Steatosis In Patients Research Articles

Cytokines, insulin resistance and arterial wall stiffness in assessing the course of non-alcoholic fatty liver disease

The progression of non-alcoholic fatty liver disease is associated with an increased prevalence of cardiovascular disease. Aim: to assess the level of cytokines, insulin resistance, arterial wall stiffness during the progression of hepatic steatosis in patients with non-alcoholic fatty liver disease. Material and methods. 87 patients with non-alcoholic fatty liver disease were examined. Group I consisted of 14 patients without steatosis, group II – 32 patients with steatosis grade 1; III – 30 patients with steatosis grade 2, IV group – 11 patients with steatosis grade 3. The control group consisted of 30 apparently healthy individuals. Steatometry with a quantitative assessment of the grade of hepatic steatosis was performed using a Soneus P7 ultrasound machine. The content of cytokines (interleukin-6, interleukin-10, TNF-α) was determined using an enzyme-linked immunosorbent assay using a Stat Fax 303 Plus analyzer. The level of insulin resistance was determined using the HOMA-IR index. Results. The content of interleukin-6 in the blood serum of patients of group IV was significantly increased relative to the level in the control group (by 1.8 times, P < 0.05), patients of group I (by 3.2 times, P < 0.05), II group (by 3.0 times, P < 0.05) and group III (2.3 times, P < 0.05). The level of TNF-α increased with the progression of structural changes in the liver and at grade 4 of steatosis its content was increased by 6.4 times (P < 0.05) relative to the level in the control group, by 8.0 times (P < 0.05) relative to group I patients, by 3.4 times (P < 0.05) – group II patients and by 1.8 times (P < 0.05) – group III patients. An increase in the HOMA-IR index by 3.2 times (P < 0.05) was found in patients with moderate steatosis and 3.9 times (P < 0.05) in patients with severe steatosis compared to controls. A correlation was established between the intima-media thickness of the left common carotid artery and the level of TNF-α (r = 0.438; P = 0.006) and the HOMA-IR index (r = 0.557; P = 0.0008). Conclusions. In patients with non-alcoholic fatty liver disease with progression of the grade of hepatic steatosis, a significant increase in proinflammatory cytokines, insulin resistance and intima-media thickness of the left common carotid artery was found.

Relationship between controlled attenuated parameter and magnetic resonance imaging-proton density fat fraction for evaluating hepatic steatosis in patients with NAFLD.

We used cross‐sectional and longitudinal studies to comprehensively compare hepatic steatosis measurements obtained with magnetic resonance imaging–proton density fat fraction (MRI‐PDFF) and controlled attenuated parameter (CAP) in hepatic steatosis in adults with nonalcoholic fatty liver disease (NAFLD). A total of 185 participants with NAFLD and 12 non‐NAFLD controls were recruited. CAP and MRI‐PDFF data were collected at baseline from all participants and from 95 patients included in the longitudinal study after 24 weeks of drug or placebo intervention. Pearson correlation, linear regression, and piecewise linear regression analyses were used to evaluate the relationship between the two modalities. Linear analysis suggested a positive correlation between CAP and MRI‐PDFF (r = 0.577, p < 0.0001); however, piecewise linear regression showed no correlation when CAP was ≥331 dB/m (p = 0.535). In the longitudinal study, both the absolute and relative change measurements were correlated between the two modalities; however, the correlation was stronger for the relative change (relative r = 0.598, absolute r = 0.492; p < 0.0001). Piecewise linear regression analysis revealed no correlation when CAP was reduced by more than 53 dB/m (p = 0.193). Conclusions: We found a correlation between CAP and MRI‐PDFF measurements for grading hepatic steatosis when CAP was <331 dB/m. While the measured absolute change and relative change were correlated, it was stronger for the relative change. These findings have implications for the clinical utility of CAP or MRI‐PDFF in the clinical diagnosis and assessment of NAFLD.

Direct Comparison of Quantitative US versus Controlled Attenuation Parameter for Liver Fat Assessment Using MRI Proton Density Fat Fraction as the Reference Standard in Patients Suspected of Having NAFLD.

Background MRI-derived proton density fat fraction (PDFF) is an accurate, reliable, and safe biologic marker for use in the noninvasive diagnosis of hepatic steatosis in patients with nonalcoholic fatty liver disease (NAFLD). Because of the cost and limited availability of MRI, it is necessary to develop an accurate method to diagnose NAFLD with potential point-of-care access. Purpose To compare the diagnostic accuracy of the quantitative US (QUS) fat fraction (FF) estimator with that of the controlled attenuation parameter (CAP) in the diagnosis of NAFLD using contemporaneous MRI-derived PDFF as the reference standard. Materials and Methods Participants with or suspected of having NAFLD were prospectively recruited at the NAFLD Research Center between July 2015 and July 2019. All participants underwent MRI-derived PDFF measurement, transient elastography with CAP measurement, and QUS. QUS FF was derived using computed QUS parameters from the acquired radiofrequency US data using a calibrated reference phantom. The area under the receiver operating characteristic curve (AUC) was calculated to assess the accuracy of QUS FF and CAP in the diagnosis of hepatic steatosis (defined as MRI-derived PDFF ≥ 5%). AUCs were compared using the DeLong test. Results A total of 123 participants were included (mean age, 52 years ± 13 [SD]; 67 [54%] women). Of these participants, 100 (81%) had MRI-derived PDFF of 5% or more. QUS FF had a significantly higher AUC for diagnosis of NAFLD than did CAP (0.92 [95% CI: 0.87, 0.98] vs 0.79 [95% CI: 0.67, 0.90], P = .03). QUS FF had a sensitivity of 98% (98 of 100) and a specificity of 48% (11 of 23). CAP had a sensitivity of 87% (87 of 100) and a specificity of 57% (13 of 23). Conclusion The quantitative US fat fraction estimator is more accurate than the controlled attenuation parameter in the diagnosis of hepatic steatosis in patients with or suspected of having nonalcoholic fatty liver disease. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Ito in this issue.

Effect of Ramadan fasting on hepatic steatosis as quantified by controlled attenuation parameter (CAP): a prospective observational study

BackgroundAlthough Ramadan fasting has a beneficial effect on health, the role of Ramadan fasting on patients with non-alcoholic fatty liver disease (NAFLD), as quantified by the controlled attenuation parameter (CAP), is not determined yet. So, this study aimed to determine the effect of Ramadan fasting on patients with NAFLD by assessing the controlled attenuation parameter (CAP) and biochemical parameters of the fatty liver.Patients and methodsA prospective observational study was conducted on 40 NAFLD patients, who were diagnosed by ultrasonography and quantified with controlled attenuation parameter (CAP) in transient elastography (FibroScan) and fasted the month of Ramadan. Transient elastography for CAP and liver stiffness measurement (LSM) were performed. Fibrosis 4 score (FIB4) and NAFLD fibrosis score (NFS) were also calculated.ResultsThere is a statistically significant change in body mass index, fasting blood glucose, HbA1c, triglycerides, LDL cholesterol, HDL cholesterol, total cholesterol, serum albumin, total protein, AST, ALT, and alkaline phosphatase after Ramadan fasting. There were significant clinical improvements after Ramadan fasting in FIB-4 (1.31 ± 0.26 and 1.24 ± 0.25 respectively, p < 0.001), CAP (318.52 ± 34.59 and 294.0 ± 20.34, respectively, p < 0. 001), and LSM (6.95 ± 1.62 and 6.59 ± 1.49, respectively, p < 0. 001).ConclusionOur study demonstrates that Ramadan fasting could improve liver steatosis in patients with NAFLD proved with a significant reduction in the CAP and LSM.

Triglyceride-Glucose Index and Hepatic Steatosis Index for the assessment of liver steatosis in HCV patients.

Liver steatosis in patients with chronic infection of hepatitis C virus (HCV) is important from multiple standpoints: faster disease progression, more frequent hepatocellular carcinoma and cirrhosis development or worse therapy response. Liver biopsy as diagnostic method, is in recent years more and more challenged due to its well-known flaws. Hepatic steatosis index (HSI) and triglyceride-glucose (TyG) Index, are surrogate scores developed in the first place for noninvasive assessment of steatosis in patients with nonalcoholic fatty liver disease (NAFLD). However, their use in the context of chronic hepatitis C (CHC) virus infection is still unclear. Aim of our study was to assess the accuracy of both HSI and TyG index in patients with CHC. The cohort included 814 patients with CHC infection in whom liver biopsy was performed. After implementing strict criteria for sample adequacy and necessary data, 424 patients were finally enrolled in our study. Histological findings were used as a reference point, and surrogate scores HSI and TyG index were expressed through receiver operating characteristic (ROC) curves in order to assess their ability in determining patients without (<5%) or with steatosis (>5%), but also to address their ability in assessing between different degrees of steatosis. The average age of study population was 37.09 years and the majority of patients were men (67%). Liver steatosis was detected in approximately half of the liver biopsy samples (50.4%). About 5% of them had severe steatosis. The area under the ROC curve values for HSI and TyG index when detecting liver steatosis were 0.76 and 0.629, respectively. Similar values were obtained comparing between absence of steatosis and mild steatosis (5-30%). Non-invasive surrogate scores HSI and TyG index in CHC patients, have good performance to detect the presence of steatosis. In this context, these tools are cheap, widely available and could be valuable asset in liver steatosis assessment outside liver biopsy.

Hepatic Steatosis Assessment as a New Strategy for the Metabolic and Nutritional Management of Duchenne Muscular Dystrophy.

Growing evidence suggests that patients with Duchenne muscular dystrophy (DMD) have an increased risk of obesity and metabolic syndrome (MetS). The aim of this study was to investigate the potential risk factors for MetS and hepatic steatosis in patients with different stages of DMD. A total of 48 patients with DMD were enrolled and classified into three stages according to ambulatory status. Body mass index (BMI), serum fasting glucose, insulin, and lipid profiles including triglycerides (TG) and high-density lipoprotein were measured, and the homeostatic model assessment for insulin resistance (HOMA-IR) index was evaluated. Ultrasound examinations of the liver were performed to assess hepatic steatosis using the Nakagami parameter index (NPI). The results showed that BMI, TG, HOMA-IR, and ultrasound NPI differed significantly among DMD stages (p < 0.05). In contrast to the low rates of conventional MetS indices, including disturbed glucose metabolism (0%), dyslipidemia (14.28%), and insulin resistance (4.76%), a high proportion (40.48%) of the patients had significant hepatic steatosis. The ultrasound NPI increased with DMD progression, and two thirds of the non-ambulatory patients had moderate to severe hepatic steatosis. Steroid treatment was a risk factor for hepatic steatosis in ambulatory patients (p < 0.05). We recommend that DMD patients should undergo ultrasound evaluations for hepatic steatosis for better metabolic and nutritional management.

Quantitative Ultrasound Assessment of Hepatic Steatosis

Non-alcoholic fatty liver disease (NAFLD) is widespread chronic disease of the live in humans withthe prevalence of 30% of the United Statespopulation.1,2 The goal of the study is to validate the performance of quantitative ultrasound algorithms in the assessment of hepatic steatosis in patients with suspected NAFLD. This prospective study enrolled a total of 31 patients with clinical suspicion of NAFLD to receive liver fat measurements by quantitative ultrasound and reference MRI measurements (proton density fat-fraction, PDFF). The following ultrasound (US) parameters based on both raw ultrasound RF (Radio Frequency) data and 2D B-mode images of the liver were analyzed with subsequent correlation with MRI-PDFF: hepatorenal index, acoustic attenuation coefficient, Nakagami coefficient parameter, shear wave viscosity, shear wave dispersion and shear wave elasticity. Ultrasound parameters were also correlated with the presence of hypertension and diabetes. The mean (± SD) age and body mass index of the patients were 49.03 (± 12.49) and 30.12 (± 6.15), respectively. Of the aforementioned ultrasound parameters, the hepatorenal index and acoustic attenuation coefficient showed a strong correlation with MRI-PDFF derivations of hepatic steatosis, with r-values of 0.829 and 0.765, respectively. None of the remaining US parameters showed strong correlations with PDFF. Significant differences in Nakagami parameters and acoustic attenuation coefficients were found in those patients with and without hypertension. Hepatorenal index and acoustic attenuation coefficient correlate well with MRI-PDFF-derived measurements of hepatic steatosis. Quantitative ultrasound is a promising tool for the diagnosis and assessment of patients with NAFLD.

Triglyceride-Rich Lipoproteins and Glycoprotein A and B Assessed by 1H-NMR in Metabolic-Associated Fatty Liver Disease.

High plasma triglyceride (TG) levels and chronic inflammation are important factors related to metabolic-associated fatty liver disease in patients at cardiovascular risk. Using nuclear magnetic resonance (1H-NMR), we aimed to study the triglyceride-rich lipoprotein (TRL) and acute-phase glycoprotein profiles of a cohort of patients with metabolic disease and their relationship with fatty liver. Plasma samples of 280 patients (type 2 diabetes, 81.1%; obesity, 63.3%; and metabolic syndrome, 91.8%) from the University Hospital Lipid Unit were collected for the measurement of small, medium and large TRL particle numbers and sizes and glycoprotein profiles (Glyc-A and Glyc-B) by 1H-NMR. Liver function parameters, including the fatty liver index (FLI) and fibrosis-4 (FIB-4) score, were assessed. Hepatic echography assessment was performed in 100 patients, and they were followed up for 10 years. TRL particle concentrations showed a strong positive association with Glyc-A and Glyc-B (ρ=0.895 and ρ=0.654, p<0.001, respectively) and with the liver function-related proteins ALT ρ=0.293, p<0.001), AST (ρ=0.318, p<0.001) and GGT (ρ=0.284, p<0.001). Likewise, TRL concentrations showed a positive association with FLI (ρ=0.425, p<0.001) but not with FIB-4. During the follow-up period of 10 years, 18 new cases of steatosis were observed among 64 patients who were disease-free at baseline. Baseline TRL particle numbers and glycoprotein levels were associated with the new development of metabolic-associated fatty liver disease (MAFLD) (AUC=0.692, p=0.018 and AUC=0.669, p=0.037, respectively). Overall, our results indicated that TRL number and acute-phase glycoproteins measured by 1H-NMR could be potential biomarkers of the development of hepatic steatosis in patients at metabolic risk.

Radiomics Analysis of Magnetic Resonance Proton Density Fat Fraction for the Diagnosis of Hepatic Steatosis in Patients With Suspected Non-Alcoholic Fatty Liver Disease.

This study aimed to assess the diagnostic feasibility of radiomics analysis based on magnetic resonance (MR)-proton density fat fraction (PDFF) for grading hepatic steatosis in patients with suspected non-alcoholic fatty liver disease (NAFLD). This retrospective study included 106 patients with suspected NAFLD who underwent a hepatic parenchymal biopsy. MR-PDFF and MR spectroscopy were performed on all patients using a 3.0-T scanner. Following whole-volume segmentation of the MR-PDFF images, 833 radiomic features were analyzed using a commercial program. Radiologic features were analyzed, including median and mean values of the multiple regions of interest and variable clinical features. A random forest regressor was used to extract the important radiomic, radiologic, and clinical features. The model was trained using 20 repeated 10-fold cross-validations to classify the NAFLD steatosis grade. The area under the receiver operating characteristic curve (AUROC) was evaluated using a classifier to diagnose steatosis grades. The levels of pathological hepatic steatosis were classified as low-grade steatosis (grade, 0-1; n = 82) and high-grade steatosis (grade, 2-3; n = 24). Fifteen important features were extracted from the radiomic analysis, with the three most important being wavelet-LLL neighboring gray tone difference matrix coarseness, original first-order mean, and 90th percentile. The MR spectroscopy mean value was extracted as a more important feature than the MR-PDFF mean or median in radiologic measures. Alanine aminotransferase has been identified as the most important clinical feature. The AUROC of the classifier using radiomics was comparable to that of radiologic measures (0.94 ± 0.09 and 0.96 ± 0.08, respectively). MR-PDFF-derived radiomics may provide a comparable alternative for grading hepatic steatosis in patients with suspected NAFLD.

Liver PP2A-Cα Protects From Parenteral Nutrition-associated Hepatic Steatosis

Background & AimsParenteral nutrition (PN) is a lifesaving therapy for patients with intestinal failure. Hepatic steatosis is a potentially fatal complication of long-term PN, but the involved pathological mechanisms are incompletely unclarified. Herein, we identify the role of protein phosphatase 2A (PP2A) in the pathogenesis of parenteral nutrition-associated hepatic steatosis (PNAHS).MethodsProteomic/phosphoproteomic analyses of liver samples from patients with PNAHS were applied to identify the mechanism of PNAHS. Total parenteral nutrition (TPN) mice model, in vivo, and in vitro experiments were used to assess the effect of PP2A-Cα on liver fatty acid metabolism.ResultsReduced expression of PP2A-Cα (catalytic subunit) enhanced activation of serine/threonine kinase Akt2 and decreased activation of adenosine monophosphate-activated protein kinase (AMPK) were associated with hepatic steatosis in patients with PNAHS. Mice given PN for 14 days developed hepatic steatosis, down-regulation of PP2A-Cα, activation of Akt2, and inhibition of AMPK. Hepatocyte-specific deletion of PP2A-Cα in mice given PN exacerbated Akt2 activation, AMPK inhibition, and hepatic steatosis through an effect on fatty acid degradation, whereas hepatocyte-specific PP2A-Cα overexpression significantly ameliorated hepatic steatosis accompanied with Akt2 suppression and AMPK activation. Additionally, pharmacological activation of Akt2 in mice overexpressing PP2A-Cα led to the aggravation of hepatic steatosis.ConclusionsOur findings demonstrate that hepatic PP2A-Cα serves as a protective factor of PNAHS due to ameliorating hepatic steatosis and improving liver function. Our study provides a strong rationale that PP2A-Cα may be involved in the pathogenesis of PNAHS.

The evaluation of serum Adropin and Lipocalin levels in women with polycystic ovary syndrome

Purpose: Polycystic Ovary Syndrome (PCOS) is related to metabolic diseases such as endothelial dysfunction, systemic inflammation, insülin resistance and dyslipidemia. Adropin is a peptide secretion that positively affects glucose homeostasis and hepatic steatosis in patients with PCOS. Lipocalin-2 mediates obesity, insulin resistance, and apoptosis induced by IL-3. The levels of adropin and lipocalin-2 in PCOS patients were studied in this study. Materials and methods: Women with PCOS (n=37) and healthy controls (n=34) were assessed in this observational and cross-sectional study. Anthropometric measurements, demographic data, metabolic and hormonal profiles, Adropin and Lipocalin-2 levels were measured in both groups. Results: In the study it was determined that PCOS group Adropin and Lipocalin-2 levels were significantly reduced. LDL-C cholesterol, Total cholesterol, Total testosterone, LH, FAI, Triglyceride and LH/FSH values and hirsutism score considerably lower in the control group than the PCOS group. Conclusion: The fact that adropin levels were reduced significantly in PCOS patients who had not yet acquired insulin resistance or who could not be detected using existing methods suggests that adropin changes in PCOS are independent of insulin. The study shows that the level of adropin decreases significantly before insulin resistance reaches pathological levels, which is associated with the young population. Low Lipocalin-2 levels in patients with PCOS suggest that this cannot be blamed for insulin receptor dysfunction secondary to apoptosis in PCOS.

Features of correction of markers of hepatocyte cytolysis and the degree of hepatocyte steatosis in patients with nonalcoholic steatohepatitis and type 2 diabetes with diabetic kidney disease

The relevance of the problem of the comorbid course of nonalcoholic steatohepatitis, type 2 diabetes and diabetic kidney disease lies in the rapid progression of all comorbid diseases, decompensation of carbohydrate metabolism processes, and the development of hepatocellular and renal failure. The specified comorbid diseases have a number of mutually burdening mechanisms, the elimination of which will contribute to achieving clinical remission of diseases, compensation of the functional potential of the liver and kidneys. The aim of the study was to find out the probable effect of the complex of metformin, rosuvastatin and bicyclol on the markers of hepatocyte cytolysis in patients with non-alcoholic steatohepatitis and type 2 diabetes with diabetic kidney disease, the degree of hepatocyte steatosis and the stage of liver fibrosis, which are markers of the progression of non-alcoholic steatohepatitis. Materials and methods. Depending on the prescribed treatment, the examined patients were randomly divided into 2 groups: (1 group – control: 28 people) received a hypocaloric diet taking into account the restrictions of diet No. 9, essential phospholipids (Essentiale forte H 300 mg 2 capsules 3 times a day ) for 90 days in order to treat active non-alcoholic steatohepatitis, for type 2 diabetes and hyperlipidemia metformin hydrochloride (Metformin-Teva 1000 mg per day, rosuvastatin (Rosuvastatin-Teva 5 mg once a day) was prescribed for 90 days. Group 2 consisted of patients (32 people), who, in addition to similar dietary recommendations, hypoglycemic and hypolipidemic therapy, instead of essential phospholipids, additionally received the drug Bicyclol 25 mg 3 times a day for 90 days. The average age of the patients was (53,8±3,52) years. Group comparison for the presentation of reference values of homeostasis indicators was made by 30 healthy persons of the appropriate age. Research results and their discussion. The analysis of indicators of cytolytic syndrome activity indicates that the activity of ALT increased before treatment (by 3,6 times, p&lt;0,05) – after treatment it decreased in patients of groups 1 and 2: by 2.2 and 3,7 times, respectively (p&lt;0,05) with the presence of a probable intergroup difference (p&lt;0,05). At the same time, the increased indicator of steatosis of hepatocytes before treatment, which exceeded the reference values by 4,0 times (p&lt;0,05) – under the influence of treatment also probably decreased in patients of 1 and 2 observation groups – by 1.2 and 1.8 times, respectively (p&lt;0,05) with the presence of a probable intergroup difference (p&lt;0,05). Thus, both traditional treatment with essential phospholipids and the drug Bicyclol actively affect and during 90 treatments contribute to the reduction of the main components of the pathological process in the liver in non-alcoholic steatohepatitis – cytolysis and fatty dystrophy of hepatocytes, but Bicyclol as part of complex hypoglycemic and hypolipidemic therapy has a more intense effect. It should also be pointed out that the effect of traditional therapy and the activity of liver fibrosis, according to previous studies, was probably lower than the proposed Bicyclol therapy. Thus, the significantly increased FibroTest indicator before treatment (3,2 times, p&lt;0,05) in patients with non-alcoholic steatohepatitis with comorbid diabetes mellitus and diabetic kidney disease in the dynamics of treatment in patients of group 1 decreased by 10,7% (p&lt; 0,05), and in patients of group 2 – by 40,0% (р&lt;0,05) with the presence of a probable intergroup difference (р&lt;0,05). The obtained data indicate a favorable anti-inflammatory effect of Bicyclol, which is aimed at inhibiting and preventing liver fibrosis. Conclusions from the study. Complex therapy with metformin, rosuvastatin in combination with bicyclol in people with comorbid non-alcoholic steatohepatitis, type 2 diabetes and diabetic kidney disease for 3 months contributed to the elimination of hepatocyte cytolysis syndrome, a significant decrease in steato-test and fibrotest indicators (p&lt;0.05), probable reducing the intensity of liver tissue fibrosis.

Effect of MTTP -493G/T, I128T, Q95H and Q244E polymorphisms on hepatic steatosis in patients with chronic hepatitis

BackgroundChronic hepatitis C is characterized by a progressive deterioration of liver function and is involved in metabolic complications, such as hepatic steatosis. ObjectiveThe aim of this study was to investigate the role of host and viral characteristics associated with -493G/T (rs1800591), I128T (rs3816873), Q95H (rs61733139), and Q244E (rs17599091) Single Nucleotide Polymorphisms (SNPs) in the Microsomal Triglyceride Transfer Protein (MTTP) gene on hepatic steatosis in chronic hepatitis C. MethodsSNPs were genotyped by PCR-RFLP and analyzed in combination with host and viral characteristics by multiple logistic regression in different genetic models of inheritance. ResultsThe authors analyzed 236 patients with chronic hepatitis C, and 53% had hepatic steatosis. The mutated allele frequencies were > 5%, and the genotypes were in Hardy-Weinberg equilibrium (p ≥ 0.05). It was observed that patients with HCV genotype 3 infection (OR = 2.74, 95% CI 1.24‒6.06, p = 0.013), female sex (OR = 2.28, 95% CI 1.21‒4.28, p = 0.011) and moderate- and high-intensity liver inflammatory activity (A2-A3) (OR = 3.61, 95% CI 1.86‒7.01, p < 0.001) alone exhibited a higher risk of steatosis. The results of multiple logistic regression analysis for interaction showed that for the -493G/T SNP, when the GT/TT genotype (dominant model) and the GT genotype (codominant model) were each combined with HCV genotype 3 infection, an 11.51-fold (95% CI 2.08‒63.59, p = 0.005) and a 15.69-fold (95% CI 2.46‒99.85, p = 0.004) increased risk of steatosis, respectively, was observed. For the I128T SNP, when both the IT/TT genotype (dominant model) and the IT genotype (codominant model) were combined with HCV genotype 3 infection, an 8.51-fold (95% CI 1.59‒45.54, p = 0.012) and an 8.40 fold (95% CI 1.51‒46.91, p = 0.015) increased risk of steatosis, respectively, was observed. ConclusionThe present study showed that the viral genotype combined with the -493G/T and I128T SNPs in the MTTP gene influences hepatic steatosis.

Quantitative evaluation of hepatic steatosis using novel ultrasound technology normalized local variance (NLV) and its standard deviation with different ROIs in patients with metabolic-associated fatty liver disease: a pilot study

PurposeThe purpose of this study was to evaluate the diagnostic performance of novel ultrasound technology normalized local variance (NLV) and the standard deviation of NLV (NLV-SD) using different ROIs for hepatic steatosis in patients with metabolic-associated fatty liver disease (MAFLD) and to identify the factors that influence the NLV value and NLV-SD value, using pathology results as the gold standard.MethodsWe prospectively enrolled 34 consecutive patients with suspected MAFLD who underwent percutaneous liver biopsy for evaluation of hepatic steatosis from June 2020 to December 2020. All patients underwent ultrasound and NLV examinations. NLV values and NLV-SD values were measured using different ROIs just before the liver biopsy procedure.ResultsThe distribution of hepatic steatosis grade on histopathology was 4/19/6/5 for none (< 5%)/ mild (5–33%)/ moderate (> 33–66%)/ and severe steatosis (> 66%), respectively. The NLV value with 50-mm-diameter ROI and NLV-SD value with 50-mm-diameter ROI showed a significant negative correlation with hepatic steatosis (spearman correlation coefficient: − 0.449, p = 0.008; − 0.471, p = 0.005). The AUROC of NLV (50 mm) for the detection of mild, moderate, and severe hepatic steatosis was 0.875, 0.735, and 0.583, respectively. The AUROC of NLV-SD (50 mm) for the detection of mild, moderate, and severe hepatic steatosis was 0.900, 0.745, and 0.603, respectively. NLV (50 mm) values and NLV-SD (50 mm) values between two readers showed excellent repeatability and the intraclass correlation coefficient (ICC) was 0.930 (p < 0.001) and 0.899 (p < 0.001). Hepatic steatosis was the only determinant factor for NLV value and NLV-SD value (p = 0.012, p = 0.038).ConclusionThe NLV (50 mm) and NLV-SD (50 mm) provided good diagnostic performance in detecting the varying degrees of hepatic steatosis with great reproducibility. This study showed that the degree of steatosis was the only significant factor affecting the NLV value and NLV-SD value.

Association of hypercholesterolemia or hypertriglyceridemia with degree of hepatic steatosis in patients with non-alcoholic fatty liver disease

Rationale: Non-alcoholic fatty liver disease (NAFLD) is the most metabolic disease in liver. NAFLD pathogenesis is associated with Insulin resistance, hyperinsulinemia, deposition of triglycerides (TGs) and liver inflammation. In this study we are evaluating the association between severity of hypertriglyceridemia and cholesterolemia with stage of liver steatosis.

Effects of sumac (Rhus coriaria) on lipid profile, leptin and steatosis in patients with non-alcoholic fatty liver disease: A randomized double-blind placebo-controlled trial

IntroductionSumac has been shown to have a positive impact on lipid profile and hepatic function in some studies. The present study aimed to investigate the effect of sumac consumption on metabolic disorder related to non-alcoholic fatty liver disease (NAFLD) in Iran. It can suggest a therapeutic strategy to reduce the complications of this disease. MethodsAccording to study inclusion and exclusion criteria 80 patients with NAFLD were selected. They were stratified according to sex, and age, and randomly allocated into two groups each comprised of 40 patients. One group received sumac powder (2 g) and another received placebo (dextrin) for 12 weeks. Blood pressure, aspartate aminotransferase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), lipid profile, leptin and steatosis status were assessed at baseline and end of the study. ResultsThe administration of sumac powder decreased the systolic blood pressure (SBP) (p = 0.02), but diastolic blood pressure (DBP) did not change (p = 0.14). Also, AST, ALT, ALP, total cholesterol, LDL-C and triglyceride (TG) were decreased but HDL-C was increased in the sumac group compared to the placebo group (p < 0.001). We did not find any change in GGT (p = 0.7) and Leptin between two groups (p = 0.48). The status of steatosis was improved in the sumac group compared to placebo (p < 0.001). ConclusionOur clinical trial study suggests that sumac powder may be a suitable choice for reducing blood pressure, serum liver enzymes and steatosis in individuals with NAFLD. Also, it can improve lipid profile. Additional studies with a longitudinal design are required to confirm our findings.

Protective association of Klotho rs495392 gene polymorphism against hepatic steatosis in non-alcoholic fatty liver disease patients.

Background/AimsNon-alcoholic fatty liver disease (NAFLD) is closely associated with metabolic dysfunction. Among the multiple factors, genetic variation acts as important modifiers. Klotho, an enzyme encoded by the klotho (KL) gene in human, has been implicated in the pathogenesis of metabolic dysfunctions. However, the impact of variants in KL on NAFLD risk remains poorly understood. The aim of this study was to investigate the impact of KL rs495392 C>A polymorphism on the histological severity of NAFLD.MethodsWe evaluated the impact of the KL rs495392 polymorphism on liver histology in 531 Chinese with NAFLD and replicated that in the population-based Rotterdam Study cohort. The interactions between the rs495392, vitamin D, and patatin-like phospholipase domain containing 3 (PNPLA3) rs738409 polymorphism were also analyzed.ResultsCarriage of the rs495392 A allele had a protective effect on steatosis severity (odds ratio [OR], 0.61; 95% confidence interval [CI], 0.42–0.89; P=0.010) in Chinese patients. After adjustment for potential confounders, the A allele remained significant with a protective effect (OR, 0.66; 95% CI, 0.45–0.98; P=0.040). The effect on hepatic steatosis was confirmed in the Rotterdam Study cohort. Additional analysis showed the association between serum vitamin D levels and NAFLD specifically in rs495392 A allele carriers, but not in non-carriers. Moreover, we found that the rs495392 A allele attenuated the detrimental impact of PNPLA3 rs738409 G allele on the risk of severe hepatic steatosis.ConclusionsThe KL rs495392 polymorphism has a protective effect against hepatic steatosis in patients with NAFLD.

Effect of cranberry supplementation on liver enzymes and cardiometabolic risk factors in patients with NAFLD: a randomized clinical trial

BackgroundWe aimed to evaluate the effect of cranberry supplementation on serum liver enzymes, hepatic steatosis, and cardiometabolic risk factors in patients with non-alcoholic fatty liver (NAFLD).MethodsIn the present parallel-designed randomized controlled clinical trial, 110 patients with NAFLD were enrolled. The patients were randomized to receive 144 mg cranberry capsule or placebo for 6 months. The primary efficacy of the treatment was lipid profile, glycemic measurements, and liver enzyme levels.ResultsThe data were reported for 46 in the supplementation group and 48 in the placebo group. The patient’s mean (SD) age was 43.16 (11.08) years. No significant differences between groups were observed regarding the post-intervention level of liver enzyme. The mean after-intervention levels of total cholesterol (p < 0.001) and triglyceride (p = 0.01) were significantly lower in the intervention group compared with the placebo group. At the end of the study, the mean insulin and HOMA-IR levels were significantly lower in the cranberry group compared with the placebo group. Significantly more patients in the cranberry group experienced a decrease in steatosis level compared with the control group.ConclusionThe results of the present study showed that cranberry supplementation had a positive effect on some lipid profiles, insulin resistance, and hepatic steatosis in patients with NAFLD.Trial registrationIRCT20200725048200N1; first registration date: 11.8.2020.

Role of Positron Emission Tomography with 2-Deoxy-2-[fluorine-18]fluoro-D-glucose Integrated with Computed Tomography in the Evaluation of Hepatic Metabolic Activity due to Steatosis in Lymphoma Patients and its Impact on Deauville Score

BACKGROUND: Liver uptake of 2-Deoxy-2-[fluorine-18]fluoro-D-glucose integrated (18F-FDG) is taken as the reference tissue in interpretation of Deauville score (DS), which is considered a response assessment. AIM: This study was conducted to evaluate the prevalence of hepatic steatosis in patients with lymphoma and the impact of hepatic metabolic activity due to steatosis on 18F-FDG liver uptake and its effect on DS. MATERIAL AND METHODS: This prospective study was conducted on 77 cases. Seventy-seven patients had baseline positron emission tomography/computed tomography (PET/CT), 69 patients had interim PET/CT, 31 patients had end of treatment (EOT) PET/CT, and 3 patients had follow-up (FU) PET/CT after EOT. The study included 49 female patients (63.6%) and 28 male patients (36.4%). The mean age = 39.5 + 13. Forty-one patients (53.2%) diagnosed as non-Hodgkin lymphoma [HL] while 36 patients (46.8%) diagnosed as HL. Steatosis was diagnosed on the unenhanced CT part of PET/CT examinations using a cutoff value of 42 Hounsfield units. Both maximum standardized uptake value (SUVmax) and SULmax were recorded on the liver and the tumor target lesion. DS was then computed. RESULTS: Among 77 cases, prevalence of steatosis in baseline (10/77, 12.9%), interim (13/69, 18.8%), and EOT/FU (4/31, 12.9%), there was no significant difference in hepatic steatosis during their time course of their treatment. There was correlation between Liver SUVmax with body mass index (BMI) in each of interim and EOT PET/CT. Regarding SULmax, there was no correlation with BMI. There was no change in interpretation of DS using either SUVmax or SULmax. CONCLUSION: Steatosis has no practical issue regarding liver metabolic activity (either SUVmax or SULmax) in interpretation of DS. Liver SUVmax is affected by body weight. Unlike, SULmax is not affected by body weight.

Concentration of LDLR, degree of hepatic fibrosis and hepatic steatosis in patients with chronic hepatitis B infection treated with tenofovir disoproxil fumarate

Epidemiological data indicate that one-third of the world's population have serological markers of hepatitis B virus infection. Hepatic steatosis is often observed in patients with chronic liver diseases. The exact mechanisms of hepatic steatosis progression and the efficacy of antiviral therapy in patients with CHB and hepatic steatosis are not yet fully understood.The aim of the study was to investigate the LDLR concentration and degree of hepatic fibrosis and hepatic steatosis in patients with chronic hepatitis B infection during tenofovir disoproxil fumarate therapy.The study group consisted of 54 patients with CHB. The LDLR concentration, assessment of the degree of hepatic fibrosis, hepatic steatosis, total cholesterol, low density lipoprotein, high density lipoprotein and triglyceride concentrations, were assessed at the beginning of therapy, 6 months later, and 12 months after commencement of therapy. The control group consisted of 18 healthy individuals.The mean LDLR concentration in the studied groups was statistically significantly lower (p<0.05) than in the controls. The antiviral therapy based on TDF had no influence on the LDLR concentration and HBsAg level.The results indicate a statistically significant lower(p<0.05) concentration of LDLR in patients with chronic hepatitis B infection. Negative correlations between HBsAg level and LDLR concentration in patients with chronic HBV, at all stages of the study may indicate, that HBsAg protects hepatocytes from LDL accumulation.