Fatty Liver Grade Research Articles

Prevalence and association of non-alcoholic fatty liver disease and insulin resistance among non-diabetic obese, overweight, and metabolically obese normal-weight adult patients attending at a tertiary care hospital in Eastern India

Background: Worldwide, the incidence of obesity, overweight, and metabolic syndrome is dramatically increasing. Non-alcoholic fatty liver disease (NAFLD) is associated with both obesity/overweight and metabolic syndrome. Aims and Objectives: The aim of this study is to assess non-invasively the prevalence and association of NAFLD and insulin resistance among non-diabetic obese, overweight, and metabolically obese normal-weight (MONW) adults. Materials and Methods: This single-center cross-sectional study included 137 subjects aged more than 18 years, out of which 50 were obese, 22 were overweight, and 31 MONW. All subjects underwent detailed history, complete physical examination, laboratory test, and grading of hepatic fat by ultrasonography. Results: The mean age (mean± standard deviation) of the patients was 36.91±11.01 years with a range of 18–67 years. 53 (38.7%) and 84 (61.3%) of the patients were male and female, respectively. Out of the 137 patients, 73 (53.3%) of patients had NAFLD. The prevalence of NAFLD was significantly higher in the obese group (56.2%) as compared to others (Z=5.56; P<0.0001). The prevalence of NAFLD among overweight, MONW, and normal body mass index (BMI) were 17.8%, 19.2%, and 6.8%, respectively. The proportion of Grade-1 and Grade-2 NAFLD was significantly higher than that of Grade-3 (Z=4.16; P<0.0001). There was a significant association between BMI, insulin resistance measured by homeostasis model assessment-estimated insulin resistance (HOMA-IR), and grade of fatty liver of the patients (P<0.0001). Conclusion: NAFLD is more prevalent in obese than other groups. The grade of fatty liver has a significant association with HOMA-IR and BMI.

Association between Bioelectrical Impedance Parameters, Magnetic Resonance Imaging Muscle Parameters, and Fatty Liver Severity in Children and Adolescents.

To evaluate the associations between pediatric fatty liver severity, bioelectrical impedance analysis (BIA), and magnetic resonance imaging parameters, including total psoas muscle surface area (tPMSA) and paraspinal muscle fat (PMF). Children and adolescents who underwent BIA and liver magnetic resonance imaging between September 2022 and November 2023 were included. Linear regression analyses identified predictors of liver proton density fat fraction (PDFF) including BIA parameters, tPMSA, and PMF. Ordinal logistic regression analysis identified the association between these parameters and fatty liver grades. Pearson's correlation coefficients were used to evaluate the relationships between tPMSA and muscle-related BIA parameters, and between PMF and fat-related BIA parameters. Overall, 74 participants aged 8 to 16 years were included in the study. In the linear regression analyses, the percentage of body fat was positively associated with PDFF in all participants, whereas muscle-related BIA parameters were negatively associated with PDFF in participants with obesity. PMF and the PMF index were positively associated with PDFF in normalweight and overweight participants. In the ordinal logistic regression, percentage of body fat was positively associated with fatty liver grade in normal-weight and overweight participants and those with obesity, whereas muscle-related BIA parameters were negatively associated with fatty liver grade in participants with obesity. The PMF index was positively associated with fatty liver grade in normal/overweight participants. In the Pearson correlation analysis, muscle-related BIA parameters were correlated with tPMSA, and the fat-related BIA parameters were correlated with PMF. BIA parameters and PMF are potential screening tools for assessing fatty liver in children.

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) in People Living With HIV Attending Centre of Excellence in HIV Care at a Tertiary Level Teaching Hospital in North India-A Pilot Study.

With the availability of free antiretroviral therapy (ART) across India, HIV in adults has become a chronic disease with prolonged survival. The emergence of various non-communicable diseases in these prolonged survivors is a cause of concern. Metabolic dysfunction-associated steatotic liver disease (MASLD) in adults with HIV infection in India has not been explored to date. In this study, we attempted to assess the existence of MASLD in thirty adults registered at the Centre of Excellence in ART Care at a tertiary teaching hospital in New Delhi. This center provides free first-line, second-line, and third-line ART to patients as well as comprehensive HIV care including counseling, nutritional advice, and inpatient admissions for intercurrent illnesses. A total of 30 subjects were enrolled in the study to assess the occurrence of MASLD among people living with HIV (PLHIV) and its risk factors and to assess hepatic fibrosis in the subjects with MASLD using transient elastography and clinical fibrosis scores. The study population included 13 subjects on ART (43.3%) and 17 ART-naïve subjects (56.6%). All the study subjects underwent ultrasonography (USG) for the identification of the development of MASLD in them. Steatosis was identified as an increase in the echogenicity of the liver seen as an increase in the hepatorenal contrast and was further graded into the 3 grades of fatty liver. Out of the 30 subjects, 16.6% (5 out of 30) were found to have MASLD on USG, with grade 1 fatty changes seen in 4 (13.3%) and grade 2 fatty changes seen in 1 out of 30 subjects (3.3%). A majority (40%) of the subjects were underweight (body mass index [BMI] < 18.5). 22.7% of the male subjects included in the study had MASLD whereas none of the females had fatty changes in the liver on USG. Out of the study subjects, MASLD was detected in 17.6% of ART-naïve subjects while it was detected in 15.4% of subjects on ART. Although no statistically significant association was seen with any of these parameters, a few important trends were observed. These might be statistically significant in a higher power study with a larger sample size. Higher BMI (mean difference [MD] = 3.25, P = .09), waist circumference (MD = 3.84, P = .15), hip circumference (MD = 4.36, P = .14), and older age (MD = 6.56, P = .07) were observed to be associated with MASLD in our study, whereas the biochemical parameters and HIV-related factors were not seen to have any particular trend of association in our study. However, a higher median CD4 count was associated with MASLD as compared to the group without fatty changes on USG. On FibroScan, all 5 subjects with fatty changes in our study were found to have liver stiffness less than 7 kPa which corresponds to F0-F1 stage of fibrosis. Using the nonalcoholic fatty liver disease score, 2 subjects had scores corresponding to F0-F2 stage of fibrosis (as per METAVIR score) while the rest (3 out of 5) had indeterminate values. While on FIB4 scoring, 4 subjects had scores suggesting stage 0-1 fibrosis while 1 had a score suggestive of stage 4-6 fibrosis as per Ishak Fibrosis staging. As PLHIV with known diabetes mellitus, obesity, and hypothyroidism were excluded from our study, the prevalence of MASLD observed in our study underestimates the real prevalence of MASLD in this specific population. No significant association was observed between ART status or ART regimen and MASLD in our study subjects. However, in light of the existing evidence of association of dolutegravir (DTG) with significant weight gain, and the recent inclusion of DTG in the first-line ART regimen nationally in India, robust surveillance and large-scale studies are recommended to study the contribution of DTG to MASLD in PLHIV, if any.

Added value of Dixon MRI in quantification of liver fat in nonalcoholic fatty liver disease

Background The Dixon method for fat/water separation employs a technique for achieving consistent fat suppression by utilizing water-only reconstruction. The fat-only Dixon technique is a tool for identifying microscopic fat and assessing pathological lesions of concern. Aim To investigate the MRI Dixon fat fraction role in assessing fat deposition among nonalcoholic fatty liver disease (NAFLD) cases and correlation with ultrasonography (USG). Patients and methods This study included 30 cases, with an age range falling between 19 and 80 years, both sexes. We included those with one or more risk factors for NAFLD in which diffuse hepatic steatosis or normal liver was identified utilizing USG of the abdomen. Participants were examined using USG examination and MRI. Results Good agreement (k=0.615) between two imagining methods (MRI T1 Dixon and USG) in detecting fatty liver with significant difference between diagnostic confidence (accuracy) of MRI T1 Dixon and USG in detection of fatty liver (P=0.005). A significant variance was observed among the grading of fatty liver by MRI T1 Dixon and the presence of METs criteria and alanine aminotransferase level (P&lt;0.05). By USG, a moderate agreement between fatty liver grading utilizing MRI T1 Dixon and fatty liver grading utilizing USG (k=0.526). Conclusions Dixon MRI was a noninvasive method for quantifying fat fraction in NAFLD. When comparing the fatty liver grading on USG with the assessment of liver fat with MRI T1 Dixon of the liver, there was a significant overlap in the fat percentage within each grade.

Healthy Lifestyle and Metabolic Dysfunction-Associated Steatotic Liver Disease: A Study of the Efficacy of Fatty Liver Regression.

Obesity is the primary cause of metabolic dysfunction-associated steatotic liver disease (MASLD). Healthy lifestyle management has potential value in the treatment of MASLD. A total of 150 patients with MASLD diagnosed at the Health Management Center of our hospital were enrolled and randomly divided into a traditional treatment (control group, n = 75) and a healthy lifestyle group (observation group, n = 75). All patients underwent a 3-month intervention. Data on general information, body composition, glucose metabolism, lipid metabolism, and inflammatory factors were analyzed. The difference in the change in fatty liver grade was statistically significant ( P < 0.05). There were statistically significant differences in treatment efficiency for physical conditions ( P < 0.05), including body fat mass, body mass index, body weight, waist circumference, and waist-to-hip ratio. In addition, there were statistically significant differences in treatment efficiency for scales such as the Diet Rating Scale, Emotional Stress Scale, and Global Physical Activity Questionnaire ( P < 0.05). Differences in treatment efficiency for body fat parameters, including percentage of body fat, visceral fat area, aspartate aminotransferase, and diastolic blood pressure, were also statistically significant ( P < 0.05). After treatment, statistically significant differences were observed in interferon-γ, insulin, low-density lipoprotein cholesterol, triglycerides, and tumor necrosis factor-α ( P < 0.05). Our study indicates that a healthy lifestyle can effectively promote the reduction of fatty liver grade in patients with MASLD, demonstrating positive effects in improving lipid metabolism and inflammatory responses in these patients.

Clinical Profile and Non-invasive Predictors of Fibrosis in a Newly Diagnosed Non-Alcoholic Fatty Liver Disease Patient in a Tertiary Health Care Center of Nepal

Non-Alcoholic Fatty Liver Disease (NAFLD) represents a spectrum of histopathologic abnormalities ranging from simple steatosis to the more aggressive non-alcoholic steatohepatitis, characterized by steatosis, parenchymal inflammation, hepatocellular ballooning and other evidence of hepatic injury. The objective of this study is to evaluate the demographic and anthropometric profile of non-alcoholic fatty liver disease and non-invasive predictors of fibrosis. This is a hospital-based observational study. A total of 280 patients were included in this study from the Department of Gastroenterology, Tribhuvan University Teaching Hospital from January 2019 to August 2021 were included. Patients presenting with non-alcoholic fatty liver disease were mostly (29.64%) of 36-45 age group. Two-third of the patients (66.78%) were asymptomatic. The mean body mass index of patients was 28.10±4.10 kg/m2 and most of them (81.07%) had body mass index &gt;25 kg/m2. More than one third of the patients (40%) with non-alcoholic fatty liver disease had presence of metabolic syndrome. The mean (±SD) ultrasound attenuation parameter was 284.22±31.58 dB/m. Fatty liver index showed a positive and a medium strength correlation with fatty liver. On Spearman rank correlation, ultrasound attenuation parameter steatosis grading was correlated positively and strongly with the USG grading of fatty liver (p&lt;0.001). On Pearson correlation, APRI, NFS and FIB-4 were positive but weakly correlated with liver stiffness measurement by FibroTouch but still the correlation was statistically significant (p&lt;0.01). Fatty liver index has shown a good correlation with the presence of steatosis by a FibroTouch. Similarly, APRI showed the highest correlation in predicting liver stiffness in the population of Nepal. Other multicenter large scale prospective analytical studies would be required for further clarify of the results of such a kind of research. Bangladesh Med J. 2023 Sept; 52(3): 35-40

The prevalence of metabolic syndrome in patients with non-alcoholic fatty liver disease in Erbil city

Background and objectives: Non-alcoholic fatty liver disease is the accumulation of fatty units in the liver in the absence of other triggers. Its development may have been primarily caused by metabolic syndrome, so the purpose of this study is to identify the prevalence of metabolic syndrome in non-alcoholic fatty liver disease and then to discover which parameter has the strongest link with non-alcoholic fatty liver disease. Methods: This cross-sectional study of 90 participants more than 18 years old with non-alcoholic fatty liver disease diagnosed by sonography in Erbil from August 2022 to May 2023. In each individual, metabolic syndrome criteria were taken and measured according to the National Cholesterol Education Program's Adult Treatment Panel III criteria, which were diagnosed by having three or more of these criteria, and ultrasound was used for the grading of fatty liver. Results: Metabolic syndrome were revealed in 69 (76.67%) of the participants. A higher proportion of patients were female 51 (56.67%) and male 39 (43.33%). It revealed a statistically significant correlation between gender and metabolic syndrome, with females and males having a corresponding 44 (49%) and 25 (28%) correlation, respectively. The most frequent factor was an expanded waist circumference in 66 (73.33%) of participants, followed by triglyceride in 62 (68.89%). Conclusion: In this study, among patients with non-alcoholic fatty liver disease significant number of the subjects had metabolic syndrome, with an increased waist circumference being the most prevalent feature, followed by high triglyceride levels, hyperglycemia, hypertension, and low high-density lipoprotein.

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.