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Hatami B, Asadi F, Bayani A, Zali MR, Kavousi K. Machine learning-based system for prediction of ascites grades in patients with liver cirrhosis using laboratory and clinical data: design and implementation study. Clin Chem Lab Med 2022; 60:1946-1954. [PMID: 35607284 DOI: 10.1515/cclm-2022-0454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/06/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of the study was to implement a non-invasive model to predict ascites grades among patients with cirrhosis. METHODS In the present study, we used modern machine learning (ML) methods to develop a scoring system solely based on routine laboratory and clinical data to help physicians accurately diagnose and predict different degrees of ascites. We used ANACONDA3-5.2.0 64 bit, free and open-source platform distribution of Python programming language with numerous modules, packages, and rich libraries that provide various methods for classification problems. Through the 10-fold cross-validation, we employed three common learning models on our dataset, k-nearest neighbors (KNN), support vector machine (SVM), and neural network classification algorithms. RESULTS According to the data received from the research institute, three types of data analysis have been performed. The algorithms used to predict ascites were KNN, cross-validation (CV), and multilayer perceptron neural networks (MLPNN), which achieved an average accuracy of 94, 91, and 90%, respectively. Also, in the average accuracy of the algorithms, KNN had the highest accuracy of 94%. CONCLUSIONS We applied well-known ML approaches to predict ascites. The findings showed a strong performance compared to the classical statistical approaches. This ML-based approach can help to avoid unnecessary risks and costs for patients with acute stages of the disease.
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Affiliation(s)
- Behzad Hatami
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farkhondeh Asadi
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azadeh Bayani
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Zali
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kaveh Kavousi
- Laboratory of Complex Biological Systems and Bioinformatics (CBB), Institute of Biochemistry and Biophysics (IBB), University of Tehran, Tehran, Iran
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Gholoobi A, Gifani M, Gholoobi A, Akhlaghi S, Pezeshki Rad M, Baradaran Rahimi V. Relationship between the prevalence and severity of non‐alcoholic fatty liver disease and coronary artery disease: Findings from a cross‐sectional study of a referral center in northeast Iran. JGH Open 2022; 6:330-337. [PMID: 35601123 PMCID: PMC9120894 DOI: 10.1002/jgh3.12746] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/13/2022] [Indexed: 11/26/2022]
Abstract
Background and Aim Non‐alcoholic fatty liver disease (NAFLD) is becoming increasingly prevalent worldwide, and cardiovascular diseases are the most common cause of death in NAFLD patients. The present study aimed to evaluate the possible relationship between the presence and severity of NAFLD and coronary artery disease (CAD). Methods A cross‐sectional study was conducted on 296 patients (122 men and 174 women, with mean age 54.10 ± 9.33 years) referred to the catheterization laboratory of Imam Reza Hospital affiliated to the Mashhad University of Medical Sciences, Mashhad, Iran, for elective coronary angiography to investigate the presence and severity of CAD. Additionally, all patients underwent abdominal ultrasonography (USG) to detect NAFLD and its severity. Results Among the 296 patients, 187 (63.2%) had CAD and 160 (50.1%) had NAFLD. NAFLD patients had significantly higher prevalence of obesity (odds ratio [OR] = 1.047, 95% confidence interval [CI] = 1.002–1.094), hypertension (OR = 1.909, 95% CI = 1.027–3.55), hyperlipidemia (OR = 3.474, 95% CI = 1.862–6.482), and CAD (OR = 2.009, 95% CI = 1.100–3.669). The percentage of patients with normal vessels was higher in the non‐NAFLD group, followed by the group with mild and severe NAFLD (P < 0.001). However, single‐ and multi‐vessel disease incidences among the non‐NAFLD, mild, and severe NAFLD groups were 36.1, 43.1, and 63.7%, respectively. Interestingly, the percentage of patients with two‐vessel stenosis was significantly higher in severe NAFLD patients than mild and non‐NAFLD patients (P < 0.001). Conclusion The prevalence and severity of NAFLD were independently associated with CAD. Mild NAFLD was primarily observed among patients with normal and non‐obstructive coronary artery patients, while severe NAFLD was more frequent in extensive CAD patients with multi‐vessel disease.
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Affiliation(s)
- Arash Gholoobi
- Department of Cardiovascular Diseases, Faculty of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | - Mehrnoosh Gifani
- Department of Radiology, Faculty of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | - Aida Gholoobi
- Metabolic Syndrome Research Center Mashhad University of Medical Sciences Mashhad Iran
- Medical Genetics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Mashhad Iran
| | - Saeed Akhlaghi
- Department of Biostatistics, School of Health Mashhad University of Medical Sciences Mashhad Iran
| | - Masoud Pezeshki Rad
- Department of Radiology, Faculty of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | - Vafa Baradaran Rahimi
- Department of Cardiovascular Diseases, Faculty of Medicine Mashhad University of Medical Sciences Mashhad Iran
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Huang K, Bai H. Liver hepatokines and peroxisomes as therapeutic targets for cardiovascular diseases. Future Cardiol 2020; 17:535-538. [PMID: 33090051 DOI: 10.2217/fca-2020-0166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Kerui Huang
- Department of Genetics, Development & Cell Biology, Iowa State University, Ames, IA 50011, USA
| | - Hua Bai
- Department of Genetics, Development & Cell Biology, Iowa State University, Ames, IA 50011, USA
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Jesuz VAD, Elias Campos MDB, Rosse de Souza V, Bede TP, Moraes BPTD, Silva AR, de Albuquerque CFG, Blondet de Azeredo V, Teodoro AJ. Lycopene and Tomato Sauce Improve Hepatic and Cardiac Cell Biomarkers in Rats. J Med Food 2019; 22:1175-1182. [PMID: 31290703 DOI: 10.1089/jmf.2019.0014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This study evaluated the effects of tomato sauce and lycopene on hepatic and cardiac cell biomarkers in rats fed a high-fat diet. Animals were split into five groups: control group, high-fat group (HG), high-fat tomato sauce group, high-fat lycopene 2 mg, and high-fat lycopene 4 mg. Food and water were offered ad libitum, whereas tomato sauce and lycopene (2 and 4 mg/day) were offered daily for 60 days. Body, heart, and liver weights, cardiosomatic and hepatosomatic indices, and serum parameters were also analyzed in rats. The animals' hearts and liver were processed, and cells were examined by flow cytometry. Results showed that the groups receiving tomato sauce and lycopene had lower glycemia. The serum concentration of high-density lipoprotein cholesterol, hepatic enzymes, and tumor necrosis factor-α did not change upon treatment. Tomato sauce and lycopene supplementation did not increase interleukin-1β in response to a high-fat diet. Cell cycle analysis of cardiac and liver cells showed a lower percentage of cells in the G0/G1 phase and an increase in the G2/M phase in HG. Both lycopene and tomato sauce reversed this effect. Both lycopene and tomato sauce reversed this effect and prevented high-fat diet-stimulated cardiac and liver cell death. Supplementation of tomato sauce and lycopene showed beneficial effects on cardiac and liver cell metabolism; therefore, it is suggested as a nutritional approach for the prevention and treatment of cardiovascular diseases and nonalcoholic hepatic steatosis.
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Affiliation(s)
- Vanessa Azevedo de Jesuz
- Food and Nutrition Program, Functional Foods Laboratory, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Monique de Barros Elias Campos
- Food and Nutrition Program, Functional Foods Laboratory, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Vanessa Rosse de Souza
- Food and Nutrition Program, Functional Foods Laboratory, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Teresa Palmiciano Bede
- Nutrition and Dietetic Department, Fluminense Federal University, Rio de Janeiro, Brazil
| | | | - Adriana Ribeiro Silva
- Immunopharmacology Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | | | - Anderson Junger Teodoro
- Food and Nutrition Program, Functional Foods Laboratory, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
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Kanwar P, Kowdley KV. The Metabolic Syndrome and Its Influence on Nonalcoholic Steatohepatitis. Clin Liver Dis 2016; 20:225-43. [PMID: 27063266 DOI: 10.1016/j.cld.2015.10.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Nonalcoholic steatohepatitis (NASH) and the metabolic syndrome (MetS) are highly prevalent in the Western population. Their pathogenesis is closely linked to insulin resistance, which serves as a therapeutic target for the management of these conditions. This review article reviews the research supporting the influence of MetS on NASH and includes studies supporting their similar epidemiology, pathogenesis, and treatment.
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Affiliation(s)
- Pushpjeet Kanwar
- Department of Gastroenterology and Hepatology, New York Methodist Hospital, 506, 6th Street, Brooklyn, NY 11215, USA
| | - Kris V Kowdley
- Department of Transplant Hepatology, Swedish Medical Center, 1101, Madison Street, Suite 200, Seattle, WA 98104, USA.
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Højland Ipsen D, Tveden-Nyborg P, Lykkesfeldt J. Normal weight dyslipidemia: Is it all about the liver? Obesity (Silver Spring) 2016; 24:556-67. [PMID: 26868960 DOI: 10.1002/oby.21443] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 09/02/2015] [Accepted: 11/30/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The liver coordinates lipid metabolism and may play a vital role in the development of dyslipidemia, even in the absence of obesity. Normal weight dyslipidemia (NWD) and patients with nonalcoholic fatty liver disease (NAFLD) who do not have obesity constitute a unique subset of individuals characterized by dyslipidemia and metabolic deterioration. This review examined the available literature on the role of the liver in dyslipidemia and the metabolic characteristics of patients with NAFLD who do not have obesity. METHODS PubMed was searched using the following keywords: nonobese, dyslipidemia, NAFLD, NWD, liver, and metabolically obese/unhealthy normal weight. Additionally, article bibliographies were screened, and relevant citations were retrieved. Studies were excluded if they had not measured relevant biomarkers of dyslipidemia. RESULTS NWD and NAFLD without obesity share a similar abnormal metabolic profile. When compared with patients with NAFLD who have obesity, the metabolic abnormalities of NAFLD without obesity are similar or less severe. Furthermore, hepatic lesions develop independent of obesity, and the extent of dyslipidemia seems comparable. CONCLUSIONS NAFLD may impair hepatic lipid handling, causing faulty lipid homeostasis, and serves as a likely starting point for initiation and propagation of dyslipidemia along with associated comorbidities in patients without obesity.
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Affiliation(s)
- David Højland Ipsen
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pernille Tveden-Nyborg
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens Lykkesfeldt
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Ciccone MM, Principi M, Ierardi E, Di Leo A, Ricci G, Carbonara S, Gesualdo M, Devito F, Zito A, Cortese F, Scicchitano P. Inflammatory bowel disease, liver diseases and endothelial function: is there a linkage? J Cardiovasc Med (Hagerstown) 2015; 16:11-21. [PMID: 25427048 DOI: 10.2459/jcm.0000000000000149] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Atherosclerosis is a systemic inflammatory disease able to deeply worsen the outcome of patients because of its serious clinical consequences. The complex inflammatory background underlining such a disease makes atherosclerosis linked to several systemic inflammatory conditions able to impair endothelial function and morphology. Inflammatory bowel diseases are a group of gastrointestinal diseases including Crohn's disease and ulcerative colitis, that is, syndromes characterized by changes in mucosal immunity and gastrointestinal physiology, which could negatively influence the vascular endothelial function and structure. Hepatitis (i.e. inflammatory diseases of the liver mainly due to viral infections) and nonalcoholic fatty liver disease could be aligned to inflammatory bowel disease in such an induction of atherosclerosis disease.Many studies tried to point out the relationship between bowel and liver inflammatory diseases and early vascular changes, considered the first step for atherosclerosis development.The aim of such a narrative review is to explain the relationship between inflammatory bowel disease, hepatitis and nonalcoholic fatty liver disease and their role in increasing cardiovascular risk profile due to early impairment in vascular function and morphology.
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Affiliation(s)
- Marco Matteo Ciccone
- aDepartment of Emergency and Organ Transplantation (DETO) bUniversity of Bari, Bari cDepartment of Medical Sciences, Section of Gastroenterology, University of Foggia, Foggia, Italy
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Öztürk H, Gümrükçüoğlu HA, Yaman M, Akyol A, Öztürk Ş, Akdağ S, Şimşek H, Şahin M, Günaydın ZY. Hepatosteatosis and carotid intima-media thickness in patients with myocardial infarction. J Med Ultrason (2001) 2015; 43:77-82. [PMID: 26703170 DOI: 10.1007/s10396-015-0649-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/09/2015] [Indexed: 01/05/2023]
Abstract
PURPOSE The aim of the study was to determine the involvement of non-alcoholic fatty liver disease (NAFLD) in myocardial infarction patients and its relation with carotid intima-media thickness (CIMT). METHODS This study consisted of 224 patients divided into three groups: those with myocardial infarction (MI), stable coronary artery disease (CAD), and normal coronary artery. Measurement of CIMT and abdominal ultrasonography for hepatosteatosis was performed in all participants. RESULTS NAFLD was significantly more frequent among MI patients compared to the other groups. There was a significant difference between CAD and the presence of NAFLD (p < 0.05). Also, we found significant correlations between the severity of CAD and hepatosteatosis grade (r = 0.648, p < 0.001), CAD and CIMT (r = 0.594, p < 0.001), and NAFLD and CIMT (r = 0.233, p = 0.005). NAFLD was also significantly correlated with the severity of CAD (r = 0.607, p < 0.001), and the grade of NAFLD significantly correlated with CIMT (r = 0.606, p < 0.001). CONCLUSION Patients with more severe CAD were more likely to have NAFLD. In addition, hepatosteatosis may be associated with coronary plaque instability and high fatty volume. Patients with NAFLD should be screened regularly for other cardiovascular risk factors, and the presence of fatty liver may help better classify these patients.
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Affiliation(s)
- Hasan Öztürk
- Radiology Department, Van High Education and Research Hospital, Van, Turkey. .,Radiology Department, Faculty of Medicine, Ordu University, Ordu, Turkey.
| | | | - Mehmet Yaman
- Cardiology Department, Samsun Education and Research Hospital, Samsun, Turkey
| | - Aytaç Akyol
- Radiology Department, Van High Education and Research Hospital, Van, Turkey
| | - Şenay Öztürk
- Radiology Department, Van High Education and Research Hospital, Van, Turkey
| | - Serkan Akdağ
- Radiology Department, Van High Education and Research Hospital, Van, Turkey
| | - Hakkı Şimşek
- Radiology Department, Van High Education and Research Hospital, Van, Turkey
| | - Musa Şahin
- Radiology Department, Van High Education and Research Hospital, Van, Turkey
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Shiga T, Shimbo T, Yoshizawa A. Multicenter investigation of lifestyle-related diseases and visceral disorders in thalidomide embryopathy at around 50 years of age. ACTA ACUST UNITED AC 2015; 103:787-93. [PMID: 26033770 PMCID: PMC5157726 DOI: 10.1002/bdra.23363] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 01/09/2015] [Accepted: 02/02/2015] [Indexed: 12/14/2022]
Abstract
Background In utero exposure to thalidomide causes a wide range of birth defects, including phocomelia, hearing loss and visceral disorders, known as thalidomide embryopathy (TE). Fifty years after the first report of TE, we conducted the first cross‐sectional multicenter study to investigate the development of lifestyle‐related diseases and identify risk factors for visceral disorders in subjects with TE. Methods Seventy‐six cases with TE (31 men, 45 women) underwent medical examinations between 2011 and 2014 to determine the types of TE‐related anomalies (limbs, auditory organs, or visceral organs) and lifestyle‐related diseases present. Logistic multiple regression analyses, adjusted for gender and age, were conducted between TE and lifestyle‐related diseases and to evaluate association between block vertebra and gallbladder aplasia. Results Fatty liver (FL), nonalcoholic FL disease and dyslipidemia were detected in 52.6%, 35.0%, and 23.7% of subjects, respectively, with higher incidences among men. Dyslipidemia was detected in 40.0% of subjects with FL and was significantly associated with FL (odds ratio = 8.86; p = 0.008). Block vertebrae were detected in 44.4% of subjects with gallbladder aplasia, and this association was significant (odds ratio = 9.96; p = 0.006). Conclusion Subjects with TE have also a risk for lifestyle‐related disease as well as the general Japanese population. In addition, cervical spine radiography and magnetic resonance imaging are recommended to assess block vertebrae in subjects with TE with gallbladder aplasia who develop shoulder pain. Birth Defects Research (Part A) 103:787–793, 2015. © 2015 The Authors Birth Defects Research Part A: Clinical and Molecular Teratology Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Tomoko Shiga
- Division of Medical Check-up, Department of General Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takuro Shimbo
- Department of Clinical Study and Informatics Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Atsuto Yoshizawa
- General Internal Medicine, National Center for Global Health and Medicine, Tokyo, Japan
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Duseja A, Singh SP, Saraswat VA, Acharya SK, Chawla YK, Chowdhury S, Dhiman RK, Jayakumar RV, Madan K, Misra SP, Mishra H, Modi SK, Muruganathan A, Saboo B, Sahay R, Upadhyay R. Non-alcoholic Fatty Liver Disease and Metabolic Syndrome-Position Paper of the Indian National Association for the Study of the Liver, Endocrine Society of India, Indian College of Cardiology and Indian Society of Gastroenterology. J Clin Exp Hepatol 2015; 5:51-68. [PMID: 25941433 PMCID: PMC4415196 DOI: 10.1016/j.jceh.2015.02.006] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 02/27/2015] [Indexed: 02/07/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is closely associated with metabolic syndrome. Prevalence of metabolic risk factors including diabetes mellitus, obesity, etc. is rapidly increasing in India putting this population at risk for NAFLD. Patients with NAFLD are at increased risk for liver-related morbidity and mortality and also cardiovascular disease risk and increased incidence of diabetes mellitus on long-term follow-up. Management of patients with NAFLD may require a multi-disciplinary approach involving not only the hepatologists but also the internists, cardiologists, and endocrinologists. This position paper which is a combined effort of the Indian National Association for Study of the Liver (INASL), Endocrine Society of India (ESI), Indian College of Cardiology (ICC) and the Indian Society of Gastroenterology (ISG) defines the spectrum of NAFLD and the association of NAFLD with insulin resistance and metabolic syndrome besides suggesting preferred approaches for the diagnosis and management of patients with NAFLD in the Indian context.
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Key Words
- ALT, Alanine Aminotransferase
- APO C3, Apolipoprotein C3
- ARFI, Acoustic Radiation Forced Impulse
- AST, Aspartate Aminotransferase
- ATPIII, Adult Treatment Panel III
- BMI, Body mass index
- CAD, Coronary artery disease
- CC, Cryptogenic Cirrhosis
- CIMT, Carotid Intima Media Thickness
- CK 18, Cytokeratin 18
- CT, Computed Tomography
- DM, Diabetes Mellitus
- EBP, Enhancer-Binding Protein
- EMA, Anti-Endomysial antibodies
- FFA, Free Fatty Acids
- FMD, Flow-Mediated Vasodilatation
- FPG, Fasting Plasma Glucose
- GTT, Glucose Tolerance Test
- HCC, Hepatocellular Carcinoma
- HOMA-IR, Homeostasis Model Assessment for Insulin Resistance
- HTG, Hepatic triglyceride
- HTN, Hypertension
- IFG, Impaired Fasting Glucose
- IGT, Impaired Glucose Tolerance
- IKK-β, Inhibitor of nuclear factor kappa-B kinase beta
- IR, Insulin resistance
- IRS-1, Insulin Receptor Substrate-1
- ITT, Insulin Tolerance Test
- LFTs, Liver Function Tests
- MRE, Magnetic Resonance Elastography
- MS, Metabolic syndrome
- NAFLD
- NAFLD, Non-alcoholic fatty liver disease
- NASH
- NASH, Non-Alcoholic Steatohepatitis
- NF-κβ, Nuclear Factor Kappa Β
- PCOS, Polycystic Ovarian Syndrome
- PPG, Post-Prandial Glucose
- PROCAM, Prospective Cardiovascular Munster study
- SREBP, Sterol-Regulatory Element-Binding Protein
- T2DM, Type 2 Diabetes Mellitus
- TE, Transient elastography
- TG, Triglycerides
- TTG, Anti-tissue transglutaminase
- VHCC, Virus-related HCC
- VLDL, Very Low Density Lipoprotein
- WHO, World Health Organization
- cryptogenic cirrhosis
- insulin resistance
- nonalcoholic steatohepatitis
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Affiliation(s)
- Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shivaram P. Singh
- Department of Gastroenterology, SCB Medical College, Cuttack, Odisha, India
- Address for correspondence: Shivaram P. Singh, Professor and Head, Department of Gastroenterology, SCB Medical College, Cuttack 753007, Odisha, India. Tel.: +91 671 2433865.
| | - Vivek A. Saraswat
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Subrat K. Acharya
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Yogesh K. Chawla
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhankar Chowdhury
- Department of Endocrinology, Institute of Postgraduate Medical Education & Research and SSKM Hospital, Kolkata, West Bengal, India
| | - Radha K. Dhiman
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Kaushal Madan
- Medanta Institute of Digestive and Hepatobiliary Sciences, Medanta—The Medicity, Gurgaon, Haryana, India
| | - Sri P. Misra
- Department of Gastroenterology, MotiLal Nehru Medical College, Allahabad, Uttar Pradesh, India
| | - Hrudananda Mishra
- Department of Cardiology, SCB Medical College, Cuttack, Odisha, India
| | - Sunil K. Modi
- Department of Cardiology, Indraprastha Apollo Hospital, New Delhi, India
| | - Arumugam Muruganathan
- The Tamil Nadu Dr. M.G.R. Medical University & AG Hospital, Tirupur, Tamil Nadu, India
| | - Banshi Saboo
- Department of Endocrinology, Diabetes Care & Hormone Clinic, Ahmedabad, Gujarat, India
| | - Rakesh Sahay
- Osmania Medical College & Osmania General Hospital, Hyderabad, Andhra Pradesh & MediCiti Hospital, Hyderabad, Andhra Pradesh, India
| | - Rajesh Upadhyay
- Department of Gastroenterology, Max Super Speciality Hospital, Shalimar Bagh, New Delhi, India
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Hashimoto E, Tokushige K, Ludwig J. Diagnosis and classification of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis: Current concepts and remaining challenges. Hepatol Res 2015; 45:20-8. [PMID: 24661406 DOI: 10.1111/hepr.12333] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 03/07/2014] [Accepted: 03/20/2014] [Indexed: 12/12/2022]
Abstract
The high prevalence of non-alcoholic fatty liver disease (NAFLD) has made the condition an important public health issue. Two clinical entities are manifestations of NAFLD, namely, non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH). The former tends to be benign and non-progressive while the latter can progress to cirrhosis, which in rare cases gives rise to hepatocellular carcinoma. The diagnosis of NAFLD is based on: (i) a history of no or limited daily alcohol intake (<20 g for women and <30 g for men); (ii) presence of hepatic steatosis by imaging or by histology; and (iii) exclusion of other liver diseases. NAFL is defined histologically by the presence of bland, primarily macrovesicular, hepatocellular fatty change, while NASH features fatty change with inflammation and evidence of hepatocyte injury, such as ballooning degeneration. Presence of fibrosis is a sign of chronicity. Thus, the diagnosis of NAFL/NASH rests on clinicopathological criteria; it always requires both clinical and biopsy-based information. NAFLD could be both the result and the cause of metabolic syndrome, with a vicious cycle operating between these conditions. Remaining challenges are: (i) the lack of a clear threshold alcohol intake for defining "non-alcoholic"; (ii) a lacking consensus for the classification of fatty liver disease; and (iii) absence of a histological definition of NASH, which currently remains the gold standard for the diagnosis. Further challenges include the overlap of the criteria for NAFLD and alcoholic liver disease as many obese individuals also consume considerable volumes of alcohol.
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Affiliation(s)
- Etsuko Hashimoto
- Department of Internal Medicine and Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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12
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Sonographic evaluation for predicting the presence and severity of coronary artery disease. Ultrasound Q 2014; 29:125-30. [PMID: 23609339 DOI: 10.1097/ruq.0b013e318291580e] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of our study was to investigate the relationship between age, sex, obesity, nonalcoholic fatty liver disease (NAFLD), carotid intima-media thickness (CIMT), and both the presence and severity of coronary artery disease (CAD) and their predictive value for the presence and severity of CAD. METHODS Our study population consisted of 136 patients who underwent coronary angiography for various reasons. Gensini scoring was used to determine the severity of coronary atherosclerosis. Carotid intima-media thickness was estimated by carotid duplex ultrasound. Nonalcoholic fatty liver disease was diagnosed by abdominal ultrasonography. Body mass index (BMI) was calculated as kilograms divided by meters squared. RESULTS Coronary artery disease was detected in 74 patients (54%). In the whole group, patients with CAD had significantly higher CIMT measurements compared with those without CAD (0.93 [SD, 0.14] and 0.72 [SD, 0.12] mm, respectively, P < 0.001). Carotid intima-media thickness was correlated with BMI (P < 0.001, r = 0.453), age (P = 0.001, r = 0.389), and grade 2-3 NAFLD (P < 0.001, r = 0.356). In the multiple logistic regression model, CIMT (odds ratio, 1.189; 95% confidence interval, 1.122-1.261; P < 0.001) was the only independent predictor of the presence of CAD. In receiver operating characteristic curve analysis, optimal cutoff value of CIMT to predict the presence of CAD was found as greater than 0.75 mm with 93.2% sensitivity and 71% specificity. In CAD group patients, Gensini score was correlated with CIMT (P < 0.001, r = 0.604), grade 2-3 NAFLD (P < 0.001, r = 0.534), BMI (P < 0.001, r = 0.498), and age (P = 0.001, r = 0.385). In the multiple stepwise linear regression model, CIMT (β = 0.444, P < 0.001) and grade 2-3 NAFLD (β = 0.353, P < 0.001) were associated with severity of CAD. CONCLUSIONS Our data suggest that CIMT is a strong independent predictor for the presence and severity of CAD. Furthermore, moderate to severe hepatosteatosis is also significantly associated with the severity of CAD. Therefore, detection of CIMT and NAFLD by ultrasonography, which is a very cheap, safe, and noninvasive radiological modality, can be used to improve CAD risk prediction.
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Efe D, Aygün F. Assessment of the relationship between non-alcoholic fatty liver disease and CAD using MSCT. Arq Bras Cardiol 2013; 102:10-8. [PMID: 24263777 PMCID: PMC3987385 DOI: 10.5935/abc.20130225] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 08/23/2013] [Indexed: 12/13/2022] Open
Abstract
Background Some risk factors for atherosclerosis are followed by non-alcoholic fatty liver
disease (NAFLD). We wanted to use Multislice computed tomography (MSCT) as
technique for searching relationship between NAFLD and coronary artery disease
(CAD). Objective The relationship between NAFLD and CAD was investigated using MSCT. Methods A total of 372 individuals with or without cardiac symptoms who had undergone MSCT
angiography were included in the study. The patients were divided into two groups
according to the presence of NAFLD. Coronary artery segments were visually
evaluated via MSCT angiography. Based on the coronary artery stenosis degree,
those with no or minimal plaques were considered normal, whereas those who had
stenosis of less than 50% and at least one plaque were considered to have
non-obstructive coronary artery disease (non-obsCAD). The patients who had at
least one plaque and coronary artery stenosis of 50% or more were considered to
have obstructive coronary artery disease (obsCAD). NAFLD was determined according
to the MSCT protocol, using the liver density. Results According to the liver density, the number of patients with non-alcoholic fatty
liver disease (group 1) was 204 (149 males, 54.8%) and with normal liver (group 2)
was 168 (95 males, 45.2%). There were 50 (24.5%) non-obsCAD and 57 (27.9%) obsCAD
cases in Group 1, and 39 (23.2%) non-obsCAD and 23 (13.7%) obsCAD cases in Group
2. Conclusions The present study using MSCT demonstrated that the frequency of coronary artery
disease in patients with NAFDL was significantly higher than that of patients
without NAFDL.
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Affiliation(s)
- Duran Efe
- Mevlana University, Faculdade de Medicina, Departamento de Radiologia, Konya, Turquia
| | - Fatih Aygün
- Mevlana University, Faculdade de Medicina, Departamento de Cirurgia Cardiovascular, Konya, Turquia
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Josef P, Ali I, Ariel P, Alon M, Nimer A. Relationship between retinal vascular caliber and coronary artery disease in patients with non-alcoholic fatty liver disease (NAFLD). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:3409-23. [PMID: 23924883 PMCID: PMC3774445 DOI: 10.3390/ijerph10083409] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 07/11/2013] [Accepted: 07/31/2013] [Indexed: 12/13/2022]
Abstract
Objective: To evaluate the relationship between retinal vascular caliber and cardiovascular disease in non-alcoholic fatty liver disease (NAFLD) patients without diabetes and hypertension. Methods: Intention to treat study of individuals who underwent cardiac computed tomography (CT) during a two year period. Coronary artery disease (CAD) was defined as stenosis of >50% in at least one major coronary artery. Liver and spleen density were measured by abdominal (CT); intima-media thickness (IMT) by Doppler ultrasound; retinal artery and vein diameter by colored-retinal angiography; and metabolic syndrome by ATP III guidelines. Serum biomarkers of insulin resistance, inflammation, and oxidant-antioxidant status were assessed. Results: Compared with 22 gender and age matched controls, the 29 NAFLD patients showed higher prevalence of coronary plaques (70% vs. 30%, p < 0.001), higher prevalence of coronary stenosis (30% vs. 15%, p < 0.001), lower retinal arteriole-to-venule ratio (AVR) (0.66 ± 0.06 vs. 0.71 ± 0.02, p < 0.01), higher IMT (0.98 ± 0.3 vs. 0.83 ± 0.1, p < 0.04), higher carotid plaques (60% vs. 40%, p < 0.001), higher homeostasis model assessment of insulin resistance (HOMA) (4.0 ± 3.4 vs. 2.0 ± 1.0, p < 0.005), and higher triglyceride levels (200 ± 80 vs. 150 ± 60, p < 0.005) than controls. Multivariate analysis showed fatty liver (OR 2.5; p < 0.01), IMT (OR 2.3 p < 0.001), and retinal AVR ratio (OR 1.5, p < 0.01) to be strongly associated with CAD independent of metabolic syndrome (OR 1.2, p < 0.05). Conclusions: Patients with smaller retinal AVR (<0.7) are likely to be at increased risk for CAD and carotid atherosclerosis in patients with NAFLD even without hypertension or diabetes.
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Affiliation(s)
- Pikkel Josef
- Department of Ophtalmology, Ziv Medical Centre, Safed 13100, Israel; E-Mails: (P.J.); (I.A.)
- Faculty of Medicine at Galilee, Bar Ilan University, Safed 13100, Israel; E-Mail:
| | - Ibrahim Ali
- Department of Ophtalmology, Ziv Medical Centre, Safed 13100, Israel; E-Mails: (P.J.); (I.A.)
- Liver Unit, Ziv Medical Centre, Safed 13100, Israel
| | - Prober Ariel
- Department of Radiology, Safed 13100, Israel; E-Mail:
| | - Marmor Alon
- Faculty of Medicine at Galilee, Bar Ilan University, Safed 13100, Israel; E-Mail:
| | - Assy Nimer
- Faculty of Medicine at Galilee, Bar Ilan University, Safed 13100, Israel; E-Mail:
- Liver Unit, Ziv Medical Centre, Safed 13100, Israel
- Author to whom correspondence should be addresse; E-Mail: ; Tel.: +972-4682-8442; Fax: +972-4682-8165
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Chuang CL. Application of hybrid case-based reasoning for enhanced performance in bankruptcy prediction. Inf Sci (N Y) 2013. [DOI: 10.1016/j.ins.2013.02.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Sera N, Hida A, Imaizumi M, Nakashima E, Akahoshi M. The association between chronic kidney disease and cardiovascular disease risk factors in atomic bomb survivors. Radiat Res 2012; 179:46-52. [PMID: 23148507 DOI: 10.1667/rr2863.1] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Atomic bomb (A-bomb) radiation is associated with cardiovascular disease (CVD) and metabolic CVD risk factors. Chronic kidney disease (CKD) is also known to be a risk factor for CVD and little is known whether CKD is associated with A-bomb radiation. To examine whether CKD is associated with CVD risk factors or with A-bomb radiation in A-bomb survivors, we classified renal dysfunction in 1,040 A-bomb survivors who were examined in 2004-2007 as normal [n = 121; estimated glomerular filtration rate (eGFR) ≥ 90 ml/min/1.73 m(2)]; mild (n = 686; eGFR 60-89 ml/min/1.73 m(2)); moderate (n = 217; eGFR 30-59 ml/min/1.73 m(2)); or severe (n = 16; eGFR <30 ml/min/1.73 m(2)). Also, we diagnosed subjects in the moderate and severe renal dysfunction groups as having CKD (n = 233; eGFR <59 ml/min/1.73 m(2)). After adjusting for age, gender, and smoking and drinking habits, we looked for an association between renal dysfunction and hypertension, diabetes mellitus (DM), hyperlipidemia, and metabolic syndrome (MetS), and between renal dysfunction and A-bomb radiation. Hypertension [odds ratio (OR), 1.57; 95% confidence interval (CI), 1.12-2.20, P = 0.009]; DM (OR, 1.79; 95% CI, 1.23-2.61, P = 0.002); hyperlipidemia (OR, 1.55; 95% CI, 1.12-2.14, P = 0.008); and MetS (OR, 1.86; 95% CI, 1.32-2.63, P < 0.001) were associated with CKD (moderate/severe renal dysfunction), and hyperlipidemia and MetS were also associated with mild renal dysfunction. CKD (OR/Gy, 1.29; 95% CI, 1.01-1.63, P = 0.038) and severe renal dysfunction (OR/Gy, 3.19; 95% CI, 1.63-6.25, P < 0.001) were significantly associated with radiation dose. CKD associated with radiation may have played a role in the development of CVD among A-bomb survivors.
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Affiliation(s)
- Nobuko Sera
- Department of a Nagasaki Clinical Studies, Radiation Effects Research Foundation, Nagasaki, Japan.
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Abstract
Non-alcoholic fatty liver disease (NAFLD) is rapidly increasing in the Asia-Pacific and affects up to 30 % of the general population. In younger children, prevalence has been reported to be between 2.1 and 4.5 %. The prevalence of NAFLD increases with increasing age. NAFLD is more prevalent in men than women, but this trend fades in older age group. NAFLD is one of the most common causes of raised serum ALT levels and the latter is closely related to the presence of features of metabolic syndrome. NAFLD may contribute to metabolic syndrome in a similar way as visceral adiposity and can be an early predictor of metabolic disorders. NAFLD increases the risk of developing diabetes mellitus and is closely related to degree of glucose intolerance. A significant proportion of patients with NAFLD have impaired glucose tolerance or diabetes mellitus but with normal fasting blood glucose, highlighting the importance of oral glucose tolerance test in NAFLD patients with normal fasting blood glucose. Besides liver-related complications, NAFLD has been associated with cardiovascular complications, hyperuricemia, gout, chronic kidney disease, gallstone disease, colorectal adenomatous polyp, and polycystic ovarian syndrome. NAFLD seems to be related to host metabolic factors rather than viral factors and does not seem to affect severity of the liver disease in patients with chronic hepatitis B. On the other hand, hepatic steatosis may be related to both host metabolic and viral factors in patients with chronic hepatitis C and seems to adversely impact on the severity of liver disease and possibly response to antiviral therapy.
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Chiang CH, Huang CC, Chan WL, Chen JW, Leu HB. The severity of non-alcoholic fatty liver disease correlates with high sensitivity C-reactive protein value and is independently associated with increased cardiovascular risk in healthy population. Clin Biochem 2010; 43:1399-404. [DOI: 10.1016/j.clinbiochem.2010.09.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 09/02/2010] [Accepted: 09/03/2010] [Indexed: 12/22/2022]
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Tsuneto A, Hida A, Sera N, Imaizumi M, Ichimaru S, Nakashima E, Seto S, Maemura K, Akahoshi M. Fatty liver incidence and predictive variables. Hypertens Res 2010; 33:638-43. [PMID: 20379184 DOI: 10.1038/hr.2010.45] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Although fatty liver predicts ischemic heart disease, the incidence and predictors of fatty liver need examination. The objective of this study was to determine fatty liver incidence and predictive variables. Using abdominal ultrasonography, we followed biennially through 2007 (mean follow-up, 11.6+/-4.6 years) 1635 Nagasaki atomic bomb survivors (606 men) without fatty liver at baseline (November 1990 through October 1992). We examined potential predictive variables with the Cox proportional hazard model and longitudinal trends with the Wilcoxon rank-sum test. In all, 323 (124 men) new fatty liver cases were diagnosed. The incidence was 19.9/1000 person-years (22.3 for men, 18.6 for women) and peaked in the sixth decade of life. After controlling for age, sex, and smoking and drinking habits, obesity (relative risk (RR), 2.93; 95% confidence interval (CI), 2.33-3.69, P<0.001), low high-density lipoprotein-cholesterol (RR, 1.87; 95% CI, 1.42-2.47; P<0.001), hypertriglyceridemia (RR, 2.49; 95% CI, 1.96-3.15; P<0.001), glucose intolerance (RR, 1.51; 95% CI, 1.09-2.10; P=0.013) and hypertension (RR, 1.63; 95% CI, 1.30-2.04; P<0.001) were predictive of fatty liver. In multivariate analysis including all variables, obesity (RR, 2.55; 95% CI, 1.93-3.38; P<0.001), hypertriglyceridemia (RR, 1.92; 95% CI, 1.41-2.62; P<0.001) and hypertension (RR, 1.31; 95% CI, 1.01-1.71; P=0.046) remained predictive. In fatty liver cases, body mass index and serum triglycerides, but not systolic or diastolic blood pressure, increased significantly and steadily up to the time of the diagnosis. Obesity, hypertriglyceridemia and, to a lesser extent, hypertension might serve as predictive variables for fatty liver.
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Affiliation(s)
- Akira Tsuneto
- Department of Cardiovascular Medicine, Course of Medical and Dental Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Sakamoto, Nagasaki, Japan.
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Assy N, Djibre A, Farah R, Grosovski M, Marmor A. Presence of coronary plaques in patients with nonalcoholic fatty liver disease. Radiology 2010; 254:393-400. [PMID: 20093511 DOI: 10.1148/radiol.09090769] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate the relationship between nonalcoholic fatty liver disease (NAFLD) and coronary artery disease (CAD) and to define determinants of CAD in patients with or without metabolic syndrome. MATERIALS AND METHODS This study was approved by the local ethics committee; informed consent was obtained. Twenty-nine subjects (mean age, 53 years +/- 7 [standard deviation]) with low to intermediate risk for CAD and with fatty liver were included. Thirty-two sex- and age-matched individuals without NAFLD served as controls. CAD was defined as a stenosis of more than 50% in at least one major coronary artery. Fatty liver was assessed by means of an attenuation of -10 HU or higher (calculated as liver attenuation minus spleen attenuation) by using computed tomography (CT), coronary plaques and stenosis by using CT coronary angiography, and biomarkers of insulin resistance, lipotoxicity, systemic inflammation, and oxidant and antioxidant status. A logistic regression analysis was performed to study multivariable associations. RESULTS When compared with controls, NAFLD patients showed a higher prevalence of calcified and noncalcified coronary plaques (67% vs 34% and 52% vs 29%, respectively; both P < .001), higher prevalence of nonobstructive coronary stenosis (34% vs 14%; P < .008), higher homeostasis model assessment of insulin resistance (3.8 epsilonU/mL +/- 3.6 vs 2.6 epsilonU/mL +/- 3.2; P < .005) and higher triglyceride levels (208 mg/dL +/- 87 vs 148 mg/dL +/- 70; P < .005). Fatty liver proved to be a strong predictor of coronary atherosclerosis (odds ratio [OR], 2; P < .04), independent of indicators for metabolic syndrome (OR, 1.2; P > .2) and C-reactive protein levels (OR, 0.7; P > .4). CONCLUSION Patients with NAFLD, even without metabolic syndrome, are at high risk for atherosclerosis. Assessment of NAFLD may be helpful for cardiovascular risk stratification.
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Affiliation(s)
- Nimer Assy
- Liver Unit, Ziv Medical Centre, Box 1008, Safed 13100, Israel.
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Işilak Z, Aparci M, Kardeşoğlu E, Yiğiner O, Uz O, Sildiroglu O, Ozmen N, Yalçin M, Cingözbay BY, Cebeci BS. Abnormal aortic elasticity in patients with liver steatosis. Diabetes Res Clin Pract 2010; 87:44-50. [PMID: 19926158 DOI: 10.1016/j.diabres.2009.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Revised: 10/15/2009] [Accepted: 10/19/2009] [Indexed: 12/26/2022]
Abstract
AIM Non-alcoholic fatty liver disease (NAFLD) may be associated with insulin resistance. We aimed to evaluate elastic properties of aorta in patients with NAFLD. MATERIAL AND METHOD Ninety-two patients with NAFLD and 47 healthy subjects were performed ultrasonographic and echocardiographic examination. Aortic stiffness index (ASI), aortic distensibility (AD) and aortic strain (AS) were compared between healthy subjects and patients and also among grade I and II liver steatosis. Statistical analysis was performed by Independent-Samples t-test, Pearson's correlation test using SPSS 11.0. RESULTS ASI was significantly increased whereas AS and AD were reduced (p>0.05) in patients compared to normal ones. ASI was significantly increased while AD and AS slightly increased in patients with grade II liver steatosis compare to grade I. SBP and DBP, cholesterol levels, fasting blood glucose (FBG) were also increased and doppler flow parameters of mitral inflow were abnormally changed in those patients. ASI was positively correlated with FBG, ALT and ALP levels, LDL cholesterol, heart rate and deceleration time of mitral E wave. CONCLUSION Elastic properties of aorta were abnormally changed in patients with NAFLD. Multiple hemodynamic abnormalities probably associated with insulin resistance may be accountable for abnormal elastic properties of aorta.
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Affiliation(s)
- Zafer Işilak
- GATA Haydarpaşa Teaching Hospital, Department of Cardiology, Istanbul, Turkey
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Visceral obesity and hypoadiponectinemia are significant determinants of hepatic dysfunction: An epidemiologic study of 3827 Japanese subjects. J Clin Gastroenterol 2009; 43:995-1000. [PMID: 19407661 DOI: 10.1097/mcg.0b013e3181962de8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM Adiponectin is an anti-inflammatory and insulin-sensitizing adipocytokine, and its serum concentrations are reduced in obesity with visceral fat accumulation. Visceral fat accumulation is an independent determinant of elevated serum liver enzymes. Hypoadiponectinemia plays important roles in the clinical progression of nonalcoholic steatohepatitis. The aim of this study was to evaluate the relation between visceral fat area (VFA), serum adiponectin concentration, and biochemical liver tests, such as aspartate aminotransferase, alanine aminotransferase (ALT), and gamma-glutamyltransferase (GGT) in normal subjects. METHODS The study group comprised 3827 Japanese subjects [mean age+/-SD; 47.6+/-10.7 y: 2854 males (48.4+/-10.7 y), 973 females (45.3+/-10.1 y)], who underwent annual health checkup in 2004. In addition to parameters measured in the annual health checkup, VFA and serum adiponectin concentration were measured by the bioelectrical impedance analysis method and a latex particle-enhanced turbidimetric assay system, respectively. RESULTS Pearson's correlation analysis showed a significant correlation between VFA and the levels of the above 3 liver enzymes in both sexes, and a significant negative correlation between adiponectin and all biochemical liver tests in men and with ALT and GGT in women. Stepwise multiple regression analysis showed that VFA was a significant determinant of serum liver tests in both sexes. Moreover, serum adiponectin concentration significantly and negatively influenced male ALT and GGT and female GGT. CONCLUSIONS Both visceral obesity and hypoadiponectinemia are significant determinants of subtle and asymptomatic hepatic dysfunction in normal Japanese subjects.
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Kuk JL, Saunders TJ, Davidson LE, Ross R. Age-related changes in total and regional fat distribution. Ageing Res Rev 2009; 8:339-48. [PMID: 19576300 DOI: 10.1016/j.arr.2009.06.001] [Citation(s) in RCA: 478] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Revised: 06/24/2009] [Accepted: 06/24/2009] [Indexed: 02/08/2023]
Abstract
Aging is associated with progressive changes in total and regional fat distribution that have negative health consequences. Indeed, a preferential increase in abdominal fat, in particular visceral fat, combined with a decrease in lower body subcutaneous fat are commonly cited in the literature. These age-related changes in body composition can occur independent of changes in total adiposity, body weight or waist circumference, and represent a phenotype closely associated with increased morbidity and mortality risk. Tissues such as the heart, liver and skeletal muscle in the elderly have increased fat deposition, which increases risk for insulin resistance and cardiovascular disease. Furthermore, aging is associated with increased fat content within bone marrow, which exposes the elderly to fracture risk beyond that associated with low bone mineral density alone. Many of the age-associated body compositional changes cannot be detected by simple anthropometric measures alone, and the influence of gender, race or ethnicity, and physical activity patterns on these changes is unclear. This review will explore some of these age-related changes in total and regional fat distribution. Consideration will also be given to the strengths and limitations associated with some of the anthropometric methodologies employed for assessing these changes.
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Barbato A, Iacone R, Tarantino G, Russo O, Sorrentino P, Avallone S, Galletti F, Farinaro E, Della Valle E, Strazzullo P. Relationships of PAI-1 levels to central obesity and liver steatosis in a sample of adult male population in southern Italy. Intern Emerg Med 2009; 4:315-23. [PMID: 19350365 DOI: 10.1007/s11739-009-0240-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Accepted: 02/20/2009] [Indexed: 12/21/2022]
Abstract
To analyse the relationship of PAI-1 plasma levels to echographically determined liver steatosis and cardiometabolic risk factors in a randomly selected sample of 254 adult male participants of the Olivetti Heart Study. Accounting for age and ongoing pharmacological treatment, PAI-1 levels were directly (P < 0.005) associated with body mass index (BMI), waist circumference (WC), serum triglyceride (TG), total cholesterol, insulin, homeostasis model assessment index, gamma-glutamyl transpeptidase and peritoneal fat. At multiple linear regression (MLR) analysis, measures of adiposity and TG exerted significant and quantitatively similar effects on PAI-1 levels. A progressive rise in PAI-1 level was detected with increasing degree of steatosis. A stepwise MLR model was used to evaluate the relative power of cardiometabolic risk factors and liver steatosis on PAI-1 levels. Adjusting for alcohol intake, BMI, WC and peritoneal fat were alternatively included in the model with other variables found to be significantly associated with plasma PAI-1 level. Liver steatosis, serum TG and various indexes of adiposity each had a significant independent impact on PAI-1 plasma level and explained overall 23% of its variability. Abdominal fat, liver steatosis and serum TG levels were significant and independent determinants of PAI-1 plasma level in an unselected sample of adult male population upon adjustment for age and therapy.
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Affiliation(s)
- Antonio Barbato
- Department of Clinical and Experimental Medicine, Federico II University of Naples Medical School, Via S. Pansini, 5, 80131 Naples, Italy
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Omagari K, Morikawa SI, Nagaoka S, Sadakane Y, Sato M, Hamasaki M, Kato S, Masuda JI, Osabe M, Kadota T, Sera K. Predictive factors for the development or regression of Fatty liver in Japanese adults. J Clin Biochem Nutr 2009; 45:56-67. [PMID: 19590708 PMCID: PMC2704327 DOI: 10.3164/jcbn.08-269] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2008] [Accepted: 01/06/2009] [Indexed: 12/11/2022] Open
Abstract
Fatty liver is commonly associated with alcohol or metabolic syndrome. We aimed to examine the longitudinal aspects of fatty liver, and clarify the independent predictors for the development or regression of fatty liver. In the present study, the clinical features of 1578 Japanese adults (1208 men and 370 women; 35 to 69 years of age) who visited our center both in 2000 and 2007–2008 were recorded and compared, including liver status diagnosed by ultrasonography. Of the 1578 participants, 217 (13.8%) showed fatty liver development, and 74 (4.7%) showed fatty liver regression. Logistic regression analysis revealed that body mass index and percentage body fat were strongly associated with the development or regression of fatty liver. Metabolic syndrome-related disorders such as serum levels of total cholesterol, triglyceride, uric acid, and fasting blood glucose were also associated with clinical course to some degree. However, the history of alcohol intake, the presence of metabolic syndrome, blood pressure, and habitual physical exercise were not independent predictors for the development or regression of fatty liver. Our present data suggest that control of body weight in men and the percentage body fat in women are particularly important for the prevention or treatment of fatty liver.
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Affiliation(s)
- Katsuhisa Omagari
- Department of Nutritional Science, Faculty of Nursing and Nutrition, University of Nagasaki, Siebold, 1-1-1 Manabino, Nagayo-cho, Nagasaki 851-2195, Japan
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26
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Lin RH. An intelligent model for liver disease diagnosis. Artif Intell Med 2009; 47:53-62. [PMID: 19540738 DOI: 10.1016/j.artmed.2009.05.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Revised: 04/29/2009] [Accepted: 05/10/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Liver disease, the most common disease in Taiwan, is not easily discovered in its initial stage; early diagnosis of this leading cause of mortality is therefore highly important. The design of an effective diagnosis model is therefore an important issue in liver disease treatment. This study accordingly employs classification and regression tree (CART) and case-based reasoning (CBR) techniques to structure an intelligent diagnosis model aiming to provide a comprehensive analytic framework to raise the accuracy of liver disease diagnosis. METHODS Based on the advice and assistance of doctors and medical specialists of liver conditions, 510 outpatient visitors using ICD-9 (International Classification of Diseases, 9th Revision) codes at a medical center in Taiwan from 2005 to 2006 were selected as the cases in the data set for liver disease diagnosis. Data on 340 patients was utilized for the development of the model and on 170 patients utilized to perform comparative analysis of the models. This paper accordingly suggests an intelligent model for the diagnosis of liver diseases which integrates CART and CBR. The major steps in applying the model include: (1) adopting CART to diagnose whether a patient suffers from liver disease; (2) for patients diagnosed with liver disease in the first step, employing CBR to diagnose the types of liver diseases. RESULTS In the first phase, CART is used to extract rules from health examination data to show whether the patient suffers from liver disease. The results indicate that the CART rate of accuracy is 92.94%. In the second phase, CBR is developed to diagnose the type of liver disease, and the new case triggers the CBR system to retrieve the most similar case from the case base in order to support the treatment of liver disease. The new case is supported by a similarity ratio, and the CBR diagnostic accuracy rate is 90.00%. Actual implementation shows that the intelligent diagnosis model is capable of integrating CART and CBR techniques to examine liver diseases with considerable accuracy. The model can be used as a supporting system in making decisions regarding liver disease diagnosis and treatment. The rules extracted from CART are helpful to physicians in diagnosing liver diseases. CBR can retrieve the most similar case from the case base in order to solve a new liver disease problem and can be of great assistance to physicians in identifying the type of liver disease, reducing diagnostic errors and improving the quality and effectiveness of medical treatment.
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Affiliation(s)
- Rong-Ho Lin
- Department of Industrial Engineering and Management, National Taipei University of Technology, Taiwan, ROC.
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Yu JH, Lee KS, Lee SY, Hong AR, Park YS. [The association of cardiovascular risk factors with nonalcoholic fatty liver disease in health checkup examinees]. J Prev Med Public Health 2009; 41:407-12. [PMID: 19037170 DOI: 10.3961/jpmph.2008.41.6.407] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The purpose of this study was to evaluate the relationship of nonalcoholic fatty liver and cardiovascular risk factors. METHODS This study was conducted to investigate the association of nonalcoholic fatty liver and cardiovascular risk factors for adult men (n=2976) and women (n=2442) who were over 19 years old, after excluding the HBsAg(+) or anti-HCV(+) patients and the men and women with increased alcohol intake (men: 40 g/week, women: 20 g/week). RESULTS Compared with the normal liver subjects, the nonalcoholic fatty liver subjects showed a significantly increased frequency of abnormal systolic blood pressure (> or =120 mmHg), fasting blood sugar (> or =100 mg/dL), total cholesterol (> or =200 mg/dL), triglyceride (> or =150 mg/dL), high density lipoprotein cholesterol (<40 mg/dL), low density lipoprotein cholesterol (> or =130 g m/dL) and abdominal obesity in men, and all these measures were significantly increased in the women except for abnormal HDL cholesterol. After adjusting for the body mass index, age, smoking, exercise and a nonalcoholic liver, the odds ratios of an abnormal waist hip ratio were 1.35(95% Confidence Interval=1.05-4.72) in the mild fatty liver, 1.61(1.19-2.18) in the moderate fatty liver, 2.77(1.57-4.92) in the severe fatty liver compared with a normal liver. The adjusted odds ratios for abnormal fasting blood sugar were 1.26(1.03-1.53) in the mild fatty liver, 1.62(1.27-2.06) in the moderate fatty liver and 1.77(1.12-2.78) in the severe fatty liver. The adjusted odds ratios for abnormal triglyceride were 1.38(1.11-1.72) in the mild fatty liver, 1.73(0.33-2.24) in the moderate fatty liver and 1.91(1.17-3.10) in the severe fatty liver of men. Adjusted odds ratios for abnormal triglyceride were 1.50(1.04-2.15) in mild, 1.71(1.07-2.68) in moderate, 1.81(0.69-4.38) in severe fatty liver of women. CONCLUSIONS The nonalcoholic fatty liver subjects had more cardiovascular risk factors compared with the normal liver subjects. Thus, prevention and treatment of the nonalcoholic fatty liver is necessary by lifestyle modifications such as restriction of alcohol intake, no smoking, exercise and adequate eating habits.
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Affiliation(s)
- Jae-Hee Yu
- Graduate School of Public Health, The Catholic University of Korea
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McKimmie RL, Daniel KR, Carr JJ, Bowden DW, Freedman BI, Register TC, Hsu FC, Lohman KK, Weinberg RB, Wagenknecht LE. Hepatic steatosis and subclinical cardiovascular disease in a cohort enriched for type 2 diabetes: the Diabetes Heart Study. Am J Gastroenterol 2008; 103:3029-35. [PMID: 18853970 PMCID: PMC3638961 DOI: 10.1111/j.1572-0241.2008.02188.x] [Citation(s) in RCA: 152] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To explore mechanisms whereby hepatic steatosis may be associated with cardiovascular risk, we investigated cross-sectional relationships between hepatic steatosis, regional fat accumulation, inflammatory biomarkers, and subclinical measures of atherosclerosis in the Diabetes Heart Study. METHODS The Diabetes Heart Study is a family study of sibling pairs concordant for type 2 diabetes. A subset of 623 randomly selected participants was evaluated for hepatic steatosis, defined as a liver:spleen attenuation ratio of <1.0 by computed tomography. We quantified visceral fat, subcutaneous fat, coronary, aortic, and carotid artery calcium by computed tomography; and carotid atherosclerosis by ultrasound. Associations between the liver:spleen attenuation ratio and these factors were expressed as Spearman correlations. RESULTS After adjustment for age, race, gender, body mass index, and diabetes status, the liver:spleen attenuation ratio correlated with visceral fat (r =-0.22, P < 0.0001) and subcutaneous fat (r =-0.13, P= 0.031). Hepatic steatosis was associated with lower high-density lipoprotein (r = 0.21, P < 0.0001), higher triglycerides (r =-0.25, P < 0.0001), higher C-reactive protein (r =-0.095, P= 0.004), and lower serum adiponectin (r = 0.34, P < 0.0001). There were no significant associations between the liver:spleen attenuation ratio and coronary, aortic, or carotid calcium, or carotid intimal thickness. CONCLUSIONS This suggests that hepatic steatosis is less likely a direct mediator of cardiovascular disease and may best be described as an epiphenomenon. The strong correlations between pro-atherogenic biomarkers, visceral fat, and elements of the metabolic syndrome suggest that hepatic steatosis reflects more than general adiposity, but represents a systemic, inflammatory, pro-atherogenic adipose state.
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Affiliation(s)
- Ryan L McKimmie
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA
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Evaluation of metabolic syndrome frequency and carotid artery intima-media thickness as risk factors for atherosclerosis in patients with nonalcoholic fatty liver disease. Dig Dis Sci 2008; 53:1352-7. [PMID: 17939039 DOI: 10.1007/s10620-007-9998-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2007] [Accepted: 08/21/2007] [Indexed: 12/13/2022]
Abstract
AIM The aim of this study was to evaluate metabolic syndrome (MetS) frequency and carotid artery intima-media thickness (IMT) as risk factors for atherosclerosis in patients with nonalcoholic fatty liver disease. METHODS A case-control study was conducted on 40 biopsy-proven NAFLD patients and 40 age-matched healthy control subjects. Common carotid artery IMT and MetS criteria [according to the Third Report of the National Cholesterol Education Expert Panel on Detection, evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP-ATPIII), the International Diabetes Federation (IDF), the American Heart Association in conjunction with the National Heart, Lung, and Blood Institute (AHA/NHLBI)] were evaluated for all study subjects. RESULTS MetS according to NCEP-ATPIII, IDF and AHA/NHLBI criteria was present in 55, 67.5 and 62.5% of NAFLD patients, respectively. The mean IMT was significantly higher in NAFLD patients (0.646 +/- 0.091 mm) than control subjects (0.544 +/- 0.067 mm), (P < 0.001). Among the vascular risk factors evaluated, the diagnosis of NAFLD and increased body mass index were significant independent predictors of increased IMT. CONCLUSIONS As cardiovascular risk factors, both MetS and increased IMT occur frequently among NAFLD patients. Screening for both conditions might be beneficial for assessment of future atherosclerotic complications.
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Kim CH, Park JY, Lee KU, Kim JH, Kim HK. Fatty liver is an independent risk factor for the development of Type 2 diabetes in Korean adults. Diabet Med 2008; 25:476-81. [PMID: 18346164 DOI: 10.1111/j.1464-5491.2008.02410.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIMS To investigate whether fatty liver per se is an independent risk factor of incident type 2 diabetes mellitus (T2DM) in Koreans. METHODS We examined the clinical and laboratory data of 5372 non-diabetic participants (3670 men and 1702 women; age 46.8 +/- 8.4 years, range 20-79 years) who underwent voluntary medical check-ups in 2000 and follow-up examinations in 2005. RESULTS Two hundred and thirty-three participants (4.3%) developed T2DM after 5 years. Univariate analysis showed that the development of diabetes was associated with: male sex; family history of diabetes; smoking; older age; higher body mass index (BMI), systolic and diastolic blood pressure, fasting plasma glucose (FPG), hepatic enzymes, total cholesterol and triglycerides; lower HDL cholesterol; and the presence of fatty liver on ultrasonography at baseline. In multiple logistic regression models, after adjusting for age, sex and alcohol consumption, patients with fatty liver were at significantly higher risk of developing T2DM compared to those without fatty liver [relative risk (RR) 3.92, 95% confidence interval (CI) 2.89-5.31]. After further adjustment for smoking, BMI, triglycerides, HDL cholesterol, FPG, alanine aminotransferase and ultrasonographer, fatty liver remained significantly associated with the development of T2DM (RR 1.51, 95% CI 1.04-2.20). Patients with moderate to severe fatty liver had higher risk ratios than patients with mild fatty liver. Exclusion of frequent drinkers did not attenuate the association. CONCLUSIONS Fatty liver on ultrasonography is associated with the development of T2DM, independently of classical risk factors, in Korean adults.
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Affiliation(s)
- C-H Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
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Hendry JH, Akahoshi M, Wang LS, Lipshultz SE, Stewart FA, Trott KR. Radiation-induced cardiovascular injury. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2008; 47:189-93. [PMID: 18193445 DOI: 10.1007/s00411-007-0155-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Accepted: 12/14/2007] [Indexed: 05/03/2023]
Affiliation(s)
- Jolyon H Hendry
- Applied Radiation Biology and Radiotherapy Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Wagramer Strasse 5, Vienna, Austria.
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Sevastianos VA, Hadziyannis SJ. Nonalcoholic fatty liver disease: from clinical recognition to treatment. Expert Rev Gastroenterol Hepatol 2008; 2:59-79. [PMID: 19072371 DOI: 10.1586/17474124.2.1.59] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is probably the most common spectrum of metabolic liver disease in the world, encompassing simple steatosis to steatohepatitis, advanced fibrosis, cirrhosis and hepatocellular carcinoma. NAFLD affects a significant part of the general population worldwide. The existing correlation between obesity and NAFLD in combination with the increase in the frequency of obesity in the developed world implies that the incidence and severity of NAFLD will increase in the near future. Newer data support the idea that NAFLD constitutes the more important cause of cryptogenic cirrhosis of the liver and a ground for the development of hepatocellular carcinoma. Liver biopsy remains the most specific and sensitive method to differentiate NAFLD, providing important information on the long-term prognosis of the patients. The 'two hit' hypothesis constitutes the currently prevailing theory for the development of NAFLD and nonalcoholic steatohepatitis. The first 'hit' is purported to be the increase of free fatty acids in hepatocytes, which results in a decrease of beta-oxidation. The second step includes all mechanisms contributing to the development of necroinflammation and fibrosis. Currently, an effective treatment for patients with NAFLD does not exist. Improvement in liver histology remains the primary goal of any therapeutic approach in patients with NAFLD. Viewing NAFLD in the frame of the metabolic syndrome opens the possibility that both the onset of the disease and disease progression could be prevented by changes in lifestyle. Physical exercise and a low calorie diet in combination with the gradual loss of body weight represent the cornerstone for the management of NAFLD patients.
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Affiliation(s)
- Vassilios A Sevastianos
- Department of Medicine & Hepatology, Henry Dunant Hospital, 107 Messogion Avenue, 11526 Athens, Greece.
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Luthra A, Nigam P, Misra A. Metabolic correlation and management strategies of non-alcoholic fatty liver disease: An Asian Indian perspective. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 2007. [DOI: 10.1016/j.dsx.2007.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Imhof A, Kratzer W, Boehm B, Meitinger K, Trischler G, Steinbach G, Piechotowski I, Koenig W. Prevalence of non-alcoholic fatty liver and characteristics in overweight adolescents in the general population. Eur J Epidemiol 2007; 22:889-97. [PMID: 17896181 DOI: 10.1007/s10654-007-9181-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Accepted: 08/31/2007] [Indexed: 01/19/2023]
Abstract
Overweight and obesity among children and adolescents are increasing. Fatty liver disease (FLD) is an emerging problem in this age group. We investigated prevalence of overweight and non-invasive FLD and associated clinical characteristics in a representative population-based sample of 378 children and adolescents aged 12-20 years who were randomly selected from the general population in Leutkirch, Southern Germany. Overweight was defined as having a body mass index above the 90th percentile for the respective age and sex. About 15% of female (29 out of 194) and 12% of male participants (22/182) were overweight. Among females, only one non-overweight individual showed signs of FLD but in more than one third of the overweight males (8/22) signs of FLD were present. Overweight subjects in general had an unfavourable lipid profile and abnormal concentrations of obesity-related hormones such as significantly lower concentrations of adiponectin and increased levels of inflammatory markers including C-reactive protein and fibrinogen. Overweight males with signs of FLD showed even more severe altered metabolic responses compared to those who were overweight without signs of liver injury. FLD was not explained by alcohol consumption or other chronic liver disease. In this sample of children and adolescents representative of the general population a high prevalence of non-alcoholic fatty liver disease (NAFLD) is found in overweight males. These individuals showed the most severe metabolic alterations compared to non-overweight and overweight individuals without NAFLD indicating even higher risk for future overweight and obesity-related diseases such as type 2 diabetes and cardiovascular disease.
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Affiliation(s)
- Armin Imhof
- Department of Internal Medicine II - Cardiology, University of Ulm Medical Center, Germany
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Nugent C, Younossi ZM. Evaluation and management of obesity-related nonalcoholic fatty liver disease. ACTA ACUST UNITED AC 2007; 4:432-41. [PMID: 17667992 DOI: 10.1038/ncpgasthep0879] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Accepted: 05/17/2007] [Indexed: 02/07/2023]
Abstract
The clinicopathologic spectrum of nonalcoholic fatty liver disease (NAFLD) ranges from simple steatosis to nonalcoholic steatohepatitis (NASH). Simple steatosis has a relatively benign clinical course, but NASH can progress to cirrhosis and hepatocellular carcinoma. NAFLD occurs in the absence of significant alcohol use and is considered to be the hepatic manifestation of metabolic syndrome. NAFLD affects approximately 30% of the US population and the incidence seems to be rising as the obesity epidemic continues. At present, the most accurate modality for the diagnosis of NASH is liver biopsy; however, many patients do not have a liver biopsy, and in the absence of more-accurate imaging technologies and serum markers, the diagnosis is frequently one of exclusion. As yet there is no convincingly effective treatment for NAFLD--a multimodal treatment plan that targets obesity, insulin resistance, hyperlipidemia and hypertension might be the best option for these patients.
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Abstract
Clinical and epidemiologic studies have associated non-alcoholic fatty liver with the metabolic syndrome, with insulin resistance as the pivotal pathogenic factor. Obesity, type 2 diabetes mellitus, dyslipidemia, and hypertension contribute to risk for liver disease and to disease progression. The presence of multiple metabolic abnormalities is associated with the severity of liver disease. Patients have a high risk for cardiovascular morbidity and mortality, mediated by early atherosclerosis. This evidence has precise therapeutic implications: only a behavioral approach to lifestyle correction will address all alterations characterizing the metabolic syndrome, including metabolic liver disease.
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Affiliation(s)
- Giulio Marchesini
- Unit of Metabolic Diseases, Department of Internal Medicine and Gastroenterology, Alma Mater Studiorum University of Bologna, Policlinico S. Orsola, Bologna, Italy.
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BABA T, AMASAKI Y, SODA M, HIDA A, IMAIZUMI M, ICHIMARU S, NAKASHIMA E, SETO S, YANO K, AKAHOSHI M. Fatty Liver and Uric Acid Levels Predict Incident Coronary Heart Disease but Not Stroke among Atomic Bomb Survivors in Nagasaki. Hypertens Res 2007; 30:823-9. [DOI: 10.1291/hypres.30.823] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Haenle MM, Brockmann SO, Kron M, Bertling U, Mason RA, Steinbach G, Boehm BO, Koenig W, Kern P, Piechotowski I, Kratzer W. Overweight, physical activity, tobacco and alcohol consumption in a cross-sectional random sample of German adults. BMC Public Health 2006; 6:233. [PMID: 16981990 PMCID: PMC1586017 DOI: 10.1186/1471-2458-6-233] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2006] [Accepted: 09/18/2006] [Indexed: 12/15/2022] Open
Abstract
Background There is a current paucity of data on the health behaviour of non-selected populations in Central Europe. Data on health behaviour were collected as part of the EMIL study which investigated the prevalence of infection with Echinococcus multilocularis and other medical conditions in an urban German population. Methods Participating in the present study were 2,187 adults (1,138 females [52.0%]; 1,049 males [48.0%], age: 18–65 years) taken from a sample of 4,000 persons randomly chosen from an urban population. Data on health behaviour like physical activity, tobacco and alcohol consumption were obtained by means of a questionnaire, documentation of anthropometric data, abdominal ultrasound and blood specimens for assessment of chemical parameters. Results The overall rate of participation was 62.8%. Of these, 50.3% of the adults were overweight or obese. The proportion of active tobacco smokers stood at 30.1%. Of those surveyed 38.9% did not participate in any physical activity. Less than 2 hours of leisure time physical activity per week was associated with female sex, higher BMI (Body Mass Index), smoking and no alcohol consumption. Participants consumed on average 12 grams of alcohol per day. Total cholesterol was in 62.0% (>5.2 mmol/l) and triglycerides were elevated in 20.5% (≥ 2.3 mmol/l) of subjects studied. Hepatic steatosis was identified in 27.4% of subjects and showed an association with male sex, higher BMI, higher age, higher total blood cholesterol, lower HDL, higher triglycerides and higher ALT. Conclusion This random sample of German urban adults was characterised by a high prevalence of overweight and obesity. This and the pattern of alcohol consumption, smoking and physical activity can be considered to put this group at high risk for associated morbidity and underscore the urgent need for preventive measures aimed at reducing the significantly increased health risk.
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Affiliation(s)
- Mark M Haenle
- Department of Internal Medicine I, University Hospital Ulm, Robert-Koch-Str. 8, 89081 Ulm, Germany
| | - Stefan O Brockmann
- Baden-Württemberg State Health Office, District Government Stuttgart, Germany
| | - Martina Kron
- Department of Biometry and Medical Documentation, University of Ulm, Ulm, Germany
| | | | - Richard A Mason
- Department of Internal Medicine I, University Hospital Ulm, Robert-Koch-Str. 8, 89081 Ulm, Germany
| | - Gerald Steinbach
- Central Department Clinical Chemistry, University Hospital Ulm, Ulm, Germany
| | - Bernhard O Boehm
- Department of Internal Medicine I, University Hospital Ulm, Robert-Koch-Str. 8, 89081 Ulm, Germany
| | - Wolfgang Koenig
- Department of Internal Medicine II, University Hospital Ulm, University of Ulm, Ulm, Germany
| | - Peter Kern
- Department of Internal Medicine II, University Hospital Ulm, University of Ulm, Ulm, Germany
| | - Isolde Piechotowski
- Baden-Württemberg State Health Office, District Government Stuttgart, Germany
| | - Wolfgang Kratzer
- Department of Internal Medicine I, University Hospital Ulm, Robert-Koch-Str. 8, 89081 Ulm, Germany
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Lautamäki R, Borra R, Iozzo P, Komu M, Lehtimäki T, Salmi M, Jalkanen S, Airaksinen KEJ, Knuuti J, Parkkola R, Nuutila P. Liver steatosis coexists with myocardial insulin resistance and coronary dysfunction in patients with type 2 diabetes. Am J Physiol Endocrinol Metab 2006; 291:E282-90. [PMID: 16478772 DOI: 10.1152/ajpendo.00604.2005] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Nonalcoholic fatty liver (NAFL) is a common comorbidity in patients with type 2 diabetes and links to the risk of coronary syndromes. The aim was to determine the manifestations of metabolic syndrome in different organs in patients with liver steatosis. We studied 55 type 2 diabetic patients with coronary artery disease using positron emission tomography. Myocardial perfusion was measured with [15O]H2O and myocardial and skeletal muscle glucose uptake with 2-deoxy-2-[18F]fluoro-D-glucose during hyperinsulinemic euglycemia. Liver fat content was determined by magnetic resonance proton spectroscopy. Patients were divided on the basis of their median (8%) into two groups with low (4.6 +/- 2.0%) and high (17.4 +/- 8.0%) liver fat content. The groups were well matched for age, BMI, and fasting plasma glucose. In addition to insulin resistance at the whole body level (P = 0.012) and muscle (P = 0.002), the high liver fat group had lower insulin-stimulated myocardial glucose uptake (P = 0.040) and glucose extraction rate (P = 0.0006) compared with the low liver fat group. In multiple regression analysis, liver fat content was the most significant explanatory variable for myocardial insulin resistance. In addition, the high liver fat group had increased concentrations of high sensitivity C-reactive protein, soluble forms of E-selectin, vascular adhesion protein-1, and intercellular adhesion molecule-1 (P < 0.05) and lower coronary flow reserve (P = 0.02) compared with the low liver fat group. In conclusion, in patients with type 2 diabetes and coronary artery disease, liver fat content is a novel independent indicator of myocardial insulin resistance and reduced coronary functional capacity. Further studies will reveal the effect of hepatic fat reduction on myocardial metabolism and coronary function.
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Lonardo A, Carani C, Carulli N, Loria P. 'Endocrine NAFLD' a hormonocentric perspective of nonalcoholic fatty liver disease pathogenesis. J Hepatol 2006; 44:1196-207. [PMID: 16618516 DOI: 10.1016/j.jhep.2006.03.005] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Amedeo Lonardo
- Dipartimento di Medicina Interna, Medicina III, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Modena, Italy.
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Lee CC, Yao YJ, Chen HL, Guo YL, Su HJ. Fatty liver and hepatic function for residents with markedly high serum PCDD/Fs levels in Taiwan. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2006; 69:367-80. [PMID: 16455615 DOI: 10.1080/15287390500244972] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
This study was designed to examine the associations between serum polychtorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) levels and adverse hepatic-related health outcomes. Residents living in the vicinity of a closed pentachlorophenol (PCP) manufacturing factory (exposure area) and other areas nearby (control area) were identified from prior investigation of serum PCDD/Fs measurements. A total of 85 subjects were recruited for the study, 52 from exposure area and 33 from control, respectively. Average level of serum PCDD/Fs was 80.1 6 50.9 pg WHO-TEQ/g lipid for those residing in exposure area, and 25.5 6 18.2 in control area. Statistically higher odds ratio (ORs) for fatty liver and gamma-glutamyltransferase (GGT) activity was found in subjects with higher serum PCDD/Fs levels and high body mass index (BMI) as compared to those with lower PCDD/Fs levels and less BMI. Data suggest that dioxin exposure and high lipid content affect the prevalence of fatty liver in exposed subjects. Future study should be directed to prevent continuous exposure to environmental PCDD/Fs from the defunct PCP factory, and to characterize prospectively, with a larger study sample size, the potential long-term consequences on hepatic function associated with contaminant exposure.
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Affiliation(s)
- Ching-Chang Lee
- Department of Environmental and Occupational Health, National Cheng Kung University, Tainan, Taiwan
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Kahlon TS, de J. Berrios J, Smith GE, Pan JL. Extrusion Conditions Modify Hypocholesterolemic Properties of Wheat Bran Fed to Hamsters. Cereal Chem 2006. [DOI: 10.1094/cc-83-0152] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- T. S. Kahlon
- Western Regional Research Center, USDA, Agricultural Research Service, 800 Buchanan Street, Albany, CA 94710. Names are necessary to report factually on available data; however, the USDA neither guarantees nor warrants the standard of the product, and the use of the name by the USDA implies no approval of the product to the exclusion of others that may also be suitable
- Corresponding author. Phone: 510-559-5665. Fax: 510-559-5777. E-mail:
| | - J. de J. Berrios
- Western Regional Research Center, USDA, Agricultural Research Service, 800 Buchanan Street, Albany, CA 94710. Names are necessary to report factually on available data; however, the USDA neither guarantees nor warrants the standard of the product, and the use of the name by the USDA implies no approval of the product to the exclusion of others that may also be suitable
| | - G. E. Smith
- Western Regional Research Center, USDA, Agricultural Research Service, 800 Buchanan Street, Albany, CA 94710. Names are necessary to report factually on available data; however, the USDA neither guarantees nor warrants the standard of the product, and the use of the name by the USDA implies no approval of the product to the exclusion of others that may also be suitable
| | - J. L. Pan
- Western Regional Research Center, USDA, Agricultural Research Service, 800 Buchanan Street, Albany, CA 94710. Names are necessary to report factually on available data; however, the USDA neither guarantees nor warrants the standard of the product, and the use of the name by the USDA implies no approval of the product to the exclusion of others that may also be suitable
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Association Between Sonographic Fatty Liver and Ischemic Electrocardiogram Among Non-obese Taiwanese Male Adults. J Med Ultrasound 2006. [DOI: 10.1016/s0929-6441(09)60092-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Loria P, Lonardo A, Carulli L, Verrone AM, Ricchi M, Lombardini S, Rudilosso A, Ballestri S, Carulli N. Review article: the metabolic syndrome and non-alcoholic fatty liver disease. Aliment Pharmacol Ther 2005; 22 Suppl 2:31-6. [PMID: 16225469 DOI: 10.1111/j.1365-2036.2005.02592.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Metabolic syndrome represents a common risk factor for premature cardiovascular disease and cancer whose core cluster includes diabetes, hypertension, dyslipidaemia and obesity. The liver is a target organ in metabolic syndrome patients in which it manifests itself with non-alcoholic fatty liver disease spanning steatosis through hepatocellular carcinoma via steatohepatitis and cirrhosis. Given that metabolic syndrome and non-alcoholic fatty liver disease affect the same insulin-resistant patients, not unexpectedly, there are amazing similarities between metabolic syndrome and non-alcoholic fatty liver disease in terms of prevalence, pathogenesis, clinical features and outcome. The available drug weaponry for metabolic syndrome includes aspirin, metformin, peroxisome proliferator-activated receptor agonists, statins, ACE (angiotensin I-converting enzyme) inhibitors and sartans, which are potentially or clinically useful also to the non-alcoholic fatty liver disease patient. Studies are needed to highlight the grey areas in this topic. Issues to be addressed include: diagnostic criteria for metabolic syndrome; nomenclature of non-alcoholic fatty liver disease; enlargement of the clinical spectrum and characterization of the prognosis of insulin resistance-related diseases; evaluation of the most specific clinical predictors of metabolic syndrome/non-alcoholic fatty liver disease and assessment of their variability over the time; characterization of the importance of new risk factors for metabolic syndrome with regard to the development and progression of non-alcoholic fatty liver disease.
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Affiliation(s)
- P Loria
- University of Modena and Reggio Emilia, Modena, Italy.
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Abstract
The metabolic syndrome is a multifaceted clinical entity resulting from the interaction of genetic, hormonal, and lifestyle factors. Over the past two decades, the number of people diagnosed with the syndrome has steadily increased and is associated with the global epidemic of obesity and diabetes. The metabolic syndrome is characterized by the clustering of disorders which includes high blood pressure, high (pro)insulin concentrations, excess body weight with central obesity, and an altered lipid profile (dyslipidaemia) that increase the likelihood to develop micro- and macrovascular complications, including coronary heart disease or stroke. Each of these disorders is by itself a risk factor for other diseases including diabetes mellitus. In combination, morbidity and mortality are dramatically increased. Because the defining thresholds for establishing the diagnosis of the metabolic syndrome are controversial, the NCEP: ATP III and the WHO have made specific suggestions. The current definitions of the metabolic syndrome can be used as predictors of vascular complications. Risk assessment and subsequent selection of probands for intervention, such as weight reduction and increased physical activity are recommended for the clinical management of the metabolic syndrome.
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Affiliation(s)
- Bernhard O Boehm
- Div of Endocrinology and Diabetes, Dept of Internal Medicine, University of Ulm, Ulm, Germany.
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Abstract
AIM: To demonstrate the prevalence of sonographic fatty liver, overweight and ischemic heart disease (IHD) among the male workers in Taiwan, and to investigate the possible association of these three factors.
METHODS: From July to September 2003, a total of 2 088 male aircraft-maintenance workers aged from 22 to 65 years (mean 40.5) underwent an annual health examination, including anthropometrical evaluation, blood pressure measurement, personal medical history assessment, biochemical blood analysis, abdominal ultrasonographic examination and digital electrocardiography (ECG). The Student’s t-test, χ2 test and multivariate logistic regression analysis were utilized to evaluate the relationship between IHD and salient risk factors.
RESULTS: The all-over prevalence of overweight was 41.4%, and that of fatty liver was 29.5% (mild, moderate and severe fatty liver being 14.5%, 11.3%, and 3.7%, respectively); while the prevalence of ischemic changes on ECG was 17.1% in this study. The abnormal rates for conventional IHD risk factors including hypertension, dyslipidemia, hyperglycemia and overweight increased in accordance with the severity of fatty liver. Overweight and severity of fatty liver were independently associated with increased risks for developing IHD. Overweight subjects had a 1.32-fold (95%CI: 1.01-1.73) increased IHD risk. Participants with mild, moderate, and severe fatty liver had a 1.88-fold (95%CI: 1.37-2.6), 2.37-fold (95%CI: 1.66-3.37) and 2.76-fold (95%CI: 1.62-4.72) increased risk for developing IHD. The prevalence of ischemic ECG for the fatty liver-affected subjects with or without overweight was 30.1% and 19.1%, while that of overweight subjects free from fatty liver was 14.4%. Compared to the subjects without fatty liver nor overweight, IHD risk for the three subgroups above was as follows: OR: 2.95 (95%CI: 2.31-4.09), OR: 1.60 (95%CI: 1.07-2.39) and OR: 1.11 (95%CI: 0.78-1.56), respectively.
CONCLUSION: The presence of fatty liver and its severity should be carefully considered as independent risk factors for IHD. Results of the study suggest the synergistic effect between fatty liver and overweight for developing IHD. Abdominal sonographic examination may provide valuable information for IHD risk assessment in addition to limited report about liver status, especially for overweight males.
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Affiliation(s)
- Yu-Cheng Lin
- Department of Family Medicine and Center for Environmental and Occupational Medicine, Shin Kong Wu Ho-Su Memorial Hospital, 95 Wen Chang Road, Shih Lin, Taipei 111, Taiwan, China
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Volzke H, Robinson DM, Kleine V, Deutscher R, Hoffmann W, Ludemann J, Schminke U, Kessler C, John U. Hepatic steatosis is associated with an increased risk of carotid atherosclerosis. World J Gastroenterol 2005; 11:1848-53. [PMID: 15793879 PMCID: PMC4305889 DOI: 10.3748/wjg.v11.i12.1848] [Citation(s) in RCA: 187] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: Although an association between hepatic steatosis and vascular risk factors has been described, direct relationships between fatty liver and atherosclerosis have not yet been investigated. The aim of the present study has been to investigate those relationships.
METHODS: The Study of Health in Pomerania examined a random population sample aged between 20 and 79 years. A study population of 4222 subjects without hepatitis B and C infections and without liver cirrhosis was available for the present analysis. Hepatic steatosis was defined sonographically and intima-media thickness (IMT) as well as plaque prevalence were estimated by carotid ultrasound.
RESULTS: The prevalence rate of hepatic steatosis was 29.9%. Among subjects aged ≥45 years, an association between hepatic steatosis and IMT of the carotid arteries was found in bivariate analysis, but not after adjustment for atherosclerotic risk factors. Individuals with fatty liver had more often carotid plaques than persons without fatty liver (plaque prevalence rate 76.8% vs 66.6%; P<0.001). This association persisted after adjustment for confounding factors and was predominantly present in subjects with no to mild alcohol consumption.
CONCLUSION: There is an independent association between hepatic steatosis and carotid atherosclerotic plaques. Metabolic changes due to nonalcoholic fatty liver disease may explain this relationship.
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Affiliation(s)
- Henry Volzke
- Institute of Epidemiology and Social Medicine, Ernst Moritz Arndt University, Walther Rathenau Str. 48, D-17487 Greifswald, Germany.
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Vehmas T, Kaukiainen A, Immonen-Räihä P, Lohman M, Luoma K. Liver echogenicity: relation to systemic blood pressure and other components of the metabolic syndrome. ULTRASOUND IN MEDICINE & BIOLOGY 2005; 31:293-299. [PMID: 15749549 DOI: 10.1016/j.ultrasmedbio.2004.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2004] [Revised: 11/29/2004] [Accepted: 12/17/2004] [Indexed: 05/24/2023]
Abstract
We studied the impact of liver echogenicity among other potential predictors of systemic blood pressure (BP) and the metabolic syndrome. 38 persons (32 males, six females, aged 29 to 66) had their liver echogenicities scored, BPs measured and standard serum laboratory tests studied. There was a significant correlation between both systolic (r=0.438, p=0.006) and diastolic (r=0.498, p=0.001) BP and liver echogenicity. Liver echogenicity was the strongest predictor for systolic BP and the second strongest (after body mass index, BMI) for diastolic BP. Body height may modify the relation between liver echogenicity and systolic BP. Liver echogenicity also correlated significantly with BMI (r=0.527, p=0.001), serum triglycerides (r=0.472, p=0.003) and, to a lesser degree, with serum total cholesterol (r=0.305, p=0.066). Incidentally found increased liver echogenicity should alert the US performer and the clinician reading the report on the possibility of elevated BP or other features of the metabolic syndrome.
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Affiliation(s)
- Tapio Vehmas
- Finnish Institute of Occupational Health, Helsinki, Finland.
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Chen QK, Chen HY, Wang LY, Chen WX, Huang ZQ. Association between fatty liver and hyperlipidemia. Shijie Huaren Xiaohua Zazhi 2004; 12:914-916. [DOI: 10.11569/wcjd.v12.i4.914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the association between the formation of fatty liver and the phenotypes of hyperlipidemia.
METHODS: A total of 258 patients with hyperlipidemia were found in 413 patients with fatty liver, and 61 cases of hyperlipidemia in non-fatty liver patients were selected randomly as controls. The complications and liver function abnormalities were compared between two groups.
RESULTS: The proportion of hypertriglyceridemia and mixed hyperlipidemia was higher in the patients with fatty liver than non-fatty liver. Odds ratios (OR) of finding fatty liver in the patients with mixed hyperlipidemia and hypertrigly-ceridemia were 5.966 and 2.960 respectively, relative to hypercholesterolemia. The percentage of complications of typeⅡdiabetes mellitus, obesity, hypertension, hyperuris-emia and the evelation of serum alanine aminotransferase (ALT), -glutamyltransferase (GGT) were higher in patients with fatty liver than non-fatty liver. But, there were no differences in coincidence of diabetes mellitus, obesity, hyperten-sion, hyperurisemia, coronary heart disease, choelithiasis among various phenotypes of hyperlipidemia.
CONCLUSION: The pathogenesis of fatty liver can be related to mixed hyperlipidemia and hypertriglyceridemia. The complications of patients with fatty liver may be more common than those with non-fatty liver, but have no differences of complications among various phenotypes of hyperlipidemia.
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Abstract
Clinicians in both the developed and also the newer industrial economies in the Asia-Pacific region will encounter non-alcoholic fatty liver disease (NAFLD) with increasing frequency. Although the region has been a significant contributor to the current state of knowledge, the spectrum of NAFLD, its severity and the potential for significant future morbidity and health costs are not widely recognized. Lifestyle changes, the epidemic of childhood and adult obesity and type 2 diabetes sweeping the Asia-Pacific represent the key substrates for the rising prevalence of NAFLD. Physicians in all disciplines need to be aware of clinical clues to the presence of NAFLD in the absence of other liver disease and in those with chronic viral hepatitis and they should be able to identify subsets at risk for liver-related morbidity. Given the scope of the problem, efforts should focus primarily on preventing or ameliorating the impact of risk factors; the key one is insulin resistance and its associates of diabetes and central obesity. Pharmacotherapy may play a role in selected individuals. A regional agenda for case definition, future study and public health initiatives is urgently required.
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Affiliation(s)
- Shivakumar Chitturi
- Storr Liver Unit, Westmead Millennium Institute, University of Sydney, Westmead Hospital, Westmead, New South Wales, Australia
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