MAFLD: A Consensus-Driven Proposed Nomenclature for Metabolic Associated Fatty Liver Disease

The association between the dietary index for gut microbiota and metabolic dysfunction-associated fatty liver disease: a cross-sectional study

BACKGROUND

The relationship between the gut microbiome and metabolic dysfunction-associated fatty liver disease (MAFLD) has garnered increasing attention. However, the association between the dietary index for gut microbiota (DI-GM), a measure of microbiome diversity, and MAFLD has yet to be fully explored.

METHODS

Data from the 2017-2020 National Health and Nutrition Examination Survey (NHANES) were analyzed, including 7243 participants. The association between DI-GM and MAFLD was investigated using weighted logistic regression, restricted cubic spline (RCS), and subgroup analyses.

RESULTS

A notable inverse association was identified between DI-GM and the prevalence of MAFLD, with each 1-point increase in DI-GM corresponding to a 6.1% reduction in MAFLD prevalence (OR = 0.939, 95% CI: 0.901-0.980). Individuals with a DI-GM score of 6 or higher had an adjusted OR of 0.794 (95% CI: 0.665-0.947) compared to those with a DI-GM score of 0-3. RCS analysis further revealed a linear relationship between DI-GM and MAFLD risk. Additionally, subgroup analyses suggested that race may modify the association between DI-GM and MAFLD (P for interaction < 0.05).

CONCLUSIONS

DI-GM is inversely associated with MAFLD prevalence, and race appears to be a significant modifier of this relationship.

Lipid metabolism indicators provide tools for the diagnosis of non-alcoholic fatty liver disease: results of a nationwide survey

Background

Cardiometabolic index (CMI), visceral adiposity index (VAI), and lipid accumulation product (LAP) are lipid-related parameters that reflect central obesity, which is closely associated with the development of non-alcoholic fatty liver disease (NAFLD). The aim of this study is to investigate the effectiveness of these lipid-related parameters in diagnosing NAFLD and to compare their predictive abilities.

Methods

This population-based study extracted datasets from the National Health and Nutrition Examination Survey (NHANES) 2017-2020. CMI, VAI, and LAP were included in the multivariate logistic model as both continuous and categorical variables to assess the relationship between different lipid-related parameters and NAFLD. To further elucidate this connection, we utilized restricted cubic splines and conducted subgroup analysis. Additionally, the receiver operating characteristics (ROC) curve was employed to evaluate the predictive effectiveness of CMI, VAI, and LAP for NAFLD.

Results

The study included 2,878 adults as the study population, of whom 1,263 participants were diagnosed with NAFLD. When lipid-related parameters were analyzed as continuous variables, they showed a positive correlation with NAFLD. The OR(95%CI) were 2.29(1.81,2.89) for CMI (per 1-unit), 1.40(1.28,1.52) for VAI (per 1-unit) and 1.15(1.11,1.20) for LAP (per 10-units). This correlation remains statistically significant when the lipid-related parameters are analyzed as categorical variables. In descending order of diagnostic capability for NAFLD, the AUC values are as follows: LAP (0.794), CMI (0.752), and VAI (0.719).

Conclusion

CMI, VAI, and LAP may be important clinical indicators for identifying NAFLD, with LAP demonstrating the best predictive ability among them.

FLAME: Training and Validating a Newly Conceived Model Incorporating Alpha-Glutathione-S-Transferase Serum Levels for Predicting Advanced Hepatic Fibrosis and Acute Cardiovascular Events in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)

Alpha-Glutathione-S-transferase (alphaGST) is a liver enzyme whose serum levels increase with the worsening of fibrosis in alcoholic and viral chronic hepatitis. Its usefulness in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) remains unexplored. From January 2016 to December 2017, 200 patients with MASLD and 30 controls were enrolled. AlphaGST serum levels were measured. Variables related to advanced fibrosis (AF) were selected via Principal Component Analysis (PCA), and the best cut-off (BCO) was estimated using ROC analysis. Liver stiffness measurement (LSM), NAFLD fibrosis (NFS), Fibrosis-4 (FIB-4), and BMI-AST/ALT Ratio-Diabetes (BARD) scores were determined. The first acute cardiovascular events (ACE) in ACE-naïve subjects were recorded over five years. A validation cohort of 60 MASLD patients was enrolled from January 2018 to May 2019 and followed for five years. AlphaGST levels increased with fibrosis stage (p < 0.0001) in both cohorts, showing high accuracy in predicting AF (TrC: AUC 0.89, VlC: AUC 0.89). PCA-selected variables were HbA1c, HDL, and alphaGST, forming the "FLAME" model. FLAME showed superior predictive performance for AF and ACEs compared to other models and scores. FLAME represents a novel tool that accurately predicts AF and ACEs in MASLD.

A Novel Point-of-Care Prediction Model for Steatotic Liver Disease: Expected Role of Mass Screening in the Global Obesity Crisis

Background/Aims

The incidence of steatotic liver disease (SLD) is increasing across all age groups as the incidence of obesity increases worldwide. The existing noninvasive prediction models for SLD require laboratory tests or imaging and perform poorly in the early diagnosis of infrequently screened populations such as young adults and individuals with healthcare disparities. We developed a machine learning-based point-of-care prediction model for SLD that is readily available to the broader population with the aim of facilitating early detection and timely intervention and ultimately reducing the burden of SLD.

Methods

We retrospectively analyzed the clinical data of 28,506 adults who had routine health check-ups in South Korea from January to December 2022. A total of 229,162 individuals were included in the external validation study. Data were analyzed and predictions were made using a logistic regression model with machine learning algorithms.

Results

A total of 20,094 individuals were categorized into SLD and non-SLD groups on the basis of the presence of fatty liver disease. We developed three prediction models: SLD model 1, which included age and body mass index (BMI); SLD model 2, which included BMI and body fat per muscle mass; and SLD model 3, which included BMI and visceral fat per muscle mass. In the derivation cohort, the area under the receiver operating characteristic curve (AUROC) was 0.817 for model 1, 0.821 for model 2, and 0.820 for model 3. In the internal validation cohort, 86.9% of individuals were correctly classified by the SLD models. The external validation study revealed an AUROC above 0.84 for all the models.

Conclusions

As our three novel SLD prediction models are cost-effective, noninvasive, and accessible, they could serve as validated clinical tools for mass screening of SLD.

Comparative application of MAFLD and MASLD diagnostic criteria on NAFLD patients: insights from a single-center cohort

The diagnostic criteria for Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) and Metabolic Associated Steatotic Liver Disease (MASLD) aim to refine the classification of fatty liver diseases previously grouped under Non-Alcoholic Fatty Liver Disease (NAFLD). This study evaluates the applicability of the MAFLD and MASLD frameworks in NAFLD patients, exploring their clinical utility in identifying high-risk patients. A total of 369 NAFLD patients were assessed using MAFLD and MASLD diagnostic criteria. Baseline characteristics, metabolic profiles, hepatic fibrosis, and cardiovascular risks were compared across the groups. Among NAFLD patients, 97.55% (n = 359) met MASLD criteria, and 97.01% (n = 357) fulfilled MAFLD criteria. Both frameworks MAFLD and MASLD captured overlapping populations, with MASLD encompassing slightly more cases. No significant differences were observed in metabolic risk factors, fibrosis indices (APRI, FIB-4, NAFLD fibrosis score), or cardiovascular risk (10-year ASCVD score). A small subset of lean NAFLD patients (10 cases) with distinct profiles remained uncategorized by either framework. Pure NAFLD cases (n = 10) were with mild insulin resistance (HOMA-IR: 3.07 ± 0.33) and slightly elevated LDL (102.5 ± 42.87 mg/dL), while fibrosis indices indicated low fibrosis risk. Steatosis indices supported the diagnosis of early-stage NAFLD with preserved liver function. These patients do not meet the criteria for inclusion in the MAFLD or MASLD frameworks, highlighting a gap in the current diagnostic systems. MAFLD and MASLD criteria align closely with NAFLD in capturing patients with metabolic risk with MASLD-enhanced inclusivity. Further refinement is required to address heterogeneity, particularly in lean NAFLD patients. Hypertension prevalence was comparable (17.4% in NAFLD, 18.2% in MAFLD, 17.8% in MASLD; p = 0.960), as was diabetes mellitus (36.7%, 37.8%, and 37.6%, respectively; p = 0.945). Body mass index was also similar across groups, with medians of 33.25, 33.6, and 33.4 kg/m2 (p = 0.731). Non-invasive markers of hepatic fibrosis, including APRI, FIB-4, and NAFLD fibrosis scores, did not differ significantly, with median FIB-4 scores around 1.05 (p = 0.953). Similarly, were the results of hepatic steatosis index and ASCVD score.

Association between Healthy Eating Index-2015 total and metabolic associated fatty liver disease in Americans: a cross-sectional study with U.S. National Health and Nutrition Examination Survey

Background

Utilizing the National Health and Nutrition Examination Survey (NHANES) dataset to investigate the relationship between dietary quality, as assessed by the Healthy Eating Index-2015 (HEI-2015), and the prevalence of metabolic associated fatty liver disease (MAFLD) among adults in the United States, our analysis revealed that an increased dietary quality was significantly correlated with a reduced risk of MAFLD in the American population.

Method

The NHANES dataset, encompassing the years 2017-2018 and comprising 3,557 participants, was incorporated into our analytical framework. Weighted multivariate linear regression model was performed to assess the linear relationship between the HEI-2015 and MAFLD. Dietary intake data were derived from two 24-h dietary recall interviews conducted as part of NHANES.

Results

Following multivariable adjustment, the weighted multivariable linear regression models demonstrated a negative correlation between the HEI-2015 total scores and the risk of MAFLD. The weighted logistic regression models revealed that each unit of increased HEI-2015 total value was associated with a 1.2% (95% CI: 0.9%, 1.5%; P < 0.001) decrease in the risk of f MAFLD. Upon categorization of the HEI-2015 scores into quartiles, the odds ratios (ORs) for the association between the risk of MAFLD and the quartile scores of HEI-2015, in comparison to the baseline quartile, were 0.945 (95% CI: 0.852-1.047; P = 0.279), 0.834 (95% CI: 0.750-0.927; P < 0.001), and 0.723 (95% CI: 0.646-0.811; P < 0.001), respectively. When participants were stratified by age and sex, subgroup analyses showed a similar trend. This pattern was also evident in the smooth curve fitting (SCF) and weighted generalized additive model (GAM).

Conclusion

Elevated dietary quality, as assessed by the total and component food scores of the HEI-2015, was significantly correlated with a diminished risk of MAFLD among participants in the NHANES survey featured in this investigation.

Nutritional Strategies for Battling Obesity-Linked Liver Disease: the Role of Medical Nutritional Therapy in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) Management

PURPOSE OF REVIEW

This narrative review explores the role of Medical Nutritional Therapy (MNT) in managing Metabolic-Associated Steatotic Liver Disease (MASLD), previously known as nonalcoholic fatty liver disease. It aims to examine the effectiveness of specific nutritional strategies in preventing and treating this obesity-linked liver disease.

RECENT FINDINGS

Emerging evidence underscores the benefits of the Mediterranean diet, low-carbohydrate diets, and intermittent fasting in reducing liver fat, improving insulin sensitivity, and mitigating inflammation. Supplementing with vitamin E, omega-3 fatty acids, and silymarin can potentially reduce liver fibrosis and promote liver health. MNT is a key intervention for MASLD management, emphasizing dietary patterns, caloric restriction, and nutraceutical supplementation. Integrating these strategies with lifestyle modifications, including regular physical activity, offers a comprehensive approach to improving metabolic and liver outcomes in patients with MASLD. Further research is needed to refine and personalize these therapeutic interventions.

The oral-gut microbiota axis: a link in cardiometabolic diseases

The oral-gut microbiota axis plays a crucial role in cardiometabolic health. This review explores the interactions between these microbiomes through enteric, hematogenous, and immune pathways, resulting in disruptions in microbial balance and metabolic processes. These disruptions contribute to systemic inflammation, metabolic disorders, and endothelial dysfunction, which are closely associated with cardiometabolic diseases. Understanding these interactions provides insights for innovative therapeutic strategies to prevent and manage cardiometabolic diseases.

Discovery of ZG-2305, an Orally Bioavailable Factor Inhibiting HIF Inhibitor for the Treatment of Obesity and Fatty Liver Disease

Genetic loss of the 2-oxoglutarate oxygenase factor inhibiting hypoxia-inducible factor (FIH) enhances both glycolysis and aerobic metabolism. FIH is thus a potential target for adiposity control and improving hepatic steatosis. We describe development of a series of novel, potent, and selective FIH inhibitors that occupy both the FIH catalytic site and a recently defined tyrosine conformational-flip pocket. ZG-2305, with a Ki of 79.6 nM for FIH, manifests 38-fold selectivity over the hypoxia-inducible factor (HIF) prolyl hydroxylase PHD2. Oral administration of ZG-2305 in the western-diet induced obesity mouse model results in improved lipid accumulation and recovery from abnormal body weight/hepatic steatosis. Amelioration of nonalcoholic steatohepatitis (NASH) related pathological phenotypes in the HF-CDAA-diet induced NASH mouse model was observed. Preliminary preclinical studies indicate ZG-2305 has good pharmacokinetic properties and an acceptable safety profile. The results imply ZG-2305 is a promising candidate for treatment of obesity and fatty liver disease.

Diet quality and physical activity affect metabolic dysfunction-associated steatotic liver disease, metabolic dysfunction and etiology-associated steatohepatitis, and compensated advanced chronic liver disease among United States adults: NHANES 2017-2020

Background and aim

Clinical data on the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction and etiology-associated steatohepatitis (MetALD) in a multi-ethnic U.S. population are limited. Additionally, the impact of physical activity (PA) and diet quality (DQ) on the risk of MASLD, MetALD, and compensated advanced chronic liver disease (cACLD) remains unclear. This study aimed to investigate the associations of PA and diet quality with the risks of MASLD, MetALD, and cACLD.

Methods and results

This cross-sectional study analyzed data from 7,125 participants in the National Health and Nutrition Examination Survey (NHANES) 2017-2020. Diet quality was assessed using the Healthy Eating Index-2015 (HEI-2015). PA was assessed based on the 2020 WHO Physical Activity Guidelines, with participants reporting the intensity, frequency, and duration of their activities over the past 7 days. MASLD and MetALD were diagnosed based on clinical criteria, and cACLD was defined by advanced liver fibrosis. Bivariate and multivariable logistic regression models were used to assess associations between PA, diet quality, and liver disease outcomes. The prevalence of MASLD and MetALD was 35.07 and 21.46%, respectively. HQD was associated with significantly lower risks of MASLD (OR: 0.49, 95% CI: 0.38-0.62) and MetALD (OR: 0.45, 95% CI: 0.36-0.56). High PA levels were linked to reduced risks of MASLD (OR: 0.47, 95% CI: 0.38-0.58) and MetALD (OR: 0.53, 95% CI: 0.39-0.72). The lowest risks for both MASLD and MetALD were observed in highly active participants with an HQD (MASLD OR: 0.41, 95% CI: 0.32-0.53; MetALD OR: 0.54, 95% CI: 0.41-0.71). Significant interactions were observed between PA, HQD, and age, BMI, and SES, which further reduced the risks of MASLD and MetALD. For cACLD, both increased PA and HQD were associated with reduced risk. Compared to non-high-activity participants with a non-HQD, physically active participants with an HQD had the lowest risk of cACLD (OR: 0.44, 95% CI: 0.24-0.82).

Conclusion

High proportions of the US population have MASLD or MetALD. HQD and high PA levels were associated with lower risks of MASLD, MetALD, and cACLD.

Impact of bariatric surgery on liver fibrosis indices among type 2 diabetes patients in a national cohort

Obesity is related to liver fibrosis, a condition marked by the collection of scar tissue in the liver due to the development of a profibrotic environment, which includes increased hepatocellular death and elevated reactive oxygen species production. The aim of study is to evaluate the effect of bariatric surgery on the association between liver fibrosis indices and obesity. This is a retrospective cohort, evaluating 1205 individuals diagnosed with type 2 diabetes (T2D) and living with obesity, who experienced bariatric surgery. These patients living with T2D and obesity were monitored after bariatric surgery for two years. The trajectory of biochemical markers and liver fibrosis indices were evaluated at five visits. These liver indices were Fibrosis-4 (FIB-4) index, aspartate aminotransferase (AST) to platelet ratio index, and non-alcoholic fatty liver disease (NAFLD) fibrosis score. FIB-4 index demonstrated notable trends based on its values. It showed an initial increase observed at the three-months visit, followed by a decline up to one year with a slight increase at the last follow-up (P-trend < 0.001). It should be mentioned that, mean FIB-4 in patients with FIB-4 ≥ 1.3 (pre-operation) did not exceed the value of 2.00, which is lower than the cut-off value of high risk for liver cirrhosis (FIB-4 ≥ 2.67). In addition, the NAFLD fibrosis score (NFS) demonstrated a substantial decline from - 0.32 ± 1.32 pre-operation to -0.86 ± 1.15 at the two-year mark (P-trend < 0.001). Finally, the AST to platelet ratio index (APRI) decreased from 0.27 ± 0.20 pre-operation to 0.23 ± 0.12 at the 12-month follow-up. Bariatric surgery significantly improves NFS and cause alterations in APRI and Fib-4 index levels without increasing the risk of liver cirrhosis development among patients with T2D and obesity.

Evidence summary of lifestyle interventions in adults with metabolic dysfunction-associated steatotic liver disease

Objective

In this study, our objective was to provide practice recommendations by thoroughly examining lifestyle interventions for adults diagnosed with metabolic dysfunction-associated steatotic liver disease (MASLD). This was achieved through a systematic review of the literature, specifically focusing on lifestyle modification interventions in adults with MASLD.

Methods

The PIPOST (Population, Intervention, Professional, Outcome, Setting, and Type of evidence) framework was used to identify the questions for summarizing evidence. Utilizing the 6S model for the hierarchy of evidence, a computerized search was conducted to retrieve articles pertaining to lifestyle interventions for adults with MASLD from websites such as the UpToDate Clinical Advisor, BMJ Best Practice, JBI Library, Cochrane Library, International Guidelines Library, and PubMed, among others. The available research included clinical decisions, clinical practice guidelines, evidence summaries, systematic evaluation, expert consensus, and expert opinions. Two researchers independently evaluated the methodology of the studies, and evidence was subsequently extracted and grouped thematically. Our review encompassed publications from January 2018 to March 2023.

Results

A total of 26 publications were identified for the final review, consisting of seven guidelines, nine systematic evaluations, and 10 expert consensuses/opinions. From these sources, we derived six themes, 28 pieces of evidence: intervention modalities, diet management, exercise management, weight loss management, personalized management, and multidisciplinary collaboration.

Conclusion

In the management of adults with MASLD, healthcare professionals should embrace a multidisciplinary team approach, adhere to the best available evidence, and develop structured and personalized interventions based on the best evidence for lifestyle modifications.

Effects of Sympathetic Denervation in Metabolism Regulation: A Novel Approach for the Treatment of MASLD?

Although metabolic dysfunction-associated steatotic liver disease (MASLD), previously termed nonalcoholic fatty liver disease, has become the most common chronic liver disorder, its complex pathophysiology has not been fully elucidated up to date. A correlation between elevated sympathetic activation and MASLD has been highlighted in recent preclinical and clinical studies. Furthermore, increased sympathetic activity has been associated with the main mechanisms involved in MASLD, such as lipid accumulation in the liver, insulin resistance, and metabolic dysregulation, while it has been also correlated with the progression of MASLD, leading to liver fibrosis. Preclinical studies demonstrated that therapies which ameliorate the activation of the sympathetic nervous system, such as renal and liver sympathetic denervation, reduce hepatic insulin resistance, decrease hepatic glucose production, and reverse hepatic steatosis in high-fat-diet models. However, data from clinical trials regarding the effect of renal denervation on metabolic parameters are conflicting, since several trials reported a favorable effect, while other trials stated no significant difference, with the profound limitation of the lack of originally designed denervation trials in this setting. Thus, a thorough review of the role of the sympathetic nervous system in the pathophysiology of MASLD, as well as the results of recent sympathetic denervation studies and trials regarding metabolic regulation and MASLD treatment would be of great importance.

Association between the triglyceride-glucose index and liver fibrosis in adults with metabolism-related fatty liver disease in the United States: a cross-sectional study of NHANES 2017-2020

OBJECTIVE

This study aimed to examine the association between the triglyceride-glucose (TyG) index and liver fibrosis (LF) in U.S. adults with Metabolic Dysfunction-Associated Steatotic Liver Disease (MAFLD).

METHODS

Using data from the 2017 to 2020 National Health and Nutrition Examination Survey (NHANES) database, we conducted a population-based cross-sectional study with 1,324 participants. MAFLD was defined as a controlled attenuation parameter (CAP) score ≥ 248 dB/m accompanied by metabolic dysfunction. A median liver stiffness measurement ≥ 8.2 kPa was used to identify significant fibrosis (≥ F2). Multivariable logistic regression was employed to assess the impact of the TyG index on LF outcomes. A restricted cubic spline (RCS) model was used to explore nonlinear effects, and receiver operating characteristic (ROC) curves were applied to evaluate the effectiveness in predicting.

RESULTS

Among the participants, 716 were men and 608 were women, aged 20 to 80 years, representing various racial groups. Significant fibrosis was observed in 137 out of 1,324 participants. After adjusting for confounding factors, a higher TyG index was significantly associated with an increased incidence of MAFLD-related LF (OR = 2.18, 95% CI, 1.14-4.18; p < 0.05). Elevated TyG levels showed a positive correlation with significant fibrosis, with an odds ratio (OR) exceeding 1 when the TyG index was above 8.054. Subgroup analyses stratified by sex, age, and body mass index (BMI) revealed differences after adjusting for confounders. The association was stronger in women (OR = 2.53, 95% CI, 1.16-5.53) than in men (OR = 1.95, 95% CI, 0.81-4.72). A significant correlation was also found between TyG levels and obesity status (overweight: OR = 4.80, 95% CI, 1.27-18.2; obese: OR = 2.26, 95% CI, 1.20-5.53). In MAFLD patients aged 40-59, TyG was strongly associated with LF (OR = 2.85, 95% CI, 1.16-6.79). Furthermore, the area under the ROC curve (AUC) for the TyG index in predicting significant fibrosis in MAFLD patients was 0.73 (95% CI, 0.68-0.78), indicating moderate predictive ability.

CONCLUSIONS

In the general U.S. population, elevated TyG index levels were positively associated with an increased risk of LF in MAFLD patients.

Microbiome and metabolomics reveal the effect of gut microbiota on liver regeneration of fatty liver disease

BACKGROUND

Metabolic dysfunction-associated fatty liver disease (MAFLD) is associated with impaired regenerative capacity and poor postoperative prognosis following hepatectomy. Previous research has highlighted the importance of the gut-liver axis in the physiological and pathological processes of the liver. However, the contribution of gut bacteria to the regeneration of livers with MAFLD and its metabolic regulatory mechanisms remain elusive.

METHODS

Partial hepatectomy (PHx) was performed on C57Bl/6J mice fed with high-fat diet (HFD) for 12 weeks. Pathological examination, immunohistochemistry, and qRT-PCR analysis were performed to assess the severity of steatosis and proliferative potential. The gut microbiome was examined by 16S rRNA gene sequencing and shotgun metagenomics, whereas liver metabolomics was analysed via untargeted and targeted metabolomics using liquid chromatography-tandem mass spectrometry (LC-MS).

FINDINGS

HFD-induced hepatic steatosis in mice led to impaired liver regeneration following PHx. The gut microbiota and liver metabolites were altered along with the liver regeneration process. Longitudinal time-series analysis revealed dynamic alterations in these data, whereas correlation analysis screened out bacterial candidates that potentially influence liver regeneration in MAFLD by modulating metabolic pathways. Among these bacteria, the dominant bacterium Akkermansia was selected for subsequent investigation. MAFLD mice gavaged with Akkermansia muciniphila (A. muciniphila) exhibited reduced liver lipid accumulation and accelerated liver regeneration, possibly through the regulation of the tricarboxylic acid (TCA) cycle.

INTERPRETATION

These data demonstrated the interplay between the gut microbiome, liver metabolomics, and liver regeneration in mice with MAFLD. A. muciniphila has the potential to serve as a clinical intervention agent to accelerate postoperative recovery in MAFLD.

FUNDING

This work was supported by the Research Project of Jinan Microecological Biomedicine Shandong Laboratory [JNL-2022008B]; the Zhejiang Provincial Natural Science Foundation of China [LZ21H180001]; the Fundamental Research Funds for the Central Universities [No. 2022ZFJH003].

How the liver transcriptome and lipid composition influence the progression of nonalcoholic fatty liver disease to hepatocellular carcinoma in a murine model

The incidence of nonalcoholic fatty liver disease (NAFLD) has been steadily increasing in Western society in recent years and has been recognized as a risk factor for the development of hepatocellular carcinoma (HCC). However, the molecular mechanisms underlying the progression from NAFLD to HCC are still unclear, despite the use of suitable mouse models. To identify the transcriptional and lipid profiles of livers from mice with NAFLD-HCC, we induced both NAFLD and NAFLD-HCC pathologies in C57BL/6J mice and performed RNA-sequencing (RNA-seq) and targeted lipidomic analysis. Our RNA-seq analysis revealed that the transcriptional signature of NAFLD in mice is characterized by changes in inflammatory response and fatty acid metabolism. Moreover, the signature of NAFLD-HCC is characterized by processes typically observed in cancer, such as epithelial to mesenchymal transition, angiogenesis and inflammatory responses. Furthermore, we found that the diet used in this study inhibited cholesterol synthesis in both models. The analysis of lipid composition also showed a significant impact of the provided diet. Therefore, our study supports the idea that a Western diet (WD) affects metabolic processes and hepatic lipid composition. Additionally, the combination of a WD with the administration of a carcinogen drives the progression from NAFLD to HCC.

The Association Between Serum Gamma-Glutamyl Transferase and Gastrointestinal Cancer Risk: A Systematic Review and Meta-Analysis

BACKGROUND

Gamma-glutamyl transferase (GGT) has been shown to have associations with several diseases including cancers. Previous studies have investigated the effect of GGT levels on the gastrointestinal (GI) cancer incidence. We aim to systematically investigate these studies to provide better insights into the interrelationship between GGT and GI cancers.

METHODS

Online databases were searched to find relevant studies investigating different GGT levels' effects on the incidence of GI cancers including colorectal, esophageal, liver, pancreas, gastric, and biliary duct cancers. Random-effect meta-analysis was conducted to pool the hazard ratios (HRs) of GGT quartiles (Qs) effect on cancer incidence.

RESULTS

A total of 26 studies were included in the final review, 12 of which underwent meta-analysis that investigated 11 million patients. Based on the meta-analysis, Q4 patients had a 69% higher hazard of GI cancer incidence (HR 1.69, 95% CI 1.41-2.02, p-value < 0.001). The hazard ratio significance was also similar for Q3 (HR 1.22, 95% CI 1.15-1.30, p-value < 0.001) and Q2 (HR 1.10, 95% CI 1.05-1.16, p-value =0.002) of GGT. Colorectal and liver cancers showed a higher hazard ratio among Q2, Q3, and Q4 of GGT compared to Q1. In pancreas and bile duct cancers, only Q4 of GGT had significantly higher HR. Q3 and Q4 of GGT levels had statistically significant associations with gastric cancer incidence.

CONCLUSION

Higher GGT levels correlate with higher rates of GI cancer incidence, especially in colorectal and hepatic cancers. Future studies should investigate this biomarker's potential role in risk assessment for digestive cancers.

Effect of Immunosuppressive Regimens on Metabolic Dysfunction-associated Fatty Liver Disease Following Liver Transplantation

Background

Metabolic dysfunction-associated fatty liver disease has been linked to negative outcomes in patients with end-stage liver disease following liver transplantation. However, the influence of immunosuppressive regimens on it has not been explored.

Methods

A retrospective analysis was conducted using the preoperative and postoperative data from patients with end-stage liver disease. The study compared three different groups: tacrolimus-based group, sirolimus-based group, and combined tacrolimus- and sirolimus-based regimens. Binary logistic regression analysis was employed to identify risk factors for metabolic dysfunction-associated fatty liver disease.

Results

A total of 171 patients participated in the study, consisting of 127 males and 44 females, with a mean age of 49.6 years. The prevalence of posttransplant metabolic dysfunction-associated fatty liver disease was 29.23%. Among the three groups, there were 111 liver transplant recipients in the tacrolimus-based group, 28 in the sirolimus-based group, and 32 in the combination group. A statistically significant difference was observed in the incidence of metabolic dysfunction-associated fatty liver disease (P < 0.05), whereas the other preoperative and postoperative parameters showed no significant differences. Multivariate analysis revealed that a low-calorie diet (95% confidence intervals: 0.15-0.90, P = 0.021) and a combination of tacrolimus- and sirolimus-based immunosuppressive regimen (95% confidence intervals: 1.01-2.77, P = 0.046) were associated with lower risk of posttransplant metabolic dysfunction-associated fatty liver disease.

Conclusions

Our study indicates that implementing a low-calorie diet and utilizing a combination of tacrolimus- and sirolimus-based immunosuppressive regimen can effectively lower the risk of posttransplant metabolic dysfunction-associated fatty liver disease following liver transplantation.

Cardiometabolic risk factors and coronary atherosclerosis progression in patients with metabolic dysfunction-associated steatotic liver disease: the influential role of quantity over type

BACKGROUND AND AIM

Individuals with metabolic dysfunction-associated steatotic liver disease (MASLD) who are at an increased risk of cardiovascular disease (CVD) are critical to identify and manage. We aimed to assess whether the risk of CVD in patients with MASLD differed according to the type or number of cardiometabolic risk factors.

METHODS

This longitudinal cohort study involved 5674 adults who underwent at least two health checkups between 2004 and 2021. Steatotic liver disease (SLD) was assessed using ultrasonography and participants with SLD were classified as having either non-MASLD or MASLD. CVD risk was evaluated using coronary artery calcium (CAC) progression as measured using multidetector computed tomography scans.

RESULTS

Over an average 5.8-year follow-up period, patients with MASLD exhibited faster CAC progression than those with non-MASLD (18% vs 11%, P < 0.01). MASLD with any cardiometabolic risk factor exacerbated CAC progression; however, the degree of CAC progression was similar among the different risk components. The adjusted ratios (95% CI) of CAC progression rates comparing non-MASLD with MASLD with one, two, three, four, and five cardiometabolic risk factors were 1.02 (0.99, 1.06), 1.04 (1.01, 1.08), 1.07 (1.03, 1.10), 1.08 (1.05, 1.11), and 1.11 (1.07, 1.15), respectively.

CONCLUSIONS

In individuals with MASLD, all cardiometabolic risk factors contributed to the deterioration of coronary atherosclerosis, with no specific factor exerting a dominant influence. Coronary atherosclerosis progression is directly associated with the cumulative number of cardiometabolic risk factors. Therefore, identifying and managing an increasing number of these factors is imperative in clinical practice, even when MASLD is diagnosed based on only one risk factor.

Prospective comparative diagnostic performance of quantitative ultrasound parameters for the measurement of hepatic steatosis in a biopsy-proven metabolic dysfunction associated steatotic liver disease cohort

OBJECTIVES

The aim of this study was to compare the diagnostic performance of attenuation imaging (ATI), shear wave elastography (SWE), and shear wave dispersion (SWD) for detecting and grading hepatic steatosis in patients with metabolic dysfunction associated steatotic liver disease (MASLD).

METHODS

Sixty-six patients with MASLD confirmed histopathologically and 34 healthy volunteers who were age/sex-matched were prospectively enrolled in this study. ATI, SWE, and SWD examinations were performed. Fibrosis stage, necroinflammatory activity, and steatosis grade were confirmed histopathologically. Steatosis was graded as follows: S0 (<5%); S1 (5%-32%); S2 (33%-66%) to S3 (>66%). We compared the diagnostic performance of ATI, SWE, and SWD for detecting and grading hepatic steatosis.

RESULTS

Both attenuation coefficient (AC) and SWD values were significantly different among the different hepatic steatosis, and both were correlated with hepatic steatosis. ATI had better diagnostic performance than SWD for detecting and grading hepatic steatosis. The area under the receiver operating characteristic (ROC) curve of ATI for detecting ≥S1, ≥S2, and =S3 were 0.917 (cut-off value of 0.69 dB/cm/MHz), 0.933 (cut-off value of 0.74 dB/cm/MHz), and 0.870 (cut-off value of 0.82 dB/cm/MHz), respectively. The area under the ROC curve of SWD value was 0.758 (cut-off value of 10.79 m/s/kHz), 0.685 (cut-off value of 12.64 m/s/kHz), and 0.722 (cut-off value of 13.24 m/s/kHz), respectively.

CONCLUSIONS

ATI technology is a reliable method for detecting and grading hepatic steatosis in patients with MASLD than SWE and SWD.

ADVANCES IN KNOWLEDGE

We compared the diagnostic performance of ATI, SWE, SWD for detecting and grading hepatic steatosis in patients with MASLD in order to find the best diagnostic parameters.

Comparison of NAFLD, MAFLD, and MASLD Prevalence and Clinical Characteristics in Asia Adults

Background/Aims

The principal limitations of the term non-alcoholic fatty liver disease (NAFLD) are the reliance on exclusionary confounder terms and the use of potentially stigmatizing language. Within three years, NAFLD went through two name changes, from NAFLD to metabolic-dysfunction-associated fatty liver disease (MAFLD) to metabolic dysfunction-associated steatotic liver disease (MASLD). However, there is no Asian consensus statement on the renaming of MASLD, and evidence on the epidemiology and characteristics in the Asia population under different diagnostic criteria remain limited. This study aimed to fill these gaps by analyzing the prevalence and characteristics of MASLD, NAFLD, and MAFLD in an Asian population.

Methods

A retrospective, cross-sectional study was conducted in regional China with participants from the health management database in 2017-2022. Demographic and laboratory metabolic profile and body composition data were obtained. Hepatic steatosis were diagnosed by ultrasound. The likelihood of having fibrosis was assessed using the NAFLD fibrosis score (NFS). Recently proposed criteria for metabolic dysfunction-associated steatotic liver disease (MASLD) were applied.

Results

A total of 20,226 subjects were included for final analysis. 7465 (36.91%) participants were categorized as MASLD patients, 10,726 (53.03%) participants were MAFLD, and 7333 (36.26%) participants were NAFLD. Compared with MAFLD, body composition of MASLD and NAFLD patients were obviously different. MASLD patients were older, had a higher body mass index and percentage of male gender, and had a higher ALT, diastolic blood pressure, triglyceride, and waist circumference but lower High-Density Lipoprotein Cholesterol (HDL-C) than non-MASLD patients. Using binary regression analysis, we found for the first time that putative bone mass (OR = 4.62, 95CI% 3.12-6.83) is associated with the risk of developing MASLD. The area under the receiver operating curve (AUC) for predicting cardiovascular outcomes (CV) was 0.644 for MAFLD and 0.701 for MASLD.

Conclusion

MASLD (36.91%) prevalence was closed to NAFLD (36.26%) and lower than MAFLD (53.03%). Presumed bone mass might be the predictor of disease progression in MASLD patients. MASLD better identifies patients likely to have a higher risk of metabolic disorders or CV events.

Application and research progress of magnetic resonance proton density fat fraction in metabolic dysfunction-associated steatotic liver disease: a comprehensive review

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), formerly known as Non-Alcoholic Fatty Liver Disease (NAFLD), is a chronic liver disorder associated with disturbances in lipid metabolism. The disease is prevalent worldwide, particularly closely linked with metabolic syndromes such as obesity and diabetes. Magnetic Resonance Proton Density Fat Fraction (MRI-PDFF), serving as a non-invasive and highly quantitative imaging assessment tool, holds promising applications in the diagnosis and research of MASLD. This paper aims to comprehensively review and summarize the applications and research progress of MRI-PDFF technology in MASLD, analyze its strengths and challenges, and anticipate its future developments in clinical practice.

NAFLD and NAFLD Related HCC: Emerging Treatments and Clinical Trials

Nonalcoholic fatty liver disease (NAFLD), recently renamed metabolic-associated fatty liver disease (MAFLD), is the most prevalent liver disease worldwide. It is associated with an increased risk of developing hepatocellular carcinoma (HCC) in the background of cirrhosis or without cirrhosis. The prevalence of NAFLD-related HCC is increasing all over the globe, and HCC surveillance in NAFLD cases is not that common. In the present review, we attempt to summarize promising treatments and clinical trials focused on NAFLD, nonalcoholic steatohepatitis (NASH), and HCC in the past five to seven years. We categorized the trials based on the type of intervention. Most of the trials are still running, with only a few completed and with conclusive results. In clinical trial NCT03942822, 25 mg/day of milled chia seeds improved NAFLD condition. Completed trial NCT03524365 concluded that Rouxen-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) results in histological resolution of NASH without worsening of fibrosis, while NCT04677101 validated sensitivity/accuracy of blood biomarkers in predicting NASH and fibrosis stage. Moreover, trials with empagliflozin (NCT05694923), curcuvail (NCT06256926), and obeticholic acid (NCT03439254) were completed but did not provide conclusive results. However, trial NCT03900429 reported effective improvement in fibrosis by at least one stage, without worsening of NAFLD activity score (NAS), as well as improvement in lipid profile of the NASH patients by 80 or 100 mg MGL-3196 (resmetirom). Funded by Madrigal Pharmaceuticals, Rezdiffra (resmetirom), used in the clinical trial NCT03900429, is the first FDA-approved drug for the treatment of NAFLD/NASH.

Value of Mac-2 Binding Protein Glycosylation Isomer (M2BPGi) in Assessing Liver Fibrosis in Metabolic Dysfunction-Associated Liver Disease: A Comprehensive Review of its Serum Biomarker Role

Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) is a broad condition characterized by lipid accumulation in the liver tissue, which can progress to fibrosis and cirrhosis if left untreated. Traditionally, liver biopsy is the gold standard for evaluating fibrosis. However, non-invasive biomarkers of liver fibrosis are developed to assess the fibrosis without the risk of biopsy complications. Novel serum biomarkers have emerged as a promising tool for non-invasive assessment of liver fibrosis in MAFLD patients. Several studies have shown that elevated levels of Mac-2 binding protein glycosylation isomer (M2BPGi) are associated with increased liver fibrosis severity in MAFLD patients. This suggests that M2BPGi could serve as a reliable marker for identifying individuals at higher risk of disease progression. Furthermore, the use of M2BPGi offers a non-invasive alternative to liver biopsy, which is invasive and prone to sampling errors. Overall, the usage of M2BPGi in assessing liver fibrosis in MAFLD holds great promise for improving risk stratification and monitoring disease progression in affected individuals. Further research is needed to validate its utility in clinical practice and establish standardized protocols for its implementation.

Ultrasound-based steatosis grading system using 2D-attenuation imaging: An individual patient data meta-analysis with external validation

BACKGROUND AND AIMS

Noninvasive tools assessing steatosis, such as ultrasonography-based 2D-attenuation imaging (ATI), are needed to tackle the worldwide burden of steatotic liver disease. This one-stage individual patient data (IPD) meta-analysis aimed to create an ATI-based steatosis grading system.

APPROACH AND RESULTS

A systematic review (EMBASE + MEDLINE, 2018-2022) identified studies, including patients with histologically or magnetic resonance imaging proton-density fat fraction (MRI-PDFF)-verified ATI for grading steatosis (S0 to S3). One-stage IPD meta-analyses were conducted using generalized mixed models with a random study-specific intercept. Created ATI-based steatosis grading system (aS0 to aS3) was externally validated on a prospective cohort of patients with type 2 diabetes and metabolic dysfunction-associated steatotic liver disease (n=174, histologically and MRI-PDFF-verified steatosis). Eleven enrolled studies included 1374 patients, classified into S0, S1, S2, and S3 in 45.4%, 35.0%, 9.3%, and 10.3% of the cases. ATI was correlated with histological steatosis ( r = 0.60; 95% CI: 0.52, 0.67; p < 0.001) and MRI-PDFF ( r = 0.70; 95% CI: 0.66, 0.73; p < 0.001) but not with liver stiffness ( r = 0.03; 95% CI: -0.04, 0.11, p = 0.343). Steatosis grade was an independent factor associated with ATI (coefficient: 0.24; 95% CI: [0.22, 0.26]; p < 0.001). ATI marginal means within S0, S1, S2, and S3 subpopulations were 0.59 (95% CI: [0.58, 0.61]), 0.69 (95% CI [0.67, 0.71]), 0.78 (95% CI: [0.76, 0.81]), and 0.85 (95% CI: [0.83, 0.88]) dB/cm/MHz; all contrasts between grades were significant ( p < 0.0001). Three ATI thresholds were calibrated to create a new ATI-based steatosis grading system (aS0 to aS3, cutoffs: 0.66, 0.73, and 0.81 dB/cm/MHz). Its external validation showed Obuchowski measures of 0.84 ± 0.02 and 0.82 ± 0.02 with histologically based and MRI-PDFF-based references.

CONCLUSIONS

ATI is a reliable, noninvasive marker of steatosis. This validated ATI-based steatosis grading system could be valuable in assessing patients with metabolic dysfunction-associated steatotic liver disease.

Zearalenone exacerbates lipid metabolism disorders by promoting liver lipid droplet formation and disrupting gut microbiota

Zearalenone (ZEA), produced by Fusarium, is a fungal toxin commonly found in maize, wheat, and other cereals. ZEA has the ability to bind to estrogen receptors of humans and animals and is an environmental endocrine disruptor that may interfere with glucose homeostasis and lipid metabolism. In this study, we first investigated the effects of chronic exposure to low doses of ZEA with a high-fat-diet (HFD) in obese C57BL/6 J mice. In the absence of significant toxicity and without affecting glucose tolerance, 50 and 100 μg/kg b. w. ZEA was found to significantly exacerbate lipid synthesis, accumulation and alter the overall transcriptional profile of the liver in mice synergistically with HFD. Validation in combination with AML-12 cells revealed that ZEA promoted lipid synthesis and increased hepatic lipid droplet accumulation via the HNF1β/PPARγ and SREBP1c-HSD17B13/PLINs signal pathways. Further, by analyzing the changes in the intestinal flora of mice and their relationship with lipid metabolism genes, it was found that ZEA decreased the relative abundance of Lactobacillus and increased the relative abundance of Ileococcus, E. faecalis, and Ricardia. These changes were significantly correlated with the expression of Pparg and Srebf1, etc. ZEA may contribute to the abnormality of lipid metabolism by influencing the intestinal microbiota. This study highlights the synergistic effects of long-term low-dose ZEA and excess lipids, providing a theoretical basis for elucidating the mechanism of chronic toxicity of ZEA and its negative impact on metabolic diseases.

MASLD/MetALD and mortality in individuals with any cardio-metabolic risk factor: A population-based study with 26.7 years of follow-up

BACKGROUND AND AIMS

A new term, metabolic dysfunction-associated steatotic liver disease (MASLD), has been proposed by a multi-society expert panel. However, it remains unclear whether hepatic steatosis per se in MASLD contributes to an increased risk of mortality in individuals with any cardio-metabolic risk factor (CMRF), which is also a significant risk factor for increased mortality. This study aimed to compare all-cause and cause-specific mortality between the "MASLD/MetALD" and "no steatotic liver disease (SLD)" groups in individuals with any CMRF.

APPROACH AND RESULTS

A population-based cohort study was conducted using 10,750 participants of the Third National Health and Nutrition Examination Survey. All-cause and cause-specific (cardiovascular, cancer, diabetes, and liver) mortality risks were compared between the "MASLD," "MetALD," and "no SLD" groups using the Cox proportional hazards model with complex survey design weights, adjusted for confounders. Over 26 years, the "MASLD" group did not show significantly increased all-cause (adjusted HR 1.04[95% CI: 0.95-1.14], p = 0.413), cardiovascular (0.88 [0.75-1.04], p = 0.139), or cancer (1.06[0.84-1.33], p = 0.635) mortality risk compared to the "no SLD" group in individuals with any CMRF. The MetALD group was associated with increased all-cause (1.41 [1.05-1.89], p = 0.022), cancer (2.35 [1.33-4.16], p = 0.004), and liver (15.04 [2.96-76.35], p = 0.002) mortality risk compared with the no SLD group. This trend was more pronounced in the MetALD group with advanced fibrosis assessed by Fibrosis-4 (FIB-4).

CONCLUSIONS

In individuals with CMRF, the presence of steatotic liver disease (MASLD) alone did not increase the risk of mortality, except in cases with more alcohol consumption (MetALD). Therefore controlling metabolic risk factors and reducing alcohol consumption in people with MASLD or MetALD will be crucial steps to improve long-term health outcomes.

Unveiling the endocrine connections of NAFLD: evidence from a comprehensive mendelian randomization study

Background

NAFLD is gaining recognition as a complex, multifactorial condition with suspected associations with endocrine disorders. This investigation employed MR analysis to explore the potential causality linking NAFLD to a spectrum of endocrine diseases, encompassing T1D, T2D, obesity, graves' disease, and acromegaly.

Methods

Our methodology leveraged a stringent IV selection process, adhering to the STROBE-MR guidelines. The MR analysis was conducted utilizing three distinct methods: IVW, WM, and MR-Egger. The IVW method was prioritized as the primary analytical approach. We conducted MR analyses to analyze the causal relationship between NAFLD and metabolic disorders. We also examined 1400 metabolites implicated in NAFLD. Metabolic pathway analysis was performed using the MetaboAnalyst database.

Results

The findings indicated that T2D (OR = 1.211, 95%CI: 0.836-1.585) and obesity (OR = 1.245, 95%CI: 0.816-1.674) are associated with an increased risk of NAFLD development. Further exploration into the the 1400 metabolites revealed that cys-gly and diacetylornithine are predictive of NAFLD, T2D, and obesity, whereas isovalerylcarnitine exhibited an inverse association, potentially inhibiting disease development. Metabolic pathways involving alanine, aspartate, and glutamate metabolism were identified as pivotal regulators in the pathophysiology of NAFLD, T2D, and obesity.

Conclusion

The present study generated innovative viewpoints on the etiology of NAFLD. Our findings underscore the significant role of T2D and obesity in NAFLD pathogenesis through metabolic pathways, presenting opportunities for targeted therapeutic strategies and warranting further investigation.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13534-024-00442-8.

Roles of X-box binding protein 1 in liver pathogenesis

The prevalence of drug-induced liver injury (DILI) and viral liver infections presents significant challenges in modern healthcare and contributes to considerable morbidity and mortality worldwide. Concurrently, metabolic dysfunctionassociated steatotic liver disease (MASLD) has emerged as a major public health concern, reflecting the increasing rates of obesity and leading to more severe complications such as fibrosis and hepatocellular carcinoma. X-box binding protein 1 (XBP1) is a distinct transcription factor with a basic-region leucine zipper structure, whose activity is regulated by alternative splicing in response to disruptions in endoplasmic reticulum (ER) homeostasis and the unfolded protein response (UPR) activation. XBP1 interacts with a key signaling component of the highly conserved UPR and is critical in determining cell fate when responding to ER stress in liver diseases. This review aims to elucidate the emerging roles and molecular mechanisms of XBP1 in liver pathogenesis, focusing on its involvement in DILI, viral liver infections, MASLD, fibrosis/cirrhosis, and liver cancer. Understanding the multifaceted functions of XBP1 in these liver diseases offers insights into potential therapeutic strategies to restore ER homeostasis and mitigate liver damage.

Novel proteomic signatures may indicate MRI-assessed intrahepatic fat state and changes: The DIRECT PLUS clinical trial

BACKGROUND AND AIMS

We demonstrated in the randomized 18-month DIRECT PLUS trial (n = 294) that a Mediterranean (MED) diet, supplemented with polyphenol-rich Mankai duckweed, green tea, and walnuts and restricted in red/processed meat, caused substantial intrahepatic fat (IHF%) loss compared with 2 other healthy diets, reducing NAFLD by half, regardless of similar weight loss. Here, we investigated the baseline proteomic profile associated with IHF% and the changes in proteomics associated with IHF% changes induced by lifestyle intervention.

APPROACH AND RESULTS

We calculated IHF% by proton magnetic resonance spectroscopy (normal IHF% <5% and abnormal IHF% ≥5%). We assayed baseline and 18-month samples for 95 proteomic biomarkers.Participants (age = 51.3 ± 10.8 y; 89% men; and body mass index = 31.3 ± 3.9 kg/m 2 ) had an 89.8% 18-month retention rate; 83% had eligible follow-up proteomics measurements, and 78% had follow-up proton magnetic resonance spectroscopy. At baseline, 39 candidate proteins were significantly associated with IHF% (false discovery rate <0.05), mostly related to immune function pathways (eg, hydroxyacid oxidase 1). An IHF% prediction based on the DIRECT PLUS by combined model ( R2 = 0.47, root mean square error = 1.05) successfully predicted IHF% ( R2 = 0.53) during testing and was stronger than separately inputting proteins/traditional markers ( R2 = 0.43/0.44). The 18-month lifestyle intervention induced changes in 18 of the 39 candidate proteins, which were significantly associated with IHF% change, with proteins related to metabolism, extracellular matrix remodeling, and immune function pathways. Thrombospondin-2 protein change was higher in the green-MED compared to the MED group, beyond weight and IHF% loss ( p = 0.01). Protein principal component analysis revealed differences in the third principal component time distinct interactions across abnormal/normal IHF% trajectory combinations; p < 0.05 for all).

CONCLUSIONS

Our findings suggest novel proteomic signatures that may indicate MRI-assessed IHF state and changes during lifestyle intervention. Specifically, carbonic anhydrase 5A, hydroxyacid oxidase 1, and thrombospondin-2 protein changes are independently associated with IHF% change, and thrombospondin-2 protein change is greater in the green-MED/high polyphenols diet.

Administration of Alistipes indistinctus prevented the progression from nonalcoholic fatty liver disease to nonalcoholic steatohepatitis by enhancing the gut barrier and increasing Lactobacillus spp

Metabolic-associated fatty liver disease (MAFLD) is an important public health problem, and the gut microbiota has become a new treatment target for MAFLD. Previously, A. indistinctus, a core gut bacterium, was shown to potentially contribute to the prevention of MAFLD. However, the effect and mechanism of A. indistinctus on MAFLD are still unclear and need to be investigated. This study primarily evaluated whether A. indistinctus can improve gut microbiota disorders and prevent the progression from nonalcoholic fatty liver (NAFL) to nonalcoholic steatohepatitis (NASH) in mice fed a high-fat diet (HFD). First, we observed that A. indistinctus significantly improved lipid metabolism disorders and reduced hepatic inflammation induced by HFD consumption in mice. We found that A. indistinctus improved gut barrier function and inhibited the LPS/TLR4/NF-κB pathway, thereby reducing hepatic inflammation. Moreover, 16S rRNA V3-V4 analyses revealed that A. indistinctus could significantly change the structure of the gut microbiota and increase the abundance of L. johnsonii by promoting its growth. Finally, we showed that L. johnsonii administration significantly improved lipid metabolism disorders and reduced hepatic lipid accumulation induced by HFD consumption in mice. In summary, A. indistinctus administration significantly reduces hepatic inflammation by improving gut barrier function and improves lipid metabolism disorders by promoting the growth of L. johnsonii. Our research improves the understanding of the gut microbiota and provides a basis for future therapeutic use of A. indistinctus.

Prevalence and associated factors of MAFLD in adults with type 2 diabetes

To estimate the prevalence and associated factors of hepatic steatosis and fibrosis in adults with type 2 diabetes (T2DM) in the United States.Data were retrieved from the 2017‒March 2020 prepandemic cycle of the National Health and Nutritional Examination and Survey (NHANES). The study population included patients with T2DM. The controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) were used to assess hepatic steatosis and fibrosis, respectively. A total of 1,290 T2DM patients were included, 85.2% (1044 patients) of whom presented with hepatic steatosis (CAP>248 dB/m). Among the 1044 T2DM patients with metabolically associated fatty liver disease (MAFLD), 29.5% developed hepatic fibrosis (LSM>8 kPa). Non-Hispanic black individuals (adjusted OR = 0.4008), BMI (adjusted OR = 1.1627), HbA1c (adjusted OR = 1.1450), TG (adjusted OR = 1.2347), HDL (adjusted OR = 0.4981), ALT (adjusted OR = 1.0227), AST (adjusted OR = 0.9396), and albumin (adjusted OR = 1.7030) were independently associated with steatosis. Age (adjusted OR = 1.0300), female sex (adjusted OR = 0.6655), BMI (adjusted OR = 1.1324), AST (adjusted OR = 1.0483), and GGT (adjusted OR = 1.0101) were independently associated with fibrosis. Heart failure was an independent factor associated with advanced fibrosis (adjusted OR = 1.9129) and cirrhosis (adjusted OR = 2.228). In the United States, hepatic steatosis is highly prevalent among T2DM patients, with 29.5% of these patients developing hepatic fibrosis. Some components of metabolic syndrome are related to hepatic steatosis and fibrosis. Moreover, heart failure is an independent factor associated with advanced fibrosis and cirrhosis.

Clinical profiles and their interaction of concurrent metabolic associated steatotic liver disease and hepatitis B virus infection

BACKGROUND

A new nomenclature of metabolic associated steatotic liver disease (MASLD) was proposed in 2023, thus expanding the diagnostic name of “MASLD combined with other etiologies”.

AIM

To investigate the clinical profiles of patients with concurrent MASLD and chronic hepatitis B virus (HBV) infection.

METHODS

This study included participants from the Taiwan Bio-bank. The diagnostic criteria of MASLD encompassed hepatic steatosis and any cardio-metabolic risk factors. Positive hepatitis B surface antigen was considered indicative of chronic HBV infection. Dual etiology was defined as MASLD combined with chronic HBV infection (MASLD-HBV). Fibrosis 4 (FIB-4) score determined the severity of liver fibrosis, and atherosclerosis was diagnosed by the presence of carotid plaques on duplex ultrasound.

RESULTS

In a total of 18980 participants (mean age, 55.18 ± 10.35 years; males, 30.42%), there were 7654 (40.3%) MASLD patients and 2128 (11.2%) HBV carriers. After propensity score matching for age and gender, HBV carriers had a lower percentage of MASLD than healthy controls. Those with dual etiology had higher aspartate aminotransferase, alanine aminotransferase (ALT), and FIB-4 levels, but lower gamma glutamyl transferase (GGT) levels than MASLD patients. In contrast, those with dual etiology had higher ALT and GGT levels, but lower FIB-4 than “HBV alone” patients. The risk of atherosclerosis was similar among these three groups.

CONCLUSION

MASLD-HBV patients have worse liver fibrosis severity than MASLD patients, but better liver fibrosis stage than “HBV alone” patients, suggesting a complex interaction between MASLD and chronic HBV infection.

Protein palmitoylation in hepatic diseases: Functional insights and therapeutic strategies

BACKGROUND

Liver pathologies represent a spectrum of conditions ranging from fatty liver to the aggressive hepatocellular carcinoma (HCC), as well as parasitic infections, which collectively pose substantial global health challenges. S-palmitoylation (commonly referred to as palmitoylation), a post-translational modification (PTM) characterized by the covalent linkage of a 16-carbon palmitic acid (PA) chain to specific cysteine residues on target proteins, plays a pivotal role in diverse cellular functions and is intimately associated with the liver's physiological and pathological states.

AIM OF REVIEW

This study aims to elucidate how protein palmitoylation affects liver disease pathophysiology and evaluates its potential as a target for diagnostic and therapeutic interventions.

KEY SCIENTIFIC CONCEPTS OF REVIEW

Recent studies have identified the key role of protein palmitoylation in regulating the development and progression of liver diseases. This review summarizes the intricate mechanisms by which protein palmitoylation modulates the pathophysiological processes of liver diseases and explores the potential of targeting protein palmitoylation modifications or the enzymes regulating this modification as prospective diagnostic biomarkers and therapeutic targets.

Impact of metabolic-associated fatty liver disease on the cholesterol efflux capacity of high-density lipoproteins in adolescents with type 2 diabetes

Context

Type 2 diabetes (DM2) is an emerging disease in the pediatric population. DM2 is associated with metabolic-associated fatty liver disease (MAFLD). High-density lipoproteins (HDLs) are lipoproteins that are believed to have atheroprotective properties that reduce the risk of cardiovascular disease (CVD). Current evidence suggests that the physicochemical and functional features of HDLs may play a key role in the pathogenesis of atherosclerosis.

Objective

We aimed to assess the impact of MAFLD on cholesterol efflux capacity (CEC) in adolescents with DM2.

Design

A cross-sectional study.

Setting

Attention clinic for Children with Diabetes of the Hospital Infantil de México Federico Gómez.

Patients or other participants

This study included a total of 70 adolescents, 47 of which had DM2 and 23 were healthy individuals.

Interventions

The presence of MAFLD was determined by MR spectroscopy with proton density fat fraction. We compared the distribution of HDL subtypes (HDL2b, HDL2a, HDL3a, HDL3b, and HDL3c) and the chemical composition of HDLs (total protein, triglycerides, phospholipids, cholesteryl esters, and free cholesterol). HDL functionality was determined by the CEC, measuring the fluorescent cholesterol efflux from J774 macrophage cells.

Main outcome measures

We were expecting to observe a decrease in HDL efflux capacity in adolescents with type 2 diabetes and MAFLD.

Results

In our study, we observed a prevalence of MAFLD in 66% of adolescents with DM2, similar to that reported in other international studies (60%-80%). In the population with DM2 and MAFLD, we did not observe a decrease in CEC. Initially we found a slight elevation of CEC in adolescents with DM2, however, with the increase in liver fat, a little decrease is observed, which could explain a probable metabolic phenomenon, since the physicochemical composition and distribution of the particles is associated with the percentage of liver fat. A positive correlation between the percentage of liver fat and the concentration of HDL2b (p = 0.011), HDL2a (p = 0.014) and average particle size (p = 0.011) and the proportion of triglycerides inside the particles (p = 0.007). Likewise, negative correlation were found with the percentage of liver fat, cholesterol esters (p = 0.010) and free cholesterol of the particles (p < 0.001). We observed a positive correlation between CEC and the percentage of triglycerides (p = 0.007), and a negative correlation with the percentage of cholesterol esters (p = 0.05) inside the HDL's particles.

Conclusions

In this group of adolescents with DM2, the presence of MAFLD was not associated with CEC; however, it is associated with abnormalities in the distribution and lipid composition of HDL particles. The momentum generated by the original proposal for MAFLD in the adult population and following the recommendations for pediatric MAFLD will be a step forward in helping to study the impact of MAFLD on the atheroprotective properties of HDL in the pediatric population.

Parallel randomised trial testing community fibrosis assessment for suspected non-alcoholic fatty liver disease: outcomes from LOCATE-NAFLD

OBJECTIVE

Non-alcoholic fatty liver disease (NAFLD) is estimated to affect a third of Australian adults, and its prevalence is predicted to rise, increasing the burden on the healthcare system. The LOCal Assessment and Triage Evaluation of Non-Alcoholic Fatty Liver Disease (LOCATE-NAFLD) trialled a community-based fibrosis assessment service using FibroScan to reduce the time to diagnosis of high-risk NAFLD and improve patient outcomes.

METHODS

We conducted a 1:1 parallel randomised trial to compare two alternative models of care for NAFLD diagnosis and assessment. Participants had suspected NAFLD and were referred to a hepatology clinic in one of three major hospitals in South-East Queensland. Eligible consenting participants were randomised to receive usual care or the intervention (LOCATE). Participants in the intervention arm received a FibroScan outside of the hospital setting, with results provided to their primary care provider and the referring hepatologist. All participants were followed up 12 months after randomisation to measure their clinical and patient-reported outcomes.

RESULTS

97 participants were recruited from October 2020 to December 2022. Of the 50 participants randomised to the intervention arm, one failed to attend their appointment, and of the 48 (98%) who had a FibroScan 13 (27%) had a liver stiffness measurement of 8.0 kPa or greater. The HR for the time to diagnosis of high risk was 1.28 (95% CI 0.59 to 2.79), indicating a faster average time to diagnosis with the intervention, but failing to conclusively demonstrate a faster time. The intervention did greatly reduce the time to FibroScan by almost 1 year (median difference 0.92 years, 95% CI 0.56 to 1.45). Other clinical outcomes showed minimal changes.

CONCLUSION

The LOCATE model shows potential for impact, particularly in reducing waiting times for patients at high risk of developing severe liver disease due to NAFLD. A larger sample and longer follow-ups are needed to measure additional clinical outcomes.

TRIAL REGISTRATION NUMBER

ACTRN12620000158965.

Association between composite dietary antioxidant index and metabolic dysfunction-associated fatty liver disease: a cross-sectional study from NHANES

BACKGROUND

Metabolic dysfunction-associated fatty liver disease (MAFLD) is a typical hepatic steatosis with metabolic dysfunction. The composite dietary antioxidant index (CDAI) measures individual antioxidant capacity, and the relationship with MAFLD has received little attention. Our goal is to explore the association of CDAI with MAFLD.

METHODS

Participants were selected from the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2020. CDAI was calculated basing on six dietary antioxidants, including zinc, selenium, carotenoids, and vitamins A, C, and E. Univariate regression and multivariable logistic regression analysis were conducted to evaluate the correlation between CDAI and MAFLD. We performed subgroup analysis to study the correlation in various populations.

RESULTS

A total of 18,163 participants, including 13,969 MAFLD and 4,194 non-MAFLD, were included. CDAI was significantly negatively correlated with MAFLD. After adjusting for all confounders (including age, gender, race, marital status, poverty ratio, education level, drinking status, smoking status, and physical activity), individuals in the highest quartile of CDAI exhibited a 27% lower likelihood of developing MAFLD than those in the lowest quartile (OR = 0.73; 95% CI [0.66, 0.81], p < 0.001). Physical activity subgroup analysis showed that this negative association was significant in the moderate-intensity physical exercise population (Model 3 in Q4, OR = 0.72; 95% CI [0.58-0.89], p < 0.001). Additionally, the changes in vitamins C were independently associated with MAFLD (Model 3, OR = 0.90; 95% CI [0.86-0.93], p < 0.001).

CONCLUSIONS

We found a negative relationship between higher CDAI scores and MAFLD. This study provided a new reference for exploring dietary interventions that affect MAFLD to reduce its incidence.

The moderating effect of dietary fiber intake on the association between sleep pattern and liver fibrosis in metabolic dysfunction-associated steatotic liver disease: a study from NHANES

BACKGROUND

Insufficient nocturnal sleep was associated with a higher risk of fibrosis in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). Dietary fiber intake may improve the stimulate the secretion of sleep cytokines, inhibit the inflammatory pathway, contribute to regulating sleep disorders and alleviate liver fibrosis. The associations of dietary fiber intake, sleep patterns, with liver fibrosis remain unclear. The study aimed to explore the associations between dietary fiber, sleep, and liver fibrosis, as well as the moderating effect of dietary fiber intake between sleep patterns and liver fibrosis in MASLD patients.

METHODS

Using data from the National Health and Nutrition Examination Survey (NHANES) database spanning from 2017 to 2020, a cross-sectional study included participants with MASLD was performed to assess the relationship between sleep patterns, dietary fiber intake, and liver fibrosis. Weighted univariate and multivariate logistic regression models were used to examine the linear connection between sleep pattern, dietary fiber intake, and liver fibrosis. Restricted cubic spline (RCS) method was also performed to describe the nonlinear relationship. A two-part linear regression model was also used to estimate threshold effects. The moderating effect of dietary fiber intake was further investigated in different subgroups. All results were presented as odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

Totally, 1343 MASLD patients were included for final analysis. Among them, 207 (15.41%) have liver fibrosis. Dietary fiber intake did not correlate significantly with sleep pattern in patients with MASLD (Spearman's r = -0.028, P = 0.1678). Poor sleep pattern was related to higher odds of liver fibrosis (OR = 3.23, 95%CI: 1.05-9.90), while dietary fiber intake ≥ 15 gm/day was associated with lower liver fibrosis risk (OR = 0.51, 95%CI: 0.32-0.83). On the association between sleep pattern and liver fibrosis stratified by dietary fiber intake revealed that poor sleep patterns (OR = 15.13, 95%CI: 4.40-52.01) remained associated with increased liver fibrosis risk among individuals with dietary fiber intake < 15 gm/day. No connection was observed between poor sleep patterns and liver fibrosis in MASLD patients with higher dietary fiber intake, with moderate dietary fiber supplementation beneficial in mitigating poor sleep patterns associated with liver fibrosis. The similar findings were also found in patients aged < 50 years old, ≥ 50 years old, females, those with and without CVD groups, hypertension, and dyslipidemia. Particularly, dietary fiber intake also moderates the relationship between sleep patterns and liver fibrosis in the F4 stage (OR = 13.26, 95%CI: 4.08-43.11).

CONCLUSION

Dietary fiber intake affects the relationship between sleep patterns and liver fibrosis in MASLD patients.

Morbidity and Mortality Risk Among People With Human Immunodeficiency Virus and Central or Visceral Adiposity: A Targeted Literature Review

BACKGROUND

Given the known relationship between human immunodeficiency virus (HIV), antiretroviral therapies, and excess visceral adipose tissue (VAT), this review sought to characterize risk of negative health outcomes associated with excess VAT and increased waist circumference (WC) in people with HIV (PWH).

METHODS

Comprehensive targeted literature searches were conducted in Medline/Embase (27 June 2022), identifying peer-reviewed articles and conference abstracts reporting on cohorts of PWH. Screening was guided by PECOS (Population, Exposure, Comparator, Outcomes, Study design) criteria. From the included studies, outcomes of interest including mortality and morbidity risk by VAT area and WC were extracted, overall, and by sex, race/ethnicity, and duration of HIV. Relationships between outcome and exposure variables were summarized.

RESULTS

Thirty-five studies were included (sample size range: 31-1748 PWH). Twenty-five studies characterized the relationship between increased WC and negative health outcomes-cardiovascular disease (CVD), arteriosclerosis, hypertension, diabetes, hepatic fat and fibrosis, and cognitive impairment-among PWH. Fifteen studies reported on increased VAT and negative health outcomes: all-cause mortality, CVD, atherosclerosis, hepatic fat, and fibrosis. Importantly, there was a 2.1-times higher odds of 5-year all-cause mortality among PWH with the highest amount of VAT in the only study identified reporting on mortality. Among the studies characterizing the relationship between morbidity and VAT, for example, 1 found that, for each 10-cm2 increase in VAT, the risk of prevalent CVD increased by 1.05 (95% CI: 1.0-1.1) times.

CONCLUSIONS

WC may be a useful and cost-effective surrogate for visceral adiposity, which is an important marker of morbidity and mortality among PWH.

The impact of a low-calorie, reduced-fat diet on liver attenuation imaging: a randomized clinical trial

PURPOSE

To investigate whether a low-calorie, reduced-fat diet affects liver attenuation imaging (ATI) measurements.

METHODS

A total of 320 participants were enrolled in this prospective study. They were randomly assigned to four groups: a fasting group, a postprandial 0.5-hour examination group, a postprandial 2-hour examination group, and a postprandial 4-hour examination group. All participants first underwent liver ATI examination in a fasting state. Those in the postprandial groups then consumed a low-calorie, reduced-fat diet before undergoing a second ATI examination at 0.5 h, 2 h, or 4 h after the meal. The ATI values were compared among the groups. The differences between postprandial and fasting ATI values were also analyzed for the postprandial groups. Additionally, the consistency of the grading diagnosis of hepatic steatosis between the postprandial and fasting states was evaluated in the postprandial groups.

RESULTS

The ATI values for the 0.5 h postprandial group, 2 h postprandial group, and 4 h postprandial group were not significantly different from those of the fasting group (P = 0.576, 0.471, and 0.992, respectively). No significant differences were noted in the ATI values recorded during the postprandial and fasting states within each of the postprandial groups (P = 0.573, 0.076, and 0.805, respectively). The kappa values for diagnostic consistency between the postprandial and fasting states across the three divergent criteria were 0.833-0.951, 0.812-0.855, and 0.737-0.862, respectively.

CONCLUSION

A low-calorie, reduced-fat diet does not significantly affect liver ATI measurements or the grading of hepatic steatosis. However, the lack of representation of older adults and populations with higher BMIs in this study may limit its generalizability, with the lack of external validation as a limitation. These issues should be tested and confirmed in further studies.

CLINICAL TRIAL NUMBER

(ChiCTR2200062314, August 2022).

Association between bowel movement frequency, stool consistency and MAFLD and advanced fibrosis in US adults: a cross-sectional study of NHANES 2005-2010

BACKGROUND

Although previous studies have established associations between specific gut microbiota (GM) and metabolic dysfunction-associated fatty liver disease (MAFLD), research examining the relationship between functional gastrointestinal symptoms and MAFLD, including advanced fibrosis, remains limited. This study aims to investigate the association between stool consistency, bowel movement frequency (BMF), and the occurrence of MAFLD and advanced fibrosis in U.S. adults.

METHODS

This population-based study included 9,928 adults from the 2005-2010 National Health and Nutrition Examination Survey (NHANES), with a mean age of 47.19 ± 16.65 years, comprising 47.7% males and 52.3% females. Weighted logistic regression was used to assess the association between stool consistency, BMF, and MAFLD or advanced fibrosis. A linear trend was assessed by treating BMF categories as continuous variables with ordinal values. The dose-response relationship between BMF and MAFLD was analyzed using restricted cubic splines (RCS) regression. Sensitivity and subgroup analyses were performed to confirm the robustness of the findings.

RESULTS

In the RCS regression, no significant nonlinear relationship was observed between BMF and the risk of MAFLD (p-overall < 0.0001; p-nonlinear = 0.0663). The multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for MAFLD were 0.82 (95% CI 0.69-0.98), 1.31 (95% CI 1.16-1.46), and 1.50 (95% CI 1.14-1.99) for participants with 3-6 BMs/week, 1-2 BMs/day, and > 2 BMs/day, respectively, compared to those with once/day (p-trend < 0.001). For stool consistency, hard stools were associated with a decreased risk of MAFLD (OR 0.77; 95% CI 0.62-0.95), whereas loose stools increased the risk (OR 1.37; 95% CI 1.05-1.80), relative to normal stools. A significant interaction between BMF and age was observed. No significant associations were found between stool consistency or BMF and advanced liver fibrosis. Sensitivity analyses confirmed the robustness of these findings.

CONCLUSIONS

This cross-sectional study demonstrates that a BMF of 3-6 BMs/week and hard stools are associated with a reduced risk of MAFLD, whereas a BMF of more than once/day and loose stools are linked to an increased risk of MAFLD. Moreover, no significant associations were observed between stool consistency, BMF, and advanced fibrosis among individuals diagnosed with MAFLD.

CLINICAL TRIAL NUMBER

Not applicable.

Effects of Bifidobacterium and rosuvastatin on metabolic-associated fatty liver disease via the gut-liver axis

BACKGROUND/AIMS

Research has indicated that treatment with rosuvastatin can improve liver pathology in metabolic-associated fatty liver disease (MAFLD) patients and that treatment with Bifidobacterium can improve MAFLD. Therefore, the effects of Bifidobacterium, rosuvastatin, and their combination on related indices in a rat model of diet-induced MAFLD need to be investigated.

METHODS

Forty rats were divided into five groups: the normal diet group (N), high-fat diet (HFD) model group (M), HFD + probiotic group (P), HFD + statin group (S), and HFD + probiotic + statin group (P-S). To establish the MAFLD model, the rats in Groups M, P, S, and P-S were fed a HFD for 8 weeks. The treatments included saline in Group N and either Bifidobacterium, rosuvastatin, or their combination in Groups P, S, and P-S by intragastrical gavage. After 4 weeks of intervention, the rats were euthanized, and samples were harvested to analyze gastrointestinal motility and liver function, pathological changes, inflammatory cytokine production, and the expression of proteins in key signaling pathways.

RESULTS

HFD feeding significantly increased the body weight, liver index, and insulin resistance (IR) index of the rats, indicating that the MAFLD model was successfully induced. Bifidobacterium reduced the liver of MAFLD rats, while Bifidobacterium with Rosuvastatin decreased the liver index, IR index, and levels of aspartate aminotransferase and alanine aminotransferase in MAFLD rats. The MAFLD model showed altered expression of proteins in signaling pathways that regulate inflammation, increased production of inflammatory cytokines, an elevated MAFLD activity score (MAS), and pathological changes in the liver. The MAFLD model also showed reduced relative counts of intestinal neurons and enteric glial cells (EGCs), altered secretion of gastrointestinal hormones, and slowed gastrointestinal emptying. Bifidobacterium, rosuvastatin, or their combination inhibited these various changes. HFD feeding changed the rats' gut microbiota, and the tested treatments inhibited these changes. These results suggest that the gastrointestinal motility disorder and abnormal liver function in MAFLD rats may be related to a reduction in Escherichia-Shigella bacteria and an increase in Asticcacaulis bacteria in the gut microbiota and that the improvement in liver function induced by Bifidobacterium plus rosuvastatin may be related to increases in Sphingomonas and Odoribacter bacteria and a decrease in Turicibacter bacteria in the gut microbiota.

CONCLUSIONS

The combined use of Bifidobacterium and rosuvastatin could better regulate the gut microbiota of MAFLD model rats, promote gastrointestinal emptying, and improve liver pathology and function than single treatment with Bifidobacterium or rosuvastatin. This provides a better strategy for the treatment of MAFLD.

Circulating irisin levels in patients with MAFLD: an updated systematic review and meta-analysis

Objective

Current research suggests that irisin is closely linked to the pathogenesis and progression of metabolic dysfunction-associated fatty liver disease (MAFLD). This systematic review and meta-analysis updates our previous meta-analysis and further explores the relevance between circulating irisin levels and MAFLD.

Methods

Nine databases (PubMed, EMBASE, Cochrane Library, CNKI, Wanfang, Weipu, CBM, Clinicaltrials.gov and gray literature) were retrieved as of 1st August, 2024. The standardized mean difference (SMD) and 95% confidence interval (CI) represent pooled effect size. We used the Newcastle-Ottawa Scale to evaluate the quality of articles and the certainty of evidence assessed by GRADE system. All statistical analyses were performed using RevMan 5.3 and Stata 12(Stata Corporation, yi TX).

Results

Fifteen case-control studies were included. Circulating irisin levels in the MAFLD group were markedly lower than those in the healthy group (SMD=-1.04 [-1.93, -0.14]). Subgroup analyses by race, age, severity and T2DM revealed that circulating irisin levels were lower in the MAFLD group compared to those in the healthy controls in the Asian population (SMD=-1.38 [-2.44, -0.31], P<0.05) and in those above 50 years old (SMD=-2.23 [-3.64, -0.81], P<0.05) and higher in the mild MAFLD groups than those in moderate to severe MAFLD groups (SMD = 11.68 [9.05, 14.31], P<0.05). And the circulating irisin levels in MAFLD patients with T2DM were significantly lower than those in healthy group (SMD = -2.90 [-4.49, -1.30]). ELISA kits from different companies also presented different relationships.

Conclusions

There were significantly lower circulating irisin levels in the MAFLD group than in the healthy control group. Although these results differed from our previous results, there is no denying that circulating irisin levels are closely associated with the advancement of MAFLD.

Exercise, exerkines and exercise mimetic drugs: Molecular mechanisms and therapeutics

Chronic diseases linked with sedentary lifestyles and poor dietary habits are increasingly common in modern society. Exercise is widely acknowledged to have a plethora of health benefits, including its role in primary prevention of various chronic conditions like type 2 diabetes mellitus, obesity, cardiovascular disease, and several musculoskeletal as well as degenerative disorders. Regular physical activity induces numerous physiological adaptations that contribute to these positive effects, primarily observed in skeletal muscle but also impacting other tissues. There is a growing interest among researchers in developing pharmaceutical interventions that mimic the beneficial effects of exercise for therapeutic applications. Exercise mimetic medications have the potential to be helpful aids in enhancing functional outcomes for patients with metabolic dysfunction, neuromuscular and musculoskeletal disorders. Some of the potential targets for exercise mimetics include pathways involved in metabolism, mitochondrial function, inflammation, and tissue regeneration. The present review aims to provide an exhaustive overview of the current understanding of exercise physiology, the role of exerkines and biomolecular pathways, and the potential applications of exercise mimetic drugs for the treatment of several diseases.

Causal associations of immunophenotypes with metabolic dysfunction-associated fatty liver disease and mediating pathways: a Mendelian randomization study

Background

Increasing evidence suggests that immunophenotypes play a crucial role in Metabolic dysfunction-associated fatty liver disease (MAFLD), but the specific immunophenotypes contributing to its pathogenesis remain unclear.

Objectives

This study aimed to elucidate the causal associations between immunophenotypes and MAFLD and identify the underlying mediation pathways involved.

Design

Mendelian randomization (MR) study.

Methods

This study is a quasi-causal inference analysis using univariable and multivariable MR (UVMR and MVMR). Five MAFLD genome-wide association studies (GWASs) and the largest immunophenotype GWAS were analyzed to assess their causal associations. Two-step MR identified potential mediators and quantified their mediation proportions. Comprehensive MR methods, multiple sensitivity analyses, meta-analyses, and false discovery rate (FDR) further enhanced the robustness of our findings.

Results

Pooled inverse-variance weighted (IVW) estimates in UVMR identified 47 immunophenotypes having a suggestive causal association with MAFLD. After adjusting for FDR, three lymphocyte phenotypes remained significant: CD20 on IgD-CD24- B cells (OR: 1.035, p fdr: 0.006), terminally differentiated CD8+ T cells %T cells (OR: 1.052, p fdr: 0.006), and CD4 on CD39+ secreting CD4+ regulatory T cells (OR: 1.036, p fdr: 0.046). Meta-analysis of IVW MVMR estimates with confounders adjustment confirmed that CD20 on IgD-CD24- B cells and terminally differentiated CD8+ T cells %T cells had significant direct causal associations on MAFLD (p fdr < 0.05). Additionally, two-step MR analysis identified the waist-to-hip ratio as a mediator, accounting for 42.64% of the causal association between CD20 on IgD-CD24- B cells and MAFLD.

Conclusion

The causal associations of three lymphocyte phenotypes with increased MAFLD risk were identified in this study. CD20 on IgD-CD24- B cells may both directly and indirectly elevate MAFLD risk, while terminally differentiated CD8+ T cells have a direct causal relationship with MAFLD. These findings suggest new possibilities for targeted therapies and underscore the potential for personalized immunotherapy in managing MAFLD.

Bibliometric analysis of autophagy in NAFLD from 2004 to 2023

BACKGROUND

Autophagy is a cellular process in which damaged organelles or unnecessary proteins are encapsulated into double-membrane structures and transported to lysosomes for degradation. Autophagy plays a crucial role in various liver diseases, including nonalcoholic fatty liver disease. This study aims to elucidate the role of autophagy in nonalcoholic fatty liver disease through bibliometric analysis.

METHODS

Literature was retrieved from Web of Science CoreCollection database, and the search time was from January 01, 2004 to December 31, 2023. Data retrieval was performed using the Bibliometrix package in R software. VOSviewer and CiteSpace were utilized to visualize the research hotspots and trends related to the effect of autophagy on nonalcoholic fatty liver disease.

RESULTS

A total of 966 papers were obtained, published in 343 journals from 1385 institutions across 57 countries. The journals with the most publications were the "International Journal of Molecular Sciences" and "Scientific Reports." China had the highest number of published papers. The most productive authors were Yen Paul M and Jung Tae Woo, while Singh R was the most frequently co-cited author. Emerging research hotspots were associated with keywords such as insulin resistance, ferroptosis, endoplasmic reticulum stress, and mitochondrial function.

CONCLUSION

Research on autophagy in nonalcoholic fatty liver disease is still in its early stages, with a growing body of literature. This study is the first to provide a comprehensive bibliometric analysis, synthesizing research trends and advancements. It identifies current development trends, global cooperation models, foundational knowledge, research hotspots, and emerging frontiers in the field.

Increased magnesium intake does not mitigate MAFLD risk associated with magnesium deficiency

Serum magnesium cannot accurately assess magnesium deficiency. The association between magnesium deficiency and metabolic dysfunction-associated fatty liver disease (MAFLD) remains unclear. Selecting 3,377 participants in the United States, we assessed the degree of magnesium deficiency in the population using magnesium depletion score (MDS). Multinomial logistic regression assessed the association between magnesium deficiency and MAFLD. Subgroup analyses assessed the association between dietary magnesium intake and MAFLD under different magnesium deficiency statuses. Structural equation modeling (SEM) revealed mediation effects. Magnesium deficiency was associated with MAFLD (ORseverevs.none: 1.69, 95%CI: 1.16-2.46; p for trend < 0.001). Magnesium intake was negatively associated with MAFLD only in the subgroup without magnesium deficiency (p for trend < 0.01). Inflammation, oxidative stress, and aging significantly mediated the association between MDS and MAFLD (all p < 0.05). In American adults, magnesium deficiency assessed by MDS might be a risk factor for MAFLD, with inflammation, oxidative stress, and aging potentially being key mechanisms. Simply increasing magnesium intake would not mitigate MAFLD risk associated with magnesium deficiency. Correcting magnesium deficiency might prevent MAFLD.

Elevated thyroid autoantibodies as risk factors for metabolic dysfunction-associated fatty liver disease in type 2 diabetes mellitus

Objective

This study aims to explore the relationship between thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) levels and metabolic dysfunction-associated fatty liver disease (MAFLD) in patients with type 2 diabetes mellitus (T2DM), providing a theoretical basis for MAFLD prevention and treatment.

Methods

From June 2020 to May 2023, 534 T2DM patients were selected from the Endocrinology Department of Xiangyang Hospital affiliated with Wuhan University of Science and Technology. After applying exclusion criteria, 432 subjects were included. Based on abdominal ultrasound and MAFLD diagnostic criteria, subjects were divided into non-MAFLD (n=163) and MAFLD (n=260) groups. Differences in various indicators between the two groups were compared. Correlation analysis assessed the relationship between TPOAb, TgAb, and other indicators, and the prevalence of MAFLD was analyzed under different thyroid function and antibody levels. Multivariate logistic regression identified risk factors for MAFLD in T2DM patients. According to the FIB-4 index, the group with MAFLD was divided into low-risk (FIB-4< 1.30, n=150), medium-risk (1.30≤FIB-4 ≤ 2.67, n=100), and high-risk liver fibrosis groups (FIB-4 > 2.67, n=10). Differences in thyroid function and autoantibody levels among the three groups were compared.

Results

Compared to non-MAFLD patients, 73.46% of MAFLD patients were overweight or obese, were younger, and had a shorter duration of diabetes. Under normal thyroid function, MAFLD patients had higher levels of TSH, TgAb, and TPOAb (P<0.05). The prevalence of TgAb+, TPOAb+, and TgAb/TPOAb+ was significantly higher at 21.9%, 22.1%, and 29.6%, respectively, with higher prevalence in females. Spearman's correlation showed a positive correlation between TgAb, TPOAb, and AST, and between TPOAb and FINS. MAFLD prevalence varied among quartiles of TSH, TPOAb, and TgAb levels, with significant differences in TPOAb and TgAb components (P<0.05). MAFLD prevalence was positively correlated with TgAb and TPOAb levels. Thyroid autoantibody-positive patients had a significantly higher MAFLD prevalence (P=0.010) at 71.96%. Multivariate logistic analysis found elevated TSH and TPOAb levels as risk factors for MAFLD in T2DM patients [(OR 1.441, 95% CI: 1.213-1.712, P<0.001), (OR 1.005, 95% CI: 1.000-1.010, P=0.040)]. Medium-risk liver fibrosis patients had higher TgAb and TPOAb levels than low-risk and high-risk groups [TgAb: 1.04(0.59,2.83) vs 1.54(0.76,7.35) vs 0.55(0.27,1.32), P=0.035; TPOAb: 1.0(0.29,3.83) vs 2.42(0.5,23.08) vs 0.17(0.09,2.71), P=0.002]. Further comparisons revealed a significant difference in TgAb levels between the medium-risk and high-risk groups (P = 0.048). Additionally, significant differences in TPOAb levels were observed between the low-risk and medium-risk groups and between the medium-risk and high-risk groups (P = 0.016,P = 0.014).

Conclusion

In T2DM patients with MAFLD, elevated TSH, TgAb, and TPOAb levels are observed under normal thyroid function. Elevated TSH and TPOAb levels are risk factors for MAFLD in T2DM patients. TgAb and TPOAb levels vary among liver fibrosis risk groups, showing an inverted "V" pattern, suggesting a role in MAFLD progression to liver fibrosis.

Predictive role of neutrophil percentage-to-albumin ratio, neutrophil-to-lymphocyte ratio, and systemic immune-inflammation index for mortality in patients with MASLD

There are no studies discussing the significance of neutrophil-to-lymphocyte ratio (NLR), neutrophil-percentage-to-albumin ratio (NPAR), and systemic immune-inflammation index (SII) in predicting poor prognosis in patients with metabolic dysfunction associated steatotic liver disease (MASLD); this study aimed to investigate the relationship between these three inflammatory markers and all-cause mortality and cardiovascular disease (CVD) mortality in patients with MASLD. Survival data for 3970 participants were obtained from National Death Index (NDI) records associated with the National Health and Nutrition Examination Survey (NHANES) dataset, the associations of NPAR, NLR, and SII with all-cause and CVD mortality were analyzed using multivariate COX regression modeling, restricted cubic spline (RCS) was used to explore nonlinear relationships and to determine the inflection point, regrouping was done according to the nonlinear inflection point, using multivariate COX regression modeling, subgroup analysis, and the Kaplan-Meier survival curves to evaluate differences in risk of death between the two groups. Time-dependent receiver operating characteristic curve (ROC) analysis was conducted to assess the predictive efficacy of NPAR, NLR, and SII on survival outcomes. Multivariate COX regression and RCS analyses revealed a positive linear correlation between NLR and all-cause and CVD mortality, whereas a nonlinear relationship was found between NPAR and SII and all-cause and CVD mortality. Further reclassified into two groups according to the inflection point, multivariate COX regression analyses showed a significant difference in the risk of death between the two NPAR groups (HR 1.37, 95% CI = (1.01, 1.86) for all-cause mortality and HR 2.03, 95% CI = (1.24, 3.32) for CVD mortality ) and no difference in the risk of death between the two SII groups (HR 1.11, 95% CI = (0.87, 1.42) for all-cause mortality and HR 1.35, 95% CI = (0.86, 2.12) for CVD mortality), and Kaplan-Meier survival curves showed that both all-cause and CVD mortality rates were higher in patients with MASLD above the NPAR inflection point (log-rank P < 0.05). Subgroup analyses showed that the associations between high levels of NPAR and all-cause mortality were generally consistent across populations (P interaction > 0.05). Also, COPD subgroups had a significant effect on the correlation between high levels of NPAR and CVD mortality (P interaction < 0.05). Time-dependent ROC show the predictive value of NPAR, NLR, and SII for all-cause and CVD mortality in MASLD patients. The correlation between NPAR and mortality was nonlinear, and NLR was linearly and positively correlated with mortality, Measuring NPAR and NLR may be useful in assessing risk and predicting prognosis in populations of patients with MASLD.

Metabolic dysfunction-associated steatotic liver disease and risk of four intrahepatic and extrahepatic diseases

INTRODUCTION AND OBJECTIVES

Recently, Delphi consensus proposed an overarching term steatotic liver disease (SLD), with various subcategories such as MASLD, MetALD and ALD. Our aim was to investigate the association between MASLD/MetALD/ALD and four intrahepatic and extrahepatic diseases (liver diseases, renal diseases, cardiovascular diseases, and cancers) in the UK Biobank cohort.

PATIENTS AND METHODS

By defining hepatic steatosis as image-derived phenotype (IDP)-PDFF >5.21%, we used data from the UK Biobank to diagnose MASLD/ MetALD/ALD. The odd ratio (OR) and the hazard ratio (HR) were calculated using the logistic regression modals and Cox regression models, respectively.

RESULTS

Among 39,230 eligible individuals, 6,865 MASLD subjects, 2,379 MetALD subjects and 884 ALD subjects were diagnosed. The last follow-up time was October 13, 2023. Consistent with the logistic analyses, MASLD/MetALD/ALD were significantly associated with a higher risk of liver diseases (HR=3.04 [95%CI:2.60-3.56], HR = 2.69 [95% CI: 2.12-3.42] and HR =3.99 [95%CI:2.92-5.45], respectively). Subjects with MASLD also had an increased higher risk of renal diseases (HR = 1.40 [95%CI:1.20-1.64]) and subjects with ALD had an increased higher risk of cancers (HR = 1.36 [95%CI:1.15-1.60]).

CONCLUSION

It is the first study to report the association between MASLD, MetALD, ALD and common intrahepatic and extrahepatic diseases based on magnetic resonance imaging data-PDFF. We found that MASLD, MetALD and ALD were risk factors for liver diseases. Meanwhile, MASLD was also a risk factor for renal diseases and ALD was a risk factor for cancers.