Criteria For Nonalcoholic Fatty Liver Disease Research Articles

Laboratory Tests, Liver Vessels Color Doppler Sonography, and FibroScan Findings in Patients with Nonalcoholic Fatty Liver Disease: An Observation Study

Objective:Determination of the amount of parenchymal damage in nonalcoholic fatty liver disease (NAFLD) is crucial to choose the best treatment and management.Aim:Here, the associations between laboratory data and severity of steatosis and fibrosis plus hepatic vessel Doppler indices in NAFLD patients were investigated.Patients and Methods:Fifty patients (20 males and 30 females) with NAFLD criteria were enrolled. Fatty liver was graded by sonography (SGFL) and FibroScan (FGFL). In addition, liver fibrosis was graded through FGLF. Damages to the portal, hepatic, and splenic veins were evaluated by color Doppler/dopplex. Serum liver enzymes and C-reactive protein (CRP) were also measured.Results:Significant association existed between SGFL and FGFL (P = 0.006). Portal vein pulsatility index (PI) and phasicity plus the triphasic and monophasic pattern of hepatic veins significantly associated with fatty liver grade evaluated by sonography. Splenic vein Peak systolic velocity and PI showed significant association with FGFL. Eventually, elevated liver enzymes and CRP significantly correlated with FGLF.Conclusion:We found that the severity of fatty liver is correlated with hepatic and portal veins damages; however, the degree of parenchymal fibrosis was independent to these indices and can be directly evaluated by FGFL. In addition, elevated liver enzymes and CRP correlated with the degree of fibrosis.

Circulating Interleukin-6 is a biomarker for coronary atherosclerosis in nonalcoholic fatty liver disease: Results from the Multi-Ethnic Study of Atherosclerosis

BackgroundBiomarkers to predict the presence and severity of subclinical cardiovascular disease (CVD) in nonalcoholic fatty liver disease (NAFLD) are lacking. Methods3876 participants from the Multi-Ethnic Study of Atherosclerosis (MESA), without known chronic liver disease underwent baseline non-contrast cardiac CT, with NAFLD defined by validated liver:spleen ratio (L:S) < 1.0, and subclinical CVD defined by coronary artery calcium (CAC) score > 0. Randomly-selected subgroups underwent detailed inflammatory marker testing, including LpPLA2 mass (N = 2951), activity (N = 3020), high-sensitivity C-reactive protein (hsCRP; N = 3849), and interleukin-6 (IL-6; N = 3764). Among those with NAFLD, we estimated the prevalence of CAC > 0 and CAC > 100 for each SD biomarker increase, using multivariable log-binomial regression models adjusted for cardiometabolic risk factors. ResultsSeventeen percent (N = 668) of participants met the criteria for NAFLD. NAFLD participants were younger (mean age 61 ± 10 vs. 63 ± 10 years, p < .0001) but more likely to have an elevated BMI (mean 31.1 ± 5.5 vs. 28.0 ± 5.2 kg/m2, p < .0001), diabetes (22% vs. 11%, p < .0001), and increased inflammatory biomarkers, including LpPLA2 activity, hsCRP and IL-6 (all p < .0001). Among NAFLD participants, IL-6 was the only biomarker independently associated with prevalent CAC > 0 (PR = 1.06 [1.00–1.11]), or CAC > 100 (PR = 1.09 [1.02–1.17]). In contrast, circulating LpPLA2 mass/activity and hsCRP were not associated with either the prevalence or severity of subclinical CVD (all p > .05). ConclusionIn a large, multi-ethnic population with NAFLD, IL-6 is independently associated with the prevalence and severity of subclinical atherosclerosis. Further research into the longitudinal effects of NAFLD on progressive CVD will determine whether IL-6 is a marker or mediator of NAFLD-related atherosclerosis.

Study on the Correlation Between Urinary Transferrin and Nonalcoholic Fatty Liver Disease.

Nonalcoholic fatty liver disease (NAFLD) can cause renal injury, and urinary transferrin (UTRF) is extremely sensitive to renal injury. We aimed to investigate the correlation between UTRF and NAFLD and to observe the distribution of NAFLD at different levels of UTRF. A total of 711 subjects fulfilled the diagnostic criteria of NAFLD and 1,396 healthy control participants were enrolled in this study. UTRF levels and other clinical and laboratory parameters were measured. The UTRF level was higher in NAFLD than in non-NAFLD patients. Unit and multiple regression analysis showed that UTRF was an independent risk factor for NAFLD, with OR values of 1.474 (1.328 - 1.635, p < 0.001) and 1.435 (1.267 - 1.625, p < 0.001), respectively. The prevalence of UTRF (groups 1, 2, 3, 4) was 25.61%, 26.56%, 38.14%, and 44.59%, respectively (p < 0.001), and the prevalence of NAFLD in the high UTRF group was significantly higher than in the low UTRF group. UTRF is an independent risk factor for NAFLD.

Association Between Urinary Alpha1-Microglobulin Levels and Nonalcoholic Fatty Liver Disease: A Cross-Sectional Study

Background: We aimed to explore the association between urinary alpha₁-microglobulin (A1M) levels and nonalcoholic fatty liver disease (NAFLD) in a Chinese population. Study: We performed a cross-sectional study among 2,215 Chinese who attended their annual health examination at First Affiliated Hospital, College of Medicine, Zhejiang University. Urinary A1M-creatinine ratio and other clinical and laboratory parameters were measured. Results: A total of 20.9% of subjects fulfilled the diagnostic criteria of NAFLD. NAFLD subjects had significantly higher urinary A1M-creatinine ratios. These levels were positively associated with NAFLD prevalence. The association between A1M-creatinine ratio and NAFLD was independent of hyperglycemia status. Stepwise regression showed that urinary A1M-creatinine ratio was significantly associated with the risk for NAFLD. Urinary A1M-creatinine ratio was an independent factor predicting advanced fibrosis (FIB-4 ≥1.3) in NAFLD patients. Conclusions: Our results showed a significant association between urinary A1M-creatinine ratio and NAFLD.

Early menarche is associated with non-alcoholic fatty liver disease in adulthood.

The aim of this study was to examine the association between early menarche (<12years) and non-alcoholic fatty liver disease (NAFLD) in premenopausal women and to explore whether it is mediated by adult obesity and insulin resistance. We analyzed data of premenopausal women, aged ≥15years, from the Korea National Health and Nutrition Examination Survey (2007-2009). We divided the women into three groups: early menarche, reference (12.00-15.99years), and late menarche. The presence of NAFLD was determined using hepatic steatosis index >36.0. Of the 4,387 women evaluated, 673 (15.4%) met the criteria for NAFLD. The prevalence of NAFLD was higher in both women with early and late menarche compared with the reference (early, 23.4%; reference, 14.0%; late, 19.9%, P<0.001). After adjustment of confounders including age, the OR for NAFLD in early menarche compared with the reference was 3.04 (95%CI: 1.99-4.65). Further adjustment of mediators, such as central obesity or insulin resistance, attenuated the association to 1.91-2.17. There was no association, however, between late menarche and NAFLD after adjustment of confounders. Early menarche was associated with an increased risk of NAFLD in young and middle-aged premenopausal Korean women.

Epidemiological features of non-alcoholic fatty liver disease in the North-West region of Russia (Results of an open multicenter prospective study DIREG 2)

Non-alcoholic fatty liver disease (NAFLD) is increasingly recognized as an important problem that can lead to cirrhosis and hepatic failure. It may be the most prevalent liver disease. However,knowledge of the epidemiology is limited. These findings encourage to conduct a larger sample size study to evaluate the real prevalence of NAFLD in the Russian population. It is important to know current prevalence of NAFLD. DIREG 2 study was performed under umbrella of leading Russian professional societies in partnership with Sanofi Russia. Objective: to estimate the prevalence of NAFLD within the general practitioner’s and gastroenterologist’s patient flow. It is important to know current prevalence of NAFLD in North-West region and to compare with DIREG 2 results. Materials and methods.Epidemiologic, observational, multicenter study assessing the prevalence of NAFLD among patients outpatient practice. A total of 50 145 patients (3769 in North-West region) including those suspected of having NAFLD criteria were enrolled in the Program. The investigators were qualified doctors (GPs therapist’s gastroenterologists), providing outpatient care for the population. The epidemiological data were obtained, recorded during two routine patient visits to investigating centers. Study results. Percentage of patients with revealed NAFLD within the patient flow primary or consistently coming to selected doctors for any reason including those suspected of having NAFLD was 37,3 % in Russia vs 49,1 % in North West Region. Conclusion. Prevalence of NAFLD among patient flow of doctors in Russia is quite high. It has been revealed a high prevalence of NANCFLD within the patient flow primary or consistently coming to selected by doctors for any reason. Refs 55. Figs 4. Table 1.

Reversal of type 2 diabetes in youth who adhere to a very-low-energy diet: a pilot study

The aim of the study was to investigate whether a very-low-energy diet (VLED) is a feasible and acceptable treatment option for type 2 diabetes in children and adolescents, and whether adherence can lead to rapid weight loss, reversal of type 2 diabetes and reduced liver fat as seen in adult studies. Eight participants with type 2 diabetes and obesity, aged 7-16years, non-medicated (n = 1) or treated with metformin (n = 7) and in some cases insulin (n = 3), followed a VLED (<3360kJ/day) for 8weeks, then transitioned to a hypocaloric diet (∼6300kJ/day) that they followed to 34weeks. HbA1c, fasting glucose and 2h post-glucose load plasma glucose (2hG) were determined from fasting blood and an OGTT. Liver fat concentration was quantified using proton magnetic resonance spectroscopy. Adherence was defined as ≥5% weight loss during the 8week VLED. Adherers (n = 5) and non-adherers (n = 3) had median weight loss of 7.5% and 0.5%, respectively, at 8weeks. Overall, HbA1c (mean [SE] 8.1% [0.7%] to 6.6% [0.5%]; p = 0.004) and 2hG (15.6 [1.6] mmol/l to 11.3 [1.0] mmol/l; p = 0.009) were significantly reduced at 8weeks compared with baseline. Liver fat was also significantly reduced from baseline (14.7% [2.2%]) to 8weeks (5.8% [1.7%]; p = 0.001). Only three out of eight participants met non-alcoholic fatty liver disease (NAFLD) criteria (≥5.5%) at 8weeks, compared with eight out of eight at baseline. The three participants on insulin therapy at baseline were able to cease therapy during the 8week VLED. At 34weeks, adherers (n = 5) achieved 12.3% weight loss, none met NAFLD criteria and four did not meet American Diabetes Association criteria for type 2 diabetes. A VLED appears to be a feasible treatment option for some youth with type 2 diabetes on metformin therapy. Youth who agree to participate and adhere to a VLED achieve rapid weight loss, dramatic reductions in liver fat and reversal of type 2 diabetes. This highlights the capacity of a VLED to be used as a first-line treatment option in newly diagnosed youth. A larger trial with a control group and longer follow-up will be required to encourage a change in standard treatment. Australian New Zealand Clinical Trial Registration Number (ACTRN) ACTRN12616000375459 ( www.ANZCTR.org.au/ACTRN12616000375459.aspx ).

Assessment of Abdominal Fat Distribution in Non-Alcoholic Fatty Liver Disease by Magnetic Resonance Imaging: a Population-based Study.

To investigate the association between non-alcoholic fatty liver disease (NAFLD) and quantitative measures of central adiposity in the general population using a semi-automated method on magnetic resonance imaging (MRI) data. Subjects were recruited from Golestan Cohort Study. Two groups of 120 individuals with and without fatty liver were randomly selected based on findings of ultrasound. Non-invasive diagnosis of NAFLD was made by combination of ultrasound and MRI. Various anthropometric indices including body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were measured. Segmentation and calculation of visceral (VFA) and subcutaneous fat area (SFA) were performed on three levels of MRI slices using semi-automated software. A total of 109 individuals fulfilled the NAFLD criteria, while 92 subjects were selected as the control group. All obesity measures, except for SFA, were significantly higher in subjects with NAFLD compared to controls. Significant associations were found between NAFLD and adiposity indices, except for SFA, with the highest odds ratio observed in WHR (OR: 3.37, CI: 1.40-3.70, P < 0.001). VFA also had the greatest correlation with ultrasound (r = 0.523, P < 0.001) and MRI (r = 0.546, P < 0.001) indicators of NAFLD. Quantitative measures of visceral adiposity are associated with NAFLD, while subcutaneous fat measures are poor indicators for identifying NAFLD. Compared to conventional anthropometric indices, VFA best correlates with ultrasound and MRI criteria of fatty liver.

Documentation Rates of Non-alcoholic Fatty Liver Disease in an Academic Internal Medicine Clinic

Introduction: Nonalcoholic fatty liver disease (NAFLD), the hepatic manifestation of metabolic syndrome, has emerged as the leading cause of chronic liver disease worldwide. NAFLD encompasses a clinical spectrum of illness, ranging from bland hepatic steatosis to nonalcoholic steatohepatitis (NASH), which can progress to cirrhosis and its associated complications. Not only is the metabolic syndrome a risk factor for NAFLD, but it predicts the presence of steatohepatitis in patients with NAFLD and can be used to target candidates for liver biopsy. Thus, we aim to compare documentation and treatment patterns of metabolic syndrome components with NAFLD documentation and treatment rates in all patients following up from recent imaging with hepatic steatosis. Methods: Review of 834 consecutive patients with abdominal or right-upper quadrant ultrasounds and 519 consecutive patients with CT (chest, angio, abdomen) with hepatic steatosis were identified between September 2013 and September 2015. All imaging and patients were at one large academic hospital. Only those patients who followed up at the affiliated academic outpatient internal medicine clinic were later included. Clinic notes from within 2 visits of the hepatic steatosis imaging findings were reviewed. Further exclusions for other secondary causes of hepatic steatosis were made (alcohol abuse, hepatitis, cirrhosis, autoimmune disease, iron overload, TPN/starvation diet, medications) (Fig. 1). Only those meeting inclusion for nonalcoholic fatty liver disease were included (n=49) (Fig. 1).Figure 1Results: Forty-nine patients were included, 26 with CT and 27 with Ultrasound findings (Fig. 1). Documentation patterns for each component of metabolic syndrome are shown (Fig. 2). Only 6.1% of patients meeting NAFLD criteria had the problem listed as an assessment, compared to 57%-79% for each other component of metabolic syndrome. Mean BMI, AST, ALT, AST/ALT are shown (Fig. 2). Metabolic syndrome characteristics addressed in the patient plan were documented between 45%-85% of the time (Fig. 3). In addition, specific treatment strategies for NAFLD were only addressed in < 45% of all afflicted patients (Fig. 3).Figure 2Figure 3Conclusion: Internal medicine physician documentation and treatment strategies for NAFLD remain poor compared to other metabolic syndrome characteristics. It remains imperative to not only document patients with NAFLD, but to address treatment modalities at each office visit for this soon-to-be leading cause of liver transplantation in the U.S.

Association of blood pressure level with nonalcoholic fatty liver disease in nonhypertensive population: Normal is not the new normal.

The functional crosstalk between nonalcoholic fatty liver disease (NAFLD) and hypertension has been reported by some literatures; however, in nonhypertensive individuals, there is no article describes the characteristic of NAFLD. In this study, we aimed to determine the strength of the association between NAFLD with normal blood pressure (BP) in nonhypertensive individuals. This cross-sectional study was conducted in the sixth Affiliated Hospital of Wenzhou Medical University, from October 2007 to December 2011. In brief, 24,200 subjects were enrolled to participate in the survey. Among those subjects, there were 5305 enrolled subjects, those with filling the diagnostic criteria for NAFLD (21.9%; 4803 males and 502 females). Nonhypertension was identified in 17,403 (71.9%; 8179 males and 9224 females). The PR% of NAFLD for the systolic blood pressure (SBP) in quartiles 1 to 4 was 10.83, 12.55, 20.38, and 19.97. SBP, diastolic blood pressure (DBP), sex, age, glutamic pyruvic transaminase, glutamic oxaloacetic transaminase, fasting plasma glucose, uric acid, triglyceride, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol are closely associated with the risk for NAFLD. SBP (odds ratio [OR]: 1.092, 95% confidence interval [CI]: 1.030–1.158; P < 0.05) and DBP (OR: 1.157, 95%CI: 1.094–1.223; P < 0.05) were found to be independent risk factors for NAFLD. Our analysis indicates that BP is significantly associated with NAFLD in nonhypertensive individuals; SBP and DBP are found to be independent risk factors for NAFLD.

EPIDEMIOLOGICAL FEATURES OF NON-ALCOHOLIC FATTY LIVER DISEASE IN NOVOSIBIRSK (SIBERIAN FEDERAL DISTRICT): REGIONAL DATA OF OPEN MULTICENTER PROSPECTIVE STUDY DIREG 2

Non-alcoholic fatty liver disease (NAFLD) is an important medical and social problem. Essentially, it can be attributed to the problems of interdisciplinary, since it involves issues related to insulin resistance, metabolic syndrome, dyslipidemia. Due to erased clinical manifestation of nonalcoholic fatty liver disease often is diagnosed at late stages of the disease — fibrosis and cirrhosis. The lack of epidemiological data in Russia has identified the need for a larger study to research the prevalence of NAFLD in the Russian Federation. DIREG 2 was the most extensive epidemiological study on the subject, which is coordinated by the leading experts in partnership with Sanofi Russia. Objective: to estimate the prevalence of NAFLD within the general practitioner’s and gastroenterologist’s patient flow. It is important to know current prevalence of NAFLD in Novosibirsk (Siberian Federal district) and to compare with DIREG 2 results. Materials and methods. Epidemiologic, observational, multicenter study assessing the prevalence of NAFLD among patients outpatient practice. A total of 50145 patients (3220 in Novosibirsk) including those suspected of having NAFLD criteria were enrolled in the Program. The investigators were qualified doctors (GPs therapist’s gastroenterologists), providing outpatient care for the population. The epidemiological data were obtained, recorded during two routine patient visits to investigating centers. Study results. Percentage of patients with revealed NAFLD within the patient flow primary or consistently coming to selected doctors for any reason including those suspected of having NAFLD was 37.3% in Russia vs 56.9% in Novosibirsk (Siberian Federal district). Conclusion. Prevalence of NAFLD among patient flow of doctors in Russia is quite high. It has been revealed a high prevalence of NANCFLD within the patient flow primary or consistently coming to selected by doctors for any reason.

PREVALENCE OF NON-ALCOHOLIC FATTY LIVER DISEASE IN REPUBLIC OF BASHKORTOSTAN (REGIONAL RESULTS OF DIREG 2 STUDY)

Non-alcoholic fatty liver disease (NAFLD) is increasingly recognized as an important problem that can lead to cirrhosis and hepatic failure. It may be the most prevalent liver disease. However, knowledge of the epidemiology is limited. These findings encourage to conduct a larger sample size study to evaluate the real prevalence of NAFLD in the Russian population. It is important to know current prevalence of NAFLD. DIREG 2 study was performed under umbrella of leading Russian professional societies in partnership with Sanofi Russia. Objective : to estimate the prevalence of NAFLD within the general practitioners and gastroenterologist’s patient flow. It is important to know current prevalence of NAFLD in Republic of Bashkortostan and to compare with DIREG 2 results. Materials and methods. Epidemiologic, observational, multicenter study assessing the prevalence of NAFLD among patient’s outpatient practice. A total of 50145 patients (3232 in Republic of Bashkortostan) including those suspected of having NAFLD criteria were enrolled in the Program. The investigators were qualified doctors (GPs/therapist’s/gastroenterologists), providing outpatient care for the population. The epidemiological data were obtained, recorded during two routine patient visits to investigating centers. Results. Percentage of patients with revealed NAFLD within the patient flow primary or consistently coming to selected doctors for any reason including those suspected of having NAFLD was 37,3% in Russia vs 40,8% in Republic of Bashkortostan. Conclusion . Prevalence of NAFLD among patient flow of doctors in Russia is quite high. It has been revealed a high prevalence of NANCFLD within the patient flow primary or consistently coming to selected by doctors for any reason.

Association of non-alcoholic fatty liver disease with renal stone disease detected on computed tomography

ObjectiveTo evaluate the association between Non-alcoholic fatty liver disease (NAFLD) with renal stone disease detected on computed tomography (CT). MethodA total 1812 patients who underwent abdomen-pelvis CT in July 2015 were included in this study. The inclusion criteria for NAFLD were as follows: (i) lower average Hounsfield unit (HU) of hepatic right lobe, left medial and lateral segment when compared with that of spleen, (ii) patients who having urolithiasis in kidneys, ureters and urinary bladder, and (iii) patients underwent abdomen-pelvis CT including noncontrast image. The statistical significance of the association between NAFLD and renal stone disease was assessed using Chi Square Test. The Odds ratios and 95% CI were calculated to assess the propensity of renal stones disease for NAFLD by using Logistic Regression analysis. ResultsThe frequency of renal stone disease in patients with NAFLD was higher approximately 19% than those who having renal stone disease without NAFLD. In addition, the presence of NAFLD was linked with renal stone disease showing that detection rate of renal stone disease in patients with NAFLD was markedly high (odds ratio: 5, 95% CI, 3–8.2) (p<0.05) in multivariate analysis. ConclusionThe presence of significant association between NAFLD with renal stone disease and NAFLD may be considered to be an independent variable as a risk factor for renal stone disease.

Serum Sialic Acid Level Is Significantly Associated with Nonalcoholic Fatty Liver Disease in a Nonobese Chinese Population: A Cross-Sectional Study.

Background/Aim. To investigate the association between serum sialic acid (SA) levels and nonalcoholic fatty liver disease (NAFLD) in a nonobese Chinese population. Methods. A cross-sectional study was performed among the 5916 adults who took their annual health examinations at International Health Care Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, from December 2013 to November 2014. Results. A total of 693 (11.71%) subjects fulfilled the diagnostic criteria of NAFLD, and NAFLD patients had significantly higher serum SA levels than controls (P < 0.001). The prevalence of NAFLD was positively associated with serum SA levels (P for trend <0.001). Serum sialic acid levels are significantly associated with features of metabolic syndrome (Ps < 0.01). Multivariate logistic regression analysis showed that serum SA level was significantly associated with risk for NAFLD (odds ratio: 1.018, 95%; confidence interval: 1.007–1.030; P = 0.002). Conclusions. Our results suggest for the first time that NAFLD patients had higher serum SA level than controls, and increased serum SA level is significantly associated with risk for NAFLD in a large nonobese Chinese population.

Nonalcoholic Fatty Liver Disease in Canadian First Nations and Non-First Nations Patients.

Background. Features of nonalcoholic fatty liver disease (NAFLD) have yet to be described in the Canadian First Nations (FN) population. The aim of this study was to compare the prevalence, severity, and outcome of NAFLD in FN versus non-FN patients at an urban, tertiary care centre. Methods. Adults with NAFLD and no additional liver disease were identified in a prospectively derived database at the University of Manitoba. Demographic, clinical, laboratory, imaging, and histologic data were analyzed. Results. 482 subjects fulfilled diagnostic criteria for NAFLD, including 33 (7%) FN. Aside from rural residence, diabetes and cholestasis being more common in FN patients, the ages, gender distributions, clinical and radiologic features, and liver enzyme/function test results were similar in the two cohorts. Noninvasive tests of fibrosis (APRI and NAFLD fibrosis scores) were also similar in the two cohorts. There were no significant differences in liver enzyme or function tests in either cohort after approximately three years of follow-up. Conclusion. Compared to the prevalence of FN persons in the general population of this study site (10–15%), FN patients were underrepresented in this NAFLD population. The severity and progression of liver disease in FN patients appear to be similar to those in non-FN patients.

Association between Serum Sialic Acid Levels and Nonalcoholic Fatty Liver Disease: A Cross-Sectional Study

Background: To assess the association between serum sialic acid (SA) levels and nonalcoholic fatty liver disease (NAFLD) in a Chinese population. Methods: A cross-sectional study was performed among 3,898 Chinese who took their annual health examination. Serum SA levels and other clinical and laboratory parameters were measured. Results: A total of 18.11% fulfilled the diagnostic criteria of NAFLD. NAFLD subjects with/without metabolic syndrome (MS) had significantly higher serum SA levels than those without NAFLD. Serum SA levels were significantly and positively correlated with components of MS (body mass index, systolic blood pressure, diastolic blood pressure, triglyceride and fasting plasma glucose) in the NAFLD group. Stepwise logistic regression analysis showed that SA levels were significantly associated with the risk factor for NAFLD. Serum SA levels were negatively correlated with the FIB-4 score, and lower serum SA levels were independent factors predicting advanced fibrosis in subjects with NAFLD. Conclusions: Our results showed a significant association between serum SA levels and NAFLD.

Nonalcoholic fatty liver disease in patients with coronary disease from a Brazil northeast area.

Background Nonalcoholic fatty liver disease (NAFLD) is the most frequent chronic liver injury around the world. It is associated with metabolic syndrome and cardiovascular diseases. Objective To evaluate the frequency and relevance of NAFLD in patients with coronary artery disease (CAD). Methods Patients from a Brazil Northeast area, who underwent elective coronary angiography (CAG) from 2009 to 2010 were included. All of them had suspicion of CAD. Criteria to CAD: presence of obstructive lesions in the epicardial coronary arteries, or in their major branches. NAFLD criteria: presence of hepatic steatosis on ultrasound; exclusion of other liver diseases; ethanol intake ≤ 20g/day. Statistics analysis included Independent t-test, Mann-Whitney and Pearson's chi-squared test. Multivariate regression analysis measured the relationship between the risk factors and the concomitant presence of CAD and NAFLD. Results A total of 244 patients were evaluated: 63.5% had CAD and 42.2% had NAFLD. NAFLD was observed in 43.9% of the CAD patients. The regression analysis showed that the relationship between CAD and NAFLD was positively correlated with HOMA-IR ≥3.0 or insulin resistance and overweight/obesity. Conclusion NAFLD was frequent among CAD patients; insulin resistance and overweight/obesity were the most relevant risk factors related to the association NAFLD and CAD. The results suggest that patients with CAD should be evaluated for NAFLD.

Association of Serum Cytokeratin-18 Fragment Concentration in Patients with Different Types of Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) is one of the most common forms of chronic liver diseases worldwide. The prevalence of NAFLD was 15% in the Asian population. In a study, NASH was observed in 42.4% of NAFLD cases in Bangladesh. It is a serious clinical problem because of its worldwide distribution and potential adverse sequel. Cytokeratin-18 fragment is a marker of hepatocyte apoptosis. Measurement of serum cytokeratin-18 fragment concentration is a noninvasive, quick and simple procedure that can be carried out easily in peripheral hospital. It can be very much helpful for early detection and frequent monitoring of disease progression and response to therapy. This cross sectional study was conducted in the Department of Clinical Pathology in collaboration with Department of Hepatology and Department of Pathology, BSMMU, Dhaka from March 2014 to February 2015. Forty patients who fulfilled the criteria of NAFLD were determined in our study. The concentration of serum CK-18 fragment was measured to evaluate its association in different types of NAFLD by enzyme linked immune sorbent assay (ELISA). In this study, we observed that the serum CK-18 fragment concentration was increased in relation to Nonalcoholic fatty liver disease Activity Score (NAS) (r=+0.7134, P<0.05). To assess diagnostic performance of CK-18 fragment were used receiver-operator characteristic (ROC) curve. The area under ROC was 0.918 for identification of NASH. Using a cutoff value of 150 U/L the sensitivity and specificity of CK-18 fragment were 85.7% and 80.8% respectively. The positive predictive value, negative predictive value and accuracy of CK-18 fragment were 66.67%, 90.91% and 80.00% respectively. Our data revealed that serum CK-18 fragment was strongly associated with Nonalcoholic fatty liver disease Activity Score (NAS). Serum CK-18 fragment may be a useful noninvasive tool for assessing NASH in patients with NAFLD.

Histopathological differences utilizing the nonalcoholic fatty liver disease activity score criteria in diabetic (type 2 diabetes mellitus) and non-diabetic patients with nonalcoholic fatty liver disease.

To study clinical and histopathological features of nonalcoholic fatty liver disease (NAFLD) in patients with and without type 2 diabetes mellitus (T2DM) using updated nonalcoholic steatohepatitis clinical research network (NASH-CRN) grading system. We retrospectively analyzed data of 235 patients with biopsy proven NAFLD with and without T2DM. This database was utilized in the previously published study comparing ethnicity outcomes in NAFLD by the same corresponding author. The pathology database from University of Chicago was utilized for enrolling consecutive patients who met the criteria for NAFLD and their detailed clinical and histopathology findings were obtained for comparison. The relevant clinical profile of patients was collected from the Electronic Medical Records around the time of liver biopsy and the histology was read by a single well-trained histopathologist. The updated criteria for type 2 diabetes have been utilized for analysis. Background data of patients with NASH and NAFLD has been included. The mean differences were compared using χ(2) and t-test along with regression analysis to evaluate the predictors of NASH and advanced fibrosis. Patients with NAFLD and T2DM were significantly older (49.9 vs 43.0, P < 0.01), predominantly female (71.4 vs 56.3, P < 0.02), had higher rate of metabolic syndrome (88.7 vs 36.4, P < 0.01), had significantly higher aspartate transaminase (AST)/alanine transaminase (ALT) ratio (0.94 vs 0.78, P < 0.01) and Fib-4 index (1.65 vs 1.06, P < 0.01) as markers of NASH, showed higher mean NAFLD activity score (3.5 vs 3.0, P = 0.03) and higher mean fibrosis score (1.2 vs 0.52, P < 0.01) compared to patients with NAFLD without T2DM. Furthermore, advanced fibrosis (32.5 vs 12.0, P < 0.01) and ballooning (27.3 vs 13.3, P < 0.01) was significantly higher among patients with NAFLD and T2DM compared to patients with NAFLD without T2DM. On multivariate analysis, T2DM was independently associated with NASH (OR = 3.27, 95%CI: 1.43-7.50, P < 0.01) and advanced fibrosis (OR = 3.45, 95%CI: 1.53-7.77, P < 0.01) in all patients with NAFLD. There was a higher rate of T2DM (38.1 vs 19.4, P < 0.01) and cirrhosis (8.3 vs 0.0, P = 0.01) along with significantly higher mean Bilirubin (0.71 vs 0.56, P = 0.01) and AST (54.2 vs 38.3, P < 0.01) and ALT (78.7 vs 57.0, P = 0.01) level among patients with NASH when compared to patients with steatosis alone. The mean platelet count (247 vs 283, P < 0.01) and high-density lipoprotein cholesterol level (42.7 vs 48.1, P = 0.01) was lower among patients with NASH compared to patients with steatosis. Patients with NAFLD and T2DM tend to have more advanced stages of NAFLD, particularly advanced fibrosis and higher rate of ballooning than patients with NAFLD without T2DM.

Thyroid function is associated with non-alcoholic fatty liver disease in euthyroid subjects

Objectives: This study was designed to test the hypothesis that normal thyroid function is associated with non-alcoholic fatty liver disease (NAFLD) in euthyroid general subjects. Methods: A total of 739 euthyroid subjects were enrolled in this cross-sectional study. Using ultrasound, a diagnosis of NAFLD was made in subjects without a history of excessive alcohol consumption or liver diseases. Fasting serum samples were collected for determining thyroid function [thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) levels] and other biochemical parameters. Results: Among the enrolled subjects, 196 (26.5%) satisfied the diagnostic criteria for NAFLD. Subjects with NAFLD had significantly higher TSH levels and lower FT4 levels than those without NAFLD (p < 0.01 for both). NAFLD prevalence increased gradually with increasing quartiles of TSH levels and decreasing quartiles of FT4 levels. After adjustment for gender and age, TSH levels were found to correlate positively with body mass index (BMI), waist circumference (WC), and LDL-cholesterol levels (p < 0.05 for all) and negatively with HDL-cholesterol levels (p < 0.01). FT4 levels correlated negatively with both BMI and WC (p < 0.05 for both). Multiple logistic regression analysis showed that TSH and FT4 levels were independent risk factors for NAFLD [odds ratio (OR): 2.21, 95% confidence interval (CI): 1.21–4.02, p = 0.01, for TSH levels; OR: 0.39, 95% CI: 0.17–0.87, p = 0.02, for FT4 levels]. Conclusion: Our findings suggest that serum FT4 and TSH levels, even those within the reference range, are associated with NAFLD in the general population, independent of known metabolic risk factors.