Attenuation Parameter Research Articles

OR24-06 The Role Of Oxidative Stress In The Association Of Smoking And Alcohol Consumption With Hepatic Steatosis

Abstract Disclosure: M. Shaheen: None. K. Schrode: None. D. Pan: None. S.M. Najjar: None. T.C. Friedman: None. Hepatic steatosis (HS) is the most prevalent chronic liver disease in the United States. While heavy alcohol consumption is known to be a risk factor for HS, the effect of moderate consumption is still debated. Similarly, while smoking is a known risk factor for many chronic conditions, its contribution to HS is still in question. A potential mechanism by which these factors could increase risk for HS is through oxidative stress. Oxidative stress is an imbalance between free radicals and antioxidants in the body that causes inflammation and cellular damage. Behaviors such as smoking and alcohol consumption are thought to increase oxidative stress. This study aims to determine the role of oxidative stress in the relationship between smoking and moderate alcohol consumption with HS among the adult population of the United States. We analyzed data for 3444 participants from the National Health and Nutrition Examination Survey 2017-2018. Hepatic steatosis was measured by FibroScan® using controlled attenuation parameter (CAP) values, and we used levels of γ-glutamyltransferase (GGT) as a biomarker for oxidative stress. We categorized alcohol consumption and smoking as none, former (for smoking), light, and moderate-heavy following the National Center for Health Statistics. We used bivariate chi square analysis and multivariable logistic regression adjusting for the demographics, laboratory, and co-morbidity and consider the design and weight. We developed two models with and without oxidative stress. In bivariate analyses, oxidative stress was significantly associated with heavier smoking and alcohol consumption, and with HS (all p<0.05). A multivariable model without oxidative stress showed that light drinking alone, light smoking alone, and combination of light smoking and light drinking were not associated with HS (p>0.05), but moderate-heavy smoking combined with light drinking or moderate-heavy drinking increased the odds of HS compared to abstinence from both smoking and drinking (Adjusted Odds Ratio [AOR]=3.9, 95% Confidence Interval [95% CI]= 1.5 - 10.2, p=0.006; AOR=6.2, 95% CI= 1.4 - 26.9, p= 0.014, respectively). When we included oxidative stress in the model, oxidative stress was independently associated with HS (AOR=1.1, 95% Ci=1.0-1.1, p=0.011) and the odds ratios for the interaction of smoking and alcohol did not change, indicating that oxidative stress was not a mediator of these relationships. Our findings indicated that smoking and alcohol consumption can interact to increase the odds of HS in the US population independent of oxidative stress. Further research is needed to identify the underlying mechanisms.Grants: R01MD012579, R24DA017298, U54MD007598, S21MD000103, UL1TR001881 Presentation: Saturday, June 17, 2023

Nanocomposites Based on Polyethylene and Nickel Ferrite: Preparation, Characterization, and Properties.

Composite materials based on NiFe2O4 nanoparticles and polyethylene matrix have been synthesized by thermal decomposition to expand the application area of high-pressure polyethylene by filling it with nanoscale particles. The synthesized compositions were obtained in the form of a dark gray powder and compressed for further study According to TEM, the average particle size in composites was 2, 3, and 4 nm in samples with a filling of 10%, 20% and 30%. The concentration dependences of the specific electrical resistivity ρV, dielectric permittivity ε, saturation magnetization MS and the parameters of reflection and attenuation of microwave power of the obtained composites were investigated. The threshold for percolation in such materials is found to be within a concentration range of 20…30%. The electronic and atomic structure of composites was studied by methods of Mössbauer spectroscopy, X-ray diffraction and X-ray absorption spectroscopy. The closest atomic environment of nickel and iron in nanoparticles is close to that of crystalline NiFe2O4. The dependence of the nanoparticles size as well as the dependence of the number of tetrahedral or octahedral iron positions in nickel ferrite nanoparticles to their content in polyethylene matrix is established. It is shown that composite materials based on NiFe2O4 nanoparticles and polyethylene matrix can be used as components of electromagnetic compatibility systems.

Comparison of Obesity-Related Indicators for Nonalcoholic Fatty Liver Disease Diagnosed by Transient Elastography.

This study aimed to assess obesity-related indices in predicting nonalcoholic fatty liver disease (NAFLD) in the United States. These indices were analyzed separately in previous studies, but evidence comparing them together was still lacking. We analyzed data from 8126 individuals in the National Health and Nutrition Examination Survey (NHANES) database and measured their body mass index (BMI), body roundness index (BRI), a body shape index, conicity index, body adiposity index, abdominal volume index (AVI), and waist-hip ratio. We used logistic analyses with odds ratios to evaluate the association between obesity-related indices and NAFLD and compared their diagnostic ability by receiver operating characteristic (ROC) curves, areas under the curve (AUCs), and net reclassification improvement (NRI). The AVI had the highest AUC (0.835 at controlled attenuation parameter [CAP] scores 263 dB/m and 0.831 at CAP scores 285 dB/m) in the ROC curve analysis. The AVI also showed better discriminatory ability than BMI (NRI = 0.0331 at CAP scores 263 dB/m and 0.0328 at CAP scores 285 dB/m), the same as BRI (NRI = 0.0283 at CAP scores 263 dB/m and 0.0272 at CAP scores 285 dB/m). In males, AVI (AUC = 0.8501 at CAP scores 263 dB/m and 0.8466 at CAP scores 285 dB/m) and BRI (AUC = 0.8517 at CAP scores 263 dB/m and 0.8497 at CAP scores 285 dB/m) had better predictive ability than BMI and similar to females. This was consistent across different age and race groups. AVI and BRI were better predictors of NAFLD than BMI.

Efficacy of Jiao's scalp acupuncture in combination with Xiangshao granules on chronic tension-type headache with concomitant nonalcoholic fatty liver disease in climacteric women.

This study aimed to assess the efficacy of Jiao's scalp acupuncture in combination with Xiangshao granules on chronic tension-type headache (CTTH) with concomitant nonalcoholic fatty liver disease (NAFLD) in climacteric women. In this study, we enrolled 150 climacteric women with CTTH and concomitant NAFLD. The participants were divided into three groups based on the random number table: medication group, acupuncture group, and acupuncture-medication group. Treatment continued for 2 months. The efficacy of CTTH was assessed based on the visual analog scale/score (VAS). The influence on NAFLD was assessed based on body mass index (BMI), controlled attenuation parameter (CAP), and the ratio of hepatic-splenic computed tomography (CT) value. The Participant Health Questionnaire-9 (PHQ-9) score was compared among the three groups. A total of 123 participants completed the trial, including 37 participants in the medication group, 41 participants in the acupuncture group, and 45 participants in the acupuncture-medication group. Results are summarized hereinafter. (1) The total clinical efficiency rates of the medication group, acupuncture group, and acupuncture-medication group were 89.19% (33 of 37), 90.24% (37 of 41), and 95.65% (44 of 46), respectively. (2) Except for the BMI of the medication group (P = 0.063), a significant difference in VAS, BMI, CAP, the ratio of hepatic-splenic CT value, and PHQ-9 score was found in the three groups (P < 0.01). (3) There was a significant difference in VAS, BMI, CAP, and PHQ-9 among the three groups (P < 0.01), with those in the acupuncture-medication group being superior. No difference in the ratio of hepatic-splenic CT value was found (P = 0.440). (4) The efficacy differed significantly among the three groups (χ2 = 8.130, P = 0.017), and it was significantly superior in the acupuncture-medication group (P = 0.008, P = 0.013). Jiao's scalp acupuncture, in combination with Xiangshao granules, was superior in treating CTTH in climacteric women compared with either acupuncture or medication. Jiao's scalp acupuncture, in combination with Xiangshao granules, was superior in subsiding the negative moods in participants with CTTH and concomitant NAFLD.

Associations of dietary advanced glycation end products with liver steatosis via vibration controlled transient elastography in the United States: a nationwide cross-sectional study.

Large population-based studies for the associations between dietary advanced glycation end products (dAGEs) intake and liver steatosis remain lacking. It is necessary to clarify the relationship of dAGEsintake with liver steatosis through the National Health and Nutrition Survey (NHANES). A total of 5856 participants in the NHANES 2017-2018 were included. The dietary AGEs intake, including ε-(carboxymethyl)lysine(CML), Nε-(1-carboxyethyl)lysine (CEL), and Nδ-(5-hydro-5-methyl-4-imidazolon-2-yl)-ornithine (MG-H1) were estimated using the combination of ultra-performance LC-tandem MS dietary AGEs database and two 24-h dietary recall interviews. Liver steatosis was assessed by controlled attenuation parameter via transient elastography. Logistic regression model was adopted to explore the relationships between dAGEs intake and hepatic steatosis. Compared with individuals of total dAGEs, CML, MG-H1 in the lowest tertile, those in the highest tertile had highest risk of hepatic steatosis, and the corresponding odds radios(ORs) (95% confidence interval(CI)) were 1.37 (1.01, 1.84), 1.36 (1.04,1.78) and 1.40 (1.06, 1.85), respectively. Subgroups analysis found that the positive association between dAGEs, CML, CEL and MG-H1 and hepatic steatosis appeared stronger in subjects with obesity and those with abnormal waist circumference (WC). There was a positive correlation between dAGEs, CML, MG-H1, and hepatic steatosis, and this association mainly existed in subjects with obesity and those with abnormal WC. Dietary AGEs restriction might be of high priority for subjects with obesity for the prevention of fatty liver disease. Further longitudinal studies are required to confirm the causal associations and explore the potential mechanisms.

Impact of Cortical Bone Thickness on the Parameters of Fast and Slow Ultrasound Wave based on 2-D Simulation

Quantitative Ultrasound (QUS) has been introduced to measure the quality of human bones using ultrasound and become one of the prevention methods for Osteoporosis diseases. Because of the porous composition inherent in human cancellous bone, the generation of both fast and slow waves occurs, and these waves exhibit a distinct association with the cancellous bone structure, particularly the extent of porosity. Nonetheless, the presence of these waves is also contingent upon the anisotropy of cancellous bone, and it is noteworthy that most human cancellous bones are enveloped by cortical bone, which may influence the parameters of the fast and slow waves. Therefore, the aim of this study is to perform a 2-Dimensional (2-D) simulation utilizing the through transmission (TT) measurement method. The primary focus is to examine the impact of cortical thickness on the parameters of both the fast and slow waves. The cortical thickness will be added to the cancellous bone models and the thickness will be varied. Then, the fast and slow wave parameters will be compared in terms of correlation coefficient to identify which wave is affected more. The result shows that the cortical thickness causes increasing in attenuation and velocity for both fast and slow waves. The increase in attenuation is due to sonometry effects while the different longitudinal velocities of water and bone material may contribute to the behaviors for phase velocity measurements. However, the fast wave shows more correlation with the cortical thickness for attenuation (R2 = 0.76) and phase velocity (R2 = 0.77) parameters. This is due to fast wave corresponding to the solid structure and increasing cortical thickness also increase the solid structure. Thus, analyzing fast waves against human cancellous bone, cortical bone thickness needs to be considered to ensure accurate measurements.

A Novel Prescription Digital Therapeutic Option for the Treatment of Metabolic Dysfunction-Associated Steatotic Liver Disease

Metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction-associated steatohepatitis are pressing public health problems occurring alongside the rising prevalence of obesity and diabetes. This feasibility study explored the use of a novel prescription digital therapeutic (PDT) in this patient population. A prospective, open-label study was conducted at two hepatology clinics. Eligible patients had a baseline FibroScan controlled attenuation parameter >274 dB/m. Participants were given access to a PDT containing a novel form of cognitive behavioral therapy designed to treat cardiometabolic disease. Laboratory assessments, FibroScan, and magnetic resonance imaging proton density fat fraction (MRI-PDFF) imaging were conducted preintervention and postintervention. Twenty-two participants were enrolled. Mean baseline fat fraction on MRI-PDFF was 18.7%. After the 90-day intervention, the mean relative reduction in MRI-PDFF was-16.2% (P= .011) in those with baseline PDFF ≥10%. Mean alanine transaminase decreased by-17.1 IU/L (P= .002). Participants achieved an average total body weight loss of-2.9% (P= .008) and controlled attenuation parameter score was reduced by-18.8 dB/m (P= .021). No serious or device-related adverse events were reported. An average improvement in health-related quality of life of+2.2 Healthy Days per month (P= .500) and high treatment satisfaction (mean Net Promoter Score of+75) were reported. After 90 days of digitally delivered cognitive behavioral therapy, improvements were observed in multiple endpoints without any adverse device effects. The safety, efficacy, and usability data observed strengthen the hypothesis that PDTs provide a scalable tool to address unmet behavioral treatment needs in metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction-associated steatohepatitis (ClinicalTrials.gov number, NCT05357248).

Non-invasive assessment of steatohepatitis indicates increased risk of coronary artery disease.

Fatty liver diseases (FLD), especially defined as metabolic dysfunction-associated FLD (MAFLD), is of growing importance for patients and health-care providers. Extrahepatic comorbidities, predominantly coronary artery disease (CAD), contribute to excess morbidity and mortality in FLD. Although the association of FLD and CAD is well known, underlying pathophysiological links are not fully understood. Non-invasive means of liver diagnostic enable a fast and thorough characterization of FLD. We therefore assessed the severity of FLD in a cohort of patients at risk of CAD. Patients scheduled for coronary angiography were characterized by anthropometry, serum-based indices of liver fibrosis (NFS, FIB4), abdominal ultrasound and vibration controlled transient elastography (VCTE) including controlled attenuation parameter (CAP) and the Fibroscan-AST (FAST) score. Patients were stratified according to indication of therapeutic coronary intervention. 120 patients were recruited, MAFLD was found in 41%, while advanced fibrosis or cirrhosis were present in only 5%. Coronary vascular intervention was indicated in 42% (n = 50). Severity of steatosis assessed by CAP and risk of fibrosis defined by elevated liver stiffness (VCTE>8 kPa) and fibrosis indices were associated with the need for coronary intervention. FAST score, a marker of fibrotic steatohepatitis, was elevated in the intervention group (0.22 vs. 0.12, p<0.001). Multivariate regression analysis revealed FAST score as strongest predictor of CAD (OR 2.3 95%, CI 1.40-2.96). MAFLD is a frequent comorbidity in patients at CAD risk, but advanced liver disease has a low prevalence in patients undergoing elective coronary angiography. Therefore, a routine VCTE-based screening for FLD cannot be recommended in cardiac patients. The association of indicators of steatohepatitis with advanced CAD points to inflammatory processes as a conjoint mechanism of both diseases.

The Effects of Ginger (Zingiber Officinale Roscoe) on Non-Alcoholic Fatty Liver Disease in Patients with Type 2 Diabetes Mellitus: A Randomized Double-Blinded Placebo-Controlled Clinical Trial

Nonalcoholic fatty liver disease (NAFLD) is a prominent etiological factor for liver cirrhosis worldwide. It is frequently associated with obesity, diabetes, dyslipidemia, and hypertension. The objective of this study is to assess the efficacy and safety of ginger (Zingiber officinale Roscoe) supplementation in patients with type 2 diabetes mellitus (T2DM) who have NAFLD. In a two-arm, double-blind, placebo-controlled clinical trial, seventy-six patients diagnosed with both T2DM and NAFLD were randomly assigned to receive either ginger powder capsules (1000 mg, twice daily) or placebo capsules (administered in the same manner) for a period of three months. Anthropometric measurements, blood pressure readings, biochemical profiles, and imaging parameters were assessed before and after the intervention. Safety measures were also evaluated. In both the ginger and placebo groups, there was a significant reduction in mean body mass index (BMI), waist and hip circumferences, as well as liver transaminase levels. Moreover, significant improvements in mean systolic and diastolic blood pressures were observed in the ginger group (p = 0.02 and < 0.0001, respectively). Within the ginger group, there was a decrease in serum insulin levels and insulin resistance (HOMA-IR) (p = 0.002 and 0.004, respectively). Furthermore, the ginger group exhibited an improvement in serum HDL-cholesterol level (p = 0.01). However, there were no significant changes in the assessed inflammatory markers or the indices obtained from fibroscan imaging, including steatosis percent and controlled attenuation parameter. This study demonstrates that ginger supplementation can significantly improve mean systolic and diastolic blood pressures. However, it does not have a significant impact on inflammatory markers or fibroscan imaging indices. Nonetheless, the three-month use of ginger improves serum insulin level, insulin resistance (HOMA-IR), and HDL-cholesterol level compared to baseline values. Further investigations with longer durations and larger sample sizes are recommended.

Non-alcoholic fatty liver disease and compromised endothelial function in people with type 2 diabetes

IntroductionNonalcoholic fatty liver disease (NAFLD) frequently coexists with type 2 diabetes mellitus (T2DM) and synergistically contributes to the development of atherosclerosis. Flow-mediated dilation (FMD) is a commonly used noninvasive test for assessing endothelial function. The main objective of this study was to explore FMD in patients with T2DM with and without NAFLD.MethodsIn this cross-sectional study, conducted on people with T2DM, NAFLD was defined as controlled attenuation parameter (CAP) score > 302 dB/m. Endothelial dysfunction was detected when arterial FMD of brachial artery was equal or less than 0.7%. Regression analyses were applied to assess factors associated with impaired FMD.ResultA total of 147 patients (72 with NAFLD and 75 without NAFLD) were included in the final analysis. Patients with NAFLD were more likely to develop FMD ≤ 7% (77.8% vs. 58.7%, P = 0.01). In multivariate analysis, NAFLD (OR = 2.581, 95% CI (1.18–5.62), P = 0.017) and hypertension (HTN) (OR = 3.114, 95% CI (1.31–7.35), P = 0.010) were associated with an increased risk of impaired FMD. However, female sex was associated with a decreased risk of impaired FMD (OR = 0.371, 95% CI (0.15–0.87), P = 0.024).ConclusionNAFLD is associated with endothelial dysfunction in people with T2DM. This risk is comparable with the risk imposed by HTN, highlighting the importance of screening and management of NAFLD in these patients.

A nutrigenetic precision approach for the management of non-alcoholic fatty liver disease

The Patatin-like phospholipase domain-containing 3 (PNPLA3) rs738409 single nucleotide polymorphism (SNP) is one of the major genetic determinant of non-alcoholic fatty liver disease (NAFLD) and is strongly regulated by changes in energy balance and dietary factors. We aimed to investigate the association between the PNPLA3 rs738409 SNP, nutrient intake and NAFLD severity. PNPLA3-rs738409 SNP was genotyped in 181 patients with NAFLD who completed the EPIC Food Frequency Questionnaire. Liver steatosis was evaluated by Controlled Attenuation Parameter (CAP) (Fibroscan®530, Echosens). According to the established cut-off, a CAP value≥300dB/m was used to identify severe steatosis (S3). An independent group of 46 biopsy-proven NAFLD subjects was used as validation cohort. Overall, median age was 53 years (range 44; 62) and 60.2% of patients were male. Most subjects (56.3%) had S3 and showed increased liver stiffness (p<0.001), AST (p=0.003) and ALT levels (p<0.001) compared to those with CAP<300dB/m. At logistic regression analyses we found that the interaction between carbohydrates intake and the carriers of the PNPLA3 G risk allele was significantly associated with S3 (p=0.001). The same result was confirmed in the validation cohort, were the interaction between high carbohydrate intake (48%) and PNPLA3 SNP was significantly associated with steatosis ≥33% (p=0.038). The intake of greater than or equal to 48% carbohydrate in NAFLD patients carriers of the CG/GG allele of PNPLA3 rs738409 may increase the risk of significant steatosis.

Impact of Bulk and Nano Bismuth Oxide on the Attenuation Parameters of Bentonite Barite Composites

Since bentonite can absorb neutrons and gamma rays without sacrificing structural integrity, it is frequently used as the main shielding material in many nuclear installations. Recently, there has been a trend toward enhancing the shielding qualities of bentonite by adding various chemicals. However, the majority of the added materials either require particular handling procedures or pose health risks. The availability of environmentally friendly additives would be wonderful. The addition of barite to bentonite composites greatly raises the density of the specimens. Additionally, the performance of bentonite–barite composites as radiation shielding materials is improved by adding various amounts of bulk and nano Bi2O3 as a filler (6%, 13%, and 20%). Energy dispersive X-ray analysis (EDX) was used to determine the chemical makeup of the produced specimens. The scanning electron microscopy (SEM) pictures showed the samples’ cross-sections’ porosity and homogeneity. 241Am, 133Ba, 137Cs, and 60Co are radioactive sources that emit energies of 59.53, 80.99, 356.01, 661.66, 1173.23, and 1332.5 keV, respectively, and the NaI (Tl) scintillation detector was used in this investigation. The area under the peak of the observed energy spectra was measured using the Genie 2000 program in both the specimen’s absence and presence. The coefficients for linear and mass attenuation were calculated. To determine the theoretical mass attenuation coefficients, the XCOM program was utilized and then compared to the corresponding experimental values. Various radiation shielding parameters dependent on the linear attenuation coefficient were computed for each studied composite. These parameters include the mean free path (MFP), half value layer (HVL), and tenth value layer (TVL). Also, the Zeff and the EABF were determined for each specimen. According to the findings, bismuth oxide was added to bentonite–barite composites to reduce the transmitted flux through the specimens, which increased the LAC of the bentonite–barite composites. Furthermore, adding nanosized bismuth oxide particles increased the sample’s density and improved the material’s shielding properties. At a photon energy of 0.356 keV, the relative deviation (∆%) between the experimental nano- and micro values for Bi2O3 (20 wt%) was 12.1974, confirming that the nanoparticles increase attenuation efficiency.

Effect of Empagliflozin and Pioglitazone on left ventricular function in patients with type two diabetes and nonalcoholic fatty liver disease without established cardiovascular disease: a randomized single-blind clinical trial

BackgroundNonalcoholic fatty liver disease (NAFLD) is a complex metabolic disorder that increases the risk for cardiovascular disease in patients with type 2 diabetes mellitus (T2DM). Global longitudinal strain (GLS) is an indicator of left ventricular (LV) mechanics and can detect subclinical myocardial dysfunction. We compared the effects of pioglitazone and empagliflozin on GLS in patients with T2DM and NAFLD without established atherosclerotic cardiovascular disease.MethodsThis study was a 24-week randomized, single-blind, and parallel-group (1: 1 ratio) clinical trial. Seventy-three participants with T2DM (being treated with metformin) and NAFLD but without established atherosclerotic cardiovascular disease (ASCVD) were randomized to empagliflozin or pioglitazone. Liver steatosis and fibrosis were measured using transient elastography, and GLS was measured by echocardiography. The primary endpoint was the change in GLS from baseline to week 24. Secondary end points include changes in controlled attenuation parameter (CAP) and Liver stiffness measure (LSM).ResultsIn this study, GLS improved by 1.56 ± 2.34% (P < 0.01) in the pioglitazone group and 1.06 ± 1.83% (P < 0.01) in the empagliflozin group without a significant difference between the two groups (P = 0.31). At baseline, GLS was inversely associated with the severity of liver fibrosis: r = − 0.311, P = 0.007. LSM in the pioglitazone and empagliflozin group [(-0.73 ± 1.59) and (-1.11 ± 1.33)] kpa (P < 0.01) decreased significantly. It was without substantial difference between the two groups (P = 0.26). Empagliflozin and pioglitazone both improved controlled attenuation parameter. The improvement was more critical in the empagliflozin group: -48.22 + 35.02 dB/m vs. -25.67 + 41.50 dB/m, P = 0.01.ConclusionSubclinical cardiac dysfunction is highly important in patients with T2DM and with NAFLD. Empagliflozin and Pioglitazone improve LV mechanics and fibrosis in patients without established ASCVD. This has a prognostic importance on cardiovascular outcomes in high-risk patients with T2DM. Moreover, empagliflozin ameliorates liver steatosis more effectively them pioglitazone. This study can serve as a start point hypothesis for the future. Further studies are needed to explore the concept in larger populations.Trial registration: This trial was registered in the Iranian Registry of Clinical Trials (IRCT): “A Comparison between the Effect of Empagliflozin and Pioglitazone on Echocardiographic Indices in Patients with Type 2 Diabetes Mellitus and Nonalcoholic Fatty Liver Disease” IRCT20190122042450N5, 29 November 2020. https://www.irct.ir/search/result?query=IRCT20190122042450N5.

Lack of associations of microRNAs with severe NAFLD in people living with HIV: discovery case-control study.

Nonalcoholic fatty liver disease (NAFLD) is highly prevalent in people living with HIV (PLWH) and the expression of some microRNAs could be useful as biomarkers for the diagnosis of NAFLD. The aim of this study was to identify patterns of differential expression of microRNAs in PLWH and assess their diagnostic value for NALFD. A discovery case-control study with PLWH was carried out. The expression of miRNAs was determined using HTG EdgeSeq technology. Cases were defined as patients with severe NAFLD and controls as patients without NAFLD, characterized using the controlled attenuation parameter (CAP). Cases and controls were matched 1:1 for age, sex, BMI, CD4+ lymphocyte count, active HCV infection, and ART regimen. Serum 2,083 simultaneous microRNA transcripts were analyzed using HTG technology and compared between cases and controls. Forty-five patients, 23 cases, and 22 controls were included in the study. In the analysis of the expression pattern of the 2,083 microRNAs, no differential expression patterns were found between both groups of patients included in the study. Analysis of the microRNA transcriptome profile of nonobese PLWH with severe NAFLD did not appear to differ from that of patients without NAFLD. Thus, microRNA might not serve as a proper biomarker for predicting severe NALFD in this population.

Effects of short-term supervised exercise training on liver fat in adolescents with obesity: a randomized controlled trial.

The objective of this study was to quantify the effects of a 4-week, supervised, high-intensity interval training (HIIT) on intrahepatic triglyceride content (IHTG, percentage), cardiorespiratory fitness (CRF), and cardiometabolic markers in adolescents with obesity. A total of 40 adolescents (age 13-18 y, BMI 36.7 ± 5.8 kg/m2 ) at risk for metabolic dysfunction-associated steatotic liver disease (MASLD) based on obesity and elevated Fibroscan measured controlled attenuation parameter (CAP) scores were randomized to HIIT three times a week for 4 weeks (n = 34) or observation (control; n = 6). Liver magnetic resonance imaging proton-density fat-fraction (MRI-PDFF), CAP, oral glucose tolerance test, serum alanine aminotransferase, dual-energy x-ray absorptiometry, and CRF tests were performed before and after intervention. Within- and between-group differences were compared. A total of 13 (38%) and 4 (66%) children had MASLD by MRI-PDFF (IHTG ≥ 5%) in the HIIT and control groups, respectively. The implemented HIIT protocol had no impact on CRF or IHTG (baseline 5.26%, Δ = -0.31 percentage points, 95% CI: -0.77 to 0.15; p = 0.179), but it decreased the 2-h glucose concentration (baseline 116 mg/dL, Δ = -11 mg/dL; 95% CI: -17.6 to -5.5; p < 0.001). When limiting the analysis to participants with MASLD (n = 17), HIIT decreased IHTG (baseline 8.81%, Δ = -1.05 percentage points, 95% CI: -2.08 to -0.01; p = 0.048). Between-group comparisons were not different. The implemented exercise protocol did not reduce IHTG, but it led to modest improvement in markers of cardiometabolic health.

Prevalence and incidence of MAFLD and associated anthropometric parameters among prepubertal children of the Shanghai Birth Cohort.

Metabolic dysfunction-associated fatty liver disease (MAFLD) is the most common chronic liver disease in adolescent and adult population. However, the epidemiologic data of MAFLD in prepubertal children remain limited. This study aimed to investigate the prevalence and incidence of MAFLD and assess the role of anthropometric parameters in identifying and predicting MAFLD in this population. Children from the Shanghai Birth Cohort Study who underwent an 8-year follow-up with anthropometric measurements and transient elastography FibroScan-502 examination (M probe, Echosens, Paris, France) were enrolled. Some of them also completed a 5-year follow-up. Diagnosis of fatty liver disease (FLD) was based on the controlled attenuation parameter (CAP) value exceeding 248dB/m, and MAFLD was defined as FLD combined with obesity or central obesity. Receiver operating characteristic (ROC) curve analysis was conducted to evaluate the diagnostic accuracy of anthropometric parameters for MAFLD. A total of 848 children (431 boys) from the Shanghai Birth Cohort Study were followed up for 8years, and among them, 385 children (189 boys) also participated in the 5-year follow-up. The prevalence of FLD and MAFLD at 5years old was 3.90% and 0.52%, respectively, while at 8years old, the prevalence rates increased to 5.07% for FLD and 3.42% for MAFLD. The 8-year-old children with MAFLD exhibited significantly higher weight, body mass index (BMI), chest circumference, waist circumference, hip circumference, waist-to-height ratio, waist-to-hip ratio, and liver stiffness measurement compared to those without MAFLD (all p < 0.05). The incidence rates of FLD and MAFLD at 8years old, considering the 5-year follow-up data, were 3.78% (14/370) and 3.13% (12/383), respectively. Obese or centrally obese children at 5years old had a higher incidence of FLD and MAFLD at the 8-year follow-up. Waist circumference and BMI showed significant associations with the presence and incidence of MAFLD, respectively, with the largest AUC values in ROC curve analysis. In addition, chest circumference was significantly associated with MAFLD in obese children. This study provides insights into the incidence and prevalence of MAFLD in prepubertal children. It underscores the importance of anthropometric parameters in identifying and predicting MAFLD in this population. Further research encompassing a broader age range and incorporating these indicators and additional metabolic markers is necessary to enhance the understanding and management of MAFLD in children.

Evaluation of Quantitative Dual-Energy Computed Tomography Parameters for Differentiation of Parotid Gland Tumors

To assess the diagnostic performance of quantitative parameters from dual-energy CT (DECT) in differentiating parotid gland tumors (PGTs). 101 patients with 108 pathologically proved PGTs were enrolled and classified into four groups: pleomorphic adenomas (PAs), warthin tumors (WTs), other benign tumors (OBTs),and malignant tumors (MTs). Conventional CT attenuation and DECT quantitative parameters, including iodine concentration (IC), normalized iodine concentration (NIC), effective atomic number (Zeff), electron density (Rho), double energy index (DEI),and the slope of the spectral Hounsfield unit curve (λHU), were obtained and compared between benign tumors (BTs) and MTs, and further compared among the four subgroups. Logistic regression analysis was used to assess the independent parameters and the receiver operating characteristic (ROC) curves were used to analyze the diagnostic performance. Attenuation, Zeff, DEI, IC, NIC, and λHU in the arterial phase (AP) and venous phase (VP) were higher in MTs than in BTs (p<0.001-0.047). λHU in VP and Zeff in AP were independent predictors with an area under the curve (AUC) of 0.84 after the combination. Furthermore, attenuation, Zeff, DEI, IC, NIC, and λHU in the AP and VP of MTs were higher than those of PAs (p<0.001-0.047). Zeff and NIC in AP and λHU in VP were independent predictors with an AUC of 0.93 after the combination. Attenuation and Rho in the precontrast phase; attenuation, Rho, Zeff, DEI, IC, NIC, and λHU in AP; and the Rho in the VP of PAs were lower than those of WTs (p<0.001-0.03). Rho in the precontrast phase and attenuationin AP were independent predictors with an AUC of 0.89 after the combination. MTs demonstrated higher Zeff, DEI, IC, NIC, and λHU in VP and lower Rho in the precontrast phase compared with WTs (p<0.001-0.04); but no independent predictors werefound. DECT quantitative parameters can help to differentiate PGTs.

Intra-gastric balloon with lifestyle modification: a promising therapeutic option for overweight and obese patients with metabolic dysfunction-associated steatotic liver disease

BackgroundData on effects of intra-gastric balloon (IGB) on metabolic dysfunction-associated steatotic liver disease (MASLD) are scarce, in part with contradictory results, and mainly obtained in tertiary care patients with diabetes and other comorbidities. We here explore effects of IGB in patients with MASLD referred to a first-line obesity clinic.MethodsIn this prospective cohort study, patients with at least significant fibrosis (≥ F2) and/or severe steatosis (S3) according to screening transient elastography (FibroScan®) were offered a second FibroScan® after 6 months lifestyle modification with or without IGB (based on patient preference). Results: 50 of 100 consecutively screened patients (generally non-diabetic) qualified for repeated evaluation and 29 (58%) of those had a second FibroScan®. At baseline, at least significant fibrosis was present in 28% and severe steatosis in 91%. IGB was placed in 19 patients (59%), whereas 10 patients (41%) preferred only lifestyle modification (no differences in baseline characteristics between both groups). After 6 months, liver stiffness decreased markedly in the IGB group (median: from 6.0 to 4.9 kPa, p = 0.005), but not in the lifestyle modification only group (median: from 5.5 to 6.9 kPa, p = 0.477). Steatosis improved in both groups, (controlled attenuation parameter values; IGB, mean ± SD: from 328 ± 34 to 272 ± 62 dB/m, p = 0.006: lifestyle modification only, mean ± SD: from 344 ± 33 to 305 ± 43 dB/m: p = 0.006).ConclusionBoth steatosis and fibrosis improve markedly in overweight/obese patients with MASLD after 6 months IGB combined with lifestyle modification. Our results warrant further research into long-term effect of IGB in these patients.

The Efficacy of Anthropometric Indicators in Predicting Non-Alcoholic Fatty Liver Disease Using FibroScan® CAP Values among the Taiwanese Population.

The controlled attenuation parameter (CAP) measurement obtained from FibroScan® is a low-risk method of assessing fatty liver. This study investigated the association between the FibroScan® CAP values and nine anthropometric indicators, including the abdominal volume index (AVI), body fat percentage (BFP), body mass index (BMI), conicity index (CI), ponderal index (PI), relative fat mass (RFM), waist circumference (WC), waist-hip ratio (WHR), and waist-to-height ratio (WHtR), and risk of non-alcoholic fatty liver disease (fatty liver). We analyzed the medical records of adult patients who had FibroScan® CAP results. CAP values <238 dB/m were coded as 0 (non- fatty liver) and ≥238 dB/m as 1 (fatty liver). An individual is considered to have class 1 obesity when their body mass index (BMI) ranges from 30 kg/m2 to 34.9 kg/m2. Class 2 obesity is defined by a BMI ranging from 35 kg/m2 to 39.9 kg/m2, while class 3 obesity is designated by a BMI of 40 kg/m2 or higher. Out of 1763 subjects, 908 (51.5%) had fatty liver. The BMI, WHtR, and PI were found to be more strongly correlated with the CAP by the cluster dendrogram with correlation coefficients of 0.58, 0.54, and 0.54, respectively (all p < 0.0001). We found that 28.3% of the individuals without obesity had fatty liver, and 28.2% of the individuals with obesity did not have fatty liver. The BMI, CI, and PI were significant predictors of fatty liver. The BMI, PI, and WHtR demonstrated better predictive ability, indicated by AUC values of 0.72, 0.68, and 0.68, respectively, a finding that was echoed in our cluster group analysis that showed interconnected clustering with the CAP. Therefore, of the nine anthropometric indicators we studied, the BMI, CI, PI, and WHtR were found to be more effective in predicting the CAP score, i.e., fatty liver.

High prevalence of de novo metabolic dysfunction-associated fatty liver disease after liver transplantation and the role of controlled attenuation parameter

Background & AimsAlthough non-alcoholic fatty liver disease (NAFLD) remains an uncommon indication for liver transplantation (LT) in the Chinese, the prevalence of NAFLD is increasing. We aimed to determine the prevalence of de novo steatosis and metabolic dysfunction-associated fatty liver disease (MAFLD) after LT.MethodsTransient elastography assessment for liver stiffness and controlled attenuation parameter (CAP) were performed after LT in 549 patients at median time of 77 months from LT. CAP was compared with implant liver biopsy, and also validated in 42 patients with post-LT liver biopsy. Longitudinal history including diabetes mellitus (DM), dyslipidemia, hypertension, and immunosuppressive regimen were recorded.ResultsThe optimal cut-off level of CAP for diagnosing at least mild (≥ S1) and moderate-to-severe steatosis (≥ S2/3) was 266 and 293 dB/m respectively, with AUROC of 0.740 and 0.954 respectively. Using this newly derived cut-off, 28.9% patients have de novo NAFLD, of which 95.6% fulfilled the criteria for MAFLD. After multivariate analysis, BMI (HR 1.34), DM (HR 2.01), hypertension (HR 2.03), HDL-cholesterol (HR 0.25), LDL-cholesterol (HR 1.5) and cryptogenic cirrhosis (HR 4.85) were associated with the development of S2/3 graft steatosis. de novo NAFLD was associated with higher incidence of new-onset hypertension (p < 0.001), graft dysfunction (defined as ALT > 40 U/L; p = 0.008), but not associated with graft fibrosis (defined as liver stiffness > 12 kPa; p = 0.761).ConclusionAlthough NAFLD remains an uncommon primary liver disease indication for LT in Chinese patients, post-transplant de novo graft steatosis is common and the majority is classified as MAFLD. Development of graft steatosis is not associated with an increase in graft fibrosis but was associated with worse metabolic control and graft dysfunction. Routine CAP measurement to detect de novo graft steatosis should be considered after LT regardless of the primary indication of LT.