Grades Of Non-alcoholic Fatty Liver Disease Research Articles

Effect of Vildagliptin versus Vildagliptin plus Metformin on Nonalcoholic Fatty Liver Disease Patients with Type 2 Diabetes Mellitus

Background/Aims: Nonalcoholic fatty liver disease (NAFLD) is believed to be the most common chronic liver disease. The present study aimed to evaluate the efficacy of the vildagliptin versus vildagliptin / metformin combination in the treatment of nonalcoholic fatty liver disease patients with type 2 diabetes mellitus (T 2DM). Methods: One hundred twenty patients, who were newly diagnosed with T 2DM, and proof of diagnosis of NAFLD, were enrolled in a twelve-month open label prospective parallel study. The patients were divided into two groups; Group 1 received vildagliptin in a dose of 50 mg twice daily and Group 2 received vildagliptin/metformin in a dose of 50 mg/ 1000 mg twice daily. Body mass index and fatty liver ultrasound grading were evaluated with the assay of HbA1c and serum levels of fasting and postprandial glucose, lipid profile, liver enzymes, fasting insulin, adiponectin, ferritin, and creatinine and blood urea with calculation of HOMA-IR before and after treatment. Results: There was a significant improvement in fatty liver ultrasound grading in both groups (p=0.001). Univariate and multivariate analysis showed that the improvement in NAFLD grading in both groups was affected by change in BMI, HbA1c, fasting insulin, HOMA-IR, triglycerides and adiponectin. After twelve months both groups showed significant decrease in BMI (p=0.001), fasting serum insulin (p<0.05 and p=0.001, respectively), HOMA-IR, HbA1c and triglycerides (p=0.001). However, adiponectin level increased significantly in both groups (p=0.001). Conclusion: Both vildagliptin or vildagliptin/metformin combination can improve fatty liver disease through their effect on BMI, serum levels of insulin, triglycerides, adiponectin and HOMA-IR.

Association of Lipid Profile with Non-Alcoholic Fatty Liver Disease diagnosed on Ultrasound

Objectives: To evaluate lipid profile parameters in patients with various grades of non-alcoholic fatty liver disease (NAFLD) diagnosed on sonography. &#x0D; Material and Method: This descriptive cross-sectional study was conducted at HBS General Hospital, Islamabad over a period of six months from January 2018 to June 2018. Seventy-nine adults of either gender diagnosed with NAFLD on ultrasonography were consecutively included. Fasting blood sample of all the subjects was analyzed for total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) Comparison of lipid abnormalities between different grades of NAFLD was done by statistical analysis with p-value &lt;0.05 considered statistically significant.&#x0D; Results: Out of the total 79 patients, grade I, II, and III NAFLD was diagnosed in 56.6%, 45.5%, and 3.9% respectively. Total cholesterol (TC), triglycerides (TG), low density lipoprotein cholesterol (LDL-C) were raised in 28 (35.4%), 43 (54.4%) and 43 (54.4%) patients respectively. Low serum high-density lipoprotein cholesterol (HDL-C) levels were seen in 74 (93.6%) of patients. Statistical analysis showed a significant increase in frequency as well as mean values in all serum lipid profile parameters with the severity of NAFLD grades except total cholesterol (TC).&#x0D; Conclusion: Increasing grades of NAFLD showed a significant correlation with higher levels of cholesterol, LDL, and decreasing levels of HDL, which are all associated with cardiovascular problems.

Bariatric Surgery in Nonalcoholic Fatty Liver Disease (NAFLD): Impact Assessment Using Paired Liver Biopsy and Fibroscan.

Bariatric surgery is associated with a positive impact on the degree of hepatic steatosis and inflammation in nonalcoholic associated fatty liver disease (NAFLD), although its effect on fibrosis is contentious. The role of Fibroscan in the post-bariatric assessment of hepatic steatosis and fibrosis is unclear. This work aims to study the impact of bariatric surgery on the course of NAFLD using both invasive (liver biopsy) and non-invasive tests (biochemical parameters and Fibroscan). In this prospective study, the impact of bariatric surgery on the course of NAFLD was assessed using paired liver biopsy (intra-operative and post-bariatric surgery 1-year follow-up). The liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) cutoffs for the assessment of hepatic fibrosis and steatosis, respectively, were calculated in both pre- and post-bariatric settings. Fifty-eight patients (70.7% females, mean age 39.2years) underwent paired liver biopsy. Post-bariatric surgery 1-year liver biopsy showed significant improvement in all the histopathological parameters of NAFLD. The mean NAFLD Activity Score declined from 2.81 (± 1.08) to 1.31 (± 1.39) post-bariatric surgery. Thirty (51.7%) patients showed improvement in fibrosis, eighteen (31%) no change, and ten (17.2%) had worsening. Worsening of fibrosis was associated with a higher median age of 44.5 versus 38years (p value = 0.033). The CAP cutoff values for the various stages of hepatic steatosis were higher pre-operatively as compared with those obtained post-bariatric surgery. Bariatric surgery is associated with significant improvement in histopathological parameters of NAFLD. Fibroscan shows good diagnostic accuracy in detecting advanced stage and grade of NAFLD.

Trimethylamine N-oxide levels are associated with NASH in obese subjects with type 2 diabetes

AimsTrimethylamine N-oxide (TMAO), choline and betaine serum levels have been associated with metabolic diseases including type 2 diabetes (T2D) and non-alcoholic fatty liver disease (NAFLD). These associations could be mediated by insulin resistance. However, the relationships among these metabolites, insulin resistance and NAFLD have not been thoroughly investigated. Moreover, it has recently been suggested that TMAO could play a role in NAFLD by altering bile acid metabolism. We examined the association between circulating TMAO, choline and betaine levels and NAFLD in obese subjects. MethodsSerum TMAO, choline, betaine and bile acid levels were measured in 357 Mexican obese patients with different grades of NAFLD as determined by liver histology. Associations of NAFLD with TMAO, choline and betaine levels were tested. Moreover, association of TMAO levels with non-alcoholic steatohepatitis (NASH) was tested separately in patients with and without T2D. ResultsTMAO and choline levels were significantly associated with NAFLD histologic features and NASH risk. While increased serum TMAO levels were significantly associated with NASH in patients with T2D, in non-T2D subjects this association lost significance after adjusting for sex, BMI and HOMA2-IR. Moreover, circulating secondary bile acids were associated both with increased TMAO levels and NASH. ConclusionsIn obese patients, circulating TMAO levels were associated with NASH mainly in the presence of T2D. Functional studies are required to evaluate the role of insulin resistance and T2D in this association, both highly prevalent in NASH patients.

High-Titre ANA Positivity in NAFLD: An Uncommon Presentation of a Common Disease.

Up to 30% of patients with non-alcoholic fatty liver disease (NAFLD) may have antinuclear antibodies (ANA).Low titre (<1:320) ANA positivity is not uncommon, but a high titre is rare.The ANA titre does not correlate with the histological grade of NAFLD.

Increased risks of different grades of non-alcoholic fatty liver disease in prediabetic subjects with impaired fasting glucose and glucose tolerance, including the isolated glycosylated hemoglobin levels of 5.7-6.4% in a Chinese population.

Aims/IntroductionContrary to the results of the majority of studies on diabetes, there are some conflicting results regarding the relationship between non‐alcoholic fatty liver disease (NAFLD) and prediabetes. No study has investigated the relationship between isolated glycated hemoglobin (HbA1c) in the range of 5.7–6.4% (HbA1c 5.7–6.4%) and NAFLD. Our aim was to investigate the effect of different glycemic statuses on NAFLD concomitantly categorized by fasting plasma glucose, 2‐h plasma glucose and HbA1c levels.Materials and MethodsNAFLD was classified into three groups by ultrasonographic examination results: normal, mild and moderate‐to‐severe. Glycemic status was divided into five groups: normoglycemia, isolated HbA1c 5.7–6.4%, impaired fasting glucose without impaired glucose tolerance (IGT), IGT and newly diagnosed diabetes. For multivariable logistic regression analyses, the outcome variable was the classified three grades of fatty changes in the liver after adjusting for other potential risk covariables.ResultsIn this cross‐sectional research, a total of 8,571 eligible individuals were enrolled and divided into three groups: 5,499 without fatty liver, 2,113 with mild NAFLD and 959 with moderate‐to‐severe NAFLD. Multivariable logistic regression analysis showed that IGT, impaired fasting glucose without IGT and isolated HbA1c 5.7–6.4% were associated with a higher risk of NAFLD in addition to newly diagnosed diabetes. Other positively predictive variables were male sex, obesity, overweight, central obesity, increased triglyceride and C‐reactive protein >1 mg/L. Negatively associated factors were elevated high‐density lipoprotein cholesterol levels.ConclusionsBesides diabetes, the increased risks of different grades of NAFLD were found for prediabetic individuals categorized by impaired fasting glucose without IGT, IGT and isolated HbA1c 5.7–6.4%.

Nonalcoholic Fatty Liver Disease and Coronary Artery Disease: Big Brothers in Patients with Acute Coronary Syndrome.

Background The prevalence of nonalcoholic fatty liver disease (NAFLD) has been increasing. This study aimed to evaluate the prevalence of NAFLD, as diagnosed by ultrasound, in patients with acute coronary syndrome (ACS) and to assess whether NAFLD is associated with the severity of coronary obstruction as diagnosed by coronary angiography. Methods We performed a prospective single-center study in patients hospitalized due to acute coronary syndrome who underwent diagnostic coronary angiography. Consecutive patients who presented to the emergency room were diagnosed with acute coronary syndrome and were included. All patients underwent ultrasonography of the upper abdomen to determine the presence or absence of NAFLD; NAFLD severity was graded from 0 to 3 based on a previously validated scale. All patients underwent diagnostic coronary angiography in the same hospital, with the same team of interventional cardiologists, who were blinded to the patients' clinical and ultrasonographic data. CAD was then angiographically graded from none to severe based on well-established angiographic criteria. Results This study included 139 patients, of whom 83 (59.7%) were male, with a mean age of 59.7 years. Of the included patients, 107 (77%) patients had CAD, 63 (45%) with serious injury. Regarding the presence of NAFLD, 76 (55.2%) had NAFLD including 18 (23.6%) with grade III disease. In severe CAD, 47 (60.5%) are associated with NAFLD, and 15 (83.3%) of the patients had severe CAD and NAFLD grade III. Conclusions NAFLD is common in patients with ACS. The intensity of NAFLD detected by ultrasonography is strongly associated with the severity of coronary artery obstruction on angiography.

Sonographic Measurement of the Thickness of Subcutaneous Tissue and Hepatic Echo-Intensity Attenuation Rate in Nonalcoholic Fatty Liver Disease

The most common cause of the chronic liver disease is non-alcoholic fatty liver disease (NAFLD). This study was designed to compare a mean subcutaneous tissue thickness (SCTT) and hepatic echo-intensity attenuation rate (HEIAR) among NAFLD grades. Sonography was carried out on 628 consecutive subjects. The distance between the skin surface and the liver capsule was measured and was labelled the SCTT. Also, the ultrasound of HEIAR was retrospectively quantified on an image archiving. HEIAR was calculated as the difference between mean intensity of echo for two regions of interest (ROIs) in near- and far-fields divided by the distance between these two ROIs multiply by frequency of the probe. Of the 628, 235 subjects were diagnosed with NAFLD. The age range was 45 – 75 years with mean 54.5 ± 6.7 years. There was a significant difference of mean SCTT among NAFLD grades (p&lt;0.001), 65.4% of subjects with SCTT measured ≥ 2.1 cm had NAFLD versus 34.6% of subjects had no NAFLD. Similarly, the differences of mean HEIAR among NAFLD grades were reported to be statistically significant (p&lt;0.001). All of the subjects with HEIAR of 1. 7dB/cm MHz and over had NAFLD. HEIAR is a useful indicator for non-invasive quantitative assessment of NAFLD where sonographically measured HEIAR equal to or over than 1.7 dB/cm MHz makes identifying NAFLD is probably (sensitivity is 59% and specificity is 89%). HEIAR is a useful indicator for non-invasive quantitative assessment of NAFLD.

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.

MR spectroscopy of the liver - a reliable non-invasive alternative for evaluating non-alcoholic fatty liver disease.

Non-alcoholic fatty liver disease (NAFLD) is one of the most common conditions worldwide that targets the liver parenchyma. NAFLD represents an intrahepatic triglyceride accumulation in the absence of excessive alcohol consumption and other diseases that affect the liver parenchyma. The current “gold standard” for evaluating the amount of intrahepatic fat is represented by liver biopsy, but many patients are reluctant and hardly accept undergoing this procedure due to its invasive nature. The current study addresses this aspect by evaluating the reliability of liver magnetic resonance spectroscopy (MRS) in diagnosing NAFLD, compared to the traditional invasive liver biopsy. The present study included a total of 38 patients based on several well-defined inclusion and exclusion criteria. We used the same NAFLD grading system for both liver MRS and liver biopsy: grade 0: <5% hepatocytes are affected; grade I: 5–33% hepatocytes are affected; grade II: 34–66% hepatocytes are affected; grade III: >66% hepatocytes are affected. Regarding the NAFLD grade, over three-quarters of patients were classified as grade I and grade II, with a strong predilection for men. The current results indicated a significant association between the NAFLD grade indicated by liver MRS and the NAFLD grade indicated by liver biopsy. At the end of our study, we recommend using liver MRS for evaluating and grading NAFLD in association with other parameters like serum triglycerides and body mass index grade as this protocol can enhance early detection and provide an accurate grading that will lead to a proper management of this disease.

Non-Alcoholic Fatty Liver Disease as a Coronary Heart Disease Severity Predictor

Background and Aim: Association of non-alcoholic fatty liver disease (NAFLD) and liver related mortality is well-known; however; its cardiovascular risk remains questionable. The aim of this work was to highlight the association between NAFLD and the severity of coronary heart disease. Method: The study was conducted between July and December 2019 at Qena university hospital, Qena, Egypt on patients who were scheduled for coronary angiography. Liver steatosis was diagnosed using FibroScan and the severity of coronary artery occlusion was assessed by Gensini score calculation. Statistical analysis was done to study the correlation between liver steatosis and angiography findings. Result: A total of 100 patients were included, mean age 48 years (±8 SD). Correlation between coronary angiography and the baseline variables revealed statistically significant positive correlation between Gensini score and ALT (p = 0.002), FBS (p < 0.001), steatosis (p < 0.001) and diabetes (p < 0.001). Also, gradual increase in the Gensini score with higher steatosis grades was noticed, medians: 10.5, 21.7, 57.6 and 102.6 in S0, S1, S2 and S3 respectively, p = 0.01. Variables that have significantly predicted higher Gensini score in univariable regression analysis were: diabetes (OR: 55.6, CI: (41 - 70)), hypertension (OR: 19, CI: (2 - 37)), F2-F4 fibrosis (OR: 33, CI: (24 - 38)) and S2-S3 steatosis (OR: 34, (23 - 40)), while in multivariable regression; the statistically significant variables were: diabetes (OR: 23, CI: (10 - 37)), hypertension (OR: 11, CI: (4.8 - 22)) and S2-S3 steatosis (OR: 24, CI: (17 - 31)). Conclusion: NAFLD is an independent cardiovascular risk predictor with statistically significant increase in Gensini score with the higher grades of NAFLD.

Effects of XIAP on high fat diet-induced hepatic steatosis: a mechanism involving NLRP3 inflammasome and oxidative stress.

Increasing evidence indicates that prolonged fat-rich diet (HFD) ingestion is a predisposing factor for metabolic disorder-associated system inflammation and oxidative stress injury, which contributes to the occurrence of non-alcoholic fatty liver disease (NAFLD). NACHT, LRR and PYD domains-containing protein 3 (NLRP3)-mediated inflammatory infiltration was determined to participate in NAFLD. X-linked inhibitor of apoptosis protein (XIAP) was recently confirmed as an essential regulator for apoptosis in cells. However, the role of XIAP in HFD-induced NAFLD is still not understood. Here, XIAP was characterized with respect to HFD-induced NLRP3 inflammasome activation and reactive oxygen species (ROS) generation in vivo and palmitate (PA)-treated cells in vitro. After HFD administration, hepatic injury was confirmed via histological assessment (grading and staging of NAFLD) and biochemical parameters, oxidative stress, and reduced antioxidant activity. Up-regulated hepatic dysfunction were further indicated by elevated dyslipidemia, lipid accumulation, and decreased fatty acid β-oxidation associated gene expression. Moreover, in the absence of XIAP, NLRP3 signaling activated by HFD-triggered oxidative stress was up-regulated, accompanied by reduction in antioxidants including HO-1, NQO-1, GST, SOD and Nrf2 activity. The detrimental effects of XIAP blocking on hepatic steatosis and related pathologies were also confirmed in PA-treated mouse liver cells. In contrast, overexpression of XIAP by transfection in vitro restrained PA-stimulated hepatic steatosis by suppression of oxidative stress, NLRP3 related inflammatory response, and impairment of Nrf2 activity, further alleviating abnormal metabolic disorder associated NAFLD. Taken together, the present study helped to elucidate how HFD-induced hepatic steatosis was regulated by XIAP, possibly via the inhibition of NLRP3 signaling and oxidative stress injury.

Melatonin Effects on Non-Alcoholic Fatty Liver Disease Are Related to MicroRNA-34a-5p/Sirt1 Axis and Autophagy.

Melatonin, an indole produced by pineal and extrapineal tissues, but also taken with a vegetarian diet, has strong anti-oxidant, anti-inflammatory and anti-obesogenic potentials. Non-alcoholic fatty liver disease (NAFLD) is the hepatic side of the metabolic syndrome. NAFLD is a still reversible phase but may evolve into steatohepatitis (NASH), cirrhosis and carcinoma. Currently, an effective therapy for blocking NAFLD staging is lacking. Silent information regulator 1 (SIRT1), a NAD+ dependent histone deacetylase, modulates the energetic metabolism in the liver. Micro-RNA-34a-5p, a direct inhibitor of SIRT1, is an emerging indicator of NAFLD grading. Thus, here we analyzed the effects of oral melatonin against NAFLD and underlying molecular mechanisms, focusing on steatosis, ER stress, mitochondrial shape and autophagy. Male C57BL/6J (WT) and SIRT1 heterozygous (HET) mice were placed either on a high-fat diet (58.4% energy from lard) (HFD) or on a standard maintenance diet (8.4% energy from lipids) for 16 weeks, drinking melatonin (10 mg/kg) or not. Indirect calorimetry, glucose tolerance, steatosis, inflammation, ER stress, mitochondrial changes, autophagy and microRNA-34a-5p expression were estimated. Melatonin improved hepatic metabolism and steatosis, influenced ER stress and mitochondrial shape, and promoted autophagy in WT HFD mice. Conversely, melatonin was ineffective in HET HFD mice, maintaining NASH changes. Indeed, autophagy was inconsistent in HET HFD or starved mice, as indicated by LC3II/LC3I ratio, p62/SQSTM1 and autophagosomes estimation. The beneficial role of melatonin in dietary induced NAFLD/NASH in mice was related to reduced expression of microRNA-34a-5p and sterol regulatory element-binding protein (SREBP1) but only in the presence of full SIRT1 availability.

CHD is Associated With Higher Grades of NAFLD Predicted by Liver Stiffness.

Background and Aim:Accumulating clinical and epidemiologic evidence indicates that nonalcoholic fatty liver disease (NAFLD) is not only associated with liver-related morbidity and mortality, but also with a greater risk of coronary heart disease (CHD). However, there is currently no diagnostic parameter for NAFLD that has been determined to reliably indicate the presence of CHD as a co-morbidity. We evaluated the liver stiffness and visceral fat thickness of NAFLD patients ultrasonographically to explore the relationship between liver stiffness, visceral fat thickness, and CHD, aiming to find explore the relationship between the liver stiffness and CHD.Methods:We enrolled 120 consecutive patients who had been initially diagnosed with CHD on the basis of their symptoms. All patients underwent coronary angiography or computed tomography angiography, and were classified into a CHD group and a non-CHD group on the basis of the results. All patients underwent liver ultrasonography, shear-wave elastography, and visceral fat thickness measurement.Results:NAFLD and visceral fat thickness were significantly positively correlated with CHD and Gensini score (P<0.001). Multivariate regression showed that age, male, cholesterol, liver stiffness, and visceral fat thickness were determinants of CHD. Age, cholesterol, liver stiffness, and visceral fat thickness cut-off points for the prediction of CHD were above 50 years old [area under the curve (AUC): 0.678; sensitivity, 87%; specificity, 42.6%], >3.76 mmol/L (AUC: 0.687; sensitivity, 68.4%; specificity, 64.8%), >6.1 kPa (AUC: 0.798; sensitivity, 50%; specificity, 92.6%), and >7.41 cm (AUC: 0.694; sensitivity, 52.6%; specificity, 87%), respectively. Compared with the use of age, gender, and cholesterol (model 1), the addition of the liver stiffness cut-off to model 1 resulted in a stronger predictive value (P=0.005).Conclusions:High-grade NAFLD is more present in symptomatic CHD. The higher degree of liver stiffness in patients with NAFLD, the higher risk of CHD in these NAFLD patients.

The grade of nonalcoholic fatty liver disease is an independent risk factor for gallstone disease: An observational Study.

There have been reports linking nonalcoholic fatty liver disease (NAFLD) with gallstone disease (GD) owing to shared risk factors. However, there are no reported associations between the different NAFLD grades and GD. This study aimed to determine whether NAFLD grade is an independent risk factor for GD in a Korean population.This study enrolled 7886 participants who completed a questionnaire and underwent medical examination and ultrasound scanning at the Health Promotion Center of Jeju National University Hospital in Korea, from January 2009 to December 2017. Fatty liver grading and presence of gallstones were investigated using abdominal ultrasound. Body mass index and biochemical parameters were measured, and age, sex, and metabolic syndrome status were collected from medical records. Univariate and multivariate analyses were performed to identify risk factors for GD.The estimated prevalences of NAFLD and GD were 40.6% and 4.5%, respectively. In the univariate analysis, factors associated with GD were age; NAFLD; presence of metabolic syndrome; and levels of fasting blood glucose, high-density lipoproteins, aspartate aminotransferase, and alanine aminotransferase. Multivariate logistic regression analysis revealed older age and higher NAFLD grade as independent risk factors for GD.Older age and higher grade of NAFLD were independent risk factors for GD in our cohort. There was a strong correlation between grade of NAFLD on abdominal ultrasonography and GD.

&lt;p&gt;Abdominal subcutaneous fat thickness and homeostasis model assessment of insulin resistance as simple predictors of nonalcoholic steatohepatitis&lt;/p&gt;

Background: Obesity, insulin resistance, and diabetes are major risk factors for nonalcoholic fatty liver disease (NAFLD). This study aims to evaluate the association between different grades of NAFLD and abdominal subcutaneous fat thickness with the homeostasis model assessment of insulin resistance (HOMA-IR).Methods: In this pilot study, 59 obese nondiabetic participants with NAFLD were enrolled. Total cholesterol, HbA1c, and HOMA-IR were measured. Abdominal subcutaneous fat thickness in the midline just below the xiphoid process in front of the left lobe of the liver (LSFT) and in the umbilical region (USFT), and the degree of hepatic steatosis, were evaluated by ultrasound scans, and their correlation with the degree of steatosis and the NAFLD Activity Score in liver biopsy was assessed.Results: Of the 59 studied participants, 15 had mild, 17 had moderate, and 27 had severe hepatic steatosis by abdominal ultrasound. The mean ± SD HOMA-IR level in NAFLD patients was 5.41±2.70. The severity of hepatic steatosis positively correlated with body mass index (P<0.001), HOMA-IR (P<0.001), serum triglycerides (P=0.001), LSFT (P<0.001), and USFT (P<0.001). Receiver operating characteristics analysis showed that LSFT at a cut-off of 3.45 cm is the most accurate predictor of severe hepatic steatosis, with 74.1% sensitivity and 84.4% specificity. The best cut-off of USFT for identifying severe hepatic steatosis is 4.55 cm, with 63% sensitivity and 81.3% specificity.Conclusion: Abdominal subcutaneous fat thicknesses in front of the left lobe of the liver and in the umbilical region, together with HOMA-IR, are reliable indicators of the severity of NAFLD in obese nondiabetic individuals.

Sarcopenia Is Significantly Associated with Presence and Severity of Nonalcoholic Fatty Liver Disease.

BackgroundThe association between nonalcoholic fatty liver disease (NAFLD) and sarcopenia has been suggested. We investigated the association between sarcopenia and NAFLD independent of visceral adiposity and searched for the clinical characteristics that affect this association.MethodsWe performed a retrospective study including of 5,989 subjects (mean age, 53.2 years; men, 57.3%) who underwent bioelectrical impedance analysis (BIA) and abdominal ultrasonography in 2012. The appendicular skeletal muscle mass (ASM) was assessed by BIA method. Sarcopenia was defined as ASM/weight (ASM%) <2 standard deviation of the mean for healthy young reference population. NAFLD was diagnosed by ultrasonography.ResultsThe prevalence of sarcopenia was 5.3%. The prevalence of NAFLD was significantly higher in subjects with sarcopenia than in those without (69.5% vs. 36.5%, P<0.001). After adjusting with age, sex, visceral fat area, hypertension, diabetes, total and low-density lipoprotein cholesterol, subjects with sarcopenia showed significantly high odds of NAFLD (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.02–1.84; P=0.036). Subjects with sarcopenia have more likely severe grade of NAFLD compared to non-sarcopenic group (OR, 1.58; 95% CI, 1.25–2.00; P<0.001). There was significant interaction for effect modification in the association between sarcopenia and NAFLD by age (P of interaction for effect modification, 0.007).ConclusionSarcopenia was significantly associated with the presence and the severity of ultrasonography-graded NAFLD in our study population independent of visceral fatness and other metabolic confounder. Younger age showed greater magnitude of association between sarcopenia and NAFLD.

Metabolic syndrome, non-alcoholic fatty liver disease and liver stiffness in psoriatic arthritis and psoriasis patients.

Non-alcoholic fatty liver disease (NAFLD), potentially evolving into liver fibrosis (LF), is frequent in psoriasis (PsO), but data in psoriatic arthritis (PsA) are lacking. Our study aimed to investigate the prevalence of NALFD and LF in PsA/PsO and the contribution of arthritis in their onset. PsA and PsO patients were consecutively enrolled. Exclusion criteria were liver diseases causing fibrosis (except NAFLD), alcohol ≥ 20g/day, daily use of non-steroidal anti-inflammatory drugs and current/previous methotrexate use. Clinical history, biochemical and clinimetrical data and insulin-resistance index HOMA (homeostatic model assessment) were assessed. Patients underwent a liver ultrasound to identify steatosis (therefore NAFLD) and transient elastography, to evaluate LF (stiffness≥ 7kPa = fibrosis). Statistical analysis included basic statistics, logistic and linear regression analyses (to assess the contribution of arthritis to NAFLD and LF grading, respectively) and Spearman's correlations; p ≤ 0.05 was considered significant. Seventy-six patients were enrolled (PsA/PsO 43/33). MetS and LF prevalence were similar between PsA and PsO (35% vs 33%, p = 0.88; 31% vs 28%, p = 0.77, respectively). NAFLD was more frequent in PsO (65% vs 35%, p = 0.044). In multivariable models with NAFLD and LF grading as outcomes, arthritis was not a significant predictor, while HOMA was independently associated with both (OR 1.34; 95%CI 1.06, 1.69; beta 0.88; 95%CI 0.54, 1.21, respectively). Female sex was independently associated with LF grading (beta 1.81; 95%CI 0.05, 3.57). NAFLD was more frequent in PsO, but MetS and LF prevalence were similar in PsA and PsO. Insulin resistance is the main determinant of NAFLD and LF, while additional contribution of arthritis seems small. Key Points • The prevalence of metabolic comorbidities, including liver fibrosis, is overall quite similar between psoriatic arthritis and psoriasis. • NAFLD is more frequently found in psoriasis than psoriatic arthritis. • The contribution of arthritis in the onset of metabolic comorbidities seems small.

The independent association of non-alcoholic fatty liver disease with lower urinary tract symptoms/benign prostatic hyperplasia and erectile function scores.

To evaluate the association between non-alcoholic fatty liver disease (NAFLD) and lower urinary tract symptoms (LUTS)/benign prostate hyperplasia (BPH) and erectile function. In all, 356 men diagnosed with LUTS/BPH were evaluated retrospectively between January 2016 and March 2018. Anthropometric and laboratory data were collected. According to the liver echogenicity degree, patients were divided into four NAFLD groups: Grade 0 was considered as normal with no NAFLD, whilst Grades 1-3 NAFLD had increasing fat deposits. LUTS symptoms, prostate-specific antigen (PSA) levels, prostate volumes (PVs), and five-item version of the International Index of Erectile Function (IIEF-5) scores were compared statistically between the NAFLD grades. PSA levels did not differ between the groups. The International Prostate Symptom Score (IPSS), PV and post-voided residual urine volume (PVR) were significantly greater in men with higher NAFLD grades. Conversely, the maximum urinary flow rate (Qmax ) and IIEF-5 score were lower in men with higher NAFLD grades. The NAFLD grade, rather than being metabolic syndrome (MetS) positive, affected prostate parameters and IIEF-5 scores. NAFLD grade correlated positively with IPSS, PV and PVR, whereas there was a negative correlation with Qmax and IIEF-5 score. Age and NAFLD were independent predictors of IPSS, PV, Qmax , and PVR on multivariate analysis. We found that NAFLD was an independent predictive factor for IPSS, PV, Qmax , PVR and IIEF-5 score. MetS was only a significant predictive factor for IIEF-5 score, thus NAFLD may identify patients at high risk of LUTS better than MetS.

SAT-104 Reversal of Nonalcoholic Fatty Liver Disease with Bariatric Surgery in South Asians: Has the Cure Been Finally Found? Real World Data From a Sri Lankan Tertiary Care Setting

Nonalcoholic fatty liver disease (NAFLD) ranges from non-progressive simple steatosis to progressive nonalcoholic steatohepatitis and can eventually progress to cirrhosis and even be complicated with hepatocellular carcinoma. The prevalence of NAFLD is alarming and is approximately 65-85% among obese individuals. In the United States, NAFLD is the commonest cause of chronic liver cell disease and it is predicted to become the most common indication for liver transplantation within the next 5 years. Unfortunately NAFLD has limited treatment options with generally suboptimal results. Although bariatric surgery has been found to have impressive rates of reversal of NAFLD in Caucasians, there is limited data on its effects among South Asians. In this study we aimed to find the effect of bariatric surgery on reversal of NAFLD among obese Sri Lankan patients. We did a retrospective analysis of medical records of 170 obese patients who underwent bariatric surgery at the Colombo South Teaching Hospital, Sri Lanka. Out of the patients 74.1% (n = 126) were females. The mean age was 38.1 ± 10.4 years. The mean pre-operative body weight and body mass index were 115.0 ± 23.0 kg and 45.1 ± 6.8 kg/m2 respectively. Laparoscopic sleeve gastrectomy was the commonest type of bariatric surgery (69.5%) performed, followed by laparoscopic mini gastric bypass (24.1%) and laparoscopic Roux-en-Y gastric bypass (4.9%). One patient underwent open sleeve gastrectomy. NAFLD was detected in 88.7% pre-operatively, according to ultrasound scan (USS) imaging (grade 1 fatty liver 29.8%, grade 2 fatty liver 58.9%). On USS imaging at 6 months after the procedure, the prevalence of fatty liver reduced to 29.4% (grade 1 fatty liver 19.6%, grade 2 fatty liver 9.8%). The pre-operative mean AST and ALT values showed a significant reduction at 6 months after the procedure (30.4 ±18.6 U/L vs 22.1 ±8.9 U/L, p<0.005 and 39.1 ±28.3 U/L vs 19.8 ±9.6 U/L, p< 0.001) as compared to baseline. The percentage of patients who had AST or ALT elevation, showed significant reduction at 6 months postoperatively as compared to baseline (35.2% vs 6.9%, p<0.01). In conclusion, bariatric surgery fully reversed NAFLD in 68.1% (p<0.001) and reduced the grade of NAFLD in 87.2% (p<0.001) of patients according to USS imaging. It significantly reduced baseline AST and ALT values by 27.3% and 49.3% respectively at 6 months post procedure. Thus bariatric surgery shows impressive levels of complete reversal and downgrading of NAFLD biochemically as well as ultrasonically in Sri Lankan patients with comparable efficacy to studies done in Caucasian populations. Bariatric surgery should be considered as a potential therapeutic option in obese South Asian patients with NAFLD, especially when it is of a higher grade.