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Agbaje AO. Novel Pediatric Waist-to-height Ratio Fat Mass Cutoff Predicts Liver Steatosis and Fibrosis Better than Body Mass Index: The NHANES. J Endocr Soc 2025; 9:bvaf079. [PMID: 40421430 PMCID: PMC12104973 DOI: 10.1210/jendso/bvaf079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2025] [Indexed: 05/28/2025] Open
Abstract
Background Recent clinical consensus statements have emphasized a shift from diagnosing obesity with body mass index (BMI) requiring confirmation with surrogate markers such as waist circumference-to-height ratio (WHtR). WHtR is a highly sensitive and specific predictor of dual-energy X-ray absorptiometry-measured total body fat mass and abdominal fat mass but not lean mass. However, newly developed WHtR adiposity cut points warrant external validation before clinical application. Objective To examine whether new WHtR cut points predict liver steatosis and fibrosis in a multiracial population. Methods Data from 6464 (54% female) multiracial US participants from the National Health and Nutrition Examination Survey conducted between 2021 and 2023 were analyzed. Liver fibrosis was assessed with transient elastography and staged as fibrosis stage F0 to F4 and liver steatosis graded S0 to S3. Results Participants' mean (SD) age was 47.3 (20.9) years. The prevalence of WHtR cut points of 0.40 to <0.50 (normal fat mass), 0.5 to <0.53 (high fat mass), and ≥0.53 (excess fat mass) was 20.3%, 13.6%, and 64.5%. Multivariable-adjusted WHtR high fat mass predicted liver steatosis (odds ratio 1.63 [95% confidence interval 1.16-2.29] P = .005) and fibrosis (1.31 [1.01-1.70] P = .043). Excess WHtR fat mass was associated with liver steatosis (4.02 [2.87-5.64] P < .001) and fibrosis (1.61 [1.03-2.54] P = .038). Normal WHtR fat mass predicted lower odds of liver steatosis (0.52 [0.37-0.73] P < .001) and fibrosis/cirrhosis (0.48 [0.30-0.76] P < .001). WHtR high fat mass and excess fat mass separately predicted higher odds of liver steatosis 1.6-fold and 6-fold, respectively, better than BMI-overweight and BMI-obesity. Conclusion The simple and universally accessible WHtR cut points may be useful in clinical and public health practice for obesity screening, diagnosis, and management.
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Affiliation(s)
- Andrew O Agbaje
- Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, 70211 Kuopio, Finland
- Children's Health and Exercise Research Centre, Department of Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter EX1 2LU, UK
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Mehta NN, Rajput M, Kumar K, Nagar A, Mahala VK, Saraswat VA, Mishra A. Evaluation of Controlled Attenuation Parameter as a Tool for Assessment of Hepatic Steatosis in Living Liver Donors. J Clin Exp Hepatol 2025; 15:102514. [PMID: 40129630 PMCID: PMC11930117 DOI: 10.1016/j.jceh.2025.102514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2024] [Accepted: 02/07/2025] [Indexed: 03/26/2025] Open
Abstract
Background Currently, there is an absence of a standardised protocol for the preoperative detection of hepatic steatosis (HS) in living liver donors. A steatotic liver graft jeopardises the outcome of the recipient with multiple potential complications. Vibration-controlled transient elastography (Fibroscan®) provides a controlled attenuation parameter (CAP), which we have utilised in our assessment of HS in living liver donors. This approach offers a promising avenue for the advancement of preoperative evaluation protocols. Methods In the period spanning from October 2022 to July 2024, a cohort of 67 liver donors were subjected to preoperative vibration-controlled transient elastography (Fibroscan®) and either preoperative or intraoperative liver biopsy. HS was defined as a fat content exceeding 10%. CAP readings were juxtaposed with liver biopsy results for the diagnosis of HS. Donors were categorised into three categories with HS <5%, 5-10% and those with HS >10% were rejected as per our institutional protocol. This facilitated a comprehensive evaluation of HS in the context of living donor liver transplantation. Results CAP was very accurate in detecting HS, with an area under the receiver operating characteristic curve of 0.99 (P < 0.05). Statistical analysis determined that a CAP cutoff value of 266 dB/m provides a sensitivity of 100% and a specificity of 98.4% for predicting HS >10%. Corresponding positive predictive value (PPV) is 85.71%, while the negative predictive value is 100%. Univariate analysis determined body mass index (BMI), age and serum triglyceride levels were associated with CAP; however, multivariate linear regression revealed an association with only BMI (P < 0.001) and age (P < 0.002). When a lower fat threshold of 5% was considered to define HS with the same cut off of CAP, the sensitivity reduced to 66.7% and specificity was 98.3% The recipients of donors with HS of 5%-10% did not show any negative outcomes. Conclusion CAP demonstrates significant potential as a predictive tool for hepatic steatosis (HS) in living liver donors. Notably, BMI and age have been identified as independent factors associated with CAP values.
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Affiliation(s)
- Naimish N. Mehta
- Department of Hepato Pancreato Biliary Surgery, Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - Manmohan Rajput
- Department of Hepato Pancreato Biliary Surgery, Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - Karan Kumar
- Department of Hepatology, Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - Anand Nagar
- Department of Hepato Pancreato Biliary Surgery, Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - Vinay K. Mahala
- Department of Surgical Gastroenterology, Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - Vivek A. Saraswat
- Department of Hepatology, Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - Akash Mishra
- Department of Community Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, India
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Zhou L, Zhang P, Xiao Q. Association between weight-adjusted waist index and hepatic steatosis and fibrosis: Analyses of the NHANES 2017 to 2020. Medicine (Baltimore) 2025; 104:e42708. [PMID: 40489808 DOI: 10.1097/md.0000000000042708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2025] Open
Abstract
The weight-adjusted waist index (WWI) is emerging as a novel indicator for assessing obesity, which is known to correlate with nonalcoholic fatty liver disease (NAFLD), a condition that can lead to hepatic steatosis and fibrosis. This research aims to explore the possible link between WWI and liver steatosis and fibrosis. We conducted a cross-sectional analysis using data from 2017 to 2020 National Health and Nutrition Examination Survey. Controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) were used to diagnose hepatic steatosis and fibrosis, respectively, by vibration-controlled transient elastography, and multivariate logistic regression analysis was employed to examine the association between WWI and the 2. The non-linear relationship was described using threshold effect analyses and fitting smoothed curves. We also performed interaction tests and subgroup analyses, considering factors such as age, gender, body mass index, hypertension, diabetes, and smoking habits. Receiver operating characteristic curves were used to estimate cutoff points for identifying NAFLD. This study included 5535 adults. Results showed that higher levels of WWI are correlated with higher CAP scores, and the strong association between WWI and CAP was still evident after accounting for all covariates (odds ratios = 12.22, 95% confidence interval: 8.63-15.80). Subgroup analyses found a robust positive correlation between WWI and CAP in individuals with hypertension (P for interaction = .018). A non-linear positive correlation with a breakpoint of 11.12 was identified between WWI and CAP. But no significant correlation between WWI and LSM was found through multiple regression analyses (odds ratios = 0.10, 95% confidence interval: -0.17 to 0.37). Nevertheless, based on smoothed curve fitting, WWI and LSM formed a U-shaped relationship, showing a positive connection when WWI was above 11, when WWI dropped below 11, it showed a negative connection. Finally, the receiver operating characteristic analysis results indicated that the WWI cutoff point for identifying NAFLD was 10.8870. To validate these results, further extensive and prospective studies are required.
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Affiliation(s)
- Lijun Zhou
- Department of Ultrasound, The Third Hospital of Mianyang, Sichuan Mental Health Center, Sichuan, China
| | - Peng Zhang
- Department of Radiology, Anzhou District People's Hospital of Mianyang City, Sichuan, China
| | - Qing Xiao
- Department of Ultrasound, The Third Hospital of Mianyang, Sichuan Mental Health Center, Sichuan, China
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4
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Nishimura T, Tada T, Akita T, Kondo R, Suzuki Y, Imajo K, Kokubu S, Abe T, Kuroda H, Hirooka M, Hiasa Y, Nogami A, Nakajima A, Ogawa S, Toyoda H, Oeda S, Takahashi H, Eguchi Y, Sugimoto K, Yano H, Tanaka J, Moriyasu F, Kage M, Kumada T, Iijima H. Diagnostic performance of attenuation imaging versus controlled attenuation parameter for hepatic steatosis with MRI-based proton density fat fraction as the reference standard: a prospective multicenter study. J Gastroenterol 2025; 60:727-737. [PMID: 39992415 PMCID: PMC12095409 DOI: 10.1007/s00535-025-02224-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/02/2025] [Indexed: 02/25/2025]
Abstract
BACKGROUND Attenuation Imaging (ATI) and controlled attenuation parameter (CAP) are non-invasive ultrasound-based methods for diagnosing hepatic steatosis. However, reports on the clinical usefulness of ATI are limited. We aimed to compare the ability of ATI and CAP to diagnose hepatic steatosis with magnetic resonance imaging-based proton density fat fraction (MRI-PDFF) as the reference standard. METHODS We performed a prospective multicenter study of 562 patients with chronic liver disease who underwent ATI, CAP, and MRI-PDFF. Patients with skin-to-liver capsule distance (SCD) ≤ 25 mm underwent CAP with an M probe; those with SCD > 25 mm underwent CAP with an XL probe. MRI-PDFF was used as the reference standard: S0 corresponds to MRI-PDFF < 5.2%, S1 to 5.2% ≤ MRI-PDFF < 11.3%, S2 to 11.3% ≤ MRI-PDFF < 17.1%, and S3 to MRI-PDFF ≥ 17.1%. RESULTS The correlation coefficients for ATI and MRI-PDFF stratified by body mass index (< 30, ≥ 30 kg/m2), SCD (< 25, ≥ 25 mm), 2-dimensional share wave elastography (< 1.8 m/s), fibrosis-4 index (≤ 2.67), albumin-bilirubin score (< - 2.60) and type IV collagen 7 s (< 5.0 ng/ml) were significantly higher than those for CAP and MRI-PDFF. Areas under the receiver operating characteristics (95% CI) for ATI and CAP were 0.895 (0.869-0.922) and 0.845 (0.809-0.881) for ≥ S1 steatosis, 0.944 (0.926-0.963) and 0.881(0.852-0.910) for ≥ S2 steatosis, and 0.928 (95% CI 0.906-0.950) and 0.860 (95% CI 0.829-0.890) for S3 steatosis. ATI had higher diagnostic performance for all hepatic steatosis grades than CAP. CONCLUSIONS ATI is a more useful non-invasive method for diagnosing hepatic steatosis than CAP.
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Affiliation(s)
- Takashi Nishimura
- Division of Hepatobiliary and Pancreatic Disease, Department of Gastroenterology, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Japan
- Ultrasound Imaging Center, Hyogo Medical University Hospital, Nishinomiya, Japan
| | - Toshifumi Tada
- Department of Internal Medicine, Japanease Red Cross Himeji Hospital, Himeji, Japan
| | - Tomoyuki Akita
- Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
| | - Reiichiro Kondo
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Yasuaki Suzuki
- Department of Gastroenterology, Nayoro City General Hospital, Nayoro, Japan
| | - Kento Imajo
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Department of Gastroenterology, Shin-Yurigaoka General Hospital, Kawasaki, Japan
| | - Shigehiro Kokubu
- Department of Gastroenterology, Shin-Yurigaoka General Hospital, Kawasaki, Japan
| | - Tamami Abe
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Yahaba, Japan
| | - Hidekatsu Kuroda
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Yahaba, Japan
| | - Masashi Hirooka
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Asako Nogami
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Sadanobu Ogawa
- Department of Clinical Research, Ogaki Municipal Hospital, Ogaki, Japan
| | - Hidenori Toyoda
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Satoshi Oeda
- Liver Center, Saga Medical School, Saga University, Saga, Japan
- Department of Laboratory Medicine, Saga University Hospital, Saga, Japan
| | | | - Yuichiro Eguchi
- Liver Center, Saga Medical School, Saga University, Saga, Japan
| | - Katsutoshi Sugimoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Hirohisa Yano
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Junko Tanaka
- Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
| | - Fuminori Moriyasu
- Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan
| | - Masayoshi Kage
- Center for Innovative Cancer Therapy, Kurume University Research, Kurume, Japan
| | - Takashi Kumada
- Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan
| | - Hiroko Iijima
- Division of Hepatobiliary and Pancreatic Disease, Department of Gastroenterology, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Japan.
- Ultrasound Imaging Center, Hyogo Medical University Hospital, Nishinomiya, Japan.
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5
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Marti-Aguado D, Carot-Sierra JM, Villalba-Ortiz A, Siddiqi H, Vallejo-Vigo RM, Lara-Romero C, Martín-Fernández M, Fernández-Patón M, Alfaro-Cervello C, Crespo A, Coello E, Merino-Murgui V, Madamba E, Benlloch S, Pérez-Rojas J, Puglia V, Ferrández A, Aguilera V, Monton C, Escudero-García D, Lluch P, Aller R, Loomba R, Romero-Gomez M, Marti-Bonmati L. Identification of Candidates for MASLD Treatment With Indeterminate Vibration-Controlled Transient Elastography. Clin Gastroenterol Hepatol 2025; 23:1183-1193.e5. [PMID: 39551253 DOI: 10.1016/j.cgh.2024.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 09/15/2024] [Accepted: 10/09/2024] [Indexed: 11/19/2024]
Abstract
BACKGROUND AND AIMS A noteworthy proportion of patients with metabolic dysfunction-associated steatotic liver disease (MASLD) have an indeterminate vibration-controlled transient elastography (VCTE). Among these patients, we aimed to identify candidates for MASLD treatment by diagnosing significant fibrosis. METHODS This was a real-world prospective study including a large dataset of MASLD patients with paired VCTE and liver biopsy from 6 centers. A total of 1196 patients were recruited and divided in training (3 centers, Spain), internal validation (2 centers, Spain), and external validation (1 center, United States) cohorts. In patients with indeterminate liver stiffness measurement (LSM) (8-12 kPa), a diagnostic algorithm was developed to identify significant fibrosis, defined as histological stage ≥F2. Statistical analysis was performed using Gaussian mixture model (GMM) and k-means unsupervised clusterization. RESULTS From the eligible population, 33%, 29%, and 31% had indeterminate VCTE in the training, internal and external validation samples, respectively. The controlled attenuation parameter allowed the differentiation of GMM clusters with a cutoff of 280 dB/m (area under the curve, 0.89; 95% confidence interval, 0.86-0.97). Within patients with <280 dB/m, a LSM between 8.0-9.0 kPa showed a 93% sensitivity and a 91% negative predictive value to exclude significant fibrosis. Among patients with ≥280 dB/m, a LSM between 10.3 and 12.0 kPa diagnosed significant fibrosis with a 91% specificity. Applying this algorithm to the validation cohorts, 36% of the indeterminate VCTE were reallocated. The reallocated high-risk group showed a prevalence of 86% significant fibrosis, opening the therapeutic window for MASLD patients. CONCLUSIONS To identify candidates for MASLD treatment among indeterminate VCTE, an algorithm-based on the sequential combination of LSM and controlled attenuation parameter thresholds can optimize the diagnosis of moderate-to-advanced fibrosis.
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Affiliation(s)
- David Marti-Aguado
- Digestive Disease Department, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain; Biomedical Imaging Research Group (GIBI2(30)), La Fe Health Research Institute, Valencia, Spain; Imaging La Fe Node, Distributed Network for Biomedical Imaging Unique Scientific and Technical Infrastructures, Valencia, Spain.
| | - José Miguel Carot-Sierra
- Department of Applied Statistics, Operations Research and Quality, Universitat Politècnica de València, Valencia, Spain
| | - Aida Villalba-Ortiz
- Department of Applied Statistics, Operations Research and Quality, Universitat Politècnica de València, Valencia, Spain
| | - Harris Siddiqi
- MASLD Research Center, Division of Gastroenterology, University of California San Diego, La Jolla, California
| | - Rose Marie Vallejo-Vigo
- Digestive Diseases Department, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, Department of Medicine, University of Seville, Seville, Spain
| | - Carmen Lara-Romero
- Digestive Diseases Department, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, Department of Medicine, University of Seville, Seville, Spain
| | - Marta Martín-Fernández
- Department of Cell Biology, Genetics, Histology and Pharmacology, University of Valladolid, Valladolid, Spain; BioCritic, Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Matías Fernández-Patón
- Biomedical Imaging Research Group (GIBI2(30)), La Fe Health Research Institute, Valencia, Spain; Imaging La Fe Node, Distributed Network for Biomedical Imaging Unique Scientific and Technical Infrastructures, Valencia, Spain
| | - Clara Alfaro-Cervello
- Pathology Department, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain; Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Ana Crespo
- Digestive Disease Department, Hospital Arnau de Vilanova, Valencia, Spain
| | - Elena Coello
- Digestive Disease Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Víctor Merino-Murgui
- Digestive Disease Department, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - Egbert Madamba
- MASLD Research Center, Division of Gastroenterology, University of California San Diego, La Jolla, California
| | - Salvador Benlloch
- Digestive Disease Department, Hospital Arnau de Vilanova, Valencia, Spain; Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain
| | - Judith Pérez-Rojas
- Pathology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Víctor Puglia
- Pathology Department, Hospital Arnau de Vilanova, Valencia, Spain
| | - Antonio Ferrández
- Pathology Department, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain; Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Victoria Aguilera
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain; Hepatology and Liver Transplantation Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Cristina Monton
- Digestive Disease Department, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - Desamparados Escudero-García
- Digestive Disease Department, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain; Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Paloma Lluch
- Digestive Disease Department, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain; Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Rocío Aller
- BioCritic, Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, Dermatology and Toxicology, Universidad de Valladolid, Valladolid, Spain; Gastroenterology Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Rohit Loomba
- MASLD Research Center, Division of Gastroenterology, University of California San Diego, La Jolla, California; Division of Gastroenterology and Hepatology, University of California San Diego, La Jolla, California
| | - Manuel Romero-Gomez
- Digestive Diseases Department, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, Department of Medicine, University of Seville, Seville, Spain; University of Seville, Seville, Spain
| | - Luis Marti-Bonmati
- Biomedical Imaging Research Group (GIBI2(30)), La Fe Health Research Institute, Valencia, Spain; Imaging La Fe Node, Distributed Network for Biomedical Imaging Unique Scientific and Technical Infrastructures, Valencia, Spain; Radiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
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Bedeschi MF, Baldassarri A, Villa R, Tanzi F, Salera S, Lombardo V, Draghi A, O'Sed NP, Casazza G, Vecchi M, Fraquelli M. Phenotypical Characterization of Gastroenterological and Metabolic Manifestations in Patients With Williams-Beuren Syndrome. Am J Med Genet A 2025; 197:e63993. [PMID: 39868851 DOI: 10.1002/ajmg.a.63993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 12/24/2024] [Accepted: 01/03/2025] [Indexed: 01/28/2025]
Abstract
Gastrointestinal (GI) symptoms are common in patients with Williams-Beuren syndrome (WBS), but their prevalence and possible causes are not yet fully known. This study assessed GI symptoms' prevalence and their possible origin by performing a predefined set of tests in adult WBS patients. Laboratory tests and a questionnaire were administered to assess GI symptoms and dietary habits. All the patients underwent the urea breath test, H2-lactose and H2-glucose breath tests, and intestinal ultrasound (IUS) and vibration-controlled transient elastography for liver stiffness measurement (LSM) and controlled attenuation parameter (CAP, dB/m). Thirty-one patients were enrolled (72% of the whole cohort, 17 males, median age 32 years). Gastroesophageal reflux disease (GERD) symptoms were reported in 29% of the patients, abdominal pain in 26%, and altered bowel habits in 48%. Pathologic signs at (IUS) were present in 60% of the cases. Prevalence was 0.26 (95% CI 0.12-0.44) for Helicobacter pylori infection and 0.61 (95% CI 0.42-0.78) for lactose intolerance. LSM was > 6 kPa (in the range of a fibrosis score > F1) in three patients, and CAP values were > 268 dB/m (corresponding to a steatosis score > S2, e.g., moderate steatosis) in nine. The presence of altered bowel habits was significantly related to chronic abdominal pain (OR 13.1, p = 0.03). Increased BMI (> 28 kg/m2) (OR 10.8, p = 0.04) was associated with the presence of moderate-severe hepatic steatosis. After specific treatment and dietary counseling, most patients reported resolution/improvement of symptoms, whereas a few retained/developed symptoms during follow-up. Chronic abdominal pain, GERD symptoms, and unbalanced metabolic parameters were common in our WBS patients, together with an increased prevalence of lactose intolerance/colonic diverticula. Specific counseling and treatment improved symptoms for most patients.
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Affiliation(s)
| | - Annarita Baldassarri
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberta Villa
- Clinical Genetics Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federico Tanzi
- Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Simona Salera
- Direzione Medica di Presidio, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Vincenza Lombardo
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Draghi
- Clinical Genetics Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicole Piazza O'Sed
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Casazza
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mirella Fraquelli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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7
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Frías M, Chicano-Gálvez E, Rivero-Juárez A, Gordon A, Corona-Mata D, Moyano JM, Peralbo-Molina Á, Camacho Á, Pérez-Valero I, Del Mar Malagón M, Rivero A. Afamin and Apolipoprotein F Associated With Liver Steatosis From People Living With HIV: A Discovery Study. Aliment Pharmacol Ther 2025; 61:1767-1774. [PMID: 40159812 DOI: 10.1111/apt.70119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2024] [Revised: 02/06/2025] [Accepted: 03/24/2025] [Indexed: 04/02/2025]
Abstract
INTRODUCTION Liver steatosis (LS) is a condition that is characterised by hepatic fat accumulation unrelated to significant alcohol consumption. This study explored the serum proteomic profile associated with LS in people living with HIV (PLWH). METHODS The study cohort comprised 266 PLWH, 21.1% and 78.9% of whom had LS and no LS, respectively. Serum samples were analysed using liquid chromatography coupled with mass spectrometry (LC-MS). RESULTS Among the 220 proteins detected, afamin (AFM) and apolipoprotein F (APOF) were identified as proteins associated with LS. Differential expression of AFM and APOF was observed in under- and normoweight patients, emphasising their potential as biomarkers in patients without overweight or obesity. CONCLUSIONS These findings suggest that the identified proteins could serve as promising biomarkers of LS in PLWH, paving the way for further investigations into the roles of these proteins in LS development in this unique population.
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Affiliation(s)
- Mario Frías
- Unit of Infectious Diseases, Hospital Universitario Reina Sofia, Clinical Virology and Zoonoses Research Group, Maimonides Biomedical Research Institute of Cordoba, University of Córdoba, Córdoba, Spain
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Eduardo Chicano-Gálvez
- Mass Spectrometry and Molecular Imaging Unit, Maimonides Biomedical Research Institute of Cordoba, Reina Sofia University Hospital, University of Cordoba, Córdoba, Spain
| | - Antonio Rivero-Juárez
- Unit of Infectious Diseases, Hospital Universitario Reina Sofia, Clinical Virology and Zoonoses Research Group, Maimonides Biomedical Research Institute of Cordoba, University of Córdoba, Córdoba, Spain
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Gordon
- Department of Cell Biology, Physiology, and Immunology, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/University of Córdoba/Reina Sofia University Hospital, Córdoba, Spain
- CIBER Fisiopatología de La Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Diana Corona-Mata
- Unit of Infectious Diseases, Hospital Universitario Reina Sofia, Clinical Virology and Zoonoses Research Group, Maimonides Biomedical Research Institute of Cordoba, University of Córdoba, Córdoba, Spain
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - José María Moyano
- Department of Computer Science and Artificial Intelligence, University of Sevilla, Sevilla, Spain
| | - Ángela Peralbo-Molina
- Mass Spectrometry and Molecular Imaging Unit, Maimonides Biomedical Research Institute of Cordoba, Reina Sofia University Hospital, University of Cordoba, Córdoba, Spain
| | - Ángela Camacho
- Unit of Infectious Diseases, Hospital Universitario Reina Sofia, Clinical Virology and Zoonoses Research Group, Maimonides Biomedical Research Institute of Cordoba, University of Córdoba, Córdoba, Spain
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Ignacio Pérez-Valero
- Unit of Infectious Diseases, Hospital Universitario Reina Sofia, Clinical Virology and Zoonoses Research Group, Maimonides Biomedical Research Institute of Cordoba, University of Córdoba, Córdoba, Spain
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - María Del Mar Malagón
- Department of Cell Biology, Physiology, and Immunology, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/University of Córdoba/Reina Sofia University Hospital, Córdoba, Spain
- CIBER Fisiopatología de La Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Rivero
- Unit of Infectious Diseases, Hospital Universitario Reina Sofia, Clinical Virology and Zoonoses Research Group, Maimonides Biomedical Research Institute of Cordoba, University of Córdoba, Córdoba, Spain
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
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8
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Yang T, Bu T, Yang B, Zhao Y, Wang Q. CKM: A new approach to managing metabolic comorbidities in MASLD? J Hepatol 2025; 82:e291-e292. [PMID: 39667600 DOI: 10.1016/j.jhep.2024.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Revised: 12/03/2024] [Accepted: 12/03/2024] [Indexed: 12/14/2024]
Affiliation(s)
- Tianyuan Yang
- Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Tong Bu
- Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Bingqing Yang
- Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yuanying Zhao
- Department of Clinical Laboratory, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Qi Wang
- Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
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9
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Vergani M, Borella ND, Rizzo M, Conti M, Perra S, Bianconi E, Sani E, Csermely A, Grespan E, Targher G, Perseghin G, Mantovani A, Ciardullo S. Metabolic dysfunction-associated steatotic liver disease, insulin sensitivity and continuous glucose monitoring metrics in patients with type 1 diabetes: A multi-centre cross-sectional study. Diabetes Obes Metab 2025; 27:3201-3211. [PMID: 40083078 PMCID: PMC12046442 DOI: 10.1111/dom.16333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2025] [Revised: 02/25/2025] [Accepted: 03/03/2025] [Indexed: 03/16/2025]
Abstract
BACKGROUND AND AIM We assessed the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) and significant liver fibrosis in adults with type 1 diabetes mellitus (T1DM) and the association of MASLD with insulin sensitivity and continuous glucose monitoring metrics. METHODS We consecutively enrolled 198 adults with T1DM undergoing vibration-controlled transient elastography with liver stiffness measurement (LSM) and controlled attenuation parameter (CAP). All participants had a continuous glucose monitoring (CGM) device. Insulin sensitivity was evaluated by estimated glucose disposal rate (eGDR). MASLD was defined as CAP ≥ 248 db/m and the presence of at least one cardiometabolic risk factor. Significant liver fibrosis was defined as LSM ≥ 7 kPa. RESULTS Patients had a mean age of 56 years, mean BMI of 26.0 ± 5.9 kg/m2, and mean eGDR of 7.1 ± 2.3 mg/kg/min. 73 (37%) patients had MASLD (using a CAP threshold of 274 dB/m), 16 (8.1%) of whom had significant liver fibrosis. MASLD was associated with a significantly lower eGDR (beta coefficient = -0.367, 95% confidence interval -0.472 to -0.261; p < 0.001). This association remained significant, even after adjustment for age, sex, body mass index, plasma triglycerides, diabetes duration, daily insulin dose, time above the range of glucose levels, LSM and chronic kidney disease. No association was observed between MASLD and CGM-derived metrics. These results were not different when we used a CAP threshold of 274 dB/m for diagnosing MASLD. CONCLUSION In T1DM, MASLD was inversely associated with eGDR and biomarkers of insulin resistance but not with CGM-derived metrics.
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Affiliation(s)
- Michela Vergani
- Department of Medicine and RehabilitationPoliclinico di MonzaMonzaItaly
- School of Medicine and SurgeryUniversity of Milano BicoccaMilanItaly
| | - Nicolò Diego Borella
- Section of Endocrinology, Diabetes and Metabolism, Department of MedicineUniversity and Azienda Ospedaliera Universitaria Integrata of VeronaVeronaItaly
| | - Mariangela Rizzo
- Department of Medicine and RehabilitationPoliclinico di MonzaMonzaItaly
- School of Medicine and SurgeryUniversity of Milano BicoccaMilanItaly
| | - Matteo Conti
- Department of Medicine and RehabilitationPoliclinico di MonzaMonzaItaly
- School of Medicine and SurgeryUniversity of Milano BicoccaMilanItaly
| | - Silvia Perra
- Department of Medicine and RehabilitationPoliclinico di MonzaMonzaItaly
| | - Eleonora Bianconi
- Department of Medicine and RehabilitationPoliclinico di MonzaMonzaItaly
| | - Elena Sani
- Section of Endocrinology, Diabetes and Metabolism, Department of MedicineUniversity and Azienda Ospedaliera Universitaria Integrata of VeronaVeronaItaly
| | - Alessandro Csermely
- Section of Endocrinology, Diabetes and Metabolism, Department of MedicineUniversity and Azienda Ospedaliera Universitaria Integrata of VeronaVeronaItaly
| | - Elisabetta Grespan
- Section of Endocrinology, Diabetes and Metabolism, Department of MedicineUniversity and Azienda Ospedaliera Universitaria Integrata of VeronaVeronaItaly
| | - Giovanni Targher
- Department of MedicineUniversity of VeronaVeronaItaly
- Metabolic Diseases Research UnitIRCCS Sacro Cuore‐Don Calabria HospitalNegrar di Valpolicella (VR)Italy
| | - Gianluca Perseghin
- Department of Medicine and RehabilitationPoliclinico di MonzaMonzaItaly
- School of Medicine and SurgeryUniversity of Milano BicoccaMilanItaly
| | - Alessandro Mantovani
- Section of Endocrinology, Diabetes and Metabolism, Department of MedicineUniversity and Azienda Ospedaliera Universitaria Integrata of VeronaVeronaItaly
| | - Stefano Ciardullo
- Department of Medicine and RehabilitationPoliclinico di MonzaMonzaItaly
- School of Medicine and SurgeryUniversity of Milano BicoccaMilanItaly
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10
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Paik JM, Hobbs K, Gupta A, Alkalbani RJ, Reyes MA, Younossi ZM. Prevalence of MASLD, Met-ALD, and ALD and Associated Fibrosis Among US Adults: Insights From NHANES 2017 to 2023. J Clin Gastroenterol 2025:00004836-990000000-00455. [PMID: 40423524 DOI: 10.1097/mcg.0000000000002202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2025] [Accepted: 04/27/2025] [Indexed: 05/28/2025]
Abstract
BACKGROUND AND AIM Steatotic liver diseases (SLD) encompasses metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic alcohol-related liver disease (MetALD), and alcohol-related liver disease (ALD). Our aim was to determine the age-standardized prevalence of fibrosis stages and cirrhosis in US adults with different subtypes of SLD. METHODS We utilized data from the National Health and Nutrition Examination Survey (NHANES) spanning 2017 to 2023. SLD was defined by a controlled attenuation parameter (CAP) ≥280 dB/m. MASLD, MetALD, and ALD were defined according to the new nomenclature. Fibrosis and cirrhosis were estimated by liver stiffness measurements. RESULTS The age-standardized prevalence of SLD was 37.08% (MASLD: 32.42%, MetALD: 2.20%, and ALD: 1.29%) with males having higher prevalence rates versus females [SLD (42.40% vs. 31.59%), MASLD (35.84% vs. 28.88%), MetALD (2.82% vs. 1.56%), and ALD (2.17% vs. 0.38%) (all P < 0.03)]. For MASLD, the highest burden was observed in Mexicans (43.96%), followed by Whites (31.75%), Hispanics (32.69%), Asians (32.41%), and Blacks (27.39%). MetALD was most prevalent among Whites (2.56%) and least prevalent among Asians (0.25%). Between 2017 and 2020 and 2021 and 2023, the prevalence of SLD and its subtypes with fibrosis and cirrhosis increased, coinciding with rising alcohol consumption. Among individuals with MASLD, component of metabolic syndrome (type 2 diabetes and Obesity, especially severe obesity with BMI ≥40 kg/m²) were associated with increased risk of fibrosis and cirrhosis. CONCLUSION The burden of SLD, its subtypes, and associated fibrosis in the US is substantial. This highlights an urgent need for targeted public health strategies to manage the rising burden of this important liver disease in the US population.
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Affiliation(s)
- James M Paik
- The Global NASH Council
- Beatty Liver and Obesity Research Program, Inova Health System
| | - Kathryn Hobbs
- Beatty Liver and Obesity Research Program, Inova Health System
- Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA
| | - Amolika Gupta
- Beatty Liver and Obesity Research Program, Inova Health System
- Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA
| | - Rand Jamal Alkalbani
- Beatty Liver and Obesity Research Program, Inova Health System
- Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA
| | - Manuel Alexander Reyes
- Beatty Liver and Obesity Research Program, Inova Health System
- Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA
| | - Zobair M Younossi
- The Global NASH Council
- Center for Outcomes Research in Liver Diseases, Washington, DC
- Beatty Liver and Obesity Research Program, Inova Health System
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11
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Wang J, He W, Cai X, Hu Z, Peng Y, Chen X, Yang P, Zeng X, Chen S, Wang D. Relative fat mass and risk of metabolic dysfunction associated steatotic liver disease and severe hepatic steatosis in U.S. adults: analysis of NHANES 2017-2020 data. BMC Gastroenterol 2025; 25:410. [PMID: 40426055 PMCID: PMC12117908 DOI: 10.1186/s12876-025-04006-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2025] [Accepted: 05/19/2025] [Indexed: 05/29/2025] Open
Abstract
BACKGROUND Relative fat mass (RFM) is a novel, easily calculated, and cost-effective index of fat content and distribution in the body, associated with the odds of developing various obesity-related diseases. However, its association with metabolic dysfunction associated steatotic liver disease (MASLD) and severe hepatic steatosis (SHS) is underexplored. This study aims to examine the relationship between RFM and the odds of having MASLD or SHS in the general adult population. METHODS This was a population-based cross-sectional study using data from the National Health and Nutrition Examination Survey (2017.01-2020.03). The aim of the statistical analysis was to examine the association between RFM and the prevalence of MASLD and SHS. Logistic regression was applied to explore this relationship. Nonlinear associations between RFM levels and MASLD or SHS prevalence were assessed using smoothed curve fitting and threshold effect models. Subgroup analyses were conducted to evaluate the consistency of this association across different population groups. RESULTS A total of 6699 participants were included in this study, of whom 2825 had MASLD and 1834 had SHS. After adjusting for confounders, significant positive associations were observed between RFM and the prevalence of MASLD and SHS (odds ratio [OR]: 1.22, 95% confidence interval [CI: ] 1.18-1.26 and OR: 1.26, 95% CI: 1.21-1.30). Smoothed curve fitting and threshold effect analysis showed a nonlinear relationship between RFM and the prevalence of MASLD and SHS, with thresholds of 41.96 for MASLD prevalence and 40.42 for SHS prevalence. When the subgroups were analyzed according to sex, age, race, education level, smoking status, household income, body mass index, hypertension, and diabetes, no significant interactions were found between RFM and most subgroups. CONCLUSIONS Our results demonstrated a positive nonlinear relationship between RFM and the prevalence of MASLD and SHS, with a threshold effect. Lower RFM levels are associated with lower odds of MASLD and SHS. These findings suggest that RFM may serve as a simple, cost-effective tool for identifying individuals at increased odds of NAFLD and SHS in the general population.
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Affiliation(s)
- Jianjun Wang
- Department of Hepatobiliary Surgery, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, China
- NHC Key Laboratory of Nuclear Technology Medical Transformation, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Wei He
- Department of Stomatology, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Xianfu Cai
- Department of Urology, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Zhaohui Hu
- Department of Hepatobiliary Surgery, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Yonghai Peng
- Department of Hepatobiliary Surgery, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Xi Chen
- Department of Hepatobiliary Surgery, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Pei Yang
- Department of Hepatobiliary Surgery, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Xintao Zeng
- Department of Hepatobiliary Surgery, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, China.
| | - Sirui Chen
- Department of Hepatobiliary Surgery, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, China.
| | - Decai Wang
- NHC Key Laboratory of Nuclear Technology Medical Transformation, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, China.
- Department of Urology, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, China.
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12
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Zhang M, Yuan Y, Wang C, Huang Y, Fan M, Li X, Qin Z. Aggregate index of systemic inflammation tied to increased fatty liver disease risk: insights from NHANES data. BMC Gastroenterol 2025; 25:399. [PMID: 40410700 PMCID: PMC12101034 DOI: 10.1186/s12876-025-03998-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2025] [Accepted: 05/15/2025] [Indexed: 05/25/2025] Open
Abstract
BACKGROUND Fatty liver disease (FLD), characterized by hepatic lipid accumulation, impairs quality of life and can progress to cirrhosis and hepatocellular carcinoma, imposing a healthcare burden. This study investigates the association between the aggregate index of systemic inflammation (AISI) and FLD prevalence, evaluating AISI's potential as an early biomarker for risk assessment. METHODS Data were obtained from the National Health and Nutrition Examination Survey (NHANES) database, which encompasses the years 2017 through 2020. Participants were chosen based on the availability of controlled attenuation parameter (CAP) scores derived from transient elastography (TE), a technique utilized for assessing liver steatosis. The formula employed to compute the AISI is as follows: AISI = N × P × M / L, where N, P, M, and L refer to neutrophils, platelets, monocytes, and lymphocytes, respectively. Additionally, demographic, socioeconomic, dietary, and health-related information was gathered. Logistic regression models were utilized to pinpoint risk factors associated with FLD, and a nomogram was created to forecast FLD risk. RESULTS Of the 3,961 participants, 2,377 (60.0%) were diagnosed with FLD based on a CAP score ≥ 248 dB/m. Elevated AISI was significantly associated with FLD (P = 0.021). Other significant risk factors included sex, age, BMI, race, marital status, hypertension, and diabetes. The nomogram demonstrated excellent discriminatory performance with an AUC of 0.814 (95% CI: 0.800, 0.827) and good calibration. CONCLUSION This study reveals a significant, independent association between elevated AISI and increased FLD risk in the U.S. population, even after adjusting for confounders. AISI demonstrated good discriminative performance for FLD, but its effect size suggests it should supplement, not replace, existing clinical risk assessment tools. AISI, a cost-effective biomarker, holds potential for enhancing FLD screening, particularly in resource-limited settings.
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Affiliation(s)
- Meng Zhang
- Guangxi International Zhuang Medicine Hospital (Affiliated International Zhuang Medicine Hospital, Guangxi University of Chinese Medicine), Nanning, 530200, China
| | - Yuan Yuan
- School of Public Health and Management, Guangxi University of Chinese Medicine, Nanning, 530200, China
| | - Chenglong Wang
- Guangxi International Zhuang Medicine Hospital (Affiliated International Zhuang Medicine Hospital, Guangxi University of Chinese Medicine), Nanning, 530200, China
| | - You Huang
- Institute of Chinese Medicine, Zhuang and Yao Medicine, Guangxi University of Chinese Medicine, Nanning, 530200, China
| | - Mingli Fan
- Institute of Chinese Medicine, Zhuang and Yao Medicine, Guangxi University of Chinese Medicine, Nanning, 530200, China
| | - Xiangling Li
- Institute of Chinese Medicine, Zhuang and Yao Medicine, Guangxi University of Chinese Medicine, Nanning, 530200, China.
| | - Zujie Qin
- Guangxi International Zhuang Medicine Hospital (Affiliated International Zhuang Medicine Hospital, Guangxi University of Chinese Medicine), Nanning, 530200, China.
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13
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Niezen S, Mendes TB, Tapper EB. Waist-to-Height Ratio Enhances Predictive Accuracy for Severe Hepatic Steatosis and Advanced Fibrosis: A National Cohort Study. Clin Gastroenterol Hepatol 2025:S1542-3565(25)00357-X. [PMID: 40378990 DOI: 10.1016/j.cgh.2025.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Revised: 03/06/2025] [Accepted: 05/06/2025] [Indexed: 05/19/2025]
Affiliation(s)
- Sebastian Niezen
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - Thiago Bosco Mendes
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Elliot B Tapper
- Division of Gastroenterology, Department of Medicine, University of Michigan, Ann Arbor, Michigan
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14
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Fan Z, Yang C, Zhao X, Zhang J. Association of cardiometabolic markers with hepatic steatosis and liver fibrosis in population without obesity and diabetes. Sci Rep 2025; 15:15695. [PMID: 40325101 PMCID: PMC12053748 DOI: 10.1038/s41598-025-01003-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2025] [Accepted: 05/02/2025] [Indexed: 05/07/2025] Open
Abstract
The link between cardiometabolic markers and hepatic steatosis and liver fibrosis in non-hypertensive, non-diabetic populations remains unclear. A study was conducted using data from the National Health and Nutrition Examination Survey. Hepatic steatosis and liver fibrosis were assessed using vibration-controlled transient elastography. Logistic regression and restricted cubic splines (RCS) were used to evaluate the associations of cardiometabolic index (CMI), atherogenic index of plasma (AIP), triglyceride-glucose index (TyG), and estimated glucose disposal rate (eGDR) on hepatic steatosis and estimated fibrosis. Mediation analysis examined the role of insulin resistance (HOMA-IR) and liver enzymes. Among 1489 participants, 39.15% had hepatic steatosis and 2.82% had liver fibrosis. Higher CMI (OR = 3.967, 95%CI: 2.297, 6.851), AIP (OR = 3.255, 95%CI: 2.031, 5.216), TyG (OR = 3.689, 95%CI: 2.363, 5.760), and FLI (OR = 2.695, 95%CI: 1.997, 7.816) tertiles of Q3 were linked to increased hepatic steatosis odds, while eGDR reduced odds (OR = 0.217, 95%CI: 0.127, 0.373). The AUC values of these four cardiac markers were greater than FLI, among which eGDR showed the highest predictive value (AUC = 0.781). In the hepatic steatosis population, CMI (OR = 1.419, 95%CI: 1.033, 2.747), AIP (OR = 5.527, 95%CI: 1.082, 28.242), and TyG (OR = 2.345, 95%CI: 1.180, 4.661) were also showed significant association with liver fibrosis, while eGDR and FIB-4 were not associated with liver fibrosis. AIP had the highest discriminative ability for liver fibrosis (AUC = 0.798). Mediation analysis showed HOMA-IR mediated 25.50%~36.20% of cardiometabolic markers' associations with hepatic steatosis, followed by liver enzymes. Cardiometabolic markers are strongly linked to hepatic steatosis and liver fibrosis in populations without traditional risk factors, even outperforming the established hepatic steatosis and the fibrosis marker, highlighting their potential for early liver disease risk identification in seemingly healthy individuals.
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Affiliation(s)
- Zhixing Fan
- Department of Cardiology, the First College of Clinical Medical Sciences, China Three Gorges University, Yichang, 443003, China
- Institute of Cardiovascular Diseases, Three Gorges University, Yichang, 443003, China
| | - Chaojun Yang
- Department of Cardiology, the First College of Clinical Medical Sciences, China Three Gorges University, Yichang, 443003, China
- Institute of Cardiovascular Diseases, Three Gorges University, Yichang, 443003, China
| | - Xiaojing Zhao
- Schoolof Foreign Stdies, China Three Gorges·University, Yichang, 443003, China
| | - Jing Zhang
- The Second Department of Infectious Disease, Shanghai Fifth People's Hospital, Fudan University, 801 Heqing Road, Minhang District, Shanghai, 201100, China.
- Center of Community-Based Health Research, Fudan University, Shanghai, 201100, China.
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15
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Oduwole O, Ding C, Bitar N, Nair D, Salter S, Silverman M, Allen R, Ng Fat L, Tsochatzis E, Bell S, Mehta G, Britton A. Steatotic liver disease is a marker of multimorbidity, not underlying cirrhosis, in older adults. NPJ GUT AND LIVER 2025; 2:10. [PMID: 40336824 PMCID: PMC12052588 DOI: 10.1038/s44355-025-00024-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2024] [Accepted: 04/06/2025] [Indexed: 05/09/2025]
Abstract
Steatotic liver disease (SLD) prevalence in adults is estimated at 30%, but older populations are understudied. Here, SLD prevalence and associated risk factors were assessed 1,021 Whitehall II study participants (mean age 72.5) using transient elastography (FibroScan). SLD was present in 33.3% (CAP ≥ 275 dB/m), with most classified as metabolic dysfunction-associated SLD. Only 2.4% had significant fibrosis ( ≥ 7.9 kPa). Adjusted for age and sex, SLD was associated with low physical activity (OR 1.60, 95% CI 1.13-2.27), poorer motor function (SF-36 PCS OR 1.21, 95% CI 1.05-1.40), difficulties in activities of daily living (OR 3.19, 95% CI 1.17-8.64), and multimorbidity (OR 1.45, 95% CI 1.22-1.73). These associations persisted after adjustment for socioeconomic, behavioural, and cardiometabolic risk factors. Frailty was associated with SLD at higher CAP thresholds ( ≥ 290 dB/m). In this older adult sample, SLD is common and appears more as a marker of multimorbidity and low physical activity than significant fibrosis.
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Affiliation(s)
- O. Oduwole
- Institute for Liver and Digestive Health, University College London, London, UK
| | - C. Ding
- Institute for Liver and Digestive Health, University College London, London, UK
- Department of Clinical Biochemistry, Royal Free Hospital, London, UK
| | - N. Bitar
- Institute for Liver and Digestive Health, University College London, London, UK
| | - D. Nair
- Department of Clinical Biochemistry, Royal Free Hospital, London, UK
| | - S. Salter
- Department of Clinical Biochemistry, Royal Free Hospital, London, UK
- Health Services Laboratories, London, UK
| | - M. Silverman
- Patient and public involvement and engagement (PPIE) representative, London, UK
| | - R. Allen
- Patient and public involvement and engagement (PPIE) representative, London, UK
| | - L. Ng Fat
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - E. Tsochatzis
- Institute for Liver and Digestive Health, University College London, London, UK
| | - S. Bell
- Precision Breast Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, UK
- Cancer Research UK Cambridge Centre, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
| | - G. Mehta
- Institute for Liver and Digestive Health, University College London, London, UK
| | - A. Britton
- Research Department of Epidemiology and Public Health, University College London, London, UK
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16
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Dissayabutra T, Chuaypen N, Somnark P, Boonkaew B, Udomkarnjananun S, Kittiskulnam P, Charoenchittang P, Prombutara P, Tangkijvanich P. Characterization of gut dysbiosis and intestinal barrier dysfunction in patients with metabolic dysfunction-associated steatotic liver disease and chronic kidney disease: a comparative study. Sci Rep 2025; 15:15481. [PMID: 40319096 PMCID: PMC12049563 DOI: 10.1038/s41598-025-00237-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Accepted: 04/25/2025] [Indexed: 05/07/2025] Open
Abstract
The mechanistic role of gut microbiota in metabolic dysfunction-associated steatotic liver disease (MASLD) and chronic kidney disease (CKD) is increasingly recognized. Despite their close association, comparative data regarding gut dysbiosis in these disorders are limited. This study included 22 healthy controls and 180 patients (90 MASLD, 60 CKD, and 30 both diseases with sex- and age-matched). Fecal bacterial 16 S ribosomal RNA sequencing and butyryl-CoA: acetate CoA transferase (BCoAT) gene expression were analyzed. Plasma intestinal fatty acid binding protein (I-FABP), representing intestinal barrier dysfunction, was assessed using the ELISA method. Our data showed that alpha and beta diversities of gut microbiota differed between MASLD and healthy controls. However, only beta diversities were different between CKD and healthy individuals. The MASLD and CKD groups displayed fewer SCFA-producing genera, particularly Bifidobacterium, than healthy controls. Fecal BCoAT levels were inversely correlated with eGFR and I-FABP levels. Patients with CKD had significantly enriched pathogenic bacteria, reduced BCoAT, and increased I-FABP levels versus MASLD. Combining significant bacterial genera discriminated MASLD from CKD with high diagnostic accuracy (AUC of 0.90). Among patients with both diseases, gut microbial alterations showed mixed characteristics of MASLD and CKD. These data highlighted the shared and distinct gut dysbiosis and related biomarkers, which could provide a better understanding of MASLD and CKD pathogenesis.
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Affiliation(s)
- Thasinas Dissayabutra
- Metabolic Diseases in Gut and Urinary System Research Unit (MeDGURU), Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Natthaya Chuaypen
- Metabolic Diseases in Gut and Urinary System Research Unit (MeDGURU), Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pornjira Somnark
- Center of Excellence in Hepatitis and Liver Cancer, Department of Biochemistry, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Bootsakorn Boonkaew
- Center of Excellence in Hepatitis and Liver Cancer, Department of Biochemistry, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Suwasin Udomkarnjananun
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Piyawan Kittiskulnam
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Division of Internal Medicine-Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Pimpisa Charoenchittang
- Department of Computer Science, Faculty of Science, Kasetsart University, Bangkok, Thailand
- Mod Gut Co., Ltd., Bangkok, Thailand
| | - Pinidphon Prombutara
- Mod Gut Co., Ltd., Bangkok, Thailand
- Omics Sciences and Bioinformatics Center, Faculty of Science, Chulalongkorn University, Bangkok, Thailand
| | - Pisit Tangkijvanich
- Center of Excellence in Hepatitis and Liver Cancer, Department of Biochemistry, Chulalongkorn University, Bangkok, 10330, Thailand.
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Jin X, Yip TCF, Wong GLH, Wong VWS, Lai JCT. The new definition of metabolic dysfunction-associated steatotic liver disease: the role of ultrasound and elastography. Ultrasonography 2025; 44:189-201. [PMID: 40211108 PMCID: PMC12081130 DOI: 10.14366/usg.24219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2024] [Revised: 03/13/2025] [Accepted: 03/18/2025] [Indexed: 04/12/2025] Open
Abstract
In 2023, nonalcoholic fatty liver disease was renamed metabolic dysfunction-associated steatotic liver disease by the American and European liver associations. This new nomenclature recognizes metabolic dysfunction as the central driver of the disease, and the diagnostic criteria now require the presence of hepatic steatosis plus at least one of five cardiometabolic risk factors. B-mode ultrasonography remains the most common and practical method for detecting hepatic steatosis, although newer ultrasound techniques based on attenuation, backscatter, and speed of sound have gained traction as tools to diagnose and quantify hepatic steatosis. Additionally, ultrasound elastography is increasingly used in routine clinical practice to assess liver fibrosis, diagnose cirrhosis, and identify clinically significant portal hypertension.
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Affiliation(s)
- Xinrui Jin
- Department of Medicine and Therapeutics, Medical Data Analytics Center, The Chinese University of Hong Kong, Hong Kong, China
- State Key Laboratory of Digestive Disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Terry Cheuk-Fung Yip
- Department of Medicine and Therapeutics, Medical Data Analytics Center, The Chinese University of Hong Kong, Hong Kong, China
- State Key Laboratory of Digestive Disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Grace Lai-Hung Wong
- Department of Medicine and Therapeutics, Medical Data Analytics Center, The Chinese University of Hong Kong, Hong Kong, China
- State Key Laboratory of Digestive Disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, Medical Data Analytics Center, The Chinese University of Hong Kong, Hong Kong, China
- State Key Laboratory of Digestive Disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Jimmy Che-To Lai
- Department of Medicine and Therapeutics, Medical Data Analytics Center, The Chinese University of Hong Kong, Hong Kong, China
- State Key Laboratory of Digestive Disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
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18
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Noon SL, Chun LF, Lam TBN, Thai NQN, Dunn W, Schwimmer JB. Prevalence and Predictors of Suspected Metabolic Dysfunction-Associated Steatotic Liver Disease in Adolescents in the United States. Aliment Pharmacol Ther 2025; 61:1479-1488. [PMID: 39943715 PMCID: PMC11981549 DOI: 10.1111/apt.70022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2024] [Revised: 12/20/2024] [Accepted: 02/01/2025] [Indexed: 04/11/2025]
Abstract
BACKGROUND Nomenclature for steatotic liver disease has been updated to include metabolic dysfunction-associated steatotic liver disease (MASLD), which requires the presence of hepatic steatosis and at least one cardiometabolic risk factor. The prevalence of MASLD in adolescents is understudied. AIM To determine the prevalence of suspected MASLD among adolescents in the United States and to examine the relationships between elevated alanine aminotransferase (ALT) and cardiometabolic risk factors. METHODS A cross-sectional analysis of the National Health and Nutrition Examination Survey from 2011 to 2020 was conducted for adolescents aged 12-19 years. Elevated ALT was defined using sex-specific biological upper limits: > 26 U/L for males and > 22 U/L for females. Suspected MASLD was identified by elevated ALT and at least one cardiometabolic risk factor. Adolescents with elevated ALT were categorised as having suspected MASLD, elevated ALT due to other causes or cryptogenic ALT elevation. RESULTS Overall, 14.6% of adolescents had elevated ALT. Of these, 77.2% had suspected MASLD, 20.2% had cryptogenic ALT elevation, 1.9% took hepatotoxic medications and 0.7% had viral hepatitis. Body mass index had the strongest association with elevated ALT (OR 3.55), followed by high triglycerides (OR 2.09), low HDL cholesterol (OR 2.05) and high blood pressure (OR 1.93). CONCLUSIONS Most adolescents with elevated ALT met MASLD criteria, yet a portion lacked cardiometabolic risk factors or other identifiable causes. These results support the adoption of MASLD criteria in adolescents while indicating a need for further research into cryptogenic ALT elevation in paediatric populations.
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Affiliation(s)
- Sheila L. Noon
- Division of Gastroenterology, Hepatology and Nutrition, Department of PediatricsUniversity of California San Diego School of MedicineSan DiegoCaliforniaUSA
- University of California, San Diego School of MedicineSan DiegoCaliforniaUSA
| | - Lauren F. Chun
- Division of Gastroenterology, Hepatology and Nutrition, Department of PediatricsUniversity of California San Diego School of MedicineSan DiegoCaliforniaUSA
- Department of GastroenterologyRady Children's HospitalSan DiegoCaliforniaUSA
| | - Tin Bo Nicholas Lam
- Division of Gastroenterology, Hepatology and Nutrition, Department of PediatricsUniversity of California San Diego School of MedicineSan DiegoCaliforniaUSA
- Department of GastroenterologyRady Children's HospitalSan DiegoCaliforniaUSA
| | - Nhat Quang N. Thai
- Division of Gastroenterology, Hepatology and Nutrition, Department of PediatricsUniversity of California San Diego School of MedicineSan DiegoCaliforniaUSA
- University of California San Diego Herbert Wertheim School of Public Health and Human Longevity ScienceSan DiegoCaliforniaUSA
- San Diego State University School of Public HealthSan DiegoCaliforniaUSA
| | - Winston Dunn
- Department of GastroenterologyThe University of Kansas Health SystemKansas CityMissouriUSA
| | - Jeffrey B. Schwimmer
- Division of Gastroenterology, Hepatology and Nutrition, Department of PediatricsUniversity of California San Diego School of MedicineSan DiegoCaliforniaUSA
- Department of GastroenterologyRady Children's HospitalSan DiegoCaliforniaUSA
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Xi W, Liao W, Li J, Yang Y, Guo T, Jiang Q, Yang A. The association between stress hyperglycemia ratio and nonalcoholic fatty liver disease among U.S. adults: A population-based study. Nutr Metab Cardiovasc Dis 2025; 35:103780. [PMID: 39638676 DOI: 10.1016/j.numecd.2024.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 10/11/2024] [Accepted: 10/20/2024] [Indexed: 12/07/2024]
Abstract
BACKGROUND AND AIM The stress hyperglycemia ratio (SHR) offers a more nuanced understanding of glucose metabolism by factoring in the background glycemia through the component of Hemoglobin A1c. The association of SHR with cardiovascular and cerebrovascular diseases has been established, but the relationship between SHR and the risk of nonalcoholic fatty liver disease (NAFLD) remains unexplored. This study aimed to elucidate the relationship between the two among U.S. adults with diabetes or prediabetes. METHODS AND RESULTS A total of 1409 participants diagnosed with diabetes or prediabetes from the National Health and Nutrition Examination Survey (NHANES) 2017-2020 were included in this study. Multiple logistic regression models (ranging from unadjusted to fully adjusted), restricted cubic splines, and subgroup analyses were employed to determine the relationship between SHR and NAFLD risk and to assess the stability of this relationship across different populations. The average age of all participants was 54.65 years, with males accounting for 47.91 %, and the prevalence of NAFLD being 68.77 %. A fully adjusted logistic regression model indicated a positive association between SHR levels and the risk of NAFLD. Specifically, for each one standard deviation increase in SHR, the risk of NAFLD increased by 20 % (OR, 1.2; 95 % CI, 1.0-1.4). Both the trend test and the restricted cubic splines suggested a linear relationship between the two variables (p for trend <0.05, p for nonlinear = 0.390). Subgroup analysis demonstrated that this positive association remained consistent across most subgroups. CONCLUSIONS SHR was identified as a valuable index for predicting the risk of NAFLD among U.S. adults with diabetes or prediabetes.
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Affiliation(s)
- Wenfeng Xi
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Wanying Liao
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Jianing Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Yingyun Yang
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Tao Guo
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Qingwei Jiang
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China.
| | - Aiming Yang
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China.
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Chang YP, Lee JY, Chen CY, Kao WY, Lin CL, Yang SS, Shih YL, Peng CY, Lee FJ, Tsai MC, Huang SC, Su TH, Tseng TC, Liu CJ, Chen PJ, Kao JH, Liu CH. Risk of Incident Type 2 Diabetes and Prediabetes in Patients With Direct Acting Antiviral-Induced Cure of Hepatitis C Virus Infection. Aliment Pharmacol Ther 2025; 61:1508-1518. [PMID: 39981689 DOI: 10.1111/apt.70029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2024] [Revised: 12/29/2024] [Accepted: 02/06/2025] [Indexed: 02/22/2025]
Abstract
BACKGROUND Data regarding the risk of incident type 2 diabetes (T2D) and prediabetes among patients with hepatitis C virus (HCV) achieving direct-acting antivirals (DAAs)-induced sustained virologic response (SVR12) remains limited. METHODS A total of 1079 patients, including 589 with normoglycemia and 490 with prediabetes, who underwent biannual fasting glucose and glycosylated haemoglobin (HbA1c) assessment for a median post-SVR12 follow-up of 5.5 years, were enrolled. We reported the crude (cIRs) and age-standardised incidence rates (ASIRs) of T2D and prediabetes. Factors associated with incident T2D and prediabetes were assessed using the Cox proportional hazards models. RESULTS The cIRs of T2D and prediabetes were 1.18 and 8.99 per 100 person-years of follow-up (PYFU), respectively. Additionally, the ASIRs of T2D and prediabetes were 1.09 (95% CI: 0.76-1.53) and 8.47 (95% CI: 7.23-9.90) per 100 PYFU. Prediabetes (adjusted hazard ratio [aHR]: 4.71; 95% confidence interval (CI): 2.55-8.70, p < 0.001), body mass index (BMI) per kg/m2 increase (aHR: 1.17; 95% CI: 1.09-1.26, p < 0.001) and liver stiffness measurement (LSM) per kPa increase (aHR: 1.05; 95% CI: 1.02-1.09, p = 0.001) were associated with a higher risk of incident T2D. Age per year increase (aHR: 1.02; 95% CI: 1.01-1.03, p < 0.001) was associated with a higher risk of incident prediabetes. CONCLUSION The incidence rates of T2D and prediabetes remain substantial among patients after HCV eradication. Lifestyle modification, drug therapy and regular monitoring of glycemic status are crucial for patients at risk of developing T2D and prediabetes following HCV clearance.
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Affiliation(s)
- Yu-Ping Chang
- Department of Internal Medicine, National Taiwan University Biomedical Park Hospital, Hsin-Chu, Taiwan
| | - Ji-Yuh Lee
- Department of Internal Medicine, National Taiwan University Hospital, Yunlin, Taiwan
| | - Chi-Yi Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
| | - Wei-Yu Kao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Graduate Institute of Metabolism and Obesity Sciences, Taipei Medical University, Taipei, Taiwan
- TMU Research Center for Digestive Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan
| | - Chih-Lin Lin
- Department of Gastroenterology, Taipei City Hospital, Taipei, Taiwan
| | - Sheng-Shun Yang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan
- Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Yu-Lueng Shih
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Cheng-Yuan Peng
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Fu-Jen Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Ming-Chang Tsai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Shang-Chin Huang
- Department of Internal Medicine, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan
| | - Tung-Hung Su
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Tai-Chung Tseng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Jen Liu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pei-Jer Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jia-Horng Kao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chen-Hua Liu
- Department of Internal Medicine, National Taiwan University Hospital, Yunlin, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
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Zou Y, Dai Y, Li Z, Lin B, Chen H, Zhuang Z, Li W, Yang Q, Dai D. Modified triglyceride-glucose indices as novel predictors of metabolic dysfunction-associated fatty liver disease in US adolescents: a nationally representative study from NHANES 2017-2020. BMC Gastroenterol 2025; 25:325. [PMID: 40312305 PMCID: PMC12044992 DOI: 10.1186/s12876-025-03915-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2025] [Accepted: 04/18/2025] [Indexed: 05/03/2025] Open
Abstract
BACKGROUND Metabolic dysfunction-associated fatty liver disease (MAFLD) has become the most prevalent chronic liver condition in adolescents. The triglyceride-glucose (TyG) index, a surrogate marker of insulin resistance, has shown promise in adult MAFLD detection but requires pediatric-specific validation, particularly when combined with anthropometric measures. This study investigated the association between modified TyG indices and MAFLD, and evaluated their predictive value in adolescents. METHODS This cross-sectional study analyzed data from 532 adolescents (12-18 years) in the 2017-2020 National Health and Nutrition Examination Survey (NHANES) with complete records. MAFLD diagnosis was based on transient elastography plus metabolic criteria. The investigators employed multivariate linear regression and restricted cubic splines (RCS) to examine linear and nonlinear relationships between modified TyG indices and CAP values. Subgroup analyses were stratified by obesity status, and sensitivity analyses were performed on the NAFLD cohort (n = 527). Receiver operating characteristic (ROC) curve analysis, using Youden's index, evaluated the predictive performance of TyG indices for MAFLD identification. RESULTS Among 130 MAFLD adolescents (vs 402 controls), modified TyG indices demonstrated significantly stronger associations with CAP in fully adjusted models compared to the original TyG index. TyG-WC showed the highest diagnostic accuracy (AUC = 0.923, 95%CI:0.900-0.947), followed by TyG-BMI (AUC = 0.917) and TyG-WHtR (AUC = 0.915), while the original TyG index performed poorly (AUC = 0.673). Subgroup analyses revealed particularly strong associations in non-obese participants, and sensitivity analyses confirmed result robustness after excluding potential confounders. Optimal cutoff values provided clinically useful screening thresholds, with TyG-WC achieving 94% sensitivity at 665.94. CONCLUSION This study demonstrates that modified TyG indices incorporating anthropometric parameters (particularly TyG-WC) significantly outperform the original TyG index for MAFLD detection in adolescents, with superior diagnostic accuracy (AUC 0.915-0.923). The robust predictive performance maintained in sensitivity analyses and non-obese subgroups supports their clinical utility as simple, non-invasive screening tools for pediatric MAFLD risk stratification.
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Affiliation(s)
- Yigui Zou
- Key Laboratory for Precision Diagnosis and Treatment of Pediatric Digestive System Disease, Endoscopy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong, 518036, China
| | - Yu Dai
- Children's Healthcare and Mental Health Center, Shenzhen Children's Hospital, Shenzhen , Guangdong, 518036, China
| | - Ziyuan Li
- Key Laboratory for Precision Diagnosis and Treatment of Pediatric Digestive System Disease, Endoscopy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong, 518036, China
| | - Baixian Lin
- Key Laboratory for Precision Diagnosis and Treatment of Pediatric Digestive System Disease, Endoscopy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong, 518036, China
| | - Hu Chen
- Key Laboratory for Precision Diagnosis and Treatment of Pediatric Digestive System Disease, Endoscopy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong, 518036, China
| | - Zeling Zhuang
- Key Laboratory for Precision Diagnosis and Treatment of Pediatric Digestive System Disease, Endoscopy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong, 518036, China
| | - Wenwen Li
- Key Laboratory for Precision Diagnosis and Treatment of Pediatric Digestive System Disease, Endoscopy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong, 518036, China
| | - Qinghua Yang
- Key Laboratory for Precision Diagnosis and Treatment of Pediatric Digestive System Disease, Endoscopy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong, 518036, China
| | - Dongling Dai
- Key Laboratory for Precision Diagnosis and Treatment of Pediatric Digestive System Disease, Endoscopy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong, 518036, China.
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22
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Zheng X, Zhao D, Wang L, Wang Y, Chen Y, Zhang Y. Prevalence of Metabolic Dysfunction-associated Steatotic Liver Disease and Cardiometabolic Risk Factor in US Adolescents. J Clin Endocrinol Metab 2025; 110:e1458-e1465. [PMID: 39136243 DOI: 10.1210/clinem/dgae553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 07/20/2024] [Accepted: 08/12/2024] [Indexed: 10/25/2024]
Abstract
CONTEXT Metabolic dysfunction-associated steatotic liver disease (MASLD) is widespread worldwide, and a strong link between MASLD and cardiometabolic risk factors (CMRFs) was highlighted in this study. OBJECTIVE This study characterized the prevalence of MASLD in adolescent population and overlapping CMRFs conditions in MASLD. METHODS This is a cross-sectional study of US adolescents aged 12 to 19 years in the 2017 through 2020 cycles of the National Health and Nutrition Examination Survey. The relationship between CMRFs and liver steatosis, evaluated by the median controlled attenuation parameter (CAP), was assessed. RESULTS The prevalence of MASLD in adolescents was 23.77%. Isolated overweight/obesity (35%) was the top CMRF. Non-Hispanic Black patients had the highest proportion of overweight/obesity plus elevated glucose (24%), whereas non-Hispanic Asians had the highest burden of dyslipidemia (2%, 14%, and 19%). Except for hypertension, overweight/obesity (β = 48.7; 95% CI, 43.4-54.0), hypertriglyceridemia (β = 15.5; 95% CI, 7.2-28.3), low HDL-C (β = 10.0; 95% CI, 3.1-16.9), elevated glucose (β = 6.9; 95% CI, 0.6-13.2) were all significantly associated with increased CAP values. Increased CAP was linked to the synergistic interactions between overweight/obesity and dyslipidemia or elevated glucose (overweight/obesity and elevated glucose: relative excess risk due to interaction [RERI] = 8.21, attributable proportion due to interaction [AP] = 0.45, synergy index [SI] = 1.91; overweight/obesity and hypertriglyceridemia: RERI = 19.00, AP = 0.69, SI = 3.53; overweight/obesity and low high-density lipoprotein cholesterol: RERI = 10.83, AP = 0.58, SI = 2.61). Adolescents with combination of overweight/obesity, dyslipidemia (β = 15.1; 95% CI, 0.1-30.2) and combination of overweight/obesity, dyslipidemia and elevated glucose (β = 48.0; 95% CI, 23.3-72.6) had a significantly higher CAP values. CONCLUSION The prevalence of MASLD was alarmingly high in adolescents, and overweight/obesity was the most important CMRF. Overweight/obesity and dyslipidemia or elevated glucose had positive additive interaction effects on liver steatosis.
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Affiliation(s)
- Xiaoyan Zheng
- Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Dongying Zhao
- Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Liwei Wang
- Department of Nursing, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Yiwen Wang
- Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Yan Chen
- Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Yongjun Zhang
- Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
- Shanghai Institute for Pediatric Research, Shanghai Jiao Tong University School of Medicine, Xinhua Hospital, Shanghai 200092, China
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Guo Y, Su W, Tao L, Zhang G, Wang K. The association between modified cardiometabolic index with non-alcoholic fatty liver disease and liver fibrosis: a cross-sectional study. BMC Gastroenterol 2025; 25:265. [PMID: 40247201 PMCID: PMC12004561 DOI: 10.1186/s12876-025-03876-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2024] [Accepted: 04/10/2025] [Indexed: 04/19/2025] Open
Abstract
BACKGROUND Cardiometabolic index (CMI) was proposed ten years ago as an indicator combining obesity and dyslipidemia. This study aimed to investigate the relationships between newly modified CMI (MCMI) with non-alcoholic fatty liver disease (NAFLD) and liver fibrosis. METHODS This cross-sectional study included participants in the 2017-2018 National Health and Nutrition Examination Survey database (NHANES). Linear regression was used to explore the relationship between MCMI and Baseline characteristics. Logistic regression was conducted to analyze the correlation among MCMI with NAFLD and liver fibrosis. Furthermore, restricted cubic spline (RCS) was performed to estimate nonlinear relationships. Receiver operating characteristic curve (ROC) was used to assess the diagnostic performance of MCMI for NAFLD and liver fibrosis. RESULTS A total of 1385 participants were enrolled in the study. After adjusting covariates, participants with high MCMI were related to increased risk of NAFLD (OR = 3.52, 95%CI: 1.44-8.61), compared with those having low MCMI. A linear association was observed between MCMI and NAFLD (p for nonlinear = 0.074), and a J-shaped nonlinear relationship was found between MCMI and liver fibrosis (p for nonlinear = 0.002). The area under the curve (AUC) for MCMI to identify NAFLD was 0.821 (95% CI 0.799-0.843), which was higher than that of CMI (AUC = 0.761, 95%CI: 0.735-0.786), fatty liver index for the U.S. population (USFLI, AUC = 0.799, 95%CI: 0.776-0.822), Triglyceride glucose index (TyG, AUC = 0.738, 95%CI: 0.712-0.765), NAFLD liver fat score (NLFS, AUC = 0.786, 95%CI: 0.761-0.810) and hepatic steatosis index (HSI, AUC = 0.799, 95%CI: 0.775-0.822). CONCLUSIONS The novel MCMI was positively corelated to the risk of NAFLD. In addition, MCMI was an effective predictor for both NAFLD and liver fibrosis.
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Affiliation(s)
- Yanjun Guo
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Wei Su
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Lulong Tao
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Guoxin Zhang
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
| | - Kun Wang
- Department of General Surgery, Division of Hepatobiliary and Transplantation Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China.
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Ma X, Li B, Liu Y, Guo X. An inverted U-shaped association between high-sensitivity C-reactive protein and the albumin ratio and hepatic steatosis and liver fibrosis: a population-based study. Front Nutr 2025; 12:1534200. [PMID: 40303878 PMCID: PMC12037389 DOI: 10.3389/fnut.2025.1534200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2024] [Accepted: 03/24/2025] [Indexed: 05/02/2025] Open
Abstract
Background The high-sensitivity C-reactive protein to albumin (CAR) ratio is a comprehensive measure of inflammation in vivo. Hepatic steatosis and fibrosis are significantly correlated with inflammation. The present study aimed to explore the possible associations between CAR and hepatic steatosis and fibrosis in the American population. Methods The study population involved the National Health and Nutrition Examination Survey (NHANES) participants from 2017 to 2020. The natural logarithm of CAR, calculated as Ln(CAR) with base "e," was used for further analyses. The relationships between Ln(CAR) and the controlled attenuation parameter (CAP) and between Ln(CAR) and liver stiffness measurement (LSM) were investigated through multivariate linear regression analysis. Interaction and subgroup analysis identified factors affecting these variables. Nonlinear relationships were elucidated by smoothing curves and threshold effect analysis. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive performance of the CAR for non-alcoholic fatty liver disease (NAFLD). The results were adjusted for U.S. population estimates. Results The study included a total of 7,404 individuals. Ln(CAR) was positively correlated with CAP in the fully adjusted model, with an effect value of β = 1.827 (95% CI, 0.611, 3.042). A more pronounced positive association was observed among participants with a BMI ≥ 25 kg/m2 in the subgroup analysis. An inverted U-shaped association was shown between Ln(CAR) and CAP through smooth curve fitting and a two-segment linear regression model, with an inflection point of (-9.594). ROC curve analysis showed that CAR had a moderate predictive value for NAFLD (AUC = 0.6895), with a sensitivity of 0.7276 and a specificity of 0.6092. No significant association was detected between Ln(CAR) and the LSM. Conclusion We demonstrate an inverted U-shaped relationship between Ln(CAR) and CAP risk within the U.S. demographic. Our results suggest that CAR may serve as a valuable diagnostic tool for NAFLD. Further prospective research is necessary to validate this conclusion.
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Affiliation(s)
| | | | | | - Xiaoyan Guo
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Dag N, Sarici B, Igci G, Yagin FH, Yilmaz S, Kutlu R. Diagnostic Performance of Ultrasound-Based Liver Fat Quantification With Reference to Magnetic Resonance Imaging Proton Density Fat Fraction and Histology. JOURNAL OF CLINICAL ULTRASOUND : JCU 2025. [PMID: 40231394 DOI: 10.1002/jcu.24010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2024] [Revised: 02/08/2025] [Accepted: 03/20/2025] [Indexed: 04/16/2025]
Abstract
PURPOSE To investigate the diagnostic performance of ultrasound attenuation imaging technology (USAT) in the evaluation of hepatic steatosis using magnetic resonance imaging proton density fat fraction (MRI PDFF) and histology as reference standards. METHODS In this single-center, prospective study, the liver fat content of 117 potential liver donor candidates was assessed by USAT and MRI PDFF between April and August 2024. Intraoperative liver biopsy was performed in 47 liver donors. Cut-off values of 6%, 17%, 22%, and 5%, 33%, 66% were used for mild, moderate, and severe steatosis in MRI PDFF and histology, respectively. The correlation between USAT and MRI PDFF was evaluated using Spearman's rho technique. Receiver operating characteristic (ROC) analysis was performed for the diagnostic performance of USAT, and optimal USAT cut-off values for different grades of hepatosteatosis were obtained. RESULTS There was a very strong correlation between USAT and MRI PDFF (rho = 0.933, p < 0.001). For MRI PDFF values greater than 6%, the area under the curve (AUC) was 0.97 [95% confidence interval (CI): 0.93-0.99] (p < 0.001). USAT cut-off values for differentiating between different grades of liver steatosis were 0.57, 0.68, and 0.76 dB/cm/MHz for mild, moderate, and severe steatosis, with sensitivities of 88.9%, 90.0%, and 86.7%, respectively. For histologically confirmed steatosis greater than 5%, the AUC was 0.94 (95% CI: 0.83-0.99) (p < 0.001), with a cut-off of 0.56 dB/cm/MHz for 84.6% sensitivity. CONCLUSION USAT demonstrates excellent diagnostic accuracy in both the quantification and grading of hepatic steatosis.
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Affiliation(s)
- Nurullah Dag
- Faculty of Medicine, Department of Radiology, Inonu University, Malatya, Türkiye
| | - Baris Sarici
- Faculty of Medicine, School of Medicine, Department of General Surgery and Liver Transplant Institute, Inonu University, Malatya, Türkiye
| | - Gulnur Igci
- Faculty of Medicine, Department of Radiology, Inonu University, Malatya, Türkiye
| | - Fatma Hilal Yagin
- Faculty of Medicine, Department of Biostatistics and Medical Informatics, Inonu University, Malatya, Türkiye
| | - Sezai Yilmaz
- Faculty of Medicine, School of Medicine, Department of General Surgery and Liver Transplant Institute, Inonu University, Malatya, Türkiye
| | - Ramazan Kutlu
- Faculty of Medicine, Department of Radiology, Inonu University, Malatya, Türkiye
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Caviglia GP, Ferro A, D'Ambrosio R, Perbellini R, Lampertico P, Periti G, Valenti L, Ciccioli C, Pennisi G, Petta S, Brodosi L, Petroni ML, Marchignoli F, Pironi L, Sagripanti A, Argenziano ME, Svegliati-Baroni G, Rosso C, Barutta F, Armandi A, Gruden G, Bugianesi E. Effectiveness of a Model of Care Based on Fibrosis-4 and Liver Stiffness Measurement for the Screening of Patients With Type 2 Diabetes Mellitus at Risk of Advanced Liver Disease: Results From an Italian Prospective Multicenter Study. Am J Gastroenterol 2025:00000434-990000000-01706. [PMID: 40226934 DOI: 10.14309/ajg.0000000000003493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Accepted: 03/26/2025] [Indexed: 04/15/2025]
Abstract
INTRODUCTION Patients with type 2 diabetes mellitus (T2DM) are at increased risk of metabolic dysfunction-associated steatotic liver disease, advanced liver fibrosis, and metabolic dysfunction-associated steatohepatitis (MASH). We evaluated the prevalence and severity of metabolic dysfunction-associated steatotic liver disease among patients with T2DM at their first referral to diabetes clinics and assessed the effectiveness of the 2-tier screening approach by Fibrosis-4 (FIB-4) and vibration-controlled transient elastography (VCTE). METHODS Consecutive patients with T2DM from 6 different diabetes clinics were prospectively enrolled. Liver stiffness measurement (LSM) was assessed by VCTE, whereas liver steatosis by controlled attenuation parameter (Fibroscan, Echosens, France). "At-risk MASH" was assessed by FibroScan-aspartate aminotransferase score. RESULTS Eight hundred patients (median age: 59, 53-65 years; males: 485, 60.6%) met the inclusion criteria. Prevalence of liver steatosis (controlled attenuation parameter ≥ 248 db/m) was 73.6%. The proportion of patients at medium/high risk of advanced liver fibrosis (LSM ≥ 8.0 kPa) was 16.9%. Patients with "at-risk MASH" (FibroScan-aspartate aminotransferase > 0.67) were 12.0%. A 2-tier screening for advanced liver fibrosis by FIB-4 and VCTE would have led to 70 patients (8.8%) referred to liver clinics with a false-negative rate of 9.6% (n = 77; patients with FIB-4 < 1.3 and LSM ≥ 8.0 kPa). At multivariate analysis, overweight/obesity (odds ratio = 3.13, 95% confidence interval 1.23-7.97) and elevated alanine aminotransferase (odds ratio = 1.91, 95% confidence interval 1.17-3.10) were independently associated with LSM ≥ 8.0 kPa in patients with FIB-4 < 1.3. DISCUSSION In diabetes clinics, the 2-tier screening using FIB-4 and VCTE is effective for the identification of patients with T2DM to be referred to hepatologists. VCTE referral may be considered for patients with overweight/obesity and elevated alanine aminotransferase classified as at low risk of advanced liver fibrosis by FIB-4.
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Affiliation(s)
| | - Arianna Ferro
- Department of Medical Sciences, University of Torino, Turin, Italy
| | - Roberta D'Ambrosio
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Riccardo Perbellini
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pietro Lampertico
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- CRC "A. M. and A. Migliavacca" Center for Liver Disease, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giulia Periti
- Precision Medicine and Biological Resource Center, Department of Transfusion Medicine, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Valenti
- Precision Medicine and Biological Resource Center, Department of Transfusion Medicine, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Carlo Ciccioli
- Section of Gastroenterology and Hepatology, Dipartimento Di Promozione Della Salute, Materno Infantile, Medicina Interna e Specialistica Di Eccellenza (PROMISE), University of Palermo, Palermo, Italy
| | - Grazia Pennisi
- Section of Gastroenterology and Hepatology, Dipartimento Di Promozione Della Salute, Materno Infantile, Medicina Interna e Specialistica Di Eccellenza (PROMISE), University of Palermo, Palermo, Italy
| | - Salvatore Petta
- Section of Gastroenterology and Hepatology, Dipartimento Di Promozione Della Salute, Materno Infantile, Medicina Interna e Specialistica Di Eccellenza (PROMISE), University of Palermo, Palermo, Italy
| | - Lucia Brodosi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Clinical Nutrition and Metabolism Unit, IRCCS AOUBO, Bologna, Italy
| | - Maria Letizia Petroni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Clinical Nutrition and Metabolism Unit, IRCCS AOUBO, Bologna, Italy
| | - Francesca Marchignoli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Clinical Nutrition and Metabolism Unit, IRCCS AOUBO, Bologna, Italy
| | - Loris Pironi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Clinical Nutrition and Metabolism Unit, IRCCS AOUBO, Bologna, Italy
| | | | - Maria Eva Argenziano
- Liver Disease and Transplant Unit, Polytechnic University of Marche, Ancona, Italy
| | | | - Chiara Rosso
- Department of Medical Sciences, University of Torino, Turin, Italy
| | - Federica Barutta
- Department of Medical Sciences, University of Torino, Turin, Italy
| | - Angelo Armandi
- Department of Medical Sciences, University of Torino, Turin, Italy
- Metabolic Liver Disease Research Program, I. Department of Internal Medicine, University Medical Center of Mainz, Mainz, Germany
| | - Gabriella Gruden
- Department of Medical Sciences, University of Torino, Turin, Italy
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Zhang Y, Zhang X, Huang C, Zhu L. Trends and Disparities in Cardiovascular Disease in US Adults with Metabolic Dysfunction-Associated Steatotic Liver Disease. Biomedicines 2025; 13:956. [PMID: 40299561 PMCID: PMC12024783 DOI: 10.3390/biomedicines13040956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2025] [Revised: 03/21/2025] [Accepted: 04/07/2025] [Indexed: 05/01/2025] Open
Abstract
Background/Objectives: Recently, the term metabolic dysfunction-associated steatotic liver disease (MASLD) has replaced non-alcoholic fatty liver disease (NAFLD). Through analysis of the trends and disparities regarding cardiovascular disease (CVD) among individuals with MASLD, identifying the leading cause of death in this population is crucial. Methods: We conducted a cross-sectional analysis of National Health and Nutrition Examination Survey (NHANES) III (1988-1994) and NHANES 2017-2020 data. MASLD was identified by using clinical profiles and liver ultrasonography to exclude other liver diseases. We estimated the prevalence of CVD among individuals with MASLD and calculated the prevalence ratios for those with and without MASLD. Results: In 2017-2020, MASLD affected 31.2% or 61.9 million US adults, and 17.0% (95% confidence interval: 13.7-20.3%) of these individuals had CVD. The absolute CVD prevalence in individuals with MASLD doubled from that in the NHANES III cohort, which was 8.7% (6.4%, 10.9%). These increases were especially notable among older adults, non-Hispanic whites, and those with higher education and income. Individuals with MASLD had a higher prevalence of total CVD than those without MASLD, even after adjusting for socioeconomic and metabolic factors. These differences were more pronounced in younger age groups. Conclusions: This study revealed a doubled 30-year trend in CVD prevalence among adults with MASLD in the US. Sociodemographic disparities emphasize the need for tailored screening, prevention, and policy measures to address gaps and promote cardiovascular health in this population.
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Affiliation(s)
- Yanbing Zhang
- Department of Hepatobiliary Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, China;
| | - Xinge Zhang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; (X.Z.); (C.H.)
| | - Chuiguo Huang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; (X.Z.); (C.H.)
| | - Lei Zhu
- Department of Hepatobiliary Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, China;
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Reuken PA, Wagner F, Finke K, Lemhöfer C, Puta C, Stengel S, Scherag A, Lewejohann JC, Stallmach A, Quickert S. Possible link between steatotic liver diseases, severe COVID-19 and cognitive impairment in post-COVID-19 syndrome. Infection 2025:10.1007/s15010-025-02531-x. [PMID: 40208509 DOI: 10.1007/s15010-025-02531-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2025] [Accepted: 03/26/2025] [Indexed: 04/11/2025]
Abstract
PURPOSE Steatotic liver diseases (SLD) have become more prevalent over the last decade and are associated not only with cardiometabolic diseases but also with psychological symptoms (depression, fatigue). These symptoms are also common in post-COVID syndrome (PCS). Therefore, the aim of the study was to analyze the burden of SLD in PCS patients. METHODS We systematically screened all PCS patients from our post-COVID outpatient clinic using transient elastography, structured questionnaires for neurocognitive evaluation and blood sample analysis. Controls without PCS and without known liver diseases were also recruited and assessed with the same approach. RESULTS 560 PCS patients and 103 healthy controls were included. The overall prevalence of SLD was high in both cohorts (57 vs. 53%). PCS patients with SLD were more frequently male (41 vs. 24%), older (52 vs. 44 years) and had more cardiometabolic diseases (87.0 vs. 46.4%). Cognitive impairment was more related to SLD in PCS patients than in the no-SLD group (OR: 1.68, CI: 1.14-2.46, p = 0.008). The presence of SLD was related to severe COVID-19 with hospitalization (OR: 2.91, CI: 1.85-4.56, p < 0.001). Within 1 year of the follow-up, 152 of 289 patients described a resolution in PCS irrespective of the presence or absence of SLD (log-rank p = 0.96). CONCLUSIONS SLD is associated with severe COVID-19 and cognitive dysfunction in PCS. Longitudinal studies are needed to assess the role of hepatic steatosis, development of post-acute infection regulation (e.g., SARS-CoV-2) and to differentiate between SLD-associated symptoms and PCS.
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Affiliation(s)
- Philipp A Reuken
- Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Freya Wagner
- Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Kathrin Finke
- Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Christina Lemhöfer
- Institute of Physical and Rehabilitation Medicine, Jena University Hospital, Jena, Germany
| | - Christian Puta
- Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
- Department of Sports Medicine and Health Promotion, Friedrich-Schiller-University Jena, Jena, Germany
| | - Sven Stengel
- Department of Neuropediatrics, Jena University Hospital, Jena, Germany
| | - André Scherag
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany
| | | | - Andreas Stallmach
- Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Stefanie Quickert
- Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
- Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany.
- Interdisciplinary Centre for Clinical Research (IZKF) Jena, Jena University Hospital, Jena, Germany.
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Wang X, Shi Y, Zi Y, Long J, Shi R. Association of serum uric acid-to-high-density lipoprotein cholesterol ratio with cardiovascular disease risk in patients with metabolic dysfunction-associated fatty liver disease: a cross-sectional NHANES analysis. Front Nutr 2025; 12:1561594. [PMID: 40271428 PMCID: PMC12016219 DOI: 10.3389/fnut.2025.1561594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2025] [Accepted: 03/31/2025] [Indexed: 04/25/2025] Open
Abstract
Objective The relationship between the serum uric acid-to-high-density lipoprotein cholesterol ratio (UHR) and cardiovascular disease (CVD) risk in patients with metabolic dysfunction-associated fatty liver disease (MAFLD) is unknown. This study aims to investigate the relationship between UHR and cardiovascular disease risk in patients with MAFLD. Methods Data for this study were obtained from the National Health and Nutrition Examination Survey (NHANES) 2017-2020, in which 3289 patients with MAFLD participated. Participants were grouped according to their 10-year cardiovascular disease risk level, which was assessed by the Framingham Risk Score (FRS). We used binary logistic regression to analyze the relationship between UHR and CVD risk and smoothed curve-fitting models and threshold effect analyses to describe the relationship between UHR and CVD risk scores. Results After adjusting for all confounders, individuals with high UHR exhibited a higher prevalence of intermediate/high risk by FRS [odds ratio (OR): 2.12, 95% confidence interval (CI): (1.34, 3.35), P = 0.001]. UHR was nonlinear positive correlated with FRS (log-likelihood ratio test < 0.001). And there was a breakpoint of 364.38 and an apparent threshold effect. When UHR was lower than 364.38, The FRS increased with increasing UHR (P < 0.0001), whereas when UHR was higher than 364.38, the relationship between FRS and UHR was statistically insignificant (P = 0.0964). Conclusion The UHR was significantly associated with a 10-year risk of cardiovascular disease in patients with MAFLD. Higher UHR was associated with higher FRS in patients with MAFLD. The UHR can be a valid biomarker for predicting the 10-year risk of cardiovascular disease in patients with MAFLD.
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Affiliation(s)
- Xianyao Wang
- Department of Gastroenterology, The First Affiliated Hospital of Dali University, Dali, Yunnan, China
| | - Yuchen Shi
- The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Ying Zi
- Department of Gastroenterology, The First Affiliated Hospital of Dali University, Dali, Yunnan, China
| | - Jun Long
- Department of Gastroenterology, The First Affiliated Hospital of Dali University, Dali, Yunnan, China
| | - Rongjie Shi
- Department of Gastroenterology, The First Affiliated Hospital of Dali University, Dali, Yunnan, China
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Yoo J, Joo I, Jeon SK, Park J, Cho EJ. Three-dimensional organ segmentation-derived CT attenuation parameters for assessing hepatic steatosis in chronic hepatitis B patients. Sci Rep 2025; 15:11747. [PMID: 40189652 PMCID: PMC11973153 DOI: 10.1038/s41598-025-96053-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2025] [Accepted: 03/25/2025] [Indexed: 04/09/2025] Open
Abstract
The utility of CT-derived parameters for hepatic steatosis assessment has primarily focused on non-alcoholic fatty liver disease. This study aimed to evaluate their applicability in chronic hepatitis B (CHB) through a retrospective analysis of 243 CHB patients. Using deep-learning-based 3D organ segmentation on abdominal CT scans at 100 kVp, the mean volumetric CT attenuation of the liver and spleen was automatically measured on pre-contrast (liver (L)_pre and spleen (S)_pre) and post-contrast (L_post and S_post) portal venous phase images. To identify mild, moderate, and severe steatosis (S1, S2, and S3 based on the controlled attenuation parameter), L_pre showed areas under the receiver operating characteristic curve (AUROCs) of 0.695, 0.779, and 0.795, significantly higher than L-S_pre (0.633, 0.691, and 0.732; Ps = 0.02, 0.003, and 0.03). Post-contrast parameters demonstrated slightly lower AUROCs than their pre-contrast counterparts (Ps = 0.15-0.81). Concomitant hepatic fibrosis influenced diagnostic performance, with CT parameters performing better in patients without severe fibrosis than those with (F3-4 on transient elastography), though statistical significance was only observed for L-S_post in severe steatosis (P = 0.037). In conclusion, CT attenuation-based parameters extracted through automated 3D analysis show promise as a tool for assessing hepatic steatosis in patients with CHB.
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Affiliation(s)
- Jeongin Yoo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
- Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul National University Hospital, Seoul, Korea.
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
| | - Sun Kyung Jeon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Junghoan Park
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Eun Ju Cho
- Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Wang QQ, Zhang N, Xu X, Lv SA, Huang ZD, Long XD, Wu J. The role of Triglyceride Glucose-Waist Circumference (TyG_WC) in predicting metabolic dysfunction-associated steatotic liver disease among individuals with hyperuricemia. BMC Gastroenterol 2025; 25:220. [PMID: 40186129 PMCID: PMC11970000 DOI: 10.1186/s12876-025-03786-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2025] [Accepted: 03/14/2025] [Indexed: 04/07/2025] Open
Abstract
BACKGROUND/AIMS The incidence of metabolic dysfunction-associated steatotic liver disease (MASLD) among individuals with hyperuricemia is significantly high. The aim of this study was to identify effective biomarkers for the detection of MASLD among patients with hyperuricemia. METHOD We conducted an analysis involving 3424 participants with hyperuricemia from the National Health and Nutrition Examination Survey (1999-2020). To identify potential significant variables, we employed Boruta's algorithm, SHapley Additive exPlanations (SHAP) and random forests. Multivariable logistic regression models were utilized to assess the odds ratio (OR) of developing MASLD. To evaluate the accuracy and clinical value of our prediction model, we employed receiver operating characteristic (ROC) curves and decision curve analysis (DCA) curves. RESULTS Among the study population of 3424 participants (mean [SD] age, 54 [20] years, 1788 [52.22%] males) with hyperuricemia, 1670 participants had MASLD. Using Boruta's algorithm, SHAP and random forests, our analysis suggested that Triglyceride Glucose-Waist Circumference (TyG_WC) was one of the most significant variables in predicting MASLD risk, with an area under the receiver operating characteristic (AUROC) of 0.865. The restricted curve spline (RCS) revealed a positive association between the odds ratio of TyG_WC and MASLD, when compared with lowest quantile of TyG_WC, the risk of MASLD for highest quantile was 137.96 times higher. The predictive strategy incorporating TyG_WC notably enhanced the clinical model, with threshold probabilities spanning from approximately 0% to 100%, resulting in a significant improvement of the net benefit. CONCLUSIONS Our analysis found that TyG_WC was one of the most significant variables in predicting MASLD risk among individuals with hyperuricemia.
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Affiliation(s)
- Qian-Qian Wang
- Department of Laboratory Medicine, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201803, China
- Department of Pathology, the Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, 533000, China
- Department of Basic Research, Key Laboratory of Tumor Molecular Pathology of Guangxi Higher Education Institutes, Baise, 533000, China
| | - Ning Zhang
- Department of Laboratory Medicine, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201803, China
- Medical Research and Education Center, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201803, China
| | - Xiang Xu
- Department of Laboratory Medicine, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201803, China
- Department of Pathology, the Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, 533000, China
- Department of Basic Research, Key Laboratory of Tumor Molecular Pathology of Guangxi Higher Education Institutes, Baise, 533000, China
| | - Si-Ang Lv
- Department of Laboratory Medicine, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201803, China
- Department of Pathology, the Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, 533000, China
- Department of Basic Research, Key Laboratory of Tumor Molecular Pathology of Guangxi Higher Education Institutes, Baise, 533000, China
| | - Zhuo-Deng Huang
- Department of Laboratory Medicine, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201803, China
- Department of Pathology, the Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, 533000, China
- Department of Basic Research, Key Laboratory of Tumor Molecular Pathology of Guangxi Higher Education Institutes, Baise, 533000, China
| | - Xi-Dai Long
- Department of Pathology, the Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, 533000, China.
- Department of Basic Research, Key Laboratory of Tumor Molecular Pathology of Guangxi Higher Education Institutes, Baise, 533000, China.
| | - Jun Wu
- Department of Laboratory Medicine, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201803, China.
- Department of Pathology, the Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, 533000, China.
- Department of Basic Research, Key Laboratory of Tumor Molecular Pathology of Guangxi Higher Education Institutes, Baise, 533000, China.
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Eslam M, Fan JG, Yu ML, Wong VWS, Cua IH, Liu CJ, Tanwandee T, Gani R, Seto WK, Alam S, Young DY, Hamid S, Zheng MH, Kawaguchi T, Chan WK, Payawal D, Tan SS, Goh GBB, Strasser SI, Viet HD, Kao JH, Kim W, Kim SU, Keating SE, Yilmaz Y, Kamani L, Wang CC, Fouad Y, Abbas Z, Treeprasertsuk S, Thanapirom K, Al Mahtab M, Lkhagvaa U, Baatarkhuu O, Choudhury AK, Stedman CAM, Chowdhury A, Dokmeci AK, Wang FS, Lin HC, Huang JF, Howell J, Jia J, Alboraie M, Roberts SK, Yoneda M, Ghazinian H, Mirijanyan A, Nan Y, Lesmana CRA, Adams LA, Shiha G, Kumar M, Örmeci N, Wei L, Lau G, Omata M, Sarin SK, George J. The Asian Pacific association for the study of the liver clinical practice guidelines for the diagnosis and management of metabolic dysfunction-associated fatty liver disease. Hepatol Int 2025; 19:261-301. [PMID: 40016576 DOI: 10.1007/s12072-024-10774-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Accepted: 12/28/2024] [Indexed: 03/01/2025]
Abstract
Metabolic dysfunction-associated fatty liver disease (MAFLD) affects over one-fourth of the global adult population and is the leading cause of liver disease worldwide. To address this, the Asian Pacific Association for the Study of the Liver (APASL) has created clinical practice guidelines focused on MAFLD. The guidelines cover various aspects of the disease, such as its epidemiology, diagnosis, screening, assessment, and treatment. The guidelines aim to advance clinical practice, knowledge, and research on MAFLD, particularly in special groups. The guidelines are designed to advance clinical practice, to provide evidence-based recommendations to assist healthcare stakeholders in decision-making and to improve patient care and disease awareness. The guidelines take into account the burden of clinical management for the healthcare sector.
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Affiliation(s)
- Mohammed Eslam
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Westmead, NSW, 2145, Australia.
| | - Jian-Gao Fan
- Center for Fatty Liver, Department of Gastroenterology, Shanghai Key Lab of Pediatric Gastroenterology and Nutrition, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ming-Lung Yu
- Hepatobiliary Division, Department of Internal MedicineCollege of Medicine and Center for Liquid Biopsy and Cohort ResearchFaculty of Internal Medicine and Hepatitis Research Center, School of Medicine, College of MedicineSchool of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, Kaohsiung Medical University, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Vincent Wai-Sun Wong
- Medical Data Analytics Centre, Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong, China
| | - Ian Homer Cua
- Institute of Digestive and Liver Diseases, St. Luke's Medical Center, Global City, Philippines
| | - Chun-Jen Liu
- Division of Gastroenterology and Hepatology, Department of Internal MedicineHepatitis Research CenterGraduate Institute of Clinical Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tawesak Tanwandee
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rino Gani
- Department of Internal Medicine, Hepatobiliary Division, Dr. Cipto Mangunkusumo National General Hospital, Universitas Indonesia, Pangeran Diponegoro Road No. 71St, Central Jakarta, 10430, Indonesia
| | - Wai-Kay Seto
- Department of Medicine, School of Clinical Medicine, State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong, China
- Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Shahinul Alam
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
| | - Dan Yock Young
- Department of Medicine, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Saeed Hamid
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Ming-Hua Zheng
- MAFLD Research Center, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Key Laboratory of Diagnosis and Treatment for The Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, China
| | - Takumi Kawaguchi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Wah-Kheong Chan
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Diana Payawal
- Department of Medicine, Cardinal Santos Medical Center, Mandaluyong, Philippines
| | - Soek-Siam Tan
- Department of Hepatology, Selayang Hospital, Batu Caves, Malaysia
| | - George Boon-Bee Goh
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore
- Medicine Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Simone I Strasser
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Hang Dao Viet
- Internal Medicine Faculty, Hanoi Medical University, Hanoi, Vietnam
| | - Jia-Horng Kao
- Graduate Institute of Clinical MedicineDepartment of Internal MedicineHepatitis Research CenterDepartment of Medical Research, National Taiwan University College of Medicine, National Taiwan University, National Taiwan University Hospital, 1 Chang-Te Street, 10002, Taipei, Taiwan
| | - Won Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
| | - Seung Up Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, 50-1, Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Shelley E Keating
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Yusuf Yilmaz
- Department of Gastroenterology, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | | | - Chia-Chi Wang
- Buddhist Tzu Chi Medical Foundation and School of Medicine, Taipei Tzu Chi Hospital, Tzu Chi University, Taipei, Taiwan
| | - Yasser Fouad
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Minia University, Cairo, Egypt
| | - Zaigham Abbas
- Department of Hepatogastroenterology, Dr.Ziauddin University Hospital, Clifton, Karachi, Pakistan
| | | | | | - Mamun Al Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Undram Lkhagvaa
- Department of Health Policy, School of Public Health, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Oidov Baatarkhuu
- Department of Infectious Diseases, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Ashok Kumar Choudhury
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | | | - Abhijit Chowdhury
- Department of Hepatology, School of Digestive and Liver Diseases, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - A Kadir Dokmeci
- Department of Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Fu-Sheng Wang
- Senior Department of Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Infectious Diseases, Chinese PLA Medical School, Chinese PLA General Hospital, Beijing, 100039, China
| | - Han-Chieh Lin
- Division of Gastroenterology and Hepatology, Department of Medicine, Institute of Clinical Medicine, School of Medicine, Taipei Veterans General Hospital, National Yang-Ming Chiao Tung University, No. 201, Section 2, Shipai RdNo. 155, Section 2, Linong St, Beitou District, Taipei City, 112, Taiwan
| | - Jee-Fu Huang
- Hepatobiliary Division, Department of Internal MedicineCollege of Medicine and Center for Liquid Biopsy and Cohort ResearchFaculty of Internal Medicine and Hepatitis Research Center, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jess Howell
- Burnet Institute, Melbourne, VIC, 3004, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC, 3008, Australia
- Department of Medicine, The University of Melbourne, Parkville, VIC, 3050, Australia
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, 3165, Australia
| | - Jidong Jia
- Liver Research Center, Beijing Key Laboratory of Translational Medicine On Liver Cirrhosis, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center of Digestive Diseases, Beijing, China
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo, 11884, Egypt
| | - Stuart K Roberts
- Department of Gastroenterology and Hepatology, Central Clinical School, The Alfred, Monash University, Melbourne, Australia
| | - Masato Yoneda
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, 236-0004, Japan
| | - Hasmik Ghazinian
- Gastroenterology and Hepatology Department, Yerevan Medical Scientific Center, Yerevan, Armenia
| | - Aram Mirijanyan
- Gastroenterology and Hepatology Department, Yerevan Medical Scientific Center, Yerevan, Armenia
| | - Yuemin Nan
- Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | | | - Leon A Adams
- Medical School, Faculty of Medicine and Health Sciences, The University of Western Australia, Nedlands, WA, Australia
| | - Gamal Shiha
- Hepatology and Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Egyptian Liver Research Institute and Hospital (ELRIAH), Sherbin, El Mansoura, Egypt
| | - Manoj Kumar
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Necati Örmeci
- Department of Gastroenterohepatology, Istanbul Health and Technology University, Istanbul, Turkey
| | - Lai Wei
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - George Lau
- Humanity and Health Medical Group, Humanity and Health Clinical Trial Center, Hong Kong SAR, China
- The Fifth Medical Center of Chinese, PLA General Hospital, Beijing, 100039, China
| | - Masao Omata
- Department of Gastroenterology, Yamanashi Central Hospital, Yamanashi, Japan
- University of Tokyo, Tokyo, Japan
| | - Shiv K Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Westmead, NSW, 2145, Australia
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Wang X, Zhang R, Yan C, Jin Y. Association of Dietary Inflammation Index with sarcopenia in adult women with nonalcoholic fatty liver disease: based on the National Health and Nutrition Examination Survey Database. Eur J Gastroenterol Hepatol 2025; 37:414-420. [PMID: 39976000 DOI: 10.1097/meg.0000000000002908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2025]
Abstract
BACKGROUND A higher Dietary Inflammatory Index (DII) is linked with an elevated risk of sarcopenia, but the relationship between the two in adult female patients with nonalcoholic fatty liver disease (NAFLD) remains uncertain. OBJECTIVE The project was designed to probe into the relationship between DII and the risk of sarcopenia in adult female NAFLD patients. METHODS As a cross-sectional study, this study used NAFLD data for adult women from the 2017 to 2018 National Health and Nutrition Examination Survey (NHANES) Database, with DII as the independent variable and sarcopenia as the dependent variable. The relationship between DII and sarcopenia was examined by utilizing weighted logistic regression. Restricted cubic splines (RCS) and threshold effect models were further employed to explore the nonlinear relationship between the two. RESULTS We included 469 NAFLD patients, of whom 65 (10.2%) were sarcopenic. In adult female NAFLD patients, a great positive correlation of DII with the risk of sarcopenia was observed in the weighted logistics regression model [odds ratio (OR): 1.459, 95% confidence interval (CI): 1.013-2.103, P = 0.045]. The RCS curve manifested a linear correlation between the two ( Pnonlinear = 0.751). The threshold analysis demonstrated that when DII > 0, DII was positively linked with an elevated risk of sarcopenia (OR: 1.328, 95% CI: 1.030-1.722, P = 0.030). CONCLUSION In adult female NAFLD patients, DII is positively linked with the risk of sarcopenia. Future research should further explore the mechanism of influence of DII on sarcopenia in NAFLD patients and evaluate whether improving eating habits can effectively reduce the occurrence of sarcopenia in women with NAFLD.
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Affiliation(s)
- Xue Wang
- Department of Gastroenterology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi Province, China
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Yang T, Yang B, Yin J, Hou C, Wang Q. Targeting Insulin Resistance and Liver Fibrosis: CKD Screening Priorities in MASLD. Biomedicines 2025; 13:842. [PMID: 40299399 PMCID: PMC12025161 DOI: 10.3390/biomedicines13040842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2025] [Revised: 03/20/2025] [Accepted: 03/25/2025] [Indexed: 04/30/2025] Open
Abstract
Background and Aims: Chronic kidney disease (CKD) is a recognized extra-hepatic disease of nonalcoholic fatty liver disease (NAFLD). With the redefinition of NAFLD as metabolic dysfunction-associated steatotic liver disease (MASLD), the importance of cardiovascular metabolic factors in MASLD has been highlighted. However, whether MASLD remains independently associated with the prevalence of CKD is yet to be determined. Method: We analyzed data from 6567 non-pregnant adults from the National Health and Nutrition Examination Survey 2017-2020. MASLD was identified using liver ultrasound transient elastography and five cardiovascular risk factors. Multivariate logistic regression, subgroup analysis, and restricted cubic splines were employed to explore the associations and interactions within the data. Results: The prevalence of CKD across MASLD subgroups with different combinations of cardiometabolic risk factors varied. Univariate regression analysis indicated a significant association between MASLD and CKD (OR: 1.68, p < 0.001). This association was not significant after adjusting for diabetes (OR: 0.94, p = 0.74) or insulin resistance (OR: 1.00, p = 0.98) and was not significant in the fully adjusted model (OR: 0.87, p = 0.64). Subgroup analysis confirmed insulin resistance as a modifier in the MASLD-CKD relationship (p for interaction = 0.02). Multivariate analysis revealed that liver stiffness measurements (LSMs) were independently associated with CKD. LSM values showed an S-shaped correlation with CKD, with risk increasing above the 8.612 kPa threshold. Conclusions: This study suggests that the direct relationship between MASLD and CKD diminished when accounting for insulin resistance. Nevertheless, liver fibrosis emerges as an independent CKD risk factor, emphasizing the critical need for targeted CKD screening among MASLD patients, particularly those with insulin resistance or advanced fibrosis.
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Affiliation(s)
- Tianyuan Yang
- Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China; (T.Y.); (B.Y.); (J.Y.)
| | - Bingqing Yang
- Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China; (T.Y.); (B.Y.); (J.Y.)
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Jingya Yin
- Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China; (T.Y.); (B.Y.); (J.Y.)
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Chenxue Hou
- Department of Pathology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China;
| | - Qi Wang
- Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China; (T.Y.); (B.Y.); (J.Y.)
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
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Corma-Gómez A, Corona-Mata D, Martín-Carmona J, Galindo MJ, Camacho A, Martín-Sierra C, Gallo-Marín M, Rincón P, Perez-Valero I, Pérez-García M, Carrasco-Dorado A, Pineda JA, Rivero-Juárez A, Rivero A, Real LM, Macías J. FibroScan-AST Score vs Liver Stiffness for the Prediction of Liver Events After HCV Cure. Open Forum Infect Dis 2025; 12:ofae628. [PMID: 40201720 PMCID: PMC11977108 DOI: 10.1093/ofid/ofae628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 10/12/2024] [Indexed: 04/10/2025] Open
Abstract
Background Liver stiffness (LS) predicts liver complication occurrence in patients with hepatitis C virus (HCV) infection after sustained virological response (SVR). The FibroScan-AST (FAST) score, which includes aspartate aminotransferase (AST) and controlled attenuation parameter (CAP; measured by FibroScan), may improve the prediction ability of isolated LS. Our aim was to compare the predictive capacity of LS vs FAST in this setting. Methods Multicenter cohort study including individuals with HIV/HCV coinfection or HCV monoinfection from Spain if they had (1) LS ≥9.5 kPa pretreatment, (2) SVR with a direct-acting antiviral (DAA)-based regimen, and (3) LS and CAP measurement at SVR. Fatty liver disease (FLD) was defined as CAP ≥248 dB/m. The primary outcome was the occurrence of a liver complication (decompensation or hepatocellular carcinoma [HCC]) after SVR. Results Three hundred patients were included; 213 (71%) had HIV. At SVR, 131 (44%) had FLD. The FAST score was <0.35 in 182 (61%), 0.35-0.67 in 79 (27%), and >0.67 in 34 (12%) patients. After a median (Q1-Q3) follow-up of 73 (53-83) months, 36 (12%) liver complications (15 [5%] HCC) occurred. LS was independently associated with an increased risk of developing liver complications (sub-hazard ratio [sHR], 1.06; 95% CI, 1.04-1.08; P < .001). In a separate model, FAST ≥0.35 was also independently associated with greater risk of liver complications (sHR, 8.12; 95% CI, 3.11-21.17; P < .001). The area under the receiver operating characteristics curve of the model based on LS was 0.83 (95% CI, 0.76-0.91), and that of the model based on FAST was 0.80 (95% CI, 0.72-0.88; P = .158). Conclusions The FAST score predicts the development of liver events after SVR but does not improve the predictive capacity of LS alone at this time point.
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Affiliation(s)
- Anaïs Corma-Gómez
- Grupo de Virología Clínica e ITS Cinical Virology and STIs Group, Unit of Infectious Diseases and Microbiology, de Hospital Universitario Virgen de Valme, Sevilla, Spain
- Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Diana Corona-Mata
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Clinical Virology and Zoonoses Research Group, Unit of Infectious Diseases, Hospital Universitario Reina Sofía, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Universidad de Córdoba (UCO), Córdoba, Spain
| | - Jésica Martín-Carmona
- Grupo de Virología Clínica e ITS Cinical Virology and STIs Group, Unit of Infectious Diseases and Microbiology, de Hospital Universitario Virgen de Valme, Sevilla, Spain
- Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Universidad de Sevilla (US), Sevilla, Spain
| | - María José Galindo
- Unit of Infectious Diseases, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain
| | - Angela Camacho
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Clinical Virology and Zoonoses Research Group, Unit of Infectious Diseases, Hospital Universitario Reina Sofía, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Universidad de Córdoba (UCO), Córdoba, Spain
| | - Carmen Martín-Sierra
- Grupo de Virología Clínica e ITS Cinical Virology and STIs Group, Unit of Infectious Diseases and Microbiology, de Hospital Universitario Virgen de Valme, Sevilla, Spain
- Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Sevilla, Spain
| | - Marina Gallo-Marín
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Clinical Virology and Zoonoses Research Group, Unit of Infectious Diseases, Hospital Universitario Reina Sofía, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Universidad de Córdoba (UCO), Córdoba, Spain
| | - Pilar Rincón
- Grupo de Virología Clínica e ITS Cinical Virology and STIs Group, Unit of Infectious Diseases and Microbiology, de Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - Ignacio Perez-Valero
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Clinical Virology and Zoonoses Research Group, Unit of Infectious Diseases, Hospital Universitario Reina Sofía, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Universidad de Córdoba (UCO), Córdoba, Spain
| | - Margarita Pérez-García
- Grupo de Virología Clínica e ITS Cinical Virology and STIs Group, Unit of Infectious Diseases and Microbiology, de Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - Angela Carrasco-Dorado
- Clinical Virology and Zoonoses Research Group, Unit of Infectious Diseases, Hospital Universitario Reina Sofía, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Universidad de Córdoba (UCO), Córdoba, Spain
| | - Juan A Pineda
- Grupo de Virología Clínica e ITS Cinical Virology and STIs Group, Unit of Infectious Diseases and Microbiology, de Hospital Universitario Virgen de Valme, Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Universidad de Sevilla (US), Sevilla, Spain
| | - Antonio Rivero-Juárez
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Clinical Virology and Zoonoses Research Group, Unit of Infectious Diseases, Hospital Universitario Reina Sofía, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Universidad de Córdoba (UCO), Córdoba, Spain
| | - Antonio Rivero
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Clinical Virology and Zoonoses Research Group, Unit of Infectious Diseases, Hospital Universitario Reina Sofía, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Universidad de Córdoba (UCO), Córdoba, Spain
| | - Luis M Real
- Grupo de Virología Clínica e ITS Cinical Virology and STIs Group, Unit of Infectious Diseases and Microbiology, de Hospital Universitario Virgen de Valme, Sevilla, Spain
- Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Universidad de Sevilla (US), Sevilla, Spain
| | - Juan Macías
- Grupo de Virología Clínica e ITS Cinical Virology and STIs Group, Unit of Infectious Diseases and Microbiology, de Hospital Universitario Virgen de Valme, Sevilla, Spain
- Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Universidad de Sevilla (US), Sevilla, Spain
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Liu CH, Cheng PN, Fang YJ, Chen CY, Kao WY, Lin CL, Yang SS, Shih YL, Peng CY, Chang YP, Huang SC, Su TH, Tseng TC, Liu CJ, Chen PJ, Kao JH. Risk of de novo HCC in patients with MASLD following direct-acting antiviral-induced cure of HCV infection. J Hepatol 2025; 82:582-593. [PMID: 39368711 DOI: 10.1016/j.jhep.2024.09.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 09/12/2024] [Accepted: 09/20/2024] [Indexed: 10/07/2024]
Abstract
BACKGROUND & AIMS Data are limited on the risk of de novo hepatocellular carcinoma (HCC) in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) who have achieved sustained virologic response at off-treatment week 12 (SVR12) using direct-acting antivirals (DAAs) for HCV. METHODS A total of 1,598 eligible patients received biannual alpha-fetoprotein (AFP) and liver imaging surveillance to detect de novo HCC after achieving SVR12. MASLD was defined as presence of controlled attenuation parameter (CAP) ≥248 dB/m and ≥1 cardiometabolic risk factor (CMRF). Cumulative HCC incidence was compared between patients with/without MASLD. We built univariable and multivariable Cox proportional hazards models to evaluate factors associated with HCC. Sensitivity analysis was performed using the Fine-Gray subdistribution hazards model. Additionally, we evaluated the mediation effect of MASLD on CMRFs and of CMRFs on MASLD for HCC using mediation analysis with bootstrapping. RESULTS The incidence rate of HCC was 1.44 per 100 person-years of follow-up (95% CI 1.19-1.74). Patients with MASLD had a higher cumulative HCC incidence than those without MASLD (log-rank test, p <0.001). Multivariable Cox regression analysis revealed that in addition to age, sex, liver stiffness measurement, platelet count, and AFP, MASLD (adjusted hazard ratio 2.07; 95% CI 1.36-3.16; p <0.001) was independently associated with HCC. This finding was confirmed by the Fine-Gray model, which showed a subdistribution hazard ratio of 2.07 (95% CI 1.34-3.19, p <0.001) for MASLD. MASLD significantly mediated CMRFs for HCC development. CONCLUSION After achieving SVR12, patients with MASLD exhibited an increased HCC risk compared to those without MASLD. Vigilant HCC surveillance and control of CMRFs to mitigate the effect of MASLD on HCC remain crucial for this population. IMPACT AND IMPLICATIONS The risk of de novo hepatocellular carcinoma (HCC) among patients with metabolic dysfunction-associated steatotic liver disease (MASLD) who have attained a sustained virologic response to direct-acting antivirals remains to be confirmed. In this study, recruiting 1,598 patients in Taiwan, individuals with MASLD had an approximately two-fold increased risk of de novo HCC compared to those without MASLD after achieving a sustained virologic response. MASLD significantly mediated cardiometabolic risk factors for HCC development. Our findings underscore the critical importance of pharmacological interventions and proactive lifestyle modifications to control cardiometabolic risk factors in patients with MASLD, as well as the need for vigilant HCC surveillance to ensure favorable outcomes following HCV eradication.
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Affiliation(s)
- Chen-Hua Liu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan
| | - Pin-Nan Cheng
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yu-Jen Fang
- Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan
| | - Chi-Yi Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
| | - Wei-Yu Kao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; TMU Research Center for Digestive Medicine, Taipei Medical University, Taipei, Taiwan; Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan
| | - Chih-Lin Lin
- Department of Gastroenterology, Taipei City Hospital, Ren-Ai Branch, Taipei, Taiwan
| | - Sheng-Shun Yang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan
| | - Yu-Lueng Shih
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Cheng-Yuan Peng
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Yu-Ping Chang
- Department of Internal Medicine, National Taiwan University Biomedical Park Hospital, Hsin-Chu, Taiwan
| | - Shang-Chin Huang
- Department of Internal Medicine, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan
| | - Tung-Hung Su
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Tai-Chung Tseng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Jen Liu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pei-Jer Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jia-Horng Kao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
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Wang P, Song D, Han J, Zhang J, Chen H, Gao R, Shen H, Li J. Comparing Three Ultrasound-Based Techniques for Diagnosing and Grading Hepatic Steatosis in Metabolic Dysfunction-Associated Steatotic Liver Disease. Acad Radiol 2025; 32:1949-1957. [PMID: 39294051 DOI: 10.1016/j.acra.2024.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 08/25/2024] [Accepted: 09/01/2024] [Indexed: 09/20/2024]
Abstract
RATIONALE AND OBJECTIVES To compare the diagnostic accuracy and grading ability of ultrasound-derived fat fraction (UDFF), controlled attenuation parameters (CAP), and hepatic/renal ratio (HRR) for hepatic steatosis in metabolic dysfunction-associated steatotic liver disease (MASLD) using magnetic resonance imaging proton density fat fraction (PDFF) as the gold standard. METHODS Patients suspected of having MASLD in our hospital between October 2023 and May 2024 were divided into the MASLD group and the control group. All patients underwent UDFF, CAP, and PDFF examinations. HRR was measured during routine ultrasound examination. In statistical analysis, we initially assessed the correlation between UDFF, CAP, HRR, and general characteristics of subjects with PDFF. Subsequently, receiver operating characteristic curve were employed to evaluate and compare the diagnostic performance of UDFF, CAP, and HRR for different grades of hepatic steatosis in MASLD. Their area under the curve, optimal cut-off value, sensitivity, and specificity were also determined. Finally, predictive factors determined hepatic steatosis in MASLD (PDFF≥6%) were identified through binary logistic regression analysis. RESULTS 115 individuals were ultimately included in the MASLD group, while 102 were included in the control group. UDFF, CAP, and HRR were all positively correlated with PDFF. Among them, UDFF exhibited the strongest correlation with PDFF (ρ = 0.91). Furthermore, in the comparison of diagnostic efficacy among different grades of hepatic steatosis, UDFF outperformed CAP and HRR (p < 0.05). However, there were no statistically significant differences in AUCs between CAP and HRR across all three grades. The AUCs for UDFF in ≥S1, ≥S2, and ≥S3 were 0.99 (95% CI 0.97 to 1.00), 0.96 (95% CI 0.93 to 0.98), and 0.97 (95% CI 0.94 to 0.99), respectively. The optimal thresholds for UDFF are determined as follows: ≥ 6% for grade S1; ≥ 15% for grade S2; and ≥ 23% for grade S3. Multivariate analysis revealed that only age, UDFF, and CAP were important influencing factors for hepatic steatosis in MASLD. CONCLUSION The diagnostic accuracy of UDFF surpassed that of CAP and HRR in the detection and grading of hepatic steatosis in MASLD.
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Affiliation(s)
- Pingping Wang
- Southeast University Zhongda Hospital, No. 87 Dingjiaqiao, Hunan Road, Gulou District, Nanjing, China
| | - Danlei Song
- Southeast University Zhongda Hospital, No. 87 Dingjiaqiao, Hunan Road, Gulou District, Nanjing, China
| | - JiaHao Han
- Southeast University Zhongda Hospital, No. 87 Dingjiaqiao, Hunan Road, Gulou District, Nanjing, China
| | - Jing Zhang
- Southeast University Zhongda Hospital, No. 87 Dingjiaqiao, Hunan Road, Gulou District, Nanjing, China
| | - Huihui Chen
- Southeast University Zhongda Hospital, No. 87 Dingjiaqiao, Hunan Road, Gulou District, Nanjing, China
| | - Ruixia Gao
- Southeast University Zhongda Hospital, No. 87 Dingjiaqiao, Hunan Road, Gulou District, Nanjing, China
| | - Huiming Shen
- Southeast University Zhongda Hospital, No. 87 Dingjiaqiao, Hunan Road, Gulou District, Nanjing, China
| | - Jia Li
- Southeast University Zhongda Hospital, No. 87 Dingjiaqiao, Hunan Road, Gulou District, Nanjing, China.
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Bastard C, Audière S, Foucquier J, Lorée H, Miette V, Bronowicki JP, Stern C, Caussy C, Sandrin L. Guided-VCTE: An Enhanced FibroScan Examination With Improved Guidance and Applicability. ULTRASOUND IN MEDICINE & BIOLOGY 2025; 51:628-637. [PMID: 39809636 DOI: 10.1016/j.ultrasmedbio.2024.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 12/06/2024] [Accepted: 12/16/2024] [Indexed: 01/16/2025]
Abstract
OBJECTIVE Although FibroScan (FS), based on Vibration-Controlled Transient Elastography (VCTE), is a widely used non-invasive device for assessing liver fibrosis and steatosis, its current standard-VCTE examination remains timely and difficult on patients with obesity. The Guided-VCTE examination uses continuous shear waves to locate the liver by providing a real-time predictive indicator for shear wave propagation and uses shear wave maps averaging to increase the signal-to-noise ratio in difficult to assess patients. We aimed to evaluate the effectiveness of the new indicator, as well as compare examination times and success rates with both standard-VCTE and Guided-VCTE examinations. METHODS We recruited 130 patients all with varying BMI in this multicenter study. Sensitivity, specificity, positive predictive values and negative predictive values assessed the new indicator effectiveness. Success rates were compared using Wilcoxon signed rank tests rates and time-to-event analyses were used to investigate examination times. Agreement and repeatability of both methods were assessed using Wilcoxon signed-rank test. RESULTS The new indicator was highly effective, with a 97% sensitivity for predicting valid liver stiffness measurements (LSM). LSM and controlled attenuation parameter results remained in good agreement between two examinations. The Guided-VCTE examination significantly increased the success rate of individual measurements and significantly reduced the time required for localization in the study cohort, especially in patients with grade 2 obesity (BMI ≥35 kg/m²). Additionally, the proportion of patients scanned in less than 4 minutes was significantly higher with the Guided-VCTE examination. CONCLUSION Guided-VCTE is a new effective technique that simplifies further FS use, particularly for patients with obesity.
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Affiliation(s)
| | | | | | | | | | - Jean-Pierre Bronowicki
- Hépato-gastroentérologie, CHRU Nancy, INSERM U1256, Université de Lorraine, Nancy, France
| | | | - Cyrielle Caussy
- Hospices Civils de Lyon, Département Endocrinologie, Diabète et Nutrition, Hôpital Lyon Sud, 69495 Pierre-Bénite, France
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Wu S, Pan J, Song M, Zhao YC, Chen W, Huang H, Zhu Y, Chen F. Performance of Magnetic Resonance Imaging and Ultrasound for Identifying the Different Degrees of Hepatic Steatosis: A Systematic Review and Meta-analysis. Acad Radiol 2025:S1076-6332(25)00204-1. [PMID: 40164534 DOI: 10.1016/j.acra.2025.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2025] [Revised: 03/05/2025] [Accepted: 03/06/2025] [Indexed: 04/02/2025]
Abstract
BACKGROUND MRI proton density fat fraction (MRI-PDFF), controlled attenuation parameters (CAP), and attenuation coefficients (AC) are capable of steatosis characterization and may be useful as noninvasive alternatives for diagnosing hepatic steatosis. PURPOSE This meta-analysis aimed to evaluate the performance of MRI-PDFF, CAP, and AC in grading hepatic steatosis, using histology as the reference standard. METHODS We conducted a comprehensive search of the PubMed, Cochrane Library, Embase, and Web of Science databases until June 2024. The quality of eligible studies was assessed. Pooled sensitivity, specificity, and area under receiver operating characteristic (AUC) curves were calculated using a bivariate random-effects model. Meta-regression analysis, subgroup analysis, and Deeks' test were performed to explore heterogeneity and assess publication bias. RESULTS This meta-analysis included 38 studies with 5056 patients with metabolic dysfunction-associated steatotic liver disease. The AUC values for grading steatosis ≥S1, ≥S2, and ≥S3 were 0.99, 0.89, and 0.90 for MRI-PDFF, 0.95, 0.84, and 0.77 for CAP, and 0.97, 0.90, and 0.89 for AC, respectively. CAP demonstrated lower accuracy for detecting steatosis grades ≥S2 and ≥S3 compared to MRI-PDFF (0.89 vs. 0.84, p<0.001; 0.90 vs. 0.77, p<0.001) and AC (0.90 vs. 0.84, p<0.001; 0.89 vs. 0.77, p<0.001). Subgroup analyses revealed that MRI-PDFF and CAP exhibited superior diagnostic performance in diagnosing ≥S2 and ≥S3 steatosis among individuals in Asia, with a body mass index ≤30 kg/m2, and age <51 years. CONCLUSION A direct comparison with CAP showed greater accuracy for MRI-PDFF and AC in diagnosing moderate and severe steatosis, and similar diagnostic performance for MRI-PDFF and AC. For patients with steatosis, AC should be incorporated into routine ultrasound screening.
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Affiliation(s)
- Shuzhen Wu
- Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou 310003, China (S.W., J.P., M.S., Y.C.Z., W.C., H.H., Y.Z., F.C.)
| | - Junhan Pan
- Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou 310003, China (S.W., J.P., M.S., Y.C.Z., W.C., H.H., Y.Z., F.C.)
| | - Mengchen Song
- Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou 310003, China (S.W., J.P., M.S., Y.C.Z., W.C., H.H., Y.Z., F.C.); Department of Radiology, Shulan (Hang Zhou) Hospital, No. 848 Dongxin Road, Hangzhou 310003, China (M.S.)
| | - Yan-Ci Zhao
- Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou 310003, China (S.W., J.P., M.S., Y.C.Z., W.C., H.H., Y.Z., F.C.)
| | - Wuyue Chen
- Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou 310003, China (S.W., J.P., M.S., Y.C.Z., W.C., H.H., Y.Z., F.C.)
| | - Huizhen Huang
- Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou 310003, China (S.W., J.P., M.S., Y.C.Z., W.C., H.H., Y.Z., F.C.)
| | - Yanyan Zhu
- Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou 310003, China (S.W., J.P., M.S., Y.C.Z., W.C., H.H., Y.Z., F.C.)
| | - Feng Chen
- Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou 310003, China (S.W., J.P., M.S., Y.C.Z., W.C., H.H., Y.Z., F.C.).
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Mathur A, Ozkaya E, Rosberger S, Sigel KM, Doucette JT, Bansal MB, Taouli B. Concordance of vibration-controlled transient elastography and magnetic resonance elastography for fibrosis staging in patients with metabolic dysfunction-associated steatotic liver disease. Eur Radiol 2025:10.1007/s00330-025-11533-0. [PMID: 40159342 DOI: 10.1007/s00330-025-11533-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Revised: 01/31/2025] [Accepted: 02/21/2025] [Indexed: 04/02/2025]
Abstract
OBJECTIVES To evaluate the concordance between vibration-controlled transient elastography (VCTE) and magnetic resonance elastography (MRE) for staging liver fibrosis and assessing hypothetical eligibility for resmetirom treatment in a cohort of patients with metabolic dysfunction-associated steatotic liver disease (MASLD). A secondary objective was to assess the performance of VCTE for liver fat quantification. MATERIALS AND METHODS This retrospective study included 103 patients (61 males; mean age 54.7 years) with suspected MASLD who underwent VCTE and MRI/MRE. The following parameters were extracted: liver stiffness (LS) from both techniques, controlled attenuation parameter (CAP) from VCTE, and MRI-proton density fat fraction (PDFF). Agreement and fibrosis stage distributions were assessed using Cohen's Kappa and McNemar's tests. ROC analysis assessed the performance of CAP against MRI-PDFF (considered the reference for steatosis). RESULTS A significant difference was observed in assigned fibrosis stage distributions between VCTE and MRE across all combinations (F0-F1 vs F2-F4, F0-F2 vs F3-F4, F0-F3 vs F4, all p < 0.001) with fair to moderate agreement between modalities (Cohen's Kappa values 0.305-0.554). VCTE assigned a higher fibrosis stage in 42 patients (40.7%). Thirty-three vs eighteen patients were classified as F2-F3 (qualified for resmetirom treatment) with VCTE vs MRE (Cohen's Kappa 0.215), which was associated with estimated cost savings of $707,701/year with MRE. VCTE-CAP achieved AUCs of 0.547, 0.754, and 0.813 for diagnosing mild, moderate, and severe steatosis, respectively. CONCLUSION VCTE and MRE have fair to moderate agreement for fibrosis staging, with VCTE tending to assign a higher fibrosis stage compared to MRE. VCTE-CAP reliably detects only severe steatosis. KEY POINTS Question What is the agreement between VCTE and MRE in staging fibrosis in MASLD and identifying patients with F2-F3 disease? Findings Limited concordance was found between VCTE and MRE for staging liver fibrosis and identifying F2-F3 disease; VCTE tended to assign higher fibrosis stages compared to MRE. Clinical relevance MRE could represent the modality of choice for selecting patients with metabolic dysfunction-associated steatohepatitis for resmetirom therapy as it potentially offers high cost-savings compared to VCTE.
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Affiliation(s)
- Anandita Mathur
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Efe Ozkaya
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - Sonam Rosberger
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Keith M Sigel
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John T Doucette
- Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Meena B Bansal
- Division of Liver Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bachir Taouli
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine Mount Sinai, New York, NY, USA.
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Chu NHS, Yu Y, He J, Li CRH, Pai SI, Leung KHT, Ma RCW, Chan JCN, Chow E. Carbohydrate Quality Is Independently Associated with Cardiometabolic Risk in Chinese Individuals with Impaired Glucose Tolerance. Nutrients 2025; 17:1123. [PMID: 40218881 PMCID: PMC11990533 DOI: 10.3390/nu17071123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2025] [Revised: 03/19/2025] [Accepted: 03/19/2025] [Indexed: 04/14/2025] Open
Abstract
Background/Objectives: Dietary manipulation with carbohydrate restriction has been extensively investigated in diabetes prevention programmes. Carbohydrate (CHO) quality, rather than quantity, is associated with various metabolic outcomes. Few studies examined the fibre/CHO ratio on lipid profiles, liver fat and insulin resistance in individuals with impaired glucose tolerance (IGT). Methods: In this comprehensive cross-sectional study, we evaluated the association of carbohydrate-related nutritional factors with metabolic parameters in a cohort of 177 Hong Kong Chinese with impaired glucose tolerance (IGT). The subjects underwent a 75 g oral glucose tolerance test (OGTT) with measurement of plasma C-peptide and lipid profiles, body composition, transient elastography, and three-day food records. The fibre/CHO ratio is calculated by dividing fibre intake by total carbohydrate intake (in grams). Results: The median (IQR) age of the study cohort was 60 (54-62) with a mean ± SD BMI of 26.7 ± 3.9 kg/m2, and 40.7% were female. A higher carbohydrate quality, measured as fibre/CHO ratio, was inversely correlated with triglycerides (r = -0.305, p < 0.001) and positively correlated with High-density lipoproteins cholesterol (HDL-C) (r = 0.354, p < 0.001). These associations remained significant after adjusting for age, gender, lipid-lowering drugs, total calorie, macronutrient and sugar intake, physical activity and sodium/potassium ratio. Blood pressure, liver fat and insulin resistance were also associated with the fibre/CHO ratio after the adjustment of these confounding factors. Consuming more than 5.5 g of fibre per 100 g carbohydrate was associated with lower serum triglycerides. Conclusions: Our results highlight the potential for using the fibre/CHO ratio as a metric for daily carbohydrate quality and the importance of addressing both carbohydrate quality and quantity in designing dietary interventions to reduce cardiometabolic risk.
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Affiliation(s)
- Natural H. S. Chu
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Yelia Yu
- UNC Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27517, USA
| | - Jie He
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Cynthia R. H. Li
- Department of Physiology, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Seong I. Pai
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow Q12 8QQ, UK
| | - Kathy H. T. Leung
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Ronald C. W. Ma
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Juliana C. N. Chan
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Elaine Chow
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
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Zhou X, Yue Z, He S, Yuan F, He X, Wang J, Wang R, Luo Y, Yi Q. Relationship between serum uric acid levels and metabolism associated fatty liver disease in postmenopausal women based on NHANES 2017-2020. Sci Rep 2025; 15:8944. [PMID: 40089555 PMCID: PMC11910611 DOI: 10.1038/s41598-025-93738-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2024] [Accepted: 03/10/2025] [Indexed: 03/17/2025] Open
Abstract
Studies have shown that postmenopausal women have more metabolic abnormalities than premenopausal women. No consensus exists on how serum uric acid (sUA) affects metabolism-associated fatty liver disease (MAFLD) in postmenopausal women.This prospective observational study examined this link using National Health and Nutrition Examination Survey (NHANES) 2017 to 2020 data. We divided women's sUA levels into four quartiles and used logistic regression, subgroup analyses, and restricted triple spline methods to compare the prevalence of MAFLD in postmenopausal and non-menopausal women. We also used histograms to analyze the effect of BMI-based indices. This population-based study involved 4477 women, including 1139 postmenopausal women aged 55-73 years. Multivariate logistic regression showed that, in the fully adjusted model, we found that participants in the highest quartile of sUA had a statistically significant 254% increased risk of MAFLD compared with participants in the lowest quartile (OR: 3.54; 95% CI 3.54 1.47-8.55; P < 0.001). Subgroup analyses showed no significant interaction between sUA levels and specific subgroups P( > 0.05 for all interactions). Additionally, RCS and threshold analysis showed a linear correlation (P = 0.186) and an ideal inflection point of 4.6 (P = 0.818) to the left. Right of the inflection point, the effect size was 1.524 (95% CI 1.291-1.814; P < 0.01). Histograms demonstrated that postmenopausal BMI increased sUA's influence on MAFLD and higher sUA levels and BMI may enhance the prevalence of MAFLA in US postmenopausal women. The results of this study suggest that monitoring sUA levels in the postmenopausal period is critical in determining the occurrence of and interventions for MAFLD.
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Affiliation(s)
- Xiaoding Zhou
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
- Center for Reproductive Medicine, Traditional Chinese Medicine Hospital of Meishan, Meishan, 620010, China
| | - Zongxiang Yue
- Center for Reproductive Medicine, Traditional Chinese Medicine Hospital of Meishan, Meishan, 620010, China
| | - Shuming He
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
- Center for Reproductive Medicine, Traditional Chinese Medicine Hospital of Meishan, Meishan, 620010, China
| | - Fengjuan Yuan
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
- Center for Reproductive Medicine, Traditional Chinese Medicine Hospital of Meishan, Meishan, 620010, China
| | - Xingrui He
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
- Center for Reproductive Medicine, Traditional Chinese Medicine Hospital of Meishan, Meishan, 620010, China
| | - Jiaqi Wang
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
- Center for Reproductive Medicine, Traditional Chinese Medicine Hospital of Meishan, Meishan, 620010, China
| | - Rong Wang
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
- Center for Reproductive Medicine, Traditional Chinese Medicine Hospital of Meishan, Meishan, 620010, China
| | - Ya Luo
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
- Center for Reproductive Medicine, Traditional Chinese Medicine Hospital of Meishan, Meishan, 620010, China
| | - Qiong Yi
- Center for Reproductive Medicine, Traditional Chinese Medicine Hospital of Meishan, Meishan, 620010, China.
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Zhaivoronok M, Dynnyk O, Livkutnyk O, Yerokhovych V, Yuzvenko V, Serednia I, Melnychenko Y, Kobyliak N. Inter- and Intraobserver variability of attenuation coefficient measurement in innovative ultrasound diagnosis of metabolic dysfunction-associated steatotic liver disease: a cross-sectional study. Front Med (Lausanne) 2025; 12:1457960. [PMID: 40182858 PMCID: PMC11965890 DOI: 10.3389/fmed.2025.1457960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 02/28/2025] [Indexed: 04/05/2025] Open
Abstract
Introduction Evaluation of the ultrasound attenuation coefficient is widely used in the diagnosis of steatotic liver disease (SLD). US steatometry with real-time attenuation coefficient measurement (ACM) is an imaging tool that can replace and surpass the B-mode and improve the noninvasive diagnosis of SLD. Aim To evaluate the intra- and interobserver variability of ACM for the assessment of SLD. Materials and methods A single-center cross-sectional study was conducted at the Kyiv City Clinical Endocrinology Center. We examined 52 patients (25 men and 27 women) with a mean age of 53.2 ± 4.73 years. B-mode and ACM were performed on a Soneus P7 US system (Ultrasign, Ukraine). Examinations were performed by 2 radiologists with 28 (expert 1) and 17 (expert 2) years of experience and 4 general practitioners (GPs) without US experience (nonexperts 1-4). The training of 4 GPs on mastering the ACM was only 60 min due to US steatophantom. Each doctor performed 5 measurements of the ACM for each patient. The inter- and intraobserver variability of the results was determined by using an intraclass correlation coefficient (ICC) with a 95% confidence interval (95% CI). Results The overall intraobserver variability after 5 days of examination was as follows: for expert 1-0.958 (95% CI 0.938-0.974); for expert 2-0.936 (95% CI 0.905-0.980); nonexpert 1-0.891 (95% CI 0.843-0.929); nonexpert 2-0.915 (95% CI 0.876-0.945); nonexpert 3-0.927 (95% CI 0.893-0.953); nonexpert 4-0.880 (95% CI 0.827-0.927). Interobserver variability at the final timepoint (day 5) was as follows: between experts 1 and 2, 0.942 (95% CI 0.898-0.967); between nonexperts 1-4 overall, 0.871 (95% CI 0.800-0.921); and overall, 0.922 (95% CI 0.883-0.951). Conclusion Real-time US steatometry with ACM measurement is an informative, simple method with excellent intra- and interobserver variability and a reproducible method for population assessment for the early diagnosis and staging of SLD. The simplicity of ACM technology allows general practitioners to master the technique within 60 min. ACM measurements can be effectively employed by general practitioners (GPs) for population screening, enabling timely identification and management of MASLD.
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Affiliation(s)
- Maksym Zhaivoronok
- Department of Nuclear Medicine, Radiation Oncology and Radiation Safety of Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Oleh Dynnyk
- “Institute of Elastography” Medical Center LLC, Kyiv, Ukraine
| | | | | | - Violetta Yuzvenko
- Endocrinology Department, Bogomolets National Medical University, Kyiv, Ukraine
- Ukrainian Scientific and Practical Center for Endocrine Surgery, Transplantation of Endocrine Organs and Tissues of the Ministry of Health of Ukraine, Kyiv, Ukraine
| | - Iryna Serednia
- Endocrinology Department, Bogomolets National Medical University, Kyiv, Ukraine
| | | | - Nazarii Kobyliak
- Endocrinology Department, Bogomolets National Medical University, Kyiv, Ukraine
- Medical Laboratory CSD, Kyiv, Ukraine
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Jiang S, Zhang F, Yang H, Han X, Mao J, Zheng G, Fan Y. Estimated sdLDL-C as a biomarker of hepatic steatosis severity in MASLD: a retrospective study. BMC Gastroenterol 2025; 25:168. [PMID: 40082781 PMCID: PMC11907928 DOI: 10.1186/s12876-025-03759-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Accepted: 03/04/2025] [Indexed: 03/16/2025] Open
Abstract
BACKGROUND Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease worldwide. However, there is a lack of cost-effective and accurate biomarkers to assess the degree of hepatic steatosis. Estimated small dense low-density lipoprotein cholesterol (EsdLDL-C), a calculated value derived from triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C) levels, has emerged as a potential indicator. This study aimed to explore the relationship between EsdLDL-C and the severity of hepatic steatosis. METHODS This single-center retrospective study estimated and directly measured small dense low-density lipoprotein cholesterol (sdLDL-C) in 1,969 patients who underwent serum lipid testing at Changzhou Third People's Hospital between January and July 2024. Among these, 461 patients diagnosed with MASLD were included in the study. These patients were further classified into mild (Mil) and moderate-to-severe (Mod-Sev) groups based on controlled attenuation parameter (CAP) values to explore the relationship between EsdLDL-C and the severity of hepatic steatosis. RESULTS The correlation coefficient (R) between EsdLDL-C and DsdLDL-C was 0.837, with a bias of 0.223. Both EsdLDL-C (OR 1.095, 95% CI 1.029-1.180) and visceral fat area (VFA) (OR 1.019, 95% CI 1.010-1.028) were identified as independent risk factors for Mod-Sev steatosis compared to the Mil group. After adjusting for all confounders, patients with MASLD had a 1.155-fold increased risk of developing Mod-Sev hepatic steatosis for each unit increase in EsdLDL-C. Furthermore, EsdLDL-C demonstrated good predictive value for Mod-Sev steatosis in MASLD patients, with an area under the curve (AUC) of 0.825 (95% CI 0.784-0.867). CONCLUSIONS EsdLDL-C may serve as a practical and cost-effective biomarker for identifying high-risk MASLD patients. TRIAL REGISTRATION The retrospective study was approved by the Ethics Committee of Changzhou Third People's Hospital (02 A-A20230015), and a waiver of informed consent was agreed to, as the data were obtained from medical records, and a waiver of informed consent would not have affected the participants.
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Affiliation(s)
- Shuo Jiang
- Center of Medical Laboratory, Changzhou Third People's Hospital, Changzhou, Jiangsu, China
| | - Fan Zhang
- Department of Endocrinology, Changzhou Third People's Hospital, Changzhou, Jiangsu, China
| | - Hui Yang
- Center of Medical Laboratory, Changzhou Third People's Hospital, Changzhou, Jiangsu, China
| | - Xue Han
- Center of Medical Laboratory, Changzhou Third People's Hospital, Changzhou, Jiangsu, China
| | - Jieru Mao
- Center of Medical Laboratory, Changzhou Third People's Hospital, Changzhou, Jiangsu, China
| | - Guojun Zheng
- Center of Medical Laboratory, Changzhou Third People's Hospital, Changzhou, Jiangsu, China.
| | - Yan Fan
- Center of Medical Laboratory, Changzhou Third People's Hospital, Changzhou, Jiangsu, China.
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Liu W, Li X, Chen L, Luo X. The association between estimated glucose disposal rate and metabolic dysfunction-associated steatotic liver disease and liver fibrosis in US adults. BMC Endocr Disord 2025; 25:67. [PMID: 40065306 PMCID: PMC11895387 DOI: 10.1186/s12902-025-01891-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Accepted: 02/26/2025] [Indexed: 03/14/2025] Open
Abstract
BACKGROUND Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease, also considered a metabolic syndrome, and is associated with poor prognosis. eGDR (estimated glucose disposal rate) is a new biomarker to assessment insulin resistance (IR). The association between eGDR and MASLD and liver fibrosis is currently unclear. OBJECTIVE The aim of this cross-sectional study is to appraise the association between eGDR and MASLD and liver fibrosis. METHODS This study have enrolled 3,100 participants from the 2017-2018 National Health and Nutrition Examination Surveys (NHANES). Binary logistic regression analysis was used to assess the association between eGDR and MASLD and liver fibrosis. Receiver operating characteristic (ROC) was applied to estimate the ability of eGDR to identify MASLD. RESULTS The mean age of the subjects was 54.59 (17.29) years, and 49.26% were female. The prevalence of MASLD and liver fibrosis was 62.19% and 11.15%, respectively. In the fully adjusted models, there were negative associations of eGDR with the controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), with βs of -15.18 and - 0.74 (all p < 0.01), respectively. There were negative associations of eGDR with MASLD and liver fibrosis, with odds ratios (ORs) and 95% confidence intervals of 0.53 (95% CI: 0.48-0.74) and 0.40 (95% CI: 0.28-0.57) (all p < 0.01). The area under the curve (AUC) of the eGDR for identifying MASLD and liver fibrosis is 0.74 and 0.75, respectively. CONCLUSION The study findings suggest a significant association between eGDR and MASLD as well as liver fibrosis. eGDR may serve as a biomarker for identifying MASLD.
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Affiliation(s)
- Wanqian Liu
- Department of Cardiovascular Medicine, Jiujiang City Key Laboratory of Cell Therapy, Jiujiang NO.1 People's Hospital, The First Hospital of Jiujiang, Jiujiang, 332000, China
| | - Xiaozhong Li
- Department of Cardiovascular Medicine, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Ling Chen
- Department of Cardiovascular Medicine, Jiujiang City Key Laboratory of Cell Therapy, Jiujiang NO.1 People's Hospital, The First Hospital of Jiujiang, Jiujiang, 332000, China
| | - Xiao Luo
- Department of Cardiovascular Medicine, Jiujiang City Key Laboratory of Cell Therapy, Jiujiang NO.1 People's Hospital, The First Hospital of Jiujiang, Jiujiang, 332000, China.
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Huang DQ, Wong VWS, Rinella ME, Boursier J, Lazarus JV, Yki-Järvinen H, Loomba R. Metabolic dysfunction-associated steatotic liver disease in adults. Nat Rev Dis Primers 2025; 11:14. [PMID: 40050362 DOI: 10.1038/s41572-025-00599-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2025] [Indexed: 03/09/2025]
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the umbrella term that comprises metabolic dysfunction-associated steatotic liver, or isolated hepatic steatosis, through to metabolic dysfunction-associated steatohepatitis, the progressive necroinflammatory disease form that can progress to fibrosis, cirrhosis and hepatocellular carcinoma. MASLD is estimated to affect more than one-third of adults worldwide. MASLD is closely associated with insulin resistance, obesity, gut microbial dysbiosis and genetic risk factors. The obesity epidemic and the growing prevalence of type 2 diabetes mellitus greatly contribute to the increasing burden of MASLD. The treatment and prevention of major metabolic comorbidities such as type 2 diabetes mellitus and obesity will probably slow the growth of MASLD. In 2023, the field decided on a new nomenclature and agreed on a set of research and action priorities, and in 2024, the US FDA approved the first drug, resmetirom, for the treatment of non-cirrhotic metabolic dysfunction-associated steatohepatitis with moderate to advanced fibrosis. Reliable, validated biomarkers that can replace histology for patient selection and primary end points in MASH trials will greatly accelerate the drug development process. Additionally, noninvasive tests that can reliably determine treatment response or predict response to therapy are warranted. Sustained efforts are required to combat the burden of MASLD by tackling metabolic risk factors, improving risk stratification and linkage to care, and increasing access to therapeutic agents and non-pharmaceutical interventions.
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Affiliation(s)
- Daniel Q Huang
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Vincent W S Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Mary E Rinella
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Jerome Boursier
- Service d'Hépato-Gastroentérologie et Oncologie Digestive, Centre Hospitalier Universitaire d'Angers, Angers, France
- Laboratoire HIFIH, SFR ICAT 4208, Université d'Angers, Angers, France
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- City University of New York Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Hannele Yki-Järvinen
- Department of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
| | - Rohit Loomba
- MASLD Research Center, Division of Gastroenterology and Hepatology, University of California at San Diego, San Diego, CA, USA.
- Division of Epidemiology, Department of Family Medicine and Public Health, University of California at San Diego, San Diego, CA, USA.
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Lv K, Zhou R, Gu Y, Kong T, Chen Y, Shao Y, Shi J, Zhang W. Status and factors influencing health-related quality of life in patients with non-alcoholic fatty liver disease in Hangzhou: a cross-sectional study. BMJ Open 2025; 15:e088357. [PMID: 40044211 PMCID: PMC11883542 DOI: 10.1136/bmjopen-2024-088357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 02/17/2025] [Indexed: 03/09/2025] Open
Abstract
OBJECTIVE Due to rapid economic development and the unique lifestyles, cultures and customs of Hangzhou, non-alcoholic fatty liver disease (NAFLD) has attracted widespread attention, with a prevalence rate of 35-45%. In this study, we used the Chinese version of the Chronic Liver Disease Questionnaire for NAFLD (CLDQ-NAFLD) to investigate the current health-related quality of life (HRQL) among patients with NAFLD and analyse the influencing factors, which provides a reference for improving the patients' HRQL. DESIGN A cross-sectional design. SETTING This study was conducted from March 2022 to March 2023 at a tertiary hospital in Hangzhou. PARTICIPANTS All patients with NAFLD included in this study were diagnosed using FibroScan, with a controlled attenuation parameter ≥248 dB/m. PRIMARY OUTCOME MEASURES The primary outcome of the study was the HRQL score, which was assessed using the Chinese version of the CLDQ-NAFLD. RESULTS A total of 502 patients with NAFLD were enrolled in this study (mean age 1.79±13.49 years; 69.7% male). The overall HRQL score was 5.89 (5.33, 6.36), and the fatigue dimension score was the lowest at 5.17 (4.33, 6.00). Multiple linear regression analyses revealed that poor HRQL score was correlated with other marital status (β=-0.096, p=0.036), liver stiffness ≥10.3 (kPa) (β=-0.110, p=0.017), regular exercise (β=-0.121, p=0.006), sex (β=-0.114, p=0.012) and alanine transaminase (ALT) levels (β=-0.139, p=0.002). A monthly income >10 000 (renminbi) was associated with a significantly higher HRQL score. CONCLUSIONS This cross-sectional survey conducted in Hangzhou, China, revealed that HRQL is impaired among patients with NAFLD. This study revealed a significant association between HRQL and sociodemographic factors, including sex, monthly income and marital status, alongside clinical factors such as liver stiffness, regular exercise and ALT level. Emphasising optimal care management is essential to improve HRQL in patients with NAFLD.
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Affiliation(s)
- Kexin Lv
- College of Nursing, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Run Zhou
- College of Nursing, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Yunpeng Gu
- College of Nursing, Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Tingting Kong
- College of Nursing, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Yutong Chen
- College of Nursing, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Yuna Shao
- School of Public Health, The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, Hong Kong
| | - Junping Shi
- Department of Infectious Disease and Hepatology, Hangzhou Normal University Affiliated Hospital, Hangzhou, Zhejiang, China
- Zhejiang Key Laboratory of Medical Epigenetics, Hangzhou, Zhejiang, China
| | - Wei Zhang
- Teaching Department, Hangzhou Normal University Affiliated Hospital, Hangzhou, Zhejiang, China
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Pan Y, Yang Y, Peng Z, Wang W, Zhang J, Sun G, Wang F, Zhu Z, Cao H, Lyu Y, Zhang Z, Yang W. Gut microbiota may modify the association between dietary polyphenol intake and serum concentrations of hippuric acid: results from a 1-year longitudinal study in China. Am J Clin Nutr 2025; 121:654-662. [PMID: 39837385 DOI: 10.1016/j.ajcnut.2025.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 01/06/2025] [Accepted: 01/15/2025] [Indexed: 01/23/2025] Open
Abstract
BACKGROUND Hippuric acid (HA), a host-microbe cometabolite, normally derives from gut microbial catabolism of dietary polyphenols. OBJECTIVES We investigated the potential interplay between dietary polyphenols and gut microbiota on circulating HA concentrations and examined the associations between serum concentrations of HA and cardiometabolic risk markers. METHODS In a 1-y cohort of 754 community-dwelling adults, serum HA and its precursor [benzoic acid (BA)], and fecal microbiota were assayed using liquid chromatography-tandem mass spectrometry and 16S ribosomal RNA sequencing, respectively. Diet, blood pressure, blood glucose, and lipid concentrations were measured twice, 1 y apart. Arterial stiffness [indicated by brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index] and liver fat accumulation [indicated by controlled attenuation parameter (CAP)] were measured after 1 y. RESULTS We identified 27 microbial genera whose relative abundance was positively associated with serum HA concentrations (PFDR < 0.05) and constructed a microbial score to reflect the overall HA-producing potential. In multivariate-adjusted linear models, dietary intake of catechins and chlorogenic acids was positively associated with serum HA concentrations among participants with a higher microbial score (β = 0.26, P = 0.03) but not among those with a lower score (β = -0.13, P = 0.30, Pinteraction = 0.03). Participants with higher intake of dietary catechins and chlorogenic acids had lower triglyceride concentrations (Percentage change = -5.9%, P < 0.05). Each 1 μmol/L increase in serum HA, but not in BA, was associated with 5.7%, 1.5%, 1.7%, 1.7%, and 1.7% decrease in triglyceride, systolic blood pressure, diastolic blood pressure, baPWV, and CAP, respectively (all P < 0.05). CONCLUSIONS The gut microbial genera that predicted circulating HA concentrations might modify the association between dietary polyphenol intake and circulating HA concentrations, and elevated serum HA concentrations are favorably associated with multiple cardiometabolic risk markers.
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Affiliation(s)
- Yutong Pan
- Department of Nutrition, Center for Big Data and Population Health of IHM, The Second Affiliated Hospital of Anhui Medical University, School of Public Health, Anhui Medical University, Hefei, China
| | - Yang Yang
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhaohong Peng
- Department of Interventional Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wuqi Wang
- Department of Nutrition, Center for Big Data and Population Health of IHM, The Second Affiliated Hospital of Anhui Medical University, School of Public Health, Anhui Medical University, Hefei, China
| | - Junyi Zhang
- Department of Nutrition, Center for Big Data and Population Health of IHM, The Second Affiliated Hospital of Anhui Medical University, School of Public Health, Anhui Medical University, Hefei, China
| | - Guobing Sun
- Department of Nutrition, Center for Big Data and Population Health of IHM, The Second Affiliated Hospital of Anhui Medical University, School of Public Health, Anhui Medical University, Hefei, China
| | - Fuyu Wang
- Department of Nutrition, Center for Big Data and Population Health of IHM, The Second Affiliated Hospital of Anhui Medical University, School of Public Health, Anhui Medical University, Hefei, China
| | - Zixuan Zhu
- Department of Nutrition, Center for Big Data and Population Health of IHM, The Second Affiliated Hospital of Anhui Medical University, School of Public Health, Anhui Medical University, Hefei, China
| | - Hongjuan Cao
- Department of Chronic Non-communicable Diseases Prevention and Control, Lu'an Municipal Center for Disease Control and Prevention, Lu'an, China
| | - Young Lyu
- Department of Chronic Non-communicable Diseases Prevention and Control, Lu'an Municipal Center for Disease Control and Prevention, Lu'an, China
| | - Zhuang Zhang
- Department of Nutrition, Center for Big Data and Population Health of IHM, The Second Affiliated Hospital of Anhui Medical University, School of Public Health, Anhui Medical University, Hefei, China
| | - Wanshui Yang
- Department of Nutrition, Center for Big Data and Population Health of IHM, The Second Affiliated Hospital of Anhui Medical University, School of Public Health, Anhui Medical University, Hefei, China.
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Fajrudheen M, Mahapatro S, Panigrahi MK, Naik S, Satapathy AK. Noninvasive Assessment of Nonalcoholic Fatty Liver Disease in Children with Overweight and Obesity by Transient Elastography. Indian J Endocrinol Metab 2025; 29:230-236. [PMID: 40416463 PMCID: PMC12101759 DOI: 10.4103/ijem.ijem_150_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 08/03/2024] [Accepted: 12/09/2024] [Indexed: 05/27/2025] Open
Abstract
Introduction Childhood obesity and nonalcoholic fatty liver disease (NAFLD) are emerging as significant health concerns. While liver biopsy remains the gold standard for diagnosis, there is a pressing need for a noninvasive alternative to identify early fibrosis. Methods A cross-sectional investigation was carried out from January 2020 to December 2021 involving overweight and obese children attending the pediatric outpatient department (OPD). The aim is to determine the occurrence of fibrotic and steatotic changes in the liver of overweight and obese children using transient elastography (TE) and to establish correlations between TE results, Pediatric NAFLD Fibrosis Index (PNFI), and other biochemical parameters. TE was utilized to assess both fibrotic and steatosis changes, while ultrasound (USG) was employed to detect steatosis in the liver. Results Two hundred and fifty-nine eligible children participated in the study. Mean age of the study cohort was 10.8 years, with males constituting 63%. Mean Z score for BMI was 1.71 ± 0.57. Fibrosis was detected in 29.3% of children by TE, while steatosis was observed in 27.7% of children. Steatosis was identified in 23.8% of cases through USG. BMI Z score, ALT (Alanine aminotransferase), AST and PNFI score exhibited significant associations with grades of liver fibrosis and steatosis as determined by TE, as well as with grades of steatosis according to USG findings. Conclusion A notable prevalence of increased liver stiffness was observed in overweight and obese children. TE proves to be a valuable tool in identifying fibrotic and steatotic changes in these children, complementing existing noninvasive modalities.
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Affiliation(s)
- Mohamed Fajrudheen
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Samarendra Mahapatro
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Manas K. Panigrahi
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Suprava Naik
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Amit K. Satapathy
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Li M, Yu H, Wan S, Hu F, Luo Q, Gong W. The fibrosis investigating navigator in diabetes (FIND): A tool to predict liver fibrosis risk in subjects with diabetes. Diabetes Obes Metab 2025; 27:1184-1197. [PMID: 39638772 PMCID: PMC11802394 DOI: 10.1111/dom.16109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Revised: 11/13/2024] [Accepted: 11/21/2024] [Indexed: 12/07/2024]
Abstract
BACKGROUND Type 2 diabetes increases the risk of cirrhosis and liver cancer. Noninvasive and early assessment of liver fibrosis is essential. We aimed to develop a score to aid in the initial assessment of liver fibrosis in the diabetic population. METHODS A fibrosis investigating navigator in diabetes (FIND) score was developed and validated in the NHANES dataset (2017-2020). Fibrosis was defined as a liver stiffness measurement (LSM) ≥8.0 kPa. The diagnostic accuracies of FIB-4, NFS, LiverRisk, steatosis-associated fibrosis estimator (SAFE) and metabolic dysfunction-associated fibrosis (MAF-5) were compared. FIND was also externally validated in various liver diseases via biopsy as a reference in an Asian centre between 2016 and 2020. Finally, we examined the prognostic implications of the FIND index utilizing data from the UK Biobank cohort (2006-2010). RESULTS The FIND score model yielded an AUROC of 0.781 for the prediction of an LSM ≥8 kPa in the validation set, which was consistently greater than that of other available models (all p < 0.05). In the whole NHANES dataset, the 85% sensitivity cut-off of 0.16 corresponded to a NPV of 91.9%, whereas the 85% specificity cut-off of 0.31 corresponded to a PPV of 50.6%. FIND displayed overall accuracies similar to those of the other models in staging fibrosis stages, with biopsy used as a reference. In the UK Biobank cohort, FIND >0.31 was associated with an increased risk of all-cause and liver-related mortality in the diabetic population in adjusted models (HR, 1.75; 95% CI, 1.62-1.89; HR, 23.59; 95% CI, 13.67-40.69). CONCLUSIONS In diabetes patients, the novel FIND score performs well in identifying subjects at risk of liver fibrosis and predicting all-cause and liver-related mortality.
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Affiliation(s)
- Mingkai Li
- Department of Gastroenterology, Shenzhen HospitalSouthern Medical UniversityShenzhenPeople's Republic of China
| | - Hongsheng Yu
- Department of GastroenterologyThe Third Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouPeople's Republic of China
| | - Sizhe Wan
- Department of Gastroenterology, Shenzhen HospitalSouthern Medical UniversityShenzhenPeople's Republic of China
| | - Fulan Hu
- Department of Biostatistics and Epidemiology, Public Health collegeShenzhen University Medical SchoolShenzhenPeople's Republic of China
| | - Qingtian Luo
- Department of Gastroenterology and Endoscopy CenterShenzhen Nanshan People’s Hospital, the 6th Affiliated Hospital of Shenzhen University Medical SchoolShenzhenPeople's Republic of China
| | - Wei Gong
- Department of Gastroenterology, Shenzhen HospitalSouthern Medical UniversityShenzhenPeople's Republic of China
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