Risk of metabolic syndrome in non-alcoholic fatty liver disease patients

Risk Factors of Non-alcoholic Fatty Liver Disease in the Iranian Adult Population: A Systematic Review and Meta-analysis

Context: Non-alcoholic fatty liver disease (NAFLD) is progressing considerably worldwide. Identifying the risk factors of NAFLD is a critical step in preventing its progression. Methods: In November 2022, two independent researchers studied seven databases, including PubMed, ISI/WoS, ProQuest, Scopus, SID, Magiran, and Google Scholar, and reference list of relevant articles, searching studies that assessed NAFLD risk factors in the Iranian adult population. Heterogeneity between studies was assessed by Cochran’s test and its composition using I2 statistics. A random-effects model was used when heterogeneity was observed; otherwise, a fixed-effects model was applied. Egger’s regression test and Trim-and-Fill analysis were used to assess publication bias. Comprehensive Meta-analysis software (version 3) was used for the analyses of the present study. Results: The results of this study showed significant associations between NAFLD with age [n = 15, odds ratio (OR) = 2.12, 95% CI: 1.79 - 2.51], body mass index (n = 46, OR = 5.00, 95% CI: 3.34 - 7.49), waist circumference (n = 20, OR = 6.37, 95% CI: 3.25 - 12.48), waist-to-hip ratio (n = 17, OR = 4.72, 95% CI: 3.93 - 5.66), total cholesterol (n = 39, OR = 1.80, 95% CI: 1.52 - 2.13), high-density lipoprotein (n = 37, OR = 0.53, 95% CI: 0.44 - 0.65), low-density lipoprotein (n = 31, OR = 1.68, 95% CI: 1.38 - 2.05), triglyceride (n = 31, OR = 3.21, 95% CI: 2.67 - 3.87), alanine aminotransferase (n = 26, OR = 4.06, 95% CI: 2.94 - 5.62), aspartate aminotransferase (n = 27, OR = 2.16, 95% CI: 1.50 - 3.12), hypertension (n = 13, OR = 2.53, 95% CI: 2.32 - 2.77), systolic blood pressure (n = 13, OR = 1.83, 95% CI: 1.53 - 2.18), diastolic blood pressure (n = 14, OR = 1.80, 95% CI: 1.48 - 2.20), fasting blood sugar (n = 31,OR = 2.91, 95% CI: 2.11- 4.01), homeostatic model assessment for insulin resistance (n = 5, OR = 1.92, 95% CI: 1.48 - 2.59), diabetes mellitus (n = 15, OR = 3.04, 95% CI: 2.46 - 3.75), metabolic syndrome (n = 10, OR = 3.56, 95% CI: 2.79 - 4.55), and physical activity (n = 11, OR = 0.32, 95% CI: 0.24 - 0.43) (P < 0.05). Conclusions: In conclusion, several factors are significantly associated with NAFLD. However, anthropometric indices had the strongest relationship with NAFLD in the Iranian adult population.

Mediators of dietary diversity score (DDS) on NAFLD in Iranian adults: a structural equation modeling study

BACKGROUND

The current study examines the association between the Dietary Diversity Score (DDS) and nonalcoholic fatty liver disease (NAFLD) in Iranian adults using structural equation modeling (SEM).

METHODS

A sample of 3220 adults from the Amol Cohort Study was recruited for this cross-sectional study. Dietary acid load (DAL) and DDS were calculated using the data obtained from a validated food frequency questionnaire. Anthropometric parameters, blood pressure, biochemical measurements, and liver ultrasonography were evaluated according to standard protocols.

RESULTS

DDS was neither directly nor indirectly associated with a greater prevalence of NAFLD. In the second model (DDS sub-scores model), the association of DAL with NAFLD was fully mediated through waist circumference (WC) (of DAL to WC: β = 0.14, P < 0.0001, and of WC to NAFLD: β = 0.50, P < 0.001). Vegetable and fruit diversity scores had a significant negative indirect relationship with NAFLD prevalence through DAL (β = -0.06, P = 0.001, β = -0.10, P < 0.001, respectively). Meat diversity score was positively associated with NAFLD prevalence in a full mediational process through DAL (β = 0.12, P < 0.001). The SEM fit indices suggested a reasonably adequate fit of the data to the DDS model (Χ2/df = 4.76, GFI = 0.98, AGFI = 0.97, IFI = 0.97, CFI = 0.97, RMSEA = 0.03, and SRMR = 0.02) and its sub-scores model (Χ²/df = 4.72, GFI = 0.98, AGFI = 0.97, IFI = 0.95, CFI = 0.95, RMSEA = 0.03, and SRMR = 0.02).

CONCLUSION

Meat diversity and lack of vegetable and fruit diversity were indirectly associated with NAFLD prevalence through DAL and WC mediators. Interventions for NAFLD may be more successful if they target a lower intake of animal protein sources and dietary diversity, particularly vegetable and fruit diversity.

Dairy product consumption was associated with a lower likelihood of non-alcoholic fatty liver disease: A systematic review and meta-analysis

Background and aims

Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease. Several epidemiological studies attempted to assess the association between dairy product and the likelihood of NAFLD, but the contribution of dairy consumption to NAFLD remains controversial. We conducted a meta-analysis to investigate the association between dairy product consumption and NAFLD.

Methods

We conducted a literature search using the PubMed, Web of Science and Scopus databases, we conducted a thorough search of the literature published before January 5, 2023. Combined odds ratios (ORs) and 95% confidence intervals (CIs) of NAFLD in relation to dairy product intake were estimated using random-effects models. Subgroup analysis and meta-regression were performed according to the study design, region, sex, body mass index (BMI), type of exposure, NAFLD diagnostic criteria, and exposure assessment tools.

Results

We initially identified 4,634 relevant studies, of which 25 complied with the inclusion criteria, including seven cross-sectional studies, six case-control studies and one cohort study. A total of 51,476 participants (14,546 patients with NAFLD) were included in the meta-analysis. There was an inverse association between dairy product consumption and NAFLD (OR = 0.97, 95% CI = 0.94-0.99). Subgroup analysis demonstrated that lower likelihood of NAFLD was associated with dairy product consumption in subgroups of Asian populations, women, patients diagnosed using NAFLD-related scores, patients with a BMI of 18.5-24.9 kg/m², dairy intake assessed using a food frequency questionnaire, milk consumption, and yogurt consumption. No noteworthy connection was observed in the other subgroups.

Conclusion

Our meta-analysis findings revealed that dairy product consumption is inversely associated with NAFLD. Consumption of dairy products could help prevent the development of non-alcoholic fatty liver disease.

Major dietary patterns in relation to chronic low back pain; a cross-sectional study from RaNCD cohort

Background

Chronic low back pain (LBP) is the most common musculoskeletal pain that affects a person’s daily activities. This present study aimed at evaluating the relationship between major dietary pattern and Chronic LBP.

Methods

This cross-sectional analysis was examined 7686 Kurdish adults. The RaNCD cohort study physician diagnosed chronic LBP. Dietary patterns were derived using principal component analysis. The three identified dietary patterns derived were named: 1) the vegetarian diet included vegetables, whole grain, legumes, nuts, olive, vegetable oil, fruits, and fruit juice; 2) high protein diet related to higher adherence to red and white meat, legumes, nuts, and egg; and 3) energy-dense diet characterized with higher intake of salt, sweet, dessert, hydrogenated fat, soft drink, refined grain, tea, and coffee. Dietary pattern scores were divided into tertiles. Binary logistic regression in crude, adjusted odds ratios (OR) and 95% confidence intervals (CI) were used to determine this association.

Results

Twenty-two per cent of participants had chronic LBP. Higher adherence to high protein dietary pattern was inversely associated with chronic LBP in crude (OR: 0.79, 95% CI: 0.69–0.9) and adjusted model (for age, sex, smoking, drinking, diabetes, physical activity, body mass index, and waist circumference) (OR: 0.84, 95% CI: 0.72–0.97). In addition, after controlling for the mentioned potential confounders, participants in the highest category of energy dense diet were positively associated with chronic LBP compared with those in the lowest category (OR: 1.13, 95% CI: 1.01–1.32).

Conclusions

Higher adherence to the high protein diet was inversely related to chronic LBP prevalence. In addition, we found that following energy dense diet was positively associated with chronic LBP.

Body composition and risk of non-alcoholic fatty liver disease: A case control study

BACKGROUND: While evidence has been a highlight that obesity may be associated with the increased incidence of Nonalcoholic fatty liver disease (NAFLD), these data have depended on defective measures of obesity such as body mass index (BMI), and usually have not the well-known relationship between body composition with NAFLD. METHODS: In a case-control study of people aged 20– 65 years, we directly measured body composition (using bioelectrical impedance analysis), height, weight, and waist and hip circumferences who referred to radiology clinics in Kermanshah, Iran. Dietary intake was assessed by the food frequency questionnaire (FFQ). RESULTS: Among 221 people examined, 103 cases with NAFLD and 119 as control were established. The risk of NAFLD was positively associated with higher BMI and the components of the body composition. These associations were strengthened after adjusting for potential confounders including gender, age, marital status, education, smoking, alcohol consumption, and physical activity CONCLUSION: An increasing prevalence of obesity may be associated with the increasing incidence of NAFLD as observed in many populations. We observed an increased risk of NAFLD associated with increased BMI, central adiposity, and the fat component of weight, but found no association with nonfat mass.

Relationship between Egg Consumption and Metabolic Syndrome. A Meta-Analysis of Observational Studies

OBJECTIVES

Aims: To explore the association between egg consumption and metabolic syndrome (MetS) in the adult population.

METHODS

The PubMed, Web of Science and Embase electronic databases were searched up to December 2021 for observational studies on the association between egg consumption and MetS in the adult population. The pooled relative risk (RR) of MetS for the highest versus lowest category of egg consumption, and the standard mean difference (SMD) of egg consumption for MetS versus control subjects were calculated. Egg consumption was assessed by a food-frequency questionnaire (FFQ) and the 24-hour recall method. The criteria for MetS were National Cholesterol Education Program-Adult Treatment Panel III (NCEP ATP III), International Diabetes Federation (IDF), Joint Interim Statement (JIS) and American Heart Association (AHA).

RESULTS

A total of 19 articles with 20 observational studies (331667 participants) were included in this meta-analysis. The overall multivariable adjusted RR (18 studies included) demonstrated that higher egg consumption was associated with a lower probability of having MetS (RR=0.92, 95%CI: 0.88 to 0.96; P<0.001). Subgroup analysis confirmed these findings in cross-sectional studies (RR=0.91, 95% CI: 0.88 to 0.95; P<0.001), studies that used the NCEP ATP III criteria (RR=0.94, 95% CI: 0.89 to 0.99; P=0.02), Asia (RR=0.92, 95% CI: 0.86 to 0.99; P=0.02), studies with samples sizes >5000 (RR=0.92, 95% CI: 0.86 to 0.96; P<0.001), studies that adjusted body mass index (BMI) (RR=0.90, 95% CI: 0.86 to 0.95; P<0.001) and energy intake (RR=0.89, 95% CI: 0.83 to 0.94; P<0.001) and high-quality studies (RR=0.91, 95% CI: 0.88 to 0.95; P<0.001). Moreover, the overall combined SMD (5 studies included) showed that the level of egg consumption in subjects with MetS was also lower than that in control subjects. (SMD=-0.22, 95% CI: -0.25 to -0.20; P<0.001). Sensitivity analysis demonstrated that this finding only existed in studies with samples sizes >5000 (SMD=-0.21, 95% CI: -0.29 to -0.12; P<0.001) and high-quality studies (SMD=-0.23, 95% CI: -0.26 to -0.20; P<0.001).

CONCLUSION

Our results suggest that higher egg consumption is associated with a lower probability of having MetS in the adult population. However, due to the limited evidence, more global well-designed prospective cohort studies are still needed.

Associations of Whole Grain and Refined Grain Consumption With Metabolic Syndrome. A Meta-Analysis of Observational Studies

Background: The associations of whole grain and refined grain consumption with metabolic syndrome (MetS) has been evaluated in several epidemiological studies with conflicting results. This meta-analysis was therefore employed to further investigate the above associations. Method: We searched the PubMed, Web of Science and Embase database until March 2021 (without restriction for inclusion time), for observational studies on the associations of whole grain and refined grain consumption with MetS. The pooled relative risk (RR) of MetS for the highest vs. lowest category of whole grain and refined grain consumption, as well as their corresponding 95% confidence interval (CI) were calculated. Results: A total of 14 observational studies, which involved seven cross-sectional and seven prospective cohort studies, were identified. Specifically, nine studies were related to whole grain consumption, and the overall multi-variable adjusted RR demonstrated that the whole grain consumption was inversely associated with MetS (RR = 0.80, 95%CI: 0.67-0.97; P = 0.021). With regard to refined grain consumption, 13 studies were included. The overall multi-variable adjusted RR indicated that refined grain consumption was positively associated with MetS (RR = 1.37, 95%CI: 1.02-1.84; P = 0.036). Conclusions: The existing evidence suggests that whole grain consumption is negatively associated with MetS, whereas refined grain consumption is positively associated with MetS. Our result might be helpful to better consider the diet effect on MetS. However, more well-designed prospective cohort studies are needed to elaborate the concerned issues further.

Better muscle strength with healthy eating

PURPOSE

Hand grip strength (HGS) can predict physical function in next year when it is positively associated with nutritional and health status. This study aimed to determine the relationship between the healthy eating index (HEI)-2015 and hand grip strength.

METHODS

This cross-sectional study was conducted on data from 4010 participants in the Ravansar non-communicable disease (RaNCD) cohort study. HGS was measured using a hand-held hydraulic hand grip dynamometer. HEI-2015 was calculated using data from the food frequency questionnaire.

RESULTS

The mean of total HEI-2015 score was significantly higher in participants with an optimal HGS than in participants with a weak HGS (P = 0.006). Higher adherence to healthy eating was associated with optimal muscle strength (OR 1.26; CI 95% 1.02-1.62). This association was remained after being adjusted for potential confounders (P = 0.01). Among the HEI-2015 components, we only found association between whole fruit, added sugar, and HGS (P = 0.01, 0.019).

CONCLUSIONS

Our findings indicated that adherence to HEI-2015 could promote muscle strength. Among the HEI-2015 components, higher intake of whole fruit and lower adherence to added sugar had significantly positive effects on HGS.

LEVEL OF EVIDENCE

Level V, descriptive cross-sectional study.

Hybrid management of thoracic aortic aneurysm in a patient with massive hemoptysis: A case report

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A thoracic aortic aneurysm (TAA) is defined as an increased diameter of aorta in the chest.

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We report a TAA case with massive hemoptysis.

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The hybrid approach seems to be advantageous for TAA patients, requiring emergency interventions.

Introduction

Thoracic aortic aneurysm (TAA) is a cardiovascular disorder, associated with high rates of mortality and morbidity. Here, we report a case of massive hemoptysis in a patient with TAA.

Presentation of case

A 49-year-old man presented with massive hemoptysis and true aneurysm of the aortic arch from the origin of the left common carotid artery to the first segment of the descending aorta. We adopted hybrid method for TAA repair. The patient remained in good condition after hybrid management.

Discussion

Although most cases of TAA are asymptomatic, it can present with a wide range of symptoms and complications. Chest pain is the most important symptom of TAA, and its sudden occurrence is a sign of rapid aneurysm expansion, dissection, or rupture. This was a rare case of TAA, as hemoptysis is not a common symptom of TAA.

Conclusion

This rare case was managed using the hybrid method which resulted in resolution of hemoptysis without any complications.