NAFLD Group Research Articles

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 < 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 < 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.

Clinical significance of serum FGF21 levels in diagnosing nonalcoholic fatty liver disease early

The endogenous FGF21 level is a potential target for diagnosing NAFLD. This study aimed to assess the clinical utility of FGF21 in diagnosing NAFLD and provide new ideas for predicting and preventing NAFLD. A total of 193 patients diagnosed with NAFLD based on diagnostic criteria and 64 healthy individuals were included in the NAFLD and non-NAFLD groups, respectively. Data on the participant names, sex, age, height, weight, blood pressure, serum FGF21 levels, liver function enzyme (AST, ALT, ALP, and GGT) levels, lipid profile (TC, TG, HDL-C, and LDL-C) indicators, and blood glucose levels were collected. The data were statistically analyzed to assess the correlations between serum FGF21 levels and related biochemical markers in NAFLD patients. The areas under the receiver operating characteristic curves (AUCs) of serum FGF21, lipids (TG + TC + HDL + LDL), and FGF21 combined with lipids for the diagnosis of NAFLD were compared. Compared with the non-NAFLD group, the NAFLD group presented significantly higher levels of FGF21. Serum FGF21 levels in the NAFLD group were positively correlated with the TG, TC, and LDL-C levels (P < 0.05). The area under the receiver operating characteristic curve (AUC) of serum FGF21 for the diagnosis of NAFLD was 0.832 (95% CI: 0.77–0.886, P < 0.001). The AUC of FGF21 combined with lipids (TG + TC + HDL + LDL) for the diagnosis of NAFLD was 0.910 (95% CI: 0.874–0.946, P < 0.001). There is a close association between elevated FGF21 levels and the development of NAFLD. The progression of NAFLD is complex and varied, and its pathogenesis is unclear. Early detection, prevention, and intervention may help slow NAFLD development or even reverse the disease. In this study, we found that the FGF21 level could be used as an auxiliary biological indicator for predicting NAFLD, and the role of FGF21 in the progression of NAFLD deserves to be investigated in the future.

Effect of obesity and NAFLD on leukocyte telomere length and hTERT gene MNS16A VNTR variant

It is known that telomere length (TL) (evaluated with T/S ratio) is shortened in the presence of obesity. In this study, we aimed to investigate how obesity in adolescents and non-alcoholic liver disease (NAFLD) within the obese group affect TL and the clinical significance of the human telomerase reverse transcriptase (hTERT) gene MNS16A VNTR variant in terms of NAFLD. Adolescents with exogenous obesity and healthy controls (aged 10–19 years) who applied to our adolescent outpatient clinic between May-October 2023 were included in this study. We performed upper abdominal ultrasonography to investigate the presence of NAFLD in adolescents with obesity and divided into two groups: those without hepatosteatosis (obese NAFLD (-)) and those with hepatosteatosis (obese NAFLD (+)). We recorded body weight, height, waist circumference, and blood pressure measurements and measured the T/S ratio (telomere sequence copy number/gene single copy number) by the Quantitative Polymerase Chain Reaction method. The groups were compared using frequentist and Bayesian methods. Eighty-three obese adolescents [63 NAFLD(+) 20 NAFLD(-)] and 69 lean controls were included in the study. Pairwise comparisons revealed that T/S ratio was significantly lower in the obese NAFLD (-) group than the obese NAFLD (+) and the control group (p = 0.025, p = 0.007, respectively). T/S ratio was lower in the LL allele group than in the other alleles (p = 0.022) and slightly higher in the obese group with metabolic syndrome compared to the obese group without metabolic syndrome (p = 0.072). hTERT-MNS16A-VNTR gene variant LL allele had a negative correlation with T/S ratio among the obese adolescent group. Patients with LL alleles had higher ALT, GGT, HOMA-IR, and ALT/AST. Diastolic blood pressure had a significant correlation with the T/S ratio. The T/S ratio was shorter in the obese adolescent group compared to healthy ones but was higher in the NAFLD (+) obese compared to the NAFLD (-) obese. ALT level and ALT/AST ratio were higher, T/S ratio was lower in the hTERT MNS16A VNTR variant LL allele group among obese adolescents. In addition, there was a significant correlation between the T/S ratio and diastolic blood pressure in obese adolescents.

Evaluation of the ability of insulin resistance and lipid-related indices to predict the presence of NAFLD in obese adolescents

BackgroundNonalcoholic fatty liver disease (NAFLD) has become an important health issue in adolescents. Although several parameters and indices have been investigated for the evaluation of NAFLD in adults, these indices are limited in adolescents. In this study, body mass index, waist circumference, triponderal mass index, HbA1c, homeostatic model assessment insulin resistance (HOMA-IR), triglyceride/high-density lipoprotein (Tg/HDL), the lipid accumulation product (LAP) index, the triglyceride-glucose (TyG) index and the aminotransferase (AT) index were examined together, and their diagnostic values in the clinical treatment of NAFLD were compared.Materials and methodsSeventynine adolescents (10–19 years old) with obesity who were admitted to a pediatric clinic between January and August 2022 and who were diagnosed with exogenous obesity without any comorbidities were included in the study. The presence of NAFLD was evaluated by liver magnetic resonance imaging. The laboratory findings were obtained retrospectively from system records. Parameters were compared between the NAFLD (+) and NAFLD (-) groups. Logistic regression analysis was used to determine the most effective factors for NAFLD treatment. Receiver operating characteristic (ROC) analysis was performed with significant indices. Sex, HOMA-IR, TyG and AT indices were evaluated together with multivariate analysis to design a diagnostic scale.ResultsHbA1c, HOMA-IR, AT indices and TyG indices were greater in the NAFLD (+) group (P = 0.012; P = 0.001; P = 0.012; P = 0.002, respectively). There was a positive correlation between liver fat percentage and HOMA-IR, the TyG index, the AT index, and Tg/HDL. According to the regression analysis, male sex and elevated HOMA-IR were determined to be significant risk factors for the presence of NAFLD. A probability scale with 4 parameters [sex, HOMA-IR, the TyG index, and alanine aminotransferase (ALT)] was designed with 82.5% specificity and 80% sensitivity.ConclusionEvaluation of the HOMA-IR and TyG indices, especially in high-risk patients, will support the diagnosis of NAFLD via ultrasonography. A probability scale with ALT, HOMA-IR, TyG, and sex data with a diagnostic accuracy of 80% may aid in the diagnosis of NAFLD in adolescents with obesity.

Relationship between Vitamin D Concentration and Lipid Concentration in Patients with NAFLD in the Hulunbuir Region of China.

We aimed to characterize the relationship between the serum 25-hydroxyvitamin D concentration and the circulating lipid concentrations of patients with NAFLD in the Hulunbuir region of China. One hundred fifty-six patients, who were diagnosed with NAFLD in the Physical Examination Department of the Second Clinical College of Inner Mongolia University for the Nationalities between January 2021 and March 2023, were recruited as NAFLD group, and 160 healthy people were recruited as a control group during the same period. The serum 25(OH)VitD, TBIL, TG, TC, LDL-C, HDL-C, AST, ALT, GGT, and FPG activities of the participants were measured, and hepatic ultrasonography was performed. The BMI of the NAFLD group was higher than of the control group (p < 0.05). The serum 25(OH)VitD3 (p < 0.05) and the HDL-C concentrations of the NAFLD group were lower than those of the normal control group. However, the AST (p < 0.05), ALT (p < 0.05), and GGT (p < 0.05) activities, and the serum TG (p < 0.05), TC (p < 0.05), LDL-C (p < 0.05), and the fasting glucose (p < 0.05) concentrations of the NAFLD group were higher than those of the normal control group. The serum 25(OH)VitD3 concentrations of the NAFLD group significantly cor-related negatively with BMI (r = -0.302, p < 0.01), TG (r = -0.221, p < 0.05), and fasting glucose (r = -0.236, p < 0.05). The BMI, TG, and fasting glucose of vitamin D-deficient participants were higher than of the participants with adequate or insufficient levels of vitamin D (p < 0.05). Finally, the BMI of vitamin D-deficient participants was higher than of those with an adequate vitamin D status (p < 0.05). A deficiency of 25(OH)VitD is more common in people from the Hulunbuir region of China than elsewhere. In addition, the vitamin D status is significantly associated with NAFLD; as the serum vitamin D concentration decreases, patients with NAFLD show greater dyslipidemia and hyperglycemia and a higher BMI.

Different aspects of immunological profile in patients with Non-Alcoholic Fatty liver disease.

NAFLD is thought to affect approximately one-fourth of the world's population. Therefore, we evaluated the role of serum complement and immunoglobulins in the NAFLD pathogenesis. 200 participants were used in this study, divided into two groups; Group I: 100 NAFLD patients and Group II: 100 healthy volunteers. The diagnosis of NAFLD is based on non-invasive methods, following the EASL guideline 2022. IgG, IgM, IgA, C3, and C4 assays were performed on all participants. When the immunological profiles of patients with NAFLD and healthy controls were compared, it was found that the mean IgA in NAFLD patients was (4.20±5.07), whereas the mean IgA in healthy controls was (2.22±1.05) (P=0.000). Additionally, a significant increase in IgG was found in NAFLD patients (17.08±3.87) compared with healthy controls (11.59±3.34), with a P value of (p<0.001). complement C3 and complement C4 levels significantly increased in nonalcoholic fatty liver disease patients (1.28± 0.61 and 0.40 ± 0.19, respectively), compared to healthy controls (0.90 ±0.27 and 0.30 ±0.12, respectively), with a significant P value (p<0.001 for each). Elevated IgA, IgG, C3 and C4 exist in patients with NAFLD and could be associated with fatty liver development and progression of hepatic fibrosis in patients with NAFLD.

Etiologies of Persistent Aminotransferase Elevations in Chronic Hepatitis B Patients Treated with Nucleos(t)ide Analogs.

Background/Aims: Recent studies revealed that patients with persistent aminotransferase elevations after antiviral treatment had higher risk of hepatic events; yet its underlying causes remain unclear. Our study aimed to investigate the etiologies of persistent aminotransferase elevations in patients treated with nucleos(t)ide analogs (NAs). Materials and Methods: A retrospective study was conducted on chronic hepatitis B (CHB) patients who had been receiving NA treatment for over a year and had an aminotransferase level greater than 40 IU/mL (more than twice, with a 3-month interval) and subsequently underwent a liver biopsy. Results: The study group included 46 patients (34 males) with a mean age of 44.8 ± 20.3 years (range: 24-71 years).The average dura- tion of NA therapy was 3.7 years (1.1-10.6 years). The etiologies of persistant transaminase elevation were categorized into 4 groups: patients with low hepatitis B virus (HBV) viral load (LVL, n = 11); concurrent non-alcoholic fatty liver disease (NAFLD, n = 12); concurrent other liver diseases (OLD, n = 12); and unknown liver dysfunction (ULD, n = 11). The proportion of G ≥ 2 inflammation was significantly higher in the LVL group (90.9%) compared to NAFLD (33.3%), OLD (50%), and ULD (27.2%) groups (P = .012). The hepatitis B e-antigen (HBeAg)-positive group exhibited a younger age (34.5 ± 10.2 vs. 48.1 ± 9.4 years, P < .001), a lower proportion of fibrosis F ≥ 2 (36.3% vs. 77.1%, P = .012), and a higher prevalence of detectable HBV DNA (54.5% vs.14.2%, P = .00632) compared to the HBeAg-negative group. Conclusion: The etiology of persistent aminotransferase elevations in CHB patients undergoing NAs treatment warrants investigation. Besides the commonly observed NAFLD and low HBV viral load, concurrent presence of other liver diseases requires elucidation.The proportion of G≥2 inflammation was higher in the LVL group.

Efficacy of Hot Tea Infusion vs. Ethanolic Extract of Moringa oleifera for the Simultaneous Treatment of Nonalcoholic Fatty Liver, Hyperlipidemia, and Hyperglycemia in a Murine Model Fed with a High-Fat Diet.

Moringa oleifera (MO) is a native tree of Asia and is cultivated in some areas of Mexico as part of traditional horticulture. The aim of the present study was to compare the efficacy of MO infusion vs. MO ethanolic extract for the simultaneous treatment of nonalcoholic fatty liver (NAFLD), hyperlipidemia, and hyperglycemia in a murine model fed with a high-fat diet (HFD). BALB/c mice were fed a balanced diet (healthy control) or an HFD for 6 months. With this, the NAFLD model was established before starting a therapeutic intervention with MO for two months. The phytochemical analysis by nuclear magnetic resonance in 1H and 13C experiments showed signals for pyrrole alkaloids and triterpenes as the main constituents of the extract and infusion preparation. A significant reduction of SGPT, SGOT, lipids, urea, and glucose in blood among NAFLD groups treated with MO (infusion or extract) was found, when compared to the NAFLD-placebo group. Steatosis and liver inflammation were found to be decreased in the MO groups, as infusion or ethanolic extract. Infusion produced a better therapeutic effect than the extract in all parameters, except glycemic control, where the extract was better. As an additional finding, it is noteworthy that treatment with MO, particularly through infusion, resulted in improved motor activity. Moreover, a reduction in anxiety-like behavior was observed exclusively with the administration of infusion. These observations provide valuable insights into the potential broader effects of Moringa oleifera beyond the primary aim of the study.

TG: A Mediator of the Relationship of Serum Uric Acid to Creatinine Ratio and Nonalcoholic Fatty Liver Disease in Non-Obese Patients with Type 2 Diabetes.

The study estimated the association between NAFLD and SUA/Cr in Chinese non-obese patients with type 2 diabetes mellitus (T2DM) and also investigated mediating effect of TG. All patients were divided into NAFLD group (n = 420) and non-NAFLD group (n = 347). The differences of biochemical indicators between the two groups were compared. The link between SUA/Cr and other parameters was checked through Spearman correlation analysis. Differences in the incidence rate of NAFLD between SUA/Cr and TG 3 tertile subgroups were tested by chi-squared. To explore the independent influence of SUA/Cr and TG on NAFLD, logistic regression was performed. The predictive value of SUA/Cr and SUA/Cr combined with BMI for NAFLD was analyzed using ROC curves. In addition, to confirm whether TG has a mediating effect on the link of SUA/Cr and NAFLD, we conducted a mediating analysis. NAFLD group had higher SUA/Cr values than individuals without NAFLD (P < 0.01). SUA/Cr was linked with TC and TG (r = 0.081, 0.215 respectively). NAFLD prevalence increased progressively from quartile 1 to quartile 3 of SUA/Cr (44% vs 57% vs 62%). Prevalence of NAFLD increased from quartile 1 to quartile 3 of TG (35.8% vs 58.7% vs 69.9%). Analysis of the logistic regression revealed that SUA/Cr and TG were statistically linked with NAFLD. The ROC curve pointed out that the area under the curve (AUC), sensitivity and specificity of SUA/Cr were 0.59, 0.629 and 0.522, respectively. The AUC, sensitivity and specificity for SUA/Cr combined with BMI were 0.719, 0.644 and 0.677, separately. The mediation analysis showed a statistically direct effect of SUA/Cr on NAFLD (β=0.148, 95% CI: 0.0393, 0.2585). The function of SUA/Cr on NAFLD partially mediated by TG (β=0.1571, 95% CI: 0.0704, 0.2869). SUA/Cr was significantly associated with NAFLD in non-obese T2DM patients, and TG partially mediated this association. SUA/Cr can be applied to predict for NAFLD.

Male patients with first diagnosed and never treated essential hypertension accompanied by organ damage are at high risk for non-alcoholic fatty liver disease indicated by Hepatic steatosis index

Abstract Background Non-alcoholic fatty liver disease (NAFLD) is closely related to the metabolic syndrome as well as to arterial hypertension and overall cardiovascular (CV) disease. We aimed to investigate if those first diagnosed and never treated patients with essential hypertension at high risk for NAFLD, measured by the Hepatic Steatosis Index (HSI), already have an impaired CV risk profile estimated by increased blood pressure burden and accompanied by the presence of hypertension-mediated organ damage (HMOD). Methods We studied 300 non-diabetic, first diagnosed and never-treated young hypertensive patients [mean age=51+11 years, 60% males, 32% smokers]. Ambulatory blood pressure monitoring (24h ABPM), CV risk factors [smoking, obesity (BMI), hyperlipidemia and HMOD [aortic stiffness (PWV), left ventricular diastolic dysfunction (EEa), cardiac hypertrophy (LVMI), coronary arteries microcirculation (CFR), carotid intima-media thickness (cIMT) and endothelial dysfunction (PBR5-25)] were estimated in each patient before treatment initiation. HIS was calculated as 8 times (ALT/AST ratio) +BMI (+2, if female; +2, if diabetes mellitus). Increased HIS levels predispose for augmented risk for NAFLD. Results The whole hypertensive population was divided regarding HSI median value=39.5 in two groups, Group A (higher risk for NAFLD group, n=150, age=50+10, 59% males, 33% smokers) and Group B (lower risk for NAFLD group, n=150, age=51+11, 60% males, 31% smokers). Group A patients had increased BMI (32+5 vs. 27+3, p&amp;lt;0.001), systolic night-time ABPM (127+15 vs. 124+11, p=0.05), office systolic (152+19 vs. 145+17 mmHg, p=0.004) and diastolic BP (94+11 vs. 90+11 mmHg, p=0.002), central systolic BP (146+20 vs. 137+15, p=0.006), Chol (216+39 vs. 206+35, p=0.02), LDL (138+35 vs.130=33 mg/dl, p=0.04) and Trigl (139+75 vs. 112+63, p=0.001), E/Ea (7+2 vs. 6+2, p=0.01) and LVMI (83+18 vs. 79+17, p=0.03) compared to Group B. All other studied demographic, laboratory, ABPM and HMOD parameters (PWV, MAU, CFR and cIMT) were similar between groups. HSI was related to BMI (p&amp;lt;0.001) and office BP, both systolic (p=0.001) and diastolic (p=0.008) in total population as well as to LVMI (r=0.17, p=0.02) in males. Finally, in multiple regression analysis, we found that HSI was independently associated with LVMI (beta=0.14, p=0.05) only in male hypertensives. Conclusions Patients first diagnosed arterial hypertension and augmented CV risk (smoking, obesity, hyperlipidemia, BP burden and HMOD) are also at high risk for NAFLD. As successful antihypertensive treatment may lead to HMOD regression, probably there is still time for those patients to be treated for hypertension disease and hyperlipidemia and quit smoking, in order to reduce future CV risk.LVMI and HSI in male hypertensives

Assessment of sympathovagal balance by HRV analysis in alcoholic and nonalcoholic fatty liver disease patients

BACKGROUND: Heart rate variability (HRV) is the variation in the time intervals between continuous heartbeats also called interbeat intervals to give information related to the heart, blood pressure, gaseous exchange, and sympathetic and parasympathetic balance. Abnormalities in the conduction of the cardiac system alter the measurements of heart rate variability and lead to alteration in autonomic function with a higher risk of mortality. So, our objective includes the assessment of sympathovagal balance in AFLD and NAFLD patients. MATERIALS AND METHODS: The study included 78 alcoholic and 54 nonalcoholic fatty liver patients. A room temperature of 23°C with 25–35% humidity will be maintained in a recording room. Basal supine heart rate and BP will be recorded by the oscillometric method using an automated blood pressure monitor Omron MX3, India. Lead II ECG will be recorded for the next 5 minutes in total resting condition for short-term HRV analysis. Short-term HRV indices including time domain and frequency domain were recorded from each patient. Under time domain, SDNN, RMSSD, and average RR were noted. Under frequency domain, LF, HF, VLF, LF (nu), HF (nu), and LF/HF were calculated. The data were collected by using a 16-bit, power lab 8/30 data acquisition system (New South Wales, Australia) with acknowledge 3.8.2 software. Inferential analyses such as independent t-tests and Mann–Whitney tests were used to compare NAFLD and AFLD patient groups. Carl Pearson correlation analysis was performed to obtain a relationship between variables. RESULTS: SDNN in (ms) which represents the overall HRV found to be decreased in both alcoholic (32.84 ± 79.08) and nonalcoholic fatty liver disease (22.04 ± 13.85) compared to the normal range (50 ± 16)) from 27 studies. The value of RMSSD in (ms) was decreased in both alcoholic (17.00 ± 12.48) and nonalcoholic fatty liver disease patients (14.00 ± 9.44) with the normal range of (42 ± 15) from 15 studies. Pearson correlation analysis showed the age of AFLD patients significantly and positively correlated with average RR. Pearson correlation analysis for the age of NAFLD patients was significantly and positively correlated with the average RR, HF, SDNN, RMSSD, and LF. CONCLUSION: Altered autonomic activity was noted in both alcoholic and nonalcoholic fatty liver disease patients. An early prognosis of fatty liver is very necessary to prevent the disease progress into later fatal life-threatening stages.

ROLE OF PHYSICAL ACTIVITY IN THE PREVENTION AND MANAGEMENT OF NON-ALCOHOLIC FATTY LIVER DISEASE

Non-alcoholic Hepatic Steatosis (NAFLD) is a major global cause of chronic liver disease. Its prevalence increases with the rise in metabolic syndrome components, primarily obesity and insulin resistance. The etiology of NAFLD is multifactorial, and recent studies suggest a "multiple hit" hypothesis that includes a combination of genetic, metabolic, and environmental factors. Lifestyle habits, including physical activity, play a significant role in its management. This study investigated the relationship between physical activity levels and the prevalence and severity of NAFLD in adults. A cross-sectional approach was used with a total of 250 participants. The participants were evenly divided into two groups: those diagnosed with NAFLD (n=125) and control subjects without NAFLD (n=125). Stratification was carefully executed to ensure equivalence in age, gender, and main co-morbidities to eliminate potential confounding variables. Among the 250 participants, with 125 individuals each in the NAFLD and control groups, no significant differences in age, BMI, or prevalence of co-morbidities such as diabetes and hypertension were observed. However, hepatic biochemical markers exhibited substantial differences between groups. ALT levels averaged 67.3 23.7 U/L for NAFLD participants compared to 24.2 ± 10.8 U/L in controls (p &lt; 0.001); AST levels were at 54.8 ± 19.6 U/L for NAFLD versus 23.4 ± 8.9 U/L for controls (p &lt; 0.001); GGT showed 89.2 ± 32.5 U/L in NAFLD individuals contrasting with 29.5 ± 13.4 U/L in controls (p &lt; 0.001). Furthermore, the FIB-4 index was higher in the NAFLD cohort (2.4 ± 0.6) than in controls (1.3 ± 0.4; p &lt; 0.001), and serum Albumin levels in NAFLD participants were 3.8 ± 0.5 g/dL, notably lower than the control's 4.5 ± 0.3 g/dL (p &lt; 0.001). The study concludes that physical activity is inversely associated with the prevalence and severity of NAFLD. Regular physical activity may be a key strategy in preventing and managing NAFLD.

Nesfatin-1 is a biomarker that plays a role in the inflammatory process of coronary artery diseases in Iraqi patients with non-alcoholic fatty liver disease.

Amis: NAFLD is considered to be the most common cause of liver conditions worldwide. Also, it is a primary reason that leads to coronary artery diseases, limiting blood flow to the heart. Therefore, This study aimed to evaluate the serum level of Nesfatin-1 and its ability to indicate the prognosis of CAD in patients with NAFLD. Material &amp; Methods: one-hundred eighty Individuals were enrolled in the study, including In both genders, blood was collected from each Individual and sent to the laboratory for biochemical tests. Findings: Data from the current study showed a significant increase in Nesfatin-1 in the CAD group and a significant decrease in Nesfatin-1 in the NAFLD group compared to the control group. In addition, there was also a significant increase in both cardiac parameters and AST in the CAD group compared to the NAFLD group and the control group. Conclusion: Patients with coronary artery disease have higher Nesfatin-1 Concentration due to Nesfatin-1 having anti-inflammatory properties that raise the level of Nesfatin-1. In addition, Data from the current study showed a significant positive correlation between Nesfatin-1 and (ALT and AST) in NAFLD patients. However, further studies are needed to confirm this conclusion. Keywords: Coronary Artery Disease, Non-alcoholic fatty liver disease, Nesfatin1, Troponin-I

Diagnostic performance of the fibrosis-4 index and the NAFLD fibrosis score for screening at-risk individuals in a health check-up setting.

The fibrosis-4 index (FIB-4) and the NAFLD fibrosis score (NFS) have been used as noninvasive screening methods for advanced fibrosis in patients with NAFLD. However, their diagnostic performance has not been evaluated in at-risk individuals regardless of hepatic steatosis. This study evaluated the performance of the FIB-4 and NFS in at-risk groups of health check-up examinees at mass screening centers. This retrospective, cross-sectional study included 8545 participants who underwent voluntary magnetic resonance elastography at a discounted fee during their regular health check-ups at 13 mass screening centers nationwide. The at-risk group was defined as those with any of the following conditions: NAFLD, 2 or more metabolic abnormalities, diabetes mellitus, or abnormal aminotransferase levels. A magnetic resonance elastography cutoff of ≥3.6kPa was used to define conventional advanced fibrosis. According to the proposed criteria, the proportion of at-risk individuals was 67.4%-80.2% in the health check-up cohort without viral or alcohol-associated liver disease. The prevalence of individuals with advanced hepatic fibrosis in each at-risk group was ~2.3%-2.8% according to various criteria. It was higher in patients without NAFLD than in those with NAFLD. A total of 28.2%-39.6% of those in each at-risk group did not show hepatic steatosis on ultrasonography. The performance of FIB-4 for advanced fibrosis in the at-risk group was comparable with that in the NAFLD group. FIB-4 showed a better area under the receiver operating characteristic curve and sensitivity than NFS in the at-risk group. FIB-4 demonstrated superior performance compared with the NFS, and its performance in at-risk individuals was similar to that observed for patients with NAFLD.

OBEZ ADOLESANLARDA YAĞLI KARACİĞER HASTALIĞININ PORTAL VEN AKIMINA ETKİSİ

Objective&#x0D; The increase in obesity in children has caused&#x0D; nonalcoholic fatty liver disease to become the most&#x0D; important chronic liver disease in the pediatric age&#x0D; group. In this study, we aimed to evaluate the portal&#x0D; diameter and blood flow velocity in obese children with&#x0D; fatty liver (NAFLD) and to compare them with normal&#x0D; healthy children.&#x0D; Material and Method&#x0D; 71 obese adolescent patients aged 10-18 years were&#x0D; divided into two groups (NAFLD group and non-&#x0D; NAFLD group) according to the presence of elevated&#x0D; transaminases and the presence of hepatosteatosis&#x0D; on ultrasound. 30 healthy adolescents were included&#x0D; in the study as the control group. Blood samples&#x0D; were taken from each patient for fasting glucose,&#x0D; insulin, transaminases, and thyroid functions. Insulin&#x0D; resistance was calculated using the HOMA index.&#x0D; Portal vein measurements were performed from the&#x0D; main portal vein before bifurcation.&#x0D; Results&#x0D; The portal vein diameter (8.5 ± 0.9 mm) of the NAFLD&#x0D; group was statistically significantly wide compared&#x0D; to both the control group (7.8 ± 2.0 mm) and the&#x0D; non-NAFLD obese group (7.6 ± 1.1 mm) (p= 0.004)&#x0D; and (p= 0.002). There was no significant difference&#x0D; between the non-NAFLD obese group and the control&#x0D; group (p=0.460, p=0.214). There was no significant&#x0D; difference between the groups in terms of portal vein&#x0D; Vmax, Vmin, RI, S/D. Although there was no difference&#x0D; in portal vein diameter in the obese groups classified&#x0D; according to insulin resistance, Vmax (33.9 ± 10.3 and&#x0D; 28.6 ± 10.6 cm/sec, p= 0.03) and Vmin (24.8 ± 6.2 and&#x0D; 20.5 ± 5.5 cm/sec) were significantly different in the&#x0D; insulin resistance group.&#x0D; Conclusion&#x0D; In this study, it was determined that portal vein diameter&#x0D; and flow velocities (Vmax and Vmin) increased in&#x0D; obese adolescents with NAFLD. Thus, we suggest&#x0D; that resistance develops in hepatic venous flow due&#x0D; to hepatic portal vein steatosis, especially in obese&#x0D; patients with insulin resistance in adolescence. This&#x0D; finding suggests that when fatty liver continues, portal&#x0D; diameter will increase in adulthood, leading to portal&#x0D; hypertension.

Exploration of Perturbed Liver Fibrosis-Related Factors and Collagen Type I in Animal Model of Non-Alcoholic Fatty Liver Disease.

To determine their involvement in the onset of the disease, we investigated the changing levels of liver fibrosis-related proteins, namely, type-I collagen, α-smooth muscle actin (α-SMA), and transforming growth factor β1 and β3 (TGF-β1, β3). The four groups of Sprague-Dawley (SD) rats were involved in the study, namely, (i) normal control group, (ii) high-fat diet group (HFD), (iii) carbon tetrachloride (CCl4) group, and (iv) NAFLD group (animal model) which were chosen at random. The NAFLD model received HFD combined with subcutaneous injection of small doses of CCl4. Histopathological examination confirmed extent of liver fibrosis, while other immunological and molecular methods were used to evaluate expression and distribution of α-SMA, type I collagen TGF-β1 and TGF-β3, at both m-RNA and protein levels. In contrast to the normal control group, the NAFLD group showed moderately elevated expressions of TGF-β1, α-SMA, and type I collagen, which was proportional on temporal scale of NAFLD persistence in the model (P < 0.05). In the early phage of NAFLD, enhancement in the mRNA transcripts and, henceforth, protein expression of TGF-β3 was observed. However, these were found to be downregulated in case of liver fibrosis (P < 0.05). This NAFLD rat model shows the histopathologic changes of human NAFLD and is suitable for the study of NAFLD pathogenesis. These findings suggest that type I collagen and the liver fibrosis-related factors TGF- β1, TGF- β3, and α-SMA may be significant contributors to NAFLD. Although NAFLD model is previously demonstrated by other researchers, our study is novel in terms of exploration of involvement of fibrosis-related factors and in particular aforementioned proteins at the early stage of NAFLD vis-à-vis dynamics of type-I collagen distribution.

Study of Serum Chemerin Level in Chronic Hepatitis C Virus Patients with and without Nonalcoholic Fatty Liver Disease

Abstract Background Chronic hepatitis C (CHC) has a number of features that suggest that it should be recognized not only as a viral disease but also as a metabolic liver disease that encompasses insulin resistance (IR), liver steatosis, impaired glucose tolerance or type 2 diabetes mellitus (T2DM) and disturbances in lipid metabolism. Objective To evaluate the role of serum Chemerin as a biomarker in patients with chronic hepatitis C virus with and without Non Alcoholic Fatty Liver Disease and its correlation to disease progress and activity and to evaluate its relationship with various laboratory parameters of the disease. Patients and Methods Type of study: A case control study. Study setting: outpatient clinics and inpatient wards at King Fahd hospital, Medina, Saudi Arabia &amp; outpatient clinics at Ain Shams university hospitals, Egypt. Study Period: 6 months. Study Population: The study was conducted on normal populations, chronic HCV patients with NAFLD, and chronic HCV patients without NAFLD. Results In the present study the mean chemerin level was found to be statistically higher in chronic hepatitis C virus patients with NAFLD group compared to chronic hepatitis C virus patients without NAFLD group and was found to be statistically higher in both previous groups than in control group (p value &amp;lt;0.05). There was significant positive correlation between serum chemerin with ALT (p value &amp;lt;0.01), AST (p value&amp;lt;0.01), BMI (P value&amp;lt;0.01), INR (p value&amp;lt;0.01), triglyceride (p value&amp;lt;0.01), FIB4 index (p value &amp;lt;0.01) and NAFLD fibrosis score (p value &amp;lt;0.01). There was significant negative correlation between serum chemerin with serum ALBUMIN (p value &amp;lt;0.01). Conclusion The results obtained in the current study demonstrate that the serum chemerin level increased in parallel with the worsening liver functional reserves in CHC patients and serum chemerin level incrased in patients with CHC associated with NAFLD. It could be concluded that chemerin may be considered as additional tools for assessment of prognosis of CHC and monitoring the virally derived metabolic abnormality.

Study Association of Serum Immunoglobulins and Non-Alcoholic Fatty Liver Disease in Egyptian Patients

Abstract Background Non-alcoholic fatty liver disease represents a spectrum of liver diseases which occurs in the absence of alcohol consumption, it has become a clinical burden around the world because of its independent relationship with increased risks of cardiovascular disease, hyperglycemia and tumor malignancy, as an example it's the most common chronic liver disease in North America, with reported prevalence rates of 10%–50% in the general population. However, only 10%–30% of NAFLD patients progress to advanced fibrosis, cirrhosis, and/or hepatocellular carcinoma. Aim of the Work The aim of this study was to further investigate the association between NAFLD and the serum immunoglobulins. Patients and Methods Atotal of one hundred Egyptian people were enrolled in the study and divided into two groups: Group 1: 50 patients with non-alcoholic fatty liver disease diagnosed by clinical, laboratory and radiological investigations. Group 2: 50 patients with non-alcoholic steatohepatitis diagnosed by clinical, radiological features of NAFLD and elevated liver enzymes. Results Results of the present study revealed that the mean age of NAFLD was 44.4±9.3 and in NASH 50.6±8.5. In our study it was proven that Nafld prevalence increases with age. Concerning gender in our study there was predominance of female gender in NASH group by about 70% but in NAFLD they represent only 48%. In our study, it was proven that BMI and waist circumference were signifcnatly higher in NASH group. DM were signifciantly more frequent in NASH group. In the present study, there was no significant difference between the studied groups regarding hemoglobin, TLC and platelets. Conclusion Our results revealed that IgA was significantly higher among NASH group, IgM and IgG were significantly higher among NAFLD group. Results of this study showed statistically significant relation between ALT, AST, GGT and INR and degree of steatosis, they were higher among NASH group and also the albumin was significantly lower among NASH group on the other hand bilirubin was non-significantly higher in NASH.

The role of bariatric surgery on beta-cell function and insulin resistance in patients with nonalcoholic fatty liver disease and steatohepatitis

BackgroundNonalcoholic fatty liver disease (NAFLD) and steatohepatitis (NASH) are strongly associated with obesity, metabolic syndrome, and insulin resistance (IR). ObjectiveThe aim of this study was to investigate the effects of metabolic surgery on pancreatic beta cell function and IR in patients with obesity and NAFLD. SettingUniversity Hospital, Germany. MethodsLiver biopsies were taken intraoperatively from 112 patients undergoing sleeve gastrectomy (n = 68) or Roux-en-Y gastric bypass (n = 44) and analyzed histologically for the presence of simple steatosis (NAFL) or NASH. Clinical and biochemical parameters were collected over up to 2 years. Beta cell function and IR were assessed using the homeostasis model assessment of beta-cell function (HOMA2-%B) and insulin resistance (HOMA2-IR) index. ResultsNASH was present in 53.6% (n = 60) of the patients and NAFL in 25.9% (n = 29). Liver enzymes, adiponectin/leptin ratio, triglycerides, and HbA1C were improved at 6 months, 1, and 2 years after surgery. HOMA2-IR was significantly lower in patients without NAFLD while HOMA2-IR did not differ between patients with NAFL and/or NASH. HOMA2-%B was highest in the NAFLD group and lowest in patients with NASH. While there was no change in HOMA2-%B and HOMA2-IR in the No-NAFLD group, HOMA2-%B decreased and IR improved in the NAFL and NASH groups. ConclusionInsufficient compensatory beta-cell function may contribute to the progression from NAFL alongside with IR to NASH. Our findings suggest that bariatric surgery decreases IR while at the same time reducing compensatory insulin oversecretion. These results are associated with beneficial changes in adipose tissue function after bariatric surgery.

Correlation of the pediatric metabolic index with NAFLD or MAFLD diagnosis, and serum adipokine levels in children

IntroductionNon-alcoholic fatty liver disease (NAFLD) is characterized by ectopic fat deposition in the liver. However, a recent classification of this condition, which also integrates the presence of coexisting metabolic disorders, termed Metabolic dysfunction Associated Fatty Liver Disease (MAFLD), has been proposed.NAFLD is increasingly common in early childhood, partly due to the increase in metabolic disease in this age. Thus, studying hepatic steatosis in the metabolic context has become important in this population as well. However, NAFLD, and thus MAFLD, diagnosis in children is challenging by the lack of non-invasive diagnostic tools comparable to the gold standard of hepatic biopsy. Recent studies have reported that the Pediatric Metabolic Index (PMI) could be a marker of insulin resistance and abnormal liver enzymes, but its association with NAFLD, MAFLD, or altered adipokines in these conditions has not been reported. The aim of this study is to evaluate the correlation between PMI with the diagnosis of NAFLD or MAFLD, together with serum levels of leptin and adiponectin, in school-age children. MethodsA cross sectional study was carried out in two hundred and twenty-three children without medical history of hypothyroidism, genetic, or chronic diseases. Anthropometry, liver ultrasound, and serum levels of lipids, leptin, and adiponectin were evaluated. The children were classified as having NAFLD or non-NAFLD, and a subgroup of MAFLD in the NAFLD group was analyzed. The PMI was calculated by the established formulas for age and gender. ResultsPMI correlated positively with the presence and severity of NAFLD (r = 0.62, p<0.001 and r = 0.79, p<0.001 respectively) and with the presence of MAFLD (r = 0.62; p<0.001). Also, this index correlated positively with serum leptin levels (r = 0.66; p<0.001) and negatively with serum adiponectin levels (r= -0.65; p<0.001). PMI showed to be a good predictor for diagnosing NAFLD in school-age children when performing a ROC curve analysis (AUROC=0.986, p< 0.0001). ConclusionPMI could be a useful tool for the early diagnosis of NAFLD or MAFLD in children. However, future studies are necessary to establish validated cut-off points for each population.