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Karaaslan H, Inan H, Turkmen AT, Altintas I, Uyar N, Eren MA. Comparison of triglyceride-glucose index and anthropometric obesity indices in predicting severe grades of hepatic steatosis in nonalcoholic fatty liver disease among non-diabetic obese individuals. HEPATOLOGY FORUM 2024; 5:113-119. [PMID: 39006142 PMCID: PMC11237241 DOI: 10.14744/hf.2023.2023.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/09/2023] [Accepted: 11/27/2023] [Indexed: 07/16/2024]
Abstract
Background and Aim The triglyceride glucose index (TyG) has been proposed as a promising indicator of both insulin resistance (IR) and non-alcoholic fatty liver disease (NAFLD). However, the efficacy of the TyG index in predicting NAFLD has not been adequately studied, particularly in obese individuals. Materials and Methods We analyzed 190 morbidly obese individuals. The TyG index, anthropometric obesity indices, homeostatic model assessment (HOMA-IR), and biochemical parameters were compared. NAFLD was diagnosed by hepatic ultrasonography and classified into four grades (0, 1, 2, and 3). Individuals in grades 2 and 3 are considered to have severe steatosis, while those in grades 0 and 1 do not. Results The area under the curve (AUC) values of the TyG index, body mass index, neck circumferences, waist-to-hip ratio, and HOMA-IR did not differ significantly in predicting severe steatosis (0.640, 0.742, 0.725, 0.620, and 0.624 respectively). However, the AUC values of waist circumference and alanine aminotransferase provided better predictions than the TyG index (0.782, 0.744, and 0.640 respectively). Conclusion The TyG index is highly effective in predicting both the presence and severity of NAFLD. However, it did not outperform simple obesity indices in predicting NAFLD and its severity in obese patients.
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Affiliation(s)
- Huseyin Karaaslan
- Department of Endocrinology, Harran University School of Medicine, Sanliurfa, Turkiye
| | - Hasan Inan
- Department of Internal Medicine, Harran University School of Medicine, Sanliurfa, Turkiye
| | - Alper Tunga Turkmen
- Department of Radiology, Harran University School of Medicine, Sanliurfa, Turkiye
| | - Ismail Altintas
- Department of Internal Medicine, Harran University School of Medicine, Sanliurfa, Turkiye
| | - Nida Uyar
- Department of Endocrinology, Harran University School of Medicine, Sanliurfa, Turkiye
| | - Mehmet Ali Eren
- Department of Endocrinology, Harran University School of Medicine, Sanliurfa, Turkiye
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Umemura A, Sasaki A, Takamura T, Takayama H, Takeshita Y, Toya Y, Kakisaka K, Hasegawa Y, Ishigaki Y. Relationship between the changes in hepatokine levels and metabolic effects after laparoscopic sleeve gastrectomy in severely obese patients. Surg Today 2024; 54:581-590. [PMID: 37957316 PMCID: PMC11102872 DOI: 10.1007/s00595-023-02767-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/25/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE To clarify the relationships between the changes in hepatokines and weight loss, and between these changes and the metabolic effects, and the roles played by these changes, after laparoscopic sleeve gastrectomy (LSG). METHODS We recruited 25 Japanese patients with severe obesity, who underwent LSG. We measured two hepatokines: selenoprotein P (SeP) and leukocyte cell-derived chemotaxin 2 (LECT2), at the baseline, and then 6 months and 1 year after LSG. Finally, we compared the changes in the hepatokines with the parameters of type 2 diabetes (T2D) and non-alcoholic steatohepatitis (NASH). RESULTS Changes in LECT2 were correlated with the percentage of total weight loss (ρ = - 0.499, P = 0.024) and the decrease in total fat area (ρ = 0.559, P = 0.003). The changes in SeP were correlated with those in hemoglobin A1c (ρ = 0.526, P = 0.043) and the insulinogenic index (ρ = 0.638, P = 0.010) in T2D patients. In patients with NASH, the LECT2 levels were correlated with liver steatosis (ρ = 0.601). CONCLUSIONS SeP levels decrease in association with HbA1c reduction, whereas LECT2 levels are associated with reductions in fat mass and NASH scores after LSG. Hepatokines may be involved in the pathology of obesity and its complications.
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Affiliation(s)
- Akira Umemura
- Department of Surgery, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba, Iwate, 028-3695, Japan.
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba, Iwate, 028-3695, Japan
| | - Toshinari Takamura
- Department of Endocrinology and Metabolism, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, 920-8640, Japan
| | - Hiroaki Takayama
- Department of Endocrinology and Metabolism, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, 920-8640, Japan
| | - Yumie Takeshita
- Department of Endocrinology and Metabolism, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, 920-8640, Japan
| | - Yosuke Toya
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University School of Medicine, Yahaba, Iwate, 028-3695, Japan
| | - Keisuke Kakisaka
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Yahaba, Iwate, 028-3695, Japan
| | - Yutaka Hasegawa
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Iwate Medical University School of Medicine, Yahaba, Iwate, 028-3695, Japan
| | - Yasushi Ishigaki
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Iwate Medical University School of Medicine, Yahaba, Iwate, 028-3695, Japan
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Niu J, Al-Yaman W, Pinyopornpanish K, Park JS, Salazar M, Xiao H, Bena J, Lyu R, Flocco G, Junna SR, Adhami T, Sims OT, Wakim-Fleming J. The Long-Term Effect of Weight Loss on the Prevention of Progression to Cirrhosis among Patients with Obesity and MASH-Related F3 Liver Fibrosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:708. [PMID: 38928954 PMCID: PMC11203621 DOI: 10.3390/ijerph21060708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/21/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024]
Abstract
This multi-center retrospective study examined the effect of weight loss on the prevention of progression to cirrhosis in a sample exclusively composed of patients with obesity and MASH-related F3 liver fibrosis. Adult patients with obesity and biopsy-confirmed MASH-related F3 liver fibrosis (n = 101) from two liver transplant centers in the US were included in the study. A higher proportion of patients who did not progress to cirrhosis achieved >5% weight loss at follow-up (59% vs. 30%, p = 0.045). In multivariable analysis, patients with >5% weight loss at follow-up had a lower hazard of developing cirrhosis compared to patients with no weight loss or weight gain (HR: 0.29, 95%, CI: 0.08-0.96); whereas, diabetes (HR: 3.24, 95%, CI: 1.21-8.67) and higher LDL levels (HR: 1.02, 95%, CI: 1.01-1.04) were associated with higher hazards of progression to cirrhosis. Weight loss >5% has the potential to prevent disease progression to cirrhosis in patients with obesity and MASH-related F3 liver fibrosis. The realization of this benefit requires weight loss maintenance longer than one year. Larger prospective studies are needed to determine how weight loss impacts other patient-centered outcomes such as mortality, hepatic decompensation, and hepatocellular carcinoma in patients with obesity and MASH-related F3 liver fibrosis.
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Affiliation(s)
- Jiafei Niu
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH 44106, USA; (J.N.); (W.A.-Y.); (K.P.); (J.S.P.); (M.S.); (G.F.); (S.R.J.); (T.A.); (J.W.-F.)
| | - Wael Al-Yaman
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH 44106, USA; (J.N.); (W.A.-Y.); (K.P.); (J.S.P.); (M.S.); (G.F.); (S.R.J.); (T.A.); (J.W.-F.)
- Department of Gastroenterology, St. Joseph Mercy Ann Arbor Hospital, Ypsiilanti, MI 48197, USA
| | - Kanokwan Pinyopornpanish
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH 44106, USA; (J.N.); (W.A.-Y.); (K.P.); (J.S.P.); (M.S.); (G.F.); (S.R.J.); (T.A.); (J.W.-F.)
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Ji Seok Park
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH 44106, USA; (J.N.); (W.A.-Y.); (K.P.); (J.S.P.); (M.S.); (G.F.); (S.R.J.); (T.A.); (J.W.-F.)
| | - Miguel Salazar
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH 44106, USA; (J.N.); (W.A.-Y.); (K.P.); (J.S.P.); (M.S.); (G.F.); (S.R.J.); (T.A.); (J.W.-F.)
| | - Huijun Xiao
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH 44106, USA; (H.X.); (J.B.); (R.L.)
| | - James Bena
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH 44106, USA; (H.X.); (J.B.); (R.L.)
| | - Ruishen Lyu
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH 44106, USA; (H.X.); (J.B.); (R.L.)
| | - Gianina Flocco
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH 44106, USA; (J.N.); (W.A.-Y.); (K.P.); (J.S.P.); (M.S.); (G.F.); (S.R.J.); (T.A.); (J.W.-F.)
| | - Shilpa R. Junna
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH 44106, USA; (J.N.); (W.A.-Y.); (K.P.); (J.S.P.); (M.S.); (G.F.); (S.R.J.); (T.A.); (J.W.-F.)
| | - Talal Adhami
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH 44106, USA; (J.N.); (W.A.-Y.); (K.P.); (J.S.P.); (M.S.); (G.F.); (S.R.J.); (T.A.); (J.W.-F.)
| | - Omar T. Sims
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH 44106, USA; (J.N.); (W.A.-Y.); (K.P.); (J.S.P.); (M.S.); (G.F.); (S.R.J.); (T.A.); (J.W.-F.)
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH 44106, USA; (H.X.); (J.B.); (R.L.)
| | - Jamile Wakim-Fleming
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH 44106, USA; (J.N.); (W.A.-Y.); (K.P.); (J.S.P.); (M.S.); (G.F.); (S.R.J.); (T.A.); (J.W.-F.)
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Bazerbachi F, Baroud S, Levy MJ, Maselli DB, Vargas EJ, Bofill-Garcia A, Law RJ, Chandrasekhara V, Storm AC, Gleeson FC, Rajan E, Iyer PG, Watt KD, Abu Dayyeh BK. Celiac artery mesenteric fat measurement with endosonography (CAMEUS) reliably correlates with obesity and related comorbidities. Gastroenterol Rep (Oxf) 2024; 12:goae039. [PMID: 38681751 PMCID: PMC11052652 DOI: 10.1093/gastro/goae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/29/2024] [Accepted: 03/20/2024] [Indexed: 05/01/2024] Open
Abstract
Background Visceral fat represents a metabolically active entity linked to adverse metabolic sequelae of obesity. We aimed to determine if celiac artery mesenteric fat thickness can be reliably measured during endoscopic ultrasound (EUS), and if these measurements correlate with metabolic disease burden. Methods This was a retrospective analysis of patients who underwent celiac artery mesenteric fat measurement with endosonography (CAMEUS) measurement at a tertiary referral center, and a validation prospective trial of patients with obesity and nonalcoholic steatohepatitis who received paired EUS exams with CAMEUS measurement before and after six months of treatment with an intragastric balloon. Results CAMEUS was measured in 154 patients [56.5% females, mean age 56.5 ± 18.0 years, body mass index (BMI) 29.8 ± 8.0 kg/m2] and was estimated at 14.7 ± 6.5 mm. CAMEUS better correlated with the presence of non-alcoholic fatty liver disease (NAFLD) (R2 = 0.248, P < 0.001) than BMI (R2 = 0.153, P < 0.001), and significantly correlated with metabolic parameters and diseases. After six months of intragastric balloon placement, the prospective cohort experienced 11.7% total body weight loss, 1.3 points improvement in hemoglobin A1c (P = 0.001), and a 29.4% average decrease in CAMEUS (-6.4 ± 5.2 mm, P < 0.001). CAMEUS correlated with improvements in weight (R2 = 0.368), aspartate aminotransferase to platelet ratio index (R2 = 0.138), and NAFLD activity score (R2 = 0.156) (all P < 0.05). Conclusions CAMEUS is a novel measure that is significantly correlated with critical metabolic indices and can be easily captured during routine EUS to risk-stratify susceptible patients. This station could allow for EUS access to sampling and therapeutics of this metabolic region.
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Affiliation(s)
- Fateh Bazerbachi
- CentraCare, Interventional Endoscopy Program, St Cloud Hospital, St. Cloud, MN, USA
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN, USA
| | - Serge Baroud
- Department of Internal Medicine, MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH, USA
| | - Michael J Levy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Daniel B Maselli
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Eric J Vargas
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | | | - Ryan J Law
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | | | - Andrew C Storm
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Ferga C Gleeson
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth Rajan
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Prasad G Iyer
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Kymberly D Watt
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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5
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Wuopio A, Baker BM, Koethe B, Goodman MD, Shin R, Bugaev N, Nepomnayshy D, Kim WC, Schnelldorfer T. Can Surgeons Reliably Identify Non-cirrhotic Liver Disease During Laparoscopic Bariatric Surgery? Obes Surg 2024; 34:769-777. [PMID: 38280161 DOI: 10.1007/s11695-024-07070-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 01/11/2024] [Accepted: 01/18/2024] [Indexed: 01/29/2024]
Abstract
INTRODUCTION Identification of liver disease during bariatric operations is an important task given the patients risk for occult fatty liver disease. Surgeon's accuracy of assessing for liver disease during an operation is poorly understood. The objective was to measure surgeons' performance on intra-operative visual assessment of the liver in a simulated environment. METHODS Liver images from 100 patients who underwent laparoscopic bariatric surgery and pre-operative ultrasound elastography between July 2020 and July 2021 were retrospectively evaluated. The perception of 15 surgeons regarding the degree of hepatic steatosis and fibrosis was collected in a simulated clinical environment by survey and compared to results determined by ultrasonographic exam. RESULTS The surgeons' ability to correctly identify the class of steatosis and fibrosis was poor (accuracy 61% and 59%, respectively) with a very weak correlation between the surgeon's predicted class and its true class (r = 0.17 and r = 0.12, respectively). When liver disease was present, surgeons completely missed its presence in 26% and 51% of steatosis and fibrosis, respectively. Digital image processing demonstrated that surgeons subjectively classified steatosis based on the "yellowness" of the liver and fibrosis based on texture of the liver, despite neither correlating with the true degree of liver disease. CONCLUSION Laparoscopic visual assessment of the liver surface for identification of non-cirrhotic liver disease was found to be an inaccurate method during laparoscopic bariatric surgery. While validation studies are needed, the results suggest the clinical need for alternative approaches.
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Affiliation(s)
- Alexandra Wuopio
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, 01805, USA
| | | | - Benjamin Koethe
- Tufts Clinical and Translational Science Institute, Tufts University, and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, 02111, USA
| | - Martin D Goodman
- Department of Surgery, Tufts Medical Center, Boston, MA, 02111, USA
| | - Reuben Shin
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, 01805, USA
| | - Nikolay Bugaev
- Department of Surgery, Tufts Medical Center, Boston, MA, 02111, USA
| | - Dmitry Nepomnayshy
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, 01805, USA
| | - Woon Cho Kim
- Department of Surgery, Tufts Medical Center, Boston, MA, 02111, USA
| | - Thomas Schnelldorfer
- Department of Surgery, Tufts Medical Center, Boston, MA, 02111, USA.
- Department of Translational Research, Lahey Hospital and Medical Center, Burlington, MA, 01805, USA.
- Surgical Imaging Lab, Tufts Medical Center, Boston, MA, 02111, USA.
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6
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Widmer J, Eden J, Abbassi F, Angelico R, Rössler F, Müllhaupt B, Dutkowski P, Bueter M, Schlegel A. How best to combine liver transplantation and bariatric surgery?-Results from a global, web-based survey. Liver Int 2024; 44:566-576. [PMID: 38082500 DOI: 10.1111/liv.15791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/20/2023] [Accepted: 10/31/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND AND AIMS Obesity is a growing healthcare challenge worldwide and a significant risk factor for liver failure as seen with non-alcoholic steatohepatitis (NASH). Combining metabolic-bariatric surgery (MBS) with liver transplantation (LT) appears as attractive strategy to treat both, the underlying liver disease and obesity. However, there is an ongoing debate on best timing and patient selection. This survey was designed to explore the current treatment practice for patients with NASH and obesity worldwide. METHODS A web-based survey was conducted in 2022 among bariatric and LT surgeons, and hepatologists from Europe, North and South America and Asia. RESULTS The survey completion rate was 74% (145/196). The average respondents were 41-50 years (38%), male (82.1%) and had >20 years of clinical experience (42.1%). Centres with a high LT-caseload for NASH were mainly located in the USA and United Kingdom. Almost 30% have already performed a combination of LT with MBS and 49% plan to do it. A majority of bariatric surgeons prefer MBS before LT (77.2%), whereas most of LT surgeons (52%) would perform MBS during LT. Most respondents (n = 114; 80%) favour sleeve gastrectomy over other bariatric techniques. One third (n = 42; 29.4%) has an established protocol regarding MBS for LT candidates. CONCLUSION The most experienced centres doing LT for NASH are in the USA and United Kingdom with growing awareness worldwide. Overall, a combination of MBS and LT has already been performed by a third of respondents. Sleeve gastrectomy is the bariatric technique of choice-preferably performed either before or during LT.
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Affiliation(s)
- Jeannette Widmer
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Zurich, Switzerland
| | - Janina Eden
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Zurich, Switzerland
| | - Fariba Abbassi
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Zurich, Switzerland
| | - Roberta Angelico
- HPB and Transplant Unit, Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Fabian Rössler
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Zurich, Switzerland
| | - Beat Müllhaupt
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Philipp Dutkowski
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Zurich, Switzerland
| | - Marco Bueter
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Zurich, Switzerland
- Department of Surgery, Spital Männedorf, Männedorf, Switzerland
| | - Andrea Schlegel
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Zurich, Switzerland
- Transplantation Center, Digestive Disease and Surgery Institute and Department of Immunology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Centre of Preclinical Research, Milan, Italy
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7
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Ahmed L, Gebran S, Persaud A, Saeed K, Khan K, Saeed S, Alothman S, Passos-Fox B, DePaz H, Suman P. The Use of Noninvasive Scores in Predicting NAFLD Progression After Bariatric Surgery. Obes Surg 2023; 33:4026-4033. [PMID: 37884692 DOI: 10.1007/s11695-023-06912-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/11/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Bariatric surgery has been postulated to impact liver function resulting in favorable effects on nonalcoholic fatty liver disease (NAFLD). We aimed to analyze the long-term impact of bariatric surgery on noninvasive scores predicting the progression of liver fibrosis in a bariatric population. METHODS We retrospectively reviewed the records of patients without pre-existing liver disease who underwent sleeve gastrectomy or Roux-en-Y gastric bypass (RYGB) at our center between 2010 and 2018. Four predictive scores for liver fibrosis (AST/ALT, APRI, Fib-4, and BARD) were calculated preoperatively, 6 months post-operatively, and annually up to 5 years. Correlations were analyzed with Pearson R. Subgroup and sensitivity analyses were performed to identify populations at increased risk. RESULTS A total of 2769 patients were included. The mean age was 40 years, and the majority was females (88.5%) and of Hispanic ethnicity (59.2%). There was a steady post-operative increase in the percentage of patients at increased risk of progression of liver fibrosis. The Fib-4 score showed the largest increase in the population at risk for liver fibrosis (11.3% preoperatively to 28.9% at 5 years). Patients with diabetes and those who underwent a sleeve gastrectomy continued to display a higher risk for liver fibrosis than did patients without diabetes and those who underwent RYGB, respectively. CONCLUSION There was an overall trend to increased liver fibrosis scores over the 5-year post-operative follow-up, but this increase remained lower than that reported in previous literature. Bariatric surgery offers NAFLD risk reduction in a high-risk population.
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Affiliation(s)
- Leaque Ahmed
- Department of Surgery, Harlem Hospital Center, 506 Lenox Ave, New York, NY, 10037, USA
- Department of Surgery, Wyckoff Heights Medical Center, 374 Stockholm St, Room C-408, Brooklyn, NY, Brooklyn, NY, 11237, USA
| | - Selim Gebran
- Department of Surgery, Wyckoff Heights Medical Center, 374 Stockholm St, Room C-408, Brooklyn, NY, Brooklyn, NY, 11237, USA.
| | - Amrita Persaud
- Department of Surgery, Harlem Hospital Center, 506 Lenox Ave, New York, NY, 10037, USA
- Department of Surgery, Wyckoff Heights Medical Center, 374 Stockholm St, Room C-408, Brooklyn, NY, Brooklyn, NY, 11237, USA
| | - Kashif Saeed
- Department of Surgery, Harlem Hospital Center, 506 Lenox Ave, New York, NY, 10037, USA
- Department of Surgery, Wyckoff Heights Medical Center, 374 Stockholm St, Room C-408, Brooklyn, NY, Brooklyn, NY, 11237, USA
| | - Khuram Khan
- Department of Surgery, Harlem Hospital Center, 506 Lenox Ave, New York, NY, 10037, USA
- Department of Surgery, Wyckoff Heights Medical Center, 374 Stockholm St, Room C-408, Brooklyn, NY, Brooklyn, NY, 11237, USA
| | - Saqib Saeed
- Department of Surgery, Harlem Hospital Center, 506 Lenox Ave, New York, NY, 10037, USA
| | - Sara Alothman
- Department of Surgery, Harlem Hospital Center, 506 Lenox Ave, New York, NY, 10037, USA
- Department of Surgery, Wyckoff Heights Medical Center, 374 Stockholm St, Room C-408, Brooklyn, NY, Brooklyn, NY, 11237, USA
| | - Bianca Passos-Fox
- Department of Surgery, Harlem Hospital Center, 506 Lenox Ave, New York, NY, 10037, USA
- Department of Surgery, Wyckoff Heights Medical Center, 374 Stockholm St, Room C-408, Brooklyn, NY, Brooklyn, NY, 11237, USA
| | - Hector DePaz
- Department of Surgery, Harlem Hospital Center, 506 Lenox Ave, New York, NY, 10037, USA
- Department of Surgery, Wyckoff Heights Medical Center, 374 Stockholm St, Room C-408, Brooklyn, NY, Brooklyn, NY, 11237, USA
| | - Paritosh Suman
- Department of Surgery, Harlem Hospital Center, 506 Lenox Ave, New York, NY, 10037, USA
- Department of Surgery, Wyckoff Heights Medical Center, 374 Stockholm St, Room C-408, Brooklyn, NY, Brooklyn, NY, 11237, USA
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8
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Amatya R, Lee D, Min KA, Shin MC. Pharmaceutical Strategies to Improve Druggability of Potential Drug Candidates in Nonalcoholic Fatty Liver Disease Therapy. Pharmaceutics 2023; 15:1963. [PMID: 37514148 PMCID: PMC10386216 DOI: 10.3390/pharmaceutics15071963] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) has become globally prevalent and is the leading cause of chronic liver disease. Although NAFLD is reversible without medical intervention in the early stage, the condition could be sequentially worsened to nonalcoholic steatohepatitis (NASH) and, eventually, cirrhosis and hepatic cancer. The progression of NAFLD is related to various factors such as genetics, pre-disposed metabolic disorders, and immunologic factors. Thankfully, to date, there have been accumulating research efforts and, as a result, different classes of potent drug candidates have been discovered. In addition, there have also been various attempts to explore pharmaceutical strategies to improve the druggability of drug candidates. In this review, we provided a brief overview of the drug candidates that have undergone clinical trials. In the latter part, strategies for developing better drugs are discussed.
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Affiliation(s)
- Reeju Amatya
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Gyeongsang National University, 501 Jinju Daero, Jinju 52828, Republic of Korea
| | - Donghee Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Gyeongsang National University, 501 Jinju Daero, Jinju 52828, Republic of Korea
| | - Kyoung Ah Min
- College of Pharmacy and Inje Institute of Pharmaceutical Sciences and Research, Inje University, 197 Injero, Gimhae 50834, Republic of Korea
| | - Meong Cheol Shin
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Gyeongsang National University, 501 Jinju Daero, Jinju 52828, Republic of Korea
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9
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Li J, Arest S, Olszowy B, Gordon J, Barrero CA, Perez-Leal O. CRISPR/Cas9-Based Screening of FDA-Approved Drugs for NRF2 Activation: A Novel Approach to Discover Therapeutics for Non-Alcoholic Fatty Liver Disease. Antioxidants (Basel) 2023; 12:1363. [PMID: 37507903 PMCID: PMC10375998 DOI: 10.3390/antiox12071363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/16/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023] Open
Abstract
With the rising prevalence of obesity, non-alcoholic fatty liver disease (NAFLD) now affects 20-25% of the global population. NAFLD, a progressive condition associated with oxidative stress, can result in cirrhosis and liver cancer in 10% and 3% of patients suffering NAFLD, respectively. Therapeutic options are currently limited, emphasizing the need for novel treatments. In this study, we examined the potential of activating the transcription factor NRF2, a crucial player in combating oxidative stress, as an innovative approach to treating NAFLD. Utilizing a CRISPR/Cas9-engineered human HEK293T cell line, we were able to monitor the expression of heme oxygenase-1 (HMOX1), an NRF2 target, using a Nanoluc luciferase tag. Our model was validated using a known NRF2 activator, after which we screened 1200 FDA-approved drugs, unearthing six compounds (Disulfiram, Thiostrepton, Auranofin, Thimerosal, Halofantrine, and Vorinostat) that enhanced NRF2 activity and antioxidant response. These compounds demonstrated protective effects against oxidative stress induced by hydrogen peroxide and lipid droplets accumulation in vitro with hepatoma HUH-7 cells. Our study underscores the utility of CRISPR/Cas9 tagging with Nanoluc luciferase in identifying potential NRF2 activators, paving the way for potential NAFLD therapeutics.
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Affiliation(s)
| | | | | | | | | | - Oscar Perez-Leal
- Department of Pharmaceutical Sciences, Moulder Center for Drug Discovery, School of Pharmacy, Temple University, Philadelphia, PA 19140, USA
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10
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Zhang S, Mak LY, Yuen MF, Seto WK. Screening strategy for non-alcoholic fatty liver disease. Clin Mol Hepatol 2023; 29:S103-S122. [PMID: 36447420 PMCID: PMC10029948 DOI: 10.3350/cmh.2022.0336] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/16/2022] [Indexed: 12/02/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease, affecting approximately 25% of the general population worldwide, and is forecasted to increase global health burden in the 21st century. With the advancement of non-invasive tests for assessing and monitoring of steatosis and fibrosis, NAFLD screening is now feasible, and is increasingly highlighted in international guidelines related to hepatology, endocrinology, and pediatrics. Identifying high-risk populations (e.g., diabetes mellitus, obesity, metabolic syndrome) based on risk factors and metabolic characteristics for non-invasive screening is crucial and may aid in designing screening strategies to be more precise and effective. Many screening modalities are currently available, from serum-based methods to ultrasonography, transient elastography, and magnetic resonance imaging, although the diagnostic performance, cost, and accessibility of different methods may impact the actual implementation. A two-step assessment with serum-based fibrosis-4 index followed by imaging test vibration-controlled transient elastography can be an option to stratify the risk of liverrelated complications in NAFLD. There is a need for fibrosis surveillance, as well as investigating the cost-effectiveness of different screening algorithms and engaging primary care for first-stage triage screening.
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Affiliation(s)
- Saisai Zhang
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong
| | - Lung-Yi Mak
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong
- State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong
| | - Man-Fung Yuen
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong
- State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong
| | - Wai-Kay Seto
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong
- State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong
- Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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11
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Verboonen Sotelo JS, Romero Manzano J, Vega Tostado G, Guzmán Barba JA, Esparza Estrada I, Orozco Álvarez Malo JO, González Ojeda A. One-anastomosis gastric bypass reversal due to severe malnutrition and acute hepatic failure: a case report. J Surg Case Rep 2023; 2023:rjad009. [PMID: 36685118 PMCID: PMC9851657 DOI: 10.1093/jscr/rjad009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/02/2023] [Indexed: 01/20/2023] Open
Abstract
The one-anastomosis gastric bypass (OAGB) is one of the most popular performed bariatric surgeries and has good long-term success for treating obesity and metabolic diseases. However, some patients can develop severe complications such as malnutrition and hepatic steatosis, which can be corrected with a reversal procedure, as seen in this case. A 20-year-old woman underwent OAGB surgery, which was converted to Roux-en-Y gastric bypass 4 months after the initial procedure due to malnutrition, both surgeries were performed at a hospital in southern Mexico. After the second surgery, she presented to our hospital with intolerance to oral feeding, vomiting and loss of 44 kg in 4 months. The patient was stabilized and scheduled for reversion surgery to normal anatomy 5 months later. She had good short-term nutritional outcomes and at the 1-year follow-up her total weight gain was 14 kg.
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Affiliation(s)
| | - Jeffry Romero Manzano
- Obesity Goodbye Center, Tijuana, Baja California 2050, Mexico
- Colegio de Cirujanos Bariatras y Enfermedades Metabólicas del Estado de Baja California, Tijuana, Baja California 2050, Mexico
| | | | | | | | - José Oscar Orozco Álvarez Malo
- Colegio de Cirujanos Bariatras y Enfermedades Metabólicas del Estado de Baja California, Tijuana, Baja California 2050, Mexico
| | - Alejandro González Ojeda
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco 44329, Mexico
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12
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Lautenbach A, Wernecke M, Mann O, Wagner J, Wolter S, Stoll F, Aberle J. Low-Grade Hepatic Steatosis Is Associated with Long-term Remission of Type 2 Diabetes Independent of Type of Bariatric-Metabolic Surgery. Obes Surg 2023; 33:530-538. [PMID: 36508157 PMCID: PMC9889466 DOI: 10.1007/s11695-022-06406-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Bariatric-metabolic surgery (BS) decreases the grade of steatosis, hepatic inflammation, and fibrosis in patients with severe obesity and non-alcoholic fatty liver disease (NAFLD). Mechanisms include substantial weight loss, but also simultaneous effects on glucose homeostasis. Therefore, we aimed to investigate the association between NAFLD and remission of type 2 diabetes (T2D) up to 8 years following different types of BS. METHODS In a retrospective cohort study including 107 patients with obesity and T2D at baseline, the association between biopsy-proven NAFLD defined as steatosis in > 5% of hepatocytes at the time of surgery and T2D remission up to 8 years following different surgical procedures was investigated. Univariate regression analysis was used to examine the association between NAFLD and remission of T2D. RESULTS Long-term remission of T2D was present in 56% of patients (n = 60). The presence of low-grade liver steatosis (grade 1) was associated with remission of T2D. Patients with a liver steatosis score ≥ 2 showed higher HbA1c levels at baseline. There were no significant differences in preoperative presence of lobular inflammation, hepatocyte ballooning, or fibrosis between patients who achieved T2D remission compared with those with no remission. Type of surgery did not affect remission of T2D. CONCLUSION Our results suggest that the presence of low-grade liver steatosis is associated with remission of T2D following sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Therefore, BS should be considered at an early NAFLD stage in patients with T2D.
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Affiliation(s)
- Anne Lautenbach
- III Department of Medicine, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany.
| | - Marie Wernecke
- III Department of Medicine, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Oliver Mann
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Jonas Wagner
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Stefan Wolter
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Fabian Stoll
- III Department of Medicine, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Jens Aberle
- III Department of Medicine, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
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13
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Shamseya AM, Afify MT, Fayad HAS, Elshafey MM. Real-time elastography “FibroScan” compared to simple non-invasive screening tools in the assessment of liver fibrosis in non-alcoholic fatty liver patients. EGYPTIAN LIVER JOURNAL 2022. [DOI: 10.1186/s43066-022-00197-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background and aim
Non-alcoholic fatty liver disease (NAFLD) and its subtype non-alcoholic steatohepatitis (NASH) are increasing worldwide. NASH is characterized by active liver inflammation with severe consequences including progressive fibrosis, cirrhosis, and eventually hepatocellular carcinoma. In Egypt, the prevalence of NAFLD diagnosed by ultrasound is about 65.3% in children and 62.7% in adults. Liver biopsy, the only reliable method of differentiating simple steatosis from NASH, has a major disadvantage of being an invasive procedure with various complications. Serum tests have limitations including non-specificity for liver inflammation and affection by clearance rates. This study aimed to assess the reliability of simple non-invasive tests for liver fibrosis (namely fibrosis-4 “FIB-4” score and NAFLD fibrosis score) in comparison with real-time elastography (RTE or FibroScan) in patients diagnosed with NAFLD.
Patients and methods
This observational prospective case–control study was conducted on 100 cases with NAFLD and 30 healthy subjects. All patients and controls were subjected to serological (FIB-4 score and NAFLD fibrosis score) and radiological (ultrasonography and RTE) assessments of liver fibrosis.
Results
In advanced FIB-4 score ≥ F3, there was a good correlation between the findings of the RTE and each of the FIB-4 scores (with a sensitivity of 90%, specificity of 93.3%, positive predictive value (PPV) of 60%, negative predictive value (NPV) of 98.8%, with a total accuracy of 93%), NAFLD fibrosis score (with a sensitivity of 52.6%, specificity of 93.8%, PPV of 66.7%, NPV of 89.4%, with a total accuracy of 86%), and grading of steatosis by ultrasound.
Conclusions
RTE is beneficial in diagnosing and assessing NAFLD, especially in advanced cases “F3 and beyond.”
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14
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Takahashi N, Sasaki A, Umemura A, Sugai T, Kakisaka K, Ishigaki Y. Identification of a Fatty Acid for Diagnosing Non-Alcoholic Steatohepatitis in Patients with Severe Obesity Undergoing Metabolic Surgery. Biomedicines 2022; 10:biomedicines10112920. [PMID: 36428489 PMCID: PMC9687903 DOI: 10.3390/biomedicines10112920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
Abstract
The prevalence of nonalcoholic steatohepatitis (NASH) in severely obese Japanese patients is extremely high. However, there are currently no methods other than liver biopsy to assess hepatic steatosis and fibrosis. The purpose of this study was to comprehensively analyze changes in fatty acid (FA) and serum-free fatty acid (FFA) metabolism in severely obese Japanese patients to determine whether these could be surrogate markers. In this study, we enrolled 20 Japanese patients who underwent laparoscopic sleeve gastrectomy (LSG) for severe obesity and intraoperative liver biopsy. Serum FFAs were analyzed with liquid chromatography-mass spectrometry, and FAs in liver tissue were assessed using matrix-assisted laser desorption/ionization-imaging mass spectrometry to determine FAs that may be indicative of a positive NASH diagnosis. All patients showed significant weight loss and metabolic improvement following LSG. Regarding weight loss and metabolic improvement indices, 23 FFAs showed significant correlations with the baseline data. Narrowing down the phospholipids to commonly detected FAs detected in liver tissue, PC(18:1e_20:4) was significantly changed in the NASH group, suggesting that it could be used as a surrogate marker for NASH diagnosis. The results suggest that specific postoperative changes in blood phospholipids could be used as surrogate markers for NASH treatment.
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Affiliation(s)
- Naoto Takahashi
- Department of Surgery, Iwate Medical University School of Medicine, Morioka 028-3695, Japan
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University School of Medicine, Morioka 028-3695, Japan
- Correspondence: ; Tel.: +81-19-6137111
| | - Akira Umemura
- Department of Surgery, Iwate Medical University School of Medicine, Morioka 028-3695, Japan
| | - Tamotsu Sugai
- Division of Molecular Diagnostic Pathology, Department of Pathology, Iwate Medical University School of Medicine, Morioka 028-3695, Japan
| | - Keisuke Kakisaka
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Morioka 028-3695, Japan
| | - Yasushi Ishigaki
- Division of Diabetes and Metabolism, Department of Internal Medicine, Iwate Medical University School of Medicine, Morioka 028-3695, Japan
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15
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Lin W, Zhang X, Zhang C, Li L, Zhang J, Xie P, Zhan Y, An W. Deletion of Smurf1 attenuates liver steatosis via stabilization of p53. J Transl Med 2022; 102:1075-1087. [PMID: 36775348 DOI: 10.1038/s41374-022-00802-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/19/2022] [Accepted: 04/28/2022] [Indexed: 11/09/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease, characterized by excessive hepatic lipid accumulation. Recently, we demonstrated that Smad ubiquitination regulatory factor 1 (Smurf1) deficiency significantly alleviates mouse hepatic steatosis. However, the mechanism of Smurf1-regulating hepatic lipid accumulation requires further exploration and clarification. Hence, this study explores the potential mechanism of Smurf1 in hepatic steatosis. In this study, hepatic Smurf1 proteins in NAFLD patients and healthy individuals were determined using immunohistochemical staining. Control and NAFLD mouse models were established by feeding Smurf1-knockout (KO) and wild-type mice with either a high-fat diet (HFD) or a chow diet (CD) for eight weeks. Oleic acid (OA)-induced steatotic hepatocytes were used as the NAFLD mode cells. Lipid content in liver tissues was analyzed. Smurf1-MDM2 interaction, MDM2 and p53 ubiquitination, and p53 target genes expression in liver tissues and hepatocytes were analyzed. We found that hepatic Smurf1 is highly expressed in NAFLD patients and HFD-induced NAFLD mice. Its deletion attenuates hepatocyte steatosis. Mechanistically, Smurf1 interacts with and stabilizes mouse double minute 2 (MDM2), promoting p53 degradation. In Smurf1-deficient hepatocytes, an increase in p53 suppresses SREBP-1c expression and elevates the expression of both malonyl-CoA decarboxylase (MCD) and lipin1 (Lpin1), two essential proteins in lipid catabolism. Contrarily, the activities of these three proteins and hepatocyte steatosis are reversed by p53 knockdown in Smurf1-deficient hepatocytes. This study shows that Smurf1 is involved in the pathogenesis of NAFLD by balancing de novo lipid synthesis and lipolysis.
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Affiliation(s)
- Wenjun Lin
- Department of Gastroenterology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xin Zhang
- State Key Laboratory of Proteomics, National Center of Protein Sciences (Beijing), Beijing Institute of Lifeomics, Beijing, China
| | - Chuan Zhang
- Department of Gastroenterology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Li Li
- Department of Gastroenterology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jing Zhang
- The Third Unit, Department of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Ping Xie
- Department of Cell Biology, Municipal Laboratory for Liver Protection and Regulation of Regeneration, Capital Medical University, Beijing, China.
| | - Yutao Zhan
- Department of Gastroenterology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
| | - Wei An
- Department of Cell Biology, Municipal Laboratory for Liver Protection and Regulation of Regeneration, Capital Medical University, Beijing, China.
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16
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Jitrukthai S, Kositamongkol C, Boonchai P, Mepramoon E, Ariyakunaphan P, Nimitpunya P, Srivanichakorn W, Chaisathaphol T, Washirasaksiri C, Auesomwang C, Sitasuwan T, Tinmanee R, Sayabovorn N, Charatcharoenwitthaya P, Phisalprapa P. Long-Term Outcomes Associated with NAFLD, ASCVD, and All-Cause Mortality of Patients with Metabolic Syndrome. J Clin Med 2022; 11:jcm11154627. [PMID: 35956240 PMCID: PMC9370024 DOI: 10.3390/jcm11154627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/28/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022] Open
Abstract
Metabolic syndrome (MetS) patients are at higher risk for nonalcoholic fatty liver disease (NAFLD), atherosclerotic cardiovascular diseases (ASCVD), and death. Given a lack of longitudinal data on patients with MetS in Southeast Asia, this study investigated the incidence of NAFLD and ASCVD and the all-cause mortality rate during a 10-year follow-up of Thai patients with MetS. Retrospective data were collected on 496 MetS patients with ultrasonography or transient elastography results. The patients had been followed up continuously by a university hospital between October 2011 and November 2021, and their mean age was 61.0 ± 10.9 years. Patients with secondary causes of hepatic steatosis were excluded. Cox proportional hazards regression models with time-varying covariates were adopted. During the 10-year follow-up, 17 patients (11.2%) developed NAFLD, and 27 (6.4%) developed ASCVD. The NAFLD and ASCVD incidence rates were 21.7 and 10.9 events per 1000 person years, respectively. The mortality rate was 14.2 deaths per 1000 person years. The prevalence of hypertension, dyslipidemia, ASCVD, NAFLD, advanced fibrosis, and cirrhosis at baseline was significantly higher in the nonsurvival group. The NAFLD incidence and mortality rate of patients with MetS were lower than those in previous studies. Intensive, holistic, and continuous care should be considered for better outcomes.
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Affiliation(s)
- Suchanart Jitrukthai
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Chayanis Kositamongkol
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Punyisa Boonchai
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Euarat Mepramoon
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Pinyapat Ariyakunaphan
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Pongpol Nimitpunya
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Weerachai Srivanichakorn
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Thanet Chaisathaphol
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Chaiwat Washirasaksiri
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Chonticha Auesomwang
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Tullaya Sitasuwan
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Rungsima Tinmanee
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Naruemit Sayabovorn
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Phunchai Charatcharoenwitthaya
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Pochamana Phisalprapa
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
- Correspondence: ; Tel./Fax: +66-2-419-7190
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17
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Alalwani J, Eljazzar S, Basil M, Tayyem R. The impact of health status, diet and lifestyle on non-alcoholic fatty liver disease: Narrative review. Clin Obes 2022; 12:e12525. [PMID: 35412016 DOI: 10.1111/cob.12525] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 12/13/2022]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is defined as the abnormal accumulation of triglycerides in the liver. NAFLD has a global prevalence of almost 30%, while incidence is rising with increasing levels of obesity, type 2 diabetes mellitus (T2DM) and metabolic syndrome. Nutrition plays a significant role in both the prevention and treatment of NAFLD. Therefore, the aim of this literature review is to explore the associations between dietary, lifestyle and other risk factors and the risk for developing NAFLD. Dietary patterns, lifestyle behaviours, comorbidities, or a combination of any may contribute to either the progression or prevention of NAFLD. Having diabetes, hypertension, or having obesity might increase the progression of NAFLD if not well treated and controlled. Diet influences the progression of NAFLD; following a western diet or simply a high-fat diet may contribute to the worsening of NAFLD and further progression to non-alcoholic steatohepatitis (NASH) and cirrhosis in later stages. On the other hand, the Mediterranean diet is the gold standard for both the treatment and prevention of NAFLD. Social behaviours, such as smoking, caffeine consumption and physical activity also play a role in the pathophysiology of NAFLD. Nutrition contributes significantly to the prevention or treatment of NAFLD, since this disease can be managed by diet and physical activity. However, further studies are still needed for a better understanding of the mechanisms of action. Randomized control trials are also needed to confirm findings in observational studies.
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Affiliation(s)
- Joud Alalwani
- Human Nutrition Department, College of Health Sciences, Qatar University, Doha, Qatar
| | - Sereen Eljazzar
- Human Nutrition Department, College of Health Sciences, Qatar University, Doha, Qatar
| | - Maya Basil
- Human Nutrition Department, College of Health Sciences, Qatar University, Doha, Qatar
| | - Reema Tayyem
- Human Nutrition Department, College of Health Sciences, Qatar University, Doha, Qatar
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18
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Theel W, Boxma-de Klerk BM, Dirksmeier-Harinck F, van Rossum EFC, Kanhai DA, Apers J, van Dalen BM, de Knegt RJ, Holleboom AG, Tushuizen ME, Grobbee DE, Wiebolt J, Castro Cabezas M. Evaluation of nonalcoholic fatty liver disease (NAFLD) in severe obesity using noninvasive tests and imaging techniques. Obes Rev 2022; 23:e13481. [PMID: 35692179 DOI: 10.1111/obr.13481] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 12/15/2022]
Abstract
The prevalence of nonalcoholic fatty liver disease (NAFLD) and the more severe and inflammatory type, nonalcoholic steatohepatitis (NASH), is increasing rapidly. Especially in high-risk patients, that is those with obesity, metabolic syndrome, and type 2 diabetes mellitus, the prevalence of NAFLD can be as high as 80% while NASH may be present in 20% of these subjects. With the worldwide increase of obesity, it is most likely that these numbers will rise. Since advanced stages of NAFLD and NASH are strongly associated with morbidity and mortality-in particular, cardiovascular disease, liver cirrhosis, and hepatocellular carcinoma-it is of great importance to identify subjects at risk. A great variety of noninvasive tests has been published to diagnose NAFLD and NASH, especially using blood- and imaging-based tests. Liver biopsy remains the gold standard for NAFLD/NASH. This review aims to summarize the different mechanisms leading to NASH and liver fibrosis, the different noninvasive liver tests to diagnose and evaluate patients with severe obesity.
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Affiliation(s)
- Willy Theel
- Department of Internal Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.,Obesity Center CGG, Rotterdam, The Netherlands
| | - Bianca M Boxma-de Klerk
- Department of Statistics and Education, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Femme Dirksmeier-Harinck
- Department of Gastroenterology and Hepatology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Elisabeth F C van Rossum
- Obesity Center CGG, Rotterdam, The Netherlands.,Department of Internal Medicine, Division of Endocrinology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Danny A Kanhai
- Department of Pediatrics, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Jan Apers
- Department of Bariatric Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Bas M van Dalen
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Robert J de Knegt
- Department of Gastroenterology and Hepatology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - Maarten E Tushuizen
- Department of Gastroenterology and Hepatology, Leiden UMC, Leiden, The Netherlands
| | - Diederick E Grobbee
- Julius Centre for Health Science and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Julius Clinical, Zeist, The Netherlands
| | - Janneke Wiebolt
- Department of Internal Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.,Obesity Center CGG, Rotterdam, The Netherlands
| | - Manuel Castro Cabezas
- Department of Internal Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.,Department of Internal Medicine, Division of Endocrinology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Julius Clinical, Zeist, The Netherlands
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19
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Mirhashemi SH, Hakakzadeh A, Yeganeh FE, Oshidari B, Rezaee SP. Effect of 8 Weeks milk thistle powder (silymarin extract) supplementation on fatty liver disease in patients candidates for bariatric surgery. Metabol Open 2022; 14:100190. [PMID: 35651885 PMCID: PMC9149185 DOI: 10.1016/j.metop.2022.100190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/27/2022] [Accepted: 05/18/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Seyed Hadi Mirhashemi
- Department of the General Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azadeh Hakakzadeh
- Department of Sports and Exercise Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Physiotherapy Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farbod Emami Yeganeh
- Department of the General Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahador Oshidari
- Department of the General Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Parviz Rezaee
- Department of the General Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- General Surgery, School of Medicine, 501 Hospital, AJA University of Medical Sciences, Iran
- Corresponding author.
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20
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Kaya E, Yilmaz Y. Metabolic-associated Fatty Liver Disease (MAFLD): A Multi-systemic Disease Beyond the Liver. J Clin Transl Hepatol 2022; 10:329-338. [PMID: 35528971 PMCID: PMC9039705 DOI: 10.14218/jcth.2021.00178] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/19/2021] [Accepted: 09/17/2021] [Indexed: 02/05/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a multisystemic clinical condition that presents with a wide spectrum of extrahepatic manifestations, such as obesity, type 2 diabetes mellitus, metabolic syndrome, cardiovascular diseases, chronic kidney disease, extrahepatic malignancies, cognitive disorders, and polycystic ovarian syndrome. Among NAFLD patients, the most common mortality etiology is cardiovascular disorders, followed by extrahepatic malignancies, diabetes mellitus, and liver-related complications. Furthermore, the severity of extrahepatic diseases is parallel to the severity of NAFLD. In clinical practice, awareness of the associations of concomitant diseases is of major importance for initiating prompt and timely screening and multidisciplinary management of the disease spectrum. In 2020, a consensus from 22 countries redefined the disease as metabolic (dysfunction)-associated fatty liver disease (MAFLD), which resulted in the redefinition of the corresponding population. Although the patients diagnosed with MAFLD and NAFLD mostly overlap, the MAFLD and NAFLD populations are not identical. In this review, we compared the associations of key extrahepatic diseases between NAFLD and MAFLD.
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Affiliation(s)
- Eda Kaya
- Department of Internal Medicine, Ruhr University Bochum, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - Yusuf Yilmaz
- Department of Gastroenterology, School of Medicine, Marmara University, Istanbul, Turkey
- Liver Research Unit, Institute of Gastroenterology, Marmara University, Istanbul, Turkey
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21
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Maevskaya M, Kotovskaya Y, Ivashkin V, Tkacheva O, Troshina E, Shestakova M, Breder V, Geyvandova N, Doschitsin V, Dudinskaya E, Ershova E, Kodzoeva K, Komshilova K, Korochanskaya N, Mayorov A, Mishina E, Nadinskaya M, Nikitin I, Pogosova N, Tarzimanova A, Shamkhalova M. The National Consensus statement on the management of adult patients with non-alcoholic fatty liver disease and main comorbidities. TERAPEVT ARKH 2022; 94:216-253. [DOI: 10.26442/00403660.2022.02.201363] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Indexed: 12/15/2022]
Abstract
The National Consensus was prepared with the participation of the National Medical Association for the Study of the Multimorbidity, Russian Scientific Liver Society, Russian Association of Endocrinologists, Russian Association of Gerontologists and Geriatricians, National Society for Preventive Cardiology, Professional Foundation for the Promotion of Medicine Fund PROFMEDFORUM.
The aim of the multidisciplinary consensus is a detailed analysis of the course of non-alcoholic fatty liver disease (NAFLD) and the main associated conditions. The definition of NAFLD is given, its prevalence is described, methods for diagnosing its components such as steatosis, inflammation and fibrosis are described.
The association of NAFLD with a number of cardio-metabolic diseases (arterial hypertension, atherosclerosis, thrombotic complications, type 2 diabetes mellitus (T2DM), obesity, dyslipidemia, etc.), chronic kidney disease (CKD) and the risk of developing hepatocellular cancer (HCC) were analyzed. The review of non-drug methods of treatment of NAFLD and modern opportunities of pharmacotherapy are presented.
The possibilities of new molecules in the treatment of NAFLD are considered: agonists of nuclear receptors, antagonists of pro-inflammatory molecules, etc. The positive properties and disadvantages of currently used drugs (vitamin E, thiazolidinediones, etc.) are described. Special attention is paid to the multi-target ursodeoxycholic acid (UDCA) molecule in the complex treatment of NAFLD as a multifactorial disease. Its anti-inflammatory, anti-oxidant and cytoprotective properties, the ability to reduce steatosis an independent risk factor for the development of cardiovascular pathology, reduce inflammation and hepatic fibrosis through the modulation of autophagy are considered.
The ability of UDCA to influence glucose and lipid homeostasis and to have an anticarcinogenic effect has been demonstrated. The Consensus statement has advanced provisions for practitioners to optimize the diagnosis and treatment of NAFLD and related common pathogenetic links of cardio-metabolic diseases.
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22
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Głuszyńska P, Lemancewicz D, Dzięcioł JB, Razak Hady H. Non-Alcoholic Fatty Liver Disease (NAFLD) and Bariatric/Metabolic Surgery as Its Treatment Option: A Review. J Clin Med 2021; 10:jcm10245721. [PMID: 34945016 PMCID: PMC8706342 DOI: 10.3390/jcm10245721] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 12/19/2022] Open
Abstract
The prevalence of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) has considerably increased over the last years. NAFLD is currently the most common cause of chronic liver disease in the developing world. The diagnosis of NAFLD/NASH is often incidental, as the early-stage of disease is frequently free of symptoms. Most patients recognized with NAFLD have severe obesity and other obesity-related disease such as type 2 diabetes mellitus (T2DM), insulin-resistance, dyslipidemia and hypertension. The only proven method for NAFLD improvement and resolution is weight loss. Bariatric surgery leads to significant and long-term weight loss as well as improvement of coexisting diseases. There is a lot of evidence suggesting that metabolic/bariatric surgery is an effective method of NAFLD treatment that leads to reduction in steatosis, hepatic inflammation and fibrosis. However, there is still a need to perform long-term studies in order to determine the role of bariatric surgery as a treatment option for NAFLD and NASH. This review discusses current evidence about epidemiology, pathogenesis and treatment options for NAFLD including bariatric/metabolic surgery and its effect on improvement and resolution of NAFLD.
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Affiliation(s)
- Paulina Głuszyńska
- Department of General and Endocrine Surgery, Medical University of Bialystok, 15-089 Białystok, Poland;
- Correspondence: ; Tel.: +48-85-831-8279
| | - Dorota Lemancewicz
- Department of Human Anatomy, Medical University of Bialystok, 15-089 Białystok, Poland; (D.L.); (J.B.D.)
| | - Janusz Bogdan Dzięcioł
- Department of Human Anatomy, Medical University of Bialystok, 15-089 Białystok, Poland; (D.L.); (J.B.D.)
| | - Hady Razak Hady
- Department of General and Endocrine Surgery, Medical University of Bialystok, 15-089 Białystok, Poland;
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23
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Eilenberg M, Munda P, Stift J, Langer FB, Prager G, Trauner M, Staufer K. Accuracy of non-invasive liver stiffness measurement and steatosis quantification in patients with severe and morbid obesity. Hepatobiliary Surg Nutr 2021; 10:610-622. [PMID: 34760965 DOI: 10.21037/hbsn-20-787] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/24/2020] [Indexed: 12/26/2022]
Abstract
Background Vibration controlled transient elastography (VCTE) and controlled attenuation parameter (CAP™) have shown reliable performance predicting fibrosis and steatosis in normal- to overweight patients but have not been validated in severe to morbid obesity. This study aimed at determining the accuracy of VCTE, CAP™ and the composite score FibroScan-AST (FAST) in patients with a body mass index (BMI) of ≥35 kg/m2. Methods Patients scheduled for bariatric-metabolic surgery underwent preoperative VCTE/CAP™ measurement, and intraoperative liver biopsy. The feasibility and accuracy of VCTE, CAP™ and the composite score FAST were retrospectively analysed to evaluate fibrosis, steatosis and active fibrotic non-alcoholic steatohepatitis [NASH + non-alcoholic fatty liver disease (NAFLD) activity score ≥4 + fibrosis grade ≥2] using per protocol (PP) and intent to diagnose (ITD) calculation. Results In total, 170 patients (median BMI 44.4 kg/m2) were included in the study. Liver biopsy showed NASH, simple steatosis, and normal livers in 60.6% (n=103), 28.8% (n=49), and 10.6% (n=18), respectively. VCTE and CAP™ delivered reliable results in 90.6% (n=154/170) and 90.5% (n=134/148). The AUC (PP) of VCTE, CAP™, and FAST were 0.687 (≥F2), 0.786 (≥F3), 0.703 (≥S2), 0.738 (S3), and 0.780 (active fibrotic NASH). The AUC increased to 0.742 (≥F2), 0.842 (≥F3), 0.712 (≥S2), 0.780 (S3), and 0.836 (active fibrotic NASH) in patients below the median BMI of 44.4 kg/m2. Conclusions VCTE, CAP™ and FAST show acceptable accuracy for the detection of fibrosis, steatosis and NASH in a real-life cohort of patients with obesity. Accuracy improves in patients with a BMI <44.4 kg/m2.
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Affiliation(s)
- Magdalena Eilenberg
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Department of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Petra Munda
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Judith Stift
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Felix B Langer
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Gerhard Prager
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Michael Trauner
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Katharina Staufer
- Department of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, Bern, Switzerland.,Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Division of Transplantation, Department of Surgery, Medical University of Vienna, Vienna, Austria
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24
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Hanna DJ, Jamieson ST, Lee CS, Pluskota CA, Bressler NJ, Benotti PN, Khurana S, Rolston DDK, Still CD. "Bioelectrical impedance analysis in managing sarcopenic obesity in NAFLD". Obes Sci Pract 2021; 7:629-645. [PMID: 34631140 PMCID: PMC8488453 DOI: 10.1002/osp4.509] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 02/02/2021] [Accepted: 02/11/2021] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Sarcopenic obesity and its association with nonalcoholic fatty liver disease (NAFLD) is under-recognized by many healthcare providers in Western medicine due to the lack of awareness and diagnostic guidelines. The result is delayed recognition and treatment, which leads to further health deterioration and increased healthcare costs. Sarcopenic obesity is characterized by the presence of increased fat mass in combination with muscle catabolism related to chronic inflammation and/or inactivity. Previous research has recommended evaluating body composition and physical function performance to adequately diagnose sarcopenic obesity. Body composition analysis can be performed by imaging applications through magnetic resonance imaging, computed tomography, and dual-energy x-ray absorptiometry. Due to the cost of each device and radiation exposure for patients as evidenced in all three modalities, bioelectrical impedance analysis offers a noninvasive approach capable of providing quick and reliable estimates of lean body and fat mass. METHODS AND RESULTS This review analyzes the current evidence-based literature, indicating a lower skeletal muscle mass and increased visceral adipose tissue correlation to the advancement of fibrosis in fatty liver disease. CONCLUSION Given the substantial promising research conducted in predominantly Asian populations regarding body tissue distribution and NAFLD, additional prospective research is needed to extend these findings in Western populations.
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Affiliation(s)
- David J. Hanna
- Obesity InstituteGeisinger Health SystemDanvillePennsylvaniaUSA
- Department of Gastroenterology and HepatologyGeisinger Health SystemDanvillePennsylvaniaUSA
| | | | | | | | | | | | - Sandeep Khurana
- Department of Gastroenterology and HepatologyGeisinger Health SystemDanvillePennsylvaniaUSA
| | - David D. K. Rolston
- Obesity InstituteGeisinger Health SystemDanvillePennsylvaniaUSA
- Department of Internal MedicineGeisinger Health SystemDanvillePennsylvaniaUSA
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25
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Bariatric Surgery and Liver Disease: General Considerations and Role of the Gut-Liver Axis. Nutrients 2021; 13:nu13082649. [PMID: 34444807 PMCID: PMC8399840 DOI: 10.3390/nu13082649] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 02/07/2023] Open
Abstract
Weight loss is a therapeutic solution for many metabolic disorders, such as obesity and its complications. Bariatric surgery aims to achieve lasting weight loss in all patients who have failed after multiple dietary attempts. Among its many benefits, it has been associated with the regression of non-alcoholic fatty liver disease (NAFLD), which is often associated with obesity, with evidence of substantial improvement in tissue inflammation and fibrosis. These benefits are mediated not only by weight loss, but also by favorable changes in systemic inflammation and in the composition of the gut microbiota. Changes in microbial metabolites such as short-chain fatty acids (SCFAs), capable of acting as endocrine mediators, and bile acids (BAs) as well as modifications of the gut-brain axis, are among the involved mechanisms. However, not all bariatric surgeries show beneficial effects on the liver; those leading to malabsorption can cause liver failure or a marked worsening of fibrosis and the development of cirrhosis. Nevertheless, there are still many unclear aspects, including the extent of the benefits and the magnitude of the risks of bariatric surgery in cirrhotic patients. In addition, the usefulness and the safety of these procedures in patients who are candidates to or who have undergone liver transplant need solid supporting evidence. This paper aims to review literature data on the use of bariatric surgery in the setting of chronic liver disease.
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26
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Dogru T, Kirik A, Gurel H, Rizvi AA, Rizzo M, Sonmez A. The Evolving Role of Fetuin-A in Nonalcoholic Fatty Liver Disease: An Overview from Liver to the Heart. Int J Mol Sci 2021; 22:ijms22126627. [PMID: 34205674 PMCID: PMC8234007 DOI: 10.3390/ijms22126627] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 12/24/2022] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is strongly associated to the features of metabolic syndrome which can progress to cirrhosis, liver failure and hepatocellular carcinoma. However, the most common cause of mortality in people with NAFLD is not liver-related but stems from atherosclerotic cardiovascular disease (CVD). The prevalence of NAFLD is on the rise, mainly as a consequence of its close association with two major worldwide epidemics, obesity and type 2 diabetes (T2D). The exact pathogenesis of NAFLD and especially the mechanisms leading to disease progression and CVD have not been completely elucidated. Human fetuin-A (alpha-2-Heremans Schmid glycoprotein), a glycoprotein produced by the liver and abundantly secreted into the circulation appears to play a role in insulin resistance, metabolic syndrome and inflammation. This review discusses the links between NAFLD and CVD by specifically focusing on fetuin-A’s function in the pathogenesis of NAFLD and atherosclerotic CVD.
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Affiliation(s)
- Teoman Dogru
- Department of Gastroenterology, Balikesir University Medical School, Cagis, Balikesir 10145, Turkey;
| | - Ali Kirik
- Department of Internal Medicine, Balikesir University Medical School, Cagis, Balikesir 10145, Turkey;
| | - Hasan Gurel
- Department of Gastroenterology, Samsun Education and Research Hospital, University of Health Sciences, Ilkadim, Samsun 55090, Turkey;
| | - Ali A. Rizvi
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University, Atlanta, GA 30322, USA;
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of South Carolina, Columbia, SC 29208, USA;
| | - Manfredi Rizzo
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of South Carolina, Columbia, SC 29208, USA;
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy
| | - Alper Sonmez
- Department of Endocrinology and Metabolism, Gulhane Medical School, University of Health Sciences, Ankara 06010, Turkey
- Correspondence:
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27
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Toman D, Vavra P, Jelinek P, Ostruszka P, Ihnat P, Foltys A, Pelikan A, Roman J. Effect of bariatric surgery on fatty liver disease in obese patients: A prospective one year follow-up study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 166:195-203. [PMID: 33885048 DOI: 10.5507/bp.2021.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/07/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD), often associated with obesity and metabolic syndrome, manifests itself as steatosis, hepatic fibrosis, cirrhosis, or even end-stage liver disease. NAFLD causes inflammation, insulin resistance and cardiovascular complications. The current study aimed to evaluate the beneficial effects of bariatric surgery on biochemical parameters of hepatic functions in obese patients by comparing them before and one-year after the surgery. METHODS A total of 72 morbidly obese patients underwent bariatric surgery between 2016 and 2018. The incidence of diabetes mellitus in this group was 29%, median body weight was 124.5 kg (109.0-140.0) and mean body mass index (BMI) was 44.38 ± 6.770 kg/m2. The used surgical procedures included gastric bypass, sleeve gastrectomy, laparoscopic gastric plication, and single anastomosis duodeno-ileal bypass-sleeve gastrectomy. Biochemical parameters including ALT/AST ratio (AAR), NAFLD fibrosis score (NFS), hepatic fibrosis index (FIB-4) and Fatty Liver Index (FLI) were evaluated in all patients at the time of surgery and one year after the intervention. RESULTS Significant improvement after the intervention was observed in 64 patients. A significant reduction in body weight (P<0.0001), waist circumference (P<0.0001), and body mass index (P<0.0001) were observed. NAFLD liver fibrosis index changed significantly (P<0.0001), suggesting a trend of improvement from advanced fibrosis towards stages 0-2. The FIB-4 fibrosis index indicated significant improvement (P=0.0136). Besides, a significant decline in hepatic steatosis (P<0.0001) was observed after bariatric surgery as compared to the pre-surgery fatty liver conditions. CONCLUSION Among the strategies to overcome NAFLD-associated impediments, bariatric surgery can be considered effective in reducing obesity and metabolic co-morbidities. TRIAL REGISTRATION ClinicalTrials.gov (NCT04569396).
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Affiliation(s)
- Daniel Toman
- Department of Surgery, Faculty of Medicine, Ostrava University, Czech Republic.,Department of Surgery, University Hospital Ostrava, Czech Republic
| | - Petr Vavra
- Department of Surgery, Faculty of Medicine, Ostrava University, Czech Republic.,Department of Surgery, University Hospital Ostrava, Czech Republic
| | - Petr Jelinek
- Department of Surgery, Faculty of Medicine, Ostrava University, Czech Republic.,Department of Surgery, University Hospital Ostrava, Czech Republic
| | - Petr Ostruszka
- Department of Surgery, Faculty of Medicine, Ostrava University, Czech Republic.,Department of Surgery, University Hospital Ostrava, Czech Republic
| | - Peter Ihnat
- Department of Surgery, Faculty of Medicine, Ostrava University, Czech Republic.,Department of Surgery, University Hospital Ostrava, Czech Republic
| | - Ales Foltys
- Department of Surgery, Faculty of Medicine, Ostrava University, Czech Republic.,Department of Surgery, University Hospital Ostrava, Czech Republic
| | - Anton Pelikan
- Department of Surgery, Faculty of Medicine, Ostrava University, Czech Republic.,Department of Surgery, University Hospital Ostrava, Czech Republic.,Department of Surgery, St. Mary's Hospital, Newport, Isle of Wight, United Kingdom.,Department of Health Care Sciences, Faculty of Humanities, Tomas Bata University Zlin, Czech Republic
| | - Jan Roman
- Department of Surgery, Faculty of Medicine, Ostrava University, Czech Republic.,Department of Surgery, University Hospital Ostrava, Czech Republic
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28
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DI Renzo C, Vitale A, D'Amico F, Cillo U. NAFLD: a multi-faceted morbid spectrum with uncertain diagnosis and complicated management. Where do we stand? Review of the literature. Minerva Surg 2021; 76:450-466. [PMID: 33855376 DOI: 10.23736/s2724-5691.21.08729-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
NASH can be considered the "contemporary era pandemic", because of its global widespread in parallel with obesity, diabetes and metabolic dysfunction. It is a disease that often poses many difficulties, since making a early diagnosis is often impossible since specific diagnostic tests and criteria are missing: so, it needs a high degree of suspicion. Most of the times the evolution to its more severe and terminal step, NASH cirrhosis, is unavoidable and so are the social pressure on health sistem and economic consequences it brings back. In this work we aim to review the literature about both NAFLD and NASH, thus structuring a wide, comprehensive, 360 degree work with a focus on all major aspects of NAFLD, spanning from diagnosis, physiopathology and its repercussions on liver transplantation. Moreover we also focused on patients related issues both in pre- and post-transplant management (when these patients are listed for liver transplant). NAFLD and NASH are a contemporary plague, and an exaustive knowledge of the problem throughout all its aspects is necessary in order to lower economic weight that metabolic issues bring back and to have a open view to possible solutions to all management issues that NASH patients have and that are oten prohibitive to a definitive cure (for example cardiovascular risk in patients otherwise eligible to liver transplantation). We aim to offer a complete view on the actual knowledge about NAFLD and NASH, by an extensive review of the literature.
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Affiliation(s)
- Chiara DI Renzo
- Hepatobiliary Surgery and Liver Transplantation, Padova University Hospital, Padova, Italy -
| | - Alessandro Vitale
- Hepatobiliary Surgery and Liver Transplantation, Padova University Hospital, Padova, Italy
| | - Francesco D'Amico
- Hepatobiliary Surgery and Liver Transplantation, Padova University Hospital, Padova, Italy
| | - Umberto Cillo
- Hepatobiliary Surgery and Liver Transplantation, Padova University Hospital, Padova, Italy
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29
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Evaluation of Liver Function Tests and Risk Score Assessment to Screen Patients for Significant Liver Disease Prior to Bariatric and Metabolic Surgery. Obes Surg 2021; 30:2840-2843. [PMID: 32124212 PMCID: PMC7260264 DOI: 10.1007/s11695-020-04486-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Bariatric and metabolic surgery is associated with significant improvement in obesity-related comorbidities, but for patients with non-alcoholic fatty liver disease (NAFLD), clinical outcomes are dependent on the severity of liver disease, i.e. improvement of NAFLD in most patients but increased risks of fulminant hepatic failure and/or bleeding varices in patients with more advanced cirrhosis. Our study showed that absolute values of liver enzymes were poor indicator of risk of liver fibrosis. The use of AST/ALT ratio, Fib 4 or NAFLD scores were appropriate screening tools, with each risk score appearing to pick out a certain phenotype of patients based on age, BMI or individual values of ALT, AST or platelet count. There is lack of agreement in some cases between FIB-4 scores and NAFLD scores when ruling out patients at high risk of liver fibrosis. Meticulous screening of patients at risk of liver fibrosis is crucial in order to reduce the risk of liver-related complications following bariatric and metabolic surgery.
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30
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Semmler G, Wernly S, Bachmayer S, Wernly B, Schwenoha L, Huber-Schönauer U, Stickel F, Niederseer D, Aigner E, Datz C. Nonalcoholic Fatty Liver Disease in Lean Subjects: Associations With Metabolic Dysregulation and Cardiovascular Risk-A Single-Center Cross-Sectional Study. Clin Transl Gastroenterol 2021; 12:e00326. [PMID: 33821832 PMCID: PMC8345908 DOI: 10.14309/ctg.0000000000000326] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/27/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Although a milder metabolic phenotype of nonalcoholic fatty liver disease (NAFLD) in lean patients (body mass index [BMI] <25 kg/m2) compared to overweight/obese patients with NAFLD is assumed, the relevance of NAFLD among lean subjects remains a matter of debate. We aimed to characterize the metabolic/cardiovascular phenotype of lean patients with NAFLD. METHODS In total, 3,043 subjects (cohort I) and 1,048 subjects (cohort II) undergoing screening colonoscopy between 2010 and 2020 without chronic liver disease other than NAFLD were assigned to one of the following groups: lean patients without NAFLD, lean NAFLD, overweight NAFLD (BMI 25-30 kg/m2), and obese NAFLD (BMI >30 kg/m2). Diagnosis of NAFLD was established using ultrasound (cohort I) and controlled attenuation parameter (cohort II). RESULTS The prevalence of lean patients with NAFLD was 6.7%/16.1% in the overall cohort I/II and 19.7%/40.0% in lean subjects of cohort I/II. Compared with lean subjects without NAFLD, lean patients with NAFLD had a higher prevalence of dyslipidemia, dysglycemia, and the metabolic syndrome, together with a higher median Framingham risk score in both cohorts (all P < 0.001). On multivariable analyses, NAFLD in lean subjects was associated with higher odds of metabolic syndrome (adjusted odds ratio cohort I: 4.27 [95% confidence interval (CI): 2.80-6.51], P < 0.001; cohort II: 2.97 [95% CI: 1.40-6.33], P < 0.001), and higher Framingham risk score (regression coefficient B cohort I: 1.93 [95% CI: 0.95-2.92], P < 0.003; cohort II: 1.09 [95% CI: 0.81-2.10], P = 0.034), among others. Only 69.8% of lean patients with NALFD in cohort I and 52.1% in cohort II fulfilled the novel criteria for metabolic associated fatty liver disease. DISCUSSION NAFLD in lean patients is associated with the metabolic syndrome and increased cardiovascular risk. Novel metabolic associated fatty liver disease criteria leave a considerable proportion of patients unclassified.
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Affiliation(s)
- Georg Semmler
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf, Salzburg, Austria
| | - Sarah Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf, Salzburg, Austria
| | - Sebastian Bachmayer
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf, Salzburg, Austria
| | - Bernhard Wernly
- Second Department of Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Lena Schwenoha
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf, Salzburg, Austria
| | - Ursula Huber-Schönauer
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf, Salzburg, Austria
| | - Felix Stickel
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - David Niederseer
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Elmar Aigner
- First Department of Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Christian Datz
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf, Salzburg, Austria
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Abdelbary M, Marzaban R, Gamal Eldeen H, Khairy M, Menesy M, Fahmy M, Ayad A, Mouheb B, Yosry A. Clinical utility of transient elastography as an imaging tool to assess the short-term impact of laparoscopic sleeve gastrectomy, together with clinical and biochemical parameters and clinico-biochemical indices, on obese patients with nonalcoholic fatty liver disease: An Egyptian pilot study. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2021. [DOI: 10.1016/j.rgmxen.2020.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Li H, Ma J, Gu L, Chen P, Chen L, Zhang X. Serum Glycocholic Acid-to-Total Bile Acid Ratio Is Independently Associated with Nonalcoholic Fatty Liver Disease: A Retrospective Cross-Sectional Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:1-10. [DOI: 10.1155/2021/6698085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Introduction and Aims. Bile acids play an essential role in the progression of nonalcoholic fatty liver disease (NAFLD). This study was aimed at investigating the association of the serum glycocholic acid- (GCA-) to-total bile acid (TBA) ratio with NAFLD in the general population. Materials and Methods. A total of 6708 subjects (2859 cases with NAFLD and 3849 controls) were enrolled in the development cohort and additional 1568 subjects (784 cases with NAFLD and 784 controls) in an independent validation cohort. Demographic characteristics and biochemical data were compared between subjects with NAFLD and controls. Multivariate logistic regression analysis was performed to determine the association of the GCA-to-TBA ratio with NAFLD. A novel model incorporating the GCA-to-TBA ratio was developed for screening NAFLD from the general population. Results. The serum TBA and GCA levels were significantly higher in subjects with NAFLD than in those without NAFLD (2.8 (2.0-4.2) μmol/L vs. 2.5 (1.8-3.7) μmol/L and 1.30 (1.10-1.53) μg/mL vs. 1.28 (1.08-1.50) μg/mL, respectively, all
), whereas the serum GCA-to-TBA ratio was significantly lower in subjects with NAFLD than in subjects without NAFLD (0.44 (0.33-0.60) vs. 0.48 (0.36-0.64),
). Logistic regression analysis showed that the GCA-to-TBA ratio was independently associated with NAFLD after adjustment for confounding factors (odds ratio: 0.81, 95% confidence interval (CI): 0.71-0.92,
). The area under the receiver operating characteristic curve of the novel developed GCA-to-TBA ratio score model in discriminating NAFLD was 0.84 (95% CI: 0.83-0.85) in the development cohort and was 0.91 (95% CI: 0.36-0.65) in the validation cohort. Conclusion. The serum GCA-to-TBA ratio is independently associated with NAFLD. A simple novel model incorporating the GCA-to-TBA ratio score has a good performance in discriminating NAFLD from the general population.
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Affiliation(s)
- Hu Li
- Department of Infectious Disease, Research Laboratory of Clinical Virology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200025, China
| | - Jin Ma
- Department of Physical Examination Center, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 201821, China
| | - Leilei Gu
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 201821, China
| | - Peizhan Chen
- Clinical Research Center, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 201821, China
| | - Li Chen
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 201821, China
| | - Xinxin Zhang
- Department of Infectious Disease, Research Laboratory of Clinical Virology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200025, China
- Clinical Research Center, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 201821, China
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Yang W, Zhao J, Zhao Y, Li W, Zhao L, Ren Y, Ou R, Xu Y. Hsa_circ_0048179 attenuates free fatty acid-induced steatosis via hsa_circ_0048179/miR-188-3p/GPX4 signaling. Aging (Albany NY) 2020; 12:23996-24008. [PMID: 33221744 PMCID: PMC7762518 DOI: 10.18632/aging.104081] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 08/17/2020] [Indexed: 12/12/2022]
Abstract
Although circular RNAs (circRNAs) are known to play key roles in non-alcoholic fatty liver disease, much about their targets and mechanisms remains unknown. We therefore investigated the actions and mechanisms of hsa_circ_0048179 in an in vitro model of NAFLD. HepG2 cells were exposed to oleate/palmitate (2:1 ratio) for 24 h to induce intracellular lipid accumulation. Using CCK-8 assays, flow cytometry, fluorescence microscopy, western blotting, RT-qPCR, and Oil red O staining, we found that oleate/palmitate treatment reduced cell viability while increasing apoptosis and lipid accumulation in HepG2 cells. Levels of the antioxidant enzyme GPX4 were decreased in oleate/palmitate-treated HepG2 cells, and there were corresponding increases in reactive oxygen species and damage to mitochondrial cristae. Levels of hsa_circ_0048179 expression were also suppressed by oleate/palmitate treatment, and GPX4 levels were markedly increased in HepG2 cells following transfection with hsa_circ_0048179. Analysis of its mechanism revealed that hsa_circ_0048179 upregulated GPX4 levels by acting as a competitive “sponge” of miR-188-3p and that hsa_circ_0048179 attenuated oleate/palmitate-induced lipid accumulation in HepG2 cells by sponging miR-188-3p. Collectively, our findings suggest that hsa_circ_0048179 may play a key role in the pathogenesis of steatosis and may thus be a useful target for drug development.
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Affiliation(s)
- Wenjun Yang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jinduo Zhao
- Department of Gynaecology and Obstetrics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ye Zhao
- Department of Gynaecology and Obstetrics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wenfeng Li
- Laboratory for Advanced Interdisciplinary Research, Institutes of Translational Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Liang Zhao
- Laboratory for Advanced Interdisciplinary Research, Institutes of Translational Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yi Ren
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, FL 32304, USA
| | - Rongying Ou
- Department of Gynaecology and Obstetrics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.,Laboratory for Advanced Interdisciplinary Research, Institutes of Translational Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yunsheng Xu
- Laboratory for Advanced Interdisciplinary Research, Institutes of Translational Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.,Department of Dermatovenereology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, China
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Tomeno W, Imajo K, Takayanagi T, Ebisawa Y, Seita K, Takimoto T, Honda K, Kobayashi T, Nogami A, Kato T, Honda Y, Kessoku T, Ogawa Y, Kirikoshi H, Sakamoto Y, Yoneda M, Saito S, Nakajima A. Complications of Non-Alcoholic Fatty Liver Disease in Extrahepatic Organs. Diagnostics (Basel) 2020; 10:E912. [PMID: 33171865 PMCID: PMC7695175 DOI: 10.3390/diagnostics10110912] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 12/13/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is now recognized as the most common chronic liver disease worldwide, along with the concurrent epidemics of metabolic syndrome and obesity. Patients with NAFLD have increased risks of end-stage liver disease, hepatocellular carcinoma, and liver-related mortality. However, the largest cause of death among patients with NAFLD is cardiovascular disease followed by extrahepatic malignancies, whereas liver-related mortality is only the third cause of death. Extrahepatic complications of NAFLD include chronic kidney disease, extrahepatic malignancies (such as colorectal cancer), psychological dysfunction, gastroesophageal reflux disease, obstructive sleep apnea syndrome, periodontitis, hypothyroidism, growth hormone deficiency, and polycystic ovarian syndrome. The objective of this narrative review was to summarize recent evidences about extrahepatic complications of NAFLD, with focus on the prevalent/incident risk of such diseases in patients with NAFLD. To date, an appropriate screening method for extrahepatic complications has not yet been determined. Collaborative care with respective experts seems to be necessary for patient management because extrahepatic complications can occur across multiple organs. Further studies are needed to reveal risk profiles at baseline and to determine an appropriate screening method for extrahepatic diseases.
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Affiliation(s)
- Wataru Tomeno
- Department of Gastroenterology, International University of Health and Welfare Atami Hospital, 13-1 Higashikaigancho, Atami-shi, Shizuoka 413-0012, Japan; (W.T.); (T.T.); (Y.E.); (K.S.); (T.T.); (K.H.); (T.K.); (Y.S.)
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (K.I.); (T.K.); (A.N.); (Y.H.); (T.K.); (Y.O.); (M.Y.); (S.S.)
| | - Kento Imajo
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (K.I.); (T.K.); (A.N.); (Y.H.); (T.K.); (Y.O.); (M.Y.); (S.S.)
| | - Takuya Takayanagi
- Department of Gastroenterology, International University of Health and Welfare Atami Hospital, 13-1 Higashikaigancho, Atami-shi, Shizuoka 413-0012, Japan; (W.T.); (T.T.); (Y.E.); (K.S.); (T.T.); (K.H.); (T.K.); (Y.S.)
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (K.I.); (T.K.); (A.N.); (Y.H.); (T.K.); (Y.O.); (M.Y.); (S.S.)
| | - Yu Ebisawa
- Department of Gastroenterology, International University of Health and Welfare Atami Hospital, 13-1 Higashikaigancho, Atami-shi, Shizuoka 413-0012, Japan; (W.T.); (T.T.); (Y.E.); (K.S.); (T.T.); (K.H.); (T.K.); (Y.S.)
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (K.I.); (T.K.); (A.N.); (Y.H.); (T.K.); (Y.O.); (M.Y.); (S.S.)
| | - Kosuke Seita
- Department of Gastroenterology, International University of Health and Welfare Atami Hospital, 13-1 Higashikaigancho, Atami-shi, Shizuoka 413-0012, Japan; (W.T.); (T.T.); (Y.E.); (K.S.); (T.T.); (K.H.); (T.K.); (Y.S.)
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (K.I.); (T.K.); (A.N.); (Y.H.); (T.K.); (Y.O.); (M.Y.); (S.S.)
| | - Tsuneyuki Takimoto
- Department of Gastroenterology, International University of Health and Welfare Atami Hospital, 13-1 Higashikaigancho, Atami-shi, Shizuoka 413-0012, Japan; (W.T.); (T.T.); (Y.E.); (K.S.); (T.T.); (K.H.); (T.K.); (Y.S.)
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (K.I.); (T.K.); (A.N.); (Y.H.); (T.K.); (Y.O.); (M.Y.); (S.S.)
| | - Kanami Honda
- Department of Gastroenterology, International University of Health and Welfare Atami Hospital, 13-1 Higashikaigancho, Atami-shi, Shizuoka 413-0012, Japan; (W.T.); (T.T.); (Y.E.); (K.S.); (T.T.); (K.H.); (T.K.); (Y.S.)
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (K.I.); (T.K.); (A.N.); (Y.H.); (T.K.); (Y.O.); (M.Y.); (S.S.)
| | - Takashi Kobayashi
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (K.I.); (T.K.); (A.N.); (Y.H.); (T.K.); (Y.O.); (M.Y.); (S.S.)
| | - Asako Nogami
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (K.I.); (T.K.); (A.N.); (Y.H.); (T.K.); (Y.O.); (M.Y.); (S.S.)
| | - Takayuki Kato
- Department of Gastroenterology, International University of Health and Welfare Atami Hospital, 13-1 Higashikaigancho, Atami-shi, Shizuoka 413-0012, Japan; (W.T.); (T.T.); (Y.E.); (K.S.); (T.T.); (K.H.); (T.K.); (Y.S.)
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (K.I.); (T.K.); (A.N.); (Y.H.); (T.K.); (Y.O.); (M.Y.); (S.S.)
| | - Yasushi Honda
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (K.I.); (T.K.); (A.N.); (Y.H.); (T.K.); (Y.O.); (M.Y.); (S.S.)
| | - Takaomi Kessoku
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (K.I.); (T.K.); (A.N.); (Y.H.); (T.K.); (Y.O.); (M.Y.); (S.S.)
| | - Yuji Ogawa
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (K.I.); (T.K.); (A.N.); (Y.H.); (T.K.); (Y.O.); (M.Y.); (S.S.)
| | - Hiroyuki Kirikoshi
- Department of Clinical Laboratory, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan;
| | - Yasunari Sakamoto
- Department of Gastroenterology, International University of Health and Welfare Atami Hospital, 13-1 Higashikaigancho, Atami-shi, Shizuoka 413-0012, Japan; (W.T.); (T.T.); (Y.E.); (K.S.); (T.T.); (K.H.); (T.K.); (Y.S.)
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (K.I.); (T.K.); (A.N.); (Y.H.); (T.K.); (Y.O.); (M.Y.); (S.S.)
| | - Masato Yoneda
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (K.I.); (T.K.); (A.N.); (Y.H.); (T.K.); (Y.O.); (M.Y.); (S.S.)
| | - Satoru Saito
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (K.I.); (T.K.); (A.N.); (Y.H.); (T.K.); (Y.O.); (M.Y.); (S.S.)
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (K.I.); (T.K.); (A.N.); (Y.H.); (T.K.); (Y.O.); (M.Y.); (S.S.)
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Bischoff SC, Bernal W, Dasarathy S, Merli M, Plank LD, Schütz T, Plauth M. ESPEN practical guideline: Clinical nutrition in liver disease. Clin Nutr 2020; 39:3533-3562. [PMID: 33213977 DOI: 10.1016/j.clnu.2020.09.001] [Citation(s) in RCA: 151] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/09/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Practical guideline is based on the current scientific ESPEN guideline on Clinical Nutrition in Liver Disease. METHODS It has been shortened and transformed into flow charts for easier use in clinical practice. The guideline is dedicated to all professionals including physicians, dieticians, nutritionists and nurses working with patients with chronic liver disease. RESULTS A total of 103 statements and recommendations are presented with short commentaries for the nutritional and metabolic management of patients with (i) acute liver failure, (ii) alcoholic steatohepatitis, (iii) non-alcoholic fatty liver disease, (iv) liver cirrhosis, and (v) liver surgery/transplantation. The disease-related recommendations are preceded by general recommendations on the diagnostics of nutritional status in liver patients and on liver complications associated with medical nutrition. CONCLUSION This practical guideline gives guidance to health care providers involved in the management of liver disease to offer optimal nutritional care.
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Affiliation(s)
- Stephan C Bischoff
- Department for Clinical Nutrition, University of Hohenheim, Stuttgart, Germany.
| | - William Bernal
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Srinivasan Dasarathy
- Division of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - Manuela Merli
- Gastroenterology and Hepatology Unit, Sapienza University of Rome, Rome, Italy
| | - Lindsay D Plank
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Tatjana Schütz
- IFB Adiposity Diseases, Leipzig University Medical Centre, Leipzig, Germany
| | - Mathias Plauth
- Department of Internal Medicine, Municipal Hospital of Dessau, Dessau, Germany
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Burra P, Becchetti C, Germani G. NAFLD and liver transplantation: Disease burden, current management and future challenges. JHEP Rep 2020; 2:100192. [PMID: 33163950 PMCID: PMC7607500 DOI: 10.1016/j.jhepr.2020.100192] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 08/06/2020] [Accepted: 08/13/2020] [Indexed: 02/07/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD), specifically its progressive form non-alcoholic steatohepatitis (NASH), represents the fastest growing indication for liver transplantation in Western countries. Diabetes mellitus, morbid obesity and cardiovascular disease are frequently present in patients with NAFLD who are candidates for liver transplantation. These factors require specific evaluation, including a detailed pre-surgical risk stratification, in order to improve outcomes after liver transplantation. Moreover, in the post-transplantation setting, the incidence of cardiovascular events and metabolic complications can be amplified by immunosuppressive therapy, which is a well-known driver of metabolic alterations. Indeed, patients with NASH are more prone to developing early post-transplant complications and, in the long-term, de novo malignancy and cardiovascular events, corresponding to higher mortality rates. Therefore, a tailored multidisciplinary approach is required for these patients, both before and after liver transplantation. Appropriate candidate selection, lifestyle modifications and specific assessment in the pre-transplant setting, as well as pharmacological strategies, adjustment of immunosuppression and a healthy lifestyle in the post-transplant setting, play a key role in correct management.
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Key Words
- CKD, chronic kidney disease
- CNI, calcineurin inhibitors
- DM, diabetes mellitus
- DPP-4, dipeptidyl peptidase-4
- ELTR, European Liver Transplant Registry
- ESLD, end-stage liver disease
- GLP1 RAs, glucagon-like peptide-1 receptor agonists
- Graft survival
- HCC, hepatocellular carcinoma
- HR, hazard ratio
- Hypertension
- IRR, incidence rate ratio
- Immunosuppressant
- LT, liver transplant
- MAFLD, metabolic dysfunction-associated fatty liver disease
- Metabolic complication
- NAFLD, non-alcoholic fatty liver disease
- NASH, non-alcoholic steatohepatitis
- New-onset diabetes after transplantation
- Non-alcoholic fatty liver disease
- Non-alcoholic steatohepatitis
- OR, odds ratio
- Obesity
- Patient survival
- SGLT2, sodium-glucose co-transporter-2
- Solid organ transplantation
- UNOS, United Network for Organ Sharing
- mTORi, mammalian target of rapamycin inhibitors
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Affiliation(s)
- Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital Padua, University of Padua, Padua, Italy
- Corresponding author. Address: Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital. Tel.: +39 0498212892; fax: + 390498217848.
| | - Chiara Becchetti
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital Padua, University of Padua, Padua, Italy
- Hepatology, Department of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Giacomo Germani
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital Padua, University of Padua, Padua, Italy
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Giuffrè M, Giuricin M, Bonazza D, Rosso N, Giraudi PJ, Masutti F, Palmucci S, Basile A, Zanconati F, de Manzini N, Tiribelli C, Palmisano S, Crocè LS. Optimization of Point-Shear Wave Elastography by Skin-to-Liver Distance to Assess Liver Fibrosis in Patients Undergoing Bariatric Surgery. Diagnostics (Basel) 2020; 10:E795. [PMID: 33036418 PMCID: PMC7601552 DOI: 10.3390/diagnostics10100795] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/01/2020] [Accepted: 10/03/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Obesity is a primary limiting factor in liver stiffness measurement (LSM). The impact of obesity has always been evaluated in terms of body mass index (BMI), without studying the effects of skin-to-liver distance (SLD) on LSM. We studied the impact of SLD on LSM in a cohort of obese patients undergoing bariatric surgery and intra-operatory liver biopsy. MATERIALS AND METHODS 299 patients underwent LSM by point-shear wave elastography (ElastPQ protocol), with two different ultrasound machines. SLD was measured as the distance between the skin and the liver capsule, perpendicular to where the region of interest (ROI) was positioned. We used the following arbitrary cut-offs: <5.7 kPa, F0-1; 5.7-7.99 kPa, F2; ≥8 kPa, F3-4. RESULTS We developed two logistic regression models using elastography-histology agreement (EHA) as the dependent variable and SLD as the independent variable. The model based on the second machine showed strongly more performant discriminative and calibration metrics (AIC 38.5, BIC 44.2, Nagelkerke Pseudo-R2 0.894, AUROC 0.90). The SLD cut-off value of 34.5 mm allowed a correct EHA with a sensitivity of 100%, a specificity of 93%, negative predictive value of 100%, positive predictive value of 87%, an accuracy of 96%, and positive likelihood ratio of 3.56. CONCLUSION The impact of SLD is machine-dependent and should be taken into consideration when interpreting LSM. We believe that our findings may serve as a reference point for appropriate fibrosis stratification by liver elastography in obese patients.
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Affiliation(s)
- Mauro Giuffrè
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (D.B.); (F.Z.); (N.d.M.); (S.P.); (L.S.C.)
- Italian Liver Foundation, 34149 Trieste, Italy; (N.R.); (P.J.G.); (C.T.)
| | - Michela Giuricin
- General Surgery Clinic, Azienda Sanitaria Universitaria Giuliano-Isontina, 34149 Trieste, Italy;
| | - Deborah Bonazza
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (D.B.); (F.Z.); (N.d.M.); (S.P.); (L.S.C.)
- Department of Pathology, Azienda Sanitaria Universitaria Giuliano-Isontina, Cattinara Hospital, 34149 Trieste, Italy
| | - Natalia Rosso
- Italian Liver Foundation, 34149 Trieste, Italy; (N.R.); (P.J.G.); (C.T.)
| | - Pablo José Giraudi
- Italian Liver Foundation, 34149 Trieste, Italy; (N.R.); (P.J.G.); (C.T.)
| | - Flora Masutti
- Liver Clinic, Azienda Sanitaria Universitaria Giuliano-Isontina, Cattinara Hospital, 34149 Trieste, Italy;
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies G.F. Ingrassia University of Catania, 95124 Catania, Italy; (S.P.); (A.B.)
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies G.F. Ingrassia University of Catania, 95124 Catania, Italy; (S.P.); (A.B.)
| | - Fabrizio Zanconati
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (D.B.); (F.Z.); (N.d.M.); (S.P.); (L.S.C.)
- Department of Pathology, Azienda Sanitaria Universitaria Giuliano-Isontina, Cattinara Hospital, 34149 Trieste, Italy
| | - Nicolò de Manzini
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (D.B.); (F.Z.); (N.d.M.); (S.P.); (L.S.C.)
- General Surgery Clinic, Azienda Sanitaria Universitaria Giuliano-Isontina, 34149 Trieste, Italy;
| | - Claudio Tiribelli
- Italian Liver Foundation, 34149 Trieste, Italy; (N.R.); (P.J.G.); (C.T.)
| | - Silvia Palmisano
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (D.B.); (F.Z.); (N.d.M.); (S.P.); (L.S.C.)
- General Surgery Clinic, Azienda Sanitaria Universitaria Giuliano-Isontina, 34149 Trieste, Italy;
| | - Lory Saveria Crocè
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (D.B.); (F.Z.); (N.d.M.); (S.P.); (L.S.C.)
- Italian Liver Foundation, 34149 Trieste, Italy; (N.R.); (P.J.G.); (C.T.)
- Liver Clinic, Azienda Sanitaria Universitaria Giuliano-Isontina, Cattinara Hospital, 34149 Trieste, Italy;
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Abdelbary MS, Marzaban R, Gamal Eldeen H, Khairy M, Menesy M, Fahmy MH, Ayad AM, Mouheb BS, Yosry A. Clinical utility of transient elastography as an imaging tool to assess the short-term impact of laparoscopic sleeve gastrectomy, together with clinical and biochemical parameters and clinico-biochemical indices, on obese patients with nonalcoholic fatty liver disease: An Egyptian pilot study. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2020; 86:125-132. [PMID: 33004251 DOI: 10.1016/j.rgmx.2020.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/08/2020] [Accepted: 04/08/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Nonalcoholic fatty liver disease (NAFLD) is a metabolic liver disorder commonly attributed to fatty acid deposition that can induce hepatic necroinflammation, defined as nonalcoholic steatohepatitis (NASH). It is strongly associated with obesity. Laparoscopic sleeve gastrectomy (LSG) is a favorable surgical modality for the treatment of morbid obesity. AIM Our study evaluated the impact of LSG on patients with NAFLD and morbid obesity, 3 months after the operation, through clinical and biochemical characteristics, clinico-biochemical indices, and imaging parameters. PATIENTS AND METHODS Morbidly obese patients with NAFLD±NASH underwent LSG. They were thoroughly evaluated clinically (body weight, body mass index, waist circumference) and biochemically (transaminases and triglycerides), as well as through the fatty liver index (FLI), the hepatic steatosis index (HSI), and ultrasound elastography imaging studies (liver stiffness measurement [LSM] and the controlled attenuation parameter [CAP]), before and 3 months after the LSG. RESULTS Twenty-six obese patients with NAFLD underwent LSG that resulted in a significantly high reduction in all the parameters analyzed, except for liver transaminases. CONCLUSION LSG is considered an efficient surgical modality for the treatment of morbidly obese patients with NAFLD.
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Affiliation(s)
- M S Abdelbary
- Departamento de Medicina Tropical, Facultad de Medicina, Universidad de El Cairo, El Cairo, Egipto
| | - R Marzaban
- Departamento de Medicina Tropical, Facultad de Medicina, Universidad de El Cairo, El Cairo, Egipto.
| | - H Gamal Eldeen
- Departamento de Medicina Tropical, Facultad de Medicina, Universidad de El Cairo, El Cairo, Egipto
| | - M Khairy
- Departamento de Medicina Tropical, Facultad de Medicina, Universidad de El Cairo, El Cairo, Egipto
| | - M Menesy
- Departamento de Medicina Tropical, Facultad de Medicina, Universidad de El Cairo, El Cairo, Egipto
| | - M H Fahmy
- Departamento de Cirugía General, Facultad de Medicina, Universidad de El Cairo, El Cairo, Egipto
| | - A M Ayad
- Departamento de Cirugía General, Facultad de Medicina, Universidad de El Cairo, El Cairo, Egipto
| | - B S Mouheb
- Departamento de Cirugía General, Facultad de Medicina, Universidad de El Cairo, El Cairo, Egipto
| | - A Yosry
- Departamento de Cirugía General, Facultad de Medicina, Universidad de El Cairo, El Cairo, Egipto
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Campani C, Bensi C, Milani S, Galli A, Tarocchi M. Resection of NAFLD-Associated HCC: Patient Selection and Reported Outcomes. J Hepatocell Carcinoma 2020; 7:107-116. [PMID: 32802809 PMCID: PMC7398743 DOI: 10.2147/jhc.s252506] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/10/2020] [Indexed: 01/27/2023] Open
Abstract
Global prevalence of non-alcoholic fatty liver disease (NAFLD) has been growing in the last decades, especially in western countries, due to increased prevalence of diabetes, obesity or other components of metabolic syndrome. NAFLD recently became an important cause of hepatocellular carcinoma (HCC), even in non-cirrhotic patients. Patients with HCC-NAFLD are usually older, with more morbidities (especially cardiovascular diseases and metabolic disorders) and have advanced disease at the diagnosis due to the absence of surveillance, which is considered not cost-effective in patients without advanced fibrosis/cirrhosis, given the large prevalence of NAFLD in the general population. For these reasons, patients with HCC-NAFLD unlikely underwent curative treatments, and have been reported to have lower overall survival (OS) compared to individuals with HCC related to other aetiologies. However, this difference is not confirmed by data of patient subgroups who received curative treatment. In our review, we selected studies published over the past 8 years that analyse characteristics and outcomes of HCC-NAFLD patients who underwent surgery with the aim of identifying features that could predict outcomes and potential selection criteria. All the studies confirm that patients with HCC-NAFLD are older, with many comorbidities and that HCC occurs frequently even in non-cirrhotic livers. There is no agreement about intraoperative and perioperative complications. Regarding outcomes, all papers agree that patients with HCC in NAFLD who undergo surgery have a better OS compared to other aetiologies. Summarizing, surgery is a good curative option for patients with HCC-NAFLD, perhaps even better than transplantation in terms of OS. In this group of patients, it seems to be essential to evaluate cardio-pulmonary and general operative risk, in addition to the normal risk assessment related to liver function to avoid an underestimation, especially for patients without severe underlying fibrosis.
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Affiliation(s)
- Claudia Campani
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Carolina Bensi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Stefano Milani
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Andrea Galli
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Mirko Tarocchi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
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Mądry E, Malesza IJ, Subramaniapillai M, Czochralska-Duszyńska A, Walkowiak M, Miśkiewicz-Chotnicka A, Walkowiak J, Lisowska A. Body Fat Changes and Liver Safety in Obese and Overweight Women Supplemented with Conjugated Linoleic Acid: A 12-Week Randomised, Double-Blind, Placebo-Controlled Trial. Nutrients 2020; 12:nu12061811. [PMID: 32560516 PMCID: PMC7353155 DOI: 10.3390/nu12061811] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/03/2020] [Accepted: 06/16/2020] [Indexed: 12/25/2022] Open
Abstract
Preliminary evidence suggests that conjugated linoleic acid (CLA) may reduce body weight and affect body composition. The present study assessed the effect of CLA supplementation on body fat composition in overweight and obese women, while also evaluating the liver safety of CLA use. Seventy-four obese or overweight women were randomly assigned to receive 3 g/day CLA or placebo for 12 weeks. Body composition (dual-energy X-ray absorptiometry) and liver function (13C-methacetin breath test and serum liver enzymes) were assessed before and after the trial. Patients receiving CLA experienced a significant reduction of total body fat expressed as mass (p = 0.0007) and percentage (p = 0.0006), android adipose tissue (p = 0.0002), gynoid adipose tissue (p = 0.0028), and visceral adipose tissue (p = 4.2 × 10−9) as well as a significant increase in lean body mass to height (p = 6.1 × 10−11) when compared to those receiving a placebo. The maximum momentary 13C recovery changes and end-point values were significantly higher in the CLA group when compared to the placebo group (p = 0.0385 and p = 0.0076, respectively). There were no significant changes in alanine aminotransferase, asparagine aminotransferase, and gamma-glutamyl transpeptidase activities between the groups. In conclusion, CLA supplementation was well tolerated and safe for the liver, which shows beneficial effects on fat composition in overweight and obese women.
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Affiliation(s)
- Edyta Mądry
- Department of Physiology, Poznan University of Medical Sciences, 61701 Poznań, Poland; (M.S.); (A.C.-D.)
- Correspondence: ; Tel.: +48-501-728-956
| | - Ida Judyta Malesza
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, 61701 Poznań, Poland; (I.J.M.); (A.M.-C.); (J.W.)
| | - Mehala Subramaniapillai
- Department of Physiology, Poznan University of Medical Sciences, 61701 Poznań, Poland; (M.S.); (A.C.-D.)
| | | | - Marek Walkowiak
- Division of Reproduction, Department of Gynecology and Obstetrics, Poznan University of Medical Sciences, 61701 Poznań, Poland;
| | - Anna Miśkiewicz-Chotnicka
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, 61701 Poznań, Poland; (I.J.M.); (A.M.-C.); (J.W.)
| | - Jarosław Walkowiak
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, 61701 Poznań, Poland; (I.J.M.); (A.M.-C.); (J.W.)
| | - Aleksandra Lisowska
- Department of Clinical Auxology and Pediatric Nursing, Poznan University of Medical Sciences, 61701 Poznań, Poland;
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Cotter TG, Rinella M. Nonalcoholic Fatty Liver Disease 2020: The State of the Disease. Gastroenterology 2020; 158:1851-1864. [PMID: 32061595 DOI: 10.1053/j.gastro.2020.01.052] [Citation(s) in RCA: 709] [Impact Index Per Article: 177.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/09/2020] [Accepted: 01/11/2020] [Indexed: 02/07/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease, with a worldwide prevalence of 25%. In the United States, NAFLD and its subtype, nonalcoholic steatohepatitis, affect 30% and 5% of the population, respectively. Considering the ongoing obesity epidemic beginning in childhood, the rise in diabetes, and other factors, the prevalence of NAFLD along with the proportion of those with advanced liver disease is projected to continue to increase. This will have an important impact on public health reflected in health care costs, including impact on the need for liver transplantation, for which nonalcoholic steatohepatitis is already close to becoming the most common indication. NAFLD patients with evidence of nonalcoholic steatohepatitis and advanced fibrosis are at markedly increased risk of adverse outcomes, including overall mortality, and liver-specific morbidity and mortality, respectively. Identification of this cohort of NAFLD patients is paramount, given the associated poorer outcomes, in order to target resources to those who need it most. Various noninvasive tools have been developed in this regard. This review provides an update on the epidemiology, clinical and prognostic features, and diagnostic approach to patients with NAFLD.
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Affiliation(s)
- Thomas G Cotter
- Division of Gastroenterology and Hepatology, The University of Chicago Medicine, Chicago, Illinois
| | - Mary Rinella
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Talavera-Urquijo E, Beisani M, Balibrea JM, Alverdy JC. Is bariatric surgery resolving NAFLD via microbiota-mediated bile acid ratio reversal? A comprehensive review. Surg Obes Relat Dis 2020; 16:1361-1369. [PMID: 32336663 DOI: 10.1016/j.soard.2020.03.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 01/18/2020] [Accepted: 03/11/2020] [Indexed: 02/07/2023]
Abstract
Despite the fact that there is still insufficient evidence to consider non-alcoholic fatty liver disease (NAFLD) as an stand-alone indication for bariatric surgery, many clinical and histopathological beneficial effects on both NAFLD and non-alcoholic steatohepatitis (NASH) have been shown. Although weight loss seems to be the obvious mechanism, weight-loss independent factors are also believed to be involved. Among them, changes in gut microbiota and bile acids (BA) composition may be playing an unappreciated role in the improvement of NAFLD. In this review we examine the mechanisms and interdependence of the gut microbiota and BA, and their influence on NAFLD pathogenesis and its reversal following bariatric surgery. According to the currently available evidence, gut microbiota has a major influence on BA composition. In fact, both BA and microbiome disturbances (dysbiosis) play a role in the etiopathogenesis of NAFLD and might be potential therapeutic targets. In addition, bariatric surgery can modify the intraluminal ileal environment in a way that causes significant repopulation of the gut microbiota and a reversal of the plasma primary/secondary BA ratio, which, in turn, induces weigh-independent metabolic improvements.
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Affiliation(s)
- Eider Talavera-Urquijo
- Department of General & Digestive Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marc Beisani
- Department of Surgery, Hospital del Mar, Barcelona, Spain
| | - José M Balibrea
- Department of Gastrointestinal Surgery, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.
| | - John C Alverdy
- Department of Surgery University of Chicago, Pritzker School of Medicine, Chicago, Illinois
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Abstract
Nonalcoholic fatty liver disease (NAFLD) is considered the hepatic manifestation of the metabolic syndrome (MetS) and comprises one of the largest health threats of the twenty-first century. In this chapter, we review the current state of knowledge of NAFLD and underline the striking similarities with atherosclerosis. We first describe current epidemiological data showing the staggering increase of NAFLD numbers and its related clinical and economic costs. We then provide an overview of pathophysiological hepatic processes in NAFLD and highlight the systemic aspects of NAFLD that point toward metabolic crosstalk between organs as an important cause of metabolic disease. Finally, we end by highlighting the currently investigated therapeutic approaches for NAFLD, which also show strong similarities with a range of treatment options for atherosclerosis.
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Cotter TG, Charlton M. Nonalcoholic Steatohepatitis After Liver Transplantation. Liver Transpl 2020; 26:141-159. [PMID: 31610081 DOI: 10.1002/lt.25657] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/07/2019] [Indexed: 02/07/2023]
Abstract
Currently, nonalcoholic steatohepatitis (NASH) is the second leading indication for liver transplantation (LT), behind alcohol-related liver disease. After transplant, both recurrent and de novo nonalcoholic fatty liver disease are common; however, recurrence rates of NASH and advanced fibrosis are low. Identification of high-risk groups and optimizing treatment of metabolic comorbidities both before and after LT is paramount to maintaining a healthy allograft, especially with the additional consequences of longterm immunosuppression. In addition, NASH LT recipients are at an increased risk of cardiovascular events and malignancy, and their condition warrants a tailored approach to management. The optimal approach to NASH LT recipients including metabolic comorbidities management, tailored immunosuppression, the role of bariatric surgery, and nutritional and pharmacotherapy of NASH are discussed in this review. Overall, aggressive management of metabolic syndrome after LT via medical and surgical modalities and a minimalist approach to immunosuppression is advised.
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Affiliation(s)
- Thomas G Cotter
- Center for Liver Diseases, The University of Chicago Medicine, Chicago, IL
| | - Michael Charlton
- Center for Liver Diseases, The University of Chicago Medicine, Chicago, IL
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45
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Jain AK, le Roux CW, Puri P, Tavakkoli A, Gletsu-Miller N, Laferrère B, Kellermayer R, DiBaise JK, Martindale RG, Wolfe BM. Proceedings of the 2017 ASPEN Research Workshop-Gastric Bypass: Role of the Gut. JPEN J Parenter Enteral Nutr 2019; 42:279-295. [PMID: 29443403 DOI: 10.1002/jpen.1121] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 11/16/2017] [Indexed: 12/11/2022]
Abstract
The goal of the National Institutes of Health-funded American Society for Parenteral and Enteral Nutrition 2017 research workshop (RW) "Gastric Bypass: Role of the Gut" was to focus on the exciting research evaluating gut-derived signals in modulating outcomes after bariatric surgery. Although gastric bypass surgery has undoubted positive effects, the mechanistic basis of improved outcomes cannot be solely explained by caloric restriction. Emerging data suggest that bile acid metabolic pathways, luminal contents, energy balance, gut mucosal integrity, as well as the gut microbiota are significantly modulated after bariatric surgery and may be responsible for the variable outcomes, each of which was rigorously evaluated. The RW served as a timely and novel academic meeting that brought together clinicians and researchers across the scientific spectrum, fostering a unique venue for interdisciplinary collaboration among investigators. It promoted engaging discussion and evolution of new research hypotheses and ideas, driving the development of novel ameliorative, therapeutic, and nonsurgical interventions targeting obesity and its comorbidities. Importantly, a critical evaluation of the current knowledge regarding gut-modulated signaling after bariatric surgery, potential pitfalls, and lacunae were thoroughly addressed.
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Affiliation(s)
- Ajay Kumar Jain
- Department of Pediatrics, SSM Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Carel W le Roux
- Diabetes Complications Research Center, University College Dublin, School of Medicine, Dublin, Ireland
| | - Puneet Puri
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, Vieginia, USA
| | - Ali Tavakkoli
- Brigham and Women's Hospital, Center for Weight Management and Metabolic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Blandine Laferrère
- Department of Medicine, Division of Endocrinology, Columbia University, New York, New York, USA
| | | | - John K DiBaise
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Bruce M Wolfe
- Oregon Health and Science University, Portland, Oregon, USA
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Khoudari G, Singh A, Noureddin M, Fritze D, Lopez R, Asaad I, Lawitz E, Poordad F, Kowdley KV, Alkhouri N. Characterization of patients with both alcoholic and nonalcoholic fatty liver disease in a large United States cohort. World J Hepatol 2019; 11:710-718. [PMID: 31749901 PMCID: PMC6856017 DOI: 10.4254/wjh.v11.i10.710] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/03/2019] [Accepted: 10/15/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the metabolic syndrome (MetS) and is characterized by steatosis in the absence of significant alcohol consumption. However, MetS and significant alcohol intake coexist in certain individuals which may lead to the development of BAFLD.
AIM To assess the clinical characteristics of patients with both alcoholic and NAFLD (BAFLD) in a large cohort in the United States.
METHODS Adults from the National Health and Nutrition Examination Survey between 2003-2014 were included. NAFLD was diagnosed based on elevated alanine aminotransferase (ALT) and being overweight or obese in the absence of other liver diseases. BAFLD patients met the criteria for NAFLD but also had either MetS or type 2 diabetes and consumed excessive amounts of alcohol. Univariable and multivariable analysis were performed to assess differences between NAFLD and BAFLD and to compare severity based on a validated fibrosis score (FIB4 index).
RESULTS The prevalence of NAFLD was at 25.9% (95%CI; 25.1-26.8) and that of BAFLD was 0.84% (0.67, 1.02) which corresponds to an estimated 1.24 million Americans affected by BAFLD. Compared to NAFLD, patients with BAFLD were more likely to be male, smokers, have higher ALT, aspartate aminotransferase, triglycerides, and lower platelets; P < 0.01 for all. More importantly, after adjusting for MetS components, BAFLD patients were significantly more likely to have advanced fibrosis [adjusted OR (95%CI) based on FIB4 index > 2.67 was 3.2 (1.4, 7.0), P = 0.004].
CONCLUSION A significant percentage of the American general population is afflicted by BAFLD and these patients tend to have more advanced liver fibrosis.
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Affiliation(s)
- George Khoudari
- Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
| | - Amandeep Singh
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Mazen Noureddin
- Department of Gastroenterology and Hepatology, Cedars Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Danielle Fritze
- Department of General Surgery, Texas Liver Institute and University of Texas Health, San Antonio, TX 78215, United States
| | - Rocio Lopez
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Imad Asaad
- Department of Gastroenterology, Metro Health System, Cleveland, OH 44109, United States
| | - Eric Lawitz
- Texas Liver Institute and University of Texas Health, San Antonio, TX 78215, United States
| | - Fred Poordad
- Texas Liver Institute and University of Texas Health, San Antonio, TX 78215, United States
| | - Kris V Kowdley
- Swedish Liver Care Network, Swedish Medical Center, Seattle, WA 98122, United States
| | - Naim Alkhouri
- Texas Liver Institute and University of Texas Health, San Antonio, TX 78215, United States
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Jimenez LS, Mendonça Chaim FH, Mendonça Chaim FD, Utrini MP, Gestic MA, Chaim EA, Cazzo E. Impact of Weight Regain on the Evolution of Non-alcoholic Fatty Liver Disease After Roux-en-Y Gastric Bypass: a 3-Year Follow-up. Obes Surg 2019; 28:3131-3135. [PMID: 29725976 DOI: 10.1007/s11695-018-3286-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The influence of post-surgical weight regain on the course of non-alcoholic fatty liver disease (NAFLD) is unclear. OBJECTIVE To evaluate the influence of weight regain on the NAFLD assessed by means of a non-invasive score after Roux-en-gastric bypass (RYGB) over a 3-year period. METHODS This is a prospective observational cohort study which evaluated individuals who underwent RYGB. Comparisons were made between the periods immediately before surgery and 12, 24, and 36 months following surgery. Liver disease was estimated by means of the NAFLD fibrosis score. Individuals were classified into three categories according to weight regain status: (1) no weight regain, (2) expected weight regain (regain less or equal than 20% of the maximal weight lost), (3) obesity recidivism (regain above 20% of the maximal weight lost). RESULTS Of 90 patients analyzed after 3 years of surgery, 35.6% presented obesity recidivism and 28.8% of the expected regain; 35.6% presented no regain. There was no difference in baseline fibrosis score between groups; at 3 years, the score observed in the relapse group was significantly higher than that observed in the other two groups (p = 0.015). The percent variation of the fibrosis score was significantly higher in the recidivism group (+ 11.8 ± 77.2%) than in the expected regain (- 45.6 ± 64.5%) and no regain (- 37.8 ± 63.2%) groups (p = 0.013). CONCLUSION Long-term significant post-RYGB weight regain is associated with a significantly attenuated improvement of NAFLD evaluated by means of liver fibrosis score.
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Affiliation(s)
- Laísa Simakawa Jimenez
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13085-000, Brazil
| | - Fábio Henrique Mendonça Chaim
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13085-000, Brazil
| | - Felipe David Mendonça Chaim
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13085-000, Brazil
| | - Murillo Pimentel Utrini
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13085-000, Brazil
| | - Martinho Antonio Gestic
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13085-000, Brazil
| | - Elinton Adami Chaim
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13085-000, Brazil
| | - Everton Cazzo
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13085-000, Brazil.
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Gils Contreras A, Bonada Sanjaume A, Montero Jaime M, Rabassa Soler A, Sabench Pereferrer F, Molina López A, Becerra Tomás N, Del Castillo Déjardin D, Salas-Salvadó J. Effects of Two Preoperatory Weight Loss Diets on Hepatic Volume, Metabolic Parameters, and Surgical Complications in Morbid Obese Bariatric Surgery Candidates: a Randomized Clinical Trial. Obes Surg 2019; 28:3756-3768. [PMID: 30109669 DOI: 10.1007/s11695-018-3413-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess which type of preoperative dietary strategy is most effective in reducing liver volume and assessing its influence on different biochemical parameters and on surgical complications in individuals undergoing bariatric surgery. METHODS Parallel randomized trial comparing the effect of a very low calorie diet (VLCD) and a low calorie diet (LCD) for a period of 21 days before surgery on hepatic volume, anthropometric and biochemical parameters. Compliance and tolerance to the diets, surgical complications, and hospital stay were also determined. RESULTS Eighty-six morbid obese participants undergoing bariatric surgery were randomized. The hepatic volume was significantly reduced in both intervention groups, but no differences in changes between groups were detected. The reduction in the hepatic volume was higher in those patients with a baseline hepatic volume > 3 L compared to those with < 3 L (adjusted P value < 0.001). The percentages of total weight lost were 5.8 and 4.2% (adjusted P value = 0.004) for participants on the VLCD and LCD, respectively. There were no differences between groups for any of the biochemical parameters analyzed, nor in the number of surgical complications nor the length of hospital stay. Adherence to the diet was good; nevertheless, participants in the VLCD intervention showed worse tolerance. CONCLUSIONS In subjects with morbid obesity undergoing bariatric surgery, compared to a LCD, a preoperative 21-day intervention with VLCD is more effective in terms of reducing total body weight but not in terms of reducing the liver volume. Both types of preoperative diets have similar effects on clinical biochemical parameters, rate of surgical complications, and hospital length stay.
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Affiliation(s)
- A Gils Contreras
- Nutrition Unit, Department of Internal Medicine, University Hospital of Sant Joan, Reus, Spain.,Human Nutrition Unit, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, C/Sant Llorenç 21, 43201, Reus, Spain
| | - A Bonada Sanjaume
- Nutrition Unit, Department of Internal Medicine, University Hospital of Sant Joan, Reus, Spain.,Human Nutrition Unit, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, C/Sant Llorenç 21, 43201, Reus, Spain
| | - M Montero Jaime
- Diagnostic Service for the Image, Department of Radiology, University Hospital of Sant Joan, Reus, Spain
| | - A Rabassa Soler
- Nutrition Unit, Department of Internal Medicine, University Hospital of Sant Joan, Reus, Spain.,Human Nutrition Unit, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, C/Sant Llorenç 21, 43201, Reus, Spain
| | - F Sabench Pereferrer
- Bariatric and Metabolic Surgery Unit, General and Digestive Surgery Department, University Hospital of Sant Joan, Reus, Spain.,Surgery Service, Sant Joan University Hospital, Faculty of Medicine and Health Sciences, IISPV, Rovira i Virgili University, Reus, Spain
| | - A Molina López
- Bariatric and Metabolic Surgery Unit, General and Digestive Surgery Department, University Hospital of Sant Joan, Reus, Spain
| | - N Becerra Tomás
- Human Nutrition Unit, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, C/Sant Llorenç 21, 43201, Reus, Spain.,Consorcio CIBER, M.P., Physiopathology of Obesity and Nutrition (CIBERobn), Instituto de Salud Carlos III (ISCIII), 28029, Madrid, Spain
| | - D Del Castillo Déjardin
- Bariatric and Metabolic Surgery Unit, General and Digestive Surgery Department, University Hospital of Sant Joan, Reus, Spain. .,Surgery Service, Sant Joan University Hospital, Faculty of Medicine and Health Sciences, IISPV, Rovira i Virgili University, Reus, Spain.
| | - J Salas-Salvadó
- Nutrition Unit, Department of Internal Medicine, University Hospital of Sant Joan, Reus, Spain. .,Human Nutrition Unit, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, C/Sant Llorenç 21, 43201, Reus, Spain. .,Consorcio CIBER, M.P., Physiopathology of Obesity and Nutrition (CIBERobn), Instituto de Salud Carlos III (ISCIII), 28029, Madrid, Spain.
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49
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Luger M, Kruschitz R, Winzer E, Schindler K, Grabovac I, Kainberger F, Krebs M, Hoppichler F, Langer F, Prager G, Marculescu R, Ludvik B. Changes in Bone Mineral Density Following Weight Loss Induced by One-Anastomosis Gastric Bypass in Patients with Vitamin D Supplementation. Obes Surg 2019; 28:3454-3465. [PMID: 29968187 DOI: 10.1007/s11695-018-3353-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Little is known about changes in bone mineral density (BMD) following weight loss after one-anastomosis gastric bypass (OAGB) and the role of serum vitamin D and its supplementation on bone metabolism. We evaluated BMD after OAGB as a function of vitamin D supplementation with respect to a minimum threshold of 25-hydroxy-vitamin-D [25(OH)D] concentration, which could prevent or decelerate an eventual bone loss. METHODS Fifty bariatric patients who participated in the randomized controlled trial were included in this analysis. BMD and anthropometric measurements by DXA and laboratory parameters were assessed before (T0), at 6 (T6), and 12 months (T12) after surgery. RESULTS OAGB resulted in a 36% total body weight loss with a decrease in body fat and an increase in lean body mass. A significant decrease in BMD was seen in lumbar spine by 7%, left hip 13%, and total body 1%, but not in forearm. Bone turnover markers increased significantly but with normal parathyroid hormone concentrations. Weight loss was not associated with changes in BMD. A serum 25(OH)D concentration > 50 nmol/l at T6 and T12 (adequate-vitamin-D-group; AVD) showed a significant lower bone loss, compared to the inadequate-vitamin-D-group (IVD; < 50 nmol/l). Lower bone loss in the left hip showed a strong correlation with higher 25(OH)D concentrations (r = 0.635, p = 0.003). CONCLUSION These findings support a dose effect of vitamin D supplementation on bone health and suggest that 25(OH)D concentrations need to be above 50 nmol/l at least during the first postoperative year to decelerate bone loss in patients undergoing OAGB. CLINICAL TRIAL REGISTRY NUMBER AND WEBSITE Clinicaltrials.gov (NCT02092376) at https://clinicaltrials.gov /. EudraCT (2013-003546-16) at https://eudract.ema.europa.eu /.
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Affiliation(s)
- Maria Luger
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Special Institute for Preventive Cardiology And Nutrition-SIPCAN, Rabenfleckweg 8, Elsbethen, 5061, Salzburg, Austria.,Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria
| | - Renate Kruschitz
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Division of Internal Medicine, General public hospital of the Order of Saint Elisabeth, Völkermarkter Straße 15-19, 9020, Klagenfurt, Austria
| | - Eva Winzer
- Special Institute for Preventive Cardiology And Nutrition-SIPCAN, Rabenfleckweg 8, Elsbethen, 5061, Salzburg, Austria. .,Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria.
| | - Karin Schindler
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Igor Grabovac
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria
| | - Franz Kainberger
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Michael Krebs
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Friedrich Hoppichler
- Special Institute for Preventive Cardiology And Nutrition-SIPCAN, Rabenfleckweg 8, Elsbethen, 5061, Salzburg, Austria.,Division of Internal Medicine, Krankenhaus der Barmherzigen Brüde Salzburgr, Kajetanerplatz 1, 5010, Salzburg, Austria
| | - Felix Langer
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Gerhard Prager
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Rodrig Marculescu
- Clinical Institute for Medical and Chemical Laboratory Diagnostics, Department of Laboratory Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Bernhard Ludvik
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Department of Medicine 1 and Karl Landsteiner Institute for Obesity and Metabolic Diseases, Rudolfstiftung Hospital, Juchgasse 25, 1030, Vienna, Austria
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50
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Arieira C, Monteiro S, Xavier S, Dias de Castro F, Magalhães J, Marinho C, Pinto R, Costa W, Pinto Correia J, Cotter J. Transient elastography: should XL probe be used in all overweight patients? Scand J Gastroenterol 2019; 54:1022-1026. [PMID: 31322445 DOI: 10.1080/00365521.2019.1644367] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Obesity is one of the main factors of transient elastography (TE) failure, considering body mass index (BMI) ≥28 kg/m2 as a limiting factor. The XL probe was designed to overcome this limitation. Aim: To compare the feasibility of the M and XL probes in patients with BMI ≥ 28 kg/m2, to evaluate differences in mean values of controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) between the two probes and find predictive factors of TE failure. Material and methods: Prospective study, including all patients with BMI ≥ 28 kg/m2 consecutively admitted for TE. Results: Included 161 patients. Measurements with M probe were reliable in 69.6% of the patients, with 68.2% of valid measurements in obese population and 58.9% in patients with skin-capsule distance (SCD) >25 mm. In 40 patients (81.6%) with an invalid M probe measurement, a reliable result was obtained with XL probe. We found that SCD >25 mm was the only predictor of M probe failure (OR: 4.9, CI: 1.64-14.63, p = .004). In those patients in which TE was possible with both probes (n = 112), mean CAP was 304 ± 49 dB/m2 with M probe and 301 ± 50 dB/m2 with XL probe (p = .59). Regarding liver stiffness, a mean value of 7.58 ± 3.47 kpas was obtained with the M probe and 6.21 ± 3.44 kpas with the XL probe (p < .001). Conclusion: There is a reliable applicability of the M probe in a high number (68.2%) of patients with a BMI ≥30 kg/m2. A SCD >25 mm was the only predictive factor of M probe failure. Mean values of LSM with XL probe were lower than those obtained with M probe.
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Affiliation(s)
- Cátia Arieira
- Gastroenterology Department, Hospital da Senhora da Oliveira , Guimarães , Portugal.,Life and Health Sciences Research Institute, School of Medicine, University of Minho , Braga/Guimarães , Portugal.,ICVS/3B's, PT Government Associate Laboratory , Braga/Guimarães , Portugal
| | - Sara Monteiro
- Gastroenterology Department, Hospital da Senhora da Oliveira , Guimarães , Portugal.,Life and Health Sciences Research Institute, School of Medicine, University of Minho , Braga/Guimarães , Portugal.,ICVS/3B's, PT Government Associate Laboratory , Braga/Guimarães , Portugal
| | - Sofia Xavier
- Gastroenterology Department, Hospital da Senhora da Oliveira , Guimarães , Portugal.,Life and Health Sciences Research Institute, School of Medicine, University of Minho , Braga/Guimarães , Portugal.,ICVS/3B's, PT Government Associate Laboratory , Braga/Guimarães , Portugal
| | - Francisca Dias de Castro
- Gastroenterology Department, Hospital da Senhora da Oliveira , Guimarães , Portugal.,Life and Health Sciences Research Institute, School of Medicine, University of Minho , Braga/Guimarães , Portugal.,ICVS/3B's, PT Government Associate Laboratory , Braga/Guimarães , Portugal
| | - Joana Magalhães
- Gastroenterology Department, Hospital da Senhora da Oliveira , Guimarães , Portugal.,Life and Health Sciences Research Institute, School of Medicine, University of Minho , Braga/Guimarães , Portugal.,ICVS/3B's, PT Government Associate Laboratory , Braga/Guimarães , Portugal
| | - Carla Marinho
- Gastroenterology Department, Hospital da Senhora da Oliveira , Guimarães , Portugal.,Life and Health Sciences Research Institute, School of Medicine, University of Minho , Braga/Guimarães , Portugal.,ICVS/3B's, PT Government Associate Laboratory , Braga/Guimarães , Portugal
| | - Rui Pinto
- Surgery Department, Hospital da Senhora da Oliveira , Guimarães , Portugal
| | - Washington Costa
- Surgery Department, Hospital da Senhora da Oliveira , Guimarães , Portugal
| | - José Pinto Correia
- Surgery Department, Hospital da Senhora da Oliveira , Guimarães , Portugal
| | - José Cotter
- Gastroenterology Department, Hospital da Senhora da Oliveira , Guimarães , Portugal.,Life and Health Sciences Research Institute, School of Medicine, University of Minho , Braga/Guimarães , Portugal.,ICVS/3B's, PT Government Associate Laboratory , Braga/Guimarães , Portugal
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