Nonalcoholic Fatty Liver Disease In China Research Articles

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.

Efficacy and safety of Qushi Huayu, a traditional Chinese medicine, in patients with nonalcoholic fatty liver disease in a randomized controlled trial

BackgroundThe effective treatment of non-alcoholic fatty liver disease (NAFLD) is an unmet medical need. Qushi Huayu (QSHY) is an empirical herbal formula with promising effects in NAFLD rodent models and a connection to gut microbiota regulation. Hypothesis/PurposeThis study aimed to evaluate the effects of QSHY in patients with NAFLD through a multicenter, randomized, double-blind, double-dummy clinical trial. Study designA total of 246 eligible patients with NAFLD and liver dysfunction were evenly divided to receive either QSHY and Dangfei Liganning capsule (DFLG) simulant or QSHY simulant and DFLG (an approved proprietary Chinese medicine for NAFLD in China) for 24 weeks. The primary outcomes were changes in liver fat content, assessed using vibration-controlled transient elastography, and serum alanine aminotransferase (ALT) levels from baseline to Week 24. ResultsBoth QSHY and DFLG led to reductions in liver fat content and liver enzyme levels post-intervention (p < 0.05). Compared to DFLG, QSHY treatment improved ALT (β, −0.128 [95 % CI, −0.25, −0.005], p = 0.041), aspartate transaminase (β, −0.134 [95 % CI, −0.256 to −0.012], p = 0.032), and fibrosis-4 score (β, −0.129 [95 % CI, −0.254 to −0.003], p = 0.044) levels. QSHY markedly improved gut dysbiosis compared to DFLG, with changes in Escherichia-Shigella and Bacteroides abundance linked to its therapeutic effect on reducing ALT. Patients with a high ALT response after QSHY treatment showed superior reductions in peripheral levels of phenylalanine and tyrosine, along with an elevation in the related microbial metabolite p-Hydroxyphenylacetic acid. ConclusionOur results demonstrate favorable clinical potential for QSHY in the treatment of NAFLD.

A bibliometric analysis and visualization of nonalcoholic fatty liver disease from 2012 to 2021.

As a common chronic liver disease, nonalcoholic fatty liver disease (NAFLD) has attracted increasing attention in the past decade. Nevertheless, there are few bibliometric analyses that systematically study this field as a whole. This paper explores the latest research progress and future research trends of NAFLD through the method of bibliometric analysis. The articles related to NAFLD, published from 2012 to 2021 in the Web of Science Core Collections, were searched on February 21, 2022, using relevant keywords. Two different scientometrics software tools were used to conduct the knowledge maps of NAFLD research field. A total of 7975 articles on NAFLD research were included. From 2012 to 2021, the publications related to NAFLD increased by year. China ranked on the top of the list with 2043 publications, and the University of California System emerged as the premier institution in this field. PLOs One, Journal of Hepatology and Scientific Reports became the prolific journals in this research field. Co-cited reference analysis revealed the landmark literature in this research field. In terms of potential hotspots, the burst keywords analysis revealed that liver fibrosis stage, sarcopenia, and autophagy will become the focus of future NAFLD research. The annual output of the global publications in the field of NAFLD research showed a strong upward trend. Research in the field of NAFLD in China and America is more mature than in other countries. Classic literature lays the foundation for research, and multi-field studies provide the new development directions. And besides, fibrosis stage, sarcopenia and autophagy research are the hot spots and frontiers of this field.

A prediction model of liver fat fraction and presence of non-alcoholic fatty liver disease (NAFLD) among patients with overweight or obesity.

The global prevalence of non-alcoholic fatty liver disease (NAFLD) has attained a level of 25.24%. The prevalence of NAFLD in China has exhibited an upward trajectory in parallel with the increasing incidence of obesity over the preceding decade. In order to comprehensively assess hepatic lipid deposition in individuals with overweight or obesity, we have devised a pioneering prognostic formula that capitalizes on clinical parameters. To this end, we have conducted a cross-sectional cohort study involving 149 overweight or obese subjects. Magnetic resonance imaging proton density fat fraction (MRI-PDFF) has been employed to evaluate the extent of liver fat accumulation. Through univariate analysis, we have identified potential factors, and the definitive elements in the prediction model were selected utilizing the forward stepwise regression algorithm. The Shang Hai Steatosis Index (SHSI) incorporates alanine aminotransferase (ALT), aspartate aminotransferase (AST), fasting insulin, and 1-h postload glycaemic levels, thereby furnishing the capability to predict NAFLD with an area under the receiver operator characteristic (AUROC) of 0.87. By establishing a threshold value of 10.96, determined through Youden's index, we have achieved a sensitivity of 69.57% and a specificity of 88.24%. The Spearman correlation coefficient between liver fat fraction ascertained by MRI-PDFF and that predicted by the SHSI equation amounts to 0.74. Consequently, the SHSI equation affords a dependable means of predicting the presence of NAFLD and liver fat accumulation within the overweight and obese population.

Application of herbs and active ingredients ameliorate non-alcoholic fatty liver disease under the guidance of traditional Chinese medicine.

Non-alcoholic fatty liver disease (NAFLD) is a global health problem, and its prevalence has been on the rise in recent years. Traditional Chinese Medicine (TCM) contains a wealth of therapeutic resources and has been in use for thousands of years regarding the prevention of liver disease and has been shown to be effective in the treatment of NAFLD in China. but the molecular mechanisms behind it have not been elucidated. In this article, we have updated and summarized the research and evidence concerning herbs and their active ingredients for the treatment in vivo and vitro models of NAFLD or NASH, by searching PubMed, Web of Science and SciFinder databases. In particular, we have found that most of the herbs and active ingredients reported so far have the effect of clearing heat and dispelling dampness, which is consistent with the concept of dampness-heat syndrome, in TCM theory. we have attempted to establish the TCM theory and modern pharmacological mechanisms links between herbs and monomers according to their TCM efficacy, experiment models, targets of modulation and amelioration of NAFLD pathology. Thus, we provide ideas and perspectives for further exploration of the pathogenesis of NAFLD and herbal therapy, helping to further the scientific connotation of TCM theories and promote the modernization of TCM.

Cardiovascular and renal burdens among patients with MAFLD and NAFLD in China.

Background/PurposeMetabolic associated fatty liver disease (MAFLD) was proposed as a new definition to put emphasis on the metabolic aspects of nonalcoholic fatty liver disease (NAFLD). We aim to compare the cardiovascular and renal burden between MAFLD and NAFLD patients.Methods12183 participants were enrolled in East China. The cardiovascular burden (Framingham risk score and previous cardiovascular diseases (CVD)) and renal burden (eGFR and chronic kidney disease (CKD)) were measured.ResultsThe risk of hypertension, dyslipidemia, diabetes, overweight/obesity, and central obesity of MAFLD patients were higher than those of NAFLD. Patients with MAFLD have a similar or higher beta coefficients in Framingham risk score [beta (95%CI): male 0.062 (0.055,0.069) vs 0.041 (0.033,0.048); female 0.014 (0.012,0.016) vs 0.012 (0.01,0.014)], and higher odds ratio in previous CVD [odds ratio (95%CI): male 1.50 (1.22,1.85) vs 1.35 (1.1,1.66); female 1.58 (1.33,1.87) vs 1.45 (1.22,1.72)], compared with those with NAFLD. However, compared with males with MAFLD, the odds ratio of CKD was higher in those with NAFLD [eGFR: -2.731 (-3.422, -2.041) vs-3.578 (-4.268, -2.887). CKD: 1.44 (1.05,1.96) vs 1.56 (1.14,2.12)]. In female, CKD was only marginally associated with NAFLD [0.8 (0.62,1.02), P=0.075], but not MAFLD [0.87 (0.68,1.11), P=0.268].ConclusionsPatients with MAFLD have a similar or higher risk of future and previous CVD compared with those with NAFLD, but the risk of CKD was higher in male with NAFLD.

Risk factors and prediction model for nonalcoholic fatty liver disease in northwest China

In recent years, nonalcoholic fatty liver disease (NAFLD) has become the most important chronic liver disease worldwide. The prevalence of NAFLD in China has also increased year by year. This study aimed to detect NAFLD early by developing a nomogram model in Chinese individuals. A total of 8861 subjects who underwent physical examination in Karamay and were 18 to 62 years old were enrolled. Clinical information, laboratory results and ultrasound findings were retrieved. The participants were randomly assigned to the development set (n = 6203) and the validation set (n = 2658). Significant variables independently associated with NAFLD were identified by least absolute shrinkage and selection operator (LASSO) regression and the multiple logistic regression model. Six variables were selected to construct the nomogram: age, sex, waist circumference (WC), body mass index (BMI), alanine aminotransferase (ALT), triglycerides and glucose index (TyG). The area under the receiver operating characteristic curve (AUROC) of the development set and validation set was 0.886 and 0.894, respectively. The calibration curves showed excellent accuracy of the nomogram model. This physical examination and laboratory test-based nomogram can predict the risk of NAFLD intuitively and individually.

The prevalence of nonalcoholic fatty liver disease in Chinese adults screened by vibration controlled transient elastography and its diagnostic discrepancy compared with ultrasound

BackgroundThe prevalence of non-alcoholic fatty liver disease (NAFLD) in China as assessed using vibration-controlled transient elastography (VCTE) and its consistency with ultrasound is still unknown. We aimed to conduct a head-to-head comparison of consecutive measurements of NAFLD with ultrasound or VCTE to evaluate the discrepancy in the prevalence and distribution of NAFLD screened by two non-invasive techniques. MethodsWe collected VCTE and ultrasound examination data from 4,388 participants who underwent health check-ups at the Health Promotion Center of Jiangsu Province Hospital between January 2017 and December 2019. The major outcome was the presence of hepatic steatosis, which was defined as a median controlled attenuation parameter (CAP) ≥ 248 dB/m by VCTE or the definition of steatosis by ultrasound. ResultsAmong the 4,388 participants, 2,214 were diagnosed with NAFLD by VCTE (CAP ≥ 248 dB/m, 50.46%). Participants with severe steatosis (CAP ≥ 280 dB/m) were commonly male (77.94% vs. 50.38%, P < 0.001), were obese (45.09% vs. 1.79%, P < 0.001), had a worse metabolic profile, had elevated liver enzyme levels, and had advanced fibrosis. The prevalence of ultrasound-diagnosed NAFLD was 56.42%. After consistency analysis, VCTE and ultrasound showed moderate agreement regarding the diagnosis of NAFLD (κ = 0.475). We then compared the characteristics and clinical features of the four groups classified by the diagnosis results of the two techniques. NAFLD participants diagnosed by VCTE only were older, more obese, and had worse metabolic and biochemical profiles than NAFLD participants diagnosed by ultrasound only; in particular, the former had a higher proportion of abnormal alanine aminotransferase and aspartate aminotransferase levels and a higher proportion of advanced fibrosis than the latter. ConclusionsMore than half of Chinese adults were affected by NAFLD according to VCTE. Screening based on VCTE is more likely to identify NAFLD patients with severe clinical features than ultrasound. Therefore, VCTE is a more practical non-invasive tool for the screening and follow-up of NAFLD in China.

Helicobacter pylori infection is not an independent risk factor of non-alcoholic fatty liver disease in China

BackgroundThe role of Helicobacter pylori (H. pylori) infection in the development of non-alcoholic fatty liver disease (NAFLD) remains controversial. The exact relationship requires further investigation. This study aimed to determine the association between them in China.MethodsA retrospective study was conducted on 71,633 participants who underwent physical examinations. 13C urea breath test (13C-UBT) was conducted to detect H. pylori infection, and ultrasonography was used to detect NAFLD.ResultsBody mass index (BMI), blood pressure (BP), and triglyceride (TG) levels were higher in participants with H. pylori infection than in those without H. pylori infection. While the levels of high-density lipoprotein cholesterol (HDL-C) for participants with H. pylori infection was lower than without H. pylori infection (P < 0.001). After adjusting for confounding factors (age, sex, BMI, BP, Scr, BUN, LDL-C, HDL-C, triglycerides, FBG and HbA1c), multivariate logistic regression analysis indicated that there was no independent relationship between them (P = 0.574). Subgroup analysis (stratified by sex, age, BMI, hypertension, diabetes and dyslipidemia) showed that H. pylori infection was not included as an independent risk factor for NAFLD. Moreover, the different grades of NAFLD were not related to H. pylori infection.ConclusionsThese results indicate that H. pylori infection is not an independent risk factor for NAFLD in China.

Association Between Neutrophil-to-Lymphocyte Ratio with Inflammatory Activity and Fibrosis in Non-alcoholic Fatty Liver Disease.

Inflammation plays an important role in the development and progression of non-alcoholic steatohepatitis (NASH), and NASH is a powerful driving force for the progression of fibrosis. The neutrophil-to-lymphocyte ratio (NLR) is a simple emerging indicator of inflammation. We aimed to assess the potential association between NLR and histological severity of non-alcoholic fatty liver disease (NAFLD). This retrospective study consisted of 231 patients with biopsy-proven NAFLD in China from August 2017 to September 2019. The steatosis, activity, and fibrosis scoring system were used to evaluate liver biopsy tissue. Of the 231 patients with NAFLD, advanced inflammatory activity was present in 43.3% and significant fibrosis in 25.5% of patients. Multivariate logistic regression analysis showed NLR to be correlated with advanced inflammatory activity (Odds ratio (OR): 0.62, 95% CI: 0.42-0.94, P = .025) and significant fibrosis (OR: 0.57, 95% CI: 0.35-0.94, P = .028). The NLR was inversely associated with the degree of steatosis, lobular inflammation and fibrosis (r = -0.16, P = .014; r = -0.15, P = .019; r = -0.13, P = .046, respectively), but had no association with the severity of ballooning. The multivariate-adjusted models had good predictability for advanced inflammatory activity (area under curves (AUC) 0.790, 95% CI: 0.730-0.850) and for significant fibrosis (AUC 0.798, 95% CI: 0.728-0.868). This study showed negative correlations between elevated NLR levels with advanced inflammatory activity and significant fibrosis in patients with NAFLD. Our results also suggested that NLR could be considered as a simple and noninvasive mark to identify high-risk populations in NAFLD.

Silymarin for Treating Toxic Liver Disease: International Consensus Recommendations

Silymarin for Treating Toxic Liver Disease: International Consensus Recommendations

Current status and perspectives of the clinical and basic research on concomitant chronic hepatitis B virus infection and nonalcoholic fatty liver disease

Chronic hepatitis B virus infection (CBI) and nonalcoholic fatty liver disease (NAFLD) are the two main etiologies of chronic liver diseases worldwide, and therefore, concomitant CBI and NAFLD (Co-CBI&NAFLD) is relatively common. There are still controversies over the influence of the interaction between CBI and NAFLD, especially NAFLD, on the progression, antiviral response, and outcome of chronic hepatitis B (CHB). Current clinical and basic research on Co-CBI&NAFLD have shown that NAFLD could inhibit HBV DNA replication to a certain degree, manifesting as a relatively low HBV DNA load, and it might increase HBsAg clearance rate in patients with CHB. Prospective or retrospective cohort studies have shown that patients with Co-CBI&NAFLD tend to have more rapid progression of liver fibrosis than those with CHB alone, as well as increased incidence rates of liver cirrhosis and hepatocellular carcinoma. Histologically, Co-CBI&NAFLD has the pathological changes of both CHB and NAFLD, and therefore, it is difficult to identify their own characteristic lesions. At present, the natural history and pathogenesis of Co-CBI&NAFLD remain unclear, and its pathological characteristics have not been fully identified. There is still a lack of high-level evidence-based supporting information on the influence of NAFLD on the course of CHB, especially its impact on antiviral response and disease outcome, and there are also no guidelines for the diagnosis/treatment or management of Co-CBI&NAFLD in China and globally. Solutions to the above issues will definitely deepen the understanding of Co-CBI&NAFLD, standardize and improve clinical diagnosis/treatment or management, and thus reduce the incidence and mortality rates of related end-stage liver diseases.

Mechanism of Huo-Xue-Qu-Yu Formula in Treating Nonalcoholic Hepatic Steatosis by Regulating Lipid Metabolism and Oxidative Stress in Rats.

Huo-Xue-Qu-Yu formula (HXQYF) is a prescription consisting of Ginkgo biloba leaf and Paeonia lactiflora Pall. for treating hyperlipidemia and NAFLD in China. Here, we investigated the hepatic and renal function, oxidative stress and lipid metabolism, and potential mechanisms of HXQYF on nonalcoholic fatty liver disease (NAFLD) rat models. NAFLD rat models were induced with high-fat diet (HFD) and 10% fructose water for 18 weeks and orally administered with or without HXQYF simultaneously. The results showed that HXQYF (22.5, 45, 90 mg/kg) significantly improved blood lipid levels via reducing serum TC, TG, LDL-C, and APOB values and elevating HDL-C and APOA1 levels in NAFLD rats. The higher levels of ALT, AST, CR, and BUN in serum induced by HFD were reduced by HXQYF. HE staining showed that HXQYF (90 mg/kg) reduced the accumulation of fat droplets and alleviated inflammatory response in liver cells. Three doses of HXQYF exhibited notable antioxidant effects by elevating SOD, GSH, and CAT activities and decreasing MDA and OH-1 levels in the liver. Furthermore, abnormal lipid metabolism caused by HFD was alleviated by HXQYF, which was associated with the upregulation of PPAR-α, AdipoR2, and CPT1 mRNAs as well as the downregulation of CYP2E1 and SREBP-1c mRNAs in liver tissue. In conclusion, our work verified that HXQYF could reduce the degree of hepatic steatosis, suppress oxidative stress, and attenuate lipid metabolism, thus preventing NAFLD.

Xiaochaihu decoction for nonalcoholic fatty liver disease: A protocol for a systematic review and meta-analysis.

Background:Nonalcoholic fatty liver disease (NAFLD) is a clinicopathologic syndrome characterized by excessive deposition of fat in hepatocytes except for alcohol and other specific hepatic factors. Xiaochaihu decoction (XD) has been widely used to treat NAFLD in China. However, there is no systematic review found. In order to evaluate the efficacy and safety of XD in the treatment of NAFLS, we need to conduct a meta-analysis and systematic evaluation.Methods:There are enrolled randomized controlled trials (RCTs) evaluating the effectiveness and safety of XD in the treatment of NAFLD. Data come mainly from 4 Chinese databases (CNKI, CBM, Wanfang, and VIP Database) and 4 English databases (Pubmed, Embase, Cochrane Library, and Web of science). The enrollment of RCTs is from the starting date of database establishment till September 30, 2021. The work such as selection of literature, data collection, quality evaluation of included literature, and assessment of publication bias will be conducted by 2 independent researchers. Meta-analysis will be performed by RevMan 5.0 software.Results:This study will provide high-quality evidence for the effectiveness and safety of XD in the treatment of NAFLD.Conclusion:The results of the study will help us determine whether XD can effectively treat NAFLD.Ethics and dissemination:This study does not require ethical approval. We will disseminate our findings by publishing results in a peer-reviewed journal.OSF registration number:DOI 10.17605/OSF.IO/A5XEM

Therapeutic roles of a natural herbal product on ameliorating hepatic steatosis via gut dysbacteriosis modulating in treatment of nonalcoholic fatty liver disease in mice

BackgroundThe gut microbiota has well documented as an important player in mediating the development of nonalcoholic fatty liver disease (NAFLD). A patent natural herbal product, compound (Fufang) Zhenzhu Tiaozhi Capsule (FTZ), composed of eight Chinese medical herbs, has prescribed for the prevention and treatment of hyperlipidemia and NAFLD in China for over a decade. Aim of the studyTo investigate gut microbiota-modulated therapeutic potential of FTZ on mice models of NAFLD. MethodsHPLC analysis performed for identifying and quantifying phytochemical constituents of FTZ. The therapeutic potentials on NAFLD were assessed by hepatic histological examination and biochemical assays of liver enzymes. The composition of the gut microbiota was analyzed by 16S rRNA sequencing. Lipid synthesis-related genes were detected using real-time quantitative polymerase chain reaction (RT-qPCR). Correlations differentially regulated bacterial taxa mediated by FTZ intervention and the clinical parameters of NAFLD obtained by Spearman's correlation analysis. ResultsSignificantly therapeutic potentials on dysbiosis of the gut microbiota modulating in high-fat and high-cholesterol (HFHC) diet-induced mice models of NAFLD revealed after FTZ intervention. Downtrends of abnormal parameters of NAFLD characterized by increased body weight (BW), fat contents, levels of total cholesterol (TC), triglyceride (TG) both the serum and liver tissue of the mice, and the activities of alanine aminotransferase (ALT), aspartate transaminase (AST) shown after FTZ intervention. Meanwhile, the over expressions of lipid synthesis-related genes in mice were down-regulated after FTZ treatment. FTZ modulated the gut microbiota composition, which increased the abundance of Bacteroidetes and reduced the ratio of Firmicutes/Bacteroidales indicated by 16S rRNA sequence data analysis. Parallelly, the increased abundance of Bacteroidetes significantly correlated with down-regulated expressions of lipogenic genes of SCD1, FAS, CD36 and C/EBP-α by FTZ intervention. ConclusionNatural herbal product of FTZ attenuated hepatic steatosis via modulating the gut microbiota in mice models of NAFLD, the pathway of FTZ down-regulated expressions of lipogenic genes of SCD1, FAS, CD36 and C/EBP-α, thereby inhibiting liver fat biosynthesis, is considered one of the important mechanisms of FTZ in preventing and treating NAFLD.

Intestinal Microecology: An Important Target for Chinese Medicine Treatment of Non-alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD) has become one of the most common chronic liver diseases worldwide, causing serious economic and medical burdens. Currently, Chinese medicine (CM) has become an important means in treating NAFLD in China. Intestinal microecology (IM) is an important part of the internal environment in the human body and is involved in the occurrence and development of NAFLD. In this paper, the authors systematically discuss the significance of IM in the pathogenesis of NAFLD and the current status of research on the CM treatment of NAFLD via IM regulation. In combination with our own research practice, we propose that IM is an important target for the treatment of NAFLD with CM and formulate plans for future research to target limitations existing in current studies.

Epidemiological Features of NAFLD From 1999 to 2018 in China.

With dramatic changes in lifestyles over the last 20years, nonalcoholic fatty liver disease (NAFLD) has become the most prevalent liver disorder in China but has not received sufficient attention. NAFLD-related advanced liver disease and its mortality along with its overall disease burden are expected to increase substantially. There is thus an imperative need to clarify the epidemiological features of NAFLD to guide a holistic approach to management. We summarize eight epidemiological features of NAFLD in China over the past two decades using systematic review and meta-analysis methodology. Our data reveal a rapid growth in the NAFLD population, especially among younger individuals. Importantly, there is a strong ethnic difference in body mass index (BMI) and genetic risk of NAFLD compared with the US population. The etiology of advanced liver disease and its complications (e.g., hepatocellular carcinoma) has been altered because of a Westernized lifestyle and the implementation of effective vaccination strategies against viral hepatitis. Regional epidemiological patterns of NAFLD indicate that economics, environment, and lifestyle are critical factors in disease progression. The analysis also indicates that a large number of patients remain undiagnosed and untreated because of the inadequacy of diagnostic tools and the absence of effective pharmacologic therapies. Given the burden of NAFLD, future policy and research efforts need to address knowledge gaps to mitigate the risk burden.

Lard-Blended Vegetable Oil Diet Reduces Risk of Nonalcoholic Fatty Liver: A Novel Discovery of Traditional Chinese Dietary Pattern

Our previous work has suggested that the traditional Chinese dietary pattern, blending lard with vegetable oil, could reduce abnormal fat accumulation in adipose tissue. As the morbidity of nonalcoholic fatty liver disease (NAFLD) in China were far lower than which in Western countries was observed, we proposed that whether the lard-blended vegetable oil diet was involved in decrease of NAFLD? The aim of the current study is to answer this question. Mice fed with a mixture of lard and vegetable oil (sunflower oil and soybean oil), particularly a mixture of lard and soybean oil, showed lower body weight, body fat rate, triglyceride and free fatty acid levels in serum and liver compared to lard diet, sunflower oil diet or soybean oil diet separately. Further analysis indicated that the expression of hormone-sensitive lipase and activation of the AMPK pathway contribute to these observed phenotypes, and insulin resistance of mixed oil diet was ameliorated compared to lard, circulating insulin content of mixed oil diet elevated properly compared to vegetable oil. Conclusion: moderate lard intake blended lard with vegetable oil especially soybean oil — has the potential to reduce the risk of nonalcoholic fatty liver via AMPK pathway activation and insulin resistance amelioration.These results indicate that the traditional dietary pattern may be responsible for the lower morbidity of NAFLD in China. Funding Statement: This research was funded by the National Key R&D Program of China [grant no. 2016YDF0501200]. Declaration of Interests: The authors declare that they have no conflicts of interest. Ethics Approval Statement: This study was performed in strict accordance with the European Community (Directive 2010/63/EU) for the care and use of laboratory animals. All the experimental protocols were approved by the Ethics Committee of Hunan Agricultural University, China (No. 43321543).

Metagenome of Gut Microbiota of Children With Nonalcoholic Fatty Liver Disease.

Aim: To investigate the intestinal flora of nonalcoholic fatty liver disease (NAFLD) in Chinese children and adolescents using metagenomic approach.Methods: All participants underwent magnetic resonance spectroscopy (MRS) to quantify liver fat content. Hepatic steatosis was defined as MRS proton density fat fraction (MRS-PDFF) >5%. A total of 58 children and adolescents were enrolled in this study, including 25 obese NAFLD patients, 18 obese non-NAFLD children, and 15 healthy children. Stool samples were collected and analyzed with metagenomics. We used Shannon index to reflect the alpha diversities of gut microbiota. Wilcoxon rank sum test and Kruskal-Wallis test were performed to evaluate alpha diversities between groups. At last, the differences of gut microbiota composition and functional annotations between obese with and without NAFLD and healthy children were assessed by Kruskal-Wallis test.Results: Significant differences in gut microbiota composition and functional annotations among three groups of children and adolescents have been observed. Deep sequencing of gut microbiota revealed high abundance of phylum Proteobacteria (Gammaproteobacteria) in obese NAFLD patients, comparing with the control group. Overall, obese children without NAFLD had less abundant Helicobacter and Helicobacter pylori. Compared to the control group, in obese children with NAFLD, the abundance of Bacteroidetes (Alistipes) were significantly reduced. Faecalibacterium prausnitzii was the only species representing a difference between obese children with and without NAFLD. There were not significant differences in terms of alpha diversity among three groups. Functional annotations demonstrated that several pathways were differentially enriched between groups, including metabolism of other amino acids, replication and repair, folding, sorting, degradation, and glycan biosynthesis and metabolism.Conclusion: Significantly differences are observed in gut microbiota composition and functional annotations between obese children with and without NAFLD in comparison to the healthy children group. The characteristic of gut microbiota in this study may contribute to a further understanding the gut-liver axis of pediatric NAFLD in China.

Unexpected Rapid Increase in the Burden of NAFLD in China From 2008 to 2018: A Systematic Review and Meta-Analysis.

With rapid lifestyle transitions, the increasing burden of nonalcoholic fatty liver disease (NAFLD) in China has emerged as a major public health issue. To obtain a comprehensive overview of the status of NAFLD over the past decade, we evaluated the epidemiology, risk factors, complications, and management of NAFLD in China through a systematic review and meta-analysis. Five English literature databases and three Chinese databases were searched for relevant topics from 2008 to 2018. A total of 392 studies with a population of 2,054,554 were included. National prevalence of NAFLD was 29.2%, with a heavier disease burden among the middle-aged, males, those in northwest China and Taiwan, regions with a gross domestic product per capita greater than 100,000 yuan, and Uygur and Hui ethnic groups. Currently, original studies on natural history and complications of NAFLD in China are scarce. Several studies revealed that NAFLD is positively correlated with the incidence of extrahepatic tumors, diabetes, cardiovascular disease and metabolic syndrome. The Chinese population may have a higher hereditary risk of NAFLD due to more frequent nonsynonymous mutations in genes regulating lipid metabolism. Ultrasonography is the primary imaging tool in the detection of NAFLD in China. Serum tests and risk stratification algorithms for staging NAFLD remain under investigation. Specific pharmaceutical treatments for NAFLD are still undergoing clinical trials. It is noteworthy that the Chinese are underrepresented compared with their proportion of the NAFLD population in such trials. Conclusion: China experienced an unexpected rapid increase in the burden of NAFLD over a short period. Rising awareness and urgent actions need to be taken in order to control the NAFLD pandemic in China.