Fatty Liver Grade Research Articles

Relationship between Hepatic Artery Resistive Index and Liver Fibrosis Score in Non-Alcoholic Fatty Liver Disease Patient

Background: Nonalcoholic fatty liver disease (NAFLD) is one of the most important precursors of chronic liver disease all over the world. Doppler ultrasonography is an essential part of evaluating the vascular haemodynamic variation seen within NAFLD. Objective: Assessment of the role of Hepatic Artery Resistive Index (HARI) in NAFLD patient and the relation between HARI and grading of fatty liver by ultrasound. Patients and methods: One hundred Egyptian patients diagnosed to have NAFLD based on ultrasound abdomen 35, 35, and 30 patients in grade1, grade 2, and grade3 NAFLD, respectively and 20 healthy subjects as control group were subjected to hepatic artery Doppler study. The study was carried out in the Outpatient Clinic of Internal Medicine Department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt. Results: Our study results showed high statistical significant difference (p-value < 0.001) between studied groups as regards hepatic artery resistance index. There was an inverse relationship between HARI and different grades of fatty liver in patients (p < 0.001). Hepatic artery resistance index (RI) decreased as the severity of diffuse fatty infiltration increases. Conclusion: Hepatic artery resistance index (RI) decreases as the severity of diffuse fatty infiltration increases.

Relationship between Hepatic Artery Resistive Index and Liver Fibrosis Score in Non-Alcoholic Fatty Liver Disease Patient

Background: Nonalcoholic fatty liver disease (NAFLD) is one of the most important precursors of chronic liver disease all over the world. Doppler ultrasonography is an essential part of evaluating the vascular haemodynamic variation seen within NAFLD. Objective: Assessment of the role of Hepatic Artery Resistive Index (HARI) in NAFLD patient and the relation between HARI and grading of fatty liver by ultrasound. Patients and methods: One hundred Egyptian patients diagnosed to have NAFLD based on ultrasound abdomen 35, 35, and 30 patients in grade1, grade 2, and grade3 NAFLD, respectively and 20 healthy subjects as control group were subjected to hepatic artery Doppler study. The study was carried out in the Outpatient Clinic of Internal Medicine Department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt. Results: Our study results showed high statistical significant difference (p-value < 0.001) between studied groups as regards hepatic artery resistance index. There was an inverse relationship between HARI and different grades of fatty liver in patients (p < 0.001). Hepatic artery resistance index (RI) decreased as the severity of diffuse fatty infiltration increases. Conclusion: Hepatic artery resistance index (RI) decreases as the severity of diffuse fatty infiltration increases.

Association between non-alcoholic fatty liver disease and myocardial glucose uptake measured by 18F-fluorodeoxyglucose positron emission tomography

BackgroundNon-alcoholic fatty liver disease (NAFLD) has emerged as an independent risk factor for cardiovascular diseases. However, there were few studies evaluating the condition of myocardial glucose metabolism in patients with NAFLD. Therefore, the aim of this study was to investigate the association between NAFLD and myocardial glucose uptake assessed by using 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and whether or not alteration of myocardial glucose uptake could be an indicator linking to cardiac dysfunction in NAFLD individuals. Methods and ResultsA total of 743 asymptomatic subjects (201 with NAFLD, 542 without NAFLD) were retrospectively studied. The ratio of maximum myocardium FDG uptake to the mean standardized uptake value of liver (SUVratio) was calculated to estimate myocardial glucose uptake by using 18F-FDG PET. The diagnosis of fatty liver and fatty liver grading was confirmed by unenhanced CT according to diagnostic criterion of previous studies. The myocardial geometric and functional data were obtained by echocardiogram. Myocardial glucose uptake was significantly lower in individuals with NAFLD compared with those without fatty liver (P < .001). When analysis of association trend was performed, SUVratio quartiles showed correlated inversely and strongly with liver steatosis (P < .001). NAFLD patients with lower myocardial glucose uptake were more likely to have higher proportion of increased LV filling pressure (P < .05). A significant relationship between myocardial SUVratio and E/e’ ratio was presented in the trend analysis (P < .05). Moreover, multivariate regression analysis showed that myocardial glucose uptake was independently associated with NAFLD after adjusting for clinical important factors (all P < .001). ConclusionsThe presence of NAFLD in otherwise healthy subjects is closely associated with decreased myocardial glucose uptake assessing by 18F-FDG PET imaging. Furthermore, the NAFLD individuals with lower myocardial glucose uptake are more likely to have high risk of having impaired diastolic heart function.

Investigation of the Effect of Artichoke (Cynara Scolymus L.) on Characteristics of the Fatty Liver

Objective: Fatty liver causes progression in liver damage and accelerates liver fibrosis. Fatty liver may enhance AST and ALT enzymes in blood. Infiltration of lipid in liver is associated with an increasing in its echogenicity, depending on the severity of the lipid infiltration. Methods: This study is a randomized non-blind clinical trial in order to investigate the effect of Artichoke (Cynara Scolymus L.) herbal tea. The leaves of the plant were consumed twice a day (one tablespoon in a glass of boiling water for 20 minutes on indirect heat) for 45 days. Using Pokak analytical sampling formula, 70 patients (47 females and 23 males) aged 25 to 63 years were finally tested and the effect of this plant on parenchymal echogenic levels of liver, AST, and ALT of their liver was investigated. Liver enzymes and abdominal ultrasound were performed at the beginning and after treatment and studied people were grouped according to the ultrasound criteria for fatty liver disease after obtaining informed consent. The means were compared using paired t-test and data were analyzed by SPSS v.18 software. Results: Results showed that studied people, for fatty liver disease were grouped as follows: mild (23 patients, %32.86) as grade 1, moderate (38 patients, %54.28) as grade 2, and severe (9 patients, %12.86) as grade 3. At the end of this study, fatty liver grade was decreased in 51 patients (P≤0.05). However, 19 women didn’t show expected change in the grade of fatty liver. The Mean±SD of the enzymes measured in all patients before and after treatment were 5.49±26.76 and 36.96±13.01 for ALT, and 3641.20±14.46 and 31.76±12.26 for AST. Statistical analysis of the results by t-test showed significant decreasing for ALT and AST levels (P≤0.01). Conclusion: The results of this study showed that it seems this plant can be used to improve the laboratory symptoms of fatty liver.

EVALUATION OF THYROID FUNCTION STATUS IN SONOGRAPHICALLY SUGGESTED FATTY LIVER SUBJECTS

Objectives: The liver metabolizes thyroid hormones and thereby influences the regulation of their systematic endocrine effects. On the other hand, thyroid hormones play an important role in hepatic lipid homeostasis. Several studies addressed the association between thyroid function tests and non alcoholic fatty liver disease. The results of those studies indicate that hypothyroidism might be related to non alcoholic fatty liver disease. The recognized link between hypothyroidism and elements of metabolic syndrome may explain this relation. The present study was performed to evaluate the thyroid function status with the severity of sonographically suggested fatty liver subjects. Materials and Methods: This cross sectional study was carried out at the Department of Medicine of Jawaharlal Nehru Medical College &amp; Hospital, Bhagalpur, Bihar during the period of June 2019 to May 2020. A total number of 155 consecutive patients having sonographically detected fatty liver from the above mentioned hospitals were included in this study and they were divided into three grades depending on the sonographic criteria. Data were analyzed between these three grades in respect of age, sex, BMI, thyroid hormone levels (FT3, FT4 and TSH), fasting lipid profile and serum liver enzyme levels. Results: 82 (52.9%) patients had grade 1, 50 (32.3%) had grade 2 and 23 (14.8%) had grade 3 fatty liver. The mean age was found 39±10.9 years in Grade 1, 39.5±10.4 years in Grade 2 and 41.4±7.1 years in Grade 3. The difference was not statistically significant (p&gt;0.05) among three groups. Male to female ratio was almost 2:3 in the whole study subjects. The mean BMI was significantly higher in grade 3 (p&lt;0.05) followed by grade 2 and grade 1. 128 (82.6%) patients were euthyroid, 23 (14.8%) were subclinical hypothyroid and 4 (2.6%) were hypothyroid. In Anova test, the mean FT3 and FT4 were significantly declined (p&lt;0.05) with increased grade but the mean TSH level was significantly increased (p=0.001) with increased grade of fatty liver. The Spearman’s rank correlation test shows that no significant but a negative correlation (r= -0.101; p=0.175) was found between FT3 and fatty liver of the study patients, but a significant negative correlation (r=-0.277; p=0.001) was observed between FT4 and fatty liver of the study patients. On the other hand a significant positive correlation (r=0.325; p=0.001) was observed between TSH and fatty liver of the study patients. Conclusion: In this study it has been found that thyroid hormone levels are significantly decreased with increasing grades of fatty liver detected by ultrasound. The underlying pathophysiology for this association is still not clear, however several mechanisms have been proposed. So the findings of this study will inspire other researchers to evaluate the thyroid function status with the severity of sonographically suggested fatty liver in larger scale.

Is Aerated Soft Drink and Packaged Juice Consumption an Independent Risk Factor to Cause Non-Alcoholic Fatty Liver Disease

BACKGROUND:&#x0D; There has been an increase in consumption of aerated sweetened soft drinks and packaged juices high in carbohydrates/fructose by humans across the globe. There have been various studies with contradictory inferences of association of chronic sweetened soft drink (rich in high fructose corn syrup) intake and NAFLD. This study was undertaken with the aim to determine the quantity, frequency, duration and type of sweet soft drinks /packaged fruit juices consumption in patients with NAFLD as compared to that in control population. Other objectives included assessment of the independent role of sweetened soft drinks as a risk factor for NAFLD in the absence of metabolic syndrome and to correlate the level of steatosis (objectively graded by ultrasonography) with the amount of intake of soft drinks in patients of NAFLD.&#x0D; METHOD :&#x0D; 50 patients of NAFLD as diagnosed clinically and by ultrasonography were identified and compared with 50 age matched control population reporting to the hospital with ailments other than NAFLD. The presence or absence of metabolic syndrome was noted in all the patients. The history of soft drink intake was obtained from the patient under following heads: a) quantity consumed, b) type of soft drink/packaged juice consumed, c) period of ingestion and d) frequency of consumption.&#x0D; RESULT :&#x0D; The average monthly consumption, duration of consumption and the mean total sugar consumption of sweetened soft drinks / packaged juices were significantly higher in patients with NAFLD versus those in the control group (p=0.0002; &lt;0.0001; p=0.002 respectively). The quantity and chronicity of intake correlated well with the grade of NAFLD. As the average monthly consumption and mean sugar consumption increased the grade of fatty liver on USG also increased (p= 0.004). A total of 11 patients out of all the 100 patients (study and control groups combined) had a daily intake of 150-300ml of SSD for a period ranging from 5 to 20 years. Two of these had grade I NAFLD whereas 9 had grade II-III NAFLD. Five of these 11 patients had a daily intake of 250ml or greater. All these 5 patients had grade II-III NAFLD documented on ultrasound findings.&#x0D; Conclusion&#x0D; The consumption of sweetened soft drinks and packaged juice is on the rise in India. The intake of these drinks is significantly higher in patients with NAFLD.

CD36 Polymorphism (rs1761667) Was Associated with Fatty Liver in a Japanese Population

Abstract Objectives Nonalcohol fatty liver disease (NAFLD) is one of the considerable health problems in the world. NAFLD is a representative phenotype in the liver reflecting individual's lifestyle. Previous studies suggested that a single nucleotide polymorphism (SNP) in the CD36 gene was associated with dietary fat intake and fat metabolism. Therefore, we hypothesized that this SNP may be associated with fatty liver (FL) and NAFLD. We conducted this cross-sectional study to examine the association between two CD36 polymorphisms (rs1761667 and rs1527483) and FL and NAFLD in a Japanese population. Methods A total of 525 local residents participated in the health check-up in Yakumo town, Hokkaido, Japan. This cross-sectional study was conducted based on clinical information collected in this health check-up. Among all participants, 57 people were excluded due to the inadequate informed consent, clinical history of liver disease. Genotyping of two polymorphisms in the CD36 gpgbrkkene was performed by using the PCR-CTPP method. Ultrasound examination was performed by four qualified ultrasonographers. In this present, NAFLD was defined as 1) presence of FL and 2) a daily alcohol consumption &amp;lt;10 g in women and &amp;lt;20 g in men. Multivariable regression analysis was performed after adjusting for age, sex, waist circumference, medicine for dyslipidemia. Results The mean age of participants was 63.4 (10.0). The minor allele frequency of rs1761667 and rs1527483 was 0.26 and 0.21, respectively. The presence of FL and NAFLD was 90 (19.2%) and 67 (14.3%), respectively. Multiple regression analyses showed a significant association between rs1761667 and presence of FL (P = 0.04), and FL grade (P = 0.03). However, rs1761667 was not significantly associated with NAFLD (P = 0.11). No significant associations were found between rs1527483 and FL and NAFLD. Conclusions A polymorphism (rs1761667) in the CD36 gene was associated with the presence of FL, but we did not find a significant association between this SNP and NAFLD. Funding Sources This study was supported by the Mishima Kaiun Memorial Foundation.

The effect of melatonin on treatment of patients with non-alcoholic fatty liver disease: a randomized double blind clinical trial

ObjectivesMany factors implicated in the pathogenesis of non-alcoholic fatty liver disease (NAFLD) are including oxidative stress, insulin resistance and abnormal production of adipokines. The aim of this clinical trial was to evaluate the effect of melatonin supplement on some important biochemical markers and signs related to NAFLD. DesignA randomized double-blind, placebo-controlled, clinical trial. SettingTwenty-four participants in the melatonin group and 21 participants in the placebo group completed the study. InterventionParticipants received 6 mg melatonin or placebo daily, 1 h before bedtime. The intervention period was 12 weeks. Main outcome measuresAnthropometric measurements, systolic and diastolic blood pressure, liver enzymes, high sensitive C‑reactive protein (hs-CRP), fatty liver grade, also leptin and adiponectin serum levels, were measured at the baseline and the end of intervention. ResultsA significant improvement was observed in weight (p = 0.043), waist circumference (p = 0.027), abdominal circumference (p = 0.043), systolic (p = 0.039), and diastolic (p = 0.015) blood pressure, leptin serum levels (p = 0.032), hs-CRP (p = 0.024), alanine aminotransferase (p = 0.011), aspartate aminotransferase (p = 0.034), also the grade of fatty liver (p = 0.020) in melatonin treated group compared with the placebo. ConclusionsAdministration of 6 mg/day melatonin had improvement effect on many factors related to NAFLD such as liver enzymes, hs-CRP, anthropometric measurements, blood pressure, leptin serum levels and the grade of fatty liver.

Utility of MR proton density fat fraction and its correlation with ultrasonography and biochemical markers in nonalcoholic fatty liver disease in overweight adolescents.

Background Clinical or biochemical markers that have good correlation with magnetic resonance proton density fat fraction (MR PDFF) can be used as simple tools for the screening for nonalcoholic fatty liver disease (NAFLD) and in determining the degree of fatty infiltration of the liver. The objective of this study was to determine the degree of relationship between MR PDFF and ultrasonography (USG) grades of fatty liver, and clinical and biochemical parameters of adolescents and to determine the sensitivity and specificity of USG for diagnosis of NAFLD. Methods This prospective study included 34 overweight adolescents (mean age, 12.1 ± 1.5 years; range, 10-15.1 years; 10 girls and 24 boys) who underwent both USG and magnetic resonance imaging (MRI). Correlation analysis was performed between MR fat fraction and USG grades of fatty liver, and clinical and biochemical parameters of fatty liver disease. Results MR fat fraction had a moderate positive correlation with serum alanine transaminase (ALT) and aspartate transaminase (AST) (ρ = 0.634, p < 0.001, ρ = 0.516, p = 0.002, respectively) and had a negligible or weak correlation with body mass index (BMI), BMI standard deviation score (SDS), waist circumference (WC), fasting insulin, homeostatic model assessment of insulin resistance (HOMA-IR), serum triglyceride, low-density lipoprotein (LDL), high-density lipoprotein (HDL) and total cholesterol levels. The sensitivity and specificity of USG in the diagnosis of NAFLD were 81% (95% confidence interval 54%-95%) and 50% (27%-73%), respectively. The MR fat fraction had a moderate positive correlation with ultrasound grades of fatty liver (ρ = 0.487, p = 0.003). Conclusions Serum ALT and AST are potential biochemical markers to assess the degree of hepatic steatosis in NAFLD, which needs validation in further studies. USG can be used as a screening tool for NAFLD, but the diagnosis should be confirmed by estimating the MR fat fraction.

Quantitative Assessment of Fatty Liver using Ultrasound withNormalized Local Variance Technique.

To assess the diagnostic performance of the normalized local variance (NLV) ultrasound technique in the detection of the fatty liver using histopathology as a reference standard. We prospectively enrolled 194 consecutive patients with clinical suspicion of diffuse liver disease or history of liver transplantation. Conventional grayscale ultrasound and NLV examinations were performed and immediately followed by liver biopsies. The degrees of fatty liver, necroinflammatory activity, and fibrosis stage were evaluated by histopathological assessment. The diagnostic performance of the NLV values in detecting each grade of fatty liver was determined using receiver operating characteristics analyses, and multivariate linear regression analyses were performed to identify variables significantly associated with the NLV values. The number of patients in each degree of fatty liver and hepatic fibrosis was 118/37/26/13 and 81/68/24/6/14 for none/mild/moderate/severe steatosis and F0 / F1/F2 / F3/F4 fibrosis on histopathological examinations, respectively. The area under the receiver operating characteristics curve and optimal cut-off NLV value for detecting fatty liver of varying degrees were 0.911 and 1.095 for ≥ S1, 0.974 and 1.055 for ≥ S2, and 0.954 and 1.025 for ≥ S3, respectively. Multivariate analyses revealed that not fibrosis or inflammation but rather the degree of steatosis was associated with the NLV value. The NLV value demonstrated excellent diagnostic performance for detecting varying degrees of fatty liver, and the degree of steatosis on histopathological examinations was the only significant factor affecting the NLV value.

Quercetin supplementation in non-alcoholic fatty liver disease

Purpose Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease which has become a public health concern, whose growing prevalence has been reported as around 33.9% in Iran. As oxidative stress plays a crucial role in the pathogenesis of NAFLD, antioxidant compounds such as quercetin could ameliorate the side effect of oxidative stress. The aim of the current study was to assess the effect of quercetin on lipid profile, liver enzymes and inflammatory indices in NAFLD patients. Design/methodology/approach In a randomized, double-blind, placebo-controlled trial conducted as a pilot study, 90 patients with NAFLD were supplemented with either a quercetin or a placebo capsule twice daily (500 mg) for 12 weeks. Both groups were advised to follow an energy-balanced diet with physical activity recommendations. Blood sample was obtained for laboratory parameters at baseline and the end of week 12. Findings At the end of the follow-up, quercetin group had significantly greater reduction in anthropometric parameters, cholesterol (−15 ± (−41, 0.00) in Q group versus −1± (−8, 2) in control group, p = 0.004), TG (−56.7 ± 22.7) in Q group versus −13.4 ± 27.7 in control group, p = 0.04), and tumor necrosis factor-α (TNF-α) (−49.5 ± (−99, 21) in Q group versus −5 ± (−21, 0.30) in the control group, p &lt; 0.0001) compared to the control group. However, changes in fatty liver grade, liver enzymes, as well as high density lipoprotein-cholesterol and high-sensitivity C-reactive protein were not significantly different between the two groups. Originality/value To the best of the authors’ knowledge, this was the first study which assessed the effect of quercetin supplementation on liver enzymes, lipid profile and inflammatory indices of NAFLD patients as a double-blind placebo-controlled pilot study.

An observational study of the evaluation of fatty liver in non-alcoholics with metabolic syndrome using fatty liver index and its correlation with USG elastography

Background: NAFLD (Non Alcoholic Fatty Liver Disease) is being considered the hepatic component of metabolic syndrome. It is now the most common cause of chronic liver disease worldwide and needs to be addressed urgently as it is asymptomatic and widely prevalent and can progress to cirrhosis and hepatocellular carcinoma. There is a need for simpler methods to diagnose the condition in modern day practice which will help in identifying vulnerable subjects and in bringing about awareness and lifestyle modifications focused on reversal of the condition. Aim of this study was to check the applicability of the fatty liver index in modern day out patient practice using formula based FLI calculator.Methods: It was a cross sectional study on patients with metabolic syndrome in a tertiary care hospital. 60 patients with metabolic syndrome, both male and female above the age of 30 years and who were non-alcoholics were enrolled in the study. BMI, waist circumference, lipid profile and GGT were obtained and FLI calculated. It was compared with the ultrasound and Elastography reports. Chi square test, Independent t test and ANOVA test were used for comparing parameters. A p value of &lt;0.05 was considered statistically significant.Results: Among 60 patients all had fatty liver which emphasizes that fatty liver is the hepatic component of metabolic syndrome. There is a significant correlation between BMI (Body Mass Index) and waist circumference in predicting fatty liver and to some extent its grade. Patients with higher BMI had a greater grade of fatty liver.Conclusions: The fatty liver index is a reliable predictor of fatty liver in people with metabolic syndrome. The grade of fatty liver increases with increase in waist circumference and increased BMI. Ultrasound and Elastography are reliable non invasive methods of detecting fatty liver. BMI and Waist circumference are strong predictive factors for fatty liver.

Co-treatment with Vitamin D Supplementation and Aerobic Training in Elderly Women with Vit D Deficiency and NAFLD: A Single-blind Controlled Trial

Background: Lifestyle intervention is considered first-line therapy for Nonalcoholic Fatty Liver Disease (NAFL). Objectives: Here, we aimed to compare the effect of combined Aerobic Training (AT) and Vitamin D (Vit D) supplementation on NAFLD in elderly women with Vit D deficiency. Methods: We recruited 40 women (60 - 65 years) with NAFLD (second or third grade) and Vit D deficiency. Then, using simple randomization, the subjects were assigned to four groups including aerobic training (AT; 60% - 75%, 20 - 40 min/day, 3 days/wk running and walking), vitamin D supplementation (Vit D; 50,000 IU one day/week), aerobic training plus vitamin D supplementation (AT + Vit D), and sedentary control (C; placebo). The data were analyzed using paired t-test and one-way analysis of variance and Tukey’s post hoc test with SPSS21 at a significance level of P < 0.05. Results: After eight weeks of intervention, fatty liver grade markedly reduced in the AT + Vit D, AT, and Vit D groups (60%, 38.88%, and 22% respectively). However, it increased by 17.60% in the control group. The combination of AT + Vit D significantly reduced liver enzymes, anthropometric indices, and glycemic indices and improved lipid profile. All groups demonstrated a significant inverse correlation between vitamin D and fatty liver grade. Conclusions: A sedentary lifestyle and Vit D deficiency accelerate the NAFLD probably by deteriorating hepatic risk factors. Additionally, adequate levels of plasma vitamin D are necessary to achieve the beneficial metabolic effects of aerobic training.

Comparison of liver enzymes and sonological grading in nonalcoholic fatty liver

Background: Nonalcoholic fatty liver disease (NAFLD) is the leading cause of diffuse liver disease with a global prevalence of 25.24% and progresses to fibrosis and nonalcoholic steatohepatitis (NASH). Diagnosing NAFLD requires demonstration of increased liver fat and ultrasound imaging is widely used for screening. Specific blood tests to diagnose NAFLD and NASH are not yet available and alanine transaminase (ALT) has been used as a marker in population based studies.&#x0D; Aims and Objective: This study was aimed to compare the liver enzymes and sonological grading in NAFLD.&#x0D; Materials and Methods: A prospective hospital based observational study was carried out in 85 patients presenting to medical outpatient department (OPD) with ultrasonogical evidence of nonalcoholic fatty liver (NAFL) from January 2016 to December 2016. The patients were sent for liver enzymes and serum ALT,aspartate aminotransferase (AST) and gamma-glutamyltransferase (GGT) were particularly correlated with the grade of NAFL.Data were collected on a preformed proformaand analyzed using the Statistical Package for the Social Sciences (SPSS)20.0 (SPSS Inc., Chicago, IL, USA).&#x0D; Results: In our study, mean age of the patients was 46.08 years and most of the patients were in age group of 40-60 years. Females (65.88%) were more affected than males (34.12%). There were 71 (83.5%) patients with grade 1 NAFL and 14 (16.5%) patients with grade 2 NAFL. The level of serum ALT increased with higher grades of NAFL. The mean ALT in grade 1 NAFL was 29.14±19.41 and in grade 2 NAFL was 42.19±2157; p= 0.027. Comparison of serum AST and GGT with ultrasonological grading did not show statistical difference.&#x0D; Conclusion: Serum ALT levels correlated with the ultrasonological grades of NAFLD (p = 0.027) whereas AST and ALT did not show statistical correlation with grades of fatty liver. Our study suggests for large sample size study for AST and GGT values relationship with ultrasonological grades.

Relationship Between Body Mass Index, Fatty Liver, Lipids Profile, Carotid Intima-Media Thickness and Subcutaneous and Visceral Fat Determined by Ultrasound

Background: Childhood obesity is a risk factor for cardiovascular diseases, hypertension, diabetes and non-alcoholic fatty liver. Early diagnosis of obesity complications in children can be helpful for more effective treatment. Objectives: The present study aimed to evaluate the relationship of body mass index (BMI), fatty liver, lipids profile, carotid arteries intima-media thickness and thickness of subcutaneous visceral fat by using the ultrasound. Methods: Sixty one obese children (BMI > 95th) were enrolled in the study. The ultrasound was performed to evaluate the presence and degree of fatty liver in all cases and also for measuring the subcutaneous tissue which was measured in the middle regions of the abdomen and the right flank and visceral fat thickness along with carotid arteries intima-media thickness. The lipids profile (TG, Chol, LDL, HDL) was measured after 12-hour fasting in all cases. Results: A significant increase in the degree of fatty liver was observed with increasing subcutaneous and visceral fat thickness (P < 0.001), but these correlations were not considerable for carotid arteries intima-media thickness. A linear relationship with a positive trend was seen between the BMI and degree of liver steatosis. The visceral fat thickness showed a significant correlation with lipids profile. Conclusions: The present study revealed significant relationships between thickness of visceral and subcutaneous fat, grade of fatty liver, and lipids profile in children.

Flaxseed oil in the context of a weight loss programme ameliorates fatty liver grade in patients with non-alcoholic fatty liver disease: a randomised double-blind controlled trial.

Long-chain n-3 fatty acids have been shown to regulate lipid metabolism and reduce fat accumulation in the liver. This trial investigated the effect of flaxseed oil, as a rich source of α-linolenic acid, on fatty liver and cardiometabolic risk factors in patients with non-alcoholic fatty liver disease (NAFLD). The randomised, double-blind, controlled trial was performed on sixty-eight NAFLD patients who were divided into flaxseed (n 34) and sunflower (n 34) oil groups. Patients were given a hypoenergetic diet (-2092 kJ/d) and 20 g/d of the corresponding oil for 12 weeks. Fatty liver grade, liver enzymes and cardiometabolic parameters were determined. The intention-to-treat approach was used for data analysis. Fatty liver grade significantly decreased in both groups (-0·68 in flaxseed v. -0·29 in sunflower, P = 0·002). Alanine aminotransferase and aspartate aminotransferase decreased in both groups (P < 0·01). Also, significant reduction was observed in blood glucose (P = 0·005) and fat mass (P = 0·01) in the flaxseed and muscle mass (P = 0·01) in the sunflower group. However, none of these alterations was significantly different between the groups. Weight, waist circumference and blood pressure were significantly decreased in both groups but only weight change was significantly different between the groups (P = 0·01). IL-6 did not significantly change in either group but showed a significant between-group difference (P = 0·03). Overall, the results showed that in the context of a low-energy diet and moderate physical activity, flaxseed oil may benefit NAFLD patients to improve fatty liver grade, weight and IL-6 compared with sunflower oil.

Efficacy of Sharapunkhadi powder (a polyherbal formulation) and lifestyle modification in the management of nonalcoholic fatty liver disease-A randomized placebo-controlled clinical trial.

Background:Nonalcoholic fatty liver disease (NAFLD) is an expanding health problem, which varies in prevalence among ethnic groups, occurring with an estimated global prevalence of 25%. In high-risk populations, the prevalence of NAFLD may be as high as 70%–90%. No established pharmacological treatment is available for NAFLD in modern medicine and hence, there is a search for alternative treatment modalities in other systems of medicine, which is safe and cost-effective.Aim:The aim is to evaluate the efficacy of Sharapunkhadi powder and lifestyle modification in the management of NAFLD.Materials and methods:Patients suffering from any of the components of metabolic syndrome, i.e. hypertension, diabetes mellitus, hypertriglyceridemia, elevated body mass index (>25 kg/m2), truncal obesity, or presenting with the symptoms of indigestion, abdominal discomfort, flatulence. were screened with liver function tests and ultrasonography (USG) of the abdomen. A total of 93 patients confirmed with fatty liver Grade 1-3 were selected for the present trial and were randomly divided into two groups. After Mridu Virechana (mild purgation) with Haritaki powder (6–8 g) according to Koshtha, in group A (n = 46), 2 capsules (500 mg each) filled with Sharapunkhadi powder thrice a day before food with warm water along with lifestyle modification were administered for 8 weeks. In group B (n = 47), capsules filled with roasted Sooji powder in the same dose as mentioned for group A was given along with lifestyle modification and were maintained as a placebo. Relief in subjective parameters such as indigestion, abdominal discomfort, and flatulence and improvement in the grades of fatty liver evident from USG was considered for the overall assessment of the therapy in both the groups. SigmaStat 3.1 software was used for statistical calculation. Wilcoxon signed-rank test for subjective criteria and Student's paired t-test for objective criteria were applied to check the level of significance in a single group before and after treatment, while Student's unpaired t-test for objective criteria was applied to assess the level of significance of difference observed between two groups.Results:After 8 weeks of treatment, it was found from USG findings that there was a statistically significant improvement by about 39.25% in group A and 31.82% in group B, in the grade of fatty liver. The combination of Sharapunkhadi powder along with lifestyle modification provided comparatively better relief in subjective and objective parameters over the placebo control group.Conclusion:Sharapunkhadi powder is a promising herbal preparation for the management of NAFLD and the combination of Sharapunkhadi powder along with lifestyle modification can yield more significant results in the management of NAFLD than lifestyle modification alone.

Association between Inflammatory Biomarkers and Nutritional Status in Fatty Liver.

The prevalence and progression of non-alcoholic fatty liver disease (NAFLD) is mediated via several factors correlating with hepatic necroinflammation (adipokines/cytokines). This study was performed to analyze the level of inflammatory markers according to the presence of NAFLD and to identify related nutritional factors. A total of 80 adults were classified into 2 groups (healthy and NAFLD), and their body composition, blood tests, and eating habits were evaluated. In addition, inflammatory markers (adiponectin, high-sensitivity C-reactive protein [CRP], and tumor necrosis factor-alpha [TNF-α]), nutrient intake status, and dietary quality were compared. The quality of diet was assessed according to the nutrient adequacy ratio and the mean adequacy ratio (MAR). The NAFLD group had a higher body mass index (p < 0.001) than the healthy group and also carried significantly higher CRP levels (p < 0.001) but lower adiponectin (p = 0.001). TNF-α levels increased significantly with fatty liver grade (p = 0.023). The NAFLD group showed significantly higher intake of energy, carbohydrates, iron, sodium, vitamin A and saturated fatty acids, but significantly lower intake of zinc and vitamin E than the healthy group. The MAR values were slightly higher in the NAFLD group but without any significant difference. The levels of adiponectin and vitamin E showed a significant inverse correlation (p < 0.05). Nutritional management of NAFLD patients is important, and the intake of antioxidant and anti-inflammatory nutrients such as zinc and vitamin E should be emphasized.

Effect of Ginger Powder Supplementation in Patients with Non-Alcoholic Fatty Liver Disease: A Randomized Clinical Trial.

BackgroundNon-alcoholic fatty liver disease (NAFLD) is one of the most common chronic liver disorders. The main causes of NAFLD are associated with insulin resistance, severe lipid metabolism disorders, oxidative stress and inflammation. Previous studies have reported that ginger has positive metabolic results.AimThe aim of this study was to determine the effect of ginger powder supplement on lipid profiles, insulin resistance, liver enzymes, inflammatory cytokines and antioxidant status in patients with NAFLD.MethodsIn this randomized clinical trial, 46 people with NAFLD were parted into two groups and subjected to the ginger or placebo capsules (3 capsules daily, each containing 500 mg of ginger or wheat flour) over 12 weeks. All patients received a diet with balanced energy and physical activity during the intervention period. Liver ultrasonography, anthropometric indices and biochemical parameters were measured before and after intervention.ResultsNo significant difference was found between the two groups in the baseline variables at the beginning of the study. At the end of the study, serum levels of alanine aminotransferase (ALT), total cholesterol, low-density lipoprotein (LDL-C), fasting blood glucose, and insulin resistance index (HOMA), C-reactive protein (hs-CRP), and fetuin-A in the group receiving a ginger supplement significantly decreased compared to placebo. However, there was no significant difference between the two groups in body weight, fasting insulin, HDL-C, triglyceride, adiponectin, alpha-tumor necrosis factor (TNF-α), total antioxidant capacity (TAC), gamma-glutamyl transferase (GGT), aspartate aminotransferase (AST), fatty liver index (FLI), fatty liver grade and blood pressure.ConclusionThe ginger supplement may be used as a complementary therapy along with existing therapies to reduce insulin resistance, liver enzymes and inflammation in patients with non-alcoholic fatty liver.

Role of Magnetic Resonance Imaging in the Monitoring of Patients with Nonalcoholic Fatty Liver Disease: Comparison with Ultrasonography, Lipid Profile, and Body Mass Index

The aim of this study was to study the role of magnetic resonance imaging (MRI) in monitoring hepatic fat content in cases of nonalcoholic fatty liver disease (NAFLD). 41 adults (mean age: 39 years, 22 males; 19 females) with NAFLD were included after obtaining approval from the institutional ethics committee. The baseline clinical (weight, body mass index [BMI]) and biochemical parameters, fatty liver grade on ultrasonography (USG), and hepatic fat signal fraction (FSF) using dual-echo chemical shift imaging and proton density fat fraction on magnetic resonance spectroscopy (MRS-PDFF) were assessed, before and after intervention (dietary and lifestyle changes and oral vitamin E for six months). They were categorized into Group A (good compliance to intervention) and Group B (poor compliance), and the clinical and imaging parameters were compared between them. After intervention, Group A (n= 30) showed significant reduction in BMI (28.35±3.25 to 27.14±3.24kg/m2; P < 0.001), hepatic FSF (19.30±9.09% to 11.18±7.61%; P < 0.05), and MRS-PDFF (18.79±8.53% to 10.64±6.66%). In Group B (n= 11), there was significant increase in BMI (28.85±2.41 to 29.31±2.57kg/m2; P < 0.001), hepatic FSF (18.96±9.79% to 21.48±11.80%; P < 0.05), and reduction in high-density lipoproteins (P < 0.05). Althoughthere was good correlation between USG and MRS in quantifying liver fat (r= 0.84-0.87; P < 0.001), USG was unable to detect <5.3% change in hepatic fat. There was poor correlation between lipid profile and MRS-PDFF. Change in body weight significantly correlated with change in hepatic fat content (r= 0.76; P < 0.001). MRI is useful in accurately quantifying and in monitoring hepatic fat content and is better than clinical and biochemical parameters and USG.