Management Of Nonalcoholic Fatty Liver Disease Research Articles

Sex-specific differences in NAFLD development: effect of a high-sucrose diet on biochemical, histological, and genetic markers in C57bl/6N mice

ABSTRACT Sucrose intake is a potential risk factor for non-alcoholic fatty liver disease (NAFLD). Individual characteristics such as sex, play arole in the biological variation of the disease, potentially related to genetic regulation. This research evaluated sex differences in biochemical, histopathological, and gene expression responses associated with NAFLD in C57bl/6N mice on a high sucrose diet. Female and male mice were assigned to control or high sucrose diets (50% sucrose solution) for 20 weeks. After sacrifice, blood and hepatic tissue were collected for analysis. Female mice revealed moderate-to-high NAFLD, whereas male mice showed mild-to-moderate NAFLD. Sex-specific variations were observed in Cd36 gene expression, an upregulation in females compared with the male group, and Adipor1 gene expression showed significant downregulation in the female group in response to high sucrose diet compared with the control group. These findings highlight the importance of considering gender disparities in the treatment and management of NAFLD.

Relationship between phase angle measured with bioelectrical impedance analysis and nonalcoholic fatty liver disease in adults

Purpose The phase angle (PhA) measured by bioelectrical impedance analysis (BIA) is associated with nutritional status and cellular health, and it is a clinically important parameter used to assess the risk of various diseases. It remains unclear whether PhA is associated with nonalcoholic fatty liver. The purpose of this study is to investigate the relationship between the BIA parameter PhA and nonalcoholic fatty liver disease (NAFLD). Design/methodology/approach This cross-sectional study was conducted with 300 adults aged 20–64 years (NAFLD: 196, normal: 104). Some biochemical findings of the participants were collected, and whole-body and segmental PhAs were measured using Tanita (MC-780) at 50 kHz. Findings The PhA values of the whole body (p = 0.003), trunk (p < 0.001), right and left legs (p < 0.001 for both) were found to significantly differ according to the degrees of fatty liver. It was observed that the highest PhA values were in normal individuals. Logistic regression analysis showed that the reduction in PhAs of the whole body (p = 0.038), right (p = 0.019) and left legs (p = 0.049) and trunk (p = 0.001) after adjusting for all confounding factors increased the risk of NAFLD. Additionally, whole body PhA was significantly associated with age (year, p = 0.02), BMI (kg/m2; p < 0.001), fat mass (kg; p = 0.001), fat mass (%; p < 0.001), albumin (g/L; p < 0.001) and CRP (mg/dL; p = 0.001). Originality/value The results of this study showed that PhA can be used in the management of NAFLD. To identify potential mechanisms in the relationship between the angle of the liver and NAFLD, large-scale prospective studies are needed.

Clinical cohort of nonalcoholic fatty liver disease in a primary care setting

ABSTRACT Background and Aims: Nonalcoholic fatty liver disease (NAFLD) is increasingly common, and primary care physicians (PCPs) are often the first to diagnose NAFLD. While guidelines on NAFLD management in primary care exist, there are limited data on clinical practice patterns. Approach: We gathered data from over 370,000 patients with at least one PCP visit between July 2016 and September 2023. Using ICD-10 codes to identify patients with a diagnosis of NAFLD or Nonalcoholic Steatohepatitis (NASH), we extracted demographics, comorbidities, laboratory results, prescriptions, imaging orders, and referrals to describe their care. Results: We identified 10,334 patients with a diagnosis code of NAFLD (93.1%) and/or NASH (16.7%) during a PCP visit. Just over half (54.8%) were female, mean age was 52.8 years, and mean BMI was 33.2 kg/m2 with 90% having overweight or obese. More than 50% had hypertension and hyperlipidemia, and 38% had diabetes. At the diagnosis visit, 2.7% had ultrasound elastography ordered, 2.7% liver biopsy, and less than 1% magnetic resonance elastography. During follow-up ranging from 0 to 7 years, patients had a mean of 15 encounters, during which 4% were diagnosed with fibrosis or cirrhosis. Only 24.2% of patients were referred to a nutritionist and 18% had an appointment, and only 0.7% were referred to hepatology and 3.8% saw a hepatologist. Conclusion: PCPs have not widely implemented clinical practice guidelines for NAFLD, resulting in suboptimal care including for the substantial minority with fibrosis or cirrhosis. Patients might benefit from targeted NAFLD education for PCPs and improved decision and management support.

The effect of myo‐inositol supplementation on AMPK/PI3K/AKT pathway and insulin resistance in patients with NAFLD

AbstractInsulin resistance (IR) is the pivotal pathological hit in non‐alcoholic fatty liver disease (NAFLD). There is specific attention to combination/conjugated therapies for NAFLD management. As myo‐inositol (MI) has been shown to improve IR in animal and human trials, this study aimed to investigate the influence of MI supplementation on glycemic response and IR through AMPK/PI3K/AKT signaling pathway in obese patients with NAFLD. This double‐blinded placebo‐controlled randomized clinical trial was conducted on 48 obese (BMI = 30–40 kg/m2) patients with NAFLD who were randomly assigned to receiving either MI (4 g/day) or placebo (maltodextrin 4 g/day) group for 8 weeks. Before and after the trial, weight, height, serum glycemic parameters (inc. fasting glucose and insulin) as well as IR indices were assessed. Moreover, the mRNA expression levels of AMPK, AKT, and PDK‐1 in peripheral blood mononuclear cells (PBMCs) were determined. MI supplementation resulted in significant increases in the fold changes of AMPK, AKT, and PDK‐1 genes (p = .019, p = .049, and p = .029, respectively). Indeed, IR improved in terms of all IR indices in MI group (p < .05) after adjusting for the confounders, apart from quantitative insulin sensitivity check index (QUICKI). The results showed that MI supplementation not only upregulated AMPK, AKT, and PDK‐1 mRNA in PBMCs but also improved IR in obese patients with NAFLD.

MiR-218-5p promotes hepatic lipogenesis through targeting Elovl5 in non-alcoholic fatty liver disease

Investigating and identifying pathogenic molecules of non-alcoholic fatty liver disease (NAFLD) has become imperative, which would serve as effective targets in the future. We established high-fat diet (HFD)-induced NAFLD model in mice and palmitic acid (PA)-induced model in mouse AML12 cells. The level of miR-218-5p was examined by qRT-PCR, and Elovl5 was identified as the potential target gene of miR-218-5p. The binding relationship between miR-218-5p and Elovl5 was validated by double luciferase reporter gene assay, and inhibition/overexpression of miR-218-5p in vitro. The functional mechanisms of miR-218-5p/Elovl5 in regulating lipogenesis in NAFLD were investigated in vivo and in vitro through gain- and loss-of-function studies. MiR-218-5p was significantly increased, and Elovl5 was decreased in model group. According to the double luciferase reporter and gene interference experiments in AML12 cells, Elovl5 was a target gene of miR-218-5p and its expression was regulated by miR-218-5p. The SREBP1-mediated lipogenesis signaling pathway regulated by Elovl5 was upregulated in model group. Moreover, silencing of miR-218-5p significantly upregulated Elovl5 expression, and suppressed SREBP1 signaling pathway in PA-induced AML-12 cells. Correspondingly, the cell injury, elevated TC, TG contents and lipid droplet accumulation were ameliorated. Furthermore, the effect of miR-218-5p on lipogenesis in vitro and in vivo was obstructed by si-Elovl5, implicating that miR-218-5p promotes lipogenesis by targeting ELOVL5 in NAFLD. miR-218-5p could promote fatty acid synthesis by targeting Elovl5, thereby accelerating the development of NAFLD, which is one of the key pathogenic mechanisms of NAFLD and provides a new molecular target for the management of NAFLD.

Analysis of Probiotic Role in Non-Alcoholic Fatty Liver Disease (NAFLD) Management: A Meta-Analysis

Background: Non-alcoholic fatty liver disease (NAFLD) is an increasing global health problem. Probiotics have emerged as a potential therapy for NAFLD, but evidence for their efficacy remains mixed. This meta-analysis aims to evaluate the effectiveness of probiotics in the management of NAFLD. Methods: A comprehensive literature search was performed on PubMed, Embase, Cochrane Library, and Web of Science databases until December 2023. Randomized controlled trials (RCTs) evaluating the effects of probiotics in NAFLD patients were included. The main outcomes evaluated were changes in liver enzymes (ALT, AST), insulin resistance index (HOMA-IR), and hepatic steatosis score. Meta-analysis was performed using a random effects model, and heterogeneity was assessed using the I² statistic. Results: Twenty-five RCTs involving 1845 patients met inclusion criteria. Meta-analysis showed that probiotics significantly reduced ALT (MD -8.45; 95% CI -12.67 to -4.23; p<0.0001) and AST (MD -6.89; 95% CI -10.11 to -3.67; p<0.0001) levels compared with placebo. Significant reductions were also observed in HOMA-IR (MD -0.68; 95% CI -1.02 to -0.34; p<0.0001) and hepatic steatosis scores (SMD -0.45; 95% CI -0.71 to -0.19; p=0.0008). Subgroup analysis showed that the effects of probiotics were more pronounced in patients with NAFLD non-alcoholic steatohepatitis (NASH) and those receiving multi-strain probiotics. Conclusion: This meta-analysis provides strong evidence that probiotics have beneficial effects on biochemical and imaging parameters in NAFLD patients. Probiotics may be considered as an adjunct therapy for NAFLD, especially in patients with NASH. However, more research is needed to determine the optimal probiotic strain, dosage, and duration of treatment.

The efficacy and safety of Dachaihu decoction in the treatment of nonalcoholic fatty liver disease: a systematic review and meta-analysis.

Nonalcoholic fatty liver disease (NAFLD), also known as metabolic associated fatty liver disease (MAFLD), is a common liver condition characterized by excessive fat accumulation in the liver which is not caused by alcohol. The main causes of NAFLD are obesity and insulin resistance. Dachaihu decoction (DCHD), a classic formula in traditional Chinese medicine, has been proved to treat NAFLD by targeting different aspects of pathogenesis and is being progressively used in the treatment of NAFLD. DCHD is commonly applied in a modified form to treat the NAFLD. In light of this, it is imperative to conduct a systematic review and meta-analysis to assess the effectiveness and safety of DCHD in the management of NAFLD. There is a need for a systematic review and meta-analysis to assess the effectiveness and safety of modified DCHD in treating NAFLD. The objective of this meta-analysis was to systematically assess the clinical effectiveness and safety of DCHD in treating NAFLD. This meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Including seven databases, both Chinese and English databases were searched for relevant studies. The quality of included studies was carefully assessed using the bias risk assessment tool in the Cochrane Handbook. Eligible articles were the source of extracted data which was meta-analyzed by using Review Manager 5.4 and Stata 17.0. A total of 10 studies containing 825 patients were included. Compared with conventional treatments, combined treatment could clearly improve the liver function of NAFLD patients, which could reduce the levels of ALT (MD = -7.69 U/L, 95% CI: -11.88 to -3.51, p < 0.001), AST (MD = -9.58 U/L, 95% CI: -12.84 to -6.33, p < 0.01), and it also had a certain impact on regulating lipid metabolism, which could reduce the levels of TC (MD = -0.85 mmol/L, 95% CI: -1.22 to 0.48, p < 0.01), TG (MD = -0.45 mmol/L, 95% CI: -0.64 to 0.21, p < 0.01). Adverse event showed that DCHD was relatively safe. Due to the inclusion of less than 10 trials in each group, it was not possible to conduct a thorough analysis of publication bias. According to the meta-analysis, in the treatment of the NAFLD, it is clear that the combination of DCHD was advantages over conventional treatment alone in improving liver function, regulating lipid metabolism. Additionally, DCHD demonstrates a relatively safe profile. Nevertheless, due to limitations in the quality and quantity of the studies incorporated, the effectiveness and safety of DCHD remain inconclusive. Consequently, further high-quality research is imperative to furnish more substantial evidence supporting the widespread clinical application of DCHD. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023397353, CRD42023397353.

Metformin use review in Non-Alcoholic Fatty Liver Disease (NFLDA) and students survey

This study presented the literature review findings and the knowledge and opinions of 41 first-year pharmacy students regarding metformin's role in managing non-alcoholic fatty liver disease (NAFLD), achieving a 92% response rate. NAFLD, affecting about a quarter of the global population, is linked with obesity, high cholesterol, and diabetes, presenting a substantial public health issue. Metformin, known for treating type 2 diabetes, is considered for NAFLD management due to its potential in improving insulin sensitivity and reducing hepatic gluconeogenesis. Survey results, analyzed using SPSS software, showed varied perceptions across demographics. Younger participants (18-24) were more familiar with metformin than older counterparts. Females were more inclined towards recommending metformin for NAFLD, understanding its benefits better than males. Notably, employed individuals and those residing outside certain states demonstrated greater awareness of metformin, suggesting regional knowledge disparities. Participants with a 4-year degree displayed enhanced familiarity with metformin's application in NAFLD. The findings highlight the need for targeted educational efforts to bridge knowledge gaps about metformin and NAFLD management among pharmacy students. This knowledge is crucial for informing curriculum enhancements and integrating NAFLD management into therapeutic courses or modules for aspiring healthcare professionals. Significant associations were identified between students' age, gender, employment status, residency, income level, and their understanding of metformin, indicating diverse educational needs.

Non-alcoholic fatty liver disease in type 2 diabetes: Emerging evidence of benefit of peroxisome proliferator-activated receptors agonists and incretin-based therapies.

Nonalcoholic fatty liver disease (NAFLD) is a global epidemic, affecting more than half of the people living with type 2 diabetes (T2D). The relationship between NAFLD and T2D is bidirectional and the presence of one perpetuates the other, which significantly increases the hepatic as well as extrahepatic complications. Until recently, there was no approved pharmacological treatment for NAFLD/ nonalcoholic steatohepatitits (NASH). However, there is evidence that drugs used for diabetes may have beneficial effects on NAFLD. Insulin sensitizers acting through peroxisome proliferator-activated receptor (PPAR) modulation act on multiple levels of NAFLD pathogenesis. Pioglitazone (PPARγ agonist) and saroglitazar (PPARα/γ agonist) are particularly beneficial and recommended by several authoritative bodies for treating NAFLD in T2D, although data on biopsy-proven NASH are lacking with the latter. Initial data on elafibanor (PPAR α/δ agonist) and Lanifibranor (pan PPAR agonist) are promising. On the other hand, incretin therapies based on glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1RA) and dual- and triple-hormone receptor co-agonists reported impressive weight loss and may have anti-inflammatory and antifibrotic properties. GLP-1 RAs have shown beneficial effects on NAFLD/NASH and more studies on potential direct effects on liver function by dual- and triple-agonists are required. Furthermore, the long-term safety of these therapies in NAFLD needs to be established. Collaborative efforts among healthcare providers such as primary care doctors, hepatologists, and endocrinologists are warranted for selecting patients for the best possible management of NAFLD in T2D.

Interpretation of the 2024 American Diabetes Association guidelines for the comprehensive management of non-alcoholic fatty liver disease combined with diabetes mellitus

Non-alcoholic fatty liver disease (NAFLD) is a common concomitant disease in adults with type 2 diabetes mellitus (T2DM) and prediabetes. Therefore, T2DM/NAFLD patient populations are at high risk for cardiovascular disease. The occurrence and progression of non-alcoholic fatty liver disease-related liver fibrosis and cardiovascular disease have a severe impact on the patient's prognosis and mortality rate. The American Diabetes Association's 2024 "Guidelines for the Standardized Management of Diabetes" put forward recommendations relevant to the screening, evaluation, treatment, and management of NAFLD in T2DM and prediabetic populations, as well as liver fibrosis. The important measures for decelerating liver inflammation and fibrosis progression and the risk of cardiovascular disease are based on improvements in lifestyle methods, weight loss, and blood sugar control.

Evaluation of health practices among individuals with non-alcoholic fatty liver disease: A randomized controlled trial

The current strategy for addressing non-alcoholic fatty liver disease (NAFLD) emphasizes lifestyle adjustments aimed at promoting weight loss. Recommendations include dietary changes and regular physical activity to support patients with NAFLD in achieving their weight loss objectives. However, there is a lack of comprehensive data assessing the efficacy of these approaches. In this randomized controlled trial (RCT) encompassing 90 meticulously chosen individuals diagnosed with NAFLD, participants were divided into intervention (n = 45) and control (n = 45) groups. Across a duration of six months, the intervention consisted of a customized dietary and exercise program designed specifically for NAFLD management, which was implemented, with pre-and post-tests conducted at the beginning and at the end of 6 months. The findings revealed that, the intervention led to improvements in health practices, particularly within the intervention group as compared to the control group, underscoring its significance in managing NAFLD.

Systematic Review and Meta-analysis of the Impact of Metabolic Surgery on Hepatic Stiffness.

Bariatric surgery is one of the effective therapeutic options for people with obesity and obesity-related co-morbidities. In addition to weight-related co-morbid diseases, including diabetes, hypertension, and hypercholesterolemia, non-alcoholic fatty liver disease (NAFLD) is common in patients with morbid obesity. Bariatric surgery is one of the therapeutic options in the management of NAFLD. Hence, this review focused on the potential role of bariatric surgery on hepatic elasticity measured through shear wave elastography. A systematic literature search was performed, and the studies regarding heterogeneity were evaluated using the random-effects model. The meta-analysis on 6 trials (3-12 months follow-up) including 350 participants showed a significant reduction of liver elasticity after surgery (WMD: -1.149, 95% CI: -1.767, -0.532, p < 0.001; I2:81.55%). Bariatric surgery is associated with decreased liver elasticity. This improvement could be related to weight loss or other mechanisms of bariatric surgery.

The relationship between muscle mass and fat content in body composition and non-alcoholic fatty liver disease in the Chinese general population: a cross-sectional study.

Non-alcoholic fatty liver disease (NAFLD) poses a significant global health challenge, necessitating comprehensive exploration of its etiology. This study investigates the intricate relationship between body composition and NAFLD prevalence, focusing on the balance between muscle mass and fat content. Employing a retrospective cross-sectional design, 2,493 participants undergoing routine health examinations were analyzed. Body compositions, including muscle mass and fat, were measured using bioelectrical-impedance analysis. The prevalence of NAFLD was assessed based on clinical guidelines. This study included 2,493 patients, including 1,601 (64.2%) men and 892(35.8%) women. The average age of these participants was 46.0 ± 13.1 years, with a mean body mass index of 25.0 ± 3.6 kg/m2. The levels of fat free mass (FFM) to fat mass (FM) ratio (FFM/FM) and appendicular skeletal muscle mass index (ASMI) demonstrated a negative association with the prevalence of NAFLD (OR (95% CI): 0.553 (0.427-0.704) and 0.850 (0.730-0.964), p < 0.001 and p = 0.022, respectively). Liver function further elucidates the multifaceted impact of body composition on hepatic health. In contrast to other parameters, FFM/FM displayed a negative association with liver damage indicators, including a negative association with alanine aminotransferase (Beta±SE: -1.00 ± 0.17, p < 0.001), with aspartate aminotransferase showing borderline significance (Beta±SE: -0.26 ± 0.15, p = 0.084). Similar associations were also evident in terms of liver productive function and bilirubin metabolism. Our study offers novel insights into the nuanced interplay between body composition and NAFLD. Recognizing the significance of the balance between muscle and fat provides a foundation for tailored interventions that may reshape the landscape of NAFLD prevention and management.

Survey of physicians' knowledge about pediatric nonalcoholic fatty liver disease in China.

To evaluate physicians' awareness and knowledge towards pediatric nonalcoholic fatty liver disease (NAFLD) and their attitude toward change in nomenclature from NAFLD to metabolic dysfunction-associated fatty liver disease (MAFLD) or metabolic dysfunction-associated steatotic liver disease (MASLD) in China. The questionnaire survey contained five parts (characteristics of the participants, epidemiology, diagnosis, management of NAFLD, and attitudes toward the nomenclature of MAFLD/MASLD). The participants included 53 hepatologists, 88 gastroenterologists (GEs), 74 endocrinologists (ENDOs), 61 primary care physicians (PCPs), and 157 pediatricians across 31 municipalities, provinces and autonomous regions of China's mainland. Hepatologists saw the largest number of pediatric NAFLD patients annually (median 9 [range 1-20]), with the lowest number by PCPs (even notwithstanding one patient annually). The primary sources of pediatric NAFLD knowledge were acquired via guidelines. Hepatologists had the highest total knowledge score among all five types of physicians. Approximately one-third of nonspecialists (ENDOs and PCPs) considered liver biopsy necessary for pediatric NAFLD patients, and this percentage increased to half in specialists (hepatologists and GEs). For nonspecialists, the major barriers to the management of pediatric NAFLD were poor patient adherence to lifestyle modifications and lacking confidence in managing NAFLD. Above 90% physicians agreed to change the nomenclature NAFLD to MAFLD; however, they were not sure whether it could reduce the economic burden. Despite the epidemic of pediatric NAFLD in China, a significant knowledge gap remains in the identification, diagnosis, and treatment of pediatric NAFLD, particularly among frontline workers such as pediatricians and PCPs. More education programs should be carried out in the future.

Exploring the therapeutic potential of silymarin-based herbal remedy (prebiotic) and probiotic blend in a mouse model of NAFLD: Insights into gut microbiota modulation and liver health

Non-alcoholic fatty liver disease (NAFLD) is a significant consequence of metabolic dysfunction, often associated with changes in the intestinal microbiota. Prebiotics and probiotics have shown promise in NAFLD management. This study evaluated a silymarin-based herbal remedy with piperine and fulvic acid, alongside a probiotic blend of Bifidobacterium adolescentis, Bifidobacterium bifidum, Lactobacillus casei, and Lactobacillus rhamnosus. Using a NAFLD mouse model induced by a high-fat and high-fructose diet, we assessed biochemical parameters, liver function, glucose levels, and conducted histological analysis. Stool samples underwent 16S rRNA metagenomic analysis to explore changes in microbiota composition. Mice on the high-fat diet exhibited elevated lipids, liver enzymes, and glucose, with reduced high-density lipoprotein levels (with p value < 0.001). Treatment, particularly with F3 (silymarin-piperine-fulvic acid herbal remedy and probiotic blend), significantly reduced hepatic fat accumulation and improved gut microbiota composition. This study highlights the potential of silymarin-based therapy combined with probiotics in attenuating NAFLD progression.

Multifunctional role of oral bacteria in the progression of non-alcoholic fatty liver disease.

Non-alcoholic fatty liver disease (NAFLD) encompasses a spectrum of liver disorders of varying severity, ultimately leading to fibrosis. This spectrum primarily consists of NAFL and non-alcoholic steatohepatitis. The pathogenesis of NAFLD is closely associated with disturbances in the gut microbiota and impairment of the intestinal barrier. Non-gut commensal flora, particularly bacteria, play a pivotal role in the progression of NAFLD. Notably, Porphyromonas gingivalis, a principal bacterium involved in periodontitis, is known to facilitate lipid accumulation, augment immune responses, and induce insulin resistance, thereby exacerbating fibrosis in cases of periodontitis-associated NAFLD. The influence of oral microbiota on NAFLD via the "oral-gut-liver" axis is gaining recognition, offering a novel perspective for NAFLD management through microbial imbalance correction. This review endeavors to encapsulate the intricate roles of oral bacteria in NAFLD and explore underlying mechanisms, emphasizing microbial control strategies as a viable therapeutic avenue for NAFLD.

Association between Dietary Quality and Non-Alcoholic Fatty Liver Disease in Korean Adults: A Nationwide, Population-Based Study Using the Korean Healthy Eating Index (2013-2021).

This study explored the relationship between the Korean Healthy Eating Index (KHEI) and non-alcoholic fatty liver disease (NAFLD). This cross-sectional study included 34,174 Korean adults. The KHEI was composed of three subcomponents (adequacy, moderation, and energy balance) and calculated based on a 24 h dietary recall. The total score ranged from 0 to 100, with a higher score indicating a greater adherence to the Korean dietary guidelines. The total KHEI scores were categorized into quartiles (Q1-Q4). NAFLD was classified using the hepatic steatosis index. Logistic regressions were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). The adjusted OR (95% CI) of NAFLD was 0.95 (0.87-1.03) for the Q2 group, 0.90 (0.83-0.98) for the Q3 group, and 0.79 (0.72-0.87) for the Q4 group, compared with the Q1 group. Among the subcomponents of the KHEI, individuals with high scores in the adequacy component, characterized by an abundant consumption of fruits, vegetables, and dairy products, exhibited the most pronounced association with NAFLD. A higher KHEI score was negatively associated with NAFLD in Korean adults. Therefore, the promotion of healthy dietary patterns can play a beneficial role in the prevention or management of NAFLD.

Current Management of Non-Alcoholic Fatty Liver Disease (NAFLD)

Non-alcoholic fatty liver disease (NAFLD) is characterized by hepatic steatosis in the absence of other causes of liver fat accumulation. The prevalence of NAFLD is increasing and now among top causes of hepatocellular carcinoma. The diagnosis of NAFLD requires evidence from liver biopsy. There are currently no specific drugs for therapy of NAFLD. Current mainstay for management of NAFLD is lifestyle interventions focused around weight loss. Lifestyle interventions can be done by dietary modification or increasing physical activity level. Pioglitazone and vitamin E are only recommended for patient whom was confirmed NAFLD by liver biopsy. New agents such as obeticholic acid, elafibranor, selonsertib, and cenicriviroc are still waiting for phase III result to be recommended as therapy for NAFLD. Bariatric surgery can be advised for NAFLD patient with obesity who is not adequately controlled by medical therapy.

Controlled attenuation parameter (CAP): the clinical value based on MRI-PDFF in children with obesity.

Controlled attenuation parameter (CAP) is a noninvasive and quantitative method to evaluate hepatic steatosis, which is not well evaluated in children. The aim ofthis study was to examine the diagnostic value of CAP forhepatic steatosis in children with obesity based on MR proton density fat fraction (PDFF). About 108 pediatric patients with nonalcoholic fatty liver disease (NAFLD) who were assessed for PDFF, CAP, and other laboratory results were enrolled. In this study, pediatric patients were separated for the obese group (n=80) and the severe obese group (n=28). Hepatic steatosis grades (0-3) were classified according to PDFF using cutoff values of 6.4 , 17.4, and 22.1 %. There are significant differences in CAP between the obese and severe obese groups (p<0.05). CAP showed a good correlation with PDFF in pediatric patients with NAFLDfor diagnosing hepatic steatosis using a cutoff valueof 265 dB/m (p<0.001). Meanwhile, ALT significantly outperforms CAP in receiver-operating curve (ROC) analysis for diagnosing hepatic steatosis grades. The diagnostic accuracy of CAP for steatosis is 77.8 %, and the diagnostic accuracy of ALT for steatosis is 83.3 %. While CAP holds promise as a diagnostic tool for pediatric NAFLD, its diagnostic performance warrants some caution. The potential of CAP is evident; however, ALTemerges as a simpler and more accurate measure for detecting hepatic steatosis in children. Further research is essential to determine the optimal role of CAP in pediatric NAFLD diagnosis and management.

Study the Physiological and Biochemical Effects of Berberine Extract on Nonalcoholic Fatty Liver Disease (NAFLD) in Male Rabbits

Nonalcoholic fatty liver disease (NAFLD) is a prevalent global health issue, characterized by hepatic steatosis and associated with metabolic comorbidities such as obesity, diabetes, and dyslipidemia. Berberine (BBR), an isoquinoline alkaloid, has emerged as a potential therapeutic agent for NAFLD. In this research, we evaluated the effects of BBR on NAFLD management and its associated complications. Our analysis included three groups involving 10 rabbits induced NAFLD by administration cholesterol rich diet, 10 rabbits administrated high rich diet with fats and cholesterol, and 10 rabbits with normal fed as control group. BBR demonstrated significant improvements in liver function biochemical markers (ALT, AST, GGT), lipid indices (TC, TG, LDL-C, HDL-C), and physiological parameters such as insulin sensitivity (HOMA-IR) and body mass index (BMI). Importantly, BBR exhibited a favorable safety profile, with minimal gastrointestinal adverse events reported. These findings highlight BBR potential as an adjunct therapy for NAFLD. However, further well-designed clinical trials involving human subjects are warranted to validate its efficacy and safety.