Fatty Liver Grade Research Articles

Effects of dapagliflozin on liver steatosis in patients with nonalcoholic fatty liver disease: a randomized controlled trial.

Nonalcoholic fatty liver disease (NAFLD) is a common liver comorbidity with considerable global consequences. This study explores the efficacy of dapagliflozin, a sodium-glucose cotransporter 2 inhibitor primarily used to manage type 2 diabetes, in reducing liver steatosis among NAFLD patients. This randomized, open-label, two-arm, parallel-group trial enrolled patients with NAFLD and a controlled attenuation parameter (CAP) score of ≥ 252dB/m. Participants were randomized (1:1) into either the control or dapagliflozin groups. The primary outcome was the change in CAP scores, measured with FibroScan after 24weeks. The trial included 150 patients, 20 of whom (13%) had type 2 diabetes. In week 24, the dapagliflozin group had significantly lower CAP score and fatty liver grade than did the control group (266.3 ± 57.8 50 vs 298.6 ± 59.0dB/m, respectively [p = 0.002]; 1.7 ± 0.7 vs 2.2 ± 0.8, respectively [p < 0.001]). Liver stiffness, waist circumference, and alanine transaminase levels decreased in both the dapagliflozin and control groups, but the between-group differences were nonsignificant (1.0 ± 0.3 vs 1.1 ± 0.3 [p = 0.678], 94.2 ± 12.7 vs 92.4 ± 11.1 [p = 0.382], and 28.8 ± 18.3 vs 28.3 ± 14.2 U/L [p = 0.856], respectively). In the multivariate analysis, a reduction in CAP was associated with dapagliflozin treatment (p = 0.01) and changes in BMI (p = 0.007). No adverse events were observed. Dapagliflozin can reduce CAP score and fatty liver grade in patients with moderate to severe NAFLD, regardless of their diabetes status.

Effect of Pomegranate Peel Consumption on Liver Enzymes, Lipid Profile, Liver Steatosis, and Hs-CRP in Patients With Non-alcoholic Fatty Liver Disease: A Double-Blind, Placebo-Controlled, Randomized Clinical Trial.

The most prevalent chronic liver disease for which there is currently no proven treatment is non-alcoholic fatty liver disease (NAFLD). An incomplete understanding of the underlying mechanisms of NAFLD may be the cause. The onset and development of this illness appear to be influenced by problems with lipid metabolism, insulin resistance, oxidative stress, and inflammation. Considering the antioxidant properties of pomegranate peel extract, this study was conducted to determine the effects of pomegranate peel consumption on some metabolic features in patients with NAFLD. Our hypothesis is that pomegranate peel can improve the grade of fatty liver, liver enzymes, lipid profile, serum high-sensitivity C-reactive protein (hs-CRP), and anthropometric indices. The aim of this study was to investigate the efficacy of pomegranate peel extract in NAFLD patients. This double-blind randomized clinical trial was conducted on 46 patients with NAFLD. Patients were randomly assigned to intervention group (n = 23) and placebo group (n = 23). Patients in the pomegranate peel group consumed two capsules, each containing 500 mg pomegranate peel extract daily as a part of low-calorie diet (i.e., 500-deficit calorie diet) for 10 weeks. While patients in the control group followed the low calorie diet and two capsules containing 500 mg maltodextrin. At the beginning and end of the study, demographic information, anthropometric indices, food intake, physical activity level, grade of fatty liver, liver enzymes, lipid profile, and serum high-sensitivity C-reactive protein (hs-CRP) were measured. Food intake was measured by 24-h food recall questionnaires and physical activity was measured by the International Physical Activity Questionnaire (IPAQ). Analysis of food recall questionnaire was done using Nutritionist IV program. Statistical analysis was performed using SPSS software (version 22), and a p value < 0.05 was defined as statistically significant. Of 46 patients, 42 of them completed the trial. At the end of the trial, pomegranate peel group had significantly higher reduction in TG (triglycerides), ALT(alanine aminotransferase), AST(aspartate transferase), hs-CRP and also had higher significant increase in HDL-C(high-density lipoprotein cholesterol) compared to the control group (p = 0/02, p = 0/02, p = 0/01, p = 0/01, and p = 0/04, respectively). However, changes in LDL-C, TC, ALP, GGT, and fatty liver grade were not significantly different between the two groups at the end of the study. The current study indicates that pomegranate peel extract has a favorable effect on liver enzymes, lipid profile, and serum high-sensitivity C-reactive protein (hs-CRP) in patients with NAFLD. To support these results, trials examining various dosages over longer time periods are necessary.

Convolutional neural network classification of ultrasound parametric images based on echo-envelope statistics for the quantitative diagnosis of liver steatosis.

Early detection and quantitative evaluation of liver steatosis are crucial. Therefore, this study investigated a method for classifying ultrasound images to fatty liver grades based on echo-envelope statistics (ES) and convolutional neural network (CNN) analyses. Three fatty liver grades, i.e., normal, mild, and moderate-to-severe, were defined using the thresholds of the magnetic resonance imaging-derived proton density fat fraction (MRI-PDFF). There were 10 cases of each grade, totaling 30 cases. To visualize the texture information affected by the deposition of fat droplets within the liver, the maps of first- and fourth-order moments and the heat maps formed from both moments were employed as parametric images derived from the ES. Several dozen to hundreds of regions of interest (ROIs) were extracted from the liver region in each parametric image. A total of 7680 ROIs were utilized for the transfer learning of a pretrained VGG-16 and classified using the transfer-learned VGG-16. The classification accuracies of the ROIs in all types of the parametric images were approximately 46%. The fatty liver grade for each case was determined by hard voting on the classified ROIs within the case. In the case of the fourth-order moment maps, the classification accuracy of the cases through hard voting mostly increased to approximately 63%. The formation of parametric images derived from the ES and the CNN classification of the parametric images were proposed for the quantitative diagnosis of liver steatosis. In more than 60% of the cases, the fatty liver grade could be estimated solely using ultrasound images.

The effect of ertugliflozin in patients with nonalcoholic fatty liver disease associated with type 2 diabetes mellitus: A randomized controlled trial.

Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease associated with liver inflammation, fibrosis, and cirrhosis and is associated with a greater risk of hepatocarcinoma. Nonalcoholic steatohepatitis (NASH) is a persistent and progressive form of NAFLD. Recent evidence suggested that ertugliflozin, a sodium-glucose cotransporter 2 inhibitor (SGLT2), suppresses NAFLD development in patients with type 2 diabetes mellitus (T2DM). The objective of this study was to determine the impact of ertugliflozin on improving NAFLD in patients with T2DM and the function of liver enzymes. This prospective, randomized, double-blind, placebo-controlled, interventional study aimed to determine the effectiveness of 15 mg of ertugliflozin versus 30 mg of the standard therapy pioglitazone versus placebo in NAFLD patients with T2DM. The study was established based on patient randomization in three groups: ertugliflozin, pioglitazone, and a placebo. This study was registered under the Australian New Zealand Clinical Trial Registry (Trial ID: ACTRN12624000032550). The impact of therapy was determined in the treatment groups by utilizing liver ultrasonography and biochemical parameters. After 24 weeks of clinical study, the results revealed significant improvement in the grades of fatty liver, especially in the ertugliflozin group. The number of patients with hepatic steatosis significantly decreased among the respective groups classified according to fatty liver grade. Among patients in the ertugliflozin and pioglitazone groups, 45% to 23.4% and 41.7% to 26.6%, respectively, decreased in the Grade 2 group. The aspartate aminotransferase and alanine aminotransferase levels were significantly lower in all the study groups, especially in the ertugliflozin group (P ≤ .001). The present study revealed that the concomitant use of ertugliflozin has favorable effects on liver enzymes, as it decreases liver fat intake and reduces complications in patients with NAFLD-associated T2DM. However, more in-depth studies will be required to observe every aspect of ertugliflozin.

Diagnostic and prognostic value of plasma lipocalin-2 levels in patients with metabolic dysfunction–associated steatotic liver disease

Abstract Background Non-Alcoholic Fatty Liver Disease, recently better recognised as Metabolic Dysfunction–Associated Steatotic Liver Disease, is the most prevalent form of chronic liver disease at present time. It is estimated to impact 32% of the world's population, hence representing a significant health burden. Aim of the work To assess the significance of plasma Lipocalin-2 (LCN2) levels in the diagnosis and prognosis of NAFLD patients. Patients and methods In this retrospective case–control study we recruited 102 subjects aged between 18 and 70 years. The included participants were split into two study groups. Group I: 51 NAFLD patients (61% men, 39% females) and Group II: 51 healthy controls (51% men and 49% females), for whom plasma LCN2 levels were assessed and correlated with NAFLD fibrosis score, FIB4 and fatty liver index. Results In this study, LCN2 levels in NAFLD patients were significantly greater compared to individuals in the control group (p &lt; 0.001), with a mean of 1893.214 ± 1002.852 ng/dL in the cases and a mean of 466.020 ± 397.699 ng/dL in the controls. This suggests the use of LCN2 as a possible diagnostic marker of NAFLD. The mean LCN2 levels in this study also significantly increased as the grade of fatty liver increased from I to III (p &lt; 0.001). This in turn proposes the use of LCN2 as a prognostic marker for NAFLD progression. LCN2 also significantly correlated with the fatty liver index and NAFLD Fibrosis scoring systems, but not with Fib-4. With an area under the ROC of 0.906, it demonstrated excellent diagnostic performance with 84% sensitivity, 90% specificity, 89.6% PPV and 85.2% NPV for the prediction of NAFLD patients. Conclusion Lipocalin-2 performs as a diagnostic and a possible prognostic marker for metabolic dysfunction-associated steatotic liver disease.

Non-invasive Assessment of Liver Fibrosis Using Shear Wave Elastography in Patients With Type 2 Diabetes Mellitus Having Non-alcoholic Fatty Liver Disease.

Background Type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD) frequently coexist due to overlapping risk factors such as metabolic syndrome and obesity. T2DM exacerbates the progression of NAFLD, increasing the risk of cirrhosis and hepatocellularcarcinoma. Thus, early detection of liver fibrosis is crucial to prevent severe liver disease. A 2D shear wave elastography (2D SWE) has emerged as a reliable non-invasive method for assessing liver stiffness, potentially reducing the need for liver biopsies and facilitating prompt treatment interventions. Methods This cross-sectional study, conducted over 18 months, included 100 T2DM and NAFLD patients from the Medicine and Diabetes Outpatient Department at SRM Medical College Hospital and Research Centre, Chengalpattu, India. Participants underwent gray-scale ultrasound to classify fatty liver (Grades I, II, and III) and 2D SWE to evaluate liver stiffness. Additional data on fasting and postprandial blood glucose, glycosylated hemoglobin (HbA1c), lipid profiles, liver function tests, and body mass index (BMI) were collected. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 21 (Released 2012; IBM Corp., Armonk, New York, United States). Results The mean age of participants was 47.9 years, with 61% being male. Fatty liver Grades I, II, and III were present in 47%, 41%, and 12% of patients, respectively. SWE results showed that 30% had stiffness values <5 kPa, 53% had values between 5.1-9 kPa, 16% had values between 9.1-13 kPa, and 1% had values >13 kPa. Liver size increased significantly with fatty liver grade (p=0.029). HbA1c levels and blood glucose levels were significantly correlated with fatty liver grades (p<0.0001). Triglyceride levels were higher with increasing fatty liver grades (p<0.0001). A significant correlation was found between gamma-glutamyl transferase (GGT) levels and SWE values (p=0.04). In the lipid profile, significant correlations were noted between SWE values and triglycerides (p=0.005), cholesterol (p=0.026), and very-low-density lipoprotein (VLDL) (p=0.131). Higher levels of HbA1c, fasting blood sugar, and postprandial blood sugar were also significantly correlated with SWE values (p<0.0001). Increasing grades of hepatic steatosis significantly correlated with SWE values (p<0.0001). BMI positively correlated with SWE values (r=0.321, p=0.001). Conclusion This study highlights the prevalence of advanced liver stiffness in patients with T2DM and NAFLD, which correlates significantly with higher grades of fatty liver, elevated HbA1c, blood sugar levels, and abnormal lipid profiles. SWE is a valuable tool for assessing liver stiffness and guiding the management of NAFLD in patients with T2DM.

An observational pilot study on Sidma kushta in relation to Yakrit &amp; Pliha as moola sthana of Raktavaha srotas

Acharya Charaka has mentioned fifteen koshtanga in the shareera. Koshtanga refers to the viscera. Two koshtanga, Yakrit and Pliha, have been designated as the moola sthana (primary centres of physiological activity) of the Raktavaha srotas (haemopoiesis). The description of Yakrit &amp; Pliha corresponds to the functions of the liver and spleen in contemporary anatomy. Kushta (skin disease) is a Rakta prodashaja vikara (disease caused due to the vitiation of blood). Sidma Kushta, or psoriasis, is one of the eighteen kushta listed in the Samhita. Its prevalence in the Indian population ranges from 0.44 to 2.8%. Recent observational studies have shown that the prevalence of NAFLD [Non-Alcoholic Fatty Liver Disease] (as diagnosed either by imaging or by histology) is remarkably higher in psoriatic patients (occurring in up to 50% of these patients) and suggested the presence of a novel hepato dermal axis. In this pilot study, six individuals diagnosed with sidma kushta were subjected to ultrasonography of the abdomen &amp; selected biochemical assays on the function of the liver, to observe the relationship between sidma kushta and moola sthana of raktavaha srotas.The data was statistically analyzed using Spearman’s correlation coefficient and a correlation was observed between the fatty liver grade and the levels of ALT, AST, and blood ammonia.

Point Shear Wave Elastography for Assessment of Liver Stiffness in Normal Individuals and in Patients With Non-alcoholic Fatty Liver Disease.

Background Non-alcoholic fatty liver disease (NAFLD) is an increasing health issue worldwide, driven by rising rates of diabetes, obesity, and hypertriglyceridemia. Often asymptomatic, NAFLD is diagnosed through blood tests, imaging, and sometimes liver biopsy. Some cases advance to non-alcoholic steatohepatitis (NASH), which can lead to complications like liver cirrhosis and liver failure. While liver biopsy is the standard test for diagnosis, non-invasive methods such as shear wave elastography (SWE) offer a simpler and more reproducible alternative for diagnosing NAFLD. This is crucial for early intervention and preventing the progression of liver damage. Objectives The objectives of the study were to measure and compare liver stiffness in healthy individuals and patients with NAFLD using point shear wave elastography (pSWE), as well as to correlate liver stiffness in NAFLD patients with the ultrasonographic grades of fatty liver. Materials and methods This observational study was carried out at Dr. D. Y. Patil Medical College, Hospitaland Research Centre in Pune, India, from December 2022 to April 2024. The study involved 82 participants in total, with 41 patients diagnosed with NAFLD (cases) and 41 healthy individuals with a sonographically normal liver (controls). pSWE was performed on each participant to measure liver stiffness, with results expressed in kilopascals (kPa). The procedure was conducted using a Samsung HS70A ultrasound machine (Samsung Electronics Pvt. Ltd., Seoul, South Korea). Data analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, USA). Non-parametric tests, such as the Mann-Whitney test and Kruskal-Wallis test, were used to evaluate the significance of differences. A p-value of less than 0.05 was considered statistically significant. Results The mean liver stiffness, measured in kilopascals (kPa), was higher in NAFLD patients (cases) (10±5.1 kPa) than in normal individuals (controls) (4.4±0.7 kPa). This difference was statistically significant, with a p-value of less than 0.001. A positive correlation (rho=0.848, p<0.001) was found between the ultrasonographic grade of fatty liver and liver stiffness in NAFLD patients. Conclusion Our study demonstrated that individuals with NAFLD exhibited significantly higher liver stiffness compared to healthy individuals, as measured by ultrasound SWE. These findings suggest that pSWE could serve as a valuable, non-invasive diagnostic tool for assessing liver stiffness in NAFLD patients. Additionally, pSWE holds the potential for evaluating and monitoring the progression of the disease. However, further research with larger sample sizes is necessary to determine the prognostic significance of liver stiffness in these patients.

Association between Chronic Kidney Disease and Non-Alcoholic Fatty Liver Disease: A Cross Sectional Study

Abstract Background Nonalcoholic fatty liver disease (NAFLD) is a growing health problem that poses a significant burden as it is currently the most prevalent form of chronic liver disease, affecting an estimated 25% of the worldwide population. Aim of the Work to evaluate the role of plasma LCN2 levels in the diagnosis and prognosis of patients with non-alcoholic fatty liver disease. Patients and Methods Our case-control study was conducted on 102 Egyptian subjects between the ages of 18 and 70, recruited from the Internal Medicine and Hepatology Department and Clinics at Ain Shams University Hospital during the period from March 2023 to August 2023, and divided them into two groups. Group I: 51 Egyptian patients diagnosed with NAFLD (61% males; 39% females). Group II: 51 Egyptian healthy controls (51% males; 49% females) Results In this study, LCN2 levels were significantly higher in cases than in the control group (p &amp;lt; 0.001), with a mean of 1893.214 ±1002.852 in the cases and a mean of 466.020 ± 397.699 in the controls. This suggests the use of LCN2 as a possible diagnostic marker of NAFLD. The mean LCN2 levels in this study also significantly increased as the grade of fatty liver increased from I to III (p &amp;lt; 0.001). This in turn proposes the use of LCN2 as a prognostic marker for NAFLD progression. LCN2 also significantly correlated with the fatty liver index and NAFLD Fibrosis scoring systems, but not with Fib-4. It showed an excellent diagnostic performance in this study with an area under ROC of 0.906, an 84% sensitivity, a 90% specificity, 89.6% PPV and 85.2% NPV for the prediction of NAFLD patients. Conclusion Lipocalin-2 performs as a diagnostic marker for non-alcoholic liver disease, and a possible prognostic test that may be used to follow up the degree of steatosis. Other studies should be done on a larger size of participants to determine the prevalence of LCN2 in Egyptian population as well as other populations. Other studies should also be expanded to include NAFLD with degrees of fibrosis, and more quantitative imaging tools could be used to compare LCN2 levels with the NAFLD stage. The levels of LCN2 can be also measured in cohort studies before and after treatment of NAFLD to evaluate its sensitivity to the response of treatment.

Fatty Liver Disease and its Impaction on Insulin Resistance

Abstract Background Non-alcoholic fatty liver disease (NAFLD) involves excess liver fat accumulation without specific causes like alcohol or viral infections, categorized into simple steatosis and nonalcoholic steatohepatitis (NASH). While simple steatosis is generally stable, NASH is linked to progressive liver disease. Diagnosis excludes secondary causes, and NAFLD, marked by hepatocyte changes, inflammation, and fibrosis, may lead to severe complications. Strongly associated with insulin resistance in liver and adipose tissues, NAFLD disrupts glucose-insulin interplay, compromising insulin's regulatory functions and contributing to metabolic disorders and disease progression. Aim of the Work The aim of the study is to investigate fatty liver disease and evaluate its impact of on insulin resistance. Patients and Methods This cross-sectional study, conducted at Ain Shams University, focuses on adults with NAFLD to assess insulin resistance. Inclusion criteria involve fatty liver disease, impaired glucose tolerance, and informed consent, while exclusions include alcohol intake and hepatitis. Data collection comprises demographics, anthropometrics, metabolic syndrome assessment, ultrasound grading of steatosis, and laboratory tests for liver function, FIB-4 index, and insulin resistance using HOMA-IR. The study aims to understand the relationship between NAFLD and insulin resistance in a clinical setting. Results In this study of 98 patients with Non-alcoholic Fatty Liver Disease (NAFLD), characterized by liver fat accumulation, insulin resistance (IR) was prevalent in 63.3%. The cases, predominantly females (52%), had mean age of 43 years, 50% were hypertensive, and 48% were diabetic. IR was directly related to age, and its prevalence was significantly higher in patients with diabetes and hypertension. IR correlated positively with body weight, BMI, ALT, AST, FIB-4, TG, and cholesterol. Fatty liver grading showed a significant association with IR, particularly in grade 2 cases. The optimal HOMA-IR cutoff for distinguishing between grade I and II fatty liver was &amp;gt;2.56, with high sensitivity (100%) and specificity (88.73%). These findings emphasize the intricate relationship between NAFLD, IR, and associated metabolic factors. Conclusion The study established a robust link between insulin resistance (IR) and Non- alcoholic Fatty Liver Disease (NAFLD), noting a 63.3% prevalence of IR in the subjects. Employing HOMA-IR, a cutoff point &amp;gt;2.56 effectively differentiated between NAFLD grades I and II, demonstrating 100% sensitivity, 88.73% specificity, and a remarkable AUC of 98. This underscores HOMA-IR's valuable role in identifying and stratifying NAFLD, especially in individuals with diabetes.

Evaluation of oral silymarin formulation efficacy in prevention of doxorubicin induced hepatotoxicity in patients with non-metastatic breast cancer.

Chemotherapy-induced hepatotoxicity is a common complication in breast cancer patients, especially with doxorubicin-containing regimens. Liver enzyme abnormality is reported in 34.8% of patients undergoing AC-T regimen and fatty liver is reported in 30% to 50% of cases. Antioxidant and anti-inflammatory properties of silymarin, a polyphenolic flavonoid extract derived from Silybum marianum, may be useful in preventing chemotherapy-induced hepatotoxicity. This study evaluated the effect of oral silymarin for preventing doxorubicin induced hepatotoxicity in non-metastatic breast cancer patients. In this triple-blind, placebo-controlled clinical trial, 50 patients with non-metastatic breast cancer were assigned to receive either 140 mg silymarin tablets or the placebo three times daily for 63 days and were evaluated for liver function test before the study and at the end of each chemotherapy cycle (every 3 weeks) for 4 cycles. In addition, an ultrasonography assessment was performed upon entry and the end of the study. Based on ultrasonography, the fatty liver grade was significantly higher in the placebo group at the end of the study. Moreover, the serum levels of aspartate aminotransferase (p = 0.015) and alkaline phosphatase (p = 0.004) at 6-week intervals, and the serum level of alkaline phosphatase (p = 0.002) at 9-week intervals were significantly lower in the silymarin group. Oral formulation of silymarin 420 mg/day for 63 days significantly prevented hepatotoxicity caused by doxorubicin in patients with non-metastatic breast cancer mostly based on liver ultrasonography but not laboratory parameters. Further investigations are suggested on different doses, durations and formulations of silymarin, particularly nano-formulations for increasing its oral bioavailability.

A Review on the Pharmacokinetics and Toxicological Profile of Rabeprazole

Rabeprazole, a proton pump inhibitor, is used for individuals with ulcers. The prodrug is transformed into an active sulphenamide form by the acidic conditions present in the parietal cells. Rabeprazole inhibits the H+K+ ATPase of the gastric cells, leading to a decrease in the generation of stomach acid in both normal and stimulated situations. The present review was based on the pharmacokinetics and toxicological profile of Rabeprazole. Once absorbed into the body, approximately 96.3–97% of rabeprazole is bound to plasma proteins. In humans, the half-life of rabeprazole is approximately one hour. The peak concentration of rabeprazole in human plasma following a single oral dose does not appear until around 3.5 hours later. Rabeprazole is metabolised mostly by the liver. Once the liver has metabolised the medicine, 90% of it will be excreted via the kidneys. The elimination fraction is 10%. Rabeprazole is mostly metabolised by the cytochrome P450 enzymes CYP2C19 and CYP3A4. . It concluded that in the human pylorus, it decreased muscular tone, maximal contraction values, and contraction frequencies. When diclofenac sodium SR, glucosamine, diacerein, calcium, and vitamin D preparations were administered in addition to rabeprazole, the patients experienced GI bleeding, fatty liver grade 1, mild epigastric discomfort, black stools, and decreased haemoglobin content.

Insights into the clinical impact of complete blood cell inflammatory markers on body composition variations and fatty liver grading in Iranian adults undergoing bariatric surgery: a retrospective longitudinal study.

In bariatric surgery, inflammatory biomarkers predict outcomes. Limited research on complete blood cell (CBC) markers stresses the need for correlation study. This research explores links between CBC inflammatory markers, body changes, and fatty liver grades in Iranian bariatric patients. This retrospective longitudinal study examined 237 bariatric surgery patients who satisfied the inclusion criteria and were deemed eligible for participation. These criteria encompassed patients who had undergone sleeve or mini-bypass surgery and were aged between 18 and 65 years. The study gathered demographic data, pre and post-surgery changes in CBC inflammatory biomarkers [neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR), mean platelet volume (MPV), MPV-to-platelet count ratio (MPV/PC), and red cell distribution width (RDW)] and fatty liver grades. Additionally, it recorded pre and post-surgery changes in body composition, such as weight, muscle mass (MM), fat mass (FM), and fat-free mass (FFM). The pre-surgery RDW marker significantly associated with FM changes, highlighting its predictive nature. While no significant association was found between changes in patients' fatty liver grade and baseline marker values, it's worth noting that individuals with higher MM at 3 months achieved a fatty liver grade of zero. Also, at 6 months, higher FFM and MM were also associated with reaching a fatty liver grade of zero. While the retrospective design of this study limits its findings to existing clinical data, future prospective research should collect additional samples, extend the observation time, and examine the long-term predictive value of these markers.

Grading of Fatty Liver Based on Computed Tomography Hounsfield Unit Values versus Ultrasonography Grading

Grading of Fatty Liver Based on Computed Tomography Hounsfield Unit Values versus Ultrasonography Grading

Effect of Bariatric Surgery on the Sonographic Grade of Metabolic-Associated Fatty Liver Disease at 12-Month Follow-Up.

Metabolic-associated fatty liver disease (MAFLD) is the most prevalent liver disease across the globe. One of the most effective treatments for this disease is weight loss. This study aimed to determine how metabolic and bariatric surgery (MBS) affects MAFLD sonographic grades. In 2021, a pre-post study was conducted on 73 patients who underwent MBS. The study collected demographic information and ultrasound grades of MAFLD before and after MBS. A total of 73 patients underwent MBS, with 58 females and 15 males. The patients had a mean age of 39.8 ± 8.88years and a mean BMI of 42.12 ± 5.98kg/m2. Of these patients, 53 (72.6%) underwent SG, while 20 (27.4%) underwent RYGB. The preoperative BMI for females and males decreased significantly at the 12-month follow-up (P = 0.0001). However, males experienced more prominent weight changes (P = 0.009), but there was no statistically significant difference in fatty liver grade changes after MBS between males and females (P = 0.056), which suggests that the effect of MBS on fatty liver grades is not gender-specific. There was a significant reduction in BMI and fatty liver grade for patients under and over 40years old after surgery (P = 0.0001). However, there was no statistically significant difference in fatty liver grade and BMI changes after MBS between the two age groups. RYGB was found to be more effective than SG in reducing fatty liver grade, BMI, and %TWL (P < 0.05). Bariatric surgery can play a vital role in reducing the weight and severity of metabolic-associated fatty liver disease.

Effect of Phalatrikadi ghana vati in a patient of non-alcoholic fatty liver disease: a case report

Abstract A 39-year-old male patient presented with complaints of decreased appetite, generalized weakness, nausea, gastric distension of the abdomen on and off, and mild pain in the upper abdomen. Ultrasonography of the whole abdomen revealed hepatomegaly with grade II diffuse fatty infiltration of the liver or nonalcoholic fatty liver disease (NAFLD). Such disorders of the hepatobiliary system are categorized as Yakritroga in Ayurveda. A drug, Phalatrikadi ghana vati, which is a combination of eight herbs known to pacify and normalize the functions of the three doshas, was prescribed to the patient for 12 weeks along with lifestyle modifications (pathya ahara–vihara). The individual contents of this drug are known to possess hepatoprotective activity. The patient showed significant relief in subjective parameters Udarasula (pain in the abdomen), Utklesa (feeling of nausea and vomiting), Aruchi (loss of appetite), and Klama (fatigue). The elevated liver enzymes were also reported to be in the normal range after the treatment, along with improved fatty liver grading. This single case report of NAFLD was managed satisfactorily with significant improvement with no side effects.

Laparoscopic Roux-en-Y Versus Mini-Gastric Bypass on Liver Function at 6 Months in Morbid Obesity Patients: A Cross-Sectional Study

Background: Various weight loss surgeries exist, with no absolute superiority; each has pros and cons. Due to rising bariatric surgeries globally, it's vital to investigate comparisons between two-mini gastric bypass and Roux-en-Y gastric bypass (RYGB), especially regarding their impact on liver function. Objectives: The purpose of this study was to "draw comparisons between the effects of mini gastric bypass and laparoscopic Roux-en-Y gastric bypass on liver function at 6 months among patients with morbid obesity." Methods: This cross-sectional study included 90 bariatric surgery candidates (Body Mass Index (BMI) 35 - 50) from 2018 - 2021. Forty-five had laparoscopic mini gastric bypass surgery, while 45 had Roux-en-Y gastric bypass. Demographic, anthropometric, lab, and sonographic tests were conducted at baseline, 3-, and 6-months post-surgery. Data was analyzed using SPSS. Results: In a study of 90 patients (75.6% female, mean age 38.6 ± 10.4 years), both surgeries (Mini gastric bypass (MGB) and RYGB) effectively reduced body weight, BMI, and waist circumference at 3- and 6-months post-surgery. However, MGB showed significantly higher BMI and weight loss compared to RYGB (P = 0.003). In 90 patients, both surgeries reduced weight and BMI. However, MGB showed better BMI/weight loss. LFTs (ALT, AST, ALP) remained stable after MGB but worsened at 3 months after RYGB before recovering by 6 months. Mini gastric bypass also showed better GGT improvement. Both procedures improved fatty liver grading, FBS, and HbA1C levels equally. No significant differences were observed in blood pressure, platelet count, hemoglobin, or MCV. Ferritin levels increased in both groups but were higher in RYGB. CRP was higher in RYGB at 3 months. Conclusions: Roux-en-Y gastric bypass temporarily exacerbated liver enzymes and inflammation, but MGB resulted with more weight reduction. In comparison to RYGB, MGB improved LFTs more consistently.

(113) Investigating the Prevalence of Erectile Dysfunction in Patients with Non-Alcoholic Fatty Liver and Its Relationship with the Severity of Fatty Liver

Abstract Introduction Today, the relationship between erectile dysfunction in men and the pathogenesis process in the field of metabolic syndrome is of interest. Non-alcoholic fatty liver disease is one of the diseases related to metabolic syndrome, which has a high prevalence. This study was conducted with the aim of evaluating the prevalence of erectile dysfunction in men with non-alcoholic fatty liver disease and investigating the relationship between its severity and the grading of liver complications. Objective In this research, the frequency of erectile dysfunction and decreased libido and sexual satisfaction in patients with non-alcoholic fatty liver disease have been investigated and compared with the control group. Also, the relationship between the severity of sexual dysfunction and fatty liver grading has been investigated. Methods In this study, 1200 patients with non-alcoholic fatty liver disease were randomly selected and participated in this study between 2019 and 2022. In order to investigate sexual disorders, the standard male sexual performance questionnaire was used along with the demographic questionnaire. Results The results of this study showed that the indicators of male sexual dysfunction in patients with non-alcoholic fatty liver have a high prevalence (44.5%). Also, the severity of erectile dysfunction has a significant relationship with the severity of non-alcoholic fatty liver disease (pv=0.002). Conclusions A holistic view of the health category requires that in the treatment of medical disorders, the effective factors and consequences of the disorder should be considered. Paying attention to the diagnosis and treatment of sexual disorders in the treatment process will be one of the most important aspects of the patient's health; Because erectile dysfunction in men, apart from the effect on sexual relations, will have destructive consequences on their psychological indicators and quality of life. On the other hand, it is possible to improve the quality of patients' health by modifying the lifestyle and interdisciplinary cooperation. Disclosure No.

Cost-effectiveness of Traditional Persian Medicine-Based Diet on NonAlcoholic Fatty Liver Disease

Background: In the context of Persian traditional medicine, there are several therapeutic strategies for managing diseases, ranging from lifestyle changes to herbal remedies.&#x0D; Objectives: Given the application of Persian traditional medicine in the management of chronic diseases, the burden of chronic illnesses, and the public’s recourse to traditional medicine specialists, this study aimed to assess the cost-effectiveness of traditional medicine dietary regimens for the treatment of non-alcoholic fatty liver disease from the perspective of the payer.&#x0D; Methods: In this study, we investigated the cost-effectiveness of providing nutrition counseling for lifestyle modification (changes in the aforementioned Setteh-e-Zarurieah) by a traditional medicine specialist compared to receiving counseling from a nutritionist for nonalcoholic fatty liver disease from the payer’s perspective. The outcomes measured were changes in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) enzymes, body mass index (BMI), and the grade of fatty liver. Cost and effectiveness data were entered into Excel software, and the ICER ratio was calculated&#x0D; Results: The results indicated that the dietary regimen prescribed by Persian traditional medicine when compared to the nutritionist’s recommended diet, resulted in a lower decrease in AST and ALT enzymes but led to a greater decrease in BMI (mean change = 0.42) and a significant change in the grade of fatty liver (OR = 9.75). Since the costs of tests, ultrasounds, and visits were equal in both groups, the cost difference was zero. In the first scenario, where traditional medicine is considered an alternative therapy and liver enzymes are the primary focus, providing nutritional counseling services by Persian traditional medicine may not be cost-effective. However, if we consider the grade of fatty liver and BMI as the primary variables, providing nutritional counseling services by Persian traditional medicine may be cost-effective.&#x0D; Conclusions: Based on the available evidence, the treatment of fatty liver using Persian traditional medicine can be considered an effective and cost-effective complementary (or alternative) intervention. Considering the long-term costs imposed by the health system and insurance organizations, it is predicted that adding visits to Persian traditional medicine specialists may reduce overall healthcare system costs.

Association between Body Mass Index (BMI) and the Incidence of Non-Alcoholic Fatty Liver Disease (NAFLD)

Background: The prevalence of obesity among the population has risen dramatically due to a sedentary lifestyle. Obesity is a risk factor for the incidence of non-alcoholic fatty liver disease (NAFLD) and the prevalence of NAFLD rises to 90% in obese. NAFLD is a clinically silent disease that has become one of the most common causes of liver disease worldwide also due to multiple extrahepatic complications or comorbidities. This study aims to find the association between the Body mass index (BMI) and the incidence of NAFLD. Method: This analytic study with a cross-sectional design was conducted on the 3rd of July 2022 in Boho Village, Samosir District of North Sumatra. The participants were based on a simple random sampling that meets the criteria of inclusion. BMI was calculated as weight in kilograms divided by the square of height in meters (kg/m2), meanwhile, we performed an abdominal ultrasound to diagnose NAFLD. Statistical analyses were performed using SPSS and using Chi-Square test to see the association between BMI and the incidence of NAFLD. Result: Among of 48 participants, most of them were fatty liver grade 1 (31.25%), and Overweight/Obese (62.5%). The incidence of NAFLD is more prevalent in obese than non-obese participants (p = 0.0001). Conclusion: The most of participants were fatty liver grade 1 (31.25%), and Overweight/Obese (62.5%). There was a significant association between BMI and the incidence of NAFLD