Factors Associated With Advanced Liver Fibrosis in a Population With Type 2 Diabetes: A Multicentric Study in Mexico City

BACKGROUND AND OBJECTIVES

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a major cause of chronic liver disease, primarily due to insulin resistance and type 2 diabetes (T2D). Despite the strong link between T2D and MASLD, identifying and treating liver fibrosis in T2D patients is still poor. This study aimed to identify the factors related to advanced liver fibrosis in T2D patients.

METHODS

This retrospective observational study used medical records from four centers in Mexico City from 2018 to 2023. The study included 2000 patients with T2D. Liver fibrosis was evaluated using the Fibrosis-4 (FIB-4) index, and insulin resistance was assessed using the estimated glucose disposal rate (eGDR).

RESULTS

The mean age of the patients was 58.9 years, with 63.7% being women. The median duration of T2D was 7 years, and the mean HbA1c was 7.63%. Overall, 20.4% had advanced liver fibrosis. The multivariate logistic regression analysis showed that diabetes duration >10 years {odds ratio (OR) = 2.105 (95% confidence interval [CI] 1.321-3.355)}, fasting glucose >126 mg/dL (OR = 1.568 [95% CI 1.085-2.265]), and microalbuminuria >300 mg/24 h (OR = 2.007 [95% CI 1.134-3.552]) were associated with advanced liver fibrosis. Conversely, the eGDR (OR = 0.805 [95% CI 0.703-0.888]), statins (OR = 0.111 [95% CI 0.073-0.168]), and pioglitazone (OR = 0.082 [95% CI 0.010-0.672]) were inversely associated.

CONCLUSION

Longer diabetes duration, insulin resistance, and microalbuminuria are independently linked to advanced liver fibrosis in T2D patients. Statins and pioglitazone may protect against liver fibrosis. Enhanced screening and management strategies targeting these factors could slow fibrosis progression and reduce the global burden of MASLD.

Diagnostic Accuracy of the LiverRisk Score to Detect Increased Liver Stiffness Among a United States General Population and Subgroups

Background

The LiverRisk score (LRS) has recently been proposed to predict liver fibrosis and future development of liver-related outcomes in the general population. Here, we performed an external validation of this score.

Methods

We used data from National Health and Nutrition Examination Survey 2017-2020, a United States population-based cohort to assess the diagnostic accuracy of the LRS to detect a liver stiffness measurement (LSM) ≥8 and ≥12 kPa. Performance was tested among the entire general population and clinically relevant subgroups.

Results

The cohort comprised 7,025 participants (aged 49 [33-63], 49% male), and 9.7% had an LSM ≥8 and 3.2% had an LSM ≥12 kPa. The area under the receiver characteristic operator curve (AUC) in the overall population was 0.73 (95% confidence interval [CI] :0.71-0.75) and 0.78 (95% CI: 0.74-0.81) to detect an LSM ≥8 and ≥ 12 kPa, respectively, significantly outperforming the fibrosis 4 index (FIB-4) but not the nonalcoholic fatty liver disease fibrosis score, steatosis-associated fibrosis estimator (SAFE), or metabolic dysfunction-associated fibrosis 5 (MAF-5). Performance was consistent among most subgroups, but AUC levels to detect an LSM ≥8 kPa decreased to <0.70 among participants aged 18-40 or 60-80 years, blacks, and individuals with diabetes or liver steatosis. The LRS categorized 80.5% as very low risk, 17.7% as low risk, and 1.8% as at risk, prevalence of an LSM ≥8 in these groups was 6.3%, 20.8%, and 50.5%, respectively. The sensitivity to detect an LSM ≥8 kPa was 47.3% in the overall population (but dropped to 21.3% for individuals aged 18-40 years) despite applying the lowest cut-off, which should yield the highest sensitivity.

Conclusion

The LRS score is a promising new tool to predict liver fibrosis; however, its diagnostic accuracy attenuates especially among patients aged 18-40 or 60-80 years. The overall sensitivity was only 47.3% at the lowest LRS cut-off. Further studies assessing cost-benefit ratios according to the LRS compared to FIB-4 and other risk scores such as MAF-5 and SAFE are required to determine its usefulness in referral strategies.

Modulation of Intestinal Flora: a Novel Immunotherapeutic Approach for Enhancing Thyroid Cancer Treatment

Over the past 3 years, there has been a growing interest in clinical research regarding the potential involvement of intestinal flora in thyroid cancer (TC). This review delves into the intricate connection between intestinal flora and TC, focusing on the particular intestinal flora that is directly linked to the disease and identifying which may be able to predict potential microbial markers of TC. In order to shed light on the inflammatory pathways connected to the onset of TC, we investigated the impact of intestinal flora on immune modulation and the connection between chronic inflammation when investigating the role of intestinal flora in the pathogenesis of TC. Furthermore, the potential role of intestinal flora metabolites in the regulation of thyroid function was clarified by exploring the effects of short-chain fatty acids and lipopolysaccharide on thyroid hormone synthesis and metabolism. Based on these findings, we further explore the effects of probiotics, prebiotics, postbiotics, vitamins, and trace elements.

Metabolic Dysfunction-Associated Steatotic Liver Disease in the MENA Region: Setting a Research and Action Priority Agenda

BACKGROUND & AIMS

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing health challenge, particularly in Middle East and North Africa (MENA) countries. This study aimed to establish a consensus-driven research and action agenda to address MASLD within the MENA region.

METHODS

Following a global MASLD research and action agenda setting study, over two Delphi rounds (Rs), MENA region experts (R1 n = 112, R2 n = 104) indicated their level of agreement with and provided feedback on MASLD research and action priorities via Qualtrics XM. In R2, panellists also ranked the priorities, which were categorised across six domains: (1) the human and economic burden, (2) defining and implementing care models, (3) disease management, (4) education and awareness, (5) patient and community perspectives, and (6) leadership and policies for the MASLD public health agenda.

RESULTS

The consensus-built MASLD research and action priority agenda for the MENA region comprises 52 priorities. Combined agreement (i.e., 'agree' + 'somewhat agree') increased from 97.6% and 98.1% in R1 to 98.2% and 98.5% in R2 with the research (n = 30) and action (n = 22) priorities, respectively. The highest ranked research priorities included developing regional MASLD databases and validating non-invasive diagnostic tools. The highest ranked action priorities included taking steps to enhance the adoption of lifestyle interventions among people living with MASLD and improving disease knowledge among healthcare providers.

CONCLUSIONS

This region-specific agenda can help to guide research and optimise clinical practice, thereby improving the understanding, prevention, and management of MASLD, enhancing health outcomes and reducing its burden within the MENA region.

Noninvasive Evaluation of Prolonged-Release Pirfenidone in Compensated Liver Cirrhosis. ODISEA Study, a Randomised Trial

BACKGROUND

Advanced liver fibrosis (ALF) predicts an adverse prognosis in chronic liver disease. In addition to etiological treatment, a new approach to stop or reverse residual fibrosis is desirable.

OBJECTIVE

To assess the efficacy and safety of prolonged-release pirfenidone (PR-PFD) versus placebo in compensated cirrhosis.

METHODS

180 patients with ALF (F4) were randomly assigned to: placebo, 1200 mg/d, and 1800 mg/d PR-PFD, plus standardised care, for 24mo. Frequency of lab tests: (3mo), liver stiffness measurement (LSM), FibroTest, ultrasound (US) (6mo), and endoscopy (annually).

RESULTS

Fibrosis evolution estimated from LSM was significantly lower only in the 1200 compared to placebo and 1800 groups (24.2 ± 2.4 vs. 15.4 ± 2.4; 27.6 ± 2.4 vs. 24.6 ± 2.4; 24.4 ± 2.3 vs. 23.3 ± 2.3 kPa, respectively, p < 0.001), in intergroup analysis, meeting the primary endpoint. Fibrotest was significantly lower only in the 1200 mg/d group, compared to baseline values (0.86 ± 0.02 vs. 0.83 ± 0.02 units, p < 0.001). Liver function test (LFT's) also improved as well as Model for End-Stage Liver Disease (MELD) score and quality of life (QoL). Decompensations occurred in 19 patients: 12 ascites (more frequent in placebo, p = 0.003), 5 variceal bleeding, 4 encephalopathies, 4 hepatocarcinomas. Adverse events were mainly mild gastrointestinal (n = 35, 48 and 46, p = 0.010) and cutaneous (n = 12, 15, and 22, p = 0.0001) in placebo, 1200 and 1800 mg/day, respectively.

CONCLUSION

PR-PFD at a dose of 1200 mg significantly decreased non-invasive liver fibrosis markers at 24 months and induced improvement in LFT's, MELD, and QoL in compensated cirrhosis, without safety concerns.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT01046474.

Perceptions, attitudes, and barriers to research engagement among general medicine undergraduates in a tertiary hospital in Guangdong, China

BACKGROUND

Research is a critical component of medical education, fostering critical thinking and evidence-based practice. However, in China, particularly in the context of general practice, undergraduate medical students often face significant barriers to engaging in research. This study aims to assess the perception, attitude, and practice toward research among undergraduate medical students in a tertiary hospital in Guangdong, China, and to identify the barriers they face.

METHODS

A cross-sectional study was conducted among 90 undergraduate medical students from a tertiary hospital in Guangdong, China, from May to June 2024. A self-administered questionnaire was used to collect data on students' perception, attitudes, practices, and perceived barriers toward research.

RESULTS

The majority of students (46.6%) expressed a strong desire to pursue postgraduate studies, while only 25.5% showed a strong interest in participating in research. Key barriers included lack of time (65.5%), insufficient research guidance (56.6%), and limited access to resources (47.8%). Students' self-assessment of their research abilities was generally low, with only 9.5% feeling confident in their ability to handle data. Positive correlations were found between access to research guidance and interest in scientific literature (r = 0.62, P < 0.001).

CONCLUSION

This study identifies key areas for improving research training among undergraduate medical students, particularly in general practice programs. It suggests that standardized curricula, enhanced mentorship, and hospital-university research platforms may help address existing gaps. Given the study's limited sample and setting, further research is needed to confirm these findings in broader contexts.

CLINICAL TRIAL NUMBER

Not applicable.

Bilirubin metabolism and its application in disease prevention: mechanisms and research advances

The role of bilirubin, a product of heme metabolism, has evolved from a traditionally perceived metabolic waste product to a critical molecule with diverse biological roles. This article comprehensively reviews the metabolic functions of bilirubin and advances in its application for disease prevention. Bilirubin is primarily derived from hemoglobin catabolism in senescent erythrocytes. It is subsequently metabolized and excreted by the liver through tightly regulated processes involving enzymes, nuclear receptors, hormones, and pharmaceuticals. Bilirubin exhibits diverse physiological functions, including antioxidant, anti-inflammatory, and immunomodulatory activities. Owing to its unique chemical structure, bilirubin scavenges free radicals, inhibits lipid peroxidation, and protects cells across multiple systems. By suppressing the NF-κB signaling pathway, it reduces inflammatory factor release and mitigates chronic inflammation. Additionally, it modulates immune cell activity to maintain homeostasis, offering therapeutic potential for autoimmune and infectious diseases. Bilirubin demonstrates significant potential in disease prevention. In cardiovascular diseases, it attenuates atherosclerosis and mitigates myocardial ischemia/reperfusion injury. For metabolic disorders, it improves insulin resistance, regulates blood glucose, and reduces hepatic steatosis, offering therapeutic benefits for diabetes and non-alcoholic fatty liver disease. In neurological conditions, its antioxidant and anti-inflammatory properties hold promise for preventing and managing neurodegenerative diseases and neonatal bilirubin encephalopathy. Although research on bilirubin has advanced significantly, its intracellular targets and molecular interaction networks remain incompletely understood, and numerous challenges hinder its clinical translation. Future efforts should leverage multi-omics technologies to elucidate its mechanisms, develop intelligent and personalized therapeutics, and conduct large-scale clinical trials to accelerate translational applications and improve patient outcomes.

Label-free multimodal optical biopsy reveals biomolecular and morphological features of diabetic kidney tissue in 2D and 3D

Kidney disease, the ninth leading cause of death in the United States, suffers from poor diagnostic efficiency (10%). Traditional biopsies use molecular reagents to enhance diagnostic power but are limited by overlapping spatial and chromatic signals, product quality variability, and additional processing. To address these challenges without disrupting routine diagnostics, we implement label-free imaging modalities-stimulated Raman scattering (SRS), second harmonic generation (SHG), and two-photon fluorescence (TPF)-within a single setup. We identify morphological, lipidomic, and metabolic biomarkers in control and diabetic kidney samples at subcellular resolution. Label-free Stimulated Raman Histology (SRH) reveals distinct collagen morphology, mesangial-glomerular volumes, lipid saturation, redox status, and lipid-protein concentrations previously unrecognized in kidney diseases. Using the same tissue section enhances diagnostic value without compromising limited tissue. These multimodal biomarkers broadly deepen the understanding of kidney disease progression by integrating lipidomic, fibrotic, and metabolic data.

Different Mechanisms in Doxorubicin-Induced Neurotoxicity: Impact of BRCA Mutations

The genotoxic drug doxorubicin (Dox) remains one of the most powerful chemotherapeutic options available for a wide range of cancers including breast, ovarian, and other cancers. However, emerging evidence links Dox treatment with chemotherapy-induced cognitive impairment, a condition that is popularly referred to as Dox-induced neurotoxicity or "chemobrain", which limits the use of the drug. There are no specific treatments for Dox-induced neurotoxicity, only interventions to mitigate the neurotoxic effects of the drug. Accumulating evidence indicates that DNA damage, oxidative stress, dysregulation of autophagy and neurogenesis, inflammation, and apoptosis play central roles in Dox-induced neurotoxicity. Additionally, germline mutations in the tumour suppressor genes breast cancer susceptibility genes 1 and 2 (BRCA1 and BRCA2) increase the risk of breast, ovarian, and related cancers. BRCA1 and BRCA2 are distinct proteins that play crucial, unique roles in homologous recombination-mediated double-stranded break repair. Furthermore, BRCA1 and 2 mitigate oxidative stress in both neural cells and brain microvascular endothelial cells, which suggests that they have a critical role as regulators of pathways central to the development of Dox-induced neurotoxicity. Despite research on the effects of Dox on cognitive function, there is a gap in knowledge about the role of BRCA1 and BRCA2 in Dox-induced neurotoxicity. In this review, we discuss existing findings about the role of different mechanisms and the role of BRCA1 and BRCA2 in Dox-induced neurotoxicity, along with future perspectives.

When Metabolic Dysfunction-Associated Steatotic Liver Disease Meets Viral Hepatitis

The interplay between Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and viral hepatitis, primarily hepatitis B virus (HBV) and hepatitis C virus (HCV), presents a complex challenge in managing chronic liver diseases. Recent epidemiological insights suggest an escalating prevalence of MASLD globally, attributed mainly to the obesity epidemic and associated metabolic disorders. Concurrently, chronic viral hepatitis remains a significant contributor to liver disease morbidity and mortality worldwide, despite advances in antiviral therapies. According to the World Health Organization (WHO) 2023 data, approximately 296 million people are living with chronic HBV infection (about 3.8% of the global population), and 58 million people with HCV infection (about 0.7%), together accounting for over 1.1 million deaths annually. The coexistence of MASLD and viral hepatitis presents a complex scenario in clinical outcomes, where the effects on liver health can vary. Although many studies highlight the potential for additive or synergistic worsening of liver conditions, leading to complications such as cirrhosis, liver failure, and HCC, the impact of HBV on MASLD is not consistent. Managing patients with dual MASLD and viral hepatitis is complex due to the interplay of metabolic and viral factors. Lifestyle modifications, including weight loss, dietary changes, and physical activity, are fundamental to MASLD management and help reduce fibrosis risk in viral hepatitis. This review examines the dual impact of MASLD and viral hepatitis on liver pathology and delineates shared pathophysiological mechanisms, including the influence on hepatic steatosis, inflammation, and fibrogenesis. It also discusses therapeutic strategies tailored to manage this comorbidity, emphasizing the need for an integrated care approach that addresses both metabolic dysfunctions and viral infection to optimize patient outcomes.

Association between serum bilirubin and type 2 diabetes mellitus risk: Findings from a schizophrenia cohort

BACKGROUND

The relationship between serum bilirubin levels and type 2 diabetes mellitus (T2DM) in individuals with schizophrenia (SCZ) remains poorly understood. This study investigated associations between total, conjugated, and unconjugated bilirubin (TB, CB, and UCB) and T2DM risk, while exploring the potential role of inflammatory pathways.

METHODS

The study included 862 SCZ patients from Baiyun Jingkang Hospital, Guangzhou, the People's Republic of China. Cox proportional hazards model assessed baseline bilirubin and T2DM risk, while causal mediation analysis explored inflammatory markers. Latent class trajectory model and logistic regression model evaluated the association between multi-timepoint trajectories of bilirubin and T2DM prevalence.

RESULTS

Over a median 3.19-year follow-up, 63 T2DM cases were diagnosed. Adjusted hazard ratios per 1 μmol/L increase were 0.88 (95 % CI: 0.82-0.95) for TB, 0.71 (0.57-0.89) for CB, and 0.86 (0.78-0.95) for UCB. Compared to the lowest tertile, the highest tertiles of TB, CB, and UCB were associated with 63 %, 74 %, and 63 % reduced T2DM risks, respectively. Lymphocyte count mediated TB (8.77 %), CB (11.68 %), and UCB (8.34 %); CRP mediated TB (3.33 %) and UCB (4.60 %) with T2DM. Persistently high TB and UCB levels were associated with lower T2DM prevalence (OR = 0.22 and 0.30, respectively).

CONCLUSION

Elevated bilirubin levels are associated with reduced T2DM risk in SCZ patients, with lymphocyte count and CRP partially mediating the bilirubin-T2DM relationship. And persistently high levels of TB and UCB linked to a lower prevalence of T2DM. These findings suggest that moderately elevated serum bilirubin may reduce T2DM risk among SCZ patients.

New steatotic liver disease criteria diagnostic performance in an agricultural population in Chile

INTRODUCTION AND OBJECTIVES

This study aims to assess the performance of Steatotic Liver Disease (SLD) criteria in identifying liver steatosis compared to the NAFLD and MAFLD definitions in an agricultural population in Chile.

PATIENTS AND METHODS

We performed a cross-sectional analysis on the MAUCO cohort, composed of 9,013 individuals aged 38 to 74. Health conditions, socio-demographics, anthropometrics, hepatic ultrasonography, blood pressure, and biological samples were obtained. Participants were classified as NAFLD, MAFLD, or any of the five SLD categories: Metabolic dysfunction-associated steatosis liver disease (MASLD), Metabolic and Alcohol-Associated Liver Disease (MetALD), Alcohol-Associated Liver Disease (ALD), Specific aetiologies, and Cryptogenic. The Framingham cardiovascular risk score and BARD liver fibrosis score were used to assess clinical relevance.

RESULTS

Liver steatosis was present in 4,082 participants (45%); SLD criteria captured an additional 176 individuals not classified under NAFLD and 103 not included under MAFLD definition. The main SLD subgroups were MASLD (95%), MetALD (1.9%) and ALD (1.3%). Individuals classified in the MetALD and ALD subgroups exhibited more severe liver steatosis and a higher cardiovascular risk. Notably, participants categorized under specific etiologies and cryptogenic subgroups were younger and had a higher risk for liver fibrosis.

CONCLUSIONS

The study reveals that SLD offers a more inclusive classification to identify high-risk individuals in the Chilean population, capturing cases that could be missed by NAFLD or MAFLD definitions by using the same resources.

Mechanistic insight into association of lysozyme, serum albumin, and insulin with aloin: Thermodynamic and conformational analysis

Lysozyme, serum albumin, and insulin carry out essential functions in the living systems. The properties and functions of these proteins may be positively impacted in association with Aloe vera, which is known to have usefulness as dietary supplement and clinical conditions. In this work, the conformational changes in these proteins have been analysed as a result of interaction with aloin, which has a long history of use in traditional health management. A combination of circular dichroism spectroscopy, fluorescence spectroscopy, and isothermal titration calorimetry have been used in analysing the associated thermodynamic signatures and structural changes. It is observed that lysozyme, and bovine serum albumin showed weak binding behaviour with aloin at molar ratio of (1:1), which is found to be entropically driven at first binding site while enthalpically driven at second binding site. Similarly for insulin also, the interaction of aloin increased with increase in its concentration and the binding of ligand at first and second site is entropically and enthalpically driven, respectively. These three proteins offer hydrophobic and hydrophilic functionalities for establishing intermolecular interactions with aloin. Differential scanning calorimetry and circular dichroism spectroscopy have provided mechanistic details on tertiary structural changes in these proteins as a result of interactions. The results offer valuable insights into molecular mechanism of conformational changes in these proteins and hence their properties in association with aloin, thereby, having biological implications related to health and food industry.

Overweight/obesity and gastrointestinal disease incidence in Denmark-a cohort study

OBJECTIVE

Obesity is associated with various gastrointestinal (GI) conditions. Because of the epidemic rise of obesity, we examined associations between overweight/obesity and incidence of individual GI diseases.

DESIGN

Cohort study.

SETTING

Denmark, 1997-2018.

PARTICIPANTS

Using nationwide healthcare registries, we identified All Danes ≥18 years with a hospital diagnosis of overweight/obesity. We created an age- and sex-matched general population comparison cohort.

EXPOSURE

A diagnosis code of overweight/obesity.

MAIN OUTCOMES AND MEASURES

We compared the incidence of hospital-diagnosed GI diseases from 1 year after overweight/obesity diagnosis.

RESULTS

We included 129 466 patients with overweight/obesity (70.9% female, median age 49.3 years). Their incidence rate of GI disease was 30.1 per 1000 person years (95% CI: 29.8-30.5) vs 16.7 (95% CI: 16.5-16.8) for comparators, yielding an adjusted hazard ratio (aHR) of 1.7 (95% CI: 1.7-1.7). The aHRs indicated elevated risk of all GI disease sub-types in the overweight/obesity cohort, including cholelithiasis: 2.8 (95% CI: 2.7-2.9), cholecystitis: 2.6 (95% CI: 2.4-2.8), acute pancreatitis: 2.2 (95% CI: 2.0-2.4), stomach ulcer: 2.0 (95% CI: 1.9-2.1), cirrhosis: 1.5 (95% CI: 1.3-1.7), and obesity-associated GI cancer: 1.2 (95% CI: 1.2-1.3). The aHR for any GI disease was 1.4 (95% CI: 1.4-1.5) in men and 1.9 (95% CI: 1.8-1.9) in women. Among patients 18 to <30 years, the aHR was 2.6 (95% CI: 2.5-2.7) vs 1.3 (95% CI: 1.3-1.4) among individuals ≥70 years.

CONCLUSIONS AND RELEVANCE

Overweight/obesity is a risk factor for a wide range of GI diseases and is expected to become an even greater clinical challenge in the future.

Chronic Hepatitis E Virus Infection Without Liver Injury in a Patient with Chronic Kidney Disease

Hepatitis E virus (HEV), the causative agent of hepatitis E, is the leading cause of acute viral hepatitis worldwide; under immunosuppression, infection can lead to chronic liver disease. Furthermore, extrahepatic manifestations, particularly renal manifestations, are frequently associated with infection. This is important considering the global burden of chronic kidney disease (CKD). However, the study of chronic hepatitis E has been limited to liver disease, and its definition with respect to renal disease is still incomplete. Recently, through a protocol aimed at identifying HEV seroprevalence in a cohort of patients on hemodialysis, we incidentally identified HEV RNA in a patient with a history of alcoholism, diabetes mellitus, and essential systemic hypertension. In this study, we aimed to follow up this case to characterize hepatitis E in the context of CKD. Notably, we identified the development of chronic HEV genotype 3 infection without seroconversion or evidence of liver damage. Moreover, apparent immunocompetence was identified in the patient. Considering that HEV is still neglected in numerous countries and that it is not included in the differential diagnosis of kidney disease, our findings support the need to consider HEV infection in patients with renal disease, even in the absence of liver deterioration.

Assessing Clinician Engagement with a Passive Clinical Decision Support System for Liver Fibrosis Risk Stratification in a Weight Management Clinic

OBJECTIVE

Metabolic dysfunction-associated steatotic liver disease (MASLD) is common in obesity. Guidelines recommend liver fibrosis risk stratification with tools such as Fibrosis-4 (FIB-4) index, liver stiffness measurement with vibration-controlled transient elastography (VCTE) and/or hepatology referral for elevated FIB-4. Despite recommendations, implementation remains limited. Using mixed methods, we evaluated a three-strategy implementation bundle to improve fibrosis risk stratification-a FIB-4-based electronic health record embedded clinical decision support system (CDSS), educational outreach, and internal facilitation in a weight management clinic.

METHODS

The primary outcome was penetration: the proportion of patients with elevated FIB-4 completing VCTE or hepatology referral. We compared rates, pre and post activation of implementation bundle using Fischer's exact test. Semi-structured provider interviews, guided by the i-PARIHS framework, assessed acceptability and feasibility three months post-implementation.

RESULTS

In the pre-activation phase, 880/3933 (22.4%) weight management visits had the necessary labs to calculate automated FIB-4 scores with 128 elevated scores. In the post-activation phase, 2513/4,634 weight management visits (54.2%) had automated FIB-4 scores; with 234 elevated score. Pre-activation, there were no VCTE and 2 hepatology referrals. Post-activation, there were 3 VCTE referrals and 2 hepatology referrals (Fischer's exact test p-value=1.00). Providers cited shared responsibility with primary care, low awareness and trust in risk-stratification tools, workflow challenges, and competing demands as barriers. Educational outreach and facilitation improved CDSS engagement, while technical issues reduced it.

CONCLUSION

This implementation strategy bundle did not achieve meaningful MASLD fibrosis risk stratification. EHR based CDSS shows promise but requires alignment with provider priorities, seamless workflow integration, and robust technical infrastructure.

Effect of treadmill walking on cardiometabolic risk factors and liver function markers in older adults with MASLD: a randomized controlled trial

BACKGROUND

Regular walking has been reported to improve metabolically-associated steatotic liver disease (MASLD) by altering the metabolic environment. However, no studies to date have focused on older individuals in both conditions. Therefore, this study aimed to investigate the effects of a 12-week walking intervention on metabolic syndrome risk factors, liver function indicators, and liver ultrasound findings in older adults with both metabolic syndrome and MASLD.

METHODS

A total of 66 participants aged 65-85 years had average ages, heights, and weights of 75.3 ± 5.8 years, 159.3 ± 9.3 cm, and 68.6 ± 6.8 kg, respectively. The participants resided in four senior living communities, and their diets were uniform. The participants from two facilities were assigned to the control group (CON, n = 33), whereas those from the other two facilities were allocated to the treadmill walking program group (WPG, n = 33). Each group comprised 13 males and 20 females. The intervention consisted of a low- to moderate-intensity walking program, conducted for 30 min per day, 6 days per week, totaling 180 min per week. The total daily calorie expenditure was recorded based on the values calculated from the treadmill. The walking intensity was adjusted by modifying the treadmill incline according to each participant's heart rate corresponding to their maximal oxygen consumption (VO₂max). The exercise intensity was set at 50% on Mondays and Fridays, 60% on Tuesdays and Thursdays, and 70% on Wednesdays and Saturdays. Sundays were designated as rest days.

RESULTS

Although there were no significant differences in caloric intake between the groups, the WPG exhibited a 52.5% increase in physical activity levels (p < 0.001), resulting in significant reductions in body weight (-10.2%), fat mass (-17.2%), and abdominal fat (-4.8%). The WPG showed a 16.1% increase in VO₂max, along with significant reductions in systolic blood pressure (-9.6%) and blood glucose (-16.9%), as well as notable improvements in lipid profiles (p < 0.001). The WPG also demonstrated significant reductions in aspartate aminotransferase (-40%), alanine aminotransferase (-23.5%), total protein (-14.4%), albumin (-8.1%), bilirubin (-17.6%), and liver ultrasound scores (-31.8%), with all changes showing significant intergroup differences (p < 0.001).

CONCLUSIONS

Along with a consistent diet, a 12-week walk has been shown to induce significant changes in the body composition and cardiometabolic factors of older adults, as well as notable improvements in liver function markers and imaging findings.

TRIAL REGISTRATION

This study was registered with the Clinical Research Information Service of the Korea Centers for Disease Control and Prevention under Clinical Trials KCT0010079 on 26/12/2024.

Assessment of Patients With Beta-Lactams Positive Provocation Tests by Biomarkers of IgG-Related Neutrophil Activation

BACKGROUND

Beta-lactams (BLs) are the predominant cause of immediate allergic reactions to drugs. Immediate hypersensitivity reactions (IHR) with positive provocation tests and negative skin and in vitro tests have undetermined mechanisms. We evaluated whether biomarkers of IgG-dependent neutrophil activation could help to assess this subgroup of BL IHRs.

METHODS

We evaluated biomarkers of neutrophil activation and neutrophil extracellular traps (NETs) in the serum of 26 BL IHR patients presenting with a positive provocation test, negative skin and serum specific IgE, and positive specific sIgG, and 8 perioperative BL IHR cases with positive skin tests and negative sIgE compared to 19 non-allergic matched controls.

RESULTS

We observed increased levels of DNase activity, neutrophil elastase (NE), myeloperoxidase (MPO)-DNA, IL8 and decreased IL4 and IL13 in patients, compared to matched controls, in the first 15 min of IHRs. DNAse activity, NE and MPO-DNA were maintained at high levels 2 h later (T0 + 2), while cell-free DNA and CXCR2 decreased significantly. IgG-related activation of neutrophils was suggested by significant correlations between NE, IL8 and CXCR2 axis and a single cluster associating BL sIgG antibodies and NE at T0 + 2, in principal factor analysis of all biomarkers.

CONCLUSION

Biomarkers of neutrophil activation and NETs were increased in BL IHRs with negative skin tests, positive sIgG and negative serum sIgE, and positive provocation test. We propose DNAse activity and NE as biomarkers for the biological assessment of BL IHRs and provocation tests and to consider IgG-related neutrophil activation as one of the mechanisms involved in BL IHRs with undetermined cause.

Immune Escape and Drug Resistance Mutations in Patients with Hepatitis B Virus Infection: Clinical and Epidemiological Implications

Hepatitis B virus (HBV) genetic variability, shaped by high mutation rates and selective pressures, complicates its management and increases the emergence of drug-resistant and immune-escape variants. This study aims to analyze immune escape mutations (IEMs) and drug resistance mutations (DRMs) in patients with HBV infection exposed to antiviral therapies and exhibiting detectable plasma HBV viremia. This monocentric retrospective real-life study was carried out at the ASST Spedali Civili di Brescia, Italy, from 2015 to 2023. A total of 102 consecutive patients with detectable serum HBV-DNA exposed to at least one NA and for whom a drug resistance assay was available were included in our study. HBV sequences were amplified, sequenced, and analyzed for mutations using Geno2pheno and Stanford University tools. Phylogenetic analysis and statistical regression were performed to confirm genotypes and identify mutation patterns and associated risk factors. Our study shows a 38.2% prevalence of DRMs, with M204I/V (95%) and L180M (64%) being the most common, and a 43% prevalence of IEMs, primarily in the major hydrophilic region. Genotype D3 exhibited a higher mutation burden than other genotypes. Significant associations were found between HBsAb presence and increased IEM burden, while HBeAg was protective against DRMs. Atypical serological profiles were observed in 18.6% of patients, including cases of HBV reactivation under immunosuppressive therapy. This study highlights the high prevalence of IEMs and DRMs in a real-world setting, particularly among HBV genotype D3 carriers. These findings underscore the importance of mutation surveillance to guide therapeutic strategies, vaccine design, and public health policies to address the challenges posed by HBV genetic variability.

Mezcal: A Review of Chemistry, Processing, and Potential Health Benefits

Mezcal is a Mexican alcoholic beverage elaborated by the distillation of fermented maguey (Agave genus) juice. In Mexico, there is an extensive variety of fermented beverages that embody many of the cultural traditions of this country. They are associated with environmental factors, naturally occurring microbiota, and the local availability of raw materials. Fermentation processes for the elaboration of ancestral beverages are an antique technology used by ethnic groups since pre-Hispanic times; however, these beverages are currently being studied with renewed attention as a source of prebiotics, probiotics, synbiotics, and postbiotics. An important sector of these products is Agave beverages, such as pulque, tequila, and mezcal. Despite the increasing demand for the last beverage, there are still relatively few studies about the chemistry, biotechnology, and health benefits of mezcal. The main aspects considered in this document are the definitions used in the mezcal industry, characteristics of wild and cultivated Agave species and varieties, mezcal elaboration technology (including juice extraction, fermentation, distillation, and aging), and potential health benefits related to mezcal, including prebiotics and probiotics, and bioactive compounds, such as phenolics and alcohol. These compounds can make mezcal a potentially functional beverage when consumed moderately.

Multidisciplinary clinical practice guideline on the management of metabolic hepatic steatosis

Metabolic hepatic steatosis (MetHS) is a clinically heterogeneous, multisystemic, dynamic, and complex disease, whose progression is one of the main causes of cirrhosis and hepatocarcinoma. This clinical practice guideline aims to respond to its main challenges, both in terms of disease burden and complexity. To this end, recommendations have been proposed to experts through the Delphi method. The consensus was optimal in recommendations regarding type 2 diabetes as a risk factor (1.5.1, 4.5.1), in which cases early detection of MetHS should be carried out (4.5.2). Its results also emphasize the importance of the use of non-invasive tests (FIB-4, NFS, HFS) for the exclusion of significant fibrosis in patients with suspected MetHS (2.3.1, 2.3.3). Diagnosis should be carried out through the sequential combination of non-invasive indices and transient elastography by FibroScan® for its risk stratification (2.3.3). A nearly unanimous consensus was reached regarding the role of early prevention in the impact on the quality of life and survival of patients (5.1.2), as well as on the effectiveness of the Mediterranean diet and physical exercise in relation to the improvement of steatosis, steatohepatitis and fibrosis in MetHS patients (5.2.2) and on the positive results offered by resmiterom and semaglutide in promoting fibrosis regression (5.4.1). Finally, a great consensus has been reached regarding the importance of multidisciplinary management in MetHS, for which it is essential to agree on multidisciplinary protocols for referral between levels in each health area (6.2.1), as well as ensuring that referrals to Hepatology/Digestive and Endocrinology or Internal Medicine services are effective and beneficial to prevent the risk of disease progression (6.2.3, 6.3.1).

The Intrinsically Disordered Region of HBx and Virus-Host Interactions: Uncovering New Therapeutic Approaches for HBV and Cancer

Human viral infections remain a significant global health challenge, contributing to a substantial number of cancer cases worldwide. Among them, infections with oncoviruses such as hepatitis B virus (HBV) and hepatitis C virus (HCV) are key drivers of hepatocellular carcinoma (HCC). Despite the availability of an effective HBV vaccine since the 1980s, millions remain chronically infected due to the persistence of covalently closed circular DNA (cccDNA) as a reservoir in hepatocytes. Current antiviral therapies, including nucleos(t)ide analogs and interferon, effectively suppress viral replication but fail to eliminate cccDNA, underscoring the urgent need for innovative therapeutic strategies. Direct-acting antiviral agents (DAAs), which have revolutionized HCV treatment with high cure rates, offer a promising model for HBV therapy. A particularly attractive target is the intrinsically disordered region (IDR) of the HBx protein, which regulates cccDNA transcription, viral replication, and oncogenesis by interacting with key host proteins. DAAs targeting these interactions could inhibit viral persistence, suppress oncogenic signaling, and overcome treatment resistance. This review highlights the potential of HBx-directed DAAs to complement existing therapies, offering renewed hope for a functional HBV cure and reduced cancer risk.

Ketogenic Diet in Steatotic Liver Disease: A Metabolic Approach to Hepatic Health

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a major cause of chronic liver dysfunction worldwide, characterized by hepatic steatosis that may progress to nonalcoholic steatohepatitis and cirrhosis. Owing to its strong association with metabolic disorders, current management focuses on weight reduction via lifestyle modifications. Recently, the very-low-calorie ketogenic diet (VLCKD) has emerged as a promising intervention due to its potential for rapid weight loss and reduction in liver fat. This review aims to evaluate the clinical evidence regarding the impact of ketogenic diets on hepatic steatosis. We conducted an extensive MEDLINE literature search in databases including PubMed, Scopus, and Web of Science up to December 2024. Studies assessing the effects of ketogenic or low-carbohydrate high-fat diets on liver fat, evaluated by imaging, histology, or biochemical markers, were included. The analysis indicates that ketogenic diets significantly reduce hepatic fat content and improve metabolic parameters, including insulin sensitivity and liver enzyme levels. Evidence further suggests that substituting saturated fats with unsaturated fats or replacing carbohydrates with proteins may enhance these benefits. However, considerable variability exists among studies and long-term data remain limited. Although short-term outcomes are encouraging, potential adverse effects such as dyslipidaemia, gastrointestinal disturbances, and transient 'keto flu' symptoms require careful clinical monitoring. Future research should focus on elucidating underlying mechanisms, optimizing dietary composition, and assessing long-term safety to establish ketogenic diets as a robust strategy for managing MASLD.

Estimates of the global prevalence of occult hepatitis B virus infection in population under 18 years old: a systematic review and meta-analysis

OBJECTIVE

Occult hepatitis B virus infection (OBI) is defined by the presence of hepatitis B virus (HBV) DNA, while HBsAg (Hepatitis B surface antigen) remains undetectable. The infectivity of OBI and its potential ability to contribute to cirrhosis and hepatocellular carcinoma has been reported, with infection in children potentially leading to more severe outcomes. However, the global prevalence and disease burden remain unclear, and this study aimed to assess the prevalence of OBI in population under 18 years old.

METHODS

We conducted a systematic literature search in PubMed, Embase, Scopus, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Chinese databases for articles evaluating OBI in population under 18 years old. The prevalence of OBI was pooled after quality assessment.

RESULTS

A total of 49 studies was included, allowing a meta-analysis of 1,070,526 HBsAg-negative individuals. Data from 28 and 25 studies were extracted for analysis of the high- and low-risk population, respectively. The overall prevalence of OBI in population ≤ 18 years old was 2.1% [95% confidence interval (CI): 0.9%-3.8%] and 9.7% (95% CI: 4.9%-15.8%) in the low- and high-risk population, respectively. In the subgroup analysis of the high-risk population, the OBI prevalence in the African, Eastern Mediterranean, and Western Pacific regions was 21.5% (95% CI: 0.0%-69.9%), 26.8% (95% CI: 13.0%-43.4%), and 4.3% (95% CI: 1.5%-8.2%), respectively. The OBI prevalence was 6.3% (95% CI: 2.7%-11.1%) in children born to mothers infected with HBV, 20.5% (95% CI: 0.0%-66.6%) in population infected with HIV or HCV, and 37.8% (95% CI: 30.8%-45.1%) in population who received blood transfusion. The OBI prevalence was 6.0% (95% CI: 2.4%-11.0%) in participants whose mothers were infected with HBV and vaccinated with hepatitis B vaccine (HepB) and HBIG, 7.1% (95% CI: 0.0%-22.9%) in participants only vaccinated with HepB.

CONCLUSION

The global prevalence of OBI among individuals under 18 years old, particularly in high-risk population, cannot be neglected. Given the stealthy transmission of OBI and its potential for serious clinical outcomes, OBI in population younger than 18 years old should be emphasized as a global health issue.

Representation of Sex, Race and Ethnicity in MASH Randomised Controlled Trials: A Systematic Review and Meta-Analysis

BACKGROUND AND AIMS

Randomised controlled trials (RCTs) have historically underrepresented female, racial and ethnic minorities across various fields. This systematic review and meta-analysis aims to examine the global distribution, reporting and participation of diverse groups based on sex, race and ethnicity in trials focused on metabolic dysfunction-associated steatohepatitis (MASH).

METHODS

PubMed and Cochrane Library databases were systematically searched for MASH RCTs (through December 13, 2024) that included any pharmacotherapy as an intervention arm. RCTs were qualitatively reviewed to assess their global distribution and reporting of populations. A meta-analysis of proportions was performed using a generalised linear mixed model.

RESULTS

One hudred and nine studies were identified, reporting data from 112 RCTs and 19 516 MASH participants. Of the 49 countries that conducted trials, 34 were high-income countries (69.4%). Sex, race and ethnicity were reported in 111 (99.1%), 69 (61.6%) and 56 (50.0%) of the 112 RCTs, respectively, with reporting improving in recent years. We found no reporting of sexual and gender minorities. The pooled proportions of female, White, Asian, Black and Hispanic/Latino groups were 54.23% (95% confidence interval [CI]: 51.31-57.12), 87.63% (95% CI: 85.37-89.58), 4.95% (95% CI: 3.42-7.10), 2.27% (95% CI: 1.89-2.71) and 31.42% (95% CI: 26.61-36.66), respectively. Meta-regressions showed a trend toward more female, White and Hispanic/Latino participants in RCTs over time.

CONCLUSIONS

Although female and Hispanic/Latino representation has increased over time, racial minorities are underrepresented in MASH trials. These data provide an overview of participant representation in MASH trials and call for collaborative efforts among researchers, sponsors, regulators and other relevant stakeholders to improve diversity in these trials.

Cardiometabolic risk factors and clinical course of liver cirrhosis

BACKGROUND

The global prevalence of Metabolic Dysfunction-Associated Liver Disease is dramatically increasing with the diffusion of cardiometabolic risk factors (CMRFs). The aim of the present study was to assess the natural course of liver cirrhosis, in terms of decompensation, development of hepatocellular carcinoma and mortality, in relation to the presence of CMRFs (type 2 diabetes mellitus, obesity, arterial hypertension, low HDL levels, hypertriglyceridemia).

PATIENTS

667 patients with liver cirrhosis (50 with CMRFs and without non-metabolic aetiological factors, 167 with non-metabolic aetiological factors and without CMRFs, and 450 with both non-metabolic aetiological factors and at least one CMRF) followed at the University and General Hospital of Padua, Italy, from 1998 to 2022, were included.

RESULTS

No difference in the occurrence of cirrhosis decompensating events and development of hepatocellular carcinoma was observed, whereas patients in the metabolic or mixed group had 4-3-fold higher all-cause mortality and significantly lower 3-years survival compared to patients in the non-metabolic group, despite a better liver function at enrolment. Hypertriglyceridemia and low HDL levels were the less prevalent CMRFs, but those associated with the highest risk of cirrhosis decompensation. Hypertriglyceridemia was also associated with an increased risk of mortality. Arterial hypertension was associated with a reduced risk of cirrhosis decompensation, but a higher risk of mortality.

CONCLUSION

Compared to patients without CMRFs, those with CMRFs had similar rates of liver cirrhosis decompensation but higher overall mortality. Hypertriglyceridemia was associated with a high risk of both liver decompensation and death.

Effect of Screen Time and Sugar Consumption Reduction on Sleep Bruxism in Children: A Randomised Clinical Trial

OBJECTIVE

Sleep bruxism (SB) is associated with alterations in dopamine and serotonin, which are related to increased consumption of added sugar and overuse of screens. The aim of this study was to compare the effect of the interventions 'Food, Fun and Family' (FFF) and Counselling and Education (CE) on the frequency of SB in children.

METHODS

A randomised clinical trial was conducted. Forty-eight participants aged between 4 and 8 years, attending the paediatric clinics of Universidad CES (Colombia) and Hospital Elina de la Serna (Argentina) participated in the study. Subjects were randomised into the FFF (experimental) and CE (regular intervention) groups. The frequency of SB was reported with the Children's Sleep Habits Questionnaire (CSHQ), the consumption of added sugar from items with the HBSC-FFQ and the time of use of screens through a diary in baseline (before starting the intervention), at Week 6 and Week 12. Data were analysed with Kruskal-Wallis test followed by Dunn's post hoc, Mann-Whitney test, a linear mixed model and logistic ordinal regression analyses.

RESULTS

The FFF group had a more significant reduction in consumption of added sugar and screen time compared to the CE group (p < 0.05), especially from Week 6 to baseline. Regression analysis showed that reducing TV watching and consumption of added sugar were associated with a decrease in SB frequency, especially in the FFF group (OR < 1, p < 0.05), and the results were consistent across different study environments.

CONCLUSION

The FFF intervention was more effective in reducing the screen time and sugar consumption and thus decreased the frequency of SB, when compared with the CE intervention.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT05310162.

Adverse impact of metabolic dysfunction on fibrosis regression following direct-acting antiviral therapy: A multicenter study for chronic hepatitis C

BACKGROUND/AIMS

Direct-acting antivirals (DAAs) effectively eradicate hepatitis C virus. This study investigated whether metabolic dysfunction influences the likelihood of fibrosis regression after DAA treatment in patients with chronic hepatitis C (CHC).

METHODS

This multicenter, retrospective study included 8,819 patients diagnosed with CHC who were treated with DAAs and achieved a sustained virological response (SVR) between January 2014 and December 2022. Fibrosis regression was defined as a 20% reduction in noninvasive surrogates for liver fibrosis, such as liver stiffness (LS) measured by vibration-controlled transient elastography (VCTE) and the fibrosis-4 (FIB-4) score. Hypercholesterolemia (h-TC) was defined as >200 mg/dL.

RESULTS

The median age of the study population was 59.6 years, with a predominance of male patients (n=4,713, 57.3%). Genotypes 1, 2, and others were confirmed in 3,872 (46.2%), 3,487 (41.6%), and 1,024 (12.2%) patients, respectively. Diabetes mellitus (DM) was present in 1,442 (17.2%) patients and the median LS was 7.50 kPa (interquartile range, 5.30-12.50). Multivariate analysis revealed that the presence of DM and pre-DAA h-TC were independently associated with a decreased probability of fibrosis regression by VCTE. Additionally, pre-DAA h-TC was independently associated with a decreased probability of fibrosis regression by the FIB-4.

CONCLUSION

Metabolic dysfunction has an unfavorable influence on fibrosis regression in patients with CHC who achieve SVR after DAA treatment.

Association of ADH1B and ALDH2 genotypes with the risk of lung adenocarcinoma

OBJECTIVE

The incidence of lung adenocarcinoma (LAD) is increasing worldwide. Single-nucleotide polymorphisms in aldehyde dehydrogenase 2 family member gene ( ALDH2 ) rs671 and alcohol dehydrogenase 1B ( ADH1B ) rs1229984 are common and functionally important genetic variants to metabolize endogenous and exogenous aldehyde chemicals, related to cancer.

METHODS

This is a case-control study. A total of 150 newly diagnosed LAD patients were from Kaohsiung Medical University Hospital, Taiwan, between 2019 and 2022. Two control groups, TWB-1 ( n  = 600) and TWB-2 ( n  = 29 683), were selected from Taiwan Biobank (TWB), and the case patients were frequency-matched with TWB-1 based on age category (30-60 or >60 years old), sex, and education levels. Logistic regression models were employed to analyze the association between two genetic variants and LAD risk.

RESULTS

A significant association was noted between ALDH2 and LAD risk. Those with ALDH2 rs671 *2/*2 in TWB-1 and TWB-2 controls had a 2.68-fold (95% CI = 1.43-4.99) and a 1.83-fold (95% CI = 1.07-3.11) increased risk of LAD, respectively, compared with those with ALDH2 rs671 *1/*1 or *1/*2 , after adjusting for covariates. This association was particularly pronounced in females. No overall significant association between ADH1B rs1229984 and LAD risk was observed.

CONCLUSION

The findings indicate a strong and robust risk association between ALDH2 rs671*2/*2 and LAD in the Taiwan population, particularly in Taiwanese female adults.

Metabolic dysfunction-associated steatotic liver disease (MASLD): Exploring systemic impacts and innovative therapies

Metabolic dysfunction-associated steatotic liver disease (MASLD), which includes the inflammatory subtype metabolic dysfunction-associated steatohepatitis, is a prominent cause of chronic liver disease with systemic effects. Insulin resistance, obesity, and dyslipidaemia produce MASLD in over 30 % of adults. It is a global health issue. From MASLD to MASH, hepatic inflammation and fibrosis grow, leading to cirrhosis, hepatocellular cancer, and extrahepatic complications such CVD, CKD, and sarcopenia. Effects of MASLD to MASH are mediated through mechanisms that include inflammation, oxidative stress, dysbiosis, and predisposition through genetic makeup. Advances in diagnostic nomenclature in the past few years have moved the emphasis away from NAFLD to MASLD, focusing on the metabolic etiology and away from the stigma of an alcoholic-related condition. Epidemiological data show a large geographical variability and increasing prevalence in younger populations, particularly in regions with high carbohydrate-rich diets and central adiposity. Lifestyle modification is considered as the main management of MASLD currently. This may include dietary intervention, exercise, and weight loss management. Pharmaceutical management is primarily aimed at metabolic dysfunction with promising findings for GLP-1 receptor agonists, pioglitazone and SGLT-2 inhibitors, which can correct both hepatic and systemic outcome. However, it still depends on well-integrated multidisciplinary care models by considering complex relationships between MASLD and its effects on extrahepatic organs. Determining complications at an early stage; developing precision medicine strategies; exploring new therapeutic targets will represent crucial factors in improving their outcomes. This review discuss the systemic nature of MASLD and calls for multiple collaborations to reduce its far-reaching health impacts and our quest for understanding its pathological mechanisms. Thus, collective efforts that are required to address MASLD are under the public health, clinical care, and research angles toward effectively containing its rapidly increasing burden.

[Cardiometabolic and genetic factors in the progression of metabolic dysfunction-associated steatotic liver disease]

AIM

To evaluate the contribution of cardiometabolicfactors and PNPLA3 I148M (rs738409 C>G) gene polymorphism to the development of compensated advanced chronic liver disease (cACLD) in patients with metabolic dysfunction-associated steatotic liver disease (MASLD).

MATERIALS AND METHODS

108 patients with MASLD were enrolled and formed the internal validation group; 30 patients with MASLD were selected for external validation. Anamnestic data, anthropometric and laboratory parameters and the presence of PNPLA3 gene polymorphism I148M (rs738409 C>G) were assessed. Steatosis was detected by assessing the controlled attenuation parameter. Liver elasticity was assessed by transient elastography. cACLD was detected when the liver stiffness was ≥8 kPa.

RESULTS

Statistically significant difference was observed in the internal validation group during comparison of the incidence of cACLD depending on the presence of arterial hypertension (odds ratio - OR 5.58; 95% confidence interval - CI 1.21-25.71), type 2 diabetes mellitus - T2DM (OR 4.58; 95% CI 1.59-13.21), obesity (OR 3.13; 95% CI 1.1-8.9), dyslipidemia (OR 6.12; 95% CI 1.33-28.19) and the mutant G allele of the PNPLA3 gene (OR 3.9; 95% CI 1.28-11.88). Patients with cACLD had significantly higher mean values of waist circumference (WC), alanine aminotransaminase, aspartate aminotransaminase, gamma-glutamyl transferase and triglycerides, non-invasive markers of steatosis and fibrosis. The compiled prognostic model demonstrated a direct relationship between the likelihood of developing cACLD and the presence of T2DM (adjusted odds ratio - AOR 3.28; 95% CI 0.62-17.33), dyslipidemia (AOR 5.89; 95% CI 1.21-28.67) and WC value (AOR 1.05; 95% CI 1.01-1.11). PNPLA3 I148M gene polymorphism did not significantly affect the development of late stages of the disease. External validation of the model showed its moderate diagnostic ability.

CONCLUSION

T2DM, dyslipidemia and WC values are the determining factors in the development of cACLD in patients with MASLD. The PNPLA3 I148M gene polymorphism has no leading importance for the development of the progressive course of MASLD in the studied cohort.

Implementation of a nurse-delivered, community-based liver screening and assessment program for people with metabolic dysfunction-associated steatotic liver disease (LOCATE-NAFLD trial)

BACKGROUND

With the high burden of Metabolic dysfunction-associated steatotic liver disease (MASLD), (previously known as Non-Alcoholic Fatty Liver Disease - NAFLD) in the community, current models of care that require specialist review for disease risk stratification overwhelm hospital clinic capacity and create inefficiencies in care. The LOCal Assessment and Triage Evaluation of Non-Alcoholic Fatty Liver Disease (LOCATE-NAFLD) randomised trial compared usual care to a community-based nurse delivered liver risk assessment. This study evaluates the implementation strategy of the LOCATE model.

METHODS

The evaluation used mixed methods (quantitative trial data and qualitative framework analysis of semi-structured interviews) to explore the general practitioner (GP) and patient perspectives of acceptability (Acceptability Framework), and factors associated with reach, effectiveness, adoption, implementation, and maintenance (RE-AIM framework) of the LOCATE model of care.

RESULTS

The LOCATE model was considered highly acceptable by both patients and GPs. The model of care achieved appropriate reach across the participating health services, reaching high-risk patients faster than usual care and with predominantly positive patient experiences. A notable reduction in anxiety and stress was experienced in the intervention group due to the shorter waiting times between referral and assessment. There was an overall perception of confidence in nursing staff capability to perform the community-based screening and GPs indicated confidence in managing low-risk MASLD without the need for specialist review. Challenges to implementation, adoption and maintenance included variable prioritisation of liver disease assessment in complex cases, the need for further GP training in MASLD assessment and treatment pathways, available funding and referral pathways for community screening, and accessibility of effective diet and exercise professional support.

CONCLUSION

Nurse delivered community-based liver screening is highly acceptable to GPs and patients and has shown to be an effective mechanism to identify high risk patients. Adoption and maintenance of the model of care faces significant challenges related to affordable access to screening, prioritisation of liver disease in complex patient cohorts, and unresolved difficulties in prescribing effective strategies for sustained lifestyle intervention in the primary care setting.

TRIAL REGISTRATION

The trial was registered on 30 January 2020 and can be found via Australian New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12620000158965.

Role of Mushroom Polysaccharides in Modulation of GI Homeostasis and Protection of GI Barrier

Edible and medicinal mushroom polysaccharides (EMMPs) have been widely studied for their various biological activities. It has been shown that EMMPs could modulate microbiota in the large intestine and improve intestinal health. However, the role of EMMPs in protecting the gastric barrier, regulating gastric microbiota, and improving gastric health cannot be ignored. Hence, this review will elucidate the effect of EMMPs on gastric and intestinal barriers, with emphasis on the interaction of EMMPs with microbiota in maintaining overall gastrointestinal health. Additionally, this review highlights the gastroprotective effects and underlying mechanisms of EMMPs against gastric mucosa injury, gastritis, gastric ulcer, and gastric cancer. Furthermore, the effects of EMMPs on intestinal diseases, including inflammatory bowel disease, colorectal cancer, and intestinal infection, are also summarized. This review will also discuss the future perspective and challenges in the use of EMMPs as a dietary supplement or a nutraceutical in preventing and treating gastrointestinal diseases.

Updated recommendations for the management of metabolic dysfunction-associated steatotic liver disease (MASLD) by the Latin American working group

Metabolic dysfunction-associated steatotic liver disease (MASLD) is one of the leading causes of chronic liver disease globally. Based on the 2023 definition, MASLD is characterized by the presence of metabolic dysfunction and limited alcohol consumption (<140 grams/week for women, <210 grams/week for men). Given the significant burden of MASLD in Latin America, this guidance was developed by the Latin American Association for the Study of the Liver (ALEH) Working Group to address key aspects of its clinical assessment and therapeutic strategies. In Latin America, ultrasonography is recommended as the initial screening tool for hepatic steatosis due to its accessibility, while Fibrosis-4 (FIB-4) is preferred for fibrosis risk stratification, with further evaluation using more specific techniques (i.e., vibration-controlled transient elastography or Enhanced Liver Fibrosis [ELF] test). A Mediterranean diet is advised for all MASLD patients, with a target of 7-10% weight loss for those with excess weight. Complete alcohol abstinence is recommended for patients with significant fibrosis, and smoking cessation is encouraged regardless of fibrosis stage. Pharmacological options should be tailored based on the presence of steatohepatitis, liver fibrosis, excess weight, and diabetes, including resmetirom, incretin-based therapies, pioglitazone, and sodium-glucose cotransporter-2 inhibitors. Bariatric surgery may be considered for MASLD patients with obesity unresponsive to lifestyle and medical interventions. Hepatocellular carcinoma screening is advised for all cirrhotic patients, with consideration given to those with advanced fibrosis based on individual risk. Finally, routine cardiovascular risk assessment and proper diabetes prevention and management remain crucial for all patients with MASLD.

Reliability of transversus abdominis thickness and inter-recti distance during forced expiration with limb adduction in primiparous women following vaginal delivery

INTRODUCTION

The postpartum period involves significant biomechanical changes that impact maternal health, particularly in the activation of the transversus abdominis (TrA) and the inter-recti distance (IRD), which may contribute to lumbo-pelvic pathologies. While lumbopelvic exercises are beneficial, it remains unclear whether upper or lower limb adduction combined with forced expiration is more effective in activating the TrA. Therefore, the primary objective of this study is to analyze changes in TrA thickness and IRD during four conditions. The secondary objective is to evaluate the intra-observer reliability of these ultrasound measurements.

METHODS

This cross-sectional study, conducted with a sample of 32 participants, assessed TrA thickness (primary outcome) and IRD (secondary outcome), quantified under four conditions: (1) resting position, (2) forced expiration, (3) forced expiration with upper limb adduction, and (4) forced expiration with lower limb adduction. Differences between the four conditions were analyzed using repeated measures ANOVA. The intra-observer reliability of these measurements was evaluated using intraclass correlation coefficients (ICC).

RESULTS

A total of 32 primiparous women between January and April 2024 were included in this study with a mean postpartum period of 9 ± 2.33. Significant variations in TrA thickness were observed across conditions (p < 0.001). Differences were noted between resting and forced expiration (MD = -0.17, p < 0.001) and forced expiration with lower limb adduction (MD = -0.20, p < 0.001) on both sides. For the right TrA, forced expiration differed from upper limb adduction (MD = -0.04, p = 0.007), while no difference was found between upper and lower limb adduction (MD = -0.005, p > 0.05). For IRD, no significant differences were detected across conditions, including resting and lower limb adduction (MD = -0.018, p = 0.727). Excellent intra-examiner reliability was demonstrated for all ultrasound measurements (ICC (1,3) 0.92-0.99).

CONCLUSIONS

There were no significant differences in TrA thickness between forced expiration isolated and when combined with adduction exercises. The high ICC values confirm the robustness of ultrasound measurements for TrA and IRD, highlighting the potential for future research in postpartum rehabilitation strategies.

TAS1R2/TAS1R3 Single-Nucleotide Polymorphisms Affect Sweet Taste Receptor Activation by Sweeteners: The SWEET Project

BACKGROUND/OBJECTIVES

Studies have hypothesised that single-nucleotide polymorphisms (SNPs) in the TAS1R2 and TAS1R3 genes may alter sweet compound detection and eating habits, thereby increasing the risk of obesity. This in vitro study aims to measure the impact of human TAS1R2/TAS1R3 polymorphisms, some of which are thought to be involved in obesity, on the response of the sweet taste receptor to various sweeteners. It also aims to identify new SNPs in an obese population associated with a decrease in or loss of TAS1R2/TAS1R3 function.

METHODS

First, the effects of 12 human TAS1R2-SNPs and 16 human TAS1R3-SNPs, previously identified in the literature, on the response of the sweet taste receptor stimulated by 12 sweeteners were investigated using functional cellular assays. Second, a total of 162 blood samples were collected from an obese population (BMI between 25 and 35 kg/m2) involved in the SWEET project. The TaqMan method for SNP genotyping was carried out using DNA extracted from blood samples to identify new SNPs and predict possible/probable TAS1R2/TAS1R3 loss of function.

RESULTS

Although certain human TAS1R2/TAS1R3 SNPs showed reduced receptor response, they were not associated with particular phenotypes. Seven SNPs were predicted to severely impair the human TAS1R2/TAS1R3 response to sweeteners.

CONCLUSIONS

Although some TAS1R2- and TAS1R3-SNPs have previously been associated with obesity, our cellular results do not confirm this association and reinforce the hypothesis, put forward by other researchers, that sweet taste perception and sugar consumption are governed by factors other than the TAS1R2 and TAS1R3 genes.

Metabolic dysfunction-associated steatotic liver disease in adults

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the umbrella term that comprises metabolic dysfunction-associated steatotic liver, or isolated hepatic steatosis, through to metabolic dysfunction-associated steatohepatitis, the progressive necroinflammatory disease form that can progress to fibrosis, cirrhosis and hepatocellular carcinoma. MASLD is estimated to affect more than one-third of adults worldwide. MASLD is closely associated with insulin resistance, obesity, gut microbial dysbiosis and genetic risk factors. The obesity epidemic and the growing prevalence of type 2 diabetes mellitus greatly contribute to the increasing burden of MASLD. The treatment and prevention of major metabolic comorbidities such as type 2 diabetes mellitus and obesity will probably slow the growth of MASLD. In 2023, the field decided on a new nomenclature and agreed on a set of research and action priorities, and in 2024, the US FDA approved the first drug, resmetirom, for the treatment of non-cirrhotic metabolic dysfunction-associated steatohepatitis with moderate to advanced fibrosis. Reliable, validated biomarkers that can replace histology for patient selection and primary end points in MASH trials will greatly accelerate the drug development process. Additionally, noninvasive tests that can reliably determine treatment response or predict response to therapy are warranted. Sustained efforts are required to combat the burden of MASLD by tackling metabolic risk factors, improving risk stratification and linkage to care, and increasing access to therapeutic agents and non-pharmaceutical interventions.

Exploring the genetic contribution in obesity: An overview of dopaminergic system genes

Obesity is a widespread global health concern that affects a significant portion of the population and is associated with reduced quality of life, morbidity, and mortality. It is considered a pandemic, with its prevalence constantly rising in Western countries. As a result, numerous studies have focused on understanding the elements that contribute to obesity. Researchers have focused on neurotransmitters in the brain to develop weight management drugs that regulate food intake. This review explores the literature on genetic influences on dopaminergic processes to determine whether genetic variation has an association with obesity in reward-responsive regions, including mesolimbic efferent and mesocortical areas. Various neurotransmitters play an essential role in regulating food intake, such as dopamine which controls through mesolimbic circuits in the brain that modulate food reward. Appetite stimulation, including primary reinforcers such as food, leads to an increase in dopamine release in the reward centers of the brain. This release is related to motivation and reinforcement, which determines the motivational weighting of the reinforcer. Changes in dopamine expression can lead to hedonic eating behaviors and contribute to the development of obesity. Genetic polymorphisms have been investigated due to their potential role in modulating the risk of obesity and eating behaviors. Therefore, it is crucial to assess the impact of genetic alterations that disrupt this pathway on the obesity phenotype.

ESRP2-microRNA-122 axis promotes the postnatal onset of liver polyploidization and maturation

Hepatocyte polyploidy and maturity are critical to acquiring specialized liver functions. Multiple intracellular and extracellular factors influence ploidy, but how they cooperate temporally to steer liver polyploidization and maturation or how post-transcriptional mechanisms integrate into these paradigms is unknown. Here, we identified an important regulatory hierarchy in which postnatal activation of epithelial splicing regulatory protein 2 (ESRP2) stimulates processing of liver-specific microRNA (miR-122) to facilitate polyploidization, maturation, and functional competence of hepatocytes. By determining transcriptome-wide protein-RNA interactions in vivo and integrating them with single-cell and bulk hepatocyte RNA-seq data sets, we delineated an ESRP2-driven RNA processing program that drives sequential replacement of fetal-to-adult transcript isoforms. Specifically, ESRP2 binds the primary miR-122 host gene transcript to promote its processing/biogenesis. Combining constitutive and inducible ESRP2 gain- and loss-of-function mouse models with miR-122 rescue experiments, we demonstrated that timed activation of ESRP2 augments the miR-122-driven program of cytokinesis failure, ensuring the proper onset and extent of hepatocyte polyploidization.

Individual and Combined Association Between Healthy Behaviors and All-Cause and Premature Mortality: A 22-Year Follow-up Cohort

OBJECTIVE

To analyze the impact of individual and combined healthy behaviors on all-cause and premature mortality risk in Mexican adults.

METHODS

Data on physical activity, fruit and vegetable intake, sleep hours, alcohol intake, and smoking from 95,142 adults from the MCPS (Mexico City Prospective Study) were used. All-cause mortality was monitored for up to 22 years, until December 31, 2020. Cox proportional hazards regression was used to assess mortality risk.

RESULTS

Physical activity (HR, 0.88; 95% CI, 0.84 to 0.92), fruit and vegetable intake (HR, 0.94; 95% CI, 0.91 to 0.98), no excessive alcohol consumption (HR, 0.86; 95% CI, 0.81 to 0.92), and not smoking (HR, 0.93; 95% CI, 0.89 to 0.97) were individually associated with lower mortality. All-cause mortality risk decreased progressively by 8% (95% CI: 0.86 to 0.99) to 29% (95% CI, 0.63 to 0.81) for each additional healthy behavior attained. Similarly, premature mortality risk decreased by 13% (95% CI, 0.80 to 0.95) to 30% (95% CI, 0.59 to 0.83).

CONCLUSION

Over 22 years, adopting a healthier life was linked with lower all-cause and premature mortality risk, decreasing with the clustering of one additional healthy behavior. Law and policy changes as well as efforts to address the root causes of not adopting healthy behaviors in low- and middle-income countries, such as creating structural conditions for people to engage in physical activity or strong social marketing to raise awareness of the daily consumption of fruits and vegetables, are needed for improving health and delaying mortality.

The Mexican drug war: Homicides and deaths of despair, 2000-2020

OBJECTIVES

In 2006, the Mexican government deployed their army on Drug Trafficking Organizations (DTOs). The attempt to remove cartel leaders spurred further conflict between DTOs and led to substantial increases in Mexico's homicide rate. The public display of homicide victims and the media coverage of violence may have elicited feelings of fear and depression, increasing the risk of deaths of despair. We examined whether, in Mexico, homicides correspond positively with region-specific rates of deaths of despair.

STUDY DESIGN

We applied a fixed effects Poisson count model controlling for population-at-risk, unemployment rates, marriage rates, year indicators, and general seasonality and trend in deaths of despair.

METHODS

We utilize data from the National Institute of Statistics, Geography and Informatics to obtain homicides (per 100,000 population) as our exposure and the count of deaths of despair (e.g., alcoholic liver disease, suicide, and drug-related deaths) as our outcome. Our sample size comprised 8064 state-months from 32 Mexican states between 2000 and 2020. We applied a fixed effects Poisson count model controlling for population-at-risk, unemployment rates, marriage rates, year indicators, and general seasonality and trend in deaths of despair.

RESULTS

Homicides (per 100,000 population) correspond with a 1.8 % increase in deaths of despair ([IRR] = 1.018; 95 % CI, 1.007-1.029). When examining type of death, alcoholic liver disease deaths drive this relation with a 1.6 % increase ([IRR] = 1.016; 95 % CI, 1.003-1.030) as a function of homicides (per 100,000 population).

CONCLUSIONS

Large and public acts of violence may induce adverse mental health, and in turn, greater deaths of despair (specifically alcoholic liver disease deaths) among Mexican populations not directly connected to homicide-related violence. Prevention efforts should target alcohol misuse and liver disease patients in Mexico.

Overcoming Barriers: The AO Foundation's Role in Latin American Scientific Growth

This manuscript presents an exploratory evaluation of the challenges and opportunities in scientific research among craniomaxillofacial surgeons in Latin America. It focuses on initiatives introduced by the AO Foundation's Research and Development (R&D) Committee to assess the current state of research involvement among AO Foundation members in the region and identify barriers to research. A survey conducted in 2023 among Latin American members of the AO Foundation gathered data on their interest in research, obstacles faced, and awareness of available opportunities, such as grants, fellowships, and mentorship programs. The outcomes revealed a strong interest in research, with 96.5% of respondents expressing a desire to engage. However, key barriers included limited time (46.5%), difficulties in project structuring and scientific writing (32.6%), and challenges in publishing (30.2%). Notably, 54.7% of respondents were unaware of the AO PEER program, and 65.6% were unfamiliar with the foundation's research grant opportunities. The AO Foundation aims to enhance scientific development in Latin America by promoting multicenter research studies, training opportunities, and developing research group leaders. These strategies seek to support and encourage surgeons in advancing their scientific activities.

Virological and Immunological Characteristics of HBeAg-Positive Chronic Hepatitis B Patients With Low HBsAg Levels

BACKGROUND

HBeAg-positive chronic hepatitis B (CHB) with low HBsAg levels represents a relatively rare serological pattern and is closely associated with the severity of liver disease. However, the underlying mechanisms in such cases remain largely unclear.

METHODS

Treatment-naïve HBeAg-positive CHB patients with low HBsAg levels in China were enrolled and analysed. In vitro cell experiments and immunoassays were conducted to investigate the effects of the preS2 deletion mutation on virus reproduction and host immune response.

RESULTS

Treatment-naïve HBeAg-positive CHB patients with low HBsAg levels (low HBsAg group) exhibited higher fibrosis scores and a greater prevalence of quasispecies mutations introduced by preS2 deletion compared to patients with positive HBeAg and high HBsAg levels (high HBsAg group). Further analysis revealed that fibrosis scores in CHB patients with the preS2 deletion mutations were significantly higher compared to both in wild-type patients and the high HBsAg group. In vitro assays indicated that while this mutation may not impact HBV replication, it significantly reduced viral infectivity. The number of viral-specific IFN-γ-secreting cells induced by the mutant was significantly lower than that induced by the wild-type strain. Additionally, the levels of HBs-specific B cells and cytokine secretion from lymphocytes triggered by the mutant strain were significantly reduced.

CONCLUSIONS

HBeAg-positive CHB patients with low HBsAg and genotype C exhibited higher noninvasive fibrosis indexes compared with typical patients, accompanied by a significant increase in quasispecies variants associated with preS2 deletion. The emergence of the preS2 deletion mutants in patients could be due to its enhanced ability to evade the host immunity.

Alcohol-Related Liver Disease, Followed by Metabolic Dysfunction-Associated Steatotic Liver Disease, Emerges as the Fastest-Growing Aetiologies for Primary Liver Cancer in the United States

OBJECTIVE

Primary liver cancer (PLC) is projected to be the third leading cause of cancer mortality in the United States in 2040. We examine the burden of PLC in the United States, stratified by sex, state and aetiological risk factors.

METHODS

Data on PLC prevalence, incidence, death and disability-adjusted life years (DALYs) were extracted from the Global Burden of Disease Study 2021. Changes in these parameters were calculated using the Joinpoint regression model.

RESULTS

There were 47,970 cases, 31,450 incident cases, 24,770 deaths and 576,920 DALYs from PLC in the United States. The highest prevalence (16,980), incidence (12,040), death (9840) and DALYs (213,410) from PLC were due to chronic hepatitis C virus infection. From 2000 to 2021, PLC incidences increased by 141%, and PLC deaths increased by 136%. Age-standardised incidence rates (ASIRs) and death rates (ASDRs) per 100,000 population for PLC increased, primarily driven by alcohol-related liver disease (ALD) (ASIR: annual percent change [APC]: +2.40%; ASDR: APC: +2.22%) and metabolic dysfunction-associated steatotic liver disease (MASLD) (ASIR: APC: +2.32%; ASDR: APC: +2.04%).

CONCLUSION

The burden of PLC in the United States has risen in the past two decades, driven mainly by ALD and followed by MASLD. These findings offer policymakers an accurate assessment of the PLC burden and emphasise the need for targeted risk factor mitigation, especially regarding alcohol related policy.

Impacts of CD36 Variants on Plasma Lipid Levels and the Risk of Early-Onset Coronary Artery Disease: A Systematic Review and Meta-Analysis

Background: Recent studies have indicated that cluster of differentiation 36 (CD36) is closely linked to dyslipidemia and early-onset coronary artery disease (EOCAD). This study is aimed at investigating the impacts of CD36 gene variants on lipid profiles and EOCAD risk. Methods: PubMed, Cochrane Library, Central, CINAHL, and ClinicalTrials.gov were searched until June 15, 2024. Results: In total, 25 studies (11,494 individuals) were included for the analysis. The A allele carriers of the rs1761667 variant had higher high-density lipoprotein cholesterol (HDL-C) levels and higher EOCAD risk than noncarriers. In contrast, the G allele carriers of the rs1049673 and rs3211956 variants had lower low-density lipoprotein cholesterol (LDL-C) levels and lower EOCAD risk than noncarriers. Subgroup analysis indicated that the antiatherosclerotic impact and reduced EOCAD risk were primarily observed in Chinese with rs1049673 and rs3211956. Conclusions: The rs1761667, rs1049673, and rs3211956 variants of the CD36 gene have significant impacts on lipid levels and may serve as genetic markers for the risk of EOCAD primarily in Chinese. The impacts of CD36 variants on EOCAD risk are mediated, at least partly, by dyslipidemia. Genetic screening of CD36 gene variants may be helpful for early intervention or prevention of EOCAD in individuals with high risk factors.

Status of scientific research integrity knowledge in dental undergraduates from 34 universities in China

BACKGROUND

This study investigated the status of research integrity knowledge among dental undergraduates from 34 Chinese universities in 5 key demographic regions.

METHODS

Questionnaires regarding the status of research integrity, including perception, attitude, and firsthand experience of scientific research integrity, were distributed to dental undergraduates of 34 Chinese universities. These universities were from 5 key demographic regions of China, i.e., eastern, western, northern, southern, and central. The questionnaires filled out by 1514 participants were further analyzed.

RESULTS

The results showed that among the participants, nearly 70% acquire scientific integrity knowledge through courses, as well as ideological and political education, while the remaining students acquire scientific integrity knowledge through other means, such as books and conferences. From the attitude perspective, most students (80-90%) oppose scientific misconduct. However, a few students also have an insufficient understanding of scientific misconduct and still need to improve their scientific research integrity training further. We also found that the research integrity training and the surrounding research environment affect students' attitudes and self-behavior regarding scientific integrity.

CONCLUSION

Our findings indicate that the ethical academic and research environment, implementation of scientific integrity courses in the curriculum, and proper supervision are vital in improving scientific research integrity knowledge in dental undergraduates in Chinese universities.

Psychosocial risks in metabolic dysfunction-associated steatotic liver disease

INTRODUCTION

Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly becoming more prevalent in the general population. MASLD is more common in persons with low socioeconomic status (SES), yet little is known about the psychosocial challenges associated with this disease, and clinical recommendations on how to approach psychosocial challenges are lacking.

AREAS COVERED

A PubMed search using the search terms MASLD, psychosocial risks, stigmatization, psychiatric comorbidities (i.e. depression, bipolar disorder, psychosis, attention deficit hyperactivity disorder, and substance abuse), SES, quality of life (QoL), over the past 20 years (2004-2024) was performed.

EXPERT OPINION

Persons with MASLD often experience psychosocial adversities that may be expressed as lower SES, high prevalence of depression, and reduced QoL. Knowledge gaps remain regarding the association between severe mental disorders (e.g. psychosis and bipolar disorders). Timely detection and treatment of MASLD in persons with psychosocial risks may require attention and cross-field collaboration. Studies on QoL in persons with MASLD differ in methodology which makes formal comparisons difficult. Psychosocial adversity may be a barrier to lifestyle modifications, which remain the cornerstone of MASLD management. Guidelines on how to address psychosocial adversities in a clinical setting are warranted to improve outcomes and decrease further multimorbidity.