Depression and increased risk of non-alcoholic fatty liver disease in individuals with obesity

Mood instability and risk of gastrointestinal diseases - a univariable and multivariable mendelian randomization study

BACKGROUND

Mood instability, characterized by sudden and unpredictable mood shifts, is prevalent in psychiatric disorders and as a personality trait. Its association with gastrointestinal diseases has been recognized but remains poorly understood in terms of causality.

METHODS

This study aims to investigate the causal relationship between mood instability and a spectrum of gastrointestinal diseases by univariable and multivariable mendelian randomization analysis. The exposure and outcome data were retrieved from the IEU open GWAS database, the UK biobank and the FinnGen study. Instrumental variables were selected to meet relevance, independence, and exclusion restriction criteria. GWAS datasets for mood instability and 28 gastrointestinal diseases were utilized, incorporating diverse populations and genders. Univariable and multivariable Mendelian randomization analyses were conducted using R software. MR statistics from different datasets for the same disease were meta-analyzed to maximize the study population.

RESULTS

In univariable MR analysis, genetic predisposition to mood instability showed significant associations with increased risk for several gastrointestinal diseases, including: gastroesophageal reflux disease, gastric ulcer, acute gastritis, irritable bowel syndrome, internal hemorrhoids, cirrhosis, cholecystitis, cholelithiasis, acute pancreatitis, chronic pancreatitis. In multivariable MR analysis, after adjusting for major depression, bipolar disorder, anxiety disorder, and schizophrenia, associations with the following gastrointestinal diseases remained statistically significant: internal hemorrhoids, cirrhosis, acute pancreatitis, chronic pancreatitis.

CONCLUSION

This study provides compelling evidence for a potential causal relationship between mood instability and certain gastrointestinal diseases underscoring the importance of considering mood instability as a potential risk factor for gastrointestinal diseases as well as the positive role of maintaining mood stability in the prevention of gastrointestinal disorders.

Depression and the risk of non-alcohol fatty liver disease: Results from a cross-sectional study and a Mendelian randomization analysis

BACKGROUND

Previous studies have suggested that psychiatric factors may be pathogenic for NAFLD. However, the association between depression and NAFLD is not been consistent, and whether depression plays a causal role in the development of NAFLD remains unclear.

METHODS

We extracted data from the National Health and Nutrition Examination Survey (NHANES) 2017-2018 to assess the correlation between depression and NAFLD risk. Based on previous genome-wide association studies (GWAS) meta-analyses on NAFLD and depression, we performed a Mendelian randomization (MR) analysis to explore the causal effect of depression on NAFLD. The primary analysis method used in the MR analysis was inverse variance weighted.

RESULTS

We ultimately extracted the data from 3878 individuals in the NHANES database to perform the cross-sectional study. Multivariable-adjusted logistic regression showed that depressed individuals had a higher risk of NAFLD than controls (odds ratio [OR] 1.33, 95 % CI 1.03-1.72, p = 0.027) among women. Based on GWAS data, we included 36 genetic variants as instrumental variables to estimate the causal effect of depression on NAFLD risk. The MR analysis revealed a causal association between genetically predicted depression and an increased risk of NAFLD (OR = 1.504, 95 % CI 1.13-2.00, p = 0.005).

LIMITATIONS

The consistency of these findings in Eastern populations requires further longitudinal studies.

CONCLUSIONS

This cross-sectional study suggested that depression might increase the risk of NAFLD in women. The MR analysis demonstrated that there exists a causal association between genetically predicated depression and NAFLD risk.

Association of depression with severe non-alcoholic fatty liver disease: evidence from the UK Biobank study and Mendelian randomization analysis

The relationship between depression and severe non-alcoholic fatty liver disease (NAFLD) has not been clearly defined. We conducted a longitudinal cohort study and a two-sample Mendelian randomization (MR) analysis to assess the association of depression with severe NAFLD risk. We used individual data from the UK Biobank study with 481,181 participants, and summary data from published genome-wide association studies. The association between depression and severe NAFLD was assessed using Cox proportional hazards regression analysis. Two-sample MR for depression with NAFLD was conducted, the principal analysis employed the inverse variance weighted (IVW) approach. In the observational study, after a median follow-up of 13.46 years, 4,563 participants had severe NAFLD. In multivariable-adjusted model, participants with depression had an increased risk of severe NAFLD (hazards ratio:1.21, 95% confidence interval (CI):1.09-1.34), as compared to those without depression. In subgroup analyses, the association between depression and severe NAFLD risk was generally observed across different subgroups. For the MR, result also showed that genetically predicted depression was causally associated with a higher risk of NAFLD (odds ratio:1.55, 95%CI:1.10-2.19) in IVW. Our study revealed a prospective association of depression with severe NAFLD, thus potentially necessitating clinical monitoring of individuals with depression for severe NAFLD.

The Causal Effects between Mood Swings and Gastrointestinal Diseases: A Mendelian Randomization Study

Background

Numerous studies have examined the links between mental disorders such as depression and bipolar disorder, and gastrointestinal (GI) diseases. However, few studies have investigated the link between mood swings and GI diseases. Given the impact of mood swings on various conditions and the growing comprehension of the gut-brain axis, this study aims to explore their causal relationship using Mendelian randomization (MR) methods.

Methods

Single-nucleotide polymorphisms (SNPs) associated with mood swings were obtained from a recent study. SNPs associated with GI diseases were identified from the FinnGen project. We conducted two-sample bidirectional MR analyses using three methods, primarily the inverse variance weighting (IVW) method. Furthermore, we performed sensitivity analyses and false discovery rate (FDR) analysis to validate the accuracy and robustness of the results.

Results

Bidirectional MR analysis revealed significant causal effects between mood swings and GI diseases according to the IVW method (odds ratio (OR): 1.213; 95% confidence interval (CI): 1.118-1.316; P = 3.490e-6; P FDR = 8.730e-5). Mood swings were linked to an increased risk for 11 of 24 diseases, including five upper GI diseases (gastroesophageal reflux disease (GERD), acute gastritis, gastroduodenal ulcer, duodenal ulcer, and functional dyspepsia), two lower GI diseases (diverticular disease of the intestine and irritable bowel syndrome (IBS)) and four hepatobiliary and pancreatic diseases (nonalcoholic fatty liver disease (NAFLD), chronic pancreatitis, acute pancreatitis, and pancreatic cancer). Inverse MR analysis showed no causal relationship between 24 GI diseases and mood swings.

Conclusions

This comprehensive MR analysis suggests that genetically predicted mood swings may be a risk factor in the development of GI diseases. Interventions for mood swings may help to treat GI diseases.

Depression and NAFLD risk: A meta-analysis and Mendelian randomization study

BACKGROUND

Both depression and nonalcoholic fatty liver disease (NAFLD) have a high global prevalence. Growing evidence suggests an association between depression and NAFLD, while the association remains unclear. Thus, in this study, we aimed to explore the effect of depression on the risk of developing NAFLD.

METHODS

The meta-analysis examined the association between depression and the risk of NAFLD by including observational studies. Relevant studies were searched in PubMed, Embase, the Cochrane Library, and Web of Science. Then a two-sample Mendelian randomization (MR) analysis was performed to explore causal association using genetic instruments identified from a genome-wide association study.

RESULTS

Six eligible studies were included in the meta-analysis, involving 289,22 depression cases among 167,554 participants. Meta-analysis showed a significant association between depression and a higher risk of developing NAFLD (OR = 1.14, 95 % CI: [1.05, 1.24], P = 0.002). However, we found no convincing evidence supporting a causal role of genetically predicted depression with NAFLD risk (OR = 0.861, 95 % CI: [0.598, 1.238], P = 0.420).

LIMITATIONS

The insufficient number of included studies, the use of summary-level data, and restrictions on population sources are the major limiting factors.

CONCLUSIONS

Meta-analysis and MR analysis demonstrated inconsistent results on the relationship between depression and a high risk of developing NAFLD. Specifically, meta-analysis confirmed that depression increases the risk of developing NAFLD, while MR analysis did not support a causal association between genetically determined depression and the risk of NAFLD.

The impact of stress on the behavior of C57BL/6 mice with liver injury: a comparative study

Introduction

Depressive-like behavior has been shown to be associated with liver damage. This study aimed to evaluate the impact of three different models of depression on the behavior of mice with liver injury.

Methods

During the 4 weeks of methionine/choline deficiency diet (MCD), adult C57BL/6 mice were randomly divided into four groups: MCD (no stress protocol, n = 6), chronic unpredictable mild stress (CUMS, n = 9), acute and repeated forced swim stress [aFSS (n = 9) and rFSS (n = 9)].

Results

All depression protocols induced increased anhedonia and anxiety-like behavior compared to baseline and had no impact on the severity of liver damage, according to ultrasonography. However, different protocols evoked different overall behavior patterns. After the depressive-like behavior induction protocols, animals subjected to aFSS did not exhibit anxiety-like behavior differences compared to MCD animals, while mice subjected to CUMS showed additional weight loss compared to FSS animals. All tested protocols for inducing depressive-like behavior decreased the short-term memory of mice with liver damage, as assessed by the novel object recognition test (NORT).

Discussion

Our results show that the use of all protocols seems to generate different levels of anxiety-like behavior, but only the depressive-like behavior induction procedures associate additional anhedonia and memory impairment in mice with liver injury.

Loneliness and Social Isolation with Risk of Incident Non-alcoholic Fatty Liver Disease, UK Biobank 2006 to 2022

Background: Although loneliness and social isolation are proposed as important risk factors for metabolic diseases, their associations with the risk of non-alcoholic fatty liver disease (NAFLD) have not been elucidated. The aims of this study were to determine whether loneliness and social isolation are independently associated with the risk of NAFLD and to explore potential mediators for the observed associations. Methods: In this large prospective cohort analysis with 405,073 participants of the UK Biobank, the status of loneliness and social isolation was assessed through self-administrated questionnaires at study recruitment. The primary endpoint of interest was incident NAFLD. Multivariable-adjusted Cox proportional hazard regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals for the associations between loneliness, social isolation, and risk of NAFLD. Results: During a median follow-up of 13.6 years, there were 5,570 cases of NAFLD identified. In the multivariable-adjusted model, loneliness and social isolation were both statistically significantly associated with an increased risk of NAFLD (HR = 1.22 and 1.13, respectively). No significant multiplicative or additive interaction was found between loneliness and social isolation on the risk of NAFLD. The mediation analysis estimated that 30.4%, 16.2%, 5.3%, 4.1%, 10.5%, and 33.2% of the loneliness-NAFLD association was mediated by unhealthy lifestyle score, obesity, current smoking, irregular physical activity, suboptimal sleep duration, and depression, respectively. On the other hand, 25.6%, 10.1%, 15.5%, 10.1%, 8.1%, 11.6%, 9.6%, 4.8%, and 3.0% of the social isolation-NAFLD association was mediated by unhealthy lifestyle score, obesity, current smoking, irregular physical activity, suboptimal sleep duration, depression, C-reactive protein, count of white blood cells, and count of neutrophils, respectively. Conclusions: Our study demonstrated that loneliness and social isolation were associated with an elevated risk of NAFLD, independent of other important risk factors. These associations were partially mediated by lifestyle, depression, and inflammatory factors. Our findings substantiate the importance of loneliness and social isolation in the development of NAFLD.

Treatment with a new barbituric acid derivative suppresses diet-induced metabolic dysfunction and non-alcoholic fatty liver disease in mice

INTRODUCTION

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease, often accompanied by obesity, diabetes, and increased risks of depression and anxiety. Currently, there are no FDA-approved drugs to treat NAFLD and its related systemic symptoms. Previously, we identified a new barbituric acid derivative (BA-5) that expressed effectiveness against fibrosis and drug-resistant hepatocellular carcinoma.

AIMS

This study investigated the potential of BA-5 against high-fat diet (HFD)-induced NAFLD and mood disorders in mice.

MAIN METHODS

Six-weeks-old male C57BL/6 mice were fed with a 45 % HFD for 8 weeks to induce NAFLD and associated metabolic disorders. Mice were treated with a BA-5 and the therapeutic effects and the underlying molecular mechanisms were investigated.

KEY FINDINGS

Administration of BA-5 significantly reduced serum levels of alanine aminotransferase (ALT), low-density lipoprotein (LDL), fatty acids (FA), and triglycerides (TG) in HFD-fed mice. BA-5 treatment decreased expressions of hepatic lipogenesis-related markers (acetyl-CoA carboxylase (ACC), fatty acid synthase (FAS), and ATP-citrate lyase (ACLY)), increased fatty acid oxidation markers (carnitine palmitoyltransferase 1A (CPT1A) and acyl-CoA oxidase 1 (ACOX1)), and attenuated hepatic fat accumulation in HFD-fed mice. Moreover, HFD-induced adipocyte size enlargement and activation of lipolysis markers such as phosphorylated (p)-hormone-sensitive lipase (HSL) 565, p-HSL 660, and perilipin were inhibited in BA-5-treated mice. Notably, HFD-induced anxiety- and depression-like behaviors significantly improved in the BA-5 treated group through enhanced anti-inflammatory responses in the hippocampus.

SIGNIFICANCE

This study provides new insights into clinical therapeutic strategies of barbituric acid derivatives for HFD-induced NAFLD and associated mood disturbances.

Cross-sectional study on stigma and motivation to adhere to lifestyle modification among vulnerable populations with fatty liver disease

Objectives

Adherence to lifestyle modification (diet, exercise, and alcohol cessation) for fatty liver disease (FLD) management remains challenging. The study examined stigma, barriers, and factors associated with motivation to adhere to lifestyle modification in a diverse and vulnerable population with FLD.

Methods

From 2/19/2020 to 2/28/2022, 249 FLD patients within San Francisco safety-net hepatology clinics were surveyed along with clinical data taken from medical records. Multivariable modeling assessed factors associated with motivation to adhere to lifestyle modification in a cross-sectional study.

Results

Median age was 53 years, 59% female, 59% Hispanic, 25% Asian/Pacific Islander, 9% White, and 2% Black, 79% were non-English speakers, 64% had ≤ high school education, and 82% reported <$30,000 annual income. Common comorbidities included hyperlipidemia (47%), hypertension (42%), diabetes (39%), and heavy alcohol use (22%). Majority (78%) reported experiencing stigma, 41% reported extreme motivation, and 58% reported ≥ two barriers. When controlling for age, sex, Hispanic ethnicity, alcohol consumption, BMI, >high school (coef 1.41, 95% CI 0.34-2.48), stigma (coef 0.34, 95% CI 0.07-0.62), and depression (coef -1.52, 95% CI -2.79 to -0.26) were associated with motivation.

Conclusions

Stigma is commonly reported among FLD patients. Interventions to enhance patient education and mental health support are critical to FLD management, especially in vulnerable populations.

The bidirectional association of nonalcoholic fatty liver disease with depression, bipolar disorder, and schizophrenia

Nonalcoholic fatty liver disease (NAFLD) is a complex metabolic-inflammatory disease associated with poor outcomes and decreased quality of life. NAFLD is overrepresented in patients with psychiatric disorders like depression, bipolar disorder, and schizophrenia; however, a comprehensive review on NAFLD and psychiatric disorders remains to be delineated. This review endeavors to investigate the association of NAFLD with psychiatric disorders, including shared pathogenesis and future clinical derivatives. Extant literature suggests that patients with psychiatric disorders (in particular, mood disorders) are more susceptible to the development of NAFLD due to multiple reasons, including but not limited to hypothalamic-pituitary-adrenal axis dysregulation, metabolic syndrome, and chronic perceived stress. Moreover, the clinical manifestations of mood disorders (e.g., anhedonia, psychomotor retardation, lifestyle modification, etc.), and potentially long-term treatment with weight-gaining agents, differentially affect these patients, making them more prone to NAFLD. Considering the increased morbidity associated with both mood disorders and NAFLD, our review recommends regular screenings for NAFLD in select patients with mood disorders exhibiting signs of increased risk (i.e., obesity, metabolic syndrome, diabetes, or family history of NAFLD) for better diagnosis and holistic care of both potentially interrelated conditions.

Depression and 24 gastrointestinal diseases: a Mendelian randomization study

The causality of the association between depression and gastrointestinal diseases is undetermined. We conducted Mendelian randomization (MR) analyses to systematically explore the associations of depression with 24 gastrointestinal diseases. Independent genetic variants associated with depression at the genome-wide significance level were selected as instrumental variables. Genetic associations with 24 gastrointestinal diseases were obtained from the UK Biobank study, the FinnGen study, and large consortia. Multivariable MR analysis was conducted to explore the mediation effects of body mass index, cigarette smoking, and type 2 diabetes. After multiple-testing corrections, genetic liability to depression was associated with an increased risk of irritable bowel syndrome, non-alcohol fatty liver disease, alcoholic liver disease, gastroesophageal reflux, chronic pancreatitis, duodenal ulcer, chronic gastritis, gastric ulcer, diverticular disease, cholelithiasis, acute pancreatitis, and ulcerative colitis. For the causal effect of genetic liability to depression on non-alcoholic fatty liver disease, a substantial proportion was mediated by body mass index. Genetic predisposition to smoking initiation mediated half of effect of depression on acute pancreatitis. This MR study suggests that depression may play a causal role in many gastrointestinal diseases.

Associations of depression score with metabolic dysfunction-associated fatty liver disease and liver fibrosis

BACKGROUND

Growing evidence suggests a link between depression and nonalcoholic fatty liver disease (NAFLD). Recently, a change from NAFLD to metabolic dysfunction-associated fatty liver disease (MAFLD) has been proposed. The aim of this study was to determine whether depression scores are associated with newly defined MAFLD as well as liver fibrosis in the US general population.

METHODS

This cross-sectional study utilized data from the 2017-March 2020 cycle of the National Health and Nutrition Examination Survey in the US. The depression score was assessed with the Patient Health Questionnaire-9 (PHQ-9). Transient elastography was utilized to evaluate hepatic steatosis and fibrosis with controlled attenuation parameters and liver stiffness measurements, respectively. All the analyses accounted for the complex design parameters and sampling weights of the survey.

RESULTS

A total of 3263 eligible subjects aged 20 years and older were included. The estimated prevalence of mild and major depression was 17.0 % (95 % confidence interval [CI]: 14.8-19.3 %) and 7.1 % (6.1-8.1 %), respectively. For every one-unit increase in depression score, a subject was 1.05 (1.02-1.08) times more likely to have MAFLD. Compared to the minimal depression group, those with mild depression had an odds ratio (OR) of 1.54 (1.06-2.25) for MAFLD. The depression score was not associated with clinically significant liver fibrosis.

CONCLUSION

The depression score measured by PHQ-9 was independently associated with MAFLD among US adults.

LIMITATIONS

Causal relationship is not available due to the cross-sectional nature of the survey design.

Chinese chestnut shell polyphenol extract regulates the JAK2/STAT3 pathway to alleviate high-fat diet-induced, leptin-resistant obesity in mice

Chinese chestnut shell is a by-product of chestnut food processing and is rich in polyphenols. This study sought to investigate the effect of chestnut shell polyphenol extract (CSP) on weight loss and lipid reduction in a 12-week high-fat diet (HFD)-induced murine obesity model. CSP (300 mg per kg body weight) was administered intragastrically daily. AG490, a JAK2 protein tyrosine kinase inhibitor, was also intraperitoneally injected. The results showed that an HFD induced leptin resistance (LR). Compared to corresponding values in the HFD group, CSP treatment improved blood lipid levels, weight, and leptin levels in obese mice (p < 0.01). Additionally, CSP treatment enhanced enzyme activity by improving total antioxidant capacity, attenuating oxidative stress, and reducing fat droplet accumulation and inflammation in the liver, epididymal, and retroperitoneal adipose tissue. CSP also activated the LEPR-JAK2/STAT3-PTP1B-SOCS-3 signal transduction pathway in hypothalamus tissue and improved LR while regulating the expression of proteins related to lipid metabolism (PPARγ, FAS, and LPL) in white adipose tissue in the retroperitoneal cavity. However, the amelioration of lipid metabolism by CSP was dependent on JAK2. Molecular docking simulation further demonstrated the strong binding affinity of procyanidin C1 (-10.3983297 kcal mol^-1) and procyanidin B1 (-9.12686729 kcal mol^-1) to the crystal structure of JAK2. These results suggest that CSP may be used to reduce HFD-induced obesity with potential application as a functional food additive.

Sex differences in the relationship between hepatic steatosis, mood and anxiety disorders

OBJECTIVE

To investigate the association between non-alcoholic fatty liver disease (NAFLD), alcoholic liver disease (ALD), mental symptoms (mood, anxiety disorders and distress) by sex.

METHODS

This a cross-sectional study performed in working-age adults from a Health Promotion Center (primary care) in São Paulo, Brazil. Self-reported mental symptoms from rating scales (21-item Beck Anxiety Inventory, Patient Health Questionnaire-9, and K6 distress scale) were evaluated by hepatic steatosis (NAFLD and ALD). Logistic regression models estimated the association between hepatic steatosis subtypes and mental symptoms by Odds ratios (OR) adjusted by confounders in the total sample and sex stratified.

RESULTS

Among 7241 participants (70.5% men, median age: 45 years), the frequency of steatosis was of 30.7% (25.1% NAFLD), being higher in men than women (70.5% vs. 29.5%, p < 0.0001), regardless of the steatosis subtype. Metabolic risk factors were similar in both subtypes of steatosis, but not mental symptoms. Overall, NAFLD was inversely associated with anxiety (OR = 0.75, 95%CI 0.63-0.90) and positively associated with depression (OR = 1.17, 95%CI 1.00-1.38). On the other hand, ALD was positively associated with anxiety (OR = 1.51; 95%CI 1.15-2.00). In sex-stratified analyses, only men presented an association of anxiety symptoms with NAFLD (OR = 0.73; 95%CI 0.60-0.89) and ALD (OR = 1.60; 95%CI 1.18-2.16).

CONCLUSIONS

The complex association between different types of steatosis (NAFLD and ALD), mood and anxiety disorders indicates the need for a deeper understanding of their common causal pathways.

Impact of nonalcoholic fatty liver disease-related metabolic state on depression

Nonalcoholic fatty liver disease (NAFLD), also recently referred as metabolic (dysfunction)-associated fatty liver disease (MAFLD), is characterized by hepatocyte steatosis in the setting of metabolic risk conditions and in the absence of an underlying precursor, for instance alcohol consumption, hepatotropic viruses and hepatotoxic drugs. A possible association between NAFLD and depression has been proposed, owing to intersecting pathophysiological pathways. This narrative review aimed to summarize the current evidence that illustrate the potential pathophysiological and clinical linkage between NAFLD-related metabolic state and depression. Prefrontal cortex lesions are suggested to be a consequence of liver steatosis-associated systematic hyperinflammatory state, a phenomenon also occurring in depression. In addition, depressive symptoms are present in neurotransmitter imbalances. These abnormalities seem to be correlated with NAFLD/MAFLD, in terms of insulin resistance (IR), ammonia and gut dysbiosis' impact on serotonin, dopamine, noradrenaline levels and gamma aminobutyric acid receptors. Furthermore, reduced levels of nesfatin-1 and copine-6-associated BDNF (brain-derived neurotrophic factor) levels have been considered as a probable link between NAFLD and depression. Regarding NAFLD-related gut dysbiosis, it stimulates mediators including lipopolysaccharides, short-chain fatty acids and bile acids, which play significant role in depression. Finally, western diet and IR, which are mainstay components of NAFLD/MAFLD, are, also, substantiated to affect neurotransmitters in hippocampus and produce neurotoxic lipids that contribute to neurologic dysfunction, and thus trigger emotional disturbances, mainly depressive symptoms.

Factors Associated with Symptoms of Depression among People with Obesity: Analysis of a 3-Year-Peruvian National Survey

INTRODUCTION

Obesity and depression contribute to the global burden of economic cost, morbidity, and mortality. Nevertheless, not all people with obesity develop depression.

OBJECTIVE

To determine the factors associated with depressive symptoms among people aged 15 or older with obesity from the National Demographic and Family Health Survey (ENDES in Spanish 2019-2021).

METHODS

Cross-sectional analytical study. The outcome of interest was the presence of depressive symptoms, assessed using the Patient Health Questionnaire-9 (PHQ-9). Crude (cPR) and adjusted (aPR) prevalence ratios were estimated using GLM Poisson distribution with robust variance estimates.

RESULTS

The prevalence of depression symptoms was 6.97%. In the multivariate analysis, a statistically significant association was found between depressive symptoms and female sex (PRa: 2.59; 95% CI 1.95-3.43); mountain region (PRa: 1.51; 95% CI 1.18-1.92); wealth index poor (PRa: 1.37; 95% CI 1.05-1.79, medium (PRa: 1.49; 95% CI 1.11-2.02), and rich (PRa: 1.65; 95% CI 1.21-2.26); daily tobacco use (PRa: 2.05, 95% CI 1.09-3.87); physical disability (PRa: 1.96, 95% CI 1.07-3.57); and a history of arterial hypertension (PRa: 2.05; 95% CI 1.63-2.55).

CONCLUSION

There are several sociodemographic factors (such as being female and living in the Andean region) and individual factors (daily use of tobacco and history of hypertension) associated with depressive symptoms in Peruvian inhabitants aged 15 or older with obesity. In this study, the COVID-19 pandemic was associated with an increase in depressive symptoms.

Self-Management and Associated Factors among Patients with Non-Alcoholic Fatty Liver Disease: A Cross-Sectional Study

Self-management is critical and essential for controlling non-alcoholic fatty liver disease, delaying progression, and preventing complications. However, information about the self-management characteristics of this population is scarce. This study explores the characteristics and self-management levels and the factors associated with self-management in patients with non-alcoholic fatty liver disease in Korea. A convenience sample of 150 patients diagnosed with non-alcoholic fatty liver disease was recruited from April to November 2019. Demographics and clinical findings were collected, and self-management, self-efficacy, fatigue, and depressive symptoms were assessed using questionnaires. Multiple linear regression analysis was performed to examine the factors associated with self-management. Self-management levels were moderate (Mean = 3.4, SD = 0.61). Self-management differed significantly by age, sex, marital status, occupation, and health education experience. Self-efficacy (β = 0.074, p = 0.020) showed a significant association with self-management, which explained 25.0% of the variance after controlling for age, sex, marital status, health education experience, occupation, controlled attenuation parameter score, and body mass index. Self-efficacy is a critical determinant of self-management among patients with non-alcoholic fatty liver disease. The study findings could assist healthcare professionals in facilitating self-management compliance and developing multidisciplinary team-based interventions for sustainable self-management.

Cerebrolysin Use in Patients with Liver Damage-A Translational Study

The treatment of acute life-threatening events in patients suffering from chronic pathologies is problematic, as physicians need to consider multisystemic drug effects. Regarding Cerebrolysin, a Sonic Hedgehog signaling pathway amplifier and one of the few approved neurotrophic treatments for stroke patients, concerns of excessive Hedgehog pathway activation that could accelerate NAFLD progression to cirrhosis seem valid. We investigated stroke patients treated with Cerebrolysin that presented elevated levels of aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT). We also investigated the efficiency of Cerebrolysin in reversing the neurogenesis inhibition within the hippocampus in a mouse model of NAFLD by evaluating behavior and histological outcomes. NeuN, BrdU and Iba1 positive signals in the cortex and hippocampus of the animals were also observed. Clinically, Cerebrolysin improved AST levels in a majority of stroke patients with hepatic damage. The same treatment in an experimental setup was able to reverse anxiety-like behavior in MCD mice, reducing their freezing time from 333.61 ± 21.81 s in MCD animals to 229.17 ± 26.28 in treated ones. The use of Cerebrolysin did not improve short-term memory nor rescued cell multiplication in the hippocampus after MCD food intake. Understanding the neuroprotective and neurotrophic effects that drugs have on NAFLD patients can significantly contribute to a suitable therapeutic approach.

Crosstalk between Depression and Breast Cancer via Hepatic Epoxide Metabolism: A Central Comorbidity Mechanism

Breast cancer (BC) is a serious global challenge, and depression is one of the risk factors and comorbidities of BC. Recently, the research on the comorbidity of BC and depression has focused on the dysfunction of the hypothalamic–pituitary–adrenal axis and the persistent stimulation of the inflammatory response. However, the further mechanisms for comorbidity remain unclear. Epoxide metabolism has been shown to have a regulatory function in the comorbid mechanism with scattered reports. Hence, this article reviews the role of epoxide metabolism in depression and BC. The comprehensive review discloses the imbalance in epoxide metabolism and its downstream effect shared by BC and depression, including overexpression of inflammation, upregulation of toxic diols, and disturbed lipid metabolism. These downstream effects are mainly involved in the construction of the breast malignancy microenvironment through liver regulation. This finding provides new clues on the mechanism of BC and depression comorbidity, suggesting in particular a potential relationship between the liver and BC, and provides potential evidence of comorbidity for subsequent studies on the pathological mechanism.

Galectin-1 in Obesity and Type 2 Diabetes

Galectin-1 is a carbohydrate-binding protein expressed in many tissues. In recent years, increasing evidence has emerged for the role of galectin-1 in obesity, insulin resistance and type 2 diabetes. Galectin-1 has been highly conserved through evolution and is involved in key cellular functions such as tissue maturation and homeostasis. It has been shown that galectin-1 increases in obesity, both in the circulation and in the adipose tissue of human and animal models. Several proteomic studies have independently identified an increased galectin-1 expression in the adipose tissue in obesity and in insulin resistance. Large population-based cohorts have demonstrated associations for circulating galectin-1 and markers of insulin resistance and incident type 2 diabetes. Furthermore, galectin-1 is associated with key metabolic pathways including glucose and lipid metabolism, as well as insulin signalling and inflammation. Intervention studies in animal models alter animal weight and metabolic profile. Several studies have also linked galectin-1 to the progression of complications in diabetes, including kidney disease and retinopathy. Here, we review the current knowledge on the clinical potential of galectin-1 in obesity and type 2 diabetes.

Reduced Quality of Life in Patients with Non-Alcoholic Fatty Liver Disease May Be Associated with Depression and Fatigue

Non-alcoholic fatty liver disease (NAFLD) is often thought of as clinically asymptomatic. However, many NAFLD patients complain of fatigue and low mood, which may affect their quality of life (QoL). This may create a barrier to weight loss and hinder the achievement of NAFLD therapy goals. Our study aimed to evaluate the QoL in NAFLD patients vs. healthy volunteers, and to analyze likely influencing factors. From March 2021 through December 2021, we enrolled 140 consecutive adult subjects (100 NAFLD patients and 40 controls). Overall, 95 patients with NAFLD and 37 controls were included in the final analysis. Fatty liver was diagnosed based on ultrasonographic findings. We employed 36-Item Short Form Health Survey (SF-36) to evaluate QoL, Hospital Anxiety and Depression Scale (HADS) to identify anxiety and/or depression, and Fatigue Assessment Scale (FAS) to measure fatigue. NAFLD patients had significantly lower physical component summary scores, as well as significantly higher HADS-D scores, compared with the control group (Mann-Whitney U criterion = 1140.0, p = 0.001 and U = 1294.5, p = 0.022, respectively). Likewise, fatigue was more common in NAFLD patients (χ2 = 4.008, p = 0.045). Impaired QoL was significantly associated with fatigue (FAS score ≥ 22, p < 0.001) and depression (HADS-D ≥ 8, p < 0.001). In conclusion, NAFLD patients had significantly poorer QoL vs. controls, in particular with respect to the physical component of health. Impaired QoL may be associated with fatigue and depression, and together they may interfere with increased physical activity and lifestyle modifications in patients with NAFLD.

Statins decrease overall mortality and cancer related mortality but are underutilized in NAFLD: a longitudinal analysis of 12,538 individuals

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease. NAFLD is associated with dyslipidemia, and cardiovascular mortality remains the leading cause of death. While statins are the first-line therapy in hyperlipidemia, their utilization has been suboptimal. Hence, we examined the use of statins in NAFLD and mortality.

RESEARCH DESIGN AND METHODS

Analysis was performed with the National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2018. Longitudinal outcomes were assessed with survival analysis.

RESULTS

Of 12,538 NAFLD patients, 6,452 were indicated for hyperlipidemia treatment. Statin usage was highest among high-risk individuals (44.28%) and lowest among low-risk individuals (8.48%). The risk of overall (HR: 0.87, CI: 0.76 to 0.99, p = 0.04) and cancer-related (SHR: 0.73, CI: 0.54 to 0.99, p = 0.04) mortality was significantly lower in NAFLD patients with statins. There was no significant decrease in cardiovascular-related mortality.

CONCLUSION

Over concerns of hepatotoxicity and lack of evidence in reducing mortality events, statins remain underutilized in NAFLD. However, statin use was associated with a significant reduction in overall and cancer-related mortality. The lack of reduction in cardiovascular disease mortality is likely a selection bias of patients, where individuals with higher risk are more likely to receive treatment.

An affordable approach to classifying type 2 diabetes based on fasting plasma glucose, TyG index and BMI: a retrospective cohort study of NHANES Data from 1988 to 2014

BACKGROUND

The β-cell function and insulin resistance required by existing methods of classifying type 2 diabetes are not routinely adopted in most medical institutions of developing countries and regions. This study aims to propose a novel, affordable classification approach and evaluate its predictive ability for several health and mortality outcomes, including cardiovascular health (CVH), retinopathy, chronic kidney disease (CKD), nonalcoholic fatty liver disease (NAFLD), advanced liver fibrosis, and mortality caused by all-cause, cardiovascular disease (CVD), cancer.

METHODS

Based on 4060 participants with diabetes (aged ≥ 30 at the time of diagnosis) selected from the National Health and Nutrition Examination Survey III & 1999-2014, we proposed a novel, but simple classification approach based on the threshold of fasting plasma glucose (FPG), triglyceride-glucose (TyG) index and body mass index (BMI). We used logistic regression model to assess its predictability for diabetes complications, and Cox regression model to estimate the mortality risks.

RESULTS

By utilizing this approach, we characterized the subjects into four subgroups: subgroup A (obesity-related), which accounts for 37% of the total, subgroup B (age-related), 38%, subgroup C (insulin resistance), 20%, and subgroup D (severe insulin deficiency), 5%. Subjects in subgroup D had a higher risk of retinopathy, in subgroup B had a lower risk of poor cardiovascular health, nonalcoholic fatty liver disease, and advanced liver fibrosis, in subgroup C had a higher risk of all-cause mortality.

CONCLUSIONS

This study proposes an affordable and practical method for classifying patients with type 2 diabetes into different subgroups, with a view to yield a high predictability of patient outcomes and to assist clinicians in providing better treatment.

Living in the non-alcoholic fatty liver disease silent epidemic: a qualitative systematic review of patients' perspectives

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) affects one-fourth of the global population. Yet, the care of these patients is limited and awareness of NAFLD remains low in the general public. Investigations into the lives of these patients are often forgotten and traditional quantitative studies only paint part of the picture.

AIM

To assess the first-hand accounts of these individuals and their perspective on living with NAFLD.

METHODS

A systematic search was conducted on Medline, Embase, CINAHL, PsycINFO and Web of Science database for qualitative literature regarding patients' perspectives on NAFLD. An inductive thematic analysis was conducted to generate themes and supportive subthemes.

RESULTS

We incuded eight articles in the review. There were three major themes including the impact on the quality of life, knowledge and information, and attitudes and perceptions on care. The impact of the quality of life details the emotional and physical distress of NAFLD. Knowledge and information include the lack of sufficient communication between healthcare providers and patients with a distinct knowledge gap. Attitudes and perceptions on care extrapolate the current active participation of patients and needs of the patients and the future care that they desire.

CONCLUSION

This review synthesises first-hand accounts of individuals with NAFLD. With the growing burden of NAFLD, future public interventions must consider individual views for success to be found. The identified themes serve as a forefront for consideration for public policies. Ultimately, NAFLD is a multisystem disease, which must be managed by a multidisciplinary team.

Behavioral health disorders related to nonalcoholic steatohepatitis

Content available: Author Interview and Audio Recording.

Anxiety and Depression in Metabolic-Dysfunction-Associated Fatty Liver Disease and Cardiovascular Risk

(1) Background: The relationship between anxiety and depression in metabolic-dysfunction-associated fatty liver disease (MAFLD) and cardiovascular (CV) risk remains uncertain. Therefore, we aimed to assess whether anxiety and depression are associated with increased CV risk in MAFLD. (2) Methods: We conducted a cross-sectional observational study involving 77 subjects (39 MAFLD patients, 38 controls), between January and September 2020. Hepatic steatosis was assessed using a combination of hepatic ultrasonography and SteatoTestTM. CV parameters were evaluated using echocardiography and Doppler ultrasound. Self-reported questionnaires pertaining to symptoms of anxiety and depression were used. Anxiety was evaluated using Lehrer Woolfolk Anxiety Symptom Questionnaire (LWASQ), further divided into somatic, behavioral, and cognitive factors, as well as a global score, and depression using Beck Depression Inventory (BDI). (3) Results: MAFLD patients presented significantly higher BDI scores (p-value 0.009) and LWASQ global scores (p-value 0.045) than controls. LWASQ somatic factor was significantly associated with global longitudinal strain (GLS) in linear analysis (-0.0404, p-value = 0.002), while it lost significance following multivariate analysis (-0.0166, p-value = 0.124). Although group (MAFLD vs. controls) predicted BDI, LWASQ global score, and LWASQ somatic factor in linear regression, they lost significance in multivariate analysis. Moreover, the relationship between interventricular septal wall thickness (IVSWT) and BDI, LWASQ global score, and LWASQ somatic factor was significant in linear analysis, but statistical significance disappeared after multivariate analysis. (4) Conclusions: Although MAFLD patients presented increased anxiety and depression risk in univariate analysis, this association lost significance in multivariate analysis. A significant association between GLS levels and LWASQ somatic factor, in addition to IVSWT in anxiety and depression in univariate analysis, was observed, but was lost after multivariate analysis.

Depression and non-alcoholic fatty liver disease: Association and potential mechanisms

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the world, and is closely related to the high incidence of obesity, metabolic syndrome, type 2 diabetes, arteriosclerotic cardiovascular disease, and colorectal tumor. Depression is a common mental disorder that is characterized by high incidence, high recurrence rate, high disability rate, and high suicide rate, which has serious harm to patients' physical and mental health, reduce the quality of life of patients. In recent years, as more and more attention has been paid to mental health of NAFLD patients, the relationship between NAFLD and depression has become one of the hot research topics. Studies have shown that the incidence of depression in NAFLD patients is higher than that in non-NAFLD patients, and the incidence of NAFLD in depressed patients is also higher. Some research results have been published on the mechanism of comorbidity between the two. This paper reviews the research progress on the correlation and common mechanism between NAFLD and depression, aiming to lay a foundation for further research on the comorbidities of NAFLD and depression, and provide a basis and research direction for the diagnosis and treatment of patients with both comorbidities.

Validation of type 2 diabetes subgroups by simple clinical parameters: a retrospective cohort study of NHANES data from 1999 to 2014

OBJECTIVES

To verify whether a simplified method based on age, body mass index (BMI) and glycated haemoglobin (HbA1c) is feasible in classifying patients with type 2 diabetes (T2D), and evaluate the predictive ability of subgroups in several health and mortality outcomes.

DESIGN

Retrospective cohort study.

SETTING

The National Health and Nutrition Examination Survey 1999-2014 cycle.

PARTICIPANTS

A total of 1960 participants with diabetes and the age at diagnosis greater than 30.

PRIMARY AND SECONDARY OUTCOME MEASURES

Participants with T2D were assigned to previously defined (by Ahlqvist) subgroups based on five variables: age, BMI, HbA1c, homoeostasis model assessment (HOMA) 2 estimates of β-cell function (HOMA2-B), and insulin resistance (HOMA2-IR), and on three variables: age, BMI and HbA1c. The classification performances of the three variables were evaluated based on 10-fold cross validation, with accuracy, precision and recall as evaluation criteria. Outcomes were assessed using logistic regression and Cox regression analysis.

RESULTS

Without HOMA measurements, it is difficult to identify severe insulin-resistant diabetes, but other subgroups can be ideally identified. There is no significant difference between the five variables and the three variables in the ability to predict the prevalence of poor cardiovascular health (CVH), chronic kidney disease, non-alcoholic fatty liver disease and advanced liver fibrosis, and the risk of all-cause, cardiovascular disease and cancer-related mortality (p>0.05), except the prevalence of poor CVH in mild age-related diabetes (p<0.05).

CONCLUSIONS

A simple classification based on age, BMI and HbA1c could be used to identify T2D with several health and mortality risks, which is accessible in most individuals with T2D. Due to its simplicity and practicality, more patients with T2D can benefit from subgroup specific treatment paradigms.

Metabolic dysfunction-associated fatty liver disease and liver fibrosis: Prevalence and associated factors in the middle-aged and older US population

AIM

The global burden of chronic liver disease is substantial. Limited studies have reported the prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) and liver fibrosis among middle-aged and older people. Therefore, we aimed to determine the nationwide prevalence of and associated factors for MAFLD and fibrosis in adults aged 45-79 years from the United States.

METHODS

This cross-sectional study utilized data from the 2017-2018 cycle of the National Health and Nutrition Examination Survey conducted with a nationally representative sample of the civilian, noninstitutionalized US population. Hepatic steatosis and fibrosis were assessed by transient elastography with controlled attenuation parameter and liver stiffness measurement, respectively.

RESULTS

A total of 1186 eligible participants aged 45-79 years were finally included in the analyses. The estimated prevalence of MAFLD, significant fibrosis (F ≥ F2), and advanced fibrosis (F ≥ F3) was 48.6% (95% confidence interval [CI], 43.1%-54.0%), 9.5% (95% CI, 6.8%-12.7%), and 6.7% (95% CI, 4.1%-10.1%), respectively. Multivariable logistic regression revealed an increased MAFLD predisposition in subjects with metabolic disorders including overweight/obesity, abdominal obesity, hypertension, and diabetes mellitus. Moreover, the presence of depression was an independent and strong predictor of MAFLD risk (odds ratio = 3.23; 95% CI, 1.37-7.11). Elevated liver enzymes, hypertension, diabetes mellitus, hepatitis virus infection, and steatosis were associated with a high risk of significant fibrosis.

CONCLUSIONS

Newly defined MAFLD is highly prevalent in the US middle-aged and older population. Approximately 1 in 10 people has significant liver fibrosis. In addition to metabolic disorders, the presence of depression potentially increases the risk of MAFLD.

Non-Alcoholic Fatty Liver Disease (NAFLD) and Potential Links to Depression, Anxiety, and Chronic Stress

Non-alcoholic fatty liver disease (NAFLD) constitutes the most common liver disease worldwide, and is frequently linked to the metabolic syndrome. The latter represents a clustering of related cardio-metabolic components, which are often observed in patients with NAFLD and increase the risk of cardiovascular disease. Furthermore, growing evidence suggests a positive association between metabolic syndrome and certain mental health problems (e.g., depression, anxiety, and chronic stress). Given the strong overlap between metabolic syndrome and NAFLD, and the common underlying mechanisms that link the two conditions, it is probable that potentially bidirectional associations are also present between NAFLD and mental health comorbidity. The identification of such links is worthy of further investigation, as this can inform more targeted interventions for patients with NAFLD. Therefore, the present review discusses published evidence in relation to associations of depression, anxiety, stress, and impaired health-related quality of life with NAFLD and metabolic syndrome. Attention is also drawn to the complex nature of affective disorders and potential overlapping symptoms between such conditions and NAFLD, while a focus is also placed on the postulated mechanisms mediating associations between mental health and both NAFLD and metabolic syndrome. Relevant gaps/weaknesses of the available literature are also highlighted, together with future research directions that need to be further explored.

Is Fatty Liver Associated With Depression? A Meta-Analysis and Systematic Review on the Prevalence, Risk Factors, and Outcomes of Depression and Non-alcoholic Fatty Liver Disease

Background and Aims: Both non-alcoholic fatty liver disease (NAFLD) and depression have a high global prevalence which is projected to increase further. While studies exploring the association have been done, there are conflicting data. This study aims to assess the prevalence and association between depression and NAFLD.

Methods: Medline and Embase were searched from inception to March 3, 2020. Meta-analysis of proportions using the generalized linear mix model was conducted to analyze the pooled prevalence of depression in NAFLD patients. Risk factors for depression in NAFLD patients were evaluated in conventional pairwise meta-analysis.

Results: Ten studies involving 2,041,752 NAFLD patients were included. Pooled prevalence of depression was 18.21% (CI: 11.12–28.38%) in patients with NAFLD and 40.68% (CI: 25.11–58.37%) in patients with non-alcoholic steatohepatitis (NASH). NAFLD resulted in significantly higher risk of development of depression (OR: 1.29, CI: 1.02–1.64, p = 0.03). NASH patients had a significantly higher risk of depression compared with NAFLD patients (RR: 2.83, CI: 2.41–3.32, p < 0.001). Diabetes, body mass index (BMI), female sex, smoking, and history of pulmonary disease were significant risk factors for depression in NAFLD patients.

Conclusion: This study demonstrated a high prevalence of depression in NAFLD patients and a significant association between both conditions. Furthermore, patients with NASH had a significantly higher risk of depression compared with those with NAFLD. Diabetes, BMI, history of lung disease or smoking, and female gender were significant risk factors. Further studies investigating the pathophysiological mechanism underlying depression and NAFLD are needed.

The Impact of Dysmetabolic Sarcopenia Among Insulin Sensitive Tissues: A Narrative Review

Sarcopenia is a common muscular affection among elderly individuals. More recently, it has been recognized as the skeletal muscle (SM) expression of the metabolic syndrome. The prevalence of sarcopenia is increasing along with visceral obesity, to which it is tightly associated. Nonetheless, it is a still underreported entity by clinicians, despite the worsening in disease burden and reduced patient quality of life. Recognition of sarcopenia is clinically challenging, and variability in study populations and diagnostic methods across the clinical studies makes it hard to reach a strong evidence. Impaired insulin activity in SM is responsible for the altered molecular pathways and clinical manifestations of sarcopenia, which is morphologically expressed by myosteatosis. Lipotoxicity, oxidative stress and adipose tissue-derived inflammation lead to both alterations in glucose disposal and protein synthesis in SM, with raising insulin resistance (IR) and SM atrophy. In particular, hyperleptinemia and leptin resistance interfere directly with SM activity, but also with the release of Growth Hormone from the hypohysis, leading to a lack in its anabolic effect on SM. Moreover, sarcopenia is independently associated to liver fibrosis in Non-Alcoholic Fatty Liver Disease (NAFLD), which in turn worsens SM functionality through the secretion of proinflammatory heptokines. The cross-talk between the liver and SM in the IR setting is of crucial relevance, given the high prevalence of NAFLD and the reciprocal impact of insulin-sensitive tissues on the overall disease burden. Along with the efforts of non-invasive diagnostic approaches, irisin and myostatin are two myokines currently evaluated as potential biomarkers for diagnosis and prognostication. Decreased irisin levels seem to be potentially associated to sarcopenia, whereas increased myostatin has shown to negatively impact on sarcopenia in pre-clinical studies. Gene variants in irisin have been explored with regard to the impact on the liver disease phenotype, with conflicting results. The gut-muscle axis has gain relevance with the evidence that insulin resistance-derived gut dysbiosis is responsible for increased endotoxemia and reduction in short-chain free fatty acids, directly affecting and predisposing to sarcopenia. Based on the current evidence, more efforts are needed to increase awareness and improve the management of sarcopenic patients.