Prophylactic effects of nutrition, dietary strategies, exercise, lifestyle and environment on nonalcoholic fatty liver disease

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease and its prevalence has risen sharply. However, whether nutrition, dietary strategies, exercise, lifestyle and environment have preventive value for NAFLD remains unclear.

METHODS

Through searching 4 databases (PubMed, Web of Science, Embase and the Cochrane Library) from inception to January 2025, we selected studies about nutrition, dietary strategies, exercise, lifestyle and environment in the prevention of NAFLD and conducted a narrative review on this topic.

RESULTS

Reasonable nutrient intake encompassing macronutrients and micronutrients have an independent protective relationship with NAFLD. Besides, proper dietary strategies including mediterranean diet, intermittent fasting diet, ketogenic diet, and dietary approaches to stop hypertension diet have their inhibitory effects on the developmental process of NAFLD. Moreover, right exercises including walking, jogging, bicycling, and swimming are recommended for the prevention of NAFLD because they could effectively reduce weight, which is an important risk factor for NAFLD, and improve liver function. In addition, embracing a healthy lifestyle including reducing sedentary behavior, not smoking, sleeping well and brushing teeth regularly is integral since it not only could reduce the risk of NAFLD but also significantly contribute to overall prevention and control. Finally, the environment, including the social and natural environments, plays a potential role in NAFLD prevention.

CONCLUSION

Nutrition, dietary strategies, exercise, lifestyle and environment play an important role in the prevention of NAFLD. Moreover, this review offers comprehensive prevention recommendations for people at high risk of NAFLD.

Disparities in liver transplantation for metabolic dysfunction-associated steatohepatitis-associated hepatocellular carcinoma

BACKGROUND

Metabolic dysfunction-associated steatohepatitis (MASH) is increasingly common, as is hepatocellular carcinoma (HCC) in the background of MASH. Liver transplantation (LT) provides superior long-term survival for patients with unresectable MASH-HCC, but not all patients have equal access to transplant. MASH-HCC disproportionately affects Hispanic patients, but minorities are less likely to undergo LT for HCC. Additionally, females also undergo LT at lower rates than males.

AIM

To investigate whether race/ethnicity and sex affect LT waitlist outcomes.

METHODS

Records of adults with MASH-HCC in the United States Organ Procurement and Transplantation Network database listed for LT between 1/2015 and 12/2021 were analyzed.

RESULTS

Most of the 3810 patients waitlisted for LT for MASH-HCC were non-Hispanic (NH) white (71.2%) or Hispanic (23.4%), with only 49 (1.1%) NH Black candidates. Hispanics underwent LT at lower rates than NH whites (71.6% vs 78.4%, P < 0.001), but race/ethnicity did not affect waitlist mortality (P = 0.06). Patients with Hispanic [hazard ratio (HR) = 0.85, 95%CI: 0.77-0.95, P = 0.002] or Asian (HR = 0.79, 95%CI: 0.63-0.98, P = 0.04) race/ethnicity were less likely to undergo LT. Women were also less likely to receive LT (male: HR = 1.16, 95%CI: 1.04-1.29, P = 0.01). Patients in regions 1 and 9 were less likely to be transplanted as well (P = 0.07).

CONCLUSION

Hispanic patients are less likely to undergo LT for MASH-HCC, concerning given their susceptibility to MASH and HCC. There were very few NH Black candidates. Disparities were also unequal across regions, which is particularly concerning in states where at-risk populations have rising cancer incidence. Additional research is needed to identify strategies for mitigating these differences in access to LT for MASH-HCC.

Mixture analysis of associations between environmental and workplace toxins and liver damage and telomere length, stratified by race/ethnicity

This study aimed to identify the worst "bad actors" in mixtures of pollutants contributing to liver damage and shorter telomeres in the U.S. population, using weighted quantile sum (WQS) modeling with stratification by race/ethnicity. We conducted a comprehensive cross-sectional analysis of mixtures of pollutants in National Health and Nutrition Examination Survey datasets: (1) 33,979 adults with blood levels of cadmium (Cd), lead (Pb), and mercury, including subsets with measurements of per-/polyfluoroalkyl substances (PFAS), and polychlorinated biphenyls (PCBs)/polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs); and (2) 7360 adults with measurements of telomeres, Cd, and Pb. Multivariable-adjusted WQS regression examined associations between WQS mixture indices and liver injury (alanine aminotransferase (ALT)-elevation), advanced liver-fibrosis (LF), and telomere length. WQSmetal indices were associated with advanced-LF in all racial/ethnic groups. The top contributor was Cd in the total population and in non-Hispanic Whites (NHW), while Pb was the top contributor in non-Hispanic Blacks (NHB). The WQSmetal-PCB-PCDD/F index was associated with ALT-elevation, with PCB126, Cd and Pb as main contributors; the odds ratio (OR) per decile was 1.50 (95 % CI, 1.26-1.78), while the OR per decile of the WQSmetal-PFAS index was 1.03 (95 % CI, 0.98-1.05), not significant. WQSmetal indices were associated with shorter telomeres. Cd was main contributor associated with advanced-LF in NHW, while Pb was the major bad actor in NHB, suggesting that NHB may be especially susceptible to Pb toxicity. Metals were associated with shorter telomeres. Metal and PCB/PCDD/F mixtures were associated with ALT-elevation. Heavy metals and organic chemicals may contribute to liver-related morbidity and healthcare disparities.

Exosomal miRNA combined with anti-inflammatory hyaluronic acid-based 3D bioprinted hepatic patch promotes metabolic reprogramming in NAFLD-mediated fibrosis

Non-alcoholic fatty liver disease (NAFLD) is a complex metabolic disorder, where the underlying molecular mechanisms are mostly not well-understood and therefore, warrants the need for therapeutic interventions targeting several metabolic pathways as a unified response. Of late, promising outcomes have been observed with mesenchymal stem cell-derived exosomes. However, reduced bioavailability due to systemic delivery and the need for repeated fresh isolation hinders their feasibility for clinical applications. In this regard, an 'off-the-shelf' 3D bioprinted hyaluronic acid-based hepatic patch to deliver encapsulated exosomes alone/or with hepatocytes (as dual-therapy) is developed as a holistic approach for ameliorating the disease condition and promoting tissue regeneration. The bioprinted hepatic patch demonstrated sustained and localized release of exosomes (∼82 % in 21 days), and healthy liver tissue-like mechanical properties while being biocompatible and biodegradable. Assessment in NAFLD rat models displayed alleviation of the altered biochemical parameters such as fat deposition, deranged liver functions, disrupted lipid, glucose, and insulin metabolism along with a reduction in localized inflammation, and associated liver fibrosis. The study suggests that a synergistic effect between the miRNA population of released exosomes, cell therapy, and the bioprinted matrix materials is crucial in targeting multiple complex metabolic pathways associated with the severity of the disease.

Deciphering the roles of neddylation modification in hepatocellular carcinoma: Molecular mechanisms and targeted therapeutics

Hepatocellular carcinoma (HCC) is the most prevalent type of malignant liver tumor with high morbidity and mortality and severely threatens human health and life quality. Thus, it is of great significance to investigate the molecular mechanism underlying the pathogenesis of HCC and seek biomarkers for early diagnosis. Neddylation, one of the most conserved post-translational modification types in eukaryotes, plays vital roles in the progression of HCC. During the process of neddylation, NEDD8 is covalently conjugated to its substrate proteins, thereby modulating multiple necessary biological processes. Currently, increasing evidence shows that the aberrant activation of neddylation is positively correlated with the occurrence and development of tumors and the poor clinical prognosis of HCC patients. Based on the current investigations, neddylation modification has been reported to target both the cullins and non-cullin substrates and subsequently affect HCC progression, including the virus infection, malignant transformation, tumor cell proliferation, migration and invasion ability, and tumor microenvironment. Therefore, inhibitors targeting the neddylation cascade have been developed and entered clinical trials, indicating satisfactory anti-HCC treatment effects. This review aims to summarize the latest progress in the molecular mechanism of pathologically aberrant neddylation in HCC, as well as the advances of neddylation-targeted inhibitors as potential drugs for HCC treatment.

Innovative nanomedicine approaches for the management of nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is the most prevalent liver disorder globally. The prevalence of NAFLD in the general population is estimated to be 25-30 %, making it the most common chronic liver condition in China as well as worldwide. Given the escalating disease burden and the scarcity of effective therapeutic interventions, there is a pressing unmet clinical need. Consequently, the development of novel pharmaceuticals has emerged as a pivotal research focus in recent years. Moreover, the advent of nano-delivery technology offers innovative solutions for NAFLD drug therapy. This paper presents a comprehensive examination of the pathogenesis and therapeutic targets of NAFLD. It critically reviews the latest advancements in nanomedicine research pertinent to NAFLD treatment. The review synthesizes a broad range of research findings to bridge the gap between current knowledge and emerging therapeutic strategies, and aims to inform and guide future research directions in NAFLD management.

Identification of the metabolomic alterations associated with the formation of bisphenol-A sulfate metabolite in HepG2 cells

The elucidation of the causal relationship between bisphenol-A (BPA) exposure and hepatoxic outcomes is challenging because of the complexity in both the BPA-derived metabolites formed in the liver and the associated endogenous molecular responses. We performed parallel metabolism experiments with BPA to characterize the BPA sulfate formation and the associated alterations in the metabolome level in HepG2 cells using mass spectrometry-based metabolome wide association study. Briefly, HepG2 cells were exposed for 8 or 24 h to 1 or 10 μM BPA in DMSO or DMSO alone. The levels of BPA sulfate in the cell culture media were quantified, and the sulfation efficiency was about 0.4 % observed for both 1 and 10 μM BPA in HepG2 cells. Targeted metabolomic analyses revealed alterations belonging to forty metabolic pathways following BPA exposure. Featured by the decreasing of estrone sulfate, estrogen metabolism was observed as the top 1 enriched pathway in response to BPA exposure. MWAS suggests that BPA sulfate formation in HepG2 cells resulted in vitamin B6 deficiency and dysregulated vitamin B6-dependent processes, for example, the kynurenine pathway in tryptophan metabolism. These findings collectively provide insights into the linkage between exogenous and endogenous metabolism and the potential initial events in BPA exposure-relevant hepatoxicity.

Association of sarcopenia assessed by CT/MRI with treatment response and clinical outcomes in noncirrhotic primary biliary cholangitis patients

BACKGROUND AND OBJECTIVE

Sarcopenia is a common complication in patients with cirrhosis. However, research on sarcopenia in patients with noncirrhotic primary biliary cholangitis (PBC) is limited. This study aimed to investigate the prevalence of sarcopenia and the associations between concomitant sarcopenia and the biochemical response to ursodeoxycholic acid (UDCA) treatment and clinical outcomes in patients with noncirrhotic PBC.

METHODS

This retrospective study enrolled consecutive patients whose baseline visits occurred between January 2009 and December 2023. Sarcopenia was assessed via pretreatment CT or MRI at the mid-L3 level through the skeletal muscle index (SMI). Baseline characteristics, response rate after UDCA administration, liver-related events were compared. And baseline liver and plasma C-reactive protein (CRP) and IL-6 levels in a subset of patients were also evaluated.

RESULTS

A total of 164 patients were included and sarcopenia was identified in 66 (40.2 %) patients. The median duration of follow-up was 4.75 (1.71, 6.40) years. The PBC patients with sarcopenia had a lower biochemical response rate (45.9 % vs. 65.9 %; P = 0.014) after 12 months of UDCA treatment and a higher incidence of liver-related events (24.2 % vs. 11.2 %, P = 0.027) during follow-up. Furthermore, higher levels of baseline CRP and IL-6 in the plasma and liver were also observed(P < 0.05).

CONCLUSIONS

Sarcopenia was highly prevalent in patients with noncirrhotic PBC. Concomitant sarcopenia may adversely affect the biochemical response to UDCA treatment and the occurrence of liver-related adverse events in PBC patients without cirrhosis.

Association of diet quality scores with risk of metabolic-associated fatty liver disease in Iranian population: a nested case-control study

Background and aim

A healthy diet has been recommended for non-alcoholic fatty liver disease (NAFLD). We aim to investigate the associations of diet quality indices with the risk of developingmetabolic-associated fatty liver disease (MAFLD).

Methods

We conducted this nested case-control study by recruiting 968 cases with MAFLD and 964 controls from the participants of the baseline phase of the Sabzevar Persian Cohort Study (SPCS). MAFLD was defined as having a fatty liver index ≥ 60 plus at least one of the following: overweight or obese, Type II diabetes mellitus, or evidence of metabolic dysregulation. Healthy Eating Index-2015 (HEI-2015) and Alternative Healthy Eating Index-2010 (AHEI-2010) were calculated from a validated food frequency questionnaire. We estimated the associations of HEI-2015 and AHEI-2010 with MAFLD risk using multivariable logistic regression.

Results

Among those in the highest relative to the lowest quintile of HEI-2015 and AHEI-2010, the multivariable-adjusted odds ratios (OR) were 0.45 (95% CI [confidence interval] 0.29-0.69; P trend = 0.002) and 0.55 (95% CI 0.35-0.85; P trend = 0.04), respectively.

Conclusion

The results of our study suggest that there is a significant associationbetween adherence to a healthy diet, indicated by a higher score of HEI or AHEI, and a reduced likelihood of developingMAFLD.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-024-01544-x.

Metabolic dysfunction-associated steatotic liver disease: A sexually dimorphic disease and breast and gynecological cancer

Metabolic dysfunction-associated steatotic liver disease (MASLD) has become a global public health and economic burden worldwide in the past few decades. Epidemiological studies have shown that MASLD is a multisystem disease that is associated not only with liver-related complications but also with an increased risk of developing extrahepatic cancers. MASLD is a sexually dimorphic disease with sex hormones playing an important role in the development and progression of MASLD, especially by the levels and ratios of circulating estrogens and androgens. MASLD is associated with hormone-sensitive cancers including breast and gynecological cancer. The risk of breast and gynecological cancer is elevated in individuals with MASLD driven by shared metabolic risk factors including obesity and insulin resistance. Multiple potential mechanisms underline these associations including metabolic dysfunction, gut dysbiosis, chronic inflammation and dysregulated release of hepatokines. However, the effect of hormone therapy including hormone replacement therapy and anti-estrogen treatment on MASLD and female-specific cancers remains debatable at this time. This synopsis will review the associations between MASLD and breast and gynecological cancer, their underlying mechanisms, implications of hormonal therapies, and their future directions.

The association between hepatic steatosis, vitamin D status, and insulin resistance in adolescents with obesity

Introduction

Epidemiological studies suggest an inverse relationship between circulating 25-hydroxy-vitamin D [25(OH)D] levels and insulin resistance (IR), yet interventional studies have yielded inconsistent findings. This study examined the relationship between changes in vitamin D status and markers of IR in adolescents, with a focus on the modifying effect of liver fat.

Methods

A post-hoc analysis was performed using data from 44 adolescents participating in a 6-month observational study evaluating biomarkers of hepatosteatosis. Participants were categorized into two groups based on vitamin D status at the end of the observation period: those whose vitamin D levels increased or remained sufficient (VDI, n = 22) and those whose levels decreased or remained insufficient/deficient (VDD, n = 22). Liver fat percentage was measured using magnetic resonance imaging (MRI) fat-fraction, and IR was assessed using the updated Homeostatic Model Assessment for Insulin Resistance (HOMA2-IR) and the triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDL).

Results

Across the cohort, liver fat was positively associated with HOMA2-IR (β = 0.08, p = 0.023). The association between changes in vitamin D status and HOMA2-IR trajectories was modified by liver fat but only in Hispanic adolescents (β = -0.18, p < 0.001). Among Hispanic adolescents in the VDD group, HOMA-IR worsened, particularly at higher levels of liver fat. In non-Hispanic adolescents, HOMA-IR increased in the VDD group (β = 0.65, p = 0.033) compared to the VDI group, independent of baseline liver fat. Across the cohort, changes in vitamin D status interacted with liver fat to influence TG/HDL trajectories (β = 0.20, p = 0.034).

Conclusions

The metabolic response to changes in vitamin D status in adolescents with IR may vary based on racial and ethnic differences and liver fat status. These findings underscore the importance of considering liver fat and racial/ethnic background in vitamin D and metabolic health studies. Future research with more extensive and diverse cohorts spanning the fatty liver disease spectrum is needed to clarify these relationships.

Predictive performance of noninvasive factors for liver fibrosis in severe obesity: a screening based on machine learning models

Objectives

Liver fibrosis resulting from nonalcoholic fatty liver disease (NAFLD) and metabolic disorders is highly prevalent in patients with severe obesity and poses a significant health challenge. However, there is a lack of data on the effectiveness of noninvasive factors in predicting liver fibrosis. Therefore, this study aimed to assess the relationship between these factors and liver fibrosis through a machine learning approach.

Methods

This study involved 512 patients who underwent bariatric surgery at an outpatient clinic in Mashhad, Iran, between December 2015 and September 2021. Patients were divided into fibrosis and non-fibrosis groups and demographic, clinical, and laboratory variables were applied to develop four machine learning models: Naive Bayes (NB), logistic regression (LR), Neural Network (NN) and Support Vector Machine (SVM).

Results

Among the 28 variables considered, six variables including (fasting blood sugar (FBS), skeletal muscle mass (SMM), hemoglobin, alanine transaminase (ALT), aspartate transaminase (AST) and triglycerides) showed high area under the curve (AUC) values for the diagnosis of liver fibrosis using 2D shear wave elastography (SWE) with LR (0.73, 95% CI: 0.65, 0.81) and SVM (0.72, 59% CI: 0.64, 0.80) models. Furthermore, the highest sensitivities were reported with SVM (0.83, 95% CI: 0.72, 0.91) and NB (0.66, 95% CI: 0.53, 0.77) models, respectively.

Conclusion

The predictive performance of six noninvasive factors of liver fibrosis was significantly superior to other factors, showing high application and accuracy in the diagnosis and prognosis of liver fibrosis.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-025-01564-1.

Association between phthalate exposure and metabolic dysfunction-associated steatotic liver disease (MASLD) - Systematic literature review

The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) is rising globally. Recent studies have suggested connections between exposure to endocrine disrupting chemicals (EDCs) and the development of MASLD. Phthalates, which are commonly utilized as plasticizers, in building materials and consumer items, exhibit endocrine disrupting effects and have been shown to interfere with lipid metabolism in mechanistic studies. The objective of this systematic review was to examine the association between MASLD and exposure to phthalates in the adult human populations. We searched PubMed, Scopus and Web of Science for studies published from the inception of each database until December 12, 2024. The literature search yielded 10 cross-sectional studies, which were analyzed in detail. The key findings of this study indicate a potential correlation between the prevalence of MASLD and exposure to certain phthalates. Among the phthalates examined, the metabolites of bis(2-ethylhexyl) phthalate (DEHP) - namely MECPP, MEHHP, and MEOHP, demonstrated the strongest and most frequent associations with MASLD. All the current studies followed cross-sectional study designs, which limits the possibility to establish a causal relationship between MASLD and phthalate exposure. Therefore, longitudinal studies are needed to corroborate these findings and shed light on the involvement of phthalate exposure in MASLD.

Association Between Perfluoroalkyl Substance (PFAS) Exposure and Nonalcoholic Fatty Liver Disease in Korean Adults: Results From the KoNEHS 2018-2020: A Cross-Sectional Study

OBJECTIVES

Nonalcoholic fatty liver disease (NAFLD) is a major public health problem and the most common chronic liver disease today. In Korea, the prevalence and incidence of NAFLD are currently very high, causing a serious social burden. Perfluoroalkyl substances (PFAS) have been consistently implicated as a potential cause of NAFLD, but research in Koreans is limited.

METHODS

Using data from the 4th Korean National Environmental Health Survey (KoNEHS, n = 2859), we investigated the association between PFAS blood levels and NAFLD. Multivariable logistic regression models were used to calculate odds ratios (ORs) for the effects of PFAS. A mediation analysis was also conducted to examine the mediating effect of obesity. Finally, weighted quantile sum (WQS) and G-computation methods were implemented to evaluate the joint effect of PFAS mixtures. Hepatic steatosis index was used as a diagnostic tool for NAFLD.

RESULTS

Through multivariable logistic regression, statistically significant associations with NAFLD were observed for perfluorooctanoic acid (PFOA) (OR 1.09-1.39), perfluorooctansulfonate (PFOS) (1.09-1.40), perfluorohexanesulfonic acid (PFHxS) (1.04-1.22), perfluorononanoic acid (PFNA) (1.12-1.42), and total PFAS (1.21-1.81). We also found that obesity was a significant mediator for PFOA, PFNA, and total PFAS. The ORs for NAFLD obtained by WQS and G-computation methods in the multivariable adjusted model were 1.10-1.46 and 1.08-1.32, respectively.

CONCLUSIONS

This study confirmed a significant association between some PFAS and increased odds of NAFLD. Excessive exposure to PFAS might explain the high prevalence and incidence of chronic liver disease in Koreans. Long-term cohort studies are needed to assess geographic and occupational exposures in the Korean population.

Novel insights into DBP-induced zebrafish liver inflammatory damage: Ferroptosis activating the HMGB1-TLR4-NF-κB signaling pathway

Typical plasticizer dibutyl phthalate (DBP) has been demonstrated to induce hepatotoxicity in zebrafish, but the underlying molecular mechanisms remain incompletely elucidated. Numerous studies have shown that ferroptosis is involved in the pathophysiological progression of hepatic disease. However, it remains unclear whether ferroptosis is involved in the DBP-induced hepatotoxicity in zebrafish. Initially, histopathological analyses have preliminarily confirmed that DBP can activate inflammatory responses in the zebrafish liver. Further investigation revealed that DBP induces ferroptosis in the zebrafish liver, characterized by iron overload, lipid peroxidation, and aberrant activation of ferroptosis pathways. Furthermore, DBP exposure induced ferroptosis, disrupting cell membranes and subsequent release of HMGB1, which are sensed by immunocytes TLR4/NF-κB signaling pathways, thereby activating the innate immune response in a context-dependent manner. Moreover, the ferroptosis inhibitor Fer-1 effectively rescues the activation of HMGB1-TLR4/NF-κB-mediated immune processes. Overall, this work enriches the molecular mechanism of DBP-induced zebrafish liver inflammatory damage and provides a reliable biomarker for future environmental risk assessment of DBP.

Synergistic benefit of thiazolidinedione and sodium-glucose cotransporter 2 inhibitor for metabolic dysfunction-associated steatotic liver disease in type 2 diabetes: a 24-week, open-label, randomized controlled trial

BACKGROUND

The close interplay between metabolic dysfunction-associated steatotic liver disease (MASLD) and type 2 diabetes supports the need to identify beneficial combination therapies of antidiabetic medications targeted for the treatment of MASLD. This study aimed to investigate the complementary effects of combination therapy with pioglitazone (PIO) and empagliflozin (EMPA) on MASLD in individuals with type 2 diabetes.

METHODS

In a randomized, open-label trial, 50 participants with type 2 diabetes and MASLD were assigned 1:1:1 to receive PIO 15 mg, EMPA 10 mg, or a combination (PIO 15 mg plus EMPA 10 mg) daily for 24 weeks. Liver fat fraction and stiffness were evaluated using magnetic resonance imaging-proton density fat fraction (MRI-PDFF) and magnetic resonance elastography (MRE), respectively.

RESULTS

Combination therapy resulted in the largest reduction in liver fat and stiffness among treatment groups. Participants experiencing a relative reduction ≥ 30% or an absolute reduction ≥ 5% in liver fat were the most prevalent in the combination group (100.0% vs. 57.1% in PIO and 87.5% in EMPA, p = 0.010). In addition, the combination group showed the highest proportion of individuals with a relative reduction ≥ 30% in liver fat and ≥ 20% in liver stiffness than the monotherapy groups (50.0% vs. 21.4% in PIO and 6.3% in EMPA, p = 0.029). Combination therapy did not induce the changes in subcutaneous fat deposition observed in the monotherapy groups, but it did show the most substantial reduction in visceral fat, concurrently showing the largest increase in adiponectin level across the three groups (p = 0.036).

CONCLUSIONS

Combination therapy of PIO with EMPA showed synergistic benefits for MASLD in individuals with type 2 diabetes, compensating for the inadequate or unfavorable effects of monotherapies; ClincialTrials.gov number, NCT03646292.

TRIAL REGISTRATION

The trial was registered at ClinicalTrials.gov (registration number: NCT03646292).

Trajectories of depressive symptoms and risk of chronic liver disease: evidence from CHARLS

BACKGROUND

It is unclear whether there is a association between the long-term depressive symptoms and chronic liver disease(CLD). The aim of present study was to investigate the relationship between the trajectories of depressive symptoms and CLD in middle-aged and older Chinese adults.

METHODS

The study included data from 7351 Chinese individuals, which from the China Health and Retirement Longitudinal Study (CHARLS). Latent Class Growth Model (LCGM) and Growth Mixture Model (GMM) identified five categories of depressive symptom trajectories from 2011 to 2015. Multiple logistic regression models were used to analyze the relationship between depressive symptom trajectories and CLD in 2015-2020.

RESULTS

We identified five distinct trajectories of depressive symptoms characterized by persistent low CES-D scores throughout follow-up (low-stable; 4621 cases [62.86%]); high starting CES-D scores but then declining (high-decreasing; 824 cases [11.21%]); persistent high CES-D scores during follow-up (high-stable; 508 cases [6.91%]); starting moderate CES-D scores but then increasing (moderate-increasing; 844 cases [11.48%]); and low starting CES-D scores that increased and then remitted through follow-up (remitting; 554 cases [7.54%]). A total of 420 (5.71%) participants developed chronic liver disease during follow-up. The ORs (95% CI) for the risk of developing chronic liver disease in participants on the moderate-increasing trajectory, high-decreasing trajectory, and high-stable trajectory were 1.44 (1.05-1.93), 1.59 (1.17-2.12), and 2.25 (1.62-3.08), respectively, compared with participants on the low-stable trajectory.

CONCLUSION

In Chinese middle-aged and older adults, individuals with moderate-increasing, high-decreasing, and high-stable trajectories of depressive symptoms over time had an increased risk of developing CLD.

Individual and joint associations of depression and physical multimorbidity with all-cause mortality: a prospective cohort study

The study aimed to investigate the separate, interactive, and combined effects of depression and physical multimorbidity on all-cause mortality using data from the National Health and Nutrition Examination Survey (NHANES) 2005-2016. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), and multimorbidity was defined as the presence of ≥ 2 chronic conditions. Cox proportional hazards models were used to assess these associations. During a median follow-up of 8.3 years (interquartile range, 5.4-11.4), 3,005 deaths occurred. After adjusting for potential confounders and multimorbidity, each one-point increase in depression score was associated with a 3% higher risk of mortality (hazard ratio [HR]: 1.03, 95% confidence interval [CI]: 1.02-1.04). Compared to those without depressive symptoms, mild and moderate to severe symptoms were linked to a 27% (HR: 1.27, 95% CI: 1.11-1.47) and 37% (HR: 1.37, 95% CI: 1.17-1.61) higher mortality risk, respectively. However, among women, only moderate to severe depression was significantly associated with increased mortality (HR: 1.50, 95% CI: 1.19-1.89). After adjusting for potential confounders and depression, multimorbidity was associated with a 64% higher mortality risk (HR: 1.64, 95% CI: 1.46-1.86). No significant interaction between depression and multimorbidity was found. Joint analysis showed that among participants without multimorbidity, moderate to severe depressive symptoms increased mortality risk (HR: 1.54, 95% CI: 1.09-2.17). In those with multimorbidity, risk increased with depression severity, peaking at HR: 2.22 (95% CI: 1.85-2.65). These findings highlight depression and multimorbidity as independent mortality risk factors, with their combined presence further amplifying this risk.

Construction and validation of a nomogram for detecting chronic kidney disease in patients with nonalcoholic fatty liver disease: Insights from the NHANES database

BACKGROUND AND OBJECTIVES

Fatty liver disease is often associated with renal impairment in many patients. Early detection and prompt intervention are crucial for improving patient quality of life and reducing mortality rates. This study aimed to develop and validate a nomogram for detecting the risk of Chronic Kidney Disease (CKD) comorbidity in adults with Nonalcoholic Fatty Liver Disease (NAFLD) in the United States.

METHODS

From the NHANES (2017‒2020) database, the authors enrolled 2848 NAFLD participants, of whom 633 also had CKD. The authors employed the Least Absolute Shrinkage and Selection Operator (LASSO) regression and multivariate logistic regression to identify variables with predictive value. The overlapping features were selected to construct a predictive model, which was presented as a nomogram. The effectiveness of the nomogram was evaluated using Receiver Operating Characteristic (ROC) curves, calibration plots, and decision curve analysis.

RESULTS

Six indicators were included in the model: age, systolic blood pressure, serum albumin, high-sensitivity C-reactive protein, total cholesterol, and triglycerides. The area under the curve of the nomogram for predicting CKD in the training set was 0.772, with a 95 % Confidence Interval (95 % CI) of 0.746 to 0.797. In the validation set, the area under the curve was 0.722, with a 95 % CI of 0.680 to 0.763. The calibration curve analyses demonstrated that the prediction outcomes of the model aligned well with the actual outcomes, indicating good clinical applicability.

CONCLUSIONS

The nomogram demonstrated excellent performance and has the potential to serve as an auxiliary tool for detecting CKD in NAFLD patients.

Camellia Japonica Radix modulates gut microbiota and 9(S)-HpODE-mediated ferroptosis to alleviate oxidative stress against MASLD

BACKGROUND

Camellia japonica radix (CJR), derived from the root of Camellia japonica L., has the potential to function as an herbal tea substitute for the prevention and intervention of metabolic dysfunction-associated steatotic liver disease (MASLD). It can provide systemic therapeutic benefits, boast a favorable safety profile, facilitate convenient consumption, and support long-term applicability. Despite its potential, research on CJR remains limited.

PURPOSE

The aim of this study aims is to elucidate the therapeutic mechanisms of CJR in MASLD, thereby providing evidence to support its clinical application.

METHODS

The therapeutic effects of CJR were evaluated using a water-supplementation model in MASLD mice. Integrated microbiome, transcriptome, proteome, and metabolome analyses were employed to comprehensively explore the mechanisms involved. A drug-target pull-down assay was performed to identify specific protein targets of small molecule metabolites in vitro. Fecal microbiota transplantation in antibiotic-treated ABX mice was conducted to confirm the critical role of gut microbiota and its metabolites. Furthermore, customized medicated feed supplemented with linoleic acid was used to explore the intervention effect of its metabolite, 9(S)-HpODE, as well as to evaluate its dietary intervention potential.

RESULTS

This present study explicitly elucidates the efficacy of CJR extract in alleviating hepatic inflammation and steatosis in a MASLD model mice, with its pharmacological mechanism associated with gut microbiota, linoleic acid metabolism, and GPX4-mediated ferroptosis. Notably, 9(S)-HpODE was discovered to be a key metabolite of linoleic acid, which could target both KEAP1 and SLC7A11, bidirectionally regulating GPX4-mediated ferroptosis, while acting as a signaling molecule at low doses to induce redox adaptation via oxidative preconditioning, thus ameliorating oxidative stress in MASLD.

CONCLUSION

Our findings indicate that both CJR and linoleic acid exhibit significant potential as dietary interventions for the management of MASLD, offering promising avenues for future research and clinical application.

Circulating glycerate predicts resilience to fructose-induced hepatic steatosis

Excessive intake of dietary fructose increases the risk of metabolic-dysfunction-associated steatotic liver disease (MASLD), cirrhosis, and cancers. However, what host factors determine disease vulnerability is incompletely understood. Here, we leverage genetically divergent mouse strains, mass spectrometry-based metabolomics, and in vivo isotope tracing, identifying circulating glycerate as a biomarker that predicts resilience to fructose-induced hepatic steatosis in both sexes. We found that the surge of circulating glycerate after an oral fructose provision reflects strong small-intestinal fructose catabolism. Such fructose clearance by the small intestine is linked to a weaker induction of hepatic de novo lipogenesis and steatosis upon chronic fructose exposure across strains. These data indicate the potential utility of an oral fructose tolerance test and circulating glycerate measurements to predict an individual's susceptibility to fructose-elicited steatotic liver and provide personalized dietary recommendations.

MASLD Risk Score (MRS) and Random Forest model (RF Model): Novel tools for screening and severity assessment of MASLD

BACKGROUND AND AIMS

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) spans from simple steatosis to progressive forms like non-alcoholic steatohepatitis (NASH), fibrosis, and cirrhosis, making early diagnosis and grading crucial. This study aimed to develop and validate predictive models for diagnosing and assessing MASLD severity using routinely available biomarkers from both public and clinical datasets.

APPROACH & RESULTS

We developed a novel MASLD Risk Score (MRS) using data from the CDC NHANES (2000-2020) and validated it in a clinically profiled Indian cohort. Unlike existing indices, the predictors were derived through data-driven feature selection from large dataset, ensuring statistical robustness. It integrates novel (Uric Acid, HOMA-IR) and established (liver enzymes, triglycerides, waist circumference, BMI) biomarkers to improve metabolic profiling and predictive accuracy. The MRS also uniquely enables grading of MASLD severity, addressing a key limitation of previous models. The MRS achieved AUROCs of 0.91 (public) and 0.85 (clinical) with accuracies of 94 % and 82 %, respectively. A Random Forest (RF) model built on the same features provided AUROCs of 0.87 (public) and 0.94 (clinical), with accuracies of 83 % and 82 %. MRS parameters were optimized using a diverse population, improving generalizability across demographics. Both models showed strong correlation with ultrasonography results and outperformed existing indices.

CONCLUSIONS

The MRS offers a novel, interpretable, and cost-effective solution for MASLD screening. Its development from a large, demographically diverse population and incorporation of varied biomarkers supports generalizability. While results are promising, external validation in multi-center clinical settings is needed to confirm broad utility.

The impact of COVID-19 pandemic on hospitalization rate, clinical impairment and mortality of cirrhotic patients

The COVID-19 pandemic caused widespread disruption to global healthcare systems, necessitating the reallocation of resources to address the immediate demands. This reorganization had significant repercussions on the management of chronic diseases, including cirrhosis. We sought to provide a comprehensive picture of the COVID-19 impact on monthly hospitalization rates of cirrhotic patients at Local Health Board 1 hospitals in the Abruzzo Region, Italy. Using the International Classification of Diseases, Ninth Revision, we identified cases of alcohol-related, nonalcohol-related, biliary, and decompensated cirrhosis. We analyzed 957 Hospital Discharge Records from January 1 to December 31, 2019 (pre-pandemic), and from January 1 to December 31, 2022 (post-pandemic). We evaluated patients' clinical impairment, length of stay, and mortality before and after the pandemic. We identified 494 hospitalizations for nonalcohol-related cirrhosis and 310 for alcohol-related cirrhosis. As key findings, hospitalizations for nonalcohol-related cirrhosis decreased (69% vs. 48%; p < .0001), while hospitalizations for alcohol-related cirrhosis increased (31% vs. 52%; p < .0001), in the post-pandemic period. Additionally, there was a significant rise in decompensated patients with alcohol-related cirrhosis post-COVID (77% vs. 65%; p = .0216). Mortality risk increased for both nonalcohol- (11% vs. 18.5%; p = .0176) and alcohol-related cirrhosis (7.7% vs. 18%; p = .0059) in the post-pandemic era. The increase in hospitalizations for alcohol-related cirrhosis is alarming and likely to have a prolonged impact on the natural history of liver diseases. There is an urgent need to reduce alcohol consumption at the population level. Continued awareness and personalized follow-up are essential for guaranteeing the standard of care during health emergencies.

Maternal Abnormal Liver Function in Early Pregnancy and Spontaneous Pregnancy Loss: A Retrospective Cohort Study

BACKGROUND

Spontaneous pregnancy loss (SPL) precedes an increased risk of reduced fertility, while its etiology mechanism remains largely unknown. Liver dysfunction presenting in early pregnancy may represent a pre-existing undiagnosed liver condition affecting fetal development. Here, we investigated whether maternal abnormal liver function in early pregnancy contributed to the incidence of SPL.

METHODS

Data on pregnant women were leveraged from the Maternal Health Care Information System in Shanghai City from 2017 to 2021. Liver dysfunction status was defined as having any elevated liver function biomarker levels (LFBs) at the first antenatal visit. SPL cases were defined as fetal death occurring before 28 weeks gestation. Generalized linear models were used to estimate crude and adjusted risk ratios (RRs and aRRs, respectively) and 95% confidence intervals (CIs).

RESULTS

Among 10,175 leveraged pregnant women, 918 (9.0%) SPL cases were recorded. Maternal liver dysfunction in early pregnancy was associated with a 49% increased risk of SPL (RR 1.49; 95% CI, 1.22-1.84). This positive association persisted after adjustment for covariates (aRR 1.55; 95% CI, 1.26-1.92). Higher γ-glutamyl transferase (GGT) and alkaline phosphatase (ALP) levels were also linked with increased risk of SPL in a linear fashion (aRRs per 1 standard deviation increase: 1.13; 95% CI, 1.08-1.17 and 1.13; 95% CI, 1.07-1.20, respectively). Similar magnitudes of associations were observed between normal weight and overweight pregnant women in subgroup analysis.

CONCLUSION

We provide new evidence that maternal abnormal liver function in early pregnancy, as well as GGT and ALP, predisposes to an increased risk of SPL.

High inherited risk predicts age-associated increases in fibrosis in patients with MASLD

BACKGROUND & AIMS

Limited data have prevented routine genetic testing from being integrated into clinical practice in metabolic dysfunction-associated steatotic liver disease (MASLD). We aimed to quantify the effect of genetic variants on changes in fibrosis severity per decade in MASLD.

METHODS

This cross-sectional study included prospectively recruited adults with MASLD aged 18-70 who underwent magnetic resonance elastography (MRE) and genotyping for PNPLA3, TM6SF2, MBOAT7, GCKR, and HSD17B13. A genetic risk score (GRS) was calculated as the sum of established risk alleles in PNPLA3 minus protective variants in HSD17B13 (0=low risk, 1=high risk). We also estimated the polygenic risk score-hepatic fat content (PRS-HFC) and the adjusted version (PRS-5). The primary endpoint was the age-related change in liver stiffness measurement (LSM) on MRE by GRS. Findings were validated using an external cohort from Latin America.

RESULTS

Among 570 participants, the median age was 57 [49-64] years, 56.8% were women, and 34.2% were Hispanic. Median MRE was 2.4 [2.1-3.0] kPa, and 51% had high GRS. High GRS was independently associated with increased LSM (β=0.28 kPa, 95%CI:0.12-0.44, p=0.001) per 10-year age increase, while the low GRS group showed no significant difference. Similar findings were observed using PRS-HFC and PRS-5. PNPLA3 genotype alone also predicted higher LSM (C/G: β=0.32 kPa, 95%CI:0.02-0.61, p=0.034; G/G: β=0.87 kPa, 95%CI:0.52-1.22, p<0.0001) and G/G genotype was associated with significantly higher LSM by age 44, which was consistent in the validation population.

CONCLUSION

GRS, PRS-HFC, PRS-5, and PNPLA3 genotypes alone are associated with greater fibrosis per decade, resulting in divergent disease trajectories starting in midlife. Assessing genetic risk in MASLD will identify high-risk patients who require more frequent monitoring.

IMPACT AND IMPLICATIONS

This study provides granular evidence that genetic predisposition, particularly the PNPLA3 G/G genotype, significantly influences the trajectory of liver fibrosis in patients with metabolic dysfunction-associated steatotic liver disease (MASLD), with a more pronounced impact emerging after the fourth decade of life. These findings highlight the importance of incorporating genetic risk assessment into MASLD management, as it allows for the early identification of high-risk individuals who may benefit from more frequent monitoring and targeted interventions. Given the rising global burden of MASLD, clinicians, researchers, and policymakers should consider integrating genetic stratification into existing risk assessment frameworks to refine screening and surveillance strategies. By optimizing patient selection for non-invasive fibrosis assessment and potential therapeutic interventions, this approach could enhance precision medicine efforts and may improve long-term outcomes.

Regulating Effect of Weekend Catch-up Sleep on Association of Hepatic Steatosis with Atherosclerotic Cardiovascular Disease

Background

Both insufficient and excessive catch-up sleep durations have been implicated in influencing the risk of cardiovascular diseases (CVDs) and metabolic disorders. However, the specific impact of weekend catch-up sleep (WCS) on the relationship between hepatic steatosis (HS) and atherosclerotic cardiovascular disease (ASCVD) remains unclear.

Aims

This cross-sectional study aims to examine the potential regulatory effect of WCS on the association between controlled attenuation parameter (CAP) and ASCVD.

Methods

Weighted logistic regression analyses were employed to evaluate the associations of CAP and WCS with ASCVD, expressed in terms of odds ratios (ORs) and 95% confidence intervals (CIs). The study also explored the effect of WCS on the CAP-ASCVD relationship and assessed the potential regulatory role of WCS in subgroups based on age, gender, body mass index, and obesity status.

Results

Eligible participants were categorized into two groups: those with an ASCVD risk < 7.5% (n = 1536) and those with an ASCVD risk ≥ 7.5% (n = 1612). After adjusting for covariates, CAP ≥ 274 dB/m was associated with a higher likelihood of ASCVD compared to the CAP < 274 dB/m (OR, 1.84, 95% CI, 1.24-2.73). When compared to a WCS duration of 0-1 hour, WCS ≥ 1 hour was found to increase the potential ASCVD risk associated with CAP (OR, 3.29, 95% CI, 1.41-7.68). Furthermore, among individuals with WCS ≥ 1 hour, CAP ≥ 274 dB/m was linked to a higher ASCVD risk than among those with CAP < 274 dB/m (OR, 3.72, 95% CI, 1.99-6.93). Additionally, in subgroups of participants aged ≥ 60 years, females, non-obese and obese individuals, WCS ≥ 1 hour was associated with an increased ASCVD risk related to CAP (all, p < 0.05).

Conclusion

A WCS duration of ≥ 1 hour may be associated with an increased ASCVD risk in adults with HS aged ≥ 40 years. However, further research is necessary to clarify the causal relationships between WCS, HS, and ASCVD.

Deacetylation of ANXA2 by SIRT2 desensitizes hepatocellular carcinoma cells to donafenib via promoting protective autophagy

Hepatocellular carcinoma (HCC) is one of the most lethal forms of cancer globally. HCC cells frequently undergo macroautophagy, also known as autophagy, which can lead to tumor progression and chemotherapy resistance. Annexin A2 (ANXA2) has been identified as a potential therapeutic target in HCC and is involved in the regulation of autophagic process. Here, we for the first time showed that ANXA2 deacetylation plays a crucial role in donafenib-induced autophagy. Mechanistically, donafenib increased SIRT2 activity via triggering both SIRT2 dephosphorylation and deacetylation by respectively downregulating cyclin E/CDK and p300. Moreover, elevation of SIRT2 activity by donafenib caused ANXA2 deacetylation at K81/K206 sites, leading to a reduction of the binding between ANXA2 and mTOR, which resulted in a decrease of mTOR phosphorylation and activity, and ultimately promoted protective autophagy and donafenib insensitivity in HCC cells. Additionally, ANXA2 deacetylation at K81/K206 sites was positively correlated with poor prognosis in HCC patients. Meanwhile, we found that selective inhibition of SIRT2 increased the sensitivity of donafenib in HCC cells by strengthening ANXA2 acetylation. In summary, this study reveals that donafenib induces protective autophagy and decreases its sensitivity in HCC cells through enhancing SIRT2-mediated ANXA2 deacetylation, which suggest that targeting ANXA2 acetylation/deacetylation may be a promising strategy for improving the sensitivity of donafenib in HCC treatment.

Inter-reader agreement of RECIST and mRECIST criteria for assessing response to transarterial chemoembolization in hepatocellular carcinoma

OBJECTIVES

To evaluate the reproducibilities of Response Evaluation Criteria in Solid Tumors (RECIST) and modified RECIST (mRECIST) for hepatocellular carcinoma (HCC) patients treated with transarterial chemoembolization (TACE) using contrast-enhanced computed tomography (CT).

METHODS

This retrospective study included 105 consecutive patients with confirmed HCC recruited from November 2002 to June 2012. The study protocol has been pre-registered at ( https://osf.io/nxg4q/ ) on the Open Science Framework (OSF) platform. Patients with pre-procedural and follow-up CT scans who had solely received TACE were included. The tumor response evaluation to TACE was conducted using RECIST 1.1 and mRECIST guidelines. Three experienced board-certified abdominal radiologists interpreted CT scans.

RESULTS

For pre-procedure CT, the agreement was more excellent when using RECIST guidelines with a "marginally significant" p-value of 0.056. This trend continued for post-procedural CT scans, with RECIST again showing significantly higher agreement with a p-value of 0.001. When evaluating the four categories of response, Gwet's coefficient was 0.90 (CI = 0.83 to 0.97) for RECIST and 0.80 (CI = 0.63 to 0.90) for mRECIST. Conversely, the Fleiss Kappa analysis demonstrated a higher agreement for the mRECIST guideline. There was an insignificant difference in RECIST and mRECIST guidelines inter-reader agreement when categorizing the tumor response with a p-value of 0.101.

CONCLUSION

Both guidelines' inter-reader reproducibility in assessing tumor response through CT after the TACE procedure was excellent, with RECIST's reproducibility being very slightly better.

Nonlinear association between body roundness index and metabolic dysfunction associated steatotic liver disease in nondiabetic Japanese adults

The global rise in obesity and diabetes has been paralleled by a rising incidence of metabolic dysfunction-associated steatotic liver disease (MASLD). Although previous studies have explored the association between body roundness index (BRI) and MASLD, the specific relationship in non-diabetic Japanese adults requires further investigation. This study analyzed data from 15,299 participants enrolled in the NAGALA cohort (2004-2015) to explore the association between BRI and MASLD through multivariable logistic regression, stratified analysis, and restricted cubic spline modeling. The prevalence of MASLD was 14.46%, with 13.73% occurring in non-obese individuals (BMI < 30). After adjusting for all confounding factors, BRI demonstrated a significant association with MASLD, yielding an adjusted odds ratio of 1.72 (95% CI 1.48-1.99). The restricted cubic spline model revealed a nonlinear relationship, with an inflection point at 3.06. Stratified analyses revealed stronger associations in individuals with lower BMI (≤ 24 kg/m2).

Prevalence of MAFLD in the U.S. based on NHANES 2009-2018: differences in demographic characteristics, physical indices and lifestyle conditions

BACKGROUND

The incidence of metabolic dysfunction-associated fatty liver disease (MAFLD) is high among U.S. adults, but studies on its occurrence in different ethnic and age groups are limited. The aim of the present study was to assess MAFLD occurrence among the U.S. adults by considering demographic characteristics, physical indices, and lifestyle conditions.

METHODS

This study utilized the National Health and Nutrition Examination Survey (NHANES) data 2009-2018 from 23,546 participants aged ≥ 20 years. Variables such as age, sex, race, body mass index (BMI), waist circumference (WC), blood pressure, sedentary behavior, sleep, and depression were analyzed.

RESULTS

Among 9933 participants, 3562 had MAFLD (34.1%), with notably higher percentages of Mexican-Americans (54.1%) and lower percentages of blacks (20.5%). The incidence of MAFLD was significantly greater (P < 0.001) in males (39%) than in females (29.2%), which was particularly evident within the 36-40 years age group. The MAFLD incidence exhibited an age-dependent pattern, initially increasing and subsequently declining (except for whites). Compared to white MAFLD patients, black MAFLD patients exhibited greater BMI, WC, systolic blood pressure (SBP), and diastolic blood pressure (DBP) values, whereas values for these measures were lower among Mexican-American patients. Logistic regression analysis adjusting for age and sex revealed that depression was more common among MAFLD patients (P < 0.001), except for severe depression (P > 0.05). Notably, the MAFLD incidence was not significantly associated with sedentary behavior or sleep duration.

CONCLUSIONS

The MAFLD incidence varies across different racial, age, and sex groups, and targeted interventions are essential for reducing the burden of MAFLD. However, further research is necessary to explore the correlations among MAFLD incidence, sleep patterns, and an inactive lifestyle.

Impact of High-Fat Diet-induced Metabolic Dysfunction-associated Steatotic Liver Disease on Heart, Kidney, and Skeletal Muscle Metabolomes in Wild-Type Mice

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) can be recapitulated in mice fed a high-fat diet. The development of MASLD and the diet per se can both perturb metabolism in key extrahepatic tissues such as the heart, kidney, and skeletal muscle. To date, these alterations have not been well described in this animal model of diet-induced MASLD. Methodology: Male C57BL/6J mice were fed either standard (SC, n = 12) or high-fat chow (HF, n = 11) for 18 weeks. Metabolites were extracted from the heart, kidney, and skeletal muscle and analyzed by 1H nuclear magnetic resonance (NMR) spectroscopy, along with multivariate and univariate statistical analyses. Results: Kidney metabolite profiles exhibited the largest differences between HF and SC diets, followed by those of skeletal muscle and then the heart. Some alterations were common across all tissues, namely decreased trimethylamine and elevated levels of linoleic acid and polyunsaturated fatty acids in HF compared to SC (p < 0.05 for all three metabolites). Overall, the metabolite variations were consistent with shifts in carbohydrate and lipid substrate selection for oxidation, increased tissue stress in the heart and kidneys, and altered choline metabolism. These findings may serve as additional important descriptors of MASLD onset and progression.

Mendelian randomization analysis of smoking, BMI, and nonalcoholic fatty liver disease in European descent populations

Nonalcoholic fatty liver disease (NAFLD) is a chronic liver condition with a steadily increasing prevalence. Evidence indicates that both smoking and obesity are significant risk factors for NAFLD, yet the extent to which smoking influences NAFLD through weight gain remains unclear. This study aimed to dissect the intricate relationship between smoking, body mass index (BMI), and NAFLD using Mendelian randomization (MR) analysis. We leveraged data from 30 genome-wide association studies involving over 1.2 million individuals, from which 123 single nucleotide polymorphisms were selected as instrumental variables for smoking. BMI data were sourced from the Genetic Investigation of Anthropometric Traits (GIANT) consortium, encompassing more than 700,000 individuals, with 521 single nucleotide polymorphisms serving as instrumental variables. NAFLD data were obtained from multiple databases, including the eMERGE Network, UK Biobank, Estonian Biobank, and FinnGen, comprising 8434 cases and 770,180 controls. All participants in this study were of European ancestry. We first applied univariate MR analysis to assess the causal relationship between smoking, NAFLD, and BMI. Subsequently, multivariate MR was used to assess the effect of smoking on NAFLD after adjusting for BMI. The coefficient product method was used to calculate the mediating effect of BMI. Results found that both smoking and high BMI were able to increase the risk of NAFLD, with odds ratios of 1.83 (95% confidence interval [CI]: 1.31-2.55) and 1.58 (95% CI: 1.42-1.77), respectively. BMI mediated 73.3% (95% CI: 62.3%-80.5%) of the effect of smoking on NAFLD. The findings support weight control and the encouragement of smoking cessation, especially in obese populations, as strategies to reduce the risk of NAFLD.

A nationwide study of primary biliary cholangitis prevalence, geographic distribution, and health care providers

BACKGROUND

Prevalence estimates of primary biliary cholangitis (PBC) in the United States have evolved with the introduction of newer real-world data capture approaches. Little is known about the geographic distribution of PBC in the United States and the health care provider (HCP) landscape for patients with PBC. This real-world study aimed to estimate the prevalence of PBC in the United States, assess regional variability in its prevalence, and describe HCPs for patients with PBC.

METHODS

Patients with PBC were identified using Komodo's Healthcare Map, a large national administrative claims database. PBC prevalence per 100,000 adults was adjusted by age and gender at the 3-digit ZIP Code tabulation area level. Patients' PBC-related medical or pharmacy claims were used to determine HCP specialties and affiliations (academic vs. nonacademic); the latest claim and all claims were examined.

RESULTS

The adjusted 2021 PBC prevalence was 40.9 per 100,000 adults. The highest absolute number of patients with PBC in the United States was in heavily populated urban areas, but prevalence adjusted for population size was highest in some rural areas. Among all claims, most (83.2%) patients received care from a specialist (gastroenterologist/hepatologist) at one time. However, only approximately half (53.5%) of patients with PBC, irrespective of therapy use, were most recently treated for PBC by a specialist.

CONCLUSIONS

This is the most comprehensive and contemporary estimation of PBC prevalence in the United States to date. The pockets of high prevalence of PBC located in some rural areas highlight the need to better evaluate PBC risk factors and potential barriers in access to specialist care once patients are diagnosed. Greater awareness of PBC and its management are needed.

Incidence and Mortality of Colorectal Cancer in Asia in 2022 and Projections for 2050

BACKGROUND

Colorectal cancer is an escalating public health concern in Asia, characterized by unique epidemiological patterns.

METHODS

We analyzed colorectal cancer data from 47 Asian countries using GLOBOCAN 2022. Spearman's correlation assessed the relationship between the Human Development Index and cancer rates. Projections for 2050 incidence and mortality were based on demographic forecasts.

RESULTS

In 2022, Asia accounted for 50.2% of global colorectal cancer cases, with 966.4 thousand new cases and 462.3 thousand deaths, including 10% in younger individuals. Age-standardized rates of incidence and mortality were 15.6/100 000 and 7.1/100 000, respectively. Incidence rates were rising faster in younger and male individuals. A significant correlation was found between the Human Development Index and cancer rates. Japan had the highest incidence rate (45.5/100 000 males; 28.5/100 000 females), and Brunei Darussalam had the highest mortality rate (21/100 000 males; 13.9/100 000 females). China recorded the highest incidence and mortality counts, with 307.7 thousand new cases and 142.6 thousand deaths in males, and 209.4 thousand new cases and 97.4 thousand deaths in females. By 2050, 1.87 million new cases and 1.01 million deaths are expected to occur in Asia, with the largest relative increases occurring in low HDI countries.

CONCLUSIONS

These findings highlight the need for targeted policies in low HDI countries, focusing on public awareness, early detection, prevention, and improving healthcare infrastructure. Interventions for younger individuals and males are also essential to address rising incidence rates.

Addressing the High and Rising Global Burden of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and Metabolic Dysfunction-Associated Steatohepatitis (MASH): From the Growing Prevalence to Payors' Perspective

BACKGROUND

The continuum of metabolic syndrome encompasses a spectrum of dysfunctions impacting obesity-linked insulin resistance, glucose homeostasis, lipid metabolism and pro-inflammatory immune responses. The global prevalence of metabolic diseases, including diabetes, chronic liver disease, cardiometabolic disease and kidney disease, has surged in recent decades, contributing significantly to population mortality. Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease, is a leading cause of liver disease worldwide. MASLD poses a significant global health challenge with its rising prevalence, placing a substantial burden on healthcare systems, impacts patient well-being and incurs significant economic costs. Addressing MASLD requires a comprehensive understanding of its interconnected factors, including its prevalence, healthcare burden and economic implications. Lack of awareness, imprecise non-invasive diagnostic methods and ineffective preventive interventions are core components of the MASLD-related problem.

AIM

The aim of this article was to summarise the global burden of MASLD from the payer's perspective.

METHODS

We carried out a review of the global comprehensive burden of MASLD. These topics led to discussions and insights by an expert panel during the 7th Metabolic Continuum Roundtable meeting, which took place in November 2023. This meeting focused on the burden, patient-reported outcomes and health economics, from payor and societal perspectives, and aimed to identify opportunities for improving patient care, optimise resource allocation and mitigate the overall impact on individuals and society related to MASLD. During the roundtable, an emphasis emerged on the need for greater awareness and strategic deployment of diagnostic, therapeutic and preventative measures to address MASLD effectively.

CONCLUSION

The global burden of MASLD is high and growing. Prioritising the prevention of metabolic dysregulation and timely therapeutic interventions can yield a holistic strategy to combat MASLD, its progression and potentially lower disease costs.

TRIAL REGISTRATION

NCT06309992.

Endurance Training Alleviates Metabolic-Associated Fatty-Liver Disease (MAFLD)-Related Testicular Impairments via Endoplasmic Reticulum Stress Regulation

BACKGROUND

Metabolic-associated fatty liver disease (MAFLD), the most prevalent liver disorder globally, affects 20%-40% of the population and presents significant health challenges. Studies link MAFLD to male reproductive dysfunction, highlighting the need for effective interventions. This study investigates the impact of MAFLD on testicular function and evaluates the protective role of endurance training, with a focus on the GRP78-IRE-1α-ATF6 signaling pathway.

METHODS

Forty-four rats were allocated into two dietary groups (n = 22 each): a standard diet control group (C) and a high-fat diet supplemented with fructose water group (FL). After 17 weeks, histological analysis confirmed MAFLD development in the FL group, while the control group showed no pathological changes. Each dietary group was further subdivided into sedentary and endurance-trained (T) subgroups (n = 10 per subgroup), resulting in four experimental groups: C, C + T, FL + T, and FL. At the end of the research, thyroid stimulating hormone (TSH), sex hormones (testosterone), tumor necrosis factor-alpha (TNF-a) as well as GRP78, IRE-1α, and AFT6 expression were assessed.

RESULTS

Our results indicated that MAFLD led to significant weight gain, disrupted serum levels of thyroid-stimulating hormone, and impaired sex hormone profile. Additionally, MAFLD triggered ER stress, evidenced by dysregulated expression of genes in the GRP78-IRE-1α-ATF6 pathway. Remarkably, endurance training mitigated these adverse effects by normalizing hormonal profiles and restoring the expression of ER stress-related genes. These findings highlight the critical role of ER stress in MAFLD-induced male reproductive dysfunction.

CONCLUSION

Overall, the present study suggests endurance training as a promising treatment strategy for addressing MAFLD and its associated reproductive complications.

Promising Long-Term Outcomes of Lung Transplantation With Hepatitis C Positive Donors: Insights From the UNOS Registry

BACKGROUND

The development of effective direct-acting antiviral treatment (DAAT) for hepatitis C virus (HCV) has opened the possibility of using HCV+ donors. We aimed to assess the long-term feasibility of lung transplantation using organs from HCV+ donors.

METHODS

We used the UNOS database to evaluate adult lung transplant recipients between 2000 and 2023. HCV+ organs were further divided into those positive for both antibody and nucleic acid testing (NAT) or antibody testing alone. Baseline recipient and donor characteristics were compared. The Kaplan-Meier method was used to assess 30-day, 1-year, and 5-year survival. We performed risk analyses using multivariate Cox regression analyses.

RESULTS

41,797 lung transplants were performed, among which 945 used HCV+ donors. Recipients of HCV+ lungs had higher FEV1 (P < .001), older (P < .001), and had higher BMI (P < .001). While 5-year survival did not differ between recipients of HCV+ and HCV- donor lungs (P = .093), graft survival was superior among recipients of HCV+ lungs (P = .038). Acute rejection rates were also lower for recipients of HCV+ lungs (P = .018). However, recipients of HCV+ lungs required significantly higher time on the ventilator post-transplant (P = .033). Donor HCV+ status, regardless of whether they were NAT- (HR 1.03, P = .766) or NAT+ (HR 0.89, P = .24), was not associated with adverse outcomes.

CONCLUSIONS

Lung transplantation with HCV+ donor lungs demonstrates promising outcomes up to 5 years post-transplant. With careful preoperative screening, DAAT treatments, and postoperative management, recipients of HCV+ lungs may expect minimal additional complications.

PNPLA3 gene variation modulates diet-induced improvement in liver lipid content in type 2 diabetes

BACKGROUND&AIMS

Lifestyle-induced weight reduction remains crucial for managing type 2 diabetes and steatotic liver disease, but its effectiveness varies. We postulated that the G allele in the rs738409 single nucleotide polymorphism within patatin-like phospholipase domain-containing protein 3 (PNPLA3), which associates with metabolic dysfunction-associated steatotic liver disease, also modulates diet-related metabolic effects.

METHODS

Participants with type 2 diabetes were randomized to 8-week hypocaloric diets (energy intake: -1,256 kJ/d of, <30 kcal% fat): high in cereal fiber and coffee excluding red meat (HF-RM + C; n = 16), or low in cereal fiber, devoid of coffee, but high in red meat (LF + RM-C; n = 15). Whole-body insulin sensitivity (M value) was assessed using [2H]glucose and hyperinsulinemic-normoglycemic clamps, hepatic lipid content (HCL) and body fat volumes by magnetic resonance spectroscopy/imaging before and after intervention.

RESULTS

Despite comparable weight loss, HCL decreased more in non-carriers (-65 %) than in G-allele carriers (-36 %) upon HF-RM + C diet (both p < 0.05 vs baseline and between groups), but only among non-carriers (-46 %, p < 0.05 vs baseline) upon LF + RM-C. Upon HF-RM + C diet, increase in insulin sensitivity was not different between carriers (+27 % p = 0.051 from baseline) and non-carriers (+21 %, p = 0.032 from baseline), p > 0.05 for between-group comparison. Upon LF + RM-C diet, both groups equally improved their whole-body insulin sensitivity (+42 % for non-carriers and +37 % for carriers, p < 0.05 vs baseline). Upon HF-RM + C diet, non-carriers decreased circulating interleukin-18 from baseline by -31 %, whereas, upon LF + RM-C diet, non-carriers decreased circulating anti-inflammatory interleukin-1 receptor antagonist levels by 14 % (both p < 0.05 vs baseline).

CONCLUSIONS

Humans with the PNPLA3 G-allele show modified dietary-induced effects on steatotic liver disease in type 2 diabetes despite body weight reduction. Registration at Clinicaltrials.gov, Identifier number: NCT01409330.

Metabolic dysfunction-associated steatotic liver disease is a risk factor for gallstones: A multicenter cohort study

AIM

Gallstone formation is associated with metabolic dysfunction. Recently, new definitions of steatotic liver disease (SLD) have been proposed, including metabolic dysfunction-associated SLD (MASLD) and moderate alcohol intake (MetALD). We investigated the effects of MASLD/MetALD on gallstone formation.

METHODS

This multicenter observational cohort study enrolled 8766 consecutive health-check examinees who underwent abdominal ultrasonography between 2008 and 2021 (total observation period 39,105.9 person-years). All patients were classified into non-SLD, MASLD, or MetALD groups. The effect of MASLD on gallstone development was evaluated using multivariate Cox regression analysis.

RESULTS

Age, male sex, and MASLD were identified as independent risk factors for gallstone development. MASLD was associated with a significantly higher risk of developing gallstones than non-SLD (hazard ratio [HR] 1.7112; 95% confidence interval [CI] 1.4294-2.0486; p < 0.0001) and MetALD (HR 1.3516, 95% CI 1.0130-1.8033, p = 0.0406). However, the risk of MetALD did not significantly differ between the SLD and non-SLD groups. Hypertension was the only significant independent cardiometabolic risk factor for gallstone development in the MASLD group (HR 1.4350, 95% CI 1.0545-1.9528; p = 0.0216). Random forest analysis and directed acyclic graphs identified hypertension as the most important direct factor affecting gallstone development in patients with MASLD.

CONCLUSIONS

MASLD was an independent risk factor for gallstone development, whereas MetALD presented a similar risk as non-SLD. Moderate alcohol consumption may reduce the risk of gallstone formation in patients with MASLD. Hypertension may be the most significant cardiometabolic risk factor for gallstone development in patients with MASLD.

Recent prevalence and trends of obesity and metabolic dysfunction-associated steatotic liver disease (MASLD) among US adolescents: 1999 to 2020

BACKGROUND

Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease (NAFLD), is understudied among US adolescents despite rising obesity rates.

METHODS

This study analysed the prevalence and trends of obesity and MASLD among US adolescents aged 12-17 using data from the National Health and Nutrition Examination Survey (NHANES). We developed a new screening model utilizing FibroScan-measured controlled attenuation parameter (CAP) scores, body measurements and blood chemistry data from 2017 to 2020 to assist in analysing MASLD trends from 1999 to 2020.

RESULTS

Between 2017 and 2020, the prevalence of obesity and MASLD was approximately 20%, with about 70% of obese adolescents affected by MASLD. The condition was more common in boys, particularly among Mexican American adolescents. Additionally, 97.2% of those with NAFLD also had MASLD. Adolescents with MASLD had significantly higher body weight, waist circumference, triglyceride levels and alanine transaminase (ALT) levels, along with lower high-density lipoprotein (HDL) cholesterol and an increased risk of liver fibrosis. Insufficient physical activity and poor diet quality were key risk factors for developing MASLD. From 1999 to 2020, the prevalence of MASLD rose significantly, paralleling the increasing rates of obesity.

CONCLUSIONS

The study underscores the pressing need to screen at-risk adolescents for metabolic issues associated with steatotic liver diseases, given the rising obesity rates among adolescents. The high overlap between MASLD and NAFLD diagnoses indicates that the transition from NAFLD to MASLD can be effectively integrated into paediatric practice.

Cardiovascular events and incident diabetes in 220 patients with MASLD according to basal liver fibrosis: a 10-year follow-up historic cohort

AIM

The aim of this study is to analyze association between liver fibrosis with CVE, incident diabetes, and cirrhosis complications.

METHODS

Historic cohort of biopsy-proven MASLD patients, divided into two groups: F0-F2 vs F3-F4 fibrosis. Baseline data included metabolic traits and liver function tests. Patients were contacted and scheduled for laboratory analysis and elastography. Endpoints were (a) CVE, defined as any of acute myocardial infarction, coronary stenting, ischemic cardiopathy, and stroke; (b) incident diabetes; (c) cirrhosis complications. Baseline data were collected at the time of liver biopsy, while follow-up data were recovered through personal interview or medical records. A stepwise logistic regression determined predictive variables for each endpoint.

RESULTS

Study population included 220 patients with median age 53 years, and 145 were women; baseline fibrosis was F0-F2 in 165 patients and F3-F4 in 55 patients; median follow-up was 9.9 years. A higher percentage of F3-F4 patients had CVE (29.4%) than F0-F2 ones (13.1%) (hazard ratio 2.42; 95% CI: 1.26-4.6; P  = 0.008). Incident diabetes occurred in 53.3% of F3-F4 and 20.2% of F0-F2 cohort (hazard ratio 3.04; 95% CI: 1.99-4.86; P  < 0.001); cirrhosis complications occurred in 9/55 F3-F4 patients and in 1/165 F0-F2 ones (hazard ratio 26.3; 95% CI: 3.3-208.3; P  = 0.002). Multivariate analysis confirmed liver fibrosis as an independent predictor of incident diabetes and cirrhosis complications. CVE were associated with baseline diabetes and aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio.

CONCLUSION

In a cohort of 220 MASLD patients followed for 9.9 years, baseline F3-F4 was associated with incident diabetes and cirrhosis complications. AST/ALT ratio and diabetes were associated with CVE.

Role of Liver Transplant in Primary and Secondary Liver Malignancies

Hepatocellular carcinoma (HCC) and cholangiocarcinoma are the primary hepatic malignancies with established pathways to transplantation and model for end-stage liver disease (MELD) exception points. Other tumors managed with liver transplantation (LT) include hepatic epithelioid hemangioendothelioma and fibrolamellar HCC. LT for metastatic neuroendocrine tumor has been established with patient selection criteria and a path to MELD exception points. Additionally, recent data on LT for patients with unresectable hepatic colorectal metastases demonstrate increasingly encouraging initial results.

Temporal trends and patterns for early- and late-onset adult liver cancer incidence vary by race/ethnicity, subsite, and histologic type in the United States from 2000 to 2019

PURPOSE

To examine incidence trends and patterns for early- and late-onset liver cancer.

METHODS

Liver and intrahepatic bile duct (IBD) cancers diagnosed between 2000 and 2019 were acquired from 22 SEER registries. Variables included early-onset (20-49) vs. late-onset (50+), anatomic subsite, histologic type (hepatocellular carcinoma [HCC] and IBD cholangiocarcinoma [ICC]), sex, and race/ethnicity. Age-standardized incidence rates were calculated using SEER*Stat. Jointpoint regression analysis was employed to estimate the annual percent change (APC) and the average APC (AAPC) with pairwise comparisons for trend by sex and by race/ethnicity stratified by age and subsite.

RESULTS

Liver cancer incidence decreased among early-onset (AAPC [95% CI] - 2.39 [- 2.74, - 2.07]) but increased among late-onset patients (2.85 [2.71, 3.01]), primarily driven by HCC (3.60 [3.50, 3.71]). IBD incidence increased for both ages with ICC incidence annually increasing 7.92% (6.84, 9.26) for early-onset and 6.32% (5.46, 8.86) for late-onset patients. Early-onset liver cancer displayed comparable trends across racial/ethnic groups; however, late-onset liver cancer showed more variation, particularly among American Indian/Alaska Native/Asian Pacific Islander (AI/AN/API) populations, which experienced a significant decrease in incidence, thereby narrowing the gap with other racial/ethnic groups. For IBD, an identical pattern of early-onset IBD among non-Hispanic Blacks (NHBs) compared to Hispanics was showed with coincidence test p = 0.1522, and a parallel pattern was observed among late-onset patients for both sexes (p = 0.5087).

CONCLUSION

Late-onset HCC continues to rise, except for NHB and AI/AN/API, where incidence rates have started to decrease over the past 4-5 years. Early and late-onset ICC incidence continues to increase across all racial/ethnic groups.

Serial changes in metabolic dysfunction-associated steatotic liver disease after sleeve gastrectomy and their associations with abdominal adiposity: a prospective cohort study

BACKGROUND

Little is known about the associations between changes in hepatic steatosis and changes in abdominal adiposity after metabolic bariatric surgery.

OBJECTIVES

To evaluate the serial changes in hepatic steatosis and abdominal adiposity following sleeve gastrectomy (SG).

SETTING

University hospital, Taiwan.

METHODS

In this prospective study, patients who underwent SG and intraoperative liver biopsy were enrolled. Magnetic resonance imaging (MRI) was performed to assess the liver fat fraction (LFF), visceral adipose tissue (VAT) area, and subcutaneous adipose tissue (SAT) area. Liver fibrosis was assessed preoperatively via biopsy and the fibrosis-4 index (FIB-4) and postoperatively with the FIB-4.

RESULTS

Seventy-six metabolic dysfunction-associated steatotic liver disease (MASLD) patients, including 67 pure MASLD patients and 9 MASLD patients with combined etiologies, were enrolled. LFF and visceral-to-subcutaneous fat ratio were associated with metabolic dysfunction-associated steatohepatitis, and VAT area was associated with significant fibrosis (≥F2). Twelve months after SG, all MRI measurements significantly improved. The median LFF of pure MASLD patients decreased from 17.4% at baseline to 4.2% and 3.7% at the 6th and 12th postoperative months, respectively. Complete resolution of steatosis was achieved in 97.5% of patients at the 12th postoperative months. Using %VAT and %SAT reductions at the sixth postoperative month as references, LFF decreased more rapidly, with fold ratios of 1.3 and 1.8, respectively.

CONCLUSIONS

SG resulted in a significant decrease in hepatic steatosis and abdominal adiposity in patients with severe obesity, but hepatic steatosis improved faster than abdominal adiposity. Hepatic steatosis resolved in almost all patients 12 months after SG.

Expanding the Liver Donor Pool: Promise and Peril

Liver transplantation remains a life-saving therapy for a growing list of indications. Although 10,660 adult liver transplants were performed in the United States in 2023, a 50% increase over the preceding decade, the demand continues to far exceed the supply. Efforts to expand the liver donor pool by using donors that were previously considered unsuitable have remained an important strategy to help overcome shortages. We discuss the progress that has been made over the past decade, as well as potential future barriers that will need to be overcome to help successfully expand the liver donor pool.

Serum 25(OH)D Levels and Risk of Nonalcoholic Fatty Liver Disease in Nonobese and Lean Individuals

PURPOSE

The impact of vitamin D deficiency on nonalcoholic fatty liver disease (NAFLD) risk in individuals without obesity or insulin resistance has not been thoroughly evaluated. We aimed to identify whether low serum levels of 25(OH)D independently contribute to NAFLD risk in nonobese or lean individuals.

MATERIALS AND METHODS

This study analyzed 241208 asymptomatic health check-up examinees who had abdominal ultrasonography. NAFLD risk was evaluated based on obesity status and serum 25(OH)D levels.

RESULTS

The overall NAFLD prevalence was 25.5%. Among the 178630 nonobese and 126909 lean participants, the prevalence rates were 13.4% and 6.7%, respectively. The multivariable adjusted odds ratios (ORs) [95% confidence intervals (CI)] for the prevalence of NAFLD, comparing serum 25(OH)D levels of 10-19 and ≥20 ng/mL with <10 ng/mL, were 0.96 (0.93-0.99) and 0.80 (0.77-0.83), respectively. Among nonobese participants, the corresponding adjusted ORs (95% CI) were 0.94 (0.90-0.99) and 0.77 (0.73-0.81), respectively. Similar results were observed among lean participants, with those having a 25(OH)D level of ≥20 ng/mL demonstrating a significantly lower odds of NAFLD (adjusted OR, 0.76; 95% CI, 0.70-0.83). Moreover, these results were consistent even among nonobese and lean individuals who showed no signs of insulin resistance.

CONCLUSION

Insufficient 25(OH)D levels independently increased the risk of NAFLD, suggesting its role in the NAFLD pathogenesis, regardless of obesity or insulin resistance status. Considering the established relationship between vitamin D deficiency and nonobese/lean NAFLD, maintaining adequate 25(OH)D levels may aid in preventing the development of NAFLD, even among nonobese or lean individuals.

Early living donor liver transplantation for alcohol-associated hepatitis: Status in the era of increasing demand, unmet needs, and future considerations

Hazardous alcohol consumption is the leading cause of liver disease worldwide. Alcohol-associated hepatitis (AH) is an acute and serious presentation of alcohol-associated liver disease that is associated with high short-term mortality. Medical management remains limited to corticosteroid therapy and intensive nutrition but improves survival in <50% of individuals. Liver transplantation (LT) is increasingly recognized as a treatment option for many patients with AH and may lead to greater survival benefits than medical management alone. The rate of waitlistings and LTs for AH has doubled in recent years, especially in the United States. Several studies from the West have reported early LT for AH to be successful, where deceased donor LT is the norm. The challenges of LT in living donor centers, particularly for those with AH, are unique and have previously not been discussed in depth. In this review, we aim to discuss the challenges unique to LDLT with respect to candidate and donor selection, ethical considerations, disparities in LDLT, post-LT alcohol relapse, and measures to prevent them while also addressing the definitions and outcomes of early-living donor liver LT for AH.