Increased risk of nonalcoholic fatty liver disease with occupational stress in Chinese policemen: A 4-year cohort study

Occupational stress trajectories and metabolic dysfunction-associated steatotic liver disease among female nurses: a prospective Cohort Study

BACKGROUND

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prominent cause of chronic liver disease, and occupational stress may serve as a potential risk factor. This study aims to assess the association between occupational stress trajectories and incident MASLD among Chinese female nurses.

METHODS

We conducted a prospective longitudinal study using data from the Nurse' Health Cohort Study, involving 1,113 female nurses, free of MASLD at baseline (2018). Occupational stress was measured using the Chinese Nurse Job Stress Scale at four time points. Group-based trajectory modeling was used to identify distinct stress trajectories. Through doctors' diagnoses, we assessed incident MASLD over a subsequent 6-year period from 2019 to 2024. Cox proportional hazards regression models evaluated the association of stress trajectories and MASLD risk, adjusting for demographics, work-related factors, and medical conditions.

RESULTS

During follow-up, 256 nurses reported incident physician-diagnosed MASLD. Three occupational stress trajectories were identified: moderate decreasing (36.4%), moderate stable (55.9%), and moderate increasing (7.7%). Participants in the moderate increasing stress trajectory had a significantly higher risk of developing MASLD (adjusted HR: 3.14, 95% CI: 2.19-4.49, p < .001) compared to those in the moderate stable trajectory. This association between stress trajectory and MASLD risk was not modified by age or BMI (pinteraction>0.50).

CONCLUSIONS AND RELEVANCE

The study concludes that increasing stress levels over time are associated with a higher incidence of MASLD. These findings underscore the importance of stress management interventions in reducing the risk of MASLD progression. Further research is needed to explore the underlying mechanisms and to develop targeted strategies for stress reduction in clinical settings.

Diagnostic indicators and lifestyle interventions of metabolic-associated fatty liver disease

MAFLD has become a major global health problem and is the leading cause of liver disease worldwide. The disease progresses from a simple fatty liver to gradual fibrosis, which progresses to cirrhosis and even hepatocellular liver cancer. However, the methods currently used for diagnosis are invasive and do not facilitate clinical assessment of the condition. As a result, research on markers for the diagnosis of MAFLD is increasing. In addition, there are no clinical medications for the treatment of MAFLD, and lifestyle interventions remain effective in the prevention and treatment of MAFLD. In this review, we attempt to make a summary of the emerging diagnostic indicators and effective lifestyle interventions for MAFLD and to provide new insights into the diagnosis and treatment of MAFLD.

Cardiovascular Risk Factors and Metabolic Syndrome among Police Officers in Kozhikode Corporation

Context

Police personnel constitute a special occupational group with exposure to stressful work environment indirectly resulting in a high prevalence of cardiovascular risk factors, including metabolic syndrome (MS), hypertension, hyperlipidemia, cigarette smoking, and a sedentary lifestyle is reported among policemen. Surveillance activities are limited in the present scenario.

Aims

The present study was designed to measure the prevalence of metabolic syndrome and other cardiovascular risk factors among police officers in Kozhikode district and observe the trend over the last 10 years.

Settings and Design

The design was cross-sectional and spanned 630 policemen of Kozhikode Corporation in Kerala Methods and Material: Data collection was done using a pre-tested questionnaire. Anthropometric and biochemical measurements were carried out using standard techniques. MS was diagnosed using the National Cholesterol Education Program-Adult Treatment Panel III criteria.

Statistical Analysis Used

Statistical analysis was performed using the SPSS 20.0 software. Prevalence of MS and cardiovascular risk factors were expressed as percentages (95% CI). Associated factors with MS were identified using Chi square test.

Results

MS was observed in 45.1% of the study population. Obesity and lack of physical activity were the commonest abnormalities. Cardiovascular risk factors identified were high body mass index (67.3%), lack of physical activity (47.1%), hypertension (16.7%), alcohol use (24.2%), smoking (17.3%) and diabetes (8.8%).

Conclusions

There is a rising prevalence (16.8% in 2012 to 45.1% in 2021) of Metabolic Syndrome among policemen in Calicut Corporation. All the cardio vascular risk factors are also highly prevalent among the policemen. Policy makers might seriously take up the issue and introduce effective policies that might help reduce the incidence of MS and other cardio vascular risk factors in the newly recruited young policemen.

Restraint stress promotes nonalcoholic steatohepatitis by regulating the farnesoid X receptor/NLRP3 signaling pathway

Psychological stress promotes nonalcoholic steatohepatitis (NASH) development. However, the pathogenesis of psychological stress-induced NASH remains unclear. This study aims to explore the underlying mechanism of restraint stress-induced NASH, which mimics psychological stress, and to discover potential NASH candidates. Methionine choline deficient diet- and high fat diet-induced hepatosteatotic mice are subjected to restraint stress to induce NASH. The mice are administrated with Xiaoyaosan granules, NOD-like receptor family pyrin domain containing 3 (NLRP3) inhibitors, farnesoid X receptor (FXR) agonists, or macrophage scavengers. Pathological changes and NLRP3 signaling in the liver are determined. These results demonstrate that restraint stress promotes hepatic inflammation and fibrosis in hepatosteatotic mice. Restraint stress increases the expressions of NLRP3, Caspase-1, Gasdermin D, interleukin-1β, cholesterol 7α-hydroxylase, and sterol 12α-hydroxylase and decreases the expression of FXR in NASH mice. Xiaoyaosan granules reverse hepatic inflammation and fibrosis and target FXR and NLRP3 signals. In addition, inhibition of NLRP3 reduces the NLRP3 inflammasome and liver damage in mice with restraint stress-induced NASH. Elimination of macrophages and activation of FXR also attenuate inflammation and fibrosis by inhibiting NLRP3 signaling. However, NLRP3 inhibitors or macrophage scavengers fail to affect the expression of FXR. In conclusion, restraint stress promotes NASH-related inflammation and fibrosis by regulating the FXR/NLRP3 signaling pathway. Xiaoyaosan granules, NLRP3 inhibitors, FXR agonists, and macrophage scavengers are potential candidates for the treatment of psychological stress-related NASH.

A Comprehensive Evaluation of Occupational Epidemiology in Western Iran: A Cohort Study in Ravansar Noncommunicable Diseases

OBJECTIVE

The present study aims to evaluate the prevalence of noncommunicable diseases (NCDs), biochemical and anthropometric indicators, and lifestyle among 10 occupational groups.

METHOD

The sample included 4818 men aged 35 to 65 years. The occupational group is based on the International Standard Classification of Occupations.

RESULT

The highest prevalence of cardiovascular diseases and type 2 diabetes mellitus was observed in managerial occupational groups (18.62%) and technicians and associate professionals ( 14 %), respectively. Musculoskeletal disorders were more in skilled agricultural, forestry, and fishery workers, as well as craft-related trades workers, and elementary occupations. The highest body mass index was related to the managers.

CONCLUSIONS

Noncommunicable diseases were higher in managers, while musculoskeletal disorders belonged to farmers and workers. Finally, lifestyle modification can help reduce NCDs and improve biochemical markers by increasing physical activity.

The Connection between Non-Alcoholic Fatty-Liver Disease, Dietary Behavior, and Food Literacy in German Working Adults

(1) Background: German working adults are particularly at risk of non-alcoholic fatty-liver disease (NAFLD), which is connected to increased cardiovascular and overall morbidity and mortality. Dietary behavior (DB) and health knowledge are crucial factors in the conceptual NAFLD model, which can directly influence this disease. These two factors largely align with the concept of food literacy (FL), which deals with proficiency in food-related skills and knowledge to promote healthy DB and prevent NAFLD. However, the potential of FL for NAFLD prevention remains unknown, because FL has not been tested in connection with DB and NAFLD. Therefore, the current study examined the direct and indirect connections between FL, DB, and NAFLD in a mediation model. (2) Methods: A total of 372 working adults (38% female) participated in a cross-sectional study by completing self-report questionnaires on FL and DB. In addition, an independent physician assessed the fatty-liver index (FLI) as an indicator of NAFLD in an occupational health checkup. (3) Results: The mediation model revealed that FL had a direct moderate connection with DB (β = 0.25, p < 0.01), but no direct connection with the FLI (β = -0.05, p = 0.36). However, DB showed a small to moderate connection with the FLI (β = -0.14, p = 0.01), which could indicate the indirect-only mediation of the relationship between FL and NAFLD via DB. (4) Conclusion: These results confirm the value of DB for the prevention of NAFLD. In addition, FL might be a vital component for improving DB and thereby function as a resource in the prevention of NAFLD. However, future longitudinal research is needed to substantiate the value of FL with respect to NAFLD.

Relationship of Helicobacter pylori Infection with Nonalcoholic Fatty Liver Disease: A Meta-Analysis

Background and Aims

Helicobacter pylori (H. pylori) and nonalcoholic fatty liver disease (NAFLD) have become increasingly recognized, both of which affect human health globally. The association of H. pylori infection with NAFLD remains unclear.

Methods

PubMed, EMBASE, and Cochrane Library databases were searched. Only a random-effects model was used. Odds ratios (ORs) and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated for the combined estimates of raw data. Adjusted ORs (aORs) and hazard ratios (aHRs) with 95% CIs were calculated for the combined estimates of data adjusted for confounders.

Results

Thirty-four studies with 218573 participants were included. Based on unadjusted data from 26 cross-sectional studies and 3 case-control studies, H. pylori infection was significantly associated with the presence of NAFLD (OR = 1.26, 95% CI = 1.17-1.36, P < 0.001). Based on adjusted data from 15 cross-sectional studies and 1 case-control study, H. pylori infection was significantly associated with the presence of NAFLD (aOR = 1.25, 95% CI = 1.08-1.44, P < 0.001). Compared with control subjects without NAFLD, patients with moderate (OR = 1.67, 95% CI = 1.17-2.39, P = 0.005) and severe (OR = 1.71, 95% CI = 1.30-2.24, P < 0.001) NAFLD, but not those with mild NAFLD (OR = 1.14, 95% CI = 0.9-1.45, P = 0.286), had significantly higher proportions of H. pylori infection. The association of H. pylori infection with the occurrence of NAFLD was statistically significant based on adjusted data from 3 cohort studies (aHR = 1.18, 95% CI = 1.05-1.34, P = 0.007), but not based on unadjusted data from 3 cohort studies (RR = 1.41, 95% CI = 0.80-2.48, P = 0.237).

Conclusion

H. pylori infection is associated with NAFLD, especially moderate and severe NAFLD. The impact of H. pylori eradication on the prevention of NAFLD should be further explored.

Support Needs and Coping Strategies in Non-Alcoholic Fatty Liver Disease (NAFLD): A Multidisciplinary Approach to Potential Unmet Challenges beyond Pharmacological Treatment

Non-alcoholic fatty liver disease (NAFLD) is the most frequently occurring chronic liver disease, affecting approximately 25–30% of the adult general population worldwide. NAFLD reflects excess hepatic accumulation of fat in the absence of increased alcohol intake, and, due to its close association with obesity, is frequently referred to as the ‘hepatic manifestation’ of metabolic syndrome. Indeed, a high percentage of individuals with NAFLD present with a combination of the cardio-metabolic comorbidities that are associated with the metabolic syndrome. In addition to its well-established link with the metabolic syndrome and increased risk for cardiovascular disease, NAFLD has also been associated with certain mental health issues (e.g., depression and stress). Although this link is now being increasingly recognized, there are still unmet needs regarding the holistic management of patients with NAFLD, which could further contribute to feelings of social isolation and loneliness. The latter conditions are also increasingly reported to pose a substantial risk to overall health and quality of life. To date, there is limited research that has explored these issues among patients with NAFLD, despite existing data which indicate that perceived loneliness and isolation may pose an additional health risk. Notably, many features associated with NAFLD have been related to these concepts, such as perceived stigma, fatigue, stress, and confusion regarding this diagnosis. As such, this review aimed to assess such potential problems faced by patients with NAFLD, and to explore the possibility of unmet support needs which could lead to perceived social isolation. Moreover, the importance of a compassionate approach towards such patients is discussed, together with potential coping strategies. Future research directions and the need for a multidisciplinary approach are also highlighted.

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.

Analysis of Differentially Expressed Genes That Aggravate Metabolic Diseases in Depression

Depression is considered the second leading cause of the global health burden after cancer. It is recognized as the most common physiological disorder. It affects about 350 million people worldwide to a serious degree. The onset of depression, inadequate food intake, abnormal glycemic control and cognitive impairment have strong associations with various metabolic disorders which are mediated through alterations in diet and physical activities. The regulatory key factors among metabolic diseases and depression are poorly understood. To understand the molecular mechanisms of the dysregulation of genes affected in depressive disorder, we employed an analytical, quantitative framework for depression and related metabolic diseases. In this study, we examined datasets containing patients with depression, obesity, diabetes and NASH. After normalizing batch effects to minimize the heterogeneity of all the datasets, we found differentially expressed genes (DEGs) common to all the datasets. We identified significantly associated enrichment pathways, ontology pathways, protein–protein cluster networks and gene–disease associations among the co-expressed genes co-expressed in depression and the metabolic disorders. Our study suggested potentially active signaling pathways and co-expressed gene sets which may play key roles in crosstalk between metabolic diseases and depression.

Dying for the job: police mortality, 1950-2018

Purpose –

This study is a mortality assessment on police officers (68-years, 1950-2018) and includes all causes of death.

Design/methodology/approach –

The authors investigated 1,853 police deaths (1950-2018) using sources of mortality that included the National Death Index, NY State, and available records from the Buffalo NY police department. Standardized Mortality Ratios were calculated. Death codes were obtained from 8th and 9th International Classification of Disease revisions in accordance with the year of death.

Findings –

Compared to the US general population, white male police officers from 1950-2018 had elevated mortality rates for some causes of death, including diseases of the circulatory system, malignant neoplasms, cirrhosis of the liver, and mental disorders. Black and female officers had lower mortality rates for all causes of death compared to the general population.

Research limitations/implications –

The findings of elevated risk for chronic disease among police need to be studied in relation to stress, lifestyle, and exposure to chemical and physical agents. There is a special need to further study officers from minority populations as larger samples become available.

Practical implications –

The results of this study will provide police and occupational health practitioners with objective evidence to determine the health impact of work on law enforcement officers.

Originality/value –

This study is longest running mortality assessment on police officers ever conducted (1950-2018) and includes white, black, and female officers.

Non-alcoholic fatty liver disease (NAFLD) and the cardiovascular disease (CVD) risk categories in primary care: is there an association?

Background

Non-alcoholic fatty liver disease (NAFLD) is an emerging novel cardiovascular disease (CVD) risk factor. It’s prevalence is increasing globally. However, there is paucity in the evidence showing the association between NAFLD and CVD risk in primary care setting. Therefore, the objectives of this study were to determine the prevalence and factors associated with NAFLD among patients with ≥1 risk factor for NAFLD or CVD attending primary care clinics.

Methodology

A cross sectional study was conducted in two clinics at a university primary care centre. Patients aged ≥18 years with ≥1 risk factor for NAFLD or CVD were recruited. Participants with history of established liver disease or chronic alcohol use were excluded. Socio-demographics, clinical related data, anthropometric measurements and blood investigation results were recorded in a proforma. Diagnosis of NAFLD was made using abdominal ultrasound. The 10-year CVD risk was calculated using the general Framingham Risk Score (FRS). Multiple logistic regression (MLogR) was performed to identify independent factors associated with NAFLD.

Results

A total of 263 participants were recruited. The mean age was 52.3 ± 14.7 years old. Male and female were equally distributed. Majority of the participants were Malays (79.8%). The overall prevalence of NAFLD was 54.4% (95%CI 48,60%). Participants in the high FRS category have higher prevalence of NAFLD (65.5%), followed by those in the moderate category (55.4%) and the low category (46.3%), p = 0.025. From MLogR, independent factors associated with NAFLD were being employed (OR = 2.44, 95%CI 1.26,4.70, p = 0.008), obesity with BMI ≥27.5 (OR = 2.89, 95%CI 1.21,6.91, p = 0.017), elevated fasting glucose ≥5.6 mmol/L (OR = 2.79, 95%CI 1.44,5.43, p = 0.002), ALT ≥34 U/L (OR = 3.70, 95%CI 1.85,7.44, p < 0.001) and high FRS category (OR = 2.82, 95%CI 1.28,6.23, p = 0.010).

Conclusion

NAFLD is highly prevalent among patients with ≥1 risk factor for NAFLD or CVD in these primary care clinics. Patients who were obese, have elevated fasting glucose, elevated ALT and in the high FRS category were more likely to have NAFLD. This study underscores the importance of targeted screening for NAFLD in those with risk factors in primary care. Aggressive intervention must be executed in those with NAFLD in order to reduce CVD complications and risk of progression.

Effects of Occupational Stress on Blood Lipids, Blood Sugar and Immune Function of Doctors

BACKGROUND

We aimed to investigate the effects of occupational stress on blood lipids, blood glucose and immune function of doctors.

METHODS

In 2017, 1291 doctors (565 males, 726 females) in The First Hospital Affiliated with Harbin Medical University (Harbin, China) were enrolled based on the principle of convenience of sampling and cluster sampling. Questionnaires were used to investigate demographic characteristics and occupational stress related factors. Level of glycated hemoglobin was detected by immunoturbidimetric method. Concentration of triglyceride was determined by glycerol phosphate oxidase end point method. Total cholesterol concentration in serum was determined by total cholesterol oxidase end point method. Concentration of serum immunoglobulin was detected by immunoturbidimetry.

RESULTS

Levels of glycated hemoglobin and triglyceride in high tension group were higher than those in the low tension group. Levels of IgG and IgM in high tension group were lower than those in low tension group. The risk of elevated glycated hemoglobin levels in > 50-yr-old age group was higher than that of the =<35-yr-old age group. Those in the high coping strategy group was higher in the low coping strategy group. The risk of elevated total cholesterol levels in drinkers is 1.158 times that of non-drinkers. The risk of IgG concentration reduction in smokers was 0.428 times that of non-smokers. The risk of a decrease in IgA concentration in doctors with good sleep quality is 1.527 times that of those with poor sleep quality.

CONCLUSION

Occupational stress can lead to increased blood lipids and sugar levels as well suppression of immune function in doctors.

Association between physical activity and risk of nonalcoholic fatty liver disease: a meta-analysis

BACKGROUND

Increased physical activity (PA) is a key element in the management of patients with nonalcoholic fatty liver disease (NAFLD); however, its association with NAFLD risk has not been systematically assessed. This meta-analysis of observational studies was to quantify this association with dose-response analysis.

METHODS

Electronic databases were searched to January 2017 for studies of adults reporting the risk of NAFLD in relation to PA with cohort or case-control designs. Studies that reported sex-specific data were included as separate studies. The overall risk estimates were pooled using a random-effects model, and the dose-response analysis was conducted to shape the quantitative relationship.

RESULTS

A total of 6 cohort studies from 5 articles with 32,657 incident NAFLD cases from 142,781 participants, and 4 case-control studies from 3 articles with 382 NAFLD cases and 302 controls were included. Compared with the lowest PA level, the highest PA level was associated with a risk reduction of NAFLD in cohort [RR (risk ratio) 0.79, 95% CI (confidence interval) 0.71-0.89] and case-control studies [OR (odds ratio) 0.43, 95% CI 0.27-0.68]. For cohort studies, both highest and moderate PA levels were superior to the light one in lowering NAFLD risk (p_{for interaction} = 0.006 and 0.02, respectively), and there was a log-linear dose-response association (p_{for nonlinearity} = 0.10) between PA and NAFLD risk [RR 0.82 (95% CI 0.73-0.91) for every 500 metabolic equivalent (MET)-minutes/week increment in PA].

CONCLUSIONS

Increased PA may lead to a reduced risk of NAFLD in a dose-dependent manner, and the current guideline-recommended minimum PA level that approximates to 500 MET-minutes/week is able to moderately reduce the NAFLD risk.

Protective effect of Hua Tan Qu Shi decoction against liver injury in rats with nonalcoholic fatty liver disease

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD), is currently a worldwide health problem. None of the existing treatment medications had got a satisfactory effect. Hua Tan Qu Shi (HTQS) decoction is a Chinese herbal formula, which has been used clinically to treat NAFLD for years. However, the underlying mechanisms are still unclear.

METHODS

High-fat diet (HFD) induced non-alcoholic fatty liver disease rats treated with or without HTQS decoction by gavage for 10 weeks and examined by serology, 24-h albuminuria, histology, immunohistochemistry, and molecular analyses.