Nonalcoholic Patients Research Articles

Cardiac metabolic index as a predictor of new-onset diabetes in non-alcoholic fatty liver disease patients: a longitudinal cohort analysis

ObjectiveThe purpose of this investigation is to assess the clinical risk linked to the onset of diabetes in individuals with non-alcoholic fatty liver disease (NAFLD) through the utilization of the cardiac metabolic index (CMI), which is derived from triglycerides, high-density lipoprotein, height, and waist circumference. Research focusing on the application of CMI for evaluating diabetes risk among NAFLD patients remains scarce, and an exploration of the association between CMI and the emergence of diabetes within this demographic has not been conducted. This investigation aims to illuminate this connection, thereby providing novel insights into the prevention of diabetes progression in individuals with NAFLD.MethodsData were procured from a cross-sectional study involving 15,435 participants conducted by the Japanese government, resulting in a final cohort of 2,503 adults aged 18 and above who met the eligibility criteria for evaluation. The CMI is determined using the formula: TG (mmol/L) / HDL-C (mmol/L) * WHtR. CMI values were categorized into quartiles (Q1 to Q4) based on their scores, arranged from low to high. The investigation utilized logistic regression models, restricted cubic spline analysis, and subgroup analyses, with adjustments made for continuous models to elucidate the association between CMI and diabetes development among individuals with NAFLD, as well as the non-linear relationship between CMI and this outcome.ResultsThe investigation comprised 2,503 subjects with an average age of 44.79 ± 8.33 years, of whom 204 were diagnosed with new-onset diabetes (8.15%). Multivariate logistic regression analysis indicated that within the CMI quartile groupings, individuals with NAFLD in the uppermost quartile (Q4) exhibited the greatest likelihood of new-onset diabetes relative to those in the lowest quartile (Q1) (odds ratio, OR = 3.239, 95% confidence interval [CI]: 1.993–5.264, P < 0.001). Additionally, escalating CMI values corresponded to an increasing probability of new-onset diabetes in NAFLD subjects (OR = 1.705, 95% CI: 1.362–2.133, P < 0.001). Restricted cubic spline analysis demonstrated a non-linear connection between CMI and new-onset diabetes in NAFLD patients (P overall < 0.001, P non-linear = 0.035), with a risk inflection point identified at a CMI of 0.5554. Subgroup analysis revealed no significant interactions between gender, age, physical activity, alcohol consumption, or smoking status and the likelihood of new-onset diabetes in this patient population (P for interaction > 0.05).ConclusionFindings from this study indicate a notable positive non-linear connection between elevated CMI scores and the probability of new-onset diabetes in individuals afflicted with NAFLD.Clinical trial numberNot applicable.

An enhanced predictive modelling framework for highly accurate non-alcoholic fatty liver disease forecasting

Non-alcoholic fatty liver disease (NAFLD) is a chronic medical ailment characterized by accumulation of excessive fat in the liver of non-alcoholic patients. In absence of any early visible indications, application of machine learning based predictive techniques for early prediction of NAFLD are quite beneficial. The objective of this paper is to present a complete framework for guided development of varied predictive machine learning models and predict NAFLD disease with high accuracy. The framework employs step–by-step data quality enhancement to medical data such as cleaning, normalization, data upscaling using SMOTE (for handling class imbalances) and correlation analysis-based feature selection to predict NAFLD with high accuracy using only clinically recorded identifiers. Comprehensive comparative analysis of prediction results of seven machine learning predictive models is done using unprocessed as well as quality enhanced data. As per the observed results, XGBoost, random forest and neural network machine learning models reported significantly higher accuracies with improved ‘AUC’ and ‘ROC’ values using preprocessed data in contrast to unprocessed data. The prediction results are also assessed on various quality metrics such as ‘accuracy’, ‘f1-score’, ‘precision’, and ‘recall’ significantly support the need for presented methodologies for qualitative NAFLD prediction modelling.

Association of Biopsy-proven Nonalcoholic Fatty Liver Disease with Obesity and Apolipoproteins.

Insulin resistance is considered the most important key mechanism in the development of nonalcoholic fatty liver disease (NAFLD). Some studies have reported that hyperinsulinemia decreases the hepatic secretion of apolipoprotein (Apo) B. Chronic hyperinsulinemia in NAFLD may be responsible for the accumulation of triglycerides in hepatocytes. We aimed to investigate whether apolipoproteins are related to histological findings in patients with biopsy-proven NAFLD. We also aimed to evaluate the effects of obesity on apolipoproteins and the pathogenesis of NAFLD. In this cross-sectional study, 91 patients with biopsy-proven NAFLD were included. The control group consisted of 39 healthy subjects who had no history of liver disease or alcohol consumption and were matched for age, gender and smoking. Apoliprotein A1 and Apo B were measured via an immunoturbidimetric method with commercially available OSR6142 Apo A1 and OSR6143 Apo B immunoassay kits on an Olympus AU2700 analyzer. Age, gender, and smoking distribution were similar among nonalcoholic steatohepatitis patients, simple steatosis patients, and controls. The differences in the mean Apo A1 and Apo B levels and the Apo B/A1 ratio among non-alcoholic steatosis, simple steatosis, and control subjects did not reach statistical significance. In addition, patients with obese NAFLD had higher steatosis scores than patients with nonobese NAFLD (p<0.05). Apo A1 and B levels and the B/A1 ratio were not associated with histopathological findings in patients with NAFLD. Fibrosis and ApoB1/A were found to be independent risk factors for metabolic associated fatty liver disease. In addition, obesity increases the grade of hepatic steatosis but does not cause lobular inflammation, ballooning or fibrosis.

Therapeutic effects of curcumin supplementation on liver enzymes of nonalcoholic fatty liver disease patients: A systematic review and meta-analysis of randomized clinical trials.

Curcumin, as an antioxidant agent, has been proposed as a potential treatment for nonalcoholic fatty liver disease (NAFLD). The aim of the current systematic review and meta-analysis was to summarize earlier findings regarding the effect of curcumin supplementation on liver enzymes and ALP in NAFLD patients. All studies published up to November 18, 2022, were searched through the PubMed, SCOPUS, and Web of Science databases to collect all randomized clinical trials (RCTs) on NAFLD patients in which curcumin was used as a treatment. A random-effects model was used to measure pooled effect sizes. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were used to report pooled effect sizes. Subgroup analysis was utilized to investigate heterogeneity. A total of 14 studies were included in this systematic review and meta-analysis. Our pooled meta-analysis indicated a significant decrease in alanine aminotransferase (ALT) following curcumin therapy by pooling 12 effect sizes (WMD: -8.72; 95% CI: -15.16, -2.27, I 2 = 94.1%) and in aspartate aminotransferase (AST) based on 13 effect sizes (WMD: -6.35; 95% CI: -9.81, -2.88, I 2 = 94.4%). However, the pooled analysis of five trials indicated that there was no significant association between curcumin therapy and alkaline phosphatase (ALP) in NAFLD patients (WMD: -4.71; 95% CI: -13.01, 3.58, I 2 = 64.2%). Nevertheless, subgroup analyses showed significant effects of curcumin on ALP with a longer duration of supplementation. The findings of this systematic review and meta-analysis support the potential effect of curcumin on the management of NAFLD. Further randomized controlled trials should be conducted in light of our findings.

DASH Diet Versus Intermittent Fasting on Insulin Resistance in NAFLD Patients

objectives: To compare between intermittent fasting and DASH diet on glycemic profile in non-alcoholic fatty liver patients. Methods:60 (men and women) prediabetic nonalcoholic fatty liver patients participated in this study; assigned randomly to three groups: Group (A): intermittent fasting time-restricted feeding (TRF) subjects consumed 100 % of their energy needs in an 8 hours period of time each day, with their caloric intake divided into three meals consumed at 1 p.m., 4 p.m., and 8 p.m. schedule (8-hr daily eating period, the remaining 16 hours per 24-hour period made up the fasting period). Group (B): the dietary approach to stop hypertension (DASH) subjects consumed 100 % of their energy needs divided into three meals consumed at 8 a.m., 1 p.m., and 8 p.m. (12-hr eating period). Group (C): control group; all subjects didn’t follow any diet regimen or calorie deficit. all participants subjected to 30 minutes moderate aerobic exercise on treadmill. Subjects tested before and after 8 weeks of the study. Results: The nonalcoholic fatty liver patients in Group B received DASH diet program more improved fasting glucose reduction percentage (18.25%), followed by patients in Group A (14.79%) received intermittent fasting program, and then those in Group C (2.55%) control group &amp; Group B received DASH diet program more improved HOMA IR reduction percentage (62.88%), followed by patients in Group A (45.23%) received intermittent fasting program, and then those in Group C (6.77%) received control group. Conclusion; both Dash &amp; IF are effective therapeutic approach to control insulin resistance in NAFLD patients, prevention strategy for diabetes type 2.

Wernicke's Encephalopathy in Crohn's Disease: A Case Report Emphasizing Thiamine Deficiency Risk During Total Parenteral Nutrition

Vitamin B1 (thiamine) is vital for carbohydrate metabolism and neurological functions. Thiamine deficiency, often associated with alcoholism, can arise due to absorption issues, increased metabolic demand, or inadequate intake. While rare in industrialized nations, it poses a risk in conditions like Crohn's disease (CD), particularly during prolonged total parenteral nutrition (TPN) without vitamin supplementation. Wernicke's Encephalopathy (WE), a complication characterized by altered mental status, ocular signs, and ataxia, can lead to Wernicke-Korsakoff syndrome (WKS). A severely malnourished 50-year-old with CD developed WE after extended TPN without thiamine supplementation. Initial symptoms included weight loss, diarrhea, and anorexia. Despite CD treatment, TPN lacked thiamine supplementation. Neurological symptoms manifested after 15 days, with MRI confirming WE. Thiamine deficiency (40 nmol/L) was treated with 500 mg thiamine injections three times a day. Despite treatment, residual symptoms persisted, evolving into Korsakoff’s syndrome. WE diagnosis is challenging due to a variable symptom triad. WKS, primarily linked to alcohol use, is underdiagnosed in nonalcoholic patients. Patients with malabsorption or malnutrition, including CD, are at risk, especially during TPN without multivitamin injections. Thiamine deficiency leads to neurotoxicity, prompting immediate thiamine administration. MRI aids diagnosis, but treatment should not be delayed. Recommended thiamine doses vary, emphasizing individualized care. Awareness of WE in CD patients is crucial, emphasizing timely recognition, risk factor understanding, and optimized treatment strategies. Nonalcoholic WKS can be prevented through prophylactic parenteral thiamine treatment in at-risk patients. This case underscores the importance of vigilance, early intervention, and thiamine supplementation during TPN in CD, highlighting the need for tailored management approaches.

Refining the predictive utility of aspartate aminotransferase to platelet ratio index in nonalcoholic fatty liver disease patients with COVID-19.

Refining the predictive utility of aspartate aminotransferase to platelet ratio index in nonalcoholic fatty liver disease patients with COVID-19.

Evaluation of adropin level and insulin resistance in non-alcoholic fatty liver patients: a meta-analysis of studies.

The recently discovered protein adropin is a highly conserved polypeptide that plays critical functions in energy homeostasis, metabolic processes, fat metabolism, and insulin resistance. On the other hand, non-alcoholic fatty liver disease (NAFLD) is a medical condition that causes the buildup of fat in the liver cells in individuals who consume little or no alcohol. The frequency of NAFLD is rising globally, and it is frequently linked to obesity, insulin resistance, type 2 diabetes, and metabolic syndrome. Therefore, this study evaluates the association between adropin levels and insulin resistance in individuals with and without NAFLD. Data from Scopus, Science Direct, and PubMed were searched between January 1, 2012, and February 18, 2024, using precise terms and stated criteria. Comprehensive Meta-Analysis V. 2 (Biostat, Englewood, NJ, USA) was used for data analysis, and Random-effect models were used to estimate the pooled mean differences with 95% CIs of adropin level, insulin level, and homeostatic model assessment for insulin resistance (HOMA-IR) associated with the exposures of interest. Our results revealed that adropin blood levels are significantly reduced in NAFLD patients compared to control individuals. The mean difference in adropin blood levels was 2.391 ng/ml with a 95% CI of 1.127 to 3.656 with I2 99.6. on the other hand, insulin resistance was significantly higher in NAFLD compared to controls (MD: -1.668, 95% CI: -2.333 to -1.002, I2=86%). Our findings reveal that adropin levels are significantly greater in healthy controls than in NAFLD patients, suggesting that adropin may have a preventative effect on NAFLD. This meta-analysis highlights how closely adropin and insulin resistance interact in non-alcoholic fatty liver disease. Also, it may open the door to new diagnostic tools and therapeutic modalities.

Can Cardiovascular Risk Be Simply Estimated in Nonalcoholic Fatty Liver Disease Patients?

Backgrounds and Aims: In the pathogenesis of nonalcoholic fatty liver disease (NAFLD), inflammation plays a pivotal role. The presence of inflammatory cells is closely linked with epicardial adipose tissue (EAT). A recently identified prognostic indicator for cardiovascular disease (CVD) is the ratio of monocyte count to HDL-cholesterol (MHR). Our primary aim was to investigate the relationship between EAT and markers of inflammation in individuals with NAFLD, and to evaluate its predictability using straightforward diagnostic measures. Material-Method: This retrospective study included two hundred eighteen patients who underwent thoracic computed tomography angiography between 2014 and 2021. The patients were divided into the NAFLD group (HU48 IU) according to the liver attenuation ratio. 136 patients in the NAFLD group and 82 in the non-NAFLD group. Results: The body mass index (BMI), triglyceride levels, notably the EAT volume and MHR in the NAFLD group, exhibited higher values than non-NAFLD group. Among participants in the NAFLD group, a positive correlation was observed between EAT volume and factors such as age, MHR, c-reactive protein, BMI, urea, glucose, and alanine aminotransferase. Through linear regression analysis, it was determined that MHR stood as the sole independent predictor of EAT volume in patients with NAFLD. Conclusion: EAT volume, a risk marker for CVD, can be predicted in NAFLD patients by MHR without radiological methods. Thus, easier and earlier detection of NAFLD patients in the high-risk group for CVD will be possible.

Prevalence of Hypothyroidism in Non-Alcoholic Fatty Liver Disease (NAFLD) Patients

Non-alcoholic fatty liver disease is a leading cause of chronic liver disease and has a high prevalence globally. The principal causes range from obesity, hypertriglyceridemia, diabetes mellitus and other endocrinopathies to drugs and certain metabolic disorders. Hypothyroidism associated with non-alcoholic fatty liver disease has raised concerns over recent years but there is limited substantive data to support this evidence. Objective: To ascertain the existing prevalence of hypothyroidism in non-alcoholic fatty liver disease patients presenting to a tertiary care hospital. Methods: It was a descriptive cross-sectional study that was executed in the Medical Department of King Edward Medical University, Mayo Hospital, Lahore from 30th July 2022 to 29th July 2023. A total of 215 patients with diagnosed non-alcoholic fatty liver disease on ultrasound were enrolled after taking informed consent and their Thyroid profile i.e., measurement of serum thyroid stimulating hormone, free tri-iodothyronine and free thyroxine was done. Results: From a total of 215 patients, 7 (3.3 %) belonged to the age bracket of 20-40 years and 208 (96.7 %) in the age range of 41-60 years with a female preponderance of 118 (54.9%) and male 97 (45.1%). Mean age was reported to be 50.79 ± 3.95 years and BMI was 23.09 ± 3.93 kg/m2. The overall prevalence of hypothyroidism was reported in 42 (19.5%) patients. Conclusion: It was concluded that there is a high prevalence (19.5%) of hypothyroidism in patients with non-alcoholic fatty liver disease.

The emergence of additional causes of thiamine deficiency in the modern world: The impact of gastric surgery

We present a case of shoshin beriberi with non-specific hyperamylasemia but on a different background of thiamine deficiency. Due to the fulminant of the clinical presentation and the lack of rapid diagnostic tests, shoshin beriberi remains under-diagnosed, particularly among non-alcoholic patients. The present report of presumed shoshin beriberi aims to highlight the emergence of additional causes of thiamine deficiency in the modern world, especially those resulting from esophagogastric surgery, which carries a substantial risk of malnutrition in the medium to long term. The timely administration of thiamine is generally safe and can result in rapid improvement, making it both a valuable therapeutic and diagnostic tool.

Effect of therapeutic lifestyle changes on patients with overweight/obesity and non-alcoholic fatty liver disease: A randomized controlled trial

BackgroundNon-alcoholic fatty liver disease is a liver condition that is increasing globally. Unfortunately, there are no successful or approved pharmacological treatments for non-alcoholic fatty liver disease. Hence, this study aimed to investigate the effect of therapeutic lifestyle changes on patients with overweight/obesity and non-alcoholic fatty liver disease. MethodsA prospective, parallel-group, randomized controlled trial was conducted. The patients were randomized into intervention and control groups using tables with random numbers. In the control group, routine health guidance was provided for 3 months, while in the intervention group, diversified lifestyle intervention was provided. The body composition, visceral fat area, abdominal circumference, and body mass index of the control and intervention groups were compared before and after the intervention. Descriptive statistics, paired t-tests, and linear regression models were used for data analysis. ResultsA total of 115 participants (57 in the intervention group and 58 in the control group) completed the study. The intervention groups had significantly greater high-density lipoprotein cholesterol levels, basal metabolic rate, muscle mass, and questionnaire scores than the control groups (P < 0.05). Furthermore, the intervention participants had lower body mass index, abdominal circumference, triglyceride levels, low-density lipoprotein cholesterol levels, and fatty liver index (P < 0.05). ConclusionsTherapeutic lifestyle changes therapy for non-alcoholic fatty liver disease patients with overweight/obesity can significantly control body mass index, improve blood lipid levels, reduce fatty liver and body fat rates, improve basic metabolism, alleviate disease, and improve quality of life. More research is needed to determine the long-term impact of therapeutic lifestyle changes in high-risk groups.

Galectin 3 and Transient Elastography as Noninvasive Methods to Assess Liver Fibrosis in Nonalcoholic Fatty Liver Disease Patients

Abstract Background Nonalcoholic fatty liver disease (NAFLD) is a condition defined by excessive fat accumulation in the liver. It is one of the most common and emerging problems worldwide which is estimated to be approximately 20% -30% in the general population. The pathogenesis is multifactor, including dietary factors, insulin resistance, adipokines, innate and adaptive immunity. Aim of the Work To evaluate serum level of Galectin 3 and Transient Elastography as Noninvasive Methods to assess Liver Fibrosis in patient with Nonalcoholic Fatty Liver Disease. Patients and Methods This was an observational prospective cross sectional study that was conducted on 150 patients with NAFLD, who had risk factors including hyperlipidemia, diabetes mellitus with NAFLD, who were attending or admitted to Hepatology unit, Ain Shams University Hospital and Bani Suef General Hospital. In this study, diagnosis was based on abdominal ultrasonic findings including increased echogenicity, loss of definition of the diaphragm, and blurring of vascular margins. This work was carried out in accordance with the World Medical Association Declaration of Helsinki. An informed written consent was obtained from the patients before enrollment in the study. The consent was taken in a separate room to ensure confidentiality. The study sought approval from the Ethics Review Committee of the Faculty of Medicine, Ain Shams University by written consent. Results In our study we found that there no statistically significant difference between studied groups regarding BMI. In our study we found that regarding comorbidities, there was no statistically significant difference between the studied groups according to hypertension while there was statistically significant difference according to DM with higher prevalence among NAFL group. In our study we found that regarding lipid profile between the studied groups, there was high statistically significant difference between the studied groups regarding cholesterol and TAG. Conclusion We revealed that there was highly statistically significant difference between the studied groups regarding cholesterol, TAG AST, ALT, serum creatine hemoglobin and platelet. Also, we found that non-invasive elastography is beneficial in the diagnosis and assessment of NAFLD when compared to the gold standard, transient hepatic elastography presented the best performance for the diagnosis and exclusion of advanced fibrosis in patients with NAFLD.

Comparative Analysis of Serum Magnesium Levels in Alcoholic and Non-Alcoholic Patients with Type 2 Diabetes Mellitus

Comparative Analysis of Serum Magnesium Levels in Alcoholic and Non-Alcoholic Patients with Type 2 Diabetes Mellitus

Associations between dietary fatty acid and plasma fatty acid composition in non-alcoholic fatty liver disease: secondary analysis from a randomised trial with a hypoenergetic low-carbohydrate high-fat and intermittent fasting diet.

Dietary fatty acids (FA) affect metabolic risk factors. The aim of this study was to explore if changes in dietary fat intake during energy restriction were associated with plasma FA composition. The study also investigated if these changes were associated with changes in liver fat, liver stiffness and plasma lipids among persons with non-alcoholic fatty liver disease. Dietary and plasma FA were investigated in patients with non-alcoholic fatty liver disease (n 48) previously enrolled in a 12-week-long open-label randomised controlled trial comparing two energy-restricted diets: a low-carbohydrate high-fat diet and intermittent fasting diet (5:2), to a control group. Self-reported 3 d food diaries were used for FA intake, and plasma FA composition was analysed using GC. Liver fat content and stiffness were measured by MRI and transient elastography. Changes in intake of total FA (r 0·41; P = 0·005), SFA (r 0·38; P = 0·011) and MUFA (r 0·42; P = 0·004) were associated with changes in liver stiffness. Changes in plasma SFA (r 0·32; P = 0·032) and C16 : 1n-7 (r 0·33; P = 0·028) were positively associated with changes in liver fat, while total n-6 PUFA (r -0·33; P = 0·028) and C20 : 4n-6 (r -0·42; P = 0·005) were inversely associated. Changes in dietary SFA, MUFA, cholesterol and C20:4 were positively associated with plasma total cholesterol and LDL-cholesterol. Modifying the composition of dietary fats during dietary interventions causes changes in the plasma FA profile in patients with non-alcoholic fatty liver disease. These changes are associated with changes in liver fat, stiffness, plasma cholesterol and TAG. Replacing SFA with PUFA may improve metabolic parameters in non-alcoholic fatty liver disease patients during weight loss treatment.

Characteristics of intestinal flora in nonobese nonalcoholic fatty liver disease patients and the impact of ursodeoxycholic acid treatment on these features.

The study aimed to investigate the alterations in gut microbiota among nonobese individuals with nonalcoholic fatty liver disease (NAFLD) and their response to treatment with ursodeoxycholic acid (UDCA). A total of 90 patients diagnosed with NAFLD and 36 healthy subjects were recruited to participate in this study. Among them, a subgroup of 14 nonobese nonalcoholic steatohepatitis (NASH) were treated with UDCA. Demographic and serologic data were collected for all participants, while stool samples were obtained for fecal microbiome analysis using 16S sequencing. In nonobese NAFLD patients, the alpha diversity of intestinal flora decreased (Shannon index, p < 0.05), and the composition of intestinal flora changed (beta diversity, p < 0.05). The abundance of 20 genera, including Fusobacterium, Lachnoclostridium, Klebsiella, etc., exhibited significant changes (p < 0.05). Among them, nine species including Fusobacterium, Lachnoclostridium, Klebsiella, etc. were found to be associated with abnormal liver enzymes and glucolipid metabolic disorders. Among the 14 NASH patients treated with UDCA, improvements were observed in terms of liver enzymes, CAP values, and E values (p < 0.05), however, no improve the glucolipid metabolism. While the alpha diversity of intestinal flora did not show significant changes after UDCA treatment, there was a notable alteration in the composition of intestinal flora (beta diversity, p < 0.05). Furthermore, UCDA treatment led to an improvement in the relative abundance of Alistipes, Holdemanella, Gilisia, etc. among nonobese NASH patients (p < 0.05). Nonobese NAFLD patients exhibit dysbiosis of the intestinal microbiota. UDCA can ameliorate hepatic enzyme abnormalities and reduce liver fat content in nonobese NASH patients, potentially through its ability to restore intestinal microbiota balance.

A Cross-Sectional Study on Non-Alcoholic Fatty Liver Disease Patients with Type 2 Diabetes Mellitus and the Association of Risk Factors with Liver Steatosis and Fibrosis Stages

A Cross-Sectional Study on Non-Alcoholic Fatty Liver Disease Patients with Type 2 Diabetes Mellitus and the Association of Risk Factors with Liver Steatosis and Fibrosis Stages

Non-alcoholic Fatty Liver Disease in Overweight and Obese Children; Can Ultrasonography Substitute Laboratory Studies? A Case-Control Study

Background: Non-alcoholic fatty liver disease (NAFLD) comprises a large burden on the global healthcare system with a high prevalence and lethal outcomes. Moreover, this disease is showing an incremental trend over time, partly due to the rise in obesity rates among children. Objectives: In this study, we aimed to elucidate the correlation of ultrasonographic and laboratory-assisted diagnosis of NAFLD in obese and normal-weight children. Methods: This study assessed 50 pediatric obese or overweight children with BMIs higher than the 85th percentile for their age and sex, as well as 50 age-and sex-matched control counterparts using ultrasonography and a liver enzyme panel. The prevalence of NAFLD and the differences in lab studies were evaluated. Then, receiver operating characteristics (ROC) curves were used to determine the optimal cut-off value for NAFLD based on liver enzymes. Results: A total of 100 participants were included in this study, 58% of whom were male. The mean age of the participants was 10.41 ± 2.224 years. The prevalence of sonographically diagnosed NAFLD in obese and overweight children was 34.0% (95% CI: 21.2% - 48.8%). The prevalence of NAFLD when assessed by lab values in this population was 58.0% (95% CI: 43.2% - 71.8%), with a low measure of agreement (K = 0.239, P = 0.058). High BMI increased the risk of NAFLD to about 8.5 times its baseline in the normal-BMI population. Non-alcoholic fatty liver disease patients had significantly higher values for aspartate aminotransferase (AST) (P &lt; 0.001), alanine aminotransferase (ALT) (P &lt; 0.001), and gamma-glutamyl transferase (GGT) (P &lt; 0.001), but not alkaline phosphatase (ALP) (P = 0.743). The ROC curves for AST, ALT, GGT, and BMI percentile had areas of 0.800, 0.899, 0.807, and 0.874, respectively, all of which could be used for screening NAFLD. A cut-off value of 43.5 IU/L for AST had a specificity and positive predictive value of 100% for the diagnosis of NAFLD in children. Conclusions: Obese and overweight children are 8.5 times more likely to develop NAFLD compared to their normal-BMI peers. For the evaluation of this disease, liver enzyme panels integrated with ultrasonographic assessment should be utilized.

Trouble Shooting ERCP: Brainstorming of Gastroenterologists

Endoscopic Retrograde Cholangiopancreatography is the passion of every budding and experienced gastroenterologist to learn. It does need full-fledged commitment, patience and dedication to learn. It's a bumpy road which even the most trained drivers find very difficult to negotiate. Sometimes the patient ends up getting free in 10 mins, while on the other hand on bad day he gets admitted in the ward for raised inflammatory markers and total leucocyte count due to secondary infection as a result of the procedure due to wrong technique or due to daunting procedure. One of the most essential prerequisites for ERCP is careful selection of cases after a detailed workup. Reviewing the deranged liver function test primarily the raised alkaline phosphatase. At times transaminitis can be mistakenly treated as non-alcoholic fatty liver disease and patients being sent home without any workup. The role of the radiologist is of paramount significance. The dilatation of CBD reported on Ultrasound isn't good enough to proceed directly to ERCP. Rather where facilities are available an MRCP should be performed prior to it being non-invasive and having no risks of injuring the pancreatic duct and causing troublesome pancreatitis. Even if the Ultrasound report is normal still an MRCP needs to be advised as that is more accurate.

Genotypic variation in CYP2E1, GCKR, and PNPLA3 among nonalcoholic steatohepatitis patients of Turkish origin.

This study examines genetic variations in CYP2E1 (rs6413432, rs3813867), GCKR (rs780094, rs1260326), and PNPLA3 (rs738409) among Turkish patients to assess their influence on nonalcoholic steatohepatitis. Allele and genotype frequencies were compared between 245 NASH patients and 120 healthy controls using SNP genotyping via polymerase chain reaction-restriction fragment length polymorphism. Additionally, the deviation of the observed genotype frequencies from Hardy-Weinberg proportion was examined. No significant differences were found in the allelic and genotypic distributions of rs6413432, rs3813867, and rs780094 between NASH patients and healthy controls. However, significant disparities were noted for rs1260326 and rs738409. Gender and age-specific distributions showed no notable differences. The only observed deviation from Hardy-Weinberg proportion was in the genotype frequency of rs738409. Variants in GCKR (rs1260326) and PNPLA3 (rs738409) are significantly associated with increased NASH risk in the Turkish population, with the rs738409 variant potentially playing a more prominent role in NASH development.