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Wang RX, Lee JJ, Mirda D, Hao J, Goebel AM, Deutsch-Link S, Serper M, Bittermann T. Association of psychosocial risk factors and liver transplant evaluation outcomes in metabolic dysfunction-associated steatotic liver disease. Liver Transpl 2024:01445473-990000000-00401. [PMID: 38869989 DOI: 10.1097/lvt.0000000000000421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/31/2024] [Indexed: 06/15/2024]
Abstract
The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a standardized psychosocial assessment tool used in liver transplantation (LT) evaluation and has been primarily studied in patients with alcohol-associated liver disease. We aimed to evaluate the relationship between SIPAT score and metabolic syndrome severity and LT waitlist outcomes in a large cohort of patients with metabolic dysfunction-associated steatotic liver disease (MASLD). We performed a single-center retrospective cohort study of patients with MASLD evaluated for LT from 2014 to 2021. The utility of the previously defined total SIPAT cutoff (<21 [excellent/good candidates] vs. ≥21 [minimally acceptable/high-risk candidates]) was studied. Multivariable logistic regression analyses examined associations between continuous SIPAT scores and LT waitlisting outcomes. The Youden J statistic was used to identify the optimal SIPAT cutoff for patients with MASLD. A total of 480 patients evaluated for transplant with MASLD were included. Only 9.4% of patients had a SIPAT score ≥21. Patients with SIPAT score ≥21 had higher hemoglobin A1c compared to patients with lower psychosocial risk (median [IQR]: 7.8 [6.0-9.7] vs. 6.6 [5.8-7.9]; p = 0.04). There were no other differences in metabolic comorbidities between SIPAT groups. Increasing SIPAT score was associated with decreased odds of listing (OR: 0.82 per 5-point increase; p = 0.003) in multivariable models. A SIPAT of ≥12 was identified as the optimal cutoff in this population, resulting in an adjusted OR for a listing of 0.53 versus SIPAT <12 ( p = 0.001). In this large cohort of patients with MASLD evaluated for LT, few patients met the previously defined high SIPAT cutoff for transplant suitability. Nevertheless, increasing the SIPAT score was associated with waitlist outcomes. Our suggested SIPAT cutoff of ≥12 for patients with MASLD warrants further external validation using data from other centers.
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Affiliation(s)
- Roy X Wang
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jason J Lee
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Danielle Mirda
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jinxuan Hao
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anna M Goebel
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sasha Deutsch-Link
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Marina Serper
- Division of Gastroenterology and Hepatology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Therese Bittermann
- Division of Gastroenterology and Hepatology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Custodio RJP, Hobloss Z, Myllys M, Hassan R, González D, Reinders J, Bornhorst J, Weishaupt AK, Seddek AL, Abbas T, Friebel A, Hoehme S, Getzmann S, Hengstler JG, van Thriel C, Ghallab A. Cognitive Functions, Neurotransmitter Alterations, and Hippocampal Microstructural Changes in Mice Caused by Feeding on Western Diet. Cells 2023; 12:2331. [PMID: 37759553 PMCID: PMC10529844 DOI: 10.3390/cells12182331] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) is the most common chronic liver disease in Western countries. It is becoming increasingly evident that peripheral organ-centered inflammatory diseases, including liver diseases, are linked with brain dysfunctions. Therefore, this study aims to unravel the effect of MASLD on brain histology, cognitive functions, and neurotransmitters. For this purpose, mice fed for 48 weeks on standard (SD) or Western diet (WD) were evaluated by behavioral tests, followed by sacrifice and analysis of the liver-brain axis including histopathology, immunohistochemistry, and biochemical analyses. Histological analysis of the liver showed features of Metabolic Dysfunction-Associated Steatohepatitis (MASH) in the WD-fed mice including lipid droplet accumulation, inflammation, and fibrosis. This was accompanied by an elevation of transaminase and alkaline phosphatase activities, increase in inflammatory cytokine and bile acid concentrations, as well as altered amino acid concentrations in the blood. Interestingly, compromised blood capillary morphology coupled with astrogliosis and microgliosis were observed in brain hippocampus of the WD mice, indicating neuroinflammation or a disrupted neurovascular unit. Moreover, attention was impaired in WD-fed mice along with the observations of impaired motor activity and balance, enhanced anxiety, and stereotyped head-twitch response (HTR) behaviors. Analysis of neurotransmitters and modulators including dopamine, serotonin, GABA, glutamate, and acetylcholine showed region-specific dysregulation in the brain of the WD-fed mice. In conclusion, the induction of MASH in mice is accompanied by the alteration of cellular morphology and neurotransmitter expression in the brain, associated with compromised cognitive functions.
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Affiliation(s)
- Raly James Perez Custodio
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Ardeystrasse 67, 44139 Dortmund, Germany; (R.J.P.C.); (Z.H.); (M.M.); (R.H.); (D.G.); (J.R.); (S.G.)
| | - Zaynab Hobloss
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Ardeystrasse 67, 44139 Dortmund, Germany; (R.J.P.C.); (Z.H.); (M.M.); (R.H.); (D.G.); (J.R.); (S.G.)
| | - Maiju Myllys
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Ardeystrasse 67, 44139 Dortmund, Germany; (R.J.P.C.); (Z.H.); (M.M.); (R.H.); (D.G.); (J.R.); (S.G.)
| | - Reham Hassan
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Ardeystrasse 67, 44139 Dortmund, Germany; (R.J.P.C.); (Z.H.); (M.M.); (R.H.); (D.G.); (J.R.); (S.G.)
- Department of Forensic Medicine and Toxicology, Faculty of Veterinary Medicine, South Valley University, Qena 83523, Egypt;
| | - Daniela González
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Ardeystrasse 67, 44139 Dortmund, Germany; (R.J.P.C.); (Z.H.); (M.M.); (R.H.); (D.G.); (J.R.); (S.G.)
| | - Jörg Reinders
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Ardeystrasse 67, 44139 Dortmund, Germany; (R.J.P.C.); (Z.H.); (M.M.); (R.H.); (D.G.); (J.R.); (S.G.)
| | - Julia Bornhorst
- Food Chemistry, Faculty of Mathematics and Natural Sciences, University of Wuppertal, Gaußstraße 20, 42119 Wuppertal, Germany; (J.B.); (A.-K.W.)
| | - Ann-Kathrin Weishaupt
- Food Chemistry, Faculty of Mathematics and Natural Sciences, University of Wuppertal, Gaußstraße 20, 42119 Wuppertal, Germany; (J.B.); (A.-K.W.)
| | - Abdel-latif Seddek
- Department of Forensic Medicine and Toxicology, Faculty of Veterinary Medicine, South Valley University, Qena 83523, Egypt;
| | - Tahany Abbas
- Histology Department, Faculty of Medicine, South Valley University, Qena 83523, Egypt;
| | - Adrian Friebel
- Institute of Computer Science & Saxonian Incubator for Clinical Research (SIKT), University of Leipzig, Haertelstraße 16-18, 04107 Leipzig, Germany; (A.F.); (S.H.)
| | - Stefan Hoehme
- Institute of Computer Science & Saxonian Incubator for Clinical Research (SIKT), University of Leipzig, Haertelstraße 16-18, 04107 Leipzig, Germany; (A.F.); (S.H.)
| | - Stephan Getzmann
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Ardeystrasse 67, 44139 Dortmund, Germany; (R.J.P.C.); (Z.H.); (M.M.); (R.H.); (D.G.); (J.R.); (S.G.)
| | - Jan G. Hengstler
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Ardeystrasse 67, 44139 Dortmund, Germany; (R.J.P.C.); (Z.H.); (M.M.); (R.H.); (D.G.); (J.R.); (S.G.)
| | - Christoph van Thriel
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Ardeystrasse 67, 44139 Dortmund, Germany; (R.J.P.C.); (Z.H.); (M.M.); (R.H.); (D.G.); (J.R.); (S.G.)
| | - Ahmed Ghallab
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Ardeystrasse 67, 44139 Dortmund, Germany; (R.J.P.C.); (Z.H.); (M.M.); (R.H.); (D.G.); (J.R.); (S.G.)
- Department of Forensic Medicine and Toxicology, Faculty of Veterinary Medicine, South Valley University, Qena 83523, Egypt;
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Kiro L, Zak M, Kushnirenko I, Chernyshov O. Complex correction of eating behaviour disorders, anthropometric and physiological indicators in patients with non-alcoholic fatty liver disease on the background of abdominal obesity. HEALTH, SPORT, REHABILITATION 2023. [DOI: 10.34142/hsr.2023.09.01.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Purpose: to evaluate the effectiveness of correction of eating behaviour disorders, anthropometric, physiological indicators by impFreelementing combined non-drug treatment for patients with non-alcoholic fatty liver disease on the background of abdominal obesity.
Material and methods
85 patients with non-alcoholic fatty liver disease on the background of abdominal obesity of the 1st degree were examined. All patients were divided into two clinical groups: 1st group (research) - 48 people, with average body mass index BMI=32.55±1.07 kg/m2, who underwent a course of cognitive behavioural therapy, diet therapy, and physical activity for 6 months; the control group - 37 people with average BMI=31.95±1.03 kg/m2 followed only a rational diet and physical activity, without cognitive behavioural therapy. The examination of the patients included the measurement of anthropometric and physiological indicators, questionnaires according to the DEBQ (Dutch Eating Behaviour Questionnaire).
Results
On the 180th day, the number of patients with normal blood pressure in the 1st group increased in 2.38 times (D=2.3511, p=0.0015), healthy eating behavior was recorded in 2.38 times more often (D=0.2215, p=0.0047) and the number of restrictive type of EB decreased in 2.0 times (D=0.4321, p=0.0031), compared to the control group.
Conclusion
A combined course of therapy in the form of a rational diet, aerobic exercise and cognitive behavioural therapy should be an integral component of early non-drug treatment, as a guarantee not only of the correction of anthropometric and functional indicators, but also of the modification of the eating behavior and a guarantee of long-term maintenance of the desired weight.
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Sharma A, Albhaisi S, Sanyal AJ. Treatments for obesity in the context of nonalcoholic steatohepatitis and mental health. Clin Liver Dis (Hoboken) 2022; 20:48-51. [PMID: 36033431 PMCID: PMC9405488 DOI: 10.1002/cld.1219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/19/2022] [Indexed: 02/04/2023] Open
Abstract
Content available: Audio Recording.
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Affiliation(s)
- Aadi Sharma
- University of VirginiaCharlottesvilleVirginiaUSA
| | - Somaya Albhaisi
- Department of Internal MedicineVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Arun J. Sanyal
- Division of Gastroenterology, Hepatology and NutritionDepartment of Internal MedicineVirginia Commonwealth UniversityRichmondVirginiaUSA
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