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Sukumar M, Vikram NK, Ranjan P, Pandey M, Bhalla AS, Ramakrishnan L, Javed D, Malhotra V, Prasad R, Mittal G. Linking Non-alcoholic Fatty Liver Disease Severity With Metabolic Syndrome Features: An Integrative Study on Clinical and Radiological Fronts. Cureus 2024; 16:e59788. [PMID: 38846245 PMCID: PMC11154025 DOI: 10.7759/cureus.59788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 05/07/2024] [Indexed: 06/09/2024] Open
Abstract
Introduction Non-alcoholic fatty liver disease (NAFLD) has become a widespread cause of chronic liver disease, ranging from simple steatosis to severe conditions like non-alcoholic steatohepatitis (NASH) and cirrhosis. Despite its similarity to alcohol-induced liver damage, NAFLD affects individuals with no significant alcohol consumption. This study explores the association between NAFLD, bone mineral density (BMD), insulin resistance, and subclinical inflammation, focusing on the Asian Indian population. The primary objective was to investigate the relationship between NAFLD and BMD, insulin levels, and markers of subclinical inflammation, hypothesizing that patients with NAFLD exhibit lower BMD, possibly linked to insulin resistance and inflammation. Methodology A cross-sectional study with 100 subjects aged 18-50 years (50 cases with NAFLD and 50 controls) was conducted. Exclusion criteria included excessive alcohol consumption, drug-induced fatty liver, severe organ dysfunction, infections, pregnancy, and acute or chronic illness. Data were collected through clinical examinations, anthropometric measurements, biochemical investigations, ultrasound diagnosis of NAFLD, and dual-energy X-ray absorptiometry (DEXA) scans for BMD assessment. Statistical analysis employed the chi-squared tests, t-tests, and Wilcoxon rank-sum tests. Results NAFLD patients had higher body mass index (BMI), waist-to-hip ratio, and markers of insulin resistance and inflammation compared to non-NAFLD controls. DEXA scans revealed significantly lower BMD in NAFLD cases, along with a higher prevalence of osteopenia. Positive correlations were observed between BMD and insulin resistance. The study contributes to understanding the link between NAFLD and lower BMD in the Asian Indian population, emphasizing the impact of insulin resistance and inflammation on bone health. The literature review supports the relevance of exploring NAFLD as an independent risk factor for low BMD. Conclusion This case-control study underscores the significant association between NAFLD and lower BMD in the Asian Indian population. Despite limitations, the findings highlight the importance of further research with larger samples and comprehensive assessments to elucidate the interplay between NAFLD, metabolic factors, and bone health.
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Affiliation(s)
- M Sukumar
- General Medicine, All India Institute of Medical Sciences, Bhopal, IND
| | - Naval K Vikram
- Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Piyush Ranjan
- Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - M Pandey
- Biostatistics, All India Institute of Medical Sciences, New Delhi, IND
| | - Ashu S Bhalla
- Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, IND
| | | | - Danish Javed
- Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy (AYUSH), All India Institute of Medical Sciences, Bhopal, IND
| | - Varun Malhotra
- Physiology, All India Institute of Medical Sciences, Bhopal, IND
| | - Roshan Prasad
- Medicine and Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Gaurav Mittal
- Internal Medicine, Mahatma Gandhi Institute of Medical Sciences, Wardha, IND
- Research and Development, Student Network Organization, Mumbai, IND
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Chatur DK, Pati SK, Ghate JR, Nanda R, Sinha M, Kodapi K. Nonalcoholic Fatty Liver Disease in Shift Workers and Its Effect on Peripheral Nerve Conduction: A Cross-Sectional Study. Cureus 2024; 16:e60632. [PMID: 38899241 PMCID: PMC11185990 DOI: 10.7759/cureus.60632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2024] [Indexed: 06/21/2024] Open
Abstract
Introduction Nonalcoholic fatty liver disease (NAFLD) presents as a multisystem disorder, heightening the risk of developing type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVDs). Occupation emerges as a significant factor influencing the occurrence of NAFLD. Research indicates that individuals engaged in shift work face an elevated risk of NAFLD, alongside obesity and T2DM, attributed to disruptions in their circadian rhythm, which precipitate hepatic steatosis and inflammation. Remarkably, peripheral neuropathy has been observed in conjunction with advanced liver disorders and NAFLD in the general population. However, the correlation between NAFLD and peripheral neuropathy remains unestablished in shift workers. Objective To identify NAFLD in seemingly healthy rotating shift workers and assess any potential impact of NAFLD on nerve function in this demographic. Methods This cross-sectional study involved 73 apparently healthy nonalcoholic security guards (aged 35 to 60 years) working in rotating shifts. The study included a comprehensive assessment, beginning with a medical history, an evaluation of physical activity, and anthropometric measurements. Confirmation of NAFLD was achieved through abdominal ultrasonography (USG), followed by the analysis of biochemical parameters. Motor and sensory nerve conduction studies (NCS) were conducted on participants with normal vitamin B12 levels using the Aleron electromyograph (EMG) machine (Recorders and Medicare Systems Private Ltd, Budanpur, India). The evaluation encompassed the Median and Common Peroneal motor nerves, as well as Median and Sural sensory nerves. Recorded parameters for motor nerves included distal motor latency (DML), compound muscle action potential (CMAP) amplitude, conduction velocity (CV), and F-wave minimum latency (F-wave), while sensory nerve parameters comprised sensory onset latency (SOL), sensory nerve action potential (SNAP) amplitude, and CV. Results Among 73 healthy security guards working in rotating shifts, 76.1% were diagnosed with NAFLD through abdominal ultrasound. Following participant withdrawals and exclusions due to vitamin B12 deficiency, a comparison of NCS parameters between NAFLD (n=24) and Non-NAFLD (n=12) groups revealed no significant disparities in motor or sensory parameters, except for a slightly diminished CMAP amplitude in the peroneal nerve of NAFLD subjects (8.21±2.83mV vs ±10.22±2.30 mV, p< 0.040). However, these differences fell within normal ranges, indicating no notable impact on peripheral nerve conduction in the presence of NAFLD. Conclusion The results indicate a high prevalence of NAFLD among individuals working rotating shifts. Moreover, the investigation suggests that despite the presence of NAFLD, there is no discernible influence on motor and sensory peripheral nerve conduction, particularly in common peroneal, median, and sural nerves.
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Affiliation(s)
- Dipali K Chatur
- Physiology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Saroj K Pati
- Radiodiagnosis, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Jayshri R Ghate
- Physiology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Rachita Nanda
- Biochemistry, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Meenakshi Sinha
- Physiology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Kalpana Kodapi
- Pathology, All India Institute of Medical Sciences, Raipur, Raipur, IND
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Vakil Z, Ahire K. Clinical Profile of Nonalcoholic Fatty Liver Disease and its Correlation with Metabolic Syndrome and Cardiovascular Risk. Int J Appl Basic Med Res 2023; 13:234-239. [PMID: 38229733 PMCID: PMC10789464 DOI: 10.4103/ijabmr.ijabmr_138_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 01/18/2024] Open
Abstract
Background Nonalcoholic fatty liver disease (NAFLD) has been projected, within the next 20 years, to become the major cause of liver-related morbidity and mortality as well as a leading indication for liver transplantation. Affected South Asian Indians are at higher risk for the development of metabolic syndrome (MS), type 2 diabetes, and cardiovascular disease. There is a dearth of data related to NAFLD and its various sequelae and correlation with cardiovascular disease in South Asia. Materials and Methods It was an observational, prospective study conducted over 2 years on 80 patients in a tertiary care hospital in Mumbai. All patients diagnosed with NAFLD were investigated for MS according to the National Cholesterol Education Program Adult Treatment Panel III criteria, and a relationship between NAFLD and MS was correlated. Results MS was found to be present in 72.5% of the patients. Significant results were obtained while correlating MS parameters and fatty liver grading, implying that patients with a higher fatty liver grading were more likely to have derangements in metabolic markers. Conclusion NAFLD was found to be associated with an increased incidence of MS and thereby a higher risk of cardiovascular disease, warranting a high index of suspicion for both. A higher ultrasound grading of fatty liver was found to be associated with an increased incidence of MS.
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Affiliation(s)
- Zahaan Vakil
- Department of General Medicine, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Kiran Ahire
- Department of General Medicine, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Pathak MP, Pathak K, Saikia R, Gogoi U, Patowary P, Chattopadhyay P, Das A. Therapeutic potential of bioactive phytoconstituents found in fruits in the treatment of non-alcoholic fatty liver disease: A comprehensive review. Heliyon 2023; 9:e15347. [PMID: 37101636 PMCID: PMC10123163 DOI: 10.1016/j.heliyon.2023.e15347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 03/15/2023] [Accepted: 04/03/2023] [Indexed: 04/28/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD), a chronic liver condition affects a large number of people around the world with a frequency of 25% of all the chronic liver disease worldwide. Several targets viz. anti-inflammatory, anti-apoptotic and, anti-fibrotic factors, anti-oxidant and insulin-sensitizing pathways, metabolic regulators as well as repurposing traditional medications have been studied for the pharmacologic therapy of NAFLD. Newer pharmacotherapies like caspases blockade, agonists of PPAR and farnesoid X receptor agonists are currently being investigated in treating human NAFLD. However, NAFLD has no FDA-approved pharmacological therapy, therefore there is a considerable unmet therapy need. Apart from the conventional treatment regime, the current approaches to treating NAFLD include lifestyle interventions including healthy diet with adequate nutrition and physical activity. Fruits are known to play a key role in the well-being of human health. Fruits are loaded with a repertoire of bioactive phytoconstituents like catechins, phytosterols, proanthocyanidin, genestin, daidzen, resveratrol, magiferin found in fruits like pear, apricot, strawberries, oranges, apples, bananas, grapes, kiwi, pineapple, watermelon, peach, grape seed and skin, mango, currants, raisins, dried dates, passion fruit and many more. These bioactive phytoconstituents are reported to demonstrate promising pharmacological efficacy like reduction in fatty acid deposition, increased lipid metabolism, modulation of insulin signaling pathway, gut microbiota and hepatic inflammation, inhibition of histone acetyltransferase enzymatic activity to name a few. Not only fruits, but their derivatives like oils, pulp, peel, or their preparations are also found to be equally beneficial in various liver diseases like NAFLD, NASH. Although most of the fruits contains potent bioactive phytoconstituents, however, the presence of sugar in fruits put a question mark on the ameliorative property of the fruits and there has been contrasting reports on the glycemic control post fruit consumption in type 2 diabetic patients. This review is an attempt to summarize the beneficial effects of fruit phytoconstituents on NAFLD based on epidemiological, clinical and experimental evidence, focusing especially on their mechanisms of action.
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Affiliation(s)
- Manash Pratim Pathak
- Faculty of Pharmaceutical Science, Assam down town University, Panikhaiti, Guwahati-781026, Assam, India
| | - Kalyani Pathak
- Department of Pharmaceutical Sciences, Dibrugarh University, Dibrugarh 786004, Assam, India
| | - Riya Saikia
- Department of Pharmaceutical Sciences, Dibrugarh University, Dibrugarh 786004, Assam, India
| | - Urvashee Gogoi
- Department of Pharmaceutical Sciences, Dibrugarh University, Dibrugarh 786004, Assam, India
| | - Pompy Patowary
- Department of Pharmaceutical Sciences, Dibrugarh University, Dibrugarh 786004, Assam, India
- Division of Pharmaceutical Technology, Defence Research Laboratory, Tezpur 784001, Assam, India
| | - Pronobesh Chattopadhyay
- Division of Pharmaceutical Technology, Defence Research Laboratory, Tezpur 784001, Assam, India
| | - Aparoop Das
- Department of Pharmaceutical Sciences, Dibrugarh University, Dibrugarh 786004, Assam, India
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Prasad M, Gupta S, Kashyap N, Kapil U. Diagnostic performance of non-invasive liver fibrosis risk scores in biopsy-proven non-alcoholic fatty liver disease patients in India. Indian J Gastroenterol 2023; 42:192-198. [PMID: 37191918 DOI: 10.1007/s12664-022-01335-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/18/2022] [Indexed: 05/17/2023]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide. India and other developing countries are witnessing an unprecedented rise in the prevalence of NAFLD. As part of population-level strategy, at primary healthcare, an efficient risk stratification is crucial to ensure appropriate and timely referral of individuals who require care at secondary and tertiary levels. The present study was conducted to assess the diagnostic performance of two non-invasive risk scores, fibrosis-4 (FIB-4), and NAFLD fibrosis score (NFS), in Indian patients of biopsy-proven NAFLD. METHODS We conducted a retrospective analysis of biopsy-proven NAFLD patients that reported to our center between 2009 and 2015. Clinical and laboratory data were collected and two non-invasive fibrosis scores, NFS and FIB-4 score, were calculated using the original formulas. Liver biopsy was utilized as gold standard for diagnosis of NAFLD, diagnostic performance was determined by plotting receiver operator characteristic (ROC) curves and area under the ROC curve (AUROC) was calculated for each score. RESULTS The mean age of 272 patients included was 40 (11.85) years and 187 (79.24%) were men. We found that the AUROCs for FIB-4 score (0.634) was higher for any degree of fibrosis as compared to NFS (0.566). The AUROC for FIB-4 for advanced liver fibrosis was 0.640 (.550-.730). The performance of the scores for advanced liver fibrosis was comparable with overlapping confidence intervals for both scores. CONCLUSION The present study found an average performance of FIB-4 and NFS risk scores for detecting advanced liver fibrosis in Indian population. This study highlights the need for devising novel context-specific risk scores for efficient risk stratification of NAFLD patients in India.
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Affiliation(s)
- Manya Prasad
- Department of Epidemiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110 070, India
| | - Sunanda Gupta
- Department of Epidemiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110 070, India
| | - Nikky Kashyap
- Department of Epidemiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110 070, India
| | - Umesh Kapil
- Department of Epidemiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110 070, India.
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Jalili V, Poorahmadi Z, Hasanpour Ardekanizadeh N, Gholamalizadeh M, Ajami M, Houshiarrad A, Hajipour A, Shafie F, Alizadeh A, Mokhtari Z, Shafaei H, Esmaeili M, Doaei S. The association between obesity with serum levels of liver enzymes, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and gamma-glutamyl transferase in adult women. Endocrinol Diabetes Metab 2022; 5:e367. [PMID: 36039792 PMCID: PMC9659656 DOI: 10.1002/edm2.367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/08/2022] [Accepted: 08/13/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Obesity-induced inflammation may independently disturb the function of critical organs such as liver. This study aimed to investigate the association of obesity with serum levels of biomarkers of liver function including alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) in adult women. METHODS This cross-sectional study was carried out on 360 adult women in the summer of 2020 in Tehran, Iran. The participants were categorized into two groups based on their body mass index (BMI≤29.9 and BMI > 30). The serum levels of ALT, AST, ALP and GGT were measured. Logistic regression method was used to assess the association between BMI and liver enzymes after adjusting for the confounders. RESULTS The mean BMI in non-obese and obese groups was 26.32 ± 2.61 and 33.40 ± 2.80 kg/m2 , respectively (p = .01). A significant association was found between BMI with ALT (β = .16, p = .002) and GGT (β = .19, p = .01) enzymes after adjustment for age. The association between BMI and GGT remained significant after further adjustments for smoking, alcohol use, physical activity and educational status. There was no significant association between BMI and liver enzymes after adjustment for dietary intake. CONCLUSIONS Obesity was associated with the level of serum liver enzymes. However, adjustment for dietary intake disappeared the significant results. Further studies are needed to determine the independent effects of obesity on the liver function.
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Affiliation(s)
- Vahideh Jalili
- Faculty of MedicineUrmia University of Medical sciencesUrmiaIran
| | - Zohreh Poorahmadi
- Department of Food and Beverage ProductsFood and Drug AdministrationTehranIran
| | | | | | - Marjan Ajami
- Department of Food and Nutrition Policy and PlanningNational Nutrition and Food Technology Research Institute, School of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical SciencesTehranIran
| | - Anahita Houshiarrad
- Department of Nutrition ResearchNational Nutrition and Food Technology Research Institute, School of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical ScienceTehranIran
| | - Azadeh Hajipour
- School of HealthQazvin University of Medical SciencesQazvinIran
| | - Fatemeh Shafie
- Nutrition Research Center, School of Nutrition and Food SciencesShiraz University of Medical SciencesShirazIran
| | - Atiyeh Alizadeh
- Department of Pharmacologynosy, Faculty of PharmacyTehran University of Medical SciencesTehranIran
| | - Zohreh Mokhtari
- Department of Clinical Biochemistry, Faculty of MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Hanieh Shafaei
- Nursing and Midwifery SchoolGuilan University of Medical SciencesRashtIran
| | - Mina Esmaeili
- Department of Nutrition ResearchNational Nutrition and Food Technology Research Institute, School of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical SciencesTehranIran
| | - Saeid Doaei
- Department of Community NutritionNational Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical SciencesTehranIran
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Chawla H, Bhosale V, Misra R, Sonkar SK, Kohli N, Jamal N, Vimal SR, Dangi B, Durgapal K, Singh S, Negi MPS, Ghatak A. Lipocalin-2 levels increase in plasma of non-alcoholic fatty liver disease patients with metabolic syndrome. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-022-01058-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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8
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Factors influencing circulating microRNAs as biomarkers for liver diseases. Mol Biol Rep 2022; 49:4999-5016. [DOI: 10.1007/s11033-022-07170-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 01/19/2022] [Indexed: 11/09/2022]
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Automatic Classification of Fatty Liver Disease Based on Supervised Learning and Genetic Algorithm. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12010521] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Fatty liver disease is considered a critical illness that should be diagnosed and detected at an early stage. In advanced stages, liver cancer or cirrhosis arise, and to identify this disease, radiologists commonly use ultrasound images. However, because of their low quality, radiologists found it challenging to recognize this disease using ultrasonic images. To avoid this problem, a Computer-Aided Diagnosis technique is developed in the current study, using Machine Learning Algorithms and a voting-based classifier to categorize liver tissues as being fatty or normal, based on extracting ultrasound image features and a voting-based classifier. Four main contributions are provided by our developed method: firstly, the classification of liver images is achieved as normal or fatty without a segmentation phase. Secondly, compared to our proposed work, the dataset in previous works was insufficient. A combination of 26 features is the third contribution. Based on the proposed methods, the extracted features are Gray-Level Co-Occurrence Matrix (GLCM) and First-Order Statistics (FOS). The fourth contribution is the voting classifier used to determine the liver tissue type. Several trials have been performed by examining the voting-based classifier and J48 algorithm on a dataset. The obtained TP, TN, FP, and FN were 94.28%, 97.14%, 5.71%, and 2.85%, respectively. The achieved precision, sensitivity, specificity, and F1-score were 94.28%, 97.05%, 94.44%, and 95.64%, respectively. The achieved classification accuracy using a voting-based classifier was 95.71% and in the case of using the J48 algorithm was 93.12%. The proposed work achieved a high performance compared with the research works.
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10
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Anand A, Singh AA, Elhence A, Vaishnav M, Biswas S, Gunjan D, Gamanagatti SR, Nayak B, Kumar R, Shalimar. Prevalence and Predictors of Nonalcoholic Fatty Liver Disease in Family Members of Patients With Nonalcoholic Fatty Liver Disease. J Clin Exp Hepatol 2022; 12:362-371. [PMID: 35535086 PMCID: PMC9077183 DOI: 10.1016/j.jceh.2021.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/25/2021] [Indexed: 12/12/2022] Open
Abstract
Background and aims Nonalcoholic fatty liver disease (NAFLD) is the commonest cause of chronic liver disease worldwide. Despite the high prevalence, no screening recommendations yet exist. We designed a prospective observational study to estimate the prevalence of NAFLD in the family of patients with NAFLD and develop a predictive model for identifying it. Methodology The prevalence of NAFLD in patients' family members was estimated using ultrasonography, and univariate and multivariate odds were calculated for its predictors. A model was created using the significant parameters on multivariate odds, and its performance was tested using the area under the receiver operating characteristic (AUROC). Results Among 447 family members of 191 patients with NAFLD, the prevalence of NAFLD was 55.9%. Family members with NAFLD were younger and had lower serum levels of aspartate aminotransferase, alanine aminotransferase (ALT), triglycerides. The liver stiffness measurement and controlled attenuation parameter values were also lesser in family members compared to the index cases. Age, body mass index (BMI), and ALT were independent predictors of NAFLD in the family members. A model combining age and BMI had an AUROC of 0.838 [95% confidence interval (CI) 0.800-0.876, P < 0.001]. Age ≥30 years and BMI ≥25 kg/m2 had an odds ratio of 33.5 (95% CI 17.0-66.0, P < 0.001) for prediction of NAFLD, in comparison to BMI <25 kg/m2 and age <30 years. Conclusion Family members of patients with NAFLD are at increased risk of NAFLD. Screening strategies using BMI and age ensure early identification and could be beneficial in clinical practice.
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Key Words
- ALT, Alanine aminotransferase
- APRI, AST to platelet ratio index
- AST, Aspartate aminotransferase
- AUROC, Area under ROC
- BMI
- BMI, Body mass index
- CAP, Controlled attenuation parameter
- CI, Confidence interval
- EASL, European Association for the Study of the Liver
- FAST, FibroScan-AST
- FDRs, First-degree relatives
- FIB-4, Fibrosis-4
- HDL-C, High-density lipoprotein-cholesterol
- HbA1C, Glycosylated hemoglobin
- LSM, Liver stiffness measure
- MetS, Metabolic syndrome
- NAFLD, Non-alcoholic fatty liver disease
- NASH, Non-alcoholic steatohepatitis
- NCEP-ATP, National Cholesterol Education Program- Adult Treatment Panel
- NFS, NAFLD fibrosis score
- OR, Odds ratio
- ROC, Receiver operating curve
- family members
- nonalcoholic fatty liver disease
- predictors
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Affiliation(s)
- Abhinav Anand
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Amit A. Singh
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Anshuman Elhence
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Manas Vaishnav
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Sagnik Biswas
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Gunjan
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | | | - Baibaswata Nayak
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Ramesh Kumar
- Department of Gastroenterology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Shalimar
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India,Address for correspondence: Dr Shalimar, Additional Professor, Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110029, India. Tel.: +91 9968405815; Fax: +91 11 26588663, +91 11 26588641.
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Bharath Kumar C, Goel A, Jaleel R, David D, Zachariah U, Ramachandran J, Eapen CE. Prevalence of Risk Factors for Nonalcoholic Fatty Liver Disease in Middle-Aged and Elderly Patients With Cryptogenic Cirrhosis. J Clin Exp Hepatol 2022; 12:492-502. [PMID: 35535099 PMCID: PMC9077180 DOI: 10.1016/j.jceh.2021.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/22/2021] [Indexed: 12/12/2022] Open
Abstract
Aim of the study To study the prevalence of risk factors for nonalcoholic fatty liver disease (NAFLD) in middle-aged (40-59 years) and elderly patients (≥60 years) with cryptogenic cirrhosis as compared to those with hepatitis B or C virus (HBV or HCV) related cirrhosis. Methods and materials Between August 2013 and December 2014, cases (cryptogenic cirrhosis) and controls (HBV/HCV cirrhosis) above 40 years of age were prospectively recruited and assessed for the cause and prevalence of risk factors for NAFLD. Results One hundred eighteen cases (male-74%; age 55 (40-74) years; median (range); Child's class A:B:C-46:38:16) and 59 controls (male-80%; age 55.5 (40-69) years; Child's class A:B:C-56:30:14) were enrolled. Obesity (53% v/s 39%, P-0.081), diabetes mellitus (DM) (52% v/s 27%; P-0.002), family history of DM (30% v/s 13%; P-0.016), family history of Obesity (21% v/s 3.5%; P-0.002) and metabolic syndrome (65% v/s 44%; P-0.01) were more among cases than controls. Lifetime weight as obese was also longer in cases than in controls (5.9 ± 6.2 years v/s 3.2 ± 5.1 years, P-0.002). On subgroup analysis, in elderly age group, DM (55% v/s 17%, P-0.006), family history of DM (40% v/s 11%, P-0.025), metabolic syndrome (76% v/s 44%, P-0.017) and family history of obesity (19% v/s 0, P-0.047) were more common in cases as compared to controls, where as in the middle-age group, family history of obesity was the only significant factor (22% v/s 5%, P-0.025). Lifetime weight as obese was longer in cases than controls in both middle and elderly age groups. Conclusion Among middle-aged and elderly patients with cirrhosis, there was a higher prevalence of risk factors for NAFLD in those with cryptogenic cirrhosis, compared to those with HBV or HCV cirrhosis.
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Affiliation(s)
| | - Ashish Goel
- Department of Hepatology, Division of GI Sciences, CMC Hospital, Vellore, Tamil Nadu, India
| | - Rajeeb Jaleel
- Department of Gastroenterology, Division of GI Sciences, CMC Hospital, Vellore, Tamil Nadu, India
| | - Deepu David
- Department of Gastroenterology, Division of GI Sciences, CMC Hospital, Vellore, Tamil Nadu, India,Address for correspondence: Department of Gastroenterology, Division of GI Sciences, CMC Hospital, Vellore, Tamil Nadu, India. Tel.: +91 4162282148.
| | - Uday Zachariah
- Department of Hepatology, Division of GI Sciences, CMC Hospital, Vellore, Tamil Nadu, India
| | - Jeyamani Ramachandran
- Department of Hepatology, Division of GI Sciences, CMC Hospital, Vellore, Tamil Nadu, India
| | - Chundamannil E. Eapen
- Department of Hepatology, Division of GI Sciences, CMC Hospital, Vellore, Tamil Nadu, India
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Sarin SK, Prasad M, Ramalingam A, Kapil U. Integration of public health measures for NAFLD into India's national programme for NCDs. Lancet Gastroenterol Hepatol 2021; 6:777-778. [PMID: 34509189 DOI: 10.1016/s2468-1253(21)00264-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 12/17/2022]
Affiliation(s)
- Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
| | - Manya Prasad
- Department of Clinical Epidemiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Archana Ramalingam
- Department of Clinical Epidemiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Umesh Kapil
- Department of Clinical Epidemiology, Institute of Liver and Biliary Sciences, New Delhi, India
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Acharya P, Chouhan K, Weiskirchen S, Weiskirchen R. Cellular Mechanisms of Liver Fibrosis. Front Pharmacol 2021; 12:671640. [PMID: 34025430 PMCID: PMC8134740 DOI: 10.3389/fphar.2021.671640] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/21/2021] [Indexed: 12/12/2022] Open
Abstract
The liver is a central organ in the human body, coordinating several key metabolic roles. The structure of the liver which consists of the distinctive arrangement of hepatocytes, hepatic sinusoids, the hepatic artery, portal vein and the central vein, is critical for its function. Due to its unique position in the human body, the liver interacts with components of circulation targeted for the rest of the body and in the process, it is exposed to a vast array of external agents such as dietary metabolites and compounds absorbed through the intestine, including alcohol and drugs, as well as pathogens. Some of these agents may result in injury to the cellular components of liver leading to the activation of the natural wound healing response of the body or fibrogenesis. Long-term injury to liver cells and consistent activation of the fibrogenic response can lead to liver fibrosis such as that seen in chronic alcoholics or clinically obese individuals. Unidentified fibrosis can evolve into more severe consequences over a period of time such as cirrhosis and hepatocellular carcinoma. It is well recognized now that in addition to external agents, genetic predisposition also plays a role in the development of liver fibrosis. An improved understanding of the cellular pathways of fibrosis can illuminate our understanding of this process, and uncover potential therapeutic targets. Here we summarized recent aspects in the understanding of relevant pathways, cellular and molecular drivers of hepatic fibrosis and discuss how this knowledge impact the therapy of respective disease.
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Affiliation(s)
- Pragyan Acharya
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Komal Chouhan
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Sabine Weiskirchen
- Institute of Molecular Pathobiochemistry, Experimental Gene Therapy and Clinical Chemistry, RWTH University Hospital Aachen, Aachen, Germany
| | - Ralf Weiskirchen
- Institute of Molecular Pathobiochemistry, Experimental Gene Therapy and Clinical Chemistry, RWTH University Hospital Aachen, Aachen, Germany
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Gautam CS, Sharma J, Singla M, Tiwana IK, Singh H. Potential Role of Dexamphetamine in the Treatment of Non-alcoholic Fatty Liver Disease: Hopes and Pitfalls. TOUCHREVIEWS IN ENDOCRINOLOGY 2021; 17:33-36. [PMID: 35118444 DOI: 10.17925/ee.2021.17.1.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 01/14/2021] [Indexed: 12/11/2022]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is one of most frequent causes of chronic liver disease. Global prevalence of NAFLD and nonalcoholic steatohepatitis (NASH) with advanced fibrosis is increasing day by day. Patients with NAFLD are more susceptible to encounter cardiovascular morbidity and mortality. Apart from lifestyle changes and dietary modifications, no effective pharmacotherapy is available to prevent the progression of NAFLD to NASH and advanced stages of hepatic fibrosis and cirrhosis. Dexamphetamine is the d-isomer of amphetamine, which acts by inhibiting monoamine reuptake and direct stimulation of dopamine and noradrenaline release. Presently, dexamphetamine is indicated for the treatment of attention deficit hyperactivity disorder and narcolepsy, but since its use was found to be associated with weight loss, it is also now used as an off-label drug for the treatment of obesity. Direct or indirect evidence is present in the form case reports, case series and from effects of related drugs to support the potential role of dexamphetamine in NAFLD. There is an urgent need to initiate preclinical and clinical studies involving robust methodology and adequate sample sizes to explore the potential of dexamphetamine in patients with NAFLD. In this review, we will discuss the therapeutic potential of dexamphetamine for the treatment of NAFLD.
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Affiliation(s)
- C S Gautam
- Department of Pharmacology, Government Medical College and Hospital, Chandigarh, India
| | - Jatin Sharma
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - Mandeep Singla
- Department of Pharmacology, Government Medical College and Hospital, Chandigarh, India
| | | | - Harmanjit Singh
- Department of Pharmacology, Government Medical College and Hospital, Chandigarh, India
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Duseja A, Chahal GS, Jain A, Mehta M, Ranjan A, Grover V. Association between nonalcoholic fatty liver disease and inflammatory periodontal disease: A case‑control study. J Indian Soc Periodontol 2021; 25:47-54. [PMID: 33642741 PMCID: PMC7904021 DOI: 10.4103/jisp.jisp_45_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 04/17/2020] [Accepted: 04/28/2020] [Indexed: 11/10/2022] Open
Abstract
Background: Recent evidence suggests an interconnection between chronic periodontal disease and systemic diseases. Aim: The aim of this study is to evaluate the possible association between nonalcoholic fatty liver disease (NAFLD) and inflammatory periodontal disease among north Indian population. Settings and Design: Tertiary health care center, cross-sectional case-control observational study. Materials and Methods: A total of 40 cases, i.e., patients with NAFLD and 40 healthy volunteers were included over a period of 8 months and their periodontal status was compared. The status of their hepatic health was ascertained by anthropometric, imaging, and biochemical evaluation including ultrasound examination of abdomen and transient elastography. Statistical Data Analysis: Paired t-test, multivariate logistic regression analysis using IBM SPSS STATISTICS (version 22.0, Armonk, NY: IBM Corp). Results: The study revealed that only 11.9% and 20% of participants had periodontitis, in healthy controls and hepatic disease patients, respectively. A statistically significant difference was observed in clinical parameters of periodontal status, except for malocclusion. Comparative analysis of tumor necrosis factor-α (TNF-α), interleukin-6, C-reactive protein, and cytokeratin-18 revealed differences in mean scores, though statistically nonsignificant. Only aspartate transaminase, number of missing teeth, and bleeding on probing (BOP) were observed with higher odds ratios for hepatic disease patients. Spearman correlation analysis revealed significant positive correlations between TNF-α and BOP, for cases. Conclusion: Patients with hepatic disease showed a higher prevalence of periodontal disease, worse oral hygiene and periodontal health status compared to healthy individuals.
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Affiliation(s)
- Ajay Duseja
- Department of Hepatology, PGIMER, Panjab University, Chandigarh, India
| | - Gurparkash Singh Chahal
- Department of Periodontology, Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, India
| | - Ashish Jain
- Department of Periodontology, Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, India
| | - Manu Mehta
- Department of Hepatology, PGIMER, Panjab University, Chandigarh, India
| | - Aditya Ranjan
- Department of Periodontology, Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, India
| | - Vishakha Grover
- Department of Periodontology, Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, India
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Nagappa B, Ramalingam A, Rastogi A, Dubey S, Thomas SS, Gupta E, Sarin SK. Number needed to screen to prevent progression of liver fibrosis to cirrhosis at primary health centers: An experience from Delhi. J Family Med Prim Care 2021; 10:1412-1418. [PMID: 34041187 PMCID: PMC8140251 DOI: 10.4103/jfmpc.jfmpc_1441_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/17/2020] [Accepted: 11/24/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Early diagnosis has been a bottleneck in the care of chronic liver disease patients and can be addressed by Community-based screening for liver fibrosis using non-invasive diagnostic techniques. OBJECTIVES The study aimed to determine the prevalence of liver fibrosis and the number needed to screen (NNS) to prevent the progression of fibrosis, among adults visiting urban Primary Health Centres (PHC). METHODS A facility-based cross-sectional study was conducted from May 2018 to April 2019 in 72 randomly chosen PHCs using a mobile screening van. A pre-tested questionnaire was used to collect relevant history from adult patients and patient attenders. A venous blood sample was collected for biochemical markers and Transient Elastography was also done to measure Liver stiffness (LSM). LSM ≥6.0 kPa was taken as the cut-off for detecting liver fibrosis. Lifestyle modifications and alcohol cessations were considered as interventions for non-alcoholic fatty liver disease (NAFLD) and alcoholic liver disease (ALD) respectively, to calculate NNS. RESULTS 7624 participants were recruited in the study with a mean age of 46 ± 12 years. Around 35.5% of participants had liver fibrosis and 3% had cirrhosis. Nearly 4% had ALD and 30% had NAFLD. NNS for preventing progression of fibrosis for ALD and NAFLD was 12 and 29 respectively. NNS was least among obese, diabetes and hypertensive participants. CONCLUSION One-third of adults visiting urban PHCs had significant liver fibrosis. Low NNS to prevent the progression of fibrosis to cirrhosis among alcohol users and other high-risk groups, substantiates the need for screening among these groups.
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Affiliation(s)
- Bharathnag Nagappa
- Department of Epidemiology, Institute of Liver and Biliary Sciences, Delhi, India
| | - Archana Ramalingam
- Department of Epidemiology, Institute of Liver and Biliary Sciences, Delhi, India
| | - Aayushi Rastogi
- Department of Epidemiology, Institute of Liver and Biliary Sciences, Delhi, India
| | - Shantanu Dubey
- Assistant Head Operations (Medical), Institute of Liver and Biliary Sciences, Delhi, India
| | - Sherin Sarah Thomas
- Department of Biochemistry (Metabolic Medicine and Immunopathology), Institute of Liver and Biliary Sciences, Delhi, India
| | - Ekta Gupta
- Department of Virology, Institute of Liver and Biliary Sciences, Delhi, India
| | - Shiv Kumar Sarin
- Department of Hepatology and Director, Institute of Liver and Biliary Sciences, Delhi, India
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Gautam CS, Sharma J, Singla M, Tiwana IK, Singh H. Potential Role of Dexamphetamine in the Treatment of Non-alcoholic Fatty Liver Disease: Hopes and Pitfalls. EUROPEAN ENDOCRINOLOGY 2021. [DOI: 10.17925/ee.2021.1.1.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Primary Versus Secondary NAFLD: Perspective on Advanced Fibrosis. J Clin Exp Hepatol 2021; 11:557-564. [PMID: 34511816 PMCID: PMC8414329 DOI: 10.1016/j.jceh.2020.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/24/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The presence of macrovesicular steatosis on liver biopsy is the commonest histopathological finding. Nonalcoholic fatty liver disease (NAFLD) is the presence of ≥5% macrovesicular steatosis without significant alcohol use. It is subdivided into primary and secondary NAFLD; information on their differences is limited. AIM To determine the histopathological differences between primary and secondary NAFLD and establish whether the prevalence of advanced fibrosis varies between the two types. METHODOLOGY Three years of retrospective study of 90 liver biopsies with ≥5% macrovesicular steatosis. Age, gender, clinical history, serum transaminase levels were noted. The biopsy was reviewed for steatosis, inflammation, and fibrosis. Differences between primary and secondary NAFLD for age, gender, AST/ALT ratio, histopathological features were determined. Descriptive statistical analysis, 2-tailed Student's t test, Chi-square test, Fisher's exact test were used, where p < 0.05 was considered significant. RESULT Primary and secondary NAFLD were 42 (46.7%) and 48 (53.3%), respectively. Inflammation was noted in 50 (55.5%) and fibrosis in 31 (34.4%). The prevalence of advanced fibrosis was 24.4%. Primary and secondary NAFLD differed significantly on ballooning degeneration, Mallory Denk bodies (MDBs), glycogenated nuclei, and fibrosis stage (p < 0.05). There were no significant differences among AST/ALT ratio, steatosis, and inflammation grade. CONCLUSION Primary NAFLD is a more severe type of liver disease. On histopathology, ballooning degeneration, MDBs, glycogenated nuclei, and advanced fibrosis was more prevalent in primary than secondary NAFLD.
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Key Words
- ALT, Alanine aminotransferase
- AST, Aspartate aminotransferase
- HBV, Hepatitis B virus
- HCC, Hepatocellular carcinoma
- HIV, Human immunodeficiency virus
- MDB, Mallory hyaline bodies
- MTX, Methotrexate
- NAFLD, Nonalcoholic fatty liver disease
- NAS, NAFLD activity score
- NASH, Nonalcoholic steatohepatitis
- advanced fibrosis
- inflammation
- non-alcoholic fatty liver disease
- primary NAFLD
- secondary NAFLD
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Khiangte B, Kothakota SR, Sasidharan M, Kareem H, Joshi S, Kumar VV, Kanala JR, Kumar C P, Nair AK. Prevalence and determinants of hepatopulmonary syndrome in decompensated chronic liver disease. Indian J Gastroenterol 2020; 39:362-369. [PMID: 32839954 DOI: 10.1007/s12664-020-01052-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 05/07/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND One of the severe complications of liver disease is hepatopulmonary syndrome (HPS). There is paucity in literature regarding the various factors associated with the development of HPS. This study was conducted to analyze the prevalence and determinants of HPS among patients with decompensated chronic liver disease (CLD). METHODS This study was a cross-sectional-observational study conducted in a tertiary care center. Decompensated CLD patients admitted for pre-liver transplant workup were included in the study. Demographic data, clinical findings, and biochemical and hematologic parameters were collected. Pulse oximetry, arterial blood gas analysis, bubble contrast echocardiogram, diffusion capacity of the lungs for carbon monoxide (DLCO), and spirometry were done to get the needed parameters. All data were entered into a Microsoft Excel sheet and analyzed using the statistical software SPSS for Windows, version 22.0. RESULTS Among 64 subjects, 58 were men (90.6%). Mean age was 54.5 years. HPS was present in 26 (40.6%) patients. Platypnea and orthodeoxia were present more often in HPS patients. DLCO was significantly impaired among patients with HPS. Portopulmonary hypertension was seen in 8 (12.5%) subjects with no difference between HPS and non-HPS patients. Subjects with HPS had more severe liver disease. A model for end-stage liver disease (MELD)-Na score > 19 was associated with HPS (sensitivity 73.08%, specificity 65.79%, PPV 59.4%, and NPV 78.1%). Multivariate analysis (binary logistic regression) revealed that a higher MELD-Na score, hepatic encephalopathy, and impaired DLCO were independently associated with HPS. CONCLUSIONS HPS is associated with more severe liver disease (as per Child-Turcotte-Pugh [CTP] stage and MELD-Na score). There was no relation between HPS and causes of CLD. Higher MELD-Na score, hepatic encephalopathy, impaired DLCO, clubbing, and spider naevi were independently associated with HPS.
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Affiliation(s)
- Benjamine Khiangte
- Department of Gastroenterology, Kerala Institute of Medical Sciences (KIMS) Hospital, Anayara PO, Trivandrum, 695 029, India
| | - Sunil Raviraj Kothakota
- Department of Gastroenterology, Kerala Institute of Medical Sciences (KIMS) Hospital, Anayara PO, Trivandrum, 695 029, India.
| | - Madhu Sasidharan
- Department of Gastroenterology, Kerala Institute of Medical Sciences (KIMS) Hospital, Anayara PO, Trivandrum, 695 029, India
| | - Harish Kareem
- Department of Gastroenterology, Kerala Institute of Medical Sciences (KIMS) Hospital, Anayara PO, Trivandrum, 695 029, India
| | - Subhashchandra Joshi
- Department of Gastroenterology, Kerala Institute of Medical Sciences (KIMS) Hospital, Anayara PO, Trivandrum, 695 029, India
| | - Vijosh V Kumar
- Department of Gastroenterology, Kerala Institute of Medical Sciences (KIMS) Hospital, Anayara PO, Trivandrum, 695 029, India
| | - Jagadeswara Reddy Kanala
- Department of Gastroenterology, Kerala Institute of Medical Sciences (KIMS) Hospital, Anayara PO, Trivandrum, 695 029, India
| | - Praveen Kumar C
- Department of Gastroenterology, Kerala Institute of Medical Sciences (KIMS) Hospital, Anayara PO, Trivandrum, 695 029, India
| | - Ajith K Nair
- Department of Gastroenterology, Kerala Institute of Medical Sciences (KIMS) Hospital, Anayara PO, Trivandrum, 695 029, India
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Venniyoor A. Non-alcoholic fatty liver and cancer. Indian J Gastroenterol 2020; 39:303. [PMID: 32617777 DOI: 10.1007/s12664-020-01065-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Ajit Venniyoor
- National Oncology Centre, The Royal Hospital, Muscat, Sultanate of Oman.
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Sinha N, Mukhopadhyay S, Sau M. Metabolic syndrome is not uncommon among lean non-alcoholic fatty liver disease patients as compared with those with obesity. Indian J Gastroenterol 2020; 39:75-83. [PMID: 32314167 DOI: 10.1007/s12664-020-01020-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/04/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is associated with obesity, which is known to be associated with metabolic syndrome (MS). However, the risk factors for NAFLD in absence of obesity (leanness) is not well-studied. This study aimed to investigate and compare the clinical characteristics, metabolic associations, and cardiovascular risk factors among patients having NAFLD with (body mass index [BMI] ≥ 23 kg/m2) or without obesity (BMI < 23 kg/m2). METHODS The cross-sectional study was conducted among the outdoor and indoor patients diagnosed as NAFLD by ultrasonography in a tertiary care teaching hospital in eastern India. Relevant anthropometric measurements, laboratory investigations, and imaging were performed. Metabolic syndrome was classified by the "International Diabetes Federation, 2005" criteria. RESULTS Among 120 NAFLD patients, 37 (30.8%) were lean, while 83 (69.2%) were obese. The components of MS such as systolic blood pressure (lean, 138.0 ± 17.6 mmHg; obese, 137.9 ± 15.3 mmHg), diastolic blood pressure (lean, 88.9 ± 6.5 mmHg; obese, 87.3 ± 6.1 mmHg), fasting blood sugar (lean, 127.8 ± 30.8 mg/dL; obese, 135.1 ± 29.5 mg/dL), and serum triglyceride (lean, 170.5 ± 34.2 mg/dL; obese, 186.4 ± 43.8 mg/dL) were comparable among patients with obese and lean NAFLD and were more often abnormal among both the groups of NAFLD as compared with controls. CONCLUSION The overall prevalence of MS among NAFLD study population was 64.2%. Lean NAFLD was also associated with the component of MS like obese NAFLD.
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Affiliation(s)
- Nirmalya Sinha
- Community Medicine, Midnapore Medical College, Midnapore, 721 101, India
| | - Saptarshi Mukhopadhyay
- Department of General Medicine, Ramakrishna Mission Seva Pratishthan, Vivekananda Institute of Medical Sciences, Kolkata, 700 026, India
| | - Manabendra Sau
- Community Medicine, Midnapore Medical College, Midnapore, 721 101, India.
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Siriwardana RC, Sivasundaram T, Paranaheva L, Ediriweera DS. Computed tomography-based evaluation of segmental variation of liver density and its implications. Indian J Gastroenterol 2020; 39:60-65. [PMID: 32152904 DOI: 10.1007/s12664-019-01008-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 10/30/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) has become a major health concern. Focal fat deposition frequently seems to involve segment IV b. This indicates a consistent pattern of fat deposition in the liver. The present study evaluates the pattern of fat distribution in the liver using computed tomogram (CT) attenuation index. METHODS Two radiologists evaluated 517 non-contrast CT scan images of the abdomen and pelvis. Two 40-mm2 regions of interest (ROIs) were selected from each segment. The hepatic segmental densities (HSDs) were obtained by calculating the mean densities of areas of corresponding liver segments. The mean hepatic attenuation (MHA) was quantified by obtaining the mean segmental densities. Densities were compared between the segments and with the MHA. RESULTS The mean age (SD) of the patients was 55.5 year (15.6), and 276 (53.4%) were males. The overall mean hepatic density was 53.05 (95% CI, 52.95-53.15) Hounsfield units (HU). The lowest mean HSD was observed in segment IV b and the highest mean HSD was observed in segment V. Segments I, IV a and IV b showed significantly lower mean HSDs and segments V, VI and VIII showed significantly higher mean HSDs compared with the overall mean MHA/mean hepatic density (MHD), whereas mean HSDs of segments II, III and VII were not significantly different from the overall mean MHA/MHD. CONCLUSION Segment IV b seems to be the most vulnerable site for fat deposition; focal lesions here should be carefully evaluated. Segments II, III and VII seem to closely represent MHD.
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Affiliation(s)
| | - Thenuka Sivasundaram
- Department of Surgery, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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Elhence A, Shalimar. Treatment of non-alcoholic fatty liver disease - Current perspectives. Indian J Gastroenterol 2020; 39:22-31. [PMID: 32152902 DOI: 10.1007/s12664-020-01021-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 02/04/2020] [Indexed: 02/04/2023]
Abstract
Therapeutics aimed at treating non-alcoholic fatty liver disease (NAFLD) target the pathogenic process from deranged metabolism leading to steatosis to cell stress and death, leading to a cascade of inflammation and fibrosis, ultimately culminating into cirrhosis. The development of drugs for management of NAFLD has bloomed over the past decade, although at present there is no approved pharmacological agent for its management. Not all patients with the disease progress to cirrhosis and decompensation; hence, treatment specifically is provided for those with a high risk of progression such as those with biopsy-proven steatohepatitis or fibrosis. Along with disease-specific management, all patients must receive therapies directed at risk factors such as dyslipidemia, insulin resistance, type 2 diabetes mellitus and obesity. Comorbidities such as cardiovascular disease, sleep apnoea and chronic kidney disease need management. A current perspective on the therapeutic options is detailed in this review.
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Affiliation(s)
- Anshuman Elhence
- Department of Gastroenterology, All India Institute of Medical Sciences, Room No 127, 1st Floor, Human Nutrition Unit, New Delhi, 110 029, India
| | - Shalimar
- Department of Gastroenterology, All India Institute of Medical Sciences, Room No 127, 1st Floor, Human Nutrition Unit, New Delhi, 110 029, India.
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24
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Makhija N, Vikram NK, Kaur G, Sharma R, Srivastava DN, Madhusudhan KS. Role of Magnetic Resonance Imaging in the Monitoring of Patients with Nonalcoholic Fatty Liver Disease: Comparison with Ultrasonography, Lipid Profile, and Body Mass Index. J Clin Exp Hepatol 2020; 10:139-149. [PMID: 32189929 PMCID: PMC7067995 DOI: 10.1016/j.jceh.2019.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 09/15/2019] [Indexed: 12/12/2022] Open
Abstract
AIM The aim of this study was to study the role of magnetic resonance imaging (MRI) in monitoring hepatic fat content in cases of nonalcoholic fatty liver disease (NAFLD). MATERIALS AND METHODS 41 adults (mean age: 39 years, 22 males; 19 females) with NAFLD were included after obtaining approval from the institutional ethics committee. The baseline clinical (weight, body mass index [BMI]) and biochemical parameters, fatty liver grade on ultrasonography (USG), and hepatic fat signal fraction (FSF) using dual-echo chemical shift imaging and proton density fat fraction on magnetic resonance spectroscopy (MRS-PDFF) were assessed, before and after intervention (dietary and lifestyle changes and oral vitamin E for six months). They were categorized into Group A (good compliance to intervention) and Group B (poor compliance), and the clinical and imaging parameters were compared between them. RESULTS After intervention, Group A (n = 30) showed significant reduction in BMI (28.35 ± 3.25 to 27.14 ± 3.24 kg/m2; P < 0.001), hepatic FSF (19.30 ± 9.09% to 11.18 ± 7.61%; P < 0.05), and MRS-PDFF (18.79 ± 8.53% to 10.64 ± 6.66%). In Group B (n = 11), there was significant increase in BMI (28.85 ± 2.41 to 29.31 ± 2.57 kg/m2; P < 0.001), hepatic FSF (18.96 ± 9.79% to 21.48 ± 11.80%; P < 0.05), and reduction in high-density lipoproteins (P < 0.05). Although there was good correlation between USG and MRS in quantifying liver fat (r = 0.84-0.87; P < 0.001), USG was unable to detect <5.3% change in hepatic fat. There was poor correlation between lipid profile and MRS-PDFF. Change in body weight significantly correlated with change in hepatic fat content (r = 0.76; P < 0.001). CONCLUSION MRI is useful in accurately quantifying and in monitoring hepatic fat content and is better than clinical and biochemical parameters and USG.
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Key Words
- BMI, Body Mass Index
- CSI, Chemical Shift Imaging
- FSF, Fat Signal Fraction
- HCC, Hepatocellular Carcinoma
- HDL, High Density Lipoproteins
- LDL, Low Density Lipoproteins
- MRI, Magnetic Resonance Imaging
- MRS, Magnetic Resonance Spectroscopy
- NAFLD, Non-Alcoholic Fatty Liver Disease
- NASH, Non-Alcoholic SteatoHepatitis
- PDFF, Proton Density Fat Fraction
- USG, Ultrasonography
- fatty liver
- magnetic resonance imaging
- nonalcoholic fatty liver disease
- ultrasonography
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Affiliation(s)
- Nikhil Makhija
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 10029, India
| | - Naval K. Vikram
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 10029, India
| | - Gurdeep Kaur
- Department of Dietetics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 10029, India
| | - Raju Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 10029, India
| | - Deep N. Srivastava
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 10029, India
| | - Kumble S. Madhusudhan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 10029, India,Address for correspondence: Dr K S Madhusudhan, Associate Professor, Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Jain V, Jana M, Upadhyay B, Ahmad N, Jain O, Upadhyay AD, Ramakrishnan L, Vikram NK. Prevalence, clinical & biochemical correlates of non-alcoholic fatty liver disease in overweight adolescents. Indian J Med Res 2019; 148:291-301. [PMID: 30425219 PMCID: PMC6251268 DOI: 10.4103/ijmr.ijmr_1966_16] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background & objectives: Non-alcoholic fatty liver disease (NAFLD) characterized by excessive accumulation of fat in the liver, which can progress to inflammation, and cirrhosis, has emerged as an important complication of obesity in adults as well as children. This study was undertaken to assess the prevalence of NAFLD and its correlation with clinical and biochemical parameters in overweight Indian adolescents. Methods: In this cross-sectional study, 218 overweight adolescents aged 10 to 16 yr and their parents were included. Measurements included anthropometry, ultrasonography to diagnose NAFLD, fasting glucose, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and lipids for adolescents and parents, and additional parameters of blood pressure, body fat percentage (BF%), fasting insulin, apolipoprotein C3, tumour necrosis factor-α and adiponectin for adolescents. The variables were compared between adolescents with and without NAFLD, and logistic regression analysis was performed. Results: Mean age and body mass index (BMI)SD score (SDS) were 11.9±1.6 yr and 2.3±1.1, respectively. NAFLD was seen in 62.5 per cent of the adolescents. The prevalence of NAFLD in the parents was similar among the adolescents with and without NAFLD, while BMI and waist circumference SDS, BF per cent, blood pressure (BP), ALT, AST, insulin and homeostatic model assessment of insulin resistance (HOMA-IR) were significantly higher in the adolescents with NAFLD. On multiple logistic regression, abdominal obesity, HOMA-IR and BF per cent were independently associated with NAFLD with odds ratios (95% confidence interval) of 2.77 (1.40-5.47), 2.21 (1.16-4.21) and 2.17 (1.12-4.22), respectively. Interpretation & conclusions: NAFLD was noted among nearly two-thirds of the overweight adolescents. An independent association was observed between abdominal obesity, HOMA-IR and body fat percentage and NAFLD in overweight adolescents.
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Affiliation(s)
- Vandana Jain
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Manisha Jana
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Babita Upadhyay
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Nayeem Ahmad
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Oshima Jain
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Datt Upadhyay
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Lakshmy Ramakrishnan
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Naval K Vikram
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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Sharma L, Gupta D, Abdullah ST. Thioacetamide potentiates high cholesterol and high fat diet induced steato-hepatitic changes in livers of C57BL/6J mice: A novel eight weeks model of fibrosing NASH. Toxicol Lett 2019; 304:21-29. [DOI: 10.1016/j.toxlet.2019.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 11/14/2018] [Accepted: 01/04/2019] [Indexed: 02/07/2023]
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Szanto KB, Li J, Cordero P, Oben JA. Ethnic differences and heterogeneity in genetic and metabolic makeup contributing to nonalcoholic fatty liver disease. Diabetes Metab Syndr Obes 2019; 12:357-367. [PMID: 30936733 PMCID: PMC6430068 DOI: 10.2147/dmso.s182331] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Obesity is the most prevalent noncommunicable disease in the 21st century, associated with triglyceride deposition in hepatocytes leading to nonalcoholic fatty liver disease (NAFLD). NAFLD is now present in around a third of the world's population. Epidemiological studies have concluded that ethnicity plays a role in complications and treatment response. However, definitive correlations of ethnicity with NAFLD are thoroughly under-reported. A comprehensive review was conducted on ethnic variation in NAFLD patients and its potential role as a crucial effector in complications and treatment response. The highest NAFLD prevalence is observed in Hispanic populations, exhibiting a worse disease progression. In contrast, African-Caribbeans exhibit the lowest risk, with less severe steatosis and inflammation, lower levels of triglycerides, and less metabolic derangement, but conversely higher prevalence of insulin resistance. The prevalence of NAFLD in Asian cohorts is under-reported, although reaching epidemic proportions in these populations. The most well-documented NAFLD patient population is that of Caucasian ethnicity, especially from the US. The relative paucity of available literature suggests there is a vital need for more large-scale multi-ethnic clinical cohort studies to determine the incidence of NAFLD within ethnic groups. This would improve therapy and drug development, as well as help identify candidate gene mutations which may differ within the population based on ethnic background.
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Affiliation(s)
- Krisztina B Szanto
- Faculty of Life Sciences and Medicine, School of Medicine, King's College London, London, UK,
- Institute for Liver and Digestive Health, University College London, London, UK,
| | - Jiawei Li
- Institute for Liver and Digestive Health, University College London, London, UK,
- Institute of Child Health, University College London, London, UK
| | - Paul Cordero
- Institute for Liver and Digestive Health, University College London, London, UK,
| | - Jude A Oben
- Institute for Liver and Digestive Health, University College London, London, UK,
- Department of Gastroenterology and Hepatology, Guy's and St Thomas' Hospital, NHS Foundation Trust, London, UK
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Bandaru VCSS, Chaudhury JR, Lalitha P, Reddy SN, Misra PK, Balaraju B, Mridula KR. Prevalence of asymptomatic nonalcoholic fatty liver disease in nondiabetic participants: a study from south india. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2019. [DOI: 10.4103/ejim.ejim_76_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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Bale G, Vishnubhotla RV, Mitnala S, Sharma M, Padaki RN, Pawar SC, Duvvur RN. Whole-Exome Sequencing Identifies a Variant in Phosphatidylethanolamine N-Methyltransferase Gene to be Associated With Lean-Nonalcoholic Fatty Liver Disease. J Clin Exp Hepatol 2019; 9:561-568. [PMID: 31695245 PMCID: PMC6823660 DOI: 10.1016/j.jceh.2019.02.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 02/03/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND AIM Nonalcoholic fatty liver disease (NAFLD) is a spectrum of liver diseases with simple steatosis on one end and hepatocellular carcinoma on the other. Although obesity is a known risk factor for NAFLD, individuals with normal body mass index (BMI) also have hepatic fatty infiltration, now termed "lean-NAFLD". It represents a distinct entity with a strong underlying genetic component. The present study aimed to sequence the complete exonic regions of individuals with lean-NAFLD to identify germline causative variants associated with disrupted hepatic fatty acid metabolism, thereby conferring susceptibility to NAFLD. METHODS Whole blood was collected from patients with lean-NAFLD (n = 6; BMI < 23.0 kg/m2) and matched lean controls (n = 2; discovery set). Liver fat was assessed using acoustic radiation force impulse (ARFI) imaging. Patients with ultrasound-detected NAFLD (n = 191) and controls (n = 105) were part of validation set. DNA was isolated, and whole-exome sequencing (WES) was performed in the discovery cohort (Ion Proton™; Ion AmpliSeq™ Exome RDY Kit). Data were analyzed (Ion Reporter software; Life Technologies), and variants identified. Validation of variants was carried out (Taqman probes; Real time-PCR). Student's t test and Fisher's exact test were used to analyze the statistical significance. RESULTS Although WES identified ∼74,000 variants in individual samples, using various pipelines. variants in genes namely phosphatidylethanolamine N-methyltransferase (PEMT) and oxysterol-binding protein-related protein10 (OSBPL10) that have roles in dietary choline intake and regulation of cholesterol homeostasis, respectively, were identified (discovery set). Furthermore, significant differences were noted in BMI (p = 0.006), waist/hip circumference (p > 0.001), waist/hip ratio (p > 0.001), aspartate aminotransferase (p > 0.001), alanine aminotransferase (p > 0.001), and triglycerides (p = 0.002) between patients and controls. Validation of variants (rs7946-PEMT and rs2290532-OSBPL10) revealed that variant in PEMT but not OSBPL10 gene was associated (p = 0.04) with threefold increased risk of NAFLD in lean individuals. CONCLUSION Our results demonstrate the association of rs7946 with lean-NAFLD. WES may be an effective strategy to identify causative variants underlying lean-NAFLD.
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Key Words
- ALT, alanine aminotransferase
- ARFI, Acoustic Radiation Force Impulse
- AST, aspartate aminotransferase
- BMI, Body mass index
- CI, confidence interval
- DNA, Deoxyribonucleic acid
- FFAs, free fatty acids
- GWAS, Genome-wide association studies
- HCC, Hepatocellular carcinoma
- HDL, high-density lipoproteins
- NAFLD, Nonalcoholic fatty Liver disease
- NASH, nonalcoholic steatohepatitis
- OSBPL10
- OSBPL10, Oxysterol-binding protein-related protein10
- PC, phosphatidylcholine
- PCR, Polymerase chain reaction
- PE, phosphatidylethanolamine
- PEMT
- PEMT, Phosphatidylethanolamine N-methyltransferase
- PHRED, Phil's Read Editor
- SIFT, Sorting Intoleratnt from Tolerant
- SNPs, Single-nucleotide polymorphisms
- SNVs, Single-nucleotide variants
- WC, Waist circumference
- WES, Whole-Exome Sequencing
- gDNA, genomic Deoxyribonucleic acid
- indel, insertion deletion
- lean-NAFLD
- ng, nano gram
- nonalcoholic fatty liver disease
- pM, pico mole
- whole-exome sequencing
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Affiliation(s)
- Govardhan Bale
- Institute of Basic Sciences and Translational Research, Asian Healthcare Foundation, Hyderabad 500082, Telangana, India
| | - Ravikanth V. Vishnubhotla
- Institute of Basic Sciences and Translational Research, Asian Healthcare Foundation, Hyderabad 500082, Telangana, India,Address for correspondence: Asian Healthcare Foundation, 6-3-661, Somajiguda, Hyderabad 500 082, India.
| | - Sasikala Mitnala
- Institute of Basic Sciences and Translational Research, Asian Healthcare Foundation, Hyderabad 500082, Telangana, India
| | - Mithun Sharma
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 500082, Telangana, India
| | - Rao N. Padaki
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 500082, Telangana, India
| | - Smita C. Pawar
- Department of Genetics, Osmania University, Hyderabad, Telangana, India
| | - Reddy N. Duvvur
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 500082, Telangana, India
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Patel R, Poddar P, Choksi D, Pandey V, Ingle M, Khairnar H, Sawant P. Predictors of 1-month and 3-months Hospital Readmissions in Decompensated Cirrhosis: A Prospective Study in a Large Asian Cohort. Ann Hepatol 2019; 18:30-39. [PMID: 31113606 DOI: 10.5604/01.3001.0012.7859] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 11/13/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND AIM Considered as a healthcare quality indicator, hospital readmissions in decompensated cirrhosis predispose the patients and the society to physical, social and economic distresses. Few studies involving North American cohorts have identified different predictors. The aim of this study was to determine and validate the predictors of 1-month and 3-months readmission in an Asian cohort. MATERIAL AND METHODS We prospectively studied 281 hospitalised patients with decompensated cirrhosis at a large tertiary care public hospital in India between August 2014 and August 2016 and followed them for 3 months. Data regarding demographic, laboratory and disease related risk factors were compiled. We used multivariate logistic regression to determine predictors of readmission at 1-month and 3-months and receiver operating curves (ROC) for significant predictors to obtain the best cut-offs. RESULTS 1-month and 3-months readmission rates in our study were 27.8% and 42.3%, respectively. Model for End stage Liver Disease (MELD) score at discharge (OR:1.24, p < 0.001) and serum sodium (OR:0.94, p-0.039) independently predicted 1-month and MELD score (OR:1.11, p-0.003), serum sodium (OR:0.94, p-0.027) and male gender (OR:2.19, p-0.008) independently predicted 3-months readmissions. Neither aetiology nor complications of cirrhosis emerged as risk factors. MELD score >14 at discharge and serum sodium < 133 mEq/L best predicted readmissions; MELD score being a better predictor than serum sodium (p - 0.0001). CONCLUSIONS High rates of early and late readmissions were found in our study. Further, this study validated readmission predictors in Asian patients. Structured interventions targeting this risk factors may diminish readmissions in decompensated cirrhosis.
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Affiliation(s)
- Ruchir Patel
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College and Hospital, Mumbai, Maharashtra, India.
| | - Prateik Poddar
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College and Hospital, Mumbai, Maharashtra, India
| | - Dhaval Choksi
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College and Hospital, Mumbai, Maharashtra, India
| | - Vikas Pandey
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College and Hospital, Mumbai, Maharashtra, India
| | - Meghraj Ingle
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College and Hospital, Mumbai, Maharashtra, India
| | - Harshad Khairnar
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College and Hospital, Mumbai, Maharashtra, India
| | - Prabha Sawant
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College and Hospital, Mumbai, Maharashtra, India
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Rout G, Nayak B, Patel AH, Gunjan D, Singh V, Kedia S, Shalimar. Therapy with Oral Directly Acting Agents in Hepatitis C Infection Is Associated with Reduction in Fibrosis and Increase in Hepatic Steatosis on Transient Elastography. J Clin Exp Hepatol 2019; 9:207-214. [PMID: 31024203 PMCID: PMC6477071 DOI: 10.1016/j.jceh.2018.06.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 06/10/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND/AIMS Direct-Acting Antivirals (DAAs) are now the standard of care for management of Chronic Hepatitis C (CHC) infection. The aim of this study was to evaluate change in Liver Stiffness Measurement (LSM) and Controlled Attenuation Parameter (CAP) by transient elastography (FibroScan®) after completion of DAA therapy. METHODS LSM and CAP were measured serially (baseline pre-treatment, at 12 weeks post therapy, and one year after completion of therapy) in a prospective cohort of 372 CHC patients treated with DAAs. Patients with at least two FibroScan measurements were included. RESULTS The mean age was 38.1 ± 12.6 years; 58.3% males. Cirrhosis as defined by biopsy or fibroscan measurement (≥12.5) kPa was found in 25.5%. On paired analysis (n = 317), LSM (IQR) decreased from a baseline value 7.1 (5.3-13.8) kPa to 6.2 (4.8-11.2) kPa 12 weeks post therapy with a median decline 0.7 (-0.6-2.6) kPa, P < 0.001. Similarly, on paired analysis (n = 160), LSM decreased from baseline 6.9 (5.1-12.7) kPa to 6.1 (4.8-9.4) kPa after one year of treatment with median decline 0.9 (-0.6-3.2) kPa, P < 0.001. In contrast, on paired analysis (n = 317), CAP increased from baseline of 213.0 (180.0-254.5) dB/m to 225.0 (190.0-269.0) dB/m at 12 weeks post therapy with median increase 7.0 (-23.5-45.5), P = 0.001. Similarly, on paired analysis (n = 160), CAP increased from baseline of 210.0 (180.3-260.8) dB/m to 234.0 (204.0-282.0) dB/m at one year post therapy with median increase 25.0 (-12.5-61.5) dB/m, P < 0.001. On multivariate linear regression analysis, low baseline CAP value and low albumin were significantly associated with increase in CAP values. CONCLUSION Treatment with DAAs reduces liver stiffness, but is associated with increase in hepatic steatosis.
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Key Words
- AASLD, American Association for the Study of Liver Diseases
- ALT, Alanine Aminotransferase
- AST, Aspartate Aminotransferase
- BMI, Body Mass Index
- CAP, Controlled Attenuation Parameter
- CHC, Chronic Hepatitis C
- DAAs, Directly-Acting Antivirals
- F0-4, METAVIR Fibrosis Stage 0 to 4
- Fibroscan
- HCV, Hepatitis C Virus
- HIV, Human Immunodeficiency Virus
- IFN, Interferon
- IQR, Interquartile Range
- LSM, Liver Stiffness Measurement
- NAFLD, Non-alcoholic Fatty Liver Disease
- SD, Standard Deviation
- SVR12
- SVR12, Sustained Viral Response at 12 Weeks
- TE, Transient Elastography
- controlled attenuation parameter
- liver stiffness measurement
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Affiliation(s)
- Gyanranjan Rout
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Baibaswata Nayak
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Arpan H. Patel
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Deepak Gunjan
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Vishwajeet Singh
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Kedia
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Shalimar
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India,Address for correspondence: Shalimar, Associate Professor, Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi 110029, India. Tel.: +91 11 26596643.
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Changes of the Fatty Acid Profile in Erythrocyte Membranes of Patients following 6-Month Dietary Intervention Aimed at the Regression of Nonalcoholic Fatty Liver Disease (NAFLD). Can J Gastroenterol Hepatol 2018; 2018:5856201. [PMID: 30631760 PMCID: PMC6304595 DOI: 10.1155/2018/5856201] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/16/2018] [Accepted: 11/22/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is closely related to the metabolism disorders of fatty acids. The pathogenesis of the disease includes an increased concentration of FFA in blood, an increase in the biosynthesis of fatty acids, and disorders in the process of β-oxidation. OBJECTIVE The aim of the study was to analyze the fatty acids in erythrocyte membranes among 55 patients with NAFLD who were subjected to a 6-month dietary intervention in order to reduce fatty liver. MATERIALS AND METHODS Basic anthropometric and biochemical measurements were performed. The profile of fatty acids was measured in the membranes of erythrocytes and analyzed by gas chromatography. The dietary compliance was evaluated using 72-diary questionnaires, anthropometric measurements. RESULTS With the reduction of fatty liver (p<0.01), the patients' biochemical and anthropometric parameters were significantly improved. A significant decrease in the concentration of alanine aminotransferase (p<0.01) and asparagine aminotransferase (p<0.01) was observed, along with a decrease in the amount of insulin (p<0.05) and insulin resistance (p<0.05). Significant changes in terms of the fatty acid profile were observed among patients who followed the dietary intervention. There was a noticeable tendency in terms of the reduction palmitic acid (p<0.055) and a significant reduction of stearic acid (p<0.05). Significant changes in the profile of fatty acids were also associated with the reductionof palmitoleic (p<0.05) and oleic acids (p<0.05). Another statistically significant change observed was the increase in polyunsaturated fatty acids. In particular (p<0.01) the rise of eicosapentaenoic (p<0.055) and docosahexaenoic acids (p<0.55) was noted. CONCLUSION The profile of fatty acids turned out to be a potential biomarker of the liver changes during NAFLD regression. Further research is needed to fully elucidate the usefulness and applicability of our findings in the management of NAFLD.
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Prevalence of nonalcoholic fatty liver disease in normal-weight and overweight preadolescent children in Haryana, India. Indian Pediatr 2018; 54:1012-1016. [DOI: 10.1007/s13312-017-1202-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Karanth J, Hande V, Hande PC. Recent update: Nonalcoholic steatohepatitis. JOURNAL OF MARINE MEDICAL SOCIETY 2018. [DOI: 10.4103/jmms.jmms_75_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Suresh S, Rajanbabu B, Veetil V, Hussain A, Veetil J. A study on the altered glycemic and lipid parameters and prevalence of insulin resistance in nonalcoholic fatty liver disease. J Family Med Prim Care 2018; 7:93-97. [PMID: 29915740 PMCID: PMC5958600 DOI: 10.4103/jfmpc.jfmpc_352_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction: Nonalcoholic fatty liver disease (NAFLD) is a hepatic disorder that develops in the absence of alcohol intake. Obesity and diabetes are considered risk factors for the development of fatty liver; however, whether fatty liver is the cause or consequence of these conditions is not yet clear. Insulin resistance (IR) is found to be a common risk factor for the development of diabetes, obesity and fatty liver. Aims and Objectives: The aim and objective of this study is to determine the prevalence of undetected diabetes, dyslipidemia, and IR in subjects with NAFLD. Materials and Methods: In apparently healthy 100 subjects, with ultrasound diagnosis of fatty liver, fasting and postprandial blood sugar levels, fasting insulin levels, and fasting lipid profile were checked. IR value was estimated using homeostatic model assessment-IR formula. Appropriate statistical methods were adopted to analyze the data. Results: A total of 66 subjects out of the 100 had IR. It was noted that IR significantly correlated with raised fasting blood sugar and fasting plasma insulin values. There was no significant correlation between IR and lipid profile values. Conclusion: The chance of developing NAFLD was high if the subjects are having IR, or vice versa. There was an increased prevalence of prediabetes and diabetes in the subjects with NAFLD. Waist circumference, rather than body mass index, was found to be a strong predictor of central adiposity and IR.
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Valvi AR, Mouriya N, Athawale RB, Bhatt NS. Hepatoprotective Ayurvedic plants - a review. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2017; 13:207-215. [PMID: 27310002 DOI: 10.1515/jcim-2015-0110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 05/11/2015] [Indexed: 12/23/2022]
Abstract
The liver plays vital functions in the maintenance and performance of the body. Most of the metabolic and physiological processes of our body as well as the detoxification of various drugs and xenobiotic chemicals occur in the liver. During this detoxification process, the reactive chemical intermediates damage the liver causing hepatotoxicity. Therefore, the maintenance of a healthy liver is vital to overall health. Unfortunately, the liver is often abused by environmental toxins, poor eating habits, alcohol, and prescription and over-the-counter drug use, which lead to liver diseases like hepatitis, non-alcoholic fatty liver disease, alcoholic liver disease, cirrhosis and hepatocellular carcinoma. The available synthetic drugs to treat liver disorders in this condition also cause further damage to the liver on long-term use. Hence, Ayurvedic plants have become increasingly popular and their use is widespread. Various Ayurvedic formulations are available in market to treat liver disease. Also there is increase in the export of Ayurvedic plants.
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Nonalcoholic fatty liver disease in Asia: emerging perspectives. J Gastroenterol 2017; 52:164-174. [PMID: 27637587 DOI: 10.1007/s00535-016-1264-3] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 09/06/2016] [Indexed: 02/07/2023]
Abstract
As in the West, nonalcoholic fatty liver disease (NAFLD) is the commonest chronic liver disease in Asia, with a prevalence higher than 40 % in some countries. The risk factors for NAFLD development are similar to those in Western countries, including increased body mass index, diabetes, insulin resistance, and metabolic syndrome. NAFLD in Asians is associated with different extrahepatic manifestations involving the cardiovascular, gastrointestinal, and renal systems. A considerable proportion of Asians with NAFLD are described as having "lean" NAFLD. Present in approximately 20 % of the Asian population, lean NAFLD is closely linked with insulin resistance, diabetes, and other metabolic complications, but its association with disease progression to nonalcoholic steatohepatitis and cirrhosis remains to be defined. There is emerging evidence of the interactions of NAFLD with hepatitis B virus and hepatitis C virus infection in Asia. Unlike in Western countries, NAFLD constitutes only a minority of cirrhosis and hepatocellular carcinoma cases in Asia. Possible explanations are the lower prevalence of obesity and the overwhelming problem of viral hepatitis in Asia. With aging of the obesity cohort in Asia, NAFLD-related liver complications are expected to increase.
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Abstract
Objective: Nonalcoholic fatty liver disease (NAFLD) and gallstones are frequently present in diabetics, but its exact prevalence is not well studied in India. We have done a prevalence study of hepatobiliary involvement in Type-2 diabetes mellitus (T2DM) and also studied the other risk factors of NAFLD. Materials and Methods: Two hundred diabetics and 200 controls underwent anthropometric measurements, abdominal ultrasonography, (USG) and biochemical tests at a tertiary care hospital. Univariate and multivariate logistic regression analyses were done. Results: One hundred and thirty (65%) diabetics and 47 (23.50%) controls were having USG evidence of fatty liver (odds ratio [OR] = 6.046, 95% confidence interval [CI]: 3.904–9.363 [P < 0.0001]). Raised liver enzymes were present in 42 (21%) diabetics and 16 (8%) controls [OR = 3.057, 95% CI: 1.654–5.648 [P < 0.004]). Gallstones were present in 32 (16%) diabetics and 10 (5%) controls (OR = 2.825; 95% CI: 1.850–4.315 P < 0.0001). In addition, waist circumference (WC) and body mass index (BMI) were significantly more in diabetics, but lipid profile was not significantly deranged as compared to controls. Then, all patients with fatty liver were compared with patients with normal liver, and we found that fatty liver group was having raised BMI, WC, liver enzymes, and more dyslipidemia. Multivariate analysis was done which shows the presence of T2DM, elevated liver enzymes, obesity, and elevated WC as independent risk factors of fatty liver. Conclusion: The prevalence of NAFLD and gallstones was higher in diabetics as compared to healthy population. In addition, the presence of T2DM, elevated liver enzymes, obesity, and elevated WC are independent predictors of NAFLD.
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Affiliation(s)
- Piyush Manoria
- Department of Gastroenterology, Sri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh, India
| | - Sameer Inamdar
- Department of Medicine, Sri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh, India
| | - Ravindra Kumar
- Central Research Laboratory, Sri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh, India
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The in vivo antineoplastic and therapeutic efficacy of troxerutin on rat preneoplastic liver: biochemical, histological and cellular aspects. Eur J Nutr 2016; 56:2353-2366. [PMID: 27488610 DOI: 10.1007/s00394-016-1275-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 07/11/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE Troxerutin (TXER), a trihydroxyethylated derivative of the natural bioflavonoid rutin, abundantly found in tea, various fruits and vegetables, is known to exhibit ample pharmacological properties. In the present investigation, we examined the antineoplastic, therapeutic efficacy and furthermore the possible mechanisms of action of TXER against NAFLD/NASH progression to hepatocarcinogenesis. METHODS The effect of TXER (12.5, 25 or 50 mg/kg b.w/day) was evaluated on the nitrosodiethylamine (NDEA) model of hepatocarcinogenesis in rats, after 16 weeks of oral treatment, with special focus on liver specific enzymes, xenobiotic metabolizing enzymes, antioxidant status, lipid peroxidation profile, DNA damage, fibrosis, cell proliferation and inflammatory status. RESULTS Administration of TXER to hepatocellular carcinoma-bearing rats restored the enzyme activities and the hepatic architecture. Furthermore, TXER significantly curtailed NDEA-induced DNA damage, cell proliferation, inflammation, fibrosis and hepatic hyperplasia. CONCLUSION This study provides the evidence that troxerutin exerts a significant therapeutic effect against liver cancer by modulating liver function enzymes, xenobiotic enzymes, oxidative damage, inhibiting cell proliferation, suppressing inflammatory response and induction of apoptosis.
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Koh JC, Loo WM, Goh KL, Sugano K, Chan WK, Chiu WYP, Choi MG, Gonlachanvit S, Lee WJ, Lee WJJ, Lee YY, Lesmana LA, Li YM, Liu CJ, Matsuura B, Nakajima A, Ng EKW, Sollano JD, Wong SKH, Wong VWS, Yang Y, Ho KY, Dan YY. Asian consensus on the relationship between obesity and gastrointestinal and liver diseases. J Gastroenterol Hepatol 2016; 31:1405-13. [PMID: 27010240 DOI: 10.1111/jgh.13385] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/10/2016] [Accepted: 03/15/2016] [Indexed: 12/13/2022]
Abstract
The incidence of obesity is increasing in Asia, with implications on gastrointestinal (GI) and liver diseases. The Gut and Obesity in Asia Workgroup comprises regional experts with the aim of studying relationship between obesity and the GI and liver diseases in Asia. Through literature review and the modified Delphi process, consensus statements examining the impact of obesity on esophageal, gastric, pancreatic, colorectal, and liver diseases, exploring relationship between gut microbiome and obesity, and assessing obesity therapies have been produced by the Gut and Obesity in Asia Workgroup. Sixteen experts participated with 9/15 statements having strong consensus (>80% agreement). The prevalence of obesity in Asia is increasing (100% percentage agreement in brackets), and this increased prevalence of obesity will result in a greater burden of obesity-related GI and liver diseases (93.8%). There was consensus that obesity increases the risk of gastric cancer (75%) and colorectal neoplasia (87.5%). Obesity was also associated with Barrett's esophagus and esophageal adenocarcinoma (66.7%) and pancreatic cancer (66.7%) in Asia. The prevalence of non-alcoholic fatty liver disease (NAFLD) in Asia is on the rise (100%), and the risk of NAFLD in Asia (100%) is increased by obesity. Obesity is a risk factor for the development of hepatocellular carcinoma (93.8%). Regarding therapy, it was agreed that bariatric surgery was an effective treatment modality for obesity (93.8%) but there was less agreement on its benefit for NAFLD (62.5%). These experts' consensus on obesity and GI diseases in Asia forms the basis for further research, and its translation into addressing this emerging issue.
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Affiliation(s)
| | - Wai Mun Loo
- Department of Medicine, National University of Singapore, Singapore
| | - Khean Lee Goh
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Wah Kheong Chan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wai Yan Philip Chiu
- Department of Surgery, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Myung-Gyu Choi
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Sutep Gonlachanvit
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Wei-Jei Lee
- Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan
| | | | - Yeong Yeh Lee
- School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Laurentius A Lesmana
- Department of Internal Medicine, Faculty of Medicine, University of Indonesia - Cipto Mangunkusumo Hospital, Jakarta Pusat, Indonesia
| | - You-Ming Li
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Chun Jen Liu
- Department of Internal Medicine, Graduate Institute of Clinical Medicine, Hepatitis Research Center, National Taiwan University College of Medicine and National Taiwan University Hospital, Taiwan
| | - Bunzo Matsuura
- Department of Lifestyle-Related Medicine and Endocrinology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Japan
| | - Enders Kwok Wai Ng
- Department of Surgery, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Jose D Sollano
- Department of Medicine, University of Santo Tomas, Manila, Philippines
| | - Simon Kin Hung Wong
- Department of Surgery, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Vincent W S Wong
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Yunsheng Yang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Khek Yu Ho
- Department of Medicine, National University of Singapore, Singapore
| | - Yock Young Dan
- Department of Medicine, National University of Singapore, Singapore
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Narasimhan G, Kota V, Rela M. Liver transplantation in India. Liver Transpl 2016; 22:1019-24. [PMID: 27082718 DOI: 10.1002/lt.24459] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 03/30/2016] [Indexed: 12/30/2022]
Abstract
Liver transplantation as an established form of treatment for end-stage liver disease has gained acceptance in India over the last 10 years. Liver transplantation in India has unique features that have contributed to the growth of both deceased donor and living donor transplantations of which living donor currently dominates the picture. Living donor contributes to 80% and deceased donor to 20% of the liver transplants currently performed in India. The majority of these transplants are performed within the private sector with public sector hospitals lagging behind significantly. This article gives an overview of the evolution of liver transplantation in India and the potential future challenges. Liver Transplantation 22 1019-1024 2016 AASLD.
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Affiliation(s)
- Gomathy Narasimhan
- Institute of Liver Disease and Transplantation, Global Health City, Chennai, India.,National Foundation for Liver Research, Chennai, India
| | - Venugopal Kota
- Institute of Liver Disease and Transplantation, Global Health City, Chennai, India.,National Foundation for Liver Research, Chennai, India
| | - Mohamed Rela
- Institute of Liver Disease and Transplantation, Global Health City, Chennai, India.,National Foundation for Liver Research, Chennai, India
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Praveenraj P, Gomes RM, Kumar S, Karthikeyan P, Shankar A, Parthasarathi R, Senthilnathan P, Rajapandian S, Palanivelu C. Prevalence and Predictors of Non-Alcoholic Fatty Liver Disease in Morbidly Obese South Indian Patients Undergoing Bariatric Surgery. Obes Surg 2016; 25:2078-87. [PMID: 25835982 DOI: 10.1007/s11695-015-1655-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Numerous studies worldwide have identified a high prevalence of non-alcoholic fatty liver disease (NAFLD) among morbidly obese subjects. Several predictors have been found to be associated with NAFLD and its histological high-risk components. Similar data from India is lacking. We aimed to determine the prevalence and the predictors of NAFLD and its histological high-risk components in a cohort of Indians with morbid obesity undergoing bariatric surgery. Safety of a routine intraoperative liver biopsy was also assessed. METHODS There were 134 morbidly obese patients who underwent bariatric surgery with concomitant liver biopsy. These were assessed for NAFLD and its histological high-risk components. Clinical, biochemical, and histological features were evaluated, and predictors of NAFLD, non-alcoholic steatohepatitis (NASH), fibrosis, and advanced fibrosis were identified. RESULTS Mean BMI was 44.66 ± 9.81. Eighty-eight (65.7 %) showed NAFLD. Forty-five (33.6 %) showed NASH and 42 (31.3 %) showed fibrosis both not mutually exclusive. Nineteen (14.1 %) showed advanced fibrosis. Higher alanine aminotransferase (ALT) independently predicted NAFLD and was significantly associated with NASH and fibrosis. Type 2 diabetes mellitus (T2DM) and the metabolic syndrome were significantly associated with fibrosis. Systemic hypertension (HT) independently predicted NASH and fibrosis. There were no intraoperative or postoperative complications related to the liver biopsy. CONCLUSIONS NAFLD has a high prevalence among morbidly obese patients. Elevated ALT, HT, T2DM, and the metabolic syndrome are predictors for NAFLD and its high-risk histological components. Routine intraoperative liver biopsy is safe in morbidly obese undergoing bariatric surgery for diagnosing NAFLD.
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Affiliation(s)
- Palanivelu Praveenraj
- Department of Minimal Access Surgery, Gem Hospital and Research Centre, 45, Pankaja Mill Road, Coimbatore, 641045, India.
| | - Rachel M Gomes
- Department of Minimal Access Surgery, Gem Hospital and Research Centre, 45, Pankaja Mill Road, Coimbatore, 641045, India.
| | - Saravana Kumar
- Department of Minimal Access Surgery, Gem Hospital and Research Centre, 45, Pankaja Mill Road, Coimbatore, 641045, India.
| | | | - Annapoorni Shankar
- Department of Pathology, Gem Hospital and Research Centre, Coimbatore, 641045, India.
| | - Ramakrishnan Parthasarathi
- Department of Minimal Access Surgery, Gem Hospital and Research Centre, 45, Pankaja Mill Road, Coimbatore, 641045, India.
| | - Palanisamy Senthilnathan
- Department of Minimal Access Surgery, Gem Hospital and Research Centre, 45, Pankaja Mill Road, Coimbatore, 641045, India.
| | - Subbiah Rajapandian
- Department of Minimal Access Surgery, Gem Hospital and Research Centre, 45, Pankaja Mill Road, Coimbatore, 641045, India.
| | - Chinnusamy Palanivelu
- Department of Minimal Access Surgery, Gem Hospital and Research Centre, 45, Pankaja Mill Road, Coimbatore, 641045, India.
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Aswathy G, Dharmarajan P, Sharma AR, Sasikumar VK, Vasudevan Nampoothiri MR. Ayurvedic management of cirrhotic ascites. Anc Sci Life 2016; 35:236-9. [PMID: 27621523 PMCID: PMC4995860 DOI: 10.4103/0257-7941.188183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Cirrhosis is the final stage of most of the chronic liver diseases and is most invariably complicated by portal hypertension resulting in ascites. A case of chronic liver disease with portal hypertension (cryptogenic cirrhosis), managed at Amrita School of Ayurveda is discussed in this paper. The clinical picture was that of an uncomplicated cirrhotic ascites. Snehapāna (therapeutic oral administration of lipids) followed by virecana (purgation) was done after an initial course of nityavirecana (daily purgation). Later Vardhamāna pippalī rasāyana [administration of single drug - pippalī (piper longum) in a structured dose pattern] was administered with an intention of rejuvenating liver cells. Ascites and lower limb oedema were completely resolved after the therapy. No recurrence of ascites has been reported after a follow up period of one year.
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Affiliation(s)
- G. Aswathy
- Department of Panchakarma, Amrita school of Ayurveda, Kollam, Kerala, India
| | | | - Ananth Ram Sharma
- Department of Panchakarma, Amrita school of Ayurveda, Kollam, Kerala, India
| | - V. K. Sasikumar
- Department of Panchakarma, Amrita school of Ayurveda, Kollam, Kerala, India
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Singh DP, Awasthi H, Luqman S, Singh S, Mani D. Hepatoprotective Effect of A Polyherbal Extract Containing Andrographis Paniculata, Tinospora Cordifolia and Solanum Nigrum Against Paracetamol Induced Hepatotoxicity. Pharmacogn Mag 2016; 11:S375-9. [PMID: 26929570 PMCID: PMC4745206 DOI: 10.4103/0973-1296.168945] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Traditionally, a number of medicinal plants are used to treat various types of hepatic disorders but few of them were pharmacologically evaluated for their safety and efficacy. The combination of Andrographis paniculata (Kalmegha), Tinospora cordifolia (Guduchi), and Solanum nigrum (Kakmachi) was traditionally used in Indian System of Medicine (Ayurveda) for the treatment of various liver-related disorders. Objective: In the present study, an attempt was made to substantiate the ethnopharmacological use of a traditional formulation in hepatoprotection against paracetamol-induced hepatotoxicity. Subjects and Methods: Swiss albino mice (weight 20–25 g) were used for this study. Intraperitoneal injection of paracetamol (500 mg/kg body weight) was used to induce hepatotoxicity. Serum levels of alanine transaminase, aspartate aminotransferase, bilirubin, alkaline phosphatase, were used as indices of liver injury. In addition total cholesterol, triglyceride, low-density lipoprotein, high-density lipoprotein and creatinine were also assayed using the standard procedure. Results: Among the two different doses, pretreatment with Polyherbal extract at 500 mg/kg body weight exhibited a significant (P < 0.05) hepatoprotective activity as compared to paracetamol group. Conclusion: The polyherbal extract exhibits a significant hepatoprotective effect in vivo. The study contributes to its use in traditional Ayurveda system for the management of liver diseases. SUMMARY Traditionally, a number of medicinal plants are used to treat various types of liver disorders but few of them were pharmacologically evaluated for their safety and efficacy. Combination of Andrographis paniculata (Kalmegha), Tinospora cordifolia (Guduchi), and Solanum nigrum (Kakmachi) was traditionally used in Ayurveda for the treatment of various liver related disorders. In the present study an attempt was made to validate the ethnopharmacological use of a traditional formulation in hepatoprotection against paracetamol induced hepatotoxicity. Swiss albino mice (weight 20-25 g) were used for this study. Intraperitoneal injection (IP) of paracetamol (500 mg/kg body weight) was used to induce hepatotoxicity. Serum levels of Alanine transaminase (ALT), Aspartate Aminotransferase (AST), Bilirubin, Alkaline phosphatase (ALP),. were used as indices of liver injury. In addition total cholesterol, triglyceride, Low density lipoprotein (LDL), High density lipoprotein (HDL) and creatinine were also assayed using standard procedure. Among the two different doses, pre-treatment with Polyherbal extract at 500 mg/kg body weight exhibited a significant (P < 0.05) hepatoprotective activity as compared to paracetamol group. The polyherbal extract exhibits significant hepatoprotective effect in vivo. The study contributes to its use in traditional Ayurveda system for the management of liver diseases.
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Affiliation(s)
- Dewasya Pratap Singh
- Department of Herbal Medicinal Products, CSIR-Central Institute of Medicinal and Aromatic Plants, Lucknow - 226 015, Uttar Pradesh, India
| | - Harshika Awasthi
- Department of Herbal Medicinal Products, CSIR-Central Institute of Medicinal and Aromatic Plants, Lucknow - 226 015, Uttar Pradesh, India
| | - Suaib Luqman
- Molecular Bioprospection Department, CSIR-Central Institute of Medicinal and Aromatic Plants, Lucknow - 226 015, Uttar Pradesh, India; Academy of Scientific and Innovative Research, CSIR-Central Institute of Medicinal and Aromatic Plants, Lucknow - 226 015, Uttar Pradesh, India
| | - Saudan Singh
- Agrotechnology Division, CSIR-Central Institute of Medicinal and Aromatic Plants, Lucknow - 226 015, Uttar Pradesh, India
| | - Dayanandan Mani
- Department of Herbal Medicinal Products, CSIR-Central Institute of Medicinal and Aromatic Plants, Lucknow - 226 015, Uttar Pradesh, India; Academy of Scientific and Innovative Research, CSIR-Central Institute of Medicinal and Aromatic Plants, Lucknow - 226 015, Uttar Pradesh, India
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Chatterjee A, Basu A, Chowdhury A, Das K, Sarkar-Roy N, Majumder PP, Basu P. Comparative analyses of genetic risk prediction methods reveal extreme diversity of genetic predisposition to nonalcoholic fatty liver disease (NAFLD) among ethnic populations of India. J Genet 2016; 94:105-13. [PMID: 25846882 DOI: 10.1007/s12041-015-0494-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a distinct pathologic condition characterized by a disease spectrum ranging from simple steatosis to steato-hepatitis, cirrhosis and hepatocellular carcinoma. Prevalence of NAFLD varies in different ethnic groups, ranging from 12% in Chinese to 45% in Hispanics. Among Indian populations, the diversity in prevalence is high, ranging from 9% in rural populations to 32% in urban populations, with geographic differences as well. Here, we wished to find out if this difference is reflected in their genetic makeup. To date, several candidate genes and a few genomewide association studies (GWAS) have been carried out, and many associations between single nucleotide polymorphisms (SNPs) and NAFLD have been observed. In this study, the risk allele frequencies (RAFs) of NAFLD-associated SNPs in 20 Indian ethnic populations (376 individuals) were analysed. We used two different measures for calculating genetic risk scores and compared their performance. The correlation of additive risk scores of NAFLD for three Hapmap populations with their weighted mean prevalence was found to be high (R(2) = 0.93). Later we used this method to compare NAFLD risk among ethnic Indian populations. Based on our observation, the Indian caste populations have high risk scores compared to Caucasians, who are often used as surrogate and similar to Indian caste population in disease gene association studies, and is significantly higher than the Indian tribal populations.
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Affiliation(s)
- Ankita Chatterjee
- National Institute of Biomedical Genomics, Netaji Subhas Sanatorium (T. B. Hospital), Kalyani 741 251, India.
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Yadav SK, Gupta RK, Saraswat VA, Rangan M, Thomas MA, Rutella S, Danese S, Wang E, Marincola FM, Haris M. Reduced cortical thickness in patients with acute-on-chronic liver failure due to non-alcoholic etiology. J Transl Med 2015; 13:322. [PMID: 26444271 PMCID: PMC4596551 DOI: 10.1186/s12967-015-0679-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/24/2015] [Indexed: 12/30/2022] Open
Abstract
Background Acute-on-chronic liver failure (ACLF) is a form of liver disease with high short-term mortality. ACLF offers considerable potential to affect the cortical areas by significant tissue injury due to loss of neurons
and other supporting cells. We measured changes in cortical thickness and metabolites profile in ACLF patients following treatment, and compared it with those of age matched healthy volunteers. Methods For the cortical thickness analysis we performed whole brain high resolution T1-weighted magnetic resonance imaging (MRI) on 15 ACLF and 10 healthy volunteers at 3T clinical MR scanner. Proton MR Spectroscopy (1H MRS) was also performed to measure level of altered metabolites. Out of 15 ACLF patients 10 survived and underwent follow-up study after clinical recovery at 3 weeks. FreeSurfer program was used to quantify cortical thickness and LC- Model software was used to quantify absolute metabolites concentrations. Neuropsychological (NP) test was performed to assess the cognitive performance in follow-up ACLF patients compared to controls. Results Significantly reduced cortical thicknesses in multiple brain sites, and significantly decreased N-acetyl aspartate (NAA), myo-inositol (mI) and significantly increased glutamate/glutamine (glx) metabolites were observed in ACLF compared to those of controls at baseline study. Follow-up patients showed significant recovery in cortical thickness and Glx level, while NAA and mI were partially recovered compared to baseline study. When compared to controls, follow-up patients still showed reduced cortical thickness and altered metabolites level. Follow-up patients had abnormal neuropsychological (NP) scores compared to controls. Conclusions Neuronal loss as suggested by the reduced NAA, decreased cellular density due to increased cerebral hyperammonemia as supported by the increased glx level, and increased proinflammatory cytokines and free radicals may account for the reduced cortical thickness in ACLF patients. Presence of reduced cortical thickness, altered metabolites and abnormal NP test scores in post recovery subjects as compared to those of controls is associated with incomplete clinical recovery. The current imaging protocol can be easily implemented in clinical settings to evaluate and monitor brain tissue changes in patients with ACLF during the course of treatment.
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Affiliation(s)
- Santosh K Yadav
- Research Branch, Sidra Medical and Research Center, P.O. Box 26999, Doha, Qatar.
| | - Rakesh K Gupta
- Department of Radiology, Fortis Memorial Research Institute, Gurgaon, Haryana, India.
| | - Vivek A Saraswat
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
| | - Murali Rangan
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
| | - Michael A Thomas
- Department of Radiological Sciences, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California, USA.
| | - Sergio Rutella
- Research Branch, Sidra Medical and Research Center, P.O. Box 26999, Doha, Qatar.
| | - Silvio Danese
- Department of Gastroenterology, IRCCS Humanitas Research Hospital, Milan, Italy.
| | - Ena Wang
- Research Branch, Sidra Medical and Research Center, P.O. Box 26999, Doha, Qatar.
| | | | - Mohammad Haris
- Research Branch, Sidra Medical and Research Center, P.O. Box 26999, Doha, Qatar.
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Nitasha Bhat GM, Nayak N, Vinodraj K, Chandralekha N, Mathai P, Cherian J. Comparison of the efficacy of cardamom (Elettaria cardamomum) with pioglitazone on dexamethasone-induced hepatic steatosis, dyslipidemia, and hyperglycemia in albino rats. J Adv Pharm Technol Res 2015; 6:136-40. [PMID: 26317079 PMCID: PMC4542401 DOI: 10.4103/2231-4040.157981] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
To evaluate the efficacy of cardamom with pioglitazone on dexamethasone-induced hepatic steatosis, dyslipidemia, and hyperglycemia in albino rats. There were four groups of 6 rats each. First group received dexamethasone alone in a dose of 8 mg/kg intraperitoneally for 6 days to induce metabolic changes and considered as dexamethasone control. Second group received cardamom suspension 1 g/kg/10 mL of 2% gum acacia orally 6 days before dexamethasone and 6 days during dexamethasone administration. Third group received pioglitazone 45 mg/kg orally 6 days before dexamethasone and 6 days during dexamethasone administration. Fourth group did not receive any medication and was considered as normal control. Fasting blood sugar, lipid profile, blood sugar 2 h after glucose load, liver weight, liver volume were recorded, and histopathological analysis was done. The effects of cardamom were compared with that of pioglitazone. Dexamethasone caused hepatomegaly, dyslipidemia and hyperglycemia. Both pioglitazone and cardamom significantly reduced hepatomegaly, dyslipidemia, and hyperglycemia (P < 0.01). Reduction of blood sugar levels after glucose load was significant with pioglitazone in comparison to cardamom (P < 0.01). Cardamom has comparable efficacy to pioglitazone in preventing dexamethasone-induced hepatomegaly, dyslipidemia, and fasting hyperglycemia.
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Affiliation(s)
- G M Nitasha Bhat
- Department of Pharmacology, KS Hegde Medical Academy, Deralakatte, Mangalore, Karnataka, India
| | - Nagendra Nayak
- Department of Pharmacology, KS Hegde Medical Academy, Deralakatte, Mangalore, Karnataka, India
| | - K Vinodraj
- Department of Pharmacology, KS Hegde Medical Academy, Deralakatte, Mangalore, Karnataka, India
| | - N Chandralekha
- Department of Pharmacology, KS Hegde Medical Academy, Deralakatte, Mangalore, Karnataka, India
| | - Paul Mathai
- Department of Pharmacology, KS Hegde Medical Academy, Deralakatte, Mangalore, Karnataka, India
| | - J Cherian
- Medical Advisor, Onco and Nephro Division, Sun Pharma, Mumbai, Maharashtra, India
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Bhala N, George J. The Burden of Non-alcoholic Fatty Liver Disease (NAFLD) in the Asia Pacific Region. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s11901-015-0264-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Duseja A, Singh SP, Saraswat VA, Acharya SK, Chawla YK, Chowdhury S, Dhiman RK, Jayakumar RV, Madan K, Misra SP, Mishra H, Modi SK, Muruganathan A, Saboo B, Sahay R, Upadhyay R. Non-alcoholic Fatty Liver Disease and Metabolic Syndrome-Position Paper of the Indian National Association for the Study of the Liver, Endocrine Society of India, Indian College of Cardiology and Indian Society of Gastroenterology. J Clin Exp Hepatol 2015; 5:51-68. [PMID: 25941433 PMCID: PMC4415196 DOI: 10.1016/j.jceh.2015.02.006] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 02/27/2015] [Indexed: 02/07/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is closely associated with metabolic syndrome. Prevalence of metabolic risk factors including diabetes mellitus, obesity, etc. is rapidly increasing in India putting this population at risk for NAFLD. Patients with NAFLD are at increased risk for liver-related morbidity and mortality and also cardiovascular disease risk and increased incidence of diabetes mellitus on long-term follow-up. Management of patients with NAFLD may require a multi-disciplinary approach involving not only the hepatologists but also the internists, cardiologists, and endocrinologists. This position paper which is a combined effort of the Indian National Association for Study of the Liver (INASL), Endocrine Society of India (ESI), Indian College of Cardiology (ICC) and the Indian Society of Gastroenterology (ISG) defines the spectrum of NAFLD and the association of NAFLD with insulin resistance and metabolic syndrome besides suggesting preferred approaches for the diagnosis and management of patients with NAFLD in the Indian context.
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Key Words
- ALT, Alanine Aminotransferase
- APO C3, Apolipoprotein C3
- ARFI, Acoustic Radiation Forced Impulse
- AST, Aspartate Aminotransferase
- ATPIII, Adult Treatment Panel III
- BMI, Body mass index
- CAD, Coronary artery disease
- CC, Cryptogenic Cirrhosis
- CIMT, Carotid Intima Media Thickness
- CK 18, Cytokeratin 18
- CT, Computed Tomography
- DM, Diabetes Mellitus
- EBP, Enhancer-Binding Protein
- EMA, Anti-Endomysial antibodies
- FFA, Free Fatty Acids
- FMD, Flow-Mediated Vasodilatation
- FPG, Fasting Plasma Glucose
- GTT, Glucose Tolerance Test
- HCC, Hepatocellular Carcinoma
- HOMA-IR, Homeostasis Model Assessment for Insulin Resistance
- HTG, Hepatic triglyceride
- HTN, Hypertension
- IFG, Impaired Fasting Glucose
- IGT, Impaired Glucose Tolerance
- IKK-β, Inhibitor of nuclear factor kappa-B kinase beta
- IR, Insulin resistance
- IRS-1, Insulin Receptor Substrate-1
- ITT, Insulin Tolerance Test
- LFTs, Liver Function Tests
- MRE, Magnetic Resonance Elastography
- MS, Metabolic syndrome
- NAFLD
- NAFLD, Non-alcoholic fatty liver disease
- NASH
- NASH, Non-Alcoholic Steatohepatitis
- NF-κβ, Nuclear Factor Kappa Β
- PCOS, Polycystic Ovarian Syndrome
- PPG, Post-Prandial Glucose
- PROCAM, Prospective Cardiovascular Munster study
- SREBP, Sterol-Regulatory Element-Binding Protein
- T2DM, Type 2 Diabetes Mellitus
- TE, Transient elastography
- TG, Triglycerides
- TTG, Anti-tissue transglutaminase
- VHCC, Virus-related HCC
- VLDL, Very Low Density Lipoprotein
- WHO, World Health Organization
- cryptogenic cirrhosis
- insulin resistance
- nonalcoholic steatohepatitis
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Affiliation(s)
- Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shivaram P. Singh
- Department of Gastroenterology, SCB Medical College, Cuttack, Odisha, India
- Address for correspondence: Shivaram P. Singh, Professor and Head, Department of Gastroenterology, SCB Medical College, Cuttack 753007, Odisha, India. Tel.: +91 671 2433865.
| | - Vivek A. Saraswat
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Subrat K. Acharya
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Yogesh K. Chawla
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhankar Chowdhury
- Department of Endocrinology, Institute of Postgraduate Medical Education & Research and SSKM Hospital, Kolkata, West Bengal, India
| | - Radha K. Dhiman
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Kaushal Madan
- Medanta Institute of Digestive and Hepatobiliary Sciences, Medanta—The Medicity, Gurgaon, Haryana, India
| | - Sri P. Misra
- Department of Gastroenterology, MotiLal Nehru Medical College, Allahabad, Uttar Pradesh, India
| | - Hrudananda Mishra
- Department of Cardiology, SCB Medical College, Cuttack, Odisha, India
| | - Sunil K. Modi
- Department of Cardiology, Indraprastha Apollo Hospital, New Delhi, India
| | - Arumugam Muruganathan
- The Tamil Nadu Dr. M.G.R. Medical University & AG Hospital, Tirupur, Tamil Nadu, India
| | - Banshi Saboo
- Department of Endocrinology, Diabetes Care & Hormone Clinic, Ahmedabad, Gujarat, India
| | - Rakesh Sahay
- Osmania Medical College & Osmania General Hospital, Hyderabad, Andhra Pradesh & MediCiti Hospital, Hyderabad, Andhra Pradesh, India
| | - Rajesh Upadhyay
- Department of Gastroenterology, Max Super Speciality Hospital, Shalimar Bagh, New Delhi, India
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50
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Praveen Raj P, Gomes RM, Kumar S, Senthilnathan P, Karthikeyan P, Shankar A, Palanivelu C. The effect of surgically induced weight loss on nonalcoholic fatty liver disease in morbidly obese Indians: "NASHOST" prospective observational trial. Surg Obes Relat Dis 2015; 11:1315-22. [PMID: 26003897 DOI: 10.1016/j.soard.2015.02.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 01/21/2015] [Accepted: 02/03/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surgically induced weight loss improves nonalcoholic fatty liver disease (NAFLD) in morbidly obese Caucasian patients. Similar data are lacking from India. OBJECTIVE To compare the histologic features of NAFLD in morbidly obese Indian patients before and 6 months after bariatric surgery. Histologic changes were also separately assessed according to the type of bariatric intervention. SETTING Teaching institution, India; private practice. METHODS All patients undergoing bariatric surgery from July 2012 to July 2013 underwent a routine liver biopsy at the time of bariatric surgery. If the biopsy specimen indicated NAFLD, patients were asked to undergo a second biopsy after 6 months. Baseline anthropometry, clinical data, biochemistry, and pathology were recorded and repeated at follow-up. RESULTS Eighty-eight of 134 index biopsy specimens indicated NAFLD. Thirty patients had paired liver biopsies. Steatosis was present in all, 14 had lobular inflammation, 10 had ballooning degeneration, and 14 had fibrosis. Mean time between the biopsies was 7.1 months (range 6-8 months). At the second biopsy, steatosis had resolution in 19 and improvement in 11, lobular inflammation had resolution in 12 and improvement in 2, ballooning had resolution in 9 and improvement in 1 and fibrosis had resolution in 11 and improvement in 3 (P<0.05 for all). Improvement was greater among those who underwent a sleeve gastrectomy in comparison to a Roux-en-Y gastric bypass, although this difference was not statistically significant. None had worsening of liver histologic results. CONCLUSIONS Surgically induced weight loss significantly and rapidly improves liver histology in morbidly obese Indians with NAFLD.
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Affiliation(s)
- P Praveen Raj
- Department of Bariatric Surgery, GEM Hospital and Research Centre, Tamil Nadu, India.
| | - Rachel M Gomes
- Department of Bariatric Surgery, GEM Hospital and Research Centre, Tamil Nadu, India
| | - Saravana Kumar
- Department of Bariatric Surgery, GEM Hospital and Research Centre, Tamil Nadu, India
| | | | | | - Annapoorni Shankar
- Department of Pathology, GEM Hospital and Research Centre, Tamil Nadu, India
| | - Chinnusamy Palanivelu
- Department of Bariatric Surgery, GEM Hospital and Research Centre, Tamil Nadu, India
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