Frequency Of Non-alcoholic Fatty Liver Disease Research Articles

Evaluation of adropin level and insulin resistance in non-alcoholic fatty liver patients: a meta-analysis of studies.

The recently discovered protein adropin is a highly conserved polypeptide that plays critical functions in energy homeostasis, metabolic processes, fat metabolism, and insulin resistance. On the other hand, non-alcoholic fatty liver disease (NAFLD) is a medical condition that causes the buildup of fat in the liver cells in individuals who consume little or no alcohol. The frequency of NAFLD is rising globally, and it is frequently linked to obesity, insulin resistance, type 2 diabetes, and metabolic syndrome. Therefore, this study evaluates the association between adropin levels and insulin resistance in individuals with and without NAFLD. Data from Scopus, Science Direct, and PubMed were searched between January 1, 2012, and February 18, 2024, using precise terms and stated criteria. Comprehensive Meta-Analysis V. 2 (Biostat, Englewood, NJ, USA) was used for data analysis, and Random-effect models were used to estimate the pooled mean differences with 95% CIs of adropin level, insulin level, and homeostatic model assessment for insulin resistance (HOMA-IR) associated with the exposures of interest. Our results revealed that adropin blood levels are significantly reduced in NAFLD patients compared to control individuals. The mean difference in adropin blood levels was 2.391 ng/ml with a 95% CI of 1.127 to 3.656 with I2 99.6. on the other hand, insulin resistance was significantly higher in NAFLD compared to controls (MD: -1.668, 95% CI: -2.333 to -1.002, I2=86%). Our findings reveal that adropin levels are significantly greater in healthy controls than in NAFLD patients, suggesting that adropin may have a preventative effect on NAFLD. This meta-analysis highlights how closely adropin and insulin resistance interact in non-alcoholic fatty liver disease. Also, it may open the door to new diagnostic tools and therapeutic modalities.

NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) AMONG OBESE PATIENTS IN A TERTIARY CARE HOSPITAL

Background: Non-alcoholic fatty liver disease (NAFLD) commonly results in cirrhosis and liver related death. Obesity is associated with an increased risk of non-alcoholic fatty liver disease. NAFLD has become an important public health problem throughout the globe. The aim of this study was to see frequency of NAFLD among obese patients admitted at the Department of Medicine of Mymensingh Medical College Hospital.
 Methods: A total of 100 obese patients having BMI ≥25 kg/M2 were included in this cross-sectional study. Patients’ characteristics, laboratory and face-to-face interview data were analyzed.
 Results: Mean age of the patients was 52.61 (SD ± 7.02) years. It was found that more patients were from 51-60 years age group (39%); followed by 41-50 years age group (28%). NAFLD was found in 79% of obese adult patients. Laboratory parameters including TG, HDL, FBG and high blood pressure were compared between NAFLD and normal obese groups. There were no significant differences between the two groups except for FBG. NAFLD patients suffered more from high blood sugar than normal obese patients. Higher intake of meat, increased smoking, lower intake of fish, higher intake of soft drinks & FBG value over 6.1 mmol/L were identified as risk factors for the development of NAFLD.
 Conclusion: NAFLD is emerging as one of the most common liver disorders claiming urgent attention of the public, clinicians and researchers. Further in-depth, large scale prospective studies are necessary to dig out more information in this topic.

Analysis of non-alcoholic fatty liver disease during induction therapy for B-cell precursor acute lymphoblastic leukemia in children and adolescents

A prospective evaluation of non-alcoholic fatty liver disease (NAFLD) during induction therapy for acute lymphoblastic leukemia (ALL) has not been performed. Herein, we prospectively investigated the frequency, risk factors, and outcomes of NAFLD during induction therapy in children and adolescents with B-cell precursor ALL (BCP-ALL). This study enrolled 74 newly diagnosed BCP-ALL cases aged 1 year and older who were admitted to our department between January 2011 and December 2020. Median age was 6.6 years (1.3-17.5 years). Plain computed tomography (CT) of the upper abdomen was performed before induction therapy, and on days 15 and 29 after initiation of induction therapy. Patients with a liver/spleen CT ratio <0.9 were defined as having NAFLD. The frequency of NAFLD was 73%. Patients with NAFLD had a higher rate of hypertriglyceridemia. There was no significant difference in 5-year overall survival and event-free survival (EFS) between patients with and without NAFLD. However, after restricting the target age to 10 years and older, 5-year EFS was significantly higher in patients with NAFLD than in those without (88.5 vs. 42.9%, respectively, P=0.037). Similarly, 5-year cumulative incidence of relapse (CIR) was significantly lower in patients with NAFLD than in those without it (5-year CIR, 6.3 vs. 57.1%, respectively, P=0.013). Patients with NAFLD exhibit better outcomes including 5-year EFS and CIR. Further studies are necessary.

Nonalcoholic Fatty Liver Disease in Polycystic Ovary Syndrome

Background and Objectives: Nonalcoholic fatty liver disease (NAFLD) and polycystic ovary syndrome (PCOS) are two prevalent metabolic disorders characterized by insulin resistance. A bidirectional relationship exists between NAFLD and PCOS. NAFLD prevalence is significantly higher and more severe in women with PCOS. This study was conducted to generate data regarding the frequency of NAFLD among Bangladeshi women with PCOS. Materials and Methods: This cross-sectional study was conducted at the endocrinology and gynecology outpatient department of a tertiary hospital in Bangladesh from October 2020 to December 2021. All adult women diagnosed with PCOS by the revised Rotterdam criteria underwent ultrasonographic evaluation for hepatic steatosis. Relevant sociodemographic and clinical data were obtained from all; all underwent hormonal and metabolic assessment. Results: Among 120 women (age 33.67 ± 10.15 years) with PCOS studied, 32 (26.7%) had NAFLD. NAFLD frequency was higher in rural than urban areas. Clinical hyperandrogenism (HA) was less frequent in the NAFLD group than in the non-NAFLD group. Two groups did not vary in the frequencies of overweight, obesity, abdominal obesity, and hypertension. Hormonal parameters were indifferent in the two groups; both groups had a similar frequency of biochemical HA. Both groups had similar plasma glucose levels and glycemic status. NAFLD patients had lower high-density lipoprotein cholesterol and higher triglyceride than the non-NAFLD patients; total and low-density lipoprotein cholesterol were similar in the two groups. Although metabolic syndrome frequency was higher (43.8% vs. 33.0%) in the NAFLD group, the difference was insignificant (P = 0.290). Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were more elevated in the NAFLD group; AST: ALT ratios were identical in the two groups. In binary logistic regression analysis, only clinical HA was associated with a lower risk of NAFLD among the study participants. Conclusion: More than one-fourth of women with PCOS have NAFLD in this study. A large-scale, multicenter study may better explain NAFLD's association and risk factors in women with PCOS.

The triglycerides and glucose index is highly associated with non-alcoholic fatty liver disease in overweight and obese women.

Although some previous studies have indicated that the triglycerides and glucose (TyG) index is associated with an increased risk of non-alcoholic fatty liver disease (NAFLD), there are still few studies in this field. The goal of this study was to assess whether the TyG index is associated with the presence of non-alcoholic fatty liver disease NAFLD in overweight and obese women. Overweight and obese women aged 20 to 65years were enrolled in a cross-sectional study and allocated into the groups with and without NAFLD. Alcohol consumption, pregnancy, normal-weight, positive markers of viral or autoimmune hepatitis, acute or chronic liver disease, renal disease, cardiovascular disease, neoplasia, and intake of hepatotoxic drugs were exclusion criteria. The diagnosis of NAFLD was established by liver ultrasound and the TyG index was calculated as the Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)]/2. A total of 420 participants were enrolled and allocated into the groups with (n = 212) and without (n = 208) NAFLD. In the overall population, the frequency of NAFLD was 50.4%. The logistic regression analysis adjusted by body mass index, waist circumference, and total body fat showed that total cholesterol (OR = 1.004; 95% CI: 1.000-1.007), triglycerides (OR = 1.002; 95% CI: 1.000-1.004), AST (OR = 1.19; 95% CI: 1.15-1.23), ALT (OR = 1.20; 95% CI: 1.15-1.25), and TyG index (OR = 3.15; 95% CI: 1.64-6.06) are significantly associated with NAFLD. The results show that the TyG index is highly associated with the presence of NAFLD in women with overweight and obesity.

Clostridioides difficile infection in patients with nonalcoholic fatty liver disease-current status.

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease, leading to fibrosis, cirrhosis and hepatocellular carcinoma and also associated with increased cardiovascular disease mortality. The pathogenesis of NAFLD is not fully understood, although NAFLD is thought to be a hepatic form of metabolic syndrome. There is an increasing understanding of the role of microbiota disturbances in NAFLD pathogenesis, and as with many other conditions affecting the microbiota, NAFLD may be a novel risk factor for Clostridioides difficile (C. difficile) colonization (CDC) and C. difficile infection (CDI). CDI is an emerging nosocomial disease, and community-acquired cases of infection are growing, probably due to an increase in CDC rates. The association of NAFLD with CDI has been shown in only 4 studies to date, three of which included less than 1000 patients, although the frequency of NAFLD in these studies was observed in almost 20% of the total patient cohort. These data revealed that NAFLD is a risk factor for CDI development and, moreover, is a risk factor for intestinal complications of CDI. More studies are needed to investigate this association and move forward CDC and CDI screening efforts for this group of patients.

Non-Alcoholic Fatty Liver Disease in Long-Term Type 2 Diabetes: Role of rs738409 PNPLA3 and rs499765 FGF21 Polymorphisms and Serum Biomarkers.

Fibroblast growth factor 21 (FGF21) signaling and genetic factors are involved in non-alcoholic fatty liver disease (NAFLD) pathogenesis. However, these factors have rarely been studied in type 2 diabetes mellitus (T2D) patients from admixed populations such as in those of Brazil. Therefore, we aimed to evaluate rs738409 patanin-like phospholipase domain-containing protein (PNPLA3) and rs499765 FGF21 polymorphisms in T2D, and their association with NAFLD, liver fibrosis, and serum biomarkers (FGF21 and cytokeratin 18 levels). A total of 158 patients were included, and the frequency of NAFLD was 88.6%, which was independently associated with elevated body mass index. Significant liver fibrosis (≥F2) was detected by transient elastography (TE) in 26.8% of NAFLD patients, and was independently associated with obesity, low density lipoprotein, and gamma-glutamyl transferase (GGT). PNPLA3 GG genotype and GGT were independently associated with cirrhosis. PNPLA3 GG genotype patients had higher GGT and AST levels; PNPLA3 GG carriers had higher TE values than CG patients, and FGF21 CG genotype patients showed lower gamma-GT values than CC patients. No differences were found in serum values of FGF21 and CK18 in relation to the presence of NAFLD or liver fibrosis. The proportion of NAFLD patients with liver fibrosis was relevant in the present admixed T2D population, and was associated with PNPLA3 polymorphisms.

Association between neck circumference and non-alcoholic fatty liver disease: cross-sectional analysis from ELSA-Brasil.

Non-alcoholic fatty liver disease (NAFLD) has become a public health problem worldwide. Neck circumference (NC) is a simple anthropometric adiposity parameter that has been correlated with cardiometabolic disorders like NAFLD. To investigate the association between NC and NAFLD, considering their obesity-modifying effect, among participants from the Longitudinal Study of Adult Health (ELSA-Brasil) baseline study. Cross-sectional study at the ELSA-Brasil centers of six public research institutions. This analysis was conducted on 5,187 women and 4,270 men of mean age 51.8 (± 9.2) years. Anthropometric indexes (NC, waist circumference [WC] and body mass index [BMI]), biochemical and clinical parameters (diabetes, hypertension and dyslipidemia) and hepatic ultrasound were measured. The association between NC and NAFLD was estimated using multinomial logistic regression, considering potential confounding effects (age, WC, diabetes, hypertension and dyslipidemia). Effect modification was investigated by including the interaction term NC x BMI in the final model. The frequency of NAFLD and mean value of NC were 33.6% and 33.9 (± 2.5) cm in women, and 45.8% and 39.4 (± 2.8) cm in men, respectively. Even after all adjustments, larger NC was associated with a greater chance of moderate/severe NAFLD (1.16; 95% confidence interval [CI] for women; 1.05, 95% CI for men; P < 0.001). Presence of multiplicative interaction between NC and BMI (P < 0.001) was also observed. NC was positively associated with NAFLD in both sexes, regardless of traditional adiposity indexes such as BMI and WC. The magnitude of the association was more pronounced among women.

Non-alcoholic fatty liver disease frequency and associated factors at admission of acute stroke

Background/purpose of the studyIf non-alcoholic fatty liver disease (NAFLD) frequency is very high in stroke patients, NAFLD may be a risk factor for stroke and identifying factors of NAFLD presence may lead to stroke prevention. This retrospective study aimed to investigate whether NAFLD frequency was very high and identify factors associated with NAFLD presence at acute stroke admission.MethodsWe included stroke patients aged 40 − 79 years who (1) were admitted from 2016 to 2019, within 24 h of onset; (2) underwent abdominal ultrasonography; and (3) underwent blood examination of biomarkers. We evaluated the frequency and significant factors of NAFLD presence.ResultsAmong 1672 stroke patients, 676 patients met our inclusion criteria, and 267 patients (39.5%) had NAFLD. Compared to patients without NAFLD, patients with NAFLD were young; had high anthropometric values; high blood pressure; low aspartate aminotransferase/alanine aminotransferase ratio (AST/ALT) ratio; high levels of liver enzymes, serum albumin, HbA1c, and serum lipids; low-density lipoprotein; high serum level of some fatty acids; and high fatty acid% of palmitic acid (PA) and dihomo-gamma-linolenic acid (DGLA). After excluding variables with multicollinearity, independent NAFLD-presence factors were high body mass index (BMI), low AST/ALT ratio, high serum albumin level, high PA%, and high DGLA level.ConclusionsThe frequency of NAFLD was high in our patient group. Significant NAFLD-presence factors were high BMI, low AST/ALT ratio, high serum albumin level, high PA%, and high DGLA level. A further study is warranted to determine the effects of the NAFLD-presence factors on stroke onset or prevention.

Hepatic Steatosis and Fibrosis in Type 2 Diabetes: A Risk-Based Approach to Targeted Screening.

Non-alcoholic fatty liver disease (NAFLD) is common in people with type 2 diabetes mellitus (T2DM). We aimed to explore predictive factors of NAFLD in T2DM and identify high risk subgroups. This was a cross-sectional study including 100 individuals with T2DM and 100 without diabetes matched for age, sex, and body mass index (BMI). Hepatic steatosis grades (calculated by controlled attenuation parameters-CAP score-3), and liver fibrosis stages (F0-F4) were determined using transient elastography. The frequency of NAFLD was comparable between the two study groups. However, CAP scores were significantly higher in individuals with diabetes (294.90 ± 53.12 vs. 269.78 ± 45.05 dB/m; P < 0.001). Fifty percent of individuals with diabetes had severe steatosis (S3), while this figure was 31.6% in those without diabetes (P < 0.05). Significant fibrosis (F2-F4) was more frequent in individuals with T2DM (13% vs. 4.1%, P = 0.02). Individuals with T2DM and advanced fibrosis had significantly higher BMI, waist circumference (WC), waist-hip ratio (WHR), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and CAP score compared to those without fibrosis (P < 0.05). In the regression analysis, a model including BMI, WHR, AST and female gender explained 50% of the variation in CAP score in patients with diabetes (all P < 0.05, adjusted R2 : 0.508). CAP scores were also the major determinant of liver fibrosis in this group (OR: 1.04; CI: 1.017-1.063; P = 0.001). Individuals with diabetes are more likely to have severe fibrosis. Obesity (especially central obesity), the female gender, elevated liver enzymes, and higher degree of insulin resistance are associated with more advanced liver disease in individuals with T2DM.

Non Alcoholic Fatty Liver Disease- Is it a Rarity in Children of Bangladesh?

Nonalcoholic fatty liver disease (NAFLD) is a disease of liver occurring due to excess accumulation of fat in the liver. For defining NAFLD, there must be evidence of hepatic steatosis (HS), either by imaging or by histology and lack of secondary causes of hepatic fat accumulation. Frequency of NAFLD is increasing worldwide. Overall prevalence of NAFLD in Bangladesh is 33.9%. Insulin resistance is the central factor for the pathogenesis of NAFLD. Most of the children are asymptomatic and are identified incidentally by elevated serum aminotransferases. The objectives of this review are to provide the pediatricians an overview of fatty liver disease in children regarding its etiology, patients’ evaluation and management. This review also provides the approach to a child with fatty liver disease based on the best available evidence from electronic literature searches. Obese (BMI for age &gt; 95th centile) and overweight children (BMI for age between 85th to 95th centile) having additional risk factors like insulin resistance should be routinely screened for NAFLD. Estimation of serum ALT and/ or ultrasonography are the recommended screening tests. Though the treatment of NAFLD includes dietary modifications, physical activities, drugs and surgery; diet and physical activities are the cornerstone of management of NAFLD.&#x0D; Bangladesh J Child Health 2020; VOL 44 (2) :97-103

P2 Hígado graso y diabetes mellitus tipo 2

Introducción: existen fuertes evidencias que vincularían a la enfermedad del hígado graso no alcohólico (HGNA) con el síndrome metabólico (SM). Al parecer la resistencia a la insulina sería lo que estas enfermedades tendrían en común.Objetivos: se planteó la necesidad de conocer la frecuencia de HGNA en pacientes con diabetes mellitus 2 que consultaron por consultorio externo de un hospital público, e identificar los factores de riesgo para el desarrollo de esta enfermedad.Materiales y métodos: se realizó un estudio descriptivo de corte transversal incluyendo a pacientes diabéticos mayores de 18 años, no bebedor y habiendo excluido otras causas de hepatopatías crónicas. Se estudiaron 102 pacientes de enero a diciembre de de2019. Los datos recogidos se volcaron en una ficha de recolección de datos elaborada para tal fin. Se realizó un análisis descriptivo de las variables en estudio. En el análisis estadístico las posibles asociaciones se hicieron con X cuadrado y fue considerado significativo p menor 0,05. El análisis se realizó en Excel.

Association between Non-Alcoholic Fatty Liver Disease and Carotid Artery Intima-Media Thickness on B-Mode Ultrasonogram

Background: Prevalence of non-alcoholic fatty liver disease (NAFLD) is rapidly increasing worldwide. It is closely associated with abdominal obesity, dyslipidemia, hypertension, and type 2 diabetes, which are all features of the metabolic syndrome. Increased carotid intima media thickness (CIMT) is generally accepted as an early indicator of atherosclerosis and has been related to cardiovascular risk factors, and cardiovascular disease including incidence of myocardial infarction and stroke. The increasing rate of type II diabetes mellitus, abdominal obesity, sedentary life style and changes in the dietary habit, all are leading to serious health burden like NAFLD in Bangladesh. These patients have a higher risk of cardiovascular diseases. Early prediction of such incidence may help reduce the deadly consequences of NAFLD.&#x0D; Methods: This cross sectional study was carried out at the department of Radiology and Imaging of Dhaka Medical College and Hospital during the period of July 2015 to June 2017. Study population comprised of the outpatients who underwent abdominal ultrasonogram. Measurement of CIMT was done by high resolution real-time B-mode ultrasonogram at the same time. Body weight, height, blood pressure and available biochemical test reports were recorded along with a brief clinical history. Data were analyzed by SPSS version 23.&#x0D; Results: A total of 101 subjects were included in this study. Of them, on ultrasonographic examination of abdomen 49(48.5%) had normal liver assigned as group A and 52(51.5%) patients had fatty liver disease assigned as group B. Mean age of group A and group B patients were 36.8±12.4 and 46.15±10.3 years, and male:female ratio was 20:29 and 28:24 respectively. Family history of cardiovascular disease, diabetes mellitus and current smoking history were 14.3% versus 19.2%, 24.5% versus 44.2% and 14.3% versus 11.5% respectively among group A and group B. Frequency of NAFLD was grade I fatty liver 32.6%, grade II fatty liver 38.4% and grade I II fatty liver was 28.8%. Mean BMI was 24.8±4.1 versus 27.9±3.5 (p&lt;0.001) and serum total cholesterol (mg/dl) was 175.1±41.3 versus 207.3±52.6 (P=0.030) among two groups. Both these parameters were significant. On the other hand mean systolic blood pressure (mm Hg) 127.5±16.1 versus 127.5±16.1 (P=0.836), mean diastolic blood pressure (mm Hg) 81.6±11.6 versus 82.4±8.7 (P=0.7.8), serum triglyceride level (mg/dl) 175.3±106.1 versus 213.4±167.4 (P=0.404) were not significant among groups. Mean CIMT (mm) was 0.62±0.15 in group A and 0.77±0.17 in group B (P&lt;0.001) respectively. This result is highly significant. Accuracy of the CIMT in patients with or without NAFLD by ROC curve showed the area under curve (AUC) was 0.752 which was fair outcome of the study. CIMT cut-off at 0.680 mm showed the highest sensitivity (75%) and specificity (63%) for the presence of fatty liver disease by ultrasonogram.&#x0D; Conclusion: This study was aimed to explore the association between non-alcoholic fatty liver disease and carotid artery intima-media thickness on B-mode ultrasonogram. There is a positive correlation between NAFLD with CIMT. High BMI and raised serum cholesterol has significant role in the development of NAFLD. A large scale study is recommended to find more accurate cut off of CIMT in the relationship with NAFLD.&#x0D; Bangladesh Crit Care J September 2020; 8(2): 112-119

Non-invasive diagnosis of nonalcoholic fatty liver disease: impact of age and other risk factors

Background and objectives Little is known regarding the diagnostic performance of fibrosis scoring systems in the diagnosis of nonalcoholic fatty liver disease (NAFLD). We aimed to determine the risk factors of NAFLD and evaluate the diagnostic performance of noninvasive fibrosis scoring systems. Materials and methods The study included consecutive patients presented with dyspepsia from January 2017 to January 2019. Clinicodemographic and laboratory parameters including HOMA-IR were recorded. Anthropometric measurements were performed. NAFLD was diagnosed with ultrasonography. The FIB4, NAFLD, BARD, and Nippon scores were calculated. Results Totally, 1008 patients were enrolled. The mean age was 52.3 ± 15 years in the NAFLD group (25.8%) and 36.7 ± 15.7 years in the non-NAFLD group (74.2%). The frequency of NAFLD was 25.8%. Age, body mass index (BMI), diabetes mellitus (DM), platelet count, HbA1c, HDL, ALT, and AST/ALT ratio were independent risk factors for NAFLD. The most sensitive and specific tests in diagnosing NAFLD were HOMA-IR and Nippon score, respectively. Conclusions Age, BMI, DM, HbA1c, platelet count, HDL, ALT, and AST/ALT ratio were independent predictors of NAFLD. The most specific and sensitive predictors of the presence of NAFLD were Nippon score and HOMA-IR value, respectively. The place of fibrosis scores in the diagnosis of NAFLD patients requires further scrutinization.

Celiac Disease, Gluten-Free Diet, and Metabolic and Liver Disorders.

Celiac disease (CD) is a chronic autoimmune enteropathy triggered by the ingestion of gluten in genetically predisposed individuals. At the time of diagnosis, the frequency of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis in individuals with CD appears to be similar to that of the general population, although a lower body mass index and a lower rate of hypercholesterolemia and type 2 diabetes mellitus are observed at diagnosis in CD patients. The effect of a gluten-free diet (GFD) in individuals with these liver and metabolic disorders is still a matter of debate. The aim of this study was to investigate the links between a GFD and metabolic/liver disorders in CD patients. A systematic electronic search of the literature from January 2009 to December 2019 was performed using Medline, Web of Science, Scopus, and the Cochrane Library. Only papers written in English concerning metabolic and liver disorders in adult patients with CD were included. Out of 1195 citations, 14 eligible studies were identified. Increases in the frequency of NAFLD, weight gain, and alterations of the lipid profile suggest that important changes happen in celiac patients on a GFD, though the physiopathology of these conditions is unclear. Although a GFD is the only effective treatment available for CD, liver function, body weight, and metabolic and nutritional profiles should be monitored in patients on a GFD.

Nonalcoholic fatty liver disease is a risk factor for large-for-gestational-age birthweight.

ObjectiveNonalcoholic fatty liver disease (NAFLD) is a well-recognized hepatic manifestation of metabolic disease in adults and has been associated with the development of gestational diabetes (GDM). Hepatic insulin resistance can result in increased release of glucose (from gluconeogenesis) and free fatty acids (due to enhanced lipolysis), which can lead in turn to fetal overgrowth. However, the relationship between maternal metabolic factors (such as circulating levels of triglycerides, free fatty acids [FFA], or adipokines) and excessive fetal birthweight in NAFLD has not been carefully examined. In this study, we evaluated the relationship between NAFLD and the subsequent risk of large-for-gestational-age (LGA) birthweight.MethodSingleton nondiabetic pregnant women were evaluated for the presence of fatty liver at 10–14 weeks of gestation by abdominal ultrasound. The degree of fatty liver was classified as Grade 0–3 steatosis. At the time of liver ultrasound, maternal blood was taken after fasting and measured for adiponectin and FFA. LGA was defined as birthweight >90th percentile for gestational age.ResultsA total of 623 women were included in the analysis. The frequency of LGA was 10.9% (68/623), and the frequency of NAFLD was 18.9%. The risk of LGA increased significantly in patients with Grade 2–3 steatosis in the first trimester. The relationship between Grade 2–3 steatosis and LGA remained significant after adjustment for maternal age, pre-pregnancy BMI, GDM, and maternal serum triglyceride levels. The concentration of maternal blood adiponectin at 10–14 weeks was significantly lower in cases with LGA than non-LGA, but the maternal blood FFA concentrations were not different between the groups.ConclusionThe presence of Grade 2–3 steatosis on ultrasound in early pregnancy was associated with the increased risk of delivering an LGA infant, even after adjustment for multiple confounding factors including GDM. Adiponectin may be the linking biomarker between NAFLD and LGA.

Epidemiological survey of hemoglobin A1c and liver fibrosis in a general population with non-alcoholic fatty liver disease.

The association between glycemia and liver fibrosis was analyzed using hemoglobin A1c (HbA1c) and the Fibrosis-4 (FIB-4) index in a large general population cohort that underwent a health checkup. A total of 6927 subjects without hepatitis B or C virus infection or habitual alcohol intake were enrolled. Non-alcoholic fatty liver disease (NAFLD) was diagnosed by ultrasonography and potential liver fibrosis (FIB-4 index ≥1.3) in NAFLD was analyzed in relation to HbA1c level. Factors associated with potential liver fibrosis of NAFLD were also analyzed. The overall frequency of NAFLD was 27.9% (1935 subjects) and the frequency of NAFLD by HbA1c level (<4.9%, 5.0-5.9%, 6.0-6.9%, 7.0-7.9%, ≥8.0%) was 16%, 27%, 54%, 53%, and 54%, respectively. Among the 1935 NAFLD cases, the frequency of potential liver fibrosis was 25.2% (487 subjects) overall and 19%, 22%, 30%, 52%, and 31%, respectively, by HbA1c category. From multivariate analysis, an HbA1c level ≥6.5% was significantly associated with potential liver fibrosis (P = 0.017, hazard ratio = 1.7). The prevalence of NAFLD and liver fibrosis of NAFLD increased according to glycemia, up to 8.0% HbA1c. Measuring HbA1c and calculating the FIB-4 index in health checkups could help to identify potential cases of liver fibrosis of NAFLD, which should then be further evaluated using other techniques to confirm liver fibrosis.

Serum Chemerin in Obese Children and Adolescents Before and After L-Carnitine Therapy: Relation to Nonalcoholic Fatty Liver Disease and Other Features of Metabolic Syndrome

Chemerin plays an important role in metabolic syndrome (MetS) including nonalcoholic fatty liver disease (NAFLD). L-carnitine (LC) may reduce plasma glucose, lipid profile, and improve liver function. The aim of the study was to assess serum chemerin in obese children with suspected NAFLD, the effect of LC on NAFLD grade, chemerin and metabolic profile. Fifty obese children were compared to 50 controls. All were subjected to anthropometric assessment, liver function, fasting lipid profile, glucose/insulin (G/I) ratio, homeostasis model assessment (HOMA) index, serum chemerin and abdominal ultrasonography before and after LC. Serum chemerin was higher in cases than controls. Eighty percent of cases had NAFLD with increase in chemerin as severity of NAFLD increased. There was a decrease in frequency of NAFLD and its severity after LC therapy. Noninvasive monitoring of serum chemerin in obese patients with suspected NAFLD could be used to diagnose NAFLD. LC supplementation is effective in treatment of NAFLD and reducing chemerin.

I148M variant in PNPLA3 reduces central adiposity and metabolic disease risks while increasing nonalcoholic fatty liver disease

The I148M variant because of the substitution of C to G in PNPLA3 (rs738409) is associated with the increased risk of nonalcoholic fatty liver disease (NAFLD). In liver, I148M variant reduces hydrolytic function of PNPLA3, which results in hepatic steatosis; however, its association with the other clinical phenotype such as adiposity and metabolic diseases is not well established. To identify the impact of I148M variant on clinical risk factors of NAFLD, we recruited 1363 generally healthy Korean males after excluding alcoholic and secondary causes of hepatic steatosis. Central adiposity was assessed by computed tomography, and hepatic steatosis was evaluated by abdominal ultrasonography. The participants were predominantly middle-aged (49.0 ± 7.1 years; range 30-60 years), and the frequency of NAFLD was 44.2%. The rs738409-G allele carriers had a 1.19-fold increased risk for NAFLD (minor allele frequency 0.43; allelic odds ratio 1.38; P = 4.3 × 10(-5) ). Interestingly, the rs738409 GG carriers showed significantly lower levels of visceral and subcutaneous adiposity (P < 0.001 and = 0.015, respectively), BMI (P < 0.001), triglycerides (P < 0.001) and insulin resistance (P = 0.002) compared to CC carriers. These negative associations between clinical risk factors and rs738409-G dosage were more prominent in non-NAFLD group compared to those in NAFLD group. The I148M variant, although increasing the risk of NAFLD, was associated with reduced levels of central adiposity, BMI, serum triglycerides and insulin resistance, suggesting differential roles in fat storage and distribution according to cell types and metabolic status.

FP598NONALCOHOLIC FATTY LIVER DISEASE - A NEW CARDIOVASCULAR RISK FACTOR IN PERITONEAL DIALYSIS PATIENTS

Although the significant improvement in the reduction of infectious complications was fulfill during the last years, cardiovascular (CVD) mortality in peritoneal dialysis (PD) patients remains unchanged. Therefore, searching for new causes of increased CVD risk in PD patients has attracted further research interest. Recent investigations indicated that nonalcoholic fatty liver disease (NAFLD), a hepatic component of metabolic syndrome, is associated with an increased risk of CVD. Accordingly, we were interested to explore the frequency of NAFLD in PD patients and to analyze factors in PD patients associated with NAFLD occurrence. In addition, we were interested to investigate is NAFLD associated with higher CVD risk in our PD patients. In the present cross-sectional study, we analyzed 58 PD patients. The controlled attenuation parameter (CAP) was used to detect and quantify liver steatosis with the help of transient elastography (TE) (Fibroscan®, Echosense SA, Paris, France). A carotid ultrasound was performed in all patients to measure carotid intima-media thickness (ITM) and plaque as surrogate measures of increased CVD risk and to investigate their association with NAFLD. NAFLD was present in 74.1% of PD patients. PD/NAFLD patients had significantly lower hemoglobin (113.6±13.8 vs. 127.5±21.3 ; p=0.007) and serum iron (11.8±4.1 vs. 16.9±7 ; p=0.002) values in comparison to the non-NAFLD/PD patients. Furthermore, PD/NAFLD patients had significantly higher values of hs-CRP (7.6±7.9 vs. 2.2±1.7 ; p=0.02) and ferritin (286.1±157.4 vs. 146.2±118 ; p=0.005) than PD patients without NAFLD. The daily number of glucose solutions (p=0.04), obesity (p=0.02), and presence of hypertension (p=0.01), diabetes (p<0.0001) and dyslipidemia (p<0.0001) were found to be independent predictors of NAFLD occurrence in PD patients. PD patients with NAFLD showed more carotid atherosclerosis than PD patients without NAFLD (table 1). In additional, CAP values (as indicator of liver steatosis) had shown strong positively association with IMT (r=0.801 ; p<0.0001). In multivariate analysis NAFLD was a strong and an independent predictor of carotid atherosclerosis in PD patients. NAFLD is highly prevalent in PD patients. PD patients with NAFLD are at high risk for atherosclerosis. The clinical implication of this finding is that presence of NAFLD in PD patients may help in cardiovascular risk stratification and assessment.The use of CAP as a screening method for NAFLD detection in PD patients could be beneficial since it is a non-invasive and quick method that is easy to perform and may be repeated.