Severity Of Fatty Liver Disease Research Articles

Association of urinary chlorpyrifos, paraquat, and cyproconazole levels with the severity of fatty liver based on MRI

BackgroundThe objective of this study was to detect the urinary levels of chlorpyrifos, paraquat, and cyproconazole in residents living in Fuyang City and to analyze the correlation between these urinary pesticides levels and the severity of fatty liver disease (FLD).MethodsAll participants’ fat fraction (FF) values were recorded by MRI (Magnetic resonance imaging). First-morning urine samples were collected from 53 participants from Fuyang Peoples’Hospital. The levels of three urinary pesticides were measured using β-glucuronidase hydrolysis followed by a. The results were analyzed by using Pearson correlation analysis and binary logistic regression analysis to reveal the correlation between three urinary pesticides and the severity of fatty liver.Results53 individuals were divided into 3 groups based on the results from MRI, with 20 cases in the normal control group, 16 cases in the mild fatty liver group, and 17 cases in the moderate and severe fatty liver group. Urinary chlorpyrifos level was increased along with the increase of the severity of fatty liver. Urinary paraquat level was significantly higher both in the low-grade fatty liver group and moderate & serve grade fatty liver group compared with the control group. No significant differences in urinary cyproconazole levels were observed among the three groups. Furthermore, urinary chlorpyrifos and paraquat levels were positively correlated with FF value. And chlorpyrifos was the risk factor that may be involved in the development of FLD and Receiver Operating Characteristic curve (ROC curve) analysis showed that chlorpyrifos and paraquat may serve as potential predictors of FLD.ConclusionThe present findings indicate urinary chlorpyrifos and paraquat were positively correlated with the severity of fatty liver. Moreover, urinary chlorpyrifos and paraquat have the potential to be considered as the predictors for development of FLD. Thus, this study may provide a new perspective from the environmental factors for the diagnosis, prevention, and treatment of FLD.

Reducing brain Aβ burden ameliorates high-fat diet-induced fatty liver disease in APP/PS1 mice

High-fat diet (HFD)-induced fatty liver disease is a deteriorating risk factor for Alzheimer’s disease (AD). Mitigating fatty liver disease has been shown to attenuate AD-like pathology in animal models. However, it remains unclear whether enhancing Aβ clearance through immunotherapy would in turn attenuate HFD-induced fatty liver or whether its efficacy would be compromised by long-term exposure to HFD. Here, the therapeutic potentials of an anti-Aβ antibody, NP106, was investigated in APP/PS1 mice by HFD feeding for 44 weeks. The data demonstrate that NP106 treatment effectively reduced Aβ burden and pro-inflammatory cytokines in HFD-fed APP/PS1 mice and ameliorated HFD-aggravated cognitive impairments during the final 18 weeks of the study. The rejuvenating characteristics of microglia were evident in APP/PS1 mice with NP106 treatment, namely enhanced microglial Aβ phagocytosis and attenuated microglial lipid accumulation, which may explain the benefits of NP106. Surprisingly, NP106 also reduced HFD-induced hyperglycemia, fatty liver, liver fibrosis, and hepatic lipids, concomitant with modifications in the expressions of genes involved in hepatic lipogenesis and fatty acid oxidation. The data further reveal that brain Aβ burden and behavioral deficits were positively correlated with the severity of fatty liver disease and fasting serum glucose levels. In conclusion, our study shows for the first time that anti-Aβ immunotherapy using NP106, which alleviates AD-like disorders in APP/PS1 mice, ameliorates fatty liver disease. Minimizing AD-related pathology and symptoms may reduce the vicious interplay between central AD and peripheral fatty liver disease, thereby highlighting the importance of developing AD therapies from a systemic disease perspective.

Association between cataract and fatty liver diseases from a nationwide cross-sectional study in South Korea

This study examined the link between fatty liver disease (FLD) and cataracts, as previous research has suggested that FLD may contribute to metabolic syndrome, systemic inflammation, and potentially cataracts. We studied a nationwide cross-sectional cohort of the Fifth Korean National Health and Nutrition Examination Survey 2010–2011. FLD was defined as nonalcoholic FLD (NAFLD) and metabolic dysfunction-associated FLD (MAFLD). Multinomial logistic regression was utilized to investigate the relationship between cataracts and FLD after adjustment for potential confounders. Participants with cataracts had higher liver fibrosis scores, including the NAFLD fibrosis score (NFS; P < 0.001), fibrosis-4 index (FIB4; P < 0.001), and fatty liver index (FLI; P = 0.001). NAFLD was not associated with a higher odds ratio (OR) for cataracts in the fully adjusted model (OR = 1.23, P = 0.058). MAFLD was significantly associated with a higher OR (OR = 1.34, P = 0.006). After adjusting for all factors, the severity of FLD was linked to an increased risk of cataracts, with significant linear trends (P values for linear trends of NFS, FIB4, and FLI < 0.05). After adjusting for well-known cataract risk factors, MAFLD was significantly associated with cataracts. Our analysis suggests that FLD may serve as an independent risk factor for cataracts.

Associations between body composition profile and hypertension in different fatty liver phenotypes.

It is currently unclear whether and how the association between body composition and hypertension varies based on the presence and severity of fatty liver disease (FLD). FLD was diagnosed using ultrasonography among 6,358 participants. The association between body composition and hypertension was analyzed separately in the whole population, as well as in subgroups of non-FLD, mild FLD, and moderate/severe FLD populations, respectively. The mediation effect of FLD in their association was explored. Fat-related anthropometric measurements and lipid metabolism indicators were positively associated with hypertension in both the whole population and the non-FLD subgroup. The strength of this association was slightly reduced in the mild FLD subgroup. Notably, only waist-to-hip ratio and waist-to-height ratio showed significant associations with hypertension in the moderate/severe FLD subgroup. Furthermore, FLD accounted for 17.26% to 38.90% of the association between multiple body composition indicators and the risk of hypertension. The association between body composition and hypertension becomes gradually weaker as FLD becomes more severe. FLD plays a significant mediating role in their association.

IL-6 Trans-Signaling Is Increased in Diabetes, Impacted by Glucolipotoxicity, and Associated With Liver Stiffness and Fibrosis in Fatty Liver Disease.

IL-6 and its circulating coreceptor sgp130 are increased in people with fatty liver disease and steatohepatitis. High glucose and lipids stimulated IL-6 and sgp130 secretion from hepatic stellate cells. sgp130 levels correlated with HbA1c, and diabetes concurrent with steatohepatitis further increased circulating levels of all IL-6 trans-signaling mediators. Circulating sgp130 positively correlated with liver stiffness and hepatic fibrosis. Metabolic stress to liver associated with fatty liver disease might shift the balance of IL-6 classical versus trans-signaling, promoting liver fibrosis that is accelerated by diabetes.

The effect of obstructive sleep apnea on fatty liver disease may be obscured by alcohol consumption: An ordinal logistic regression analysis

BackgroundObstructive sleep apnea (OSA) is closely associated with non-alcoholic fatty liver disease (NAFLD). The current definition of NAFLD cannot exclude the involvement of alcohol consumption in the development of fatty liver disease (FLD), but alcohol can aggravate OSA and participate in steatosis. There is limited evidence on the relationship between OSA and alcohol and its effect on FLD severity. ObjectiveTo determine the effect of OSA on FLD severity based on ordinal responses, and its relationship with alcohol consumption, in order to develop strategies for the prevention and treatment of FLD. MethodsPatients with chief complaints of "snoring" who underwent polysomnography and abdominal ultrasound between January 2015 and October 2022 were selected. A total of 325 cases were divided into three groups according to abdominal ultrasound results: no FLD (n = 66), mild FLD (n = 116), and moderately severe FLD (n = 143) group. Patients were also categorized into alcoholic and nonalcoholic groups. Univariate analysis was used to examine the correlation between OSA and FLD severity. Multivariate ordinal logistic regression analysis was further used to identify the determinants of FLD severity and differences between the alcoholic and nonalcoholic groups. ResultsA higher proportion of moderately severe FLD was observed in the group with an apnea/hypopnea index (AHI) > 30 compared to the AHI<15 group in all participants and in the nonalcoholic population (all p < 0.05). There was no significant difference among these groups in the alcoholic population. Ordinal logistic regression analysis found that in all participants, age [OR = 0.966(0.947–0.986)], BMI [OR = 1.293 (1.205–1.394)], diabetes mellitus [OR = 1.932(1.132–3.343)], hyperlipidemia [OR = 2.432(1.355–4.464)], severe OSA [OR = 2.36(1.315–4.259)] (all p < 0.05) were the independent risk factors for more severe FLD. However, different risk factors applied according to alcohol consumption. In addition to age and BMI, the independent risk factors for the alcoholic group also included diabetes mellitus [OR = 3.323(1.494–7.834)] while in the non-alcoholic group risk factors included hyperlipidemia [OR = 4.094(1.639–11.137)], and severe OSA[OR = 2.956(1.334–6.664)] (all p < 0.05). ConclusionSevere OSA is an independent determinant for developing more severe NAFLD in nonalcoholic population, and alcohol consumption may obscure the effect of OSA on the progression of FLD.

0512 Apnea-Hypopnea Index does not correlate with Non-Alcoholic Fatty Liver Disease scores

Abstract Introduction Obstructive Sleep Apnea (OSA) and Nonalcoholic Fatty Liver Disease (NAFLD) are two conditions that have increased in prevalence in the United States. NAFLD is a spectrum of liver disease ranging from steatosis to non-alcoholic steatohepatitis (NASH) to cirrhosis. The purpose of this project is to study the relationship between OSA, measured by apnea-hypopnea index and/or arterial oxygen saturation nadir (O2 nadir) during sleep (independent variable) vs. extent of NAFLD as measured by non-invasive scores such as NAFLD Fibrosis score, aminotransferase to platelet ratio index (APRI), BARD score and FIB-4 score (dependent variable). Methods A convenient sample of 91 haphazardly selected veterans with OSA and NAFLD from the Veterans Affairs (VA) Computerized Record System (CPRS) system were included in the study. NAFLD eligibility was determined by abdominal ultrasound, CT scan, MRI, or biopsy. Dependent variables were NAFLD scores of APRI, NAFLD Fibrosis, BARD, and FIB-4. OSA was determined by in-lab polysomnogram or home sleep study. Independent variables were AHI, O2 nadir, age and body mass index (BMI). Patients with a history of alcohol abuse or Hepatitis B or C were excluded from the study. A multiple regression analysis was used to describe the relationship between OSA and NAFLD scores. P&amp;lt; 0.05 was considered statistically significant. Results Age correlated with FIB-4 score, BARD score, and NAFLD fibrosis score (p = &amp;lt; 0.001, 0.003, &amp;lt; 0.001, respectively). BMI correlated with NAFLD fibrosis score (p &amp;lt; 0.001). When controlled for age and BMI, AHI and O2 nadir did not correlate with APRI, NAFLD fibrosis, BARD, or FIB-4 scores. Conclusion OSA measured by AHI and O2 nadir do not correlate with severity of fatty liver disease as measured by APRI, NAFLD fibrosis, BARD, or FIB-4 scores. Support (if any) None

Возможности использования электрических и вязкоупругих параметров эритроцитов для диагностики стеатогепатита у пациентов с жировой болезнью печени

Aim: to study the possibilities of using electrical and viscoelastic parameters of erythrocytes to differentiate steatohepatitis from liver steatosis. Patients and Methods: 84 men (48.9±2.5 years) with fatty liver disease diagnosed by abdominal ultrasound were examined. Liver fibrosis severity, which did not exceed grade 1, was determined by indirect elastometry on the FibroScan® 502 Echosens device (France), with confirmation using the FibroTest–ActiTest test system (BioPredictive, France). Patients were divided into 2 groups according to the severity of hepatic necroinflammatory activity, assessed using the same test system. Group 1 (n=44) included patients with hepatic steatosis with minimal histologic disease activity (A 0–1); group 2 (n=40) included patients with steatohepatitis with significant necro-inflammatory activity (A 2–3). The electrical and viscoelastic parameters of erythrocytes were determined by dielectrophoresis at 4 frequencies of an inhomogeneous alternating electric field. Results and Discussion: the most significant electrical and viscoelastic indicators allowing to differentiate steatohepatitis from fatty liver disease were reduced values of strain amplitude at a frequency of 1 MHz (p=0.0003), dipole moment (p=0.009), capacity (p=0.014) and cell polarizability at a frequency of 1 MHz (p=0.03) and more high summarized viscosity (p=0.006), rigidity (p=0.005) and electrical conductivity (p=0.008). Diagnostic panel, including a set of electrical and viscoelastic parameters of erythrocytes, for the differentiation of steatohepatitis from steatosis demonstrated the following: AUC 0.904, sensitivity 0.9, specificity 0.83. Correlations of erythrocyte parameters with indicators of cytolysis syndrome (transaminase activity, serum iron levels, direct bilirubin) and serum inflammatory markers (fibrinogen, C-reactive protein, ferritin) were established. Conclusion: the electrical and viscoelastic parameters of erythrocytes studied using the dielectrophoresis should be considered as a new promising method in determining the severity of fatty liver disease. KEYWORDS: fatty liver disease, steatohepatitis, steatosis, electrical and viscoelastic parameters, erythrocytes, dielectrophoresis, diagnostic model. FOR CITATION: Kruchinina M.V., Parulikova M.V., Belkovets A.V., Gromov A.A. Possibilities of using electrical and viscoelastic parameters of erythrocytes for the diagnosis of steatohepatitis in patients with fatty liver disease. Russian Medical Inquiry. 2023;7(5):249–257 (in Russ.). DOI: 10.32364/2587-6821-2023-7-5-2.

Association between non-alcoholic fatty liver disease and epicardial adipose tissue volume with cardiometabolic risk in coronary heart disease

BackgroundRegional adiposity has a significant impact on the formation of adverse metabolic and cardiovascular risk profiles. While much of the attention was directed to the importance of intra-abdominal adipose tissue, there were several new investigations about mediastinal and epicardial regions’ visceral adiposity. Our study aimed to determine the association between non-alcoholic fatty liver and increased epicardial adipose tissue mass with coronary artery disease severity.MethodsThis study was conducted on sixty patients who presented with symptoms of coronary artery disease and attended elective coronary angiography to rule out coronary artery disease. All patients have been subjected to full hepatic profile, noninvasive scoring system such as Fibrosis-4 and non-alcoholic fatty liver disease fibrosis score and abdominal ultrasound for diagnosis of non-alcoholic fatty liver disease and trans-thoracic echocardiography for measurement of average epicardial adipose tissue thickness. Student T test, analysis of variance test, chi-square test, and Fisher’s exact test were used for statistical analysis.ResultsAccording to the severity of coronary artery disease, patients with significant coronary stenosis had statistically significant higher degree of hepatic steatosis in abdominal ultrasound (P value < 0.001) while regarding the non-alcoholic fatty liver disease fibrosis score and Fibrosis-4 for non-alcoholic fatty liver disease diagnosis, there was no significance between both groups. Also, the epicardial adipose tissue mean thickness was found to be statistically significantly higher among those with significant coronary stenosis than those without [7.859 ± 0.691 mm versus 5.600 ± 0.386 mm]. Moreover, statistically significant higher epicardial adipose tissue thickness values were found among grade 3 hepatic steatosis than in grades 2, 1, or 0 (P value < 0.001). At a cutoff > 6.1 mm, epicardial adipose tissue thickness was a valuable tool in discrimination between significant and non-significant coronary artery disease with specificity and sensitivity of 100%.ConclusionHigh epicardial adipose tissue thickness may represent a marker of severity of non-alcoholic fatty liver disease as well as an independent predictor of coronary artery disease risk.

Clinical Significance of Serum CD14 and Its Polymorphism as a Biomarker of Non-Alcoholic Fatty Liver Disease

Background: Liver inflammation is deliberated a risk factor for the ongoing liver damage including non-alcoholic steatohepatitis, cirrhosis, and hepatoma. CD14, an effectual mediator for the monocytes activation, has been postulated as a marker of liver inflammation and fibrosis. This study is constructed to detect the alterations in the CD14 serum levels in 40 NAFLD cases and 14 healthy controls along with to analyze the role of CD14 polymorphisms in the causation and severity of Non-Alcoholic Fatty Liver Disease (NAFLD). Liver enzymes, glycated hemoglobin, together with lipid profile were estimated in all included subjects. The diagnosis of NAFLD depends largely on ultrasonography. NAFLD fibrosis score and FIB-4 score were calculated. Serum CD14 was quantified by EnzymeLinked Immunosorbent Assay (ELISA) and C14-159C/T SNP was genotyped via Polymerase Chain Reaction (PCR) and Restriction Fragment Length Polymorphisms (RFLP). Results: Serum CD14 was markedly higher in the diabetic subjects either lean or overweight/obese than the controls (P&lt;0.05). Receiver Operating Characteristic (ROC) curve showed that the optimum cutoff for CD14 was 2.97 ng/ml for discriminating NAFLD patients from their healthy counterparts with a sensitivity of 76.3% and specificity of 78.6%. There was no discrepancy in the prevalence of CD14 genotypes among NAFLD cases and controls. Moreover, the frequency of the CD14 genotypes was analogous in NAFLD patients with NFS≤0.676 and patients with NFS&gt;0.676 (P=1.000). Conclusion: The former observations advocate the potential role of CD14 in both the pathogenesis and progression of NAFLD. Yet, it didn't correlate with the NFS, consequently it couldn't forecast the severity of the disease. Furthermore, no association was distinguished linking CD14 C-(159) T polymorphism and the risk of NAFLD occurrence.

Remnant Lipoprotein Cholesterol as a Factor Related to Adult Fatty Liver Disease

Dyslipidemia is related to fatty liver disease (FLD), whose relationship with remnant lipoprotein cholesterol (RLP-C), a component of blood lipids, remains unclear. To clarify the correlation between RLP-C and the occurrence and severity of FLD and establish an FLD discriminant model based on health check indicators. Retrospective study of participants who underwent health check-up in the First Affiliated Hospital of China Medical University (Shenyang, China) between January and December 2019. We categorized participants according to liver ultrasound results and analyzed the correlation between RLP-C and occurrence of FLD (n = 38 885) through logistic regression, restricted cubic spline, and receiver operating characteristic curve. We categorized the severity of FLD according to the control attenuation parameter and analyzed the correlation between RLP-C and FLD severity through multiple logistic regression; only males were included (n = 564). The adjusted OR (aOR) per SD between RLP-C and FLD was 2.33 (95% CI 2.21-2.46, P < .001), indicating a dose-response relationship (P < .0001). The optimal cut-off value of RLP-C was 0.45 mmol/L and the area under the curve (AUC) was 0.79. The AUC of the 8-variable model was 0.89 in both the training and the validation sets. FLD severity was related to the level of RLP-C (aOR per SD = 1.29, 95% CI 1.07-1.55, P = .008). RLP-C has a strong positive correlation with FLD occurrence and FLD severity. These results may help clinicians identify and implement interventions in individuals with high FLD risk and reduce FLD prevalence.

Кластерний аналіз як метод оцінки тяжкості перебігу неалкогольної жирової хвороби печінки у пацієнтів з гіпертонічною хворобою

The purpose of the study was to determine the possibilities of cluster analysis as a method for assessing the severity of Non-alcoholic fatty liver disease in its comorbidity with hypertension. Materials and methods. In the study, we examined 63 patients with non-alcoholic steatohepatitis and hypertension, 62 patients with isolated non-alcoholic steatohepatitis and 20 healthy individuals as a control group. All patients underwent anthropometric examinations, including determination of waist circumference, measuring systolic and diastolic blood pressure, performing routine laboratory tests, revealing plasma levels of kallistatin, interleukin-1β and interleukin-10 by enzyme-linked immunosorbent assay. Abdominal ultrasonography was performed to determine the thickness of the right, left and caudal lobes of the liver, and 2-dimensional shear wave elastography with calculating the liver parenchyma stiffness (E, kPa) was performed to determine the fibrotic changes of the liver. Cluster analysis was performed in the program "STATISTICA 8.0." using a hierarchical method and k-means algorithm with pre-standardized data. Results and discussion. According to the results of clustering, 3 subgroups of patients with non-alcoholic fatty liver disease and hypertension were identified. Cluster 1 was characterized by low systolic and diastolic blood pressure, waist circumference, low levels of alanine aminotransferase and aspartate aminotransferase, moderate interleukin-1β levels, low activity of kallistatin and interleukin-10, ultrasound signs of hepatomegaly and increased liver parenchyma stiffness. Cluster 2 included patients with the highest systolic and diastolic blood pressure, moderate waist circumference, highest alanine aminotransferase, aspartate aminotransferase and interleukin-1β levels, low activity of kallistatin and interleukin-10, the most pronounced ultrasound hepatomegaly signs and the worst liver elastography results. Cluster 3 was characterized by moderate systolic and diastolic blood, minimum alanine aminotransferase, aspartate aminotransferase and interleukin-1β content, highest kallistatin and interleukin-10 levels, minimum thickness of liver lobes and lowest liver parenchymal stiffness. Clusters differed significantly from the control group in all parameters, and from the isolated non-alcoholic fatty liver disease group, significant differences were found in all characteristics except waist circumference and interleukin-1β levels. The clusters varied in at least 4 parameters, and the maximum dissimilarity was found between clusters 2 and 3, which differed by 9 indicators. Conclusion. Thus, the clustering of examination results of the patients with non-alcoholic fatty liver disease and hypertension showed a statistically significant distribution of groups according to the severity of liver fibrosis. The elevated systolic and diastolic blood pressure, increased alanine aminotransferase and aspartate aminotransferase, decreased activity of kallistatin and interleukin-10 and signs of hepatomegaly according to ultrasound data could be considered as markers of severe liver fibrosis. The cluster distribution of patients with non-alcoholic fatty liver disease and hypertension opens prospects for the development of new integrated methods in assessment of liver parenchyma changes severity in patients with this comorbidity

The relationship between non-alcoholic fatty liver disease and acute coronary syndrome severity: is non-alcoholic fatty liver disease a risk marker of coronary atherosclerotic disease?

Abstract Background/Introduction Non-alcoholic fatty liver disease (NAFLD) has been significantly associated with atherosclerotic disease independent of classical risk factors. However, the role of NAFLD in this context remains unclear. The systemic inflammation described in NAFLD related to liver disease progression may be one factor that can influence the progression and instability of atherosclerotic disease and, consequently, in the clinical characteristics of acute coronary syndrome (ACS). Purpose To assess the potential relationship between NAFLD and ACS severity. Methods We performed a retrospective study in adult patients with ACS who presented to the emergency room of a quaternary care medical centre between March 2015 and March 2016 and selected 99 patients without previously known coronary artery disease or liver disease, without a history of significant alcohol consumption, terminal disease, other acute illness, use of statins, amiodarone, or other steatogenic drugs. The diagnostic criteria for acute myocardial infarction (AMI) with ST-segment elevation (STEMI) were ST elevation ≥1mm in ≥2 contiguous leads (2mm for leads V1 to V3). The acute myocardial infarction without ST-segment elevation (NSTEMI) diagnostic was established in patients who did not meet the criteria for STEMI and who had elevated necrosis markers (creatine kinase-MB isoform and troponin I). Unstable angina (UA) diagnostic was established in patients who did not meet the criteria for STEMI and NSTEMI but had more than three cardiovascular risk factors and typical thoracic pain. The presence of steatosis and its degrees was assessed using ultrasound, and the diagnosis of NAFLD was based on the presence of steatosis and clinical history. Results The diagnosis of UA, NSTEMI and STEMI was established in 40, 33 and 26 patients, respectively, and NAFLD was observed in 30%, 66.6% and 76.9% of these patients. NAFLD patients were 5.8 times more likely to have a diagnosis of AMI than UA (p&amp;lt;0.001), were 7.88 times more likely to have a diagnosis of STEMI than UA (p&amp;lt;0.001) and were 4.7 times more likely to have a diagnosis of NSTEMI than UA (p&amp;lt;0.01). Patients with grades 2 and 3 liver steatosis were 4.2 times more likely to have a diagnosis of AMI than UA (p&amp;lt;0.01) and were 8.2 times more likely to have a diagnosis of STEMI than UA (p&amp;lt;0.01). There was no significant relationship between other variables evaluated and the clinical presentation of ACS. Conclusion(s) In this study, the frequency of AMI presentation in NAFLD patients with ACS was significantly higher than the frequency of UA, suggesting a significant relationship between NAFLD and the severity of ACS, independent of the classic risk factors assessed. The results also suggest that the steatosis degree can proportionally influence this context. Therefore, NAFLD could be considered a potential risk marker for coronary atherosclerotic disease progression and instability. Funding Acknowledgement Type of funding sources: None.

S3387 Correlation Study of Non Alcoholic Fatty Liver Disease (NAFLD) Severity With Cardiometabolic Disorders in Subjects Undergoing Health Check-Up in New Delhi, India

S3387 Correlation Study of Non Alcoholic Fatty Liver Disease (NAFLD) Severity With Cardiometabolic Disorders in Subjects Undergoing Health Check-Up in New Delhi, India

Cascaded Deep Learning Neural Network for Automated Liver Steatosis Diagnosis Using Ultrasound Images

Diagnosing liver steatosis is an essential precaution for detecting hepatocirrhosis and liver cancer in the early stages. However, automatic diagnosis of liver steatosis from ultrasound (US) images remains challenging due to poor visual quality from various origins, such as speckle noise and blurring. In this paper, we propose a fully automated liver steatosis prediction model using three deep learning neural networks. As a result, liver steatosis can be automatically detected with high accuracy and precision. First, transfer learning is used for semantically segmenting the liver and kidney (L-K) on parasagittal US images, and then cropping the L-K area from the original US images. The second neural network also involves semantic segmentation by checking the presence of a ring that is typically located around the kidney and cropping of the L-K area from the original US images. These cropped L-K areas are inputted to the final neural network, SteatosisNet, in order to grade the severity of fatty liver disease. The experimental results demonstrate that the proposed model can predict fatty liver disease with the sensitivity of 99.78%, specificity of 100%, PPV of 100%, NPV of 99.83%, and diagnostic accuracy of 99.91%, which is comparable to the common results annotated by medical experts.

Utility of Fibroscan XL to assess the severity of non-alcoholic fatty liver disease in patients undergoing bariatric surgery

Significant weight loss can modify the progression of Nonalcoholic fatty liver disease (NAFLD) with the most convincing evidence coming from bariatric surgery cohorts. Effective ways to non-invasively characterise NAFLD in these patients has been lacking, with high Fibroscan failure rates reported. We prospectively evaluated the utility of Fibroscan using XL-probe over a two-year period. 190 consecutive patients undergoing bariatric surgery were followed as part of their routine care. All patients had Fibroscan performed on the day of surgery and at follow-up a mean of 13 months (± 6.3) later. The majority of patients were female (82%) with mean age of 42. Fibroscan was successful in 167 (88%) at baseline and 100% at follow up. Patients with a failed Fibroscan had higher body mass index (BMI) and alanine transaminase (ALT), but no difference in FIB-4/NAFLD score. Mean baseline Liver stiffness measurement was 5.1 kPa, with 87% of patients classified as no fibrosis and 4% as advanced fibrosis. Mean baseline controlled attenuation parameter was 291, with 78% having significant steatosis, 56% of which was moderate-severe. Significant fibrosis was associated with higher BMI and HbA1c. Significant steatosis was associated with higher BMI, ALT, triglycerides and insulin resistance. Mean follow up time was 12 months with weight loss of 25.7% and BMI reduction of 10.4 kg/m2. Seventy patients had repeat fibroscan with reductions in steatosis seen in 90% and fibrosis in 67%. Sixty-four percent had complete resolution of steatosis. Fibroscan can be performed reliably in bariatric cohorts and is useful at baseline and follow-up. Significant steatosis, but not fibrosis was seen in this cohort with substantial improvements post-surgery.

Combined effects of PNPLA3, TM6SF2 and HSD17B13 variants on severity of biopsy-proven non-alcoholic fatty liver disease

ObjectiveSeveral single-nucleotide polymorphisms have been identified to be disadvantageous or protective in regard to disease severity in patients with non-alcoholic fatty liver disease (NAFLD). However, it is unclear, whether including genetic risk factor(s) either alone or combined into risk stratification algorithms for NAFLD actually provides incremental benefit over clinical risk factors.DesignPatients with biopsy-proven NAFLD were genotyped for the PNPLA3-rs738409(minor allele:G), TM6SF2-rs58542926(minor allele:T) and HSD17B13- rs72613567 (minor allele:TA) variants. The NAFLD activity score (NAS) and fibrosis stage (F0–F4) were used to grade and stage all liver biopsy samples. Patients from seven centers throughout Central Europe were considered for the study.Results703 patients were included: NAS ≥ 5:173(24.6%); Fibrosis: F3–4:81(11.5%). PNPLA3 G/G genotype was associated with a NAS ≥ 5(aOR 2.23, p = 0.007) and advanced fibrosis (aOR-3.48, p < 0.001).TM6SF2 T/- was associated with advanced fibrosis (aOR 1.99, p = 0.023). HSD17B13 TA/- was associated with a lower probability of NAS ≥ 5(TA/T: aOR 0.65, p = 0.041, TA/TA: aOR 0.40, p = 0.033). Regarding the predictive capability for NAS ≥ 5, well-known risk factors (age, sex, BMI, diabetes, and ALT; baseline model) had an AUC of 0.758, Addition of PNPLA3(AUC 0.766), HSB17B13(AUC 0.766), and their combination(AUC 0.775), but not of TM6SF2(AUC 0.762), resulted in a higher diagnostic accuracy of the model. Addition of genetic markers for the prediction of advanced fibrosis (baseline model: age, sex, BMI, diabetes: AUC 0.777) resulted in a higher AUC if PNPLA3(AUC 0.789), and TM6SF2(AUC 0.786) but not if HSD17B13(0.777) were added.ConclusionIn biopsy-proven NAFLD, PNPLA3 G/-, TM6SF2 T/- and HSD17B13 TA/- carriage are associated with severity of NAFLD. Incorporating these genetic risk factors into risk stratification models might improve their predictive accuracy for severity of NAFLD and/or advanced fibrosis on liver biopsy.

Association of obstructive sleep apnea with non-alcoholic fatty liver disease in patients with obesity: an observational study

PurposeObstructive Sleep Apnea (OSA) is associated with the presence and severity of Non-Alcoholic Fatty Liver Disease (NAFLD). We aimed to investigate the relationship between the severity of OSA and NAFLD and to recognize a polysomnographic parameter correlated with progression of fibrosis, determined by a non-invasive score of liver fibrosis, FIBrosis-4 index (FIB-4), in patients affected by severe obesity and OSA.MethodsWe enrolled 334 patients (Body Mass Index, BMI 44.78 ± 8.99 kg/m2), divided into classes according to severity of OSA evaluated with Apnea Hypopnea Index (AHI): OSAS 0 or absent (17%), mild OSA (26%), moderate OSA (20%), severe OSAS (37%). We studied anthropometric, polysomnographic, biochemical data and FIB-4. A multiple regression model was computed to identify a polysomnographic independent predictor of FIB-4 among those parameters previously simple correlated with FIB-4.ResultsThe severity of OSA was associated with a decrease in High-Density Lipoprotein–cholesterol (HDL) and an increase in BMI, triglycerides, Homeostasis model assessment insulin-resistance index (HOMA), transaminases and FIB-4. FIB-4 correlated with sex, age, BMI, AHI, mean percentage oxyhaemoglobin (meanSaO2%), number of desaturations, platelets, transaminases, HDL, triglycerides and HOMA. The only variables independently related to FIB-4 were sex, BMI, triglycerides and meanSpO2 (r = 0.47, AdjRsqr = 0.197).ConclusionMeanSpO2% represented an independent determinant for the worsening of FIB-4 in patients with severe obesity and OSA. Hence, it could hypothesize a clinical role of meanSaO2% in recognizing patients with obesity and OSA and higher risk of developing advanced fibrosis and, thus, to undergo further investigation.Level IIIEvidence obtained from well-designed cohort analytic studies.

PNPLA3 and SERPINA1 Variants Are Associated with Severity of Fatty Liver Disease at First Referral to a Tertiary Center.

Single nucleotide polymorphisms (SNPs), including PNPLA3 rs738409 and SERPINA1 rs17580, have been identified as risk modifiers in the progression fatty liver disease (alcoholic (ALD) or non-alcoholic (NAFLD)). While PNPLA3 has been studied in various settings, the value of both SNPs has so far not been addressed in a real-world cohort of subjects referred for a diagnostic work-up of liver disease. Thus, liver disease severity was assessed in 1257 consecutive patients with suspected ALD or NAFLD at the time of referral to a tertiary center. Advanced chronic liver disease (ACLD) was present in 309 (24.6%) patients and clinically significant portal hypertension (CSPH) was present in 185 (14.7%) patients. The PNPLA3 G-allele was independently associated with a higher liver stiffness measurement (LSM; adjusted B: 2.707 (1.435–3.979), p < 0.001), and higher odds of ACLD (adjusted odds ratio (aOR): 1.971 (1.448–2.681), p < 0.001) and CSPH (aOR: 1.685 (1.180–2.406), p = 0.004). While the SERPINA1 Z-allele was not associated with a higher LSM or the presence of ACLD, it was independently associated with higher odds of CSPH (aOR: 2.122 (1.067–4.218), p = 0.032). Associations of the PNPLA3 G-allele and the SERPINA1 Z-allele with CSPH were maintained independently of each other. The presence of both risk variants further increased the likelihood of ACLD and CSPH.

How Good Is Trans Abdominal Ultrasound for Evaluating NAFLD in the General Population? A Cross-Sectional Study

Nonalcoholic fatty liver disease (NAFLD) is one of the most common cause of liver test abnormality and chronic liver disease in the world and can increase liver related mortality. Association of NAFLD with metabolic syndrome increase mortality due to cardiovascular disease too. NAFLD is categorized histologically into the nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). Liver biopsy has been known as gold standard of evaluating NAFLD, but this procedure is invasive. It is time to replace available and easier way to diagnose, and predict the prognosis for better management of NAFLD. This study was comparing the result of transabdominal ultrasonography with Fibroscan as a new and accurate method for evaluating severity of fatty liver disease. This was a cross-sectional study that was conducted using 101 patients with NAFLD. All patients who had TUS by one experienced radiologist and fibro scan at the same time were included. Visual liver echogenicity was basis of grading in TUS. Fibro scans results are based on controlled attenuation parameters (CAP) which is not operator dependent. Other information, such as age, waist, and BMI, were also gathered. TUS has a low value for the diagnosis of liver fibrosis in NAFLD patients and predicting prognosis. TUS has a good correlation with fibroscan in grade 0 and 1of fatty liver, but in grade 2 and 3 of fatty liver, we can not rely on TUS for accurate grading.