseasesFondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San MatteoPaviaItaly
| | - Giovanni Savietto
- Department of RadiologyFondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San MatteoPaviaItaly
| | - Carmine Tinelli
- Department of Clinical Epidemiology and Biometric UnitFondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San MatteoPaviaItaly
| | - Mara Nichetti
- Department of Applied Health SciencesAzienda di Servizi Alla Persona di PaviaPaviaItaly
| | - Mariangela Rondanelli
- Department of Public HealthUniversity of PaviaPaviaItaly
- Istituto di Ricovero e Cura a Carattere Scientifico Mondino FoundationPaviaItaly
| | - Fabrizio Calliada
- Department of Clinical, Surgical, Diagnostic, and Pediatric SciencesUniversity of PaviaPaviaItaly
| | - Lorenzo Preda
- Department of Clinical, Surgical, Diagnostic, and Pediatric SciencesUniversity of PaviaPaviaItaly
- Department of RadiologyFondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San MatteoPaviaItaly
| | - Carlo Filice
- Department of Clinical, Surgical, Diagnostic, and Pediatric SciencesUniversity of PaviaPaviaItaly
- Department of Clinical Sciences and Infectious DiseasesFondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San MatteoPaviaItaly
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Liu D, Shen Y, Zhang R, Xun J, Wang J, Liu L, Steinhart C, Chen J, Lu H. Prevalence and risk factors of metabolic associated fatty liver disease among people living with HIV in China. J Gastroenterol Hepatol 2021; 36:1670-1678. [PMID: 33140878 DOI: 10.1111/jgh.15320] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/01/2020] [Accepted: 10/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM The new definition for metabolic associated fatty liver disease (MAFLD), formerly named non-alcoholic fatty liver disease (NAFLD), would undoubtedly have significant influence on diagnosis, epidemiology, and new drug research. We investigated the prevalence and risk factors of MAFLD among people living with HIV (PLWH). METHODS In this cross-sectional study, transient elastography was performed in PLWH without significant alcohol intake and hepatitis B virus and hepatitis C virus infection. NAFLD was diagnosed as controlled attenuation parameter (CAP) ≥ 248 dB/m by transient elastography, and MAFLD was defined according to the 2020 international consensus. Advanced fibrosis was defined as liver stiffness measurement (LSM) ≥ 10 kPa. RESULTS Among the 361 PLWH enrolled, the prevalence of NAFLD and MAFLD were 37.67% and 34.90%, respectively. Compared with the non-MAFLD group, the prevalence of elevated alanine aminotransferase (ALT) level (44.44% vs 16.17%, P < 0.001) and advanced fibrosis (19.05% vs 2.55%, P < 0.001) were significantly higher in the MAFLD group. A positive correlation between LSM and CAP values was found in the MAFLD group (rs = 0.350, P < 0.001) but not in the non-MAFLD group. In multivariate analysis, independent risk predictors for MAFLD were higher ALT level (odds ratio [OR] 1.015, 95% confidence interval [CI] 1.003-1.028, P = 0.018), higher uric acid (OR 1.005, 95% CI 1.002-1.009, P = 0.003), higher total cholesterol (OR 1.406, 95% CI 1.029-1.921, P = 0.032), and greater waist-height ratio (OR 1.291, 95% CI 1.196-1.393, P < 0.001). CONCLUSIONS A third of PLWH had MAFLD, which was highly accordant with the prevalence of NAFLD. Routine screening for MAFLD is necessary in PLWH.
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Affiliation(s)
- Danping Liu
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yinzhong Shen
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Renfang Zhang
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Jingna Xun
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.,Scientific Research Center, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Jiangrong Wang
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Li Liu
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Corklin Steinhart
- College of Medicine, The University of Central Florida, Orlando, Florida, USA.,CAN Community Health, Sarasota, Florida, USA
| | - Jun Chen
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Hongzhou Lu
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
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Campos-Varela I, Villagrasa A, Simon-Talero M, Riveiro-Barciela M, Ventura-Cots M, Aguilera-Castro L, Alvarez-Lopez P, Nordahl EA, Anton A, Bañares J, Barber C, Barreira-Diaz A, Biagetti B, Camps-Relats L, Ciudin A, Cocera R, Dopazo C, Fernandez A, Jimenez C, Jimenez MM, Jofra M, Gil C, Gomez-Gavara C, Guanozzi D, Guevara JA, Lobo B, Malagelada C, Martinez-Camprecios J, Mayorga L, Miret E, Pando E, Pérez-Lopez A, Pigrau M, Prio A, Rivera-Esteban JM, Romero A, Tasayco S, Vidal-Gonzalez J, Vidal L, Minguez B, Augustin S, Genesca J. The role of liver steatosis as measured with transient elastography and transaminases on hard clinical outcomes in patients with COVID-19. Therap Adv Gastroenterol 2021; 14:17562848211016567. [PMID: 34104210 PMCID: PMC8170328 DOI: 10.1177/17562848211016567] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 04/12/2021] [Indexed: 02/04/2023] Open
Abstract
Liver injury has been widely described in patients with Coronavirus disease 2019 (COVID-19). We aimed to study the effect of liver biochemistry alterations, previous liver disease, and the value of liver elastography on hard clinical outcomes in COVID-19 patients. We conducted a single-center prospective observational study in 370 consecutive patients admitted for polymerase chain reaction (PCR)-confirmed COVID-19 pneumonia. Clinical and laboratory data were collected at baseline and liver parameters and clinical events recorded during follow-up. Transient elastography [with Controlled Attenuation Parameter (CAP) measurements] was performed at admission in 98 patients. All patients were followed up until day 28 or death. The two main outcomes of the study were 28-day mortality and the occurrence of the composite endpoint intensive care unit (ICU) admission and/or death. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were elevated at admission in 130 patients (35%) and 167 (45%) patients, respectively. Overall, 14.6% of patients presented the composite endpoint ICU and/or death. Neither ALT elevations, prior liver disease, liver stiffness nor liver steatosis (assessed with CAP) had any effect on outcomes. However, patients with abnormal baseline AST had a higher occurrence of the composite ICU/death (21% versus 9.5%, p = 0.002). Patients ⩾65 years and with an AST level > 50 U/ml at admission had a significantly higher risk of ICU and/or death than those with AST ⩽ 50 U/ml (50% versus 13.3%, p < 0.001). In conclusion, mild liver damage is prevalent in COVID-19 patients, but neither ALT elevation nor liver steatosis influenced hard clinical outcomes. Elevated baseline AST is a strong predictor of hard outcomes, especially in patients ⩾65 years.
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Affiliation(s)
- Isabel Campos-Varela
- Liver Unit, Department of Internal Medicine,
Hospital Universitari Vall d’Hebron, Pg. Vall d’Hebron, 119-129, Barcelona,
08035, Spain
- Centro de Investigación Biomédica en Red de
Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos
III, Madrid, Spain
| | - Ares Villagrasa
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Macarena Simon-Talero
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de
Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos
III, Madrid, Spain
| | - Mar Riveiro-Barciela
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de
Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos
III, Madrid, Spain
| | - Meritxell Ventura-Cots
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de
Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos
III, Madrid, Spain
| | - Lara Aguilera-Castro
- Department of Gastroenterology, Vall d’Hebron
Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona,
Spain
| | - Patricia Alvarez-Lopez
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Emilie A Nordahl
- Department of Clinical Pharmacology, Vall
d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Adrian Anton
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Bañares
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Claudia Barber
- Department of Gastroenterology, Vall d’Hebron
Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona,
Spain
| | - Ana Barreira-Diaz
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Betina Biagetti
- Department of Endocrinology, Vall d’Hebron
Barcelona Hospital Campus, Barcelona, Spain
| | - Laura Camps-Relats
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andrea Ciudin
- Department of Endocrinology, Vall d’Hebron
Barcelona Hospital Campus, Barcelona, Spain
| | - Raul Cocera
- Department of Urology, Vall d’Hebron Barcelona
Hospital Campus, Barcelona, Spain
| | - Cristina Dopazo
- Department of Hepatobiliar Surgery and Liver
Transplant, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Andrea Fernandez
- Department of Hepatobiliar Surgery and Liver
Transplant, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Cesar Jimenez
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria M Jimenez
- Department of Hematology, Vall d’Hebron
Barcelona Hospital Campus, Barcelona, Spain
| | - Mariona Jofra
- Department of Hepatobiliar Surgery and Liver
Transplant, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Clara Gil
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Concepción Gomez-Gavara
- Department of Hepatobiliar Surgery and Liver
Transplant, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Danila Guanozzi
- Department of Gastroenterology, Vall d’Hebron
Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona,
Spain
| | - Jorge A Guevara
- Department of Endoscopy, Vall d’Hebron
Barcelona Hospital Campus, Barcelona, Spain
| | - Beatriz Lobo
- Department of Gastroenterology, Vall d’Hebron
Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona,
Spain
| | - Carolina Malagelada
- Department of Gastroenterology, Vall d’Hebron
Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona,
Spain
| | - Joan Martinez-Camprecios
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luis Mayorga
- Department of Gastroenterology, Vall d’Hebron
Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona,
Spain
| | - Enric Miret
- Department of Urology, Vall d’Hebron Barcelona
Hospital Campus, Barcelona, Spain
| | - Elizabeth Pando
- Department of Hepatobiliar Surgery and Liver
Transplant, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Ana Pérez-Lopez
- Department of Hematology, Vall d’Hebron
Barcelona Hospital Campus, Barcelona, Spain
| | - Marc Pigrau
- Department of Endoscopy, Vall d’Hebron
Barcelona Hospital Campus, Barcelona, Spain
| | - Alba Prio
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jesus M Rivera-Esteban
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alba Romero
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Stephanie Tasayco
- Department of Gastroenterology, Vall d’Hebron
Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona,
Spain
| | - Judit Vidal-Gonzalez
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Vidal
- Department of Hepatobiliar Surgery and Liver
Transplant, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Beatriz Minguez
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de
Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos
III, Madrid, Spain
| | - Salvador Augustin
- Liver Unit, Department of Internal Medicine,
Hospital Universitari Vall d’Hebron, Pg. Vall d’Hebron, 119-129, Barcelona,
08035, Spain
| | - Joan Genesca
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de
Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos
III, Madrid, Spain
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Cervo A, Milic J, Mazzola G, Schepis F, Petta S, Krahn T, Lebouche B, Deschenes M, Cascio A, Guaraldi G, Sebastiani G. Prevalence, Predictors, and Severity of Lean Nonalcoholic Fatty Liver Disease in Patients Living With Human Immunodeficiency Virus. Clin Infect Dis 2021; 71:e694-e701. [PMID: 32280969 DOI: 10.1093/cid/ciaa430] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 04/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The burden of nonalcoholic fatty liver disease (NAFLD) is growing in people living with human immunodeficiency virus (HIV). NAFLD is associated with obesity; however, it can occur in normoweight (lean) patients. We aimed to investigate lean NAFLD in patients living with HIV. METHODS We included patients living with HIV mono-infection from 3 prospective cohorts. NAFLD was diagnosed by transient elastography (TE) and defined as controlled attenuation parameter ≥248 dB/m, in absence of alcohol abuse. Lean NAFLD was defined when a body mass index was <25 kg/m2. Significant liver fibrosis was defined as TE ≥7.1 kPa. The presence of diabetes, hypertension, or hyperlipidemia defined metabolically abnormal patients. RESULTS We included 1511 patients, of whom 57.4% were lean. The prevalence of lean NAFLD patients in the whole cohort was 13.9%. NAFLD affected 24.2% of lean patients. The proportions of lean NAFLD patients who were metabolically abnormal or had elevated alanine aminotransferase (ALT) were higher than among those who were lean patients without NAFLD (61.9% vs 48.9% and 36.7% vs 24.2%, respectively). Lean NAFLD patients had a higher prevalence of significant liver fibrosis than lean patients without NAFLD (15.7% vs 7.6%, respectively). After adjusting for sex, ethnicity, hypertension, CD4 cell count, nadir CD4 <200µ/L, and time since HIV diagnosis, predictors of NAFLD in lean patients were age (adjusted OR [aOR], 1.29; 95% confidence interval [CI], 1.04-1.59), high triglycerides (aOR, 1.34; 95% CI, 1.11-1.63), and high ALT (aOR, 1.15; 95% CI, 1.05-1.26), while a high level of high-density lipoprotein cholesterol was protective (aOR, 0.45; 95% CI, .26-.77). CONCLUSIONS NAFLD affects 1 in 4 lean patients living with HIV mono-infection. Investigations for NAFLD should be proposed in older patients with dyslipidemia and elevated ALT, even if normoweight.
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Affiliation(s)
- Adriana Cervo
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada.,Infectious Diseases Unit, Department of Health Promotion Sciences and Mother and Child Care "Giuseppe D'Alessandro" (PROMISE), University of Palermo, Palermo, Italy
| | - Jovana Milic
- Infectious Diseases Clinic, University of Modena and Reggio Emilia, University of Modena and Reggio Emilia, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Mazzola
- Infectious Diseases Unit, Department of Health Promotion Sciences and Mother and Child Care "Giuseppe D'Alessandro" (PROMISE), University of Palermo, Palermo, Italy
| | - Filippo Schepis
- Hepatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Salvatore Petta
- Gastroenterology and Hepatology Service, Department of Health Promotion Sciences and Mother and Child Care "Giuseppe D'Alessandro" (PROMISE), University of Palermo, Palermo, Italy
| | - Thomas Krahn
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
| | - Bertrand Lebouche
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada.,Department of Family Medicine, McGill University, Montreal, Canada
| | - Marc Deschenes
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Canada
| | - Antonio Cascio
- Infectious Diseases Unit, Department of Health Promotion Sciences and Mother and Child Care "Giuseppe D'Alessandro" (PROMISE), University of Palermo, Palermo, Italy
| | - Giovanni Guaraldi
- Infectious Diseases Clinic, University of Modena and Reggio Emilia, University of Modena and Reggio Emilia, Modena, Italy
| | - Giada Sebastiani
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada.,Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Canada
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41
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Krahn T, Martel M, Sapir-Pichhadze R, Kronfli N, Falutz J, Guaraldi G, Lebouche B, Klein MB, Wong P, Deschenes M, Ghali P, Sebastiani G. Nonalcoholic Fatty Liver Disease and the Development of Metabolic Comorbid Conditions in Patients With Human Immunodeficiency Virus Infection. J Infect Dis 2021; 222:787-797. [PMID: 32249283 DOI: 10.1093/infdis/jiaa170] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/02/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cardiovascular and liver disease are main causes of death in people with human immunodeficiency virus (HIV) (PWH). In HIV-uninfected patients, nonalcoholic fatty liver disease (NAFLD) is associated with incident metabolic complications. We investigated the effect of NAFLD on development of metabolic comorbid conditions in PWH. METHODS We included PWH undergoing a screening program for NAFLD using transient elastography. NAFLD was defined as a controlled attenuation parameter ≥248 dB/m with exclusion of other liver diseases. Incident diabetes, hypertension, dyslipidemia, and chronic kidney disease were investigated using survival analysis and Cox proportional hazards. RESULTS The study included 485 HIV-monoinfected patients. During a median follow-up of 40.1 months (interquartile range, 26.5-50.7 months), patients with NAFLD had higher incidences of diabetes (4.74 [95% confidence interval, 3.09-7.27] vs 0.87 [.42-1.83] per 100 person-years) and dyslipidemia (8.16 [5.42-12.27] vs 3.99 [2.67-5.95] per 100 person-years) than those without NAFLD. With multivariable analysis, NAFLD was an independent predictor of diabetes (adjusted hazard ratio, 5.13; 95% confidence interval, 2.14-12.31) and dyslipidemia (2.35; 1.34-4.14) development. CONCLUSIONS HIV-monoinfected patients with NAFLD are at higher risk of incident diabetes and dyslipidemia. Early referral strategies and timely management of metabolic risk may improve outcomes.
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Affiliation(s)
- Thomas Krahn
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Myriam Martel
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Ruth Sapir-Pichhadze
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nadine Kronfli
- Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Julian Falutz
- Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Bertrand Lebouche
- Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.,Department of Family Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marina B Klein
- Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Philip Wong
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marc Deschenes
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Peter Ghali
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Giada Sebastiani
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.,Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
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42
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Gu Q, Cen L, Lai J, Zhang Z, Pan J, Zhao F, Yu C, Li Y, Chen C, Chen W, Shen Z. A meta-analysis on the diagnostic performance of magnetic resonance imaging and transient elastography in nonalcoholic fatty liver disease. Eur J Clin Invest 2021; 51:e13446. [PMID: 33128454 DOI: 10.1111/eci.13446] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/15/2020] [Accepted: 10/27/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Noninvasive methods have been used for the assessment of hepatic steatosis in patients with nonalcoholic fatty liver disease (NAFLD). The aim was to assess the efficacy and accuracy of both magnetic resonance imaging(MRI) and transient elastography(TE) for the evaluation of hepatic steatosis. MATERIALS AND METHODS The PubMed, Cochrane Library, Embase, MEDLINE and Web of Science databases were searched to retrieve studies examining the accuracy of MRI-proton density fat fraction(PDFF) and TE-controlled attenuation parameter(CAP) for evaluating the grading of steatosis(S0-S3) diagnosed by liver biopsy in NAFLD. We compared the sensitivity, specificity, hierarchical summary receiver operating characteristic curves(HSROC) and clinical utility of these methods. RESULTS Twenty-four articles with a total of 2979 patients with NAFLD were included. The steatosis distribution was 8.1%/35.1%/32.2%/24.6% for S0/S1/S2/S3. For the diagnostic accuracy of MRI-PDFF, the HSROCs were 0.97 for ≥S1, 0.91 for ≥S2 and 0.90 for ≥S3. For the diagnostic accuracy of TE-based CAP, the HSROCs were 0.85 for ≥S1, 0.83 for ≥S2 and 0.79 for ≥S3. Following a 'positive' measurement (over the threshold value) for ≥S1, the corresponding post-test probabilities of PDFF and CAP for the presence of steatosis were 82% and 61%, respectively, when the pretest probability was 24%. If the values were below these thresholds ('negative' results), the post-test probabilities were 3% and 7%. CONCLUSION MRI-PDFF and TE-CAP both provide highly accurate noninvasive approaches for quantifying and staging hepatic steatosis in NAFLD. Compared with TE-CAP, MRI-PDFF is significantly more accurate for evaluating dichotomized grades of steatosis.
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Affiliation(s)
- Qing Gu
- Center of Endoscopy, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, Zhejiang Province, 310003, China
| | - Li Cen
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, Zhejiang Province, 310003, China
| | - Jiawei Lai
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, Zhejiang Province, 310003, China.,Department of Emergency, The First People's Hospital of Xiaoshan District, Hangzhou, China
| | - Zhongchen Zhang
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, Zhejiang Province, 310003, China
| | - Jiaqi Pan
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, Zhejiang Province, 310003, China
| | - Feng Zhao
- Department of Radiation Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, Zhejiang Province, 310003, China
| | - Chaohui Yu
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, Zhejiang Province, 310003, China
| | - Youming Li
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, Zhejiang Province, 310003, China
| | - Chunxiao Chen
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, Zhejiang Province, 310003, China
| | - Weixing Chen
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, Zhejiang Province, 310003, China
| | - Zhe Shen
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, Zhejiang Province, 310003, China
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43
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Jia S, Zhao Y, Liu J, Guo X, Chen M, Zhou S, Zhou J. Magnetic Resonance Imaging-Proton Density Fat Fraction vs. Transient Elastography- Controlled Attenuation Parameter in Diagnosing Non-alcoholic Fatty Liver Disease in Children and Adolescents: A Meta-Analysis of Diagnostic Accuracy. Front Pediatr 2021; 9:784221. [PMID: 35087774 PMCID: PMC8787332 DOI: 10.3389/fped.2021.784221] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/24/2021] [Indexed: 12/12/2022] Open
Abstract
Background and Aim: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in children and adolescents, and its prevalence increases with obesity. Magnetic resonance imaging (MRI) and transient elastography (TE) have been widely used to non-invasively evaluate NAFLD in adults. This study aimed to determine the efficacy and accuracy of MRI-proton density fat fraction (MRI-PDFF) and TE-controlled attenuation parameter (TE-CAP) in distinguishing hepatic steatosis in children and adolescents. Materials and Methods: In this meta-analysis, the PubMed, Cochrane Library, Embase, Medline, and Web of Science databases were searched for articles that reported studies on the accuracy of MRI-PDFF or TE-CAP in grading the steatosis in children and adolescents with NAFLD. This study compared the sensitivity, specificity, and hierarchical summary receiver operating characteristic curves (HSROCs) of MRI-PDFF and TE-CAP in distinguishing between steatosis grades S0 and S1-3. Results: A total of eight articles involving 874 children and adolescents with NAFLD were included in this study. The proportions of steatosis grades were 5 and 95% for S0 and S1-3, respectively. MRI-PDFF accurately diagnosed S1-3 steatosis, with a summary sensitivity of 0.95 (95% CI, 0.92-0.97), specificity of 0.92 (95% CI, 0.77-0.98), and HSROC of 0.96 (95% CI, 0.94-0.98). Likewise, TE-CAP accurately diagnosed S1-3 steatosis, with a summary sensitivity of 0.86 (95% CI, 0.70-0.94), specificity of 0.88 (95% CI, 0.71-0.96), and HSROC of 0.94 (95% CI, 0.91-0.95). Following a "positive" measurement (over the threshold value) for S1-3, the corresponding post-test probabilities of MRI-PDFF and TE-CAP for the presence of steatosis reached 92 and 88%, respectively, at the pretest probability of 50%. When the values were below the mentioned threshold values ("negative" results), the post-test probabilities of MRI-PDFF and TE-CAP became 5 and 13%, respectively. Conclusion: Both MRI-PDFF and TE-CAP are highly accurate non-invasive methods to grade the hepatic steatosis in children and adolescents with NAFLD. Furthermore, MRI-PDFF is significantly more accurate in assessing steatosis grade than TE-CAP. Systematic Review Registration: PROSPERO, identifier: CRD42021220422.
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Affiliation(s)
- Shuangzhen Jia
- Division of Gastroenterology, Shenzhen Children's Hospital, Shenzhen, China
| | - Yuzhen Zhao
- Division of Gastroenterology, Shenzhen Children's Hospital, Shenzhen, China
| | - Jiaqi Liu
- Division of Gastroenterology, Shenzhen Children's Hospital, Shenzhen, China
| | - Xu Guo
- Division of Gastroenterology, Shenzhen Children's Hospital, Shenzhen, China
| | - Moxian Chen
- Division of Gastroenterology, Shenzhen Children's Hospital, Shenzhen, China
| | - Shaoming Zhou
- Division of Gastroenterology, Shenzhen Children's Hospital, Shenzhen, China
| | - Jianli Zhou
- Division of Gastroenterology, Shenzhen Children's Hospital, Shenzhen, China
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Nascimbeni F, Lugari S, Cassinerio E, Motta I, Cavicchioli A, Dalla Salda A, Bursi S, Donatiello S, Spina V, Cappellini MD, Andreone P, Carubbi F. Liver steatosis is highly prevalent and is associated with metabolic risk factors and liver fibrosis in adult patients with type 1 Gaucher disease. Liver Int 2020; 40:3061-3070. [PMID: 32810900 DOI: 10.1111/liv.14640] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 07/24/2020] [Accepted: 08/08/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Gaucher disease (GD) is associated with peculiar metabolic abnormalities (ie hypermetabolic state, peripheral insulin resistance, dyslipidaemia), partially reverted by enzyme replacement therapy (ERT) at the expense of weight gain. Such metabolic alterations together with an unhealthy lifestyle acquired by an ageing GD population may favour the development of liver steatosis. We aimed at evaluating the prevalence of significant liver steatosis and at identifying the factors associated with liver steatosis in a cohort of patients with type 1 GD. METHODS Twenty adult type 1 GD patients from an Italian academic referral centre were prospectively submitted to vibration-controlled transient elastography (Fibroscan®) with controlled attenuation parameter (CAP); significant steatosis was defined as CAP values ≥250 dB/min. RESULTS Median CAP values were 234 [165-358] dB/min and 8 patients (40%) had significant steatosis. Significant steatosis was associated with indices of adiposity (weight, BMI and waist circumference), high blood pressure, insulin resistance and metabolic syndrome. GD-related variables and dose and duration of ERT were not associated with significant steatosis. In the subgroup of 16 patients on stable ERT for at least 24 months, CAP resulted significantly and positively associated with liver stiffness (rho 0.559, P = .024). CONCLUSIONS Significant steatosis is highly prevalent in adult type 1 GD patients and is strongly associated with a worse metabolic profile, featuring metabolic dysfunction-associated fatty liver disease (MAFLD). MAFLD may determine liver fibrosis progression in GD patients on stable ERT and may be a risk factor for long-term liver-related complications.
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Affiliation(s)
- Fabio Nascimbeni
- Regional Referral Centre for Lysosomal Storage Diseases, Division of Internal Medicine and Metabolism, Civil Hospital, AOU of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Simonetta Lugari
- Regional Referral Centre for Lysosomal Storage Diseases, Division of Internal Medicine and Metabolism, Civil Hospital, AOU of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Elena Cassinerio
- Rare Diseases Centre, Department of Medicine and Medical Specialities, "Ca' Granda" Foundation IRCCS, Milan, Italy
| | - Irene Motta
- Rare Diseases Centre, Department of Medicine and Medical Specialities, "Ca' Granda" Foundation IRCCS, Milan, Italy
| | - Alessia Cavicchioli
- Regional Referral Centre for Lysosomal Storage Diseases, Division of Internal Medicine and Metabolism, Civil Hospital, AOU of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Annalisa Dalla Salda
- Regional Referral Centre for Lysosomal Storage Diseases, Division of Internal Medicine and Metabolism, Civil Hospital, AOU of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Serena Bursi
- Regional Referral Centre for Lysosomal Storage Diseases, Division of Internal Medicine and Metabolism, Civil Hospital, AOU of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Vincenzo Spina
- Radiology Division, Civil Hospital, AOU of Modena, Modena, Italy
| | - Maria Domenica Cappellini
- Rare Diseases Centre, Department of Medicine and Medical Specialities, "Ca' Granda" Foundation IRCCS, Milan, Italy
| | - Pietro Andreone
- Regional Referral Centre for Lysosomal Storage Diseases, Division of Internal Medicine and Metabolism, Civil Hospital, AOU of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Carubbi
- Regional Referral Centre for Lysosomal Storage Diseases, Division of Internal Medicine and Metabolism, Civil Hospital, AOU of Modena, University of Modena and Reggio Emilia, Modena, Italy
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Yu XY, Song XX, Tong YL, Wu LY, Song ZY. Usefulness of controlled attenuation parameter and liver stiffness measurement for detecting increased arterial stiffness in asymptomatic populations in China. Medicine (Baltimore) 2020; 99:e23360. [PMID: 33235107 PMCID: PMC7710246 DOI: 10.1097/md.0000000000023360] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In recent studies, vibration-controlled transient elastography (FibroScan) has been reported as an alternative noninvasive approach for measuring liver steatosis and fibrosis. The present study aimed to investigate the feasibility of FibroScan controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) in the detection of increased arterial stiffness in asymptomatic populations in China.A retrospective cohort recruiting 4747 asymptomatic patients with no underlying causes of liver disease and having FibroScan and brachial-ankle pulse wave velocity (baPWV) during wellness check-up was covered. Nonalcoholic fatty liver disease (NAFLD) was defined as a CAP ≥238 dB/m. NAFLD with significant fibrosis was defined as an LSM ≥7.3 kPa in the presence of NAFLD. Increased arterial stiffness was determined as a BaPWV ≥1.4m/second.Among the 4747 study participants, 1596 subjects (33.6%) suffered from increased arterial stiffness. The prevalence of increased arterial stiffness progressively increased across CAP quartiles and LSM quartiles in NAFLD (23.5%, 30.8%, 38.3%, 43.7%, P < .001 and 33.1%, 36.8%, 40.4%, 48.2%, P < .001, respectively). After conventional cardiovascular risk factors were adjusted (age, sex, overweight, diabetes mellitus, hypertension, hypercholesterolemia, and current smoking habits), multivariate logistic regression analysis revealed that CAP (odd ratio [OR] = 1.005; 95% confidence interval [CI]: 1.003-1.006; P < .001), NAFLD (OR = 1.427; 95% CI: 1.212-1.681; P < .001), LSM in NAFLD (OR = 1.073; 95% CI: 1.023-1.125; P = .003), and significant fibrosis in NAFLD (OR = 1.480; 95% CI: 1.090-2.010; P = .012) were independently associated with increased arterial stiffness. Furthermore, in a multivariate logistic regression analysis, OR (95% CI) for the maximal vs. the minimal quartile of CAP was 1.602 (1.268-2.024), and that of LSM in NAFLD was 1.362 (1.034-1.792) after adjustment for the above-mentioned risk factors. Notably, NAFLD and significant fibrosis in NAFLD were significantly correlated only with increased arterial stiffness in subjects without hypertension or diabetes mellitus after adjustment for the above-mentioned risk factors.CAP-defined NAFLD and LSM-defined significant fibrosis in NAFLD showed significant and independent relationships with increased arterial stiffness even after adjustment for conventional cardiovascular risk factors, which can be conducive to stratifying relative risk of subjects having undergone screening assessment for cardiovascular disease.
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Affiliation(s)
- Xin-yan Yu
- Department of General Practice and Health Management Center
| | - Xiao-xiao Song
- Department of Endocrinology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yu-ling Tong
- Department of General Practice and Health Management Center
| | - Ling-yan Wu
- Department of General Practice and Health Management Center
| | - Zhen-ya Song
- Department of General Practice and Health Management Center
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Oeda S, Tanaka K, Oshima A, Matsumoto Y, Sueoka E, Takahashi H. Diagnostic Accuracy of FibroScan and Factors Affecting Measurements. Diagnostics (Basel) 2020; 10:diagnostics10110940. [PMID: 33198092 PMCID: PMC7696616 DOI: 10.3390/diagnostics10110940] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 12/12/2022] Open
Abstract
Evaluating liver steatosis and fibrosis is important for patients with non-alcoholic fatty liver disease. Although liver biopsy and pathological assessment is the gold standard for these conditions, this technique has several disadvantages. The evaluation of steatosis and fibrosis using ultrasound B-mode imaging is qualitative and subjective. The liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) determined using FibroScan are the evidence-based non-invasive measures of liver fibrosis and steatosis, respectively. The LSM and CAP measurements are carried out simultaneously, and the median values of more than ten valid measurements are used to quantify liver fibrosis and steatosis. Here, we demonstrate that the reliability of the LSM depends on the interquartile range to median ratio (IQR/Med), but CAP values do not depend on IQR/Med. In addition, the LSM is affected by inflammation, congestion, and cholestasis in addition to fibrosis, while CAP values are affected by the body mass index in addition to steatosis. We also show that the M probe provides higher LSM values but lower CAP values than the XL probe in the same population. However, there was no statistically significant difference between the diagnostic accuracies of the two probes. These findings are important to understand the reliability of FibroScan measurements and the factors influencing measurement values for all patients.
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Affiliation(s)
- Satoshi Oeda
- Liver Center, Saga University Hospital, 5-1-1 Nabeshima, Saga 849-8501, Japan;
- Department of Laboratory Medicine, Saga University Hospital, 5-1-1 Nabeshima, Saga 849-8501, Japan; (A.O.); (Y.M.); (E.S.)
- Correspondence:
| | - Kenichi Tanaka
- Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan;
| | - Ayaka Oshima
- Department of Laboratory Medicine, Saga University Hospital, 5-1-1 Nabeshima, Saga 849-8501, Japan; (A.O.); (Y.M.); (E.S.)
| | - Yasue Matsumoto
- Department of Laboratory Medicine, Saga University Hospital, 5-1-1 Nabeshima, Saga 849-8501, Japan; (A.O.); (Y.M.); (E.S.)
| | - Eisaburo Sueoka
- Department of Laboratory Medicine, Saga University Hospital, 5-1-1 Nabeshima, Saga 849-8501, Japan; (A.O.); (Y.M.); (E.S.)
- Department of Clinical Laboratory Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Hirokazu Takahashi
- Liver Center, Saga University Hospital, 5-1-1 Nabeshima, Saga 849-8501, Japan;
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Gandha N, Wibawa LP, Jacoeb TNA, Sulaiman AS. Correlation Between Psoriasis Severity and Nonalcoholic Fatty Liver Disease Degree Measured Using Controlled Attenuation Parameter. Psoriasis (Auckl) 2020; 10:39-44. [PMID: 33117662 PMCID: PMC7586013 DOI: 10.2147/ptt.s272286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/25/2020] [Indexed: 12/31/2022]
Abstract
Background A growing body of evidence links psoriasis to several metabolic disorders, but the causal relationship between psoriasis and nonalcoholic fatty liver disease (NAFLD) remains understudied. Purpose To measure the correlation between the severity of psoriasis and the degree of NAFLD. Patients and Methods A cross-sectional study was conducted on adult patients with psoriasis in the Dermatovenereology Outpatient Clinic of Cipto Mangunkusumo Hospital from December 2017 through February 2018. Psoriasis severity (psoriasis area and severity index [PASI] and body surface area [BSA]) was recorded and compared with NAFLD degree measured by controlled attenuation parameter (CAP). Results A total of 36 subjects were enrolled with an average age of 49.08 years (±15.52 years). The proportions of mild, moderate, and severe psoriasis were 50%, 27.8%, and 22.2%, respectively. Median of PASI was 6.1 (2–38.4) and BSA was 7.5 (2–93). The proportion of NAFLD was 77.8%. The mean of the CAP score was 250.03±45.64. There was no statistically significant correlation between psoriasis severity based on PASI and CAP score (r = 0.258; p = 0.128). However, if the degree of psoriasis was based on BSA, a significant correlation was found (r = 0.382; p = 0.021). The body mass index (BMI) and abdominal circumference were significantly correlated with CAP score (r = 0.448, p = 0.006 and r = 0.485, p = 0.003, respectively). Conclusion Psoriasis extension correlates with NAFLD severity; further studies should assess in detail the effect of therapies on this pathophysiological link.
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Affiliation(s)
- Nico Gandha
- Department of Dermatology and Venereology, Faculty of Medicine Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Larisa Paramitha Wibawa
- Department of Dermatology and Venereology, Faculty of Medicine Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Tjut Nurul Alam Jacoeb
- Department of Dermatology and Venereology, Faculty of Medicine Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Andri Sanityoso Sulaiman
- Department of Internal Medicine, Faculty of Medicine Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
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Chalasani S, Mathur K, Shammas N, Orman E, Vuppalanchi R, Lammert C. Hepatic steatosis is highly prevalent but is not correlated with stiffness in autoimmune hepatitis. Medicine (Baltimore) 2020; 99:e22805. [PMID: 33080756 PMCID: PMC7571921 DOI: 10.1097/md.0000000000022805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The prevalence and impact of hepatic steatosis among patients with autoimmune hepatitis (AIH) is not well described.We conducted a cross-sectional study to determine the prevalence of hepatic steatosis in AIH patients and examined its relationship with hepatic fibrosis using vibration controlled transient elastography. Liver stiffness measurement (LSM), controlled attenuation parameter (CAP), gender, current age, and body mass index (BMI) were collected from 277 AIH patients. Hepatic steatosis was defined as CAP >263 db/m.The study participants were mostly female (82%) with an average age of 49 years and BMI 29.7 kg/m. Mean LSM was 12.5 (standard deviation 13.5) kPa and CAP was 244 (standard deviation 63) db/m. The prevalence of coexisting steatosis was 33.2%, and steatosis did not correlate with LSM (r = 0.05, P = .46). In this study, only gender (females with 31% lower LSM on average compared to males, P = .001) and BMI (each unit increase of BMI resulted in a 1.48% increase on average LSM, P = .01) correlated with LSM. Male gender had significant association with increased LSM, after controlling for age, BMI, and CAP (P = .001).This exploratory study using noninvasive vibration controlled transient elastography revealed hepatic steatosis is highly prevalent in patients with AIH but not associated with liver fibrosis.
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Zheng M, Chen Y, Chen C, Gopal N, Jiao J. Clinical characteristics of platelets and its possible gender dimorphism in patients with nonalcoholic fatty liver disease (NAFLD). Postgrad Med 2020; 133:299-306. [PMID: 32921191 DOI: 10.1080/00325481.2020.1823095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to analyze the characteristics of platelet-associated parameters in nonalcoholic fatty liver disease (NAFLD) patients with varying degrees of disease severity and investigate the sexual dimorphism of platelet features in NAFLD patients. METHODS A total of 829 NAFLD patients were divided into separate groups based on body mass index (BMI), liver stiffness measurement (LSM), controlled attenuation parameter (CAP), and alanine aminotransferase (ALT) levels. The platelet count (PC), mean platelet volume (MPV), and platelet distribution width (PDW) parameters were analyzed among different groups, and the sex-based differences were compared. RESULTS The PC decreased with age in both sexes; in 30-59-year-old female subjects, the PC decreased by a conspicuous margin. The MPV increased with age in females, but not in males. The PDW increased significantly in females aged 30-59 years. With the increase in BMI and CAP, the PC showed a decreasing trend. The MPV increased with the increasing CAP value in male patients. With the increasing LSM value, the PC displayed a decreasing trend. CONCLUSION The PC showed marked sex-based differences in NAFLD patients and is affected by age and BMI. Regular changes of platelet parameters could be found in patients with varying degrees of NAFLD. These changes might be helpful in assessing the severity of NAFLD.
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Affiliation(s)
- Meina Zheng
- Department of Gastroenterolgy and Hepatology,China-Japan Union Hospital, Jilin University, Changchun, China
| | - Yanzhen Chen
- Department of Gastroenterolgy and Hepatology,China-Japan Union Hospital, Jilin University, Changchun, China
| | - Chengliang Chen
- Department of Gastroenterolgy and Hepatology,China-Japan Union Hospital, Jilin University, Changchun, China
| | - Nandhini Gopal
- Department of Gastroenterolgy and Hepatology,China-Japan Union Hospital, Jilin University, Changchun, China
| | - Jian Jiao
- Department of Gastroenterolgy and Hepatology,China-Japan Union Hospital, Jilin University, Changchun, China
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Fan Y, Wang L, Ding Y, Sheng Q, Zhang C, Li Y, Han C, Dou X. Controlled attenuation parameter value-based diagnostic algorithm improves the accuracy of liver stiffness measurement in chronic hepatitis B patients. Aging (Albany NY) 2020; 12:16072-16082. [PMID: 32836216 PMCID: PMC7485708 DOI: 10.18632/aging.103522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/05/2020] [Indexed: 11/25/2022]
Abstract
Liver stiffness measurement (LSM) frequently overestimates the severity of liver fibrosis because of steatosis. However, the impact of the controlled attenuation parameter (CAP) on liver stiffness cutoff values remains unknown; CAP was used to quantify and diagnose the severity of hepatic steatosis. The study was conducted to determine the effect of CAP on liver stiffness cutoff values in chronic hepatitis B (CHB) patients. A retrospective cross-sectional study was performed in liver biopsy-proven CHB patients. The median LSM (kPa) in the elevated CAP group was higher than that in the normal CAP group at the same fibrosis stage. For S2-4, the area under the receiver operating characteristic (AUROC) curve of LSM was 0.78 and 0.72 in the normal and elevated CAP groups, respectively. When a cutoff value of 8.9 kPa was used, the diagnostic accuracy was 77.82% and 63.41% in the normal and elevated CAP groups, respectively. Compared with the alanine transaminase (ALT)-based LSM algorithm, the CAP-based LSM algorithm had a similar correct diagnosis rate (33.64% vs. 33.94%, respectively) but a lower misdiagnosis rate (16.97% vs. 20.30%, respectively). The new CAP-based LSM diagnostic algorithm will improve the diagnostic accuracy of liver fibrosis in CHB patients.
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Affiliation(s)
- Yaoxin Fan
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, Shenyang Liaoning Province, China
| | - Lin Wang
- Department of Health Management, Shengjing Hospital of China Medical University, Shenyang Liaoning Province, China
| | - Yang Ding
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, Shenyang Liaoning Province, China
| | - Qiuju Sheng
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, Shenyang Liaoning Province, China
| | - Chong Zhang
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, Shenyang Liaoning Province, China
| | - Yanwei Li
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, Shenyang Liaoning Province, China
| | - Chao Han
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, Shenyang Liaoning Province, China
| | - Xiaoguang Dou
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, Shenyang Liaoning Province, China
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