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Yang CY, Chen JH, Chen CY, Kao CY, Huang SF, Chang WY, Tu HP, Huang JF, Yu ML, Tai CM. Serial changes in metabolic dysfunction-associated steatotic liver disease after sleeve gastrectomy and their associations with abdominal adiposity: a prospective cohort study. Surg Obes Relat Dis 2025; 21:537-546. [PMID: 39706718 DOI: 10.1016/j.soard.2024.11.007] [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: 07/09/2024] [Revised: 10/10/2024] [Accepted: 11/13/2024] [Indexed: 12/23/2024]
Abstract
BACKGROUND Little is known about the associations between changes in hepatic steatosis and changes in abdominal adiposity after metabolic bariatric surgery. OBJECTIVES To evaluate the serial changes in hepatic steatosis and abdominal adiposity following sleeve gastrectomy (SG). SETTING University hospital, Taiwan. METHODS In this prospective study, patients who underwent SG and intraoperative liver biopsy were enrolled. Magnetic resonance imaging (MRI) was performed to assess the liver fat fraction (LFF), visceral adipose tissue (VAT) area, and subcutaneous adipose tissue (SAT) area. Liver fibrosis was assessed preoperatively via biopsy and the fibrosis-4 index (FIB-4) and postoperatively with the FIB-4. RESULTS Seventy-six metabolic dysfunction-associated steatotic liver disease (MASLD) patients, including 67 pure MASLD patients and 9 MASLD patients with combined etiologies, were enrolled. LFF and visceral-to-subcutaneous fat ratio were associated with metabolic dysfunction-associated steatohepatitis, and VAT area was associated with significant fibrosis (≥F2). Twelve months after SG, all MRI measurements significantly improved. The median LFF of pure MASLD patients decreased from 17.4% at baseline to 4.2% and 3.7% at the 6th and 12th postoperative months, respectively. Complete resolution of steatosis was achieved in 97.5% of patients at the 12th postoperative months. Using %VAT and %SAT reductions at the sixth postoperative month as references, LFF decreased more rapidly, with fold ratios of 1.3 and 1.8, respectively. CONCLUSIONS SG resulted in a significant decrease in hepatic steatosis and abdominal adiposity in patients with severe obesity, but hepatic steatosis improved faster than abdominal adiposity. Hepatic steatosis resolved in almost all patients 12 months after SG.
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Affiliation(s)
- Chung-Yi Yang
- Department of Medical imaging, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Bariatric and Metabolism International Surgery Center, E-Da Hospital, Kaohsiung, Taiwan
| | - Jian-Han Chen
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Bariatric and Metabolism International Surgery Center, E-Da Hospital, Kaohsiung, Taiwan; Division of General Surgery, E-Da Hospital, Kaohsiung, Taiwan
| | - Chung-Yen Chen
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Bariatric and Metabolism International Surgery Center, E-Da Hospital, Kaohsiung, Taiwan; Division of General Surgery, E-Da Hospital, Kaohsiung, Taiwan
| | - Cheng-Yi Kao
- Department of Medical imaging, E-DA Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Shiu-Feng Huang
- Investigator and Attending Physician, Institute of Molecular and Genomic Medicine, National Health Research Institutes
| | - Wen-Yu Chang
- Bariatric and Metabolism International Surgery Center, E-Da Hospital, Kaohsiung, Taiwan; Department of Dermatology, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Hung-Pin Tu
- Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jee-Fu Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Center of Hepatitis Research, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Center of Hepatitis Research, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Chi-Ming Tai
- Bariatric and Metabolism International Surgery Center, E-Da Hospital, Kaohsiung, Taiwan; School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
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Yao Z, Shang W, Yang F, Tian W, Zhao G, Xu X, Md RZ, Tian T, Li W, Huang M, Zhao Y, Huang Q. Nomogram for predicting severe abdominal adhesions prior to definitive surgery in patients with anastomotic fistula post-small intestine resection: a cohort study. Int J Surg 2025; 111:2046-2054. [PMID: 39705136 DOI: 10.1097/js9.0000000000002191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 11/20/2024] [Indexed: 12/22/2024]
Abstract
BACKGROUND This study aimed to develop and validate a nomogram for predicting the presence of severe intra-abdominal adhesions before definitive surgery (DS) for anastomotic fistula following small intestine resection (SIR). METHODS Patients were enrolled from January 2009 to October 2023 and were randomly divided (2:1) into development and validation cohorts. Predictors of severe adhesion were identified and integrated into a nomogram. The nomogram's performance was evaluated through calibration, discrimination, and clinical utility. Results : A total of 414 patients were included, with 276 in the development cohort and 138 in the validation cohort. Severe adhesion was diagnosed in 54 (13%) patients, including 37 (13.4%) in the development cohort and 17 (12.3%) in the validation cohort ( P = 0.76). Five predictors were identified: Sequential Organ Failure Assessment score, duration of early-stage abdominal infection, preoperative albumin (Alb) <35 g/L, visceral to subcutaneous fat area ratio, and preoperative C-reactive protein >10 mg/L. The nomogram demonstrated robust discrimination, with a concordance index (C-index) of 0.80 (95% CI, 0.76-0.90) in internal validation, and was well-calibrated. In the validation cohort, the model maintained good discrimination (C-index = 0.79; 95% CI, 0.67-0.94) and calibration. Decision curve analysis affirmed the nomogram's clinical utility. CONCLUSION This study introduces a practical nomogram for assessing the risk of severe abdominal adhesion prior to DS in patients undergoing surgery for anastomotic fistula after SIR.
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Affiliation(s)
- Zheng Yao
- Department of General Surgery, Jiangning Hospital, Nanjing, Jiangsu, China
| | - Weiwei Shang
- Department of General Surgery, Jiangning Hospital, Nanjing, Jiangsu, China
| | - Fan Yang
- Research Institute of General Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Weiliang Tian
- Research Institute of General Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Guoping Zhao
- Research Institute of General Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xin Xu
- Department of General Surgery, Jiangning Hospital, Nanjing, Jiangsu, China
| | - Risheng Zhao Md
- Department of General Surgery, Jiangning Hospital, Nanjing, Jiangsu, China
| | - Tao Tian
- Department of General Surgery, Shanghai 9th Hospital, Shanghai, China
| | - Wuhan Li
- Department of General Surgery, Anhui Provincial Hospital, Hefei, Anhui, China
| | - Ming Huang
- Department of General Surgery, Jiangning Hospital, Nanjing, Jiangsu, China
| | - Yunzhao Zhao
- Department of General Surgery, Jiangning Hospital, Nanjing, Jiangsu, China
| | - Qian Huang
- Research Institute of General Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
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Radmehr M, Homayounfar R, Djazayery A. The relationship between anthropometric indices and non-alcoholic fatty liver disease in adults: a cross-sectional study. Front Nutr 2025; 11:1494497. [PMID: 39839301 PMCID: PMC11747202 DOI: 10.3389/fnut.2024.1494497] [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: 09/11/2024] [Accepted: 12/19/2024] [Indexed: 01/23/2025] Open
Abstract
Background Non-alcoholic fatty liver disease (NAFLD) is a widespread liver condition associated with diabetes, metabolic syndrome, and cardiovascular diseases, yet public awareness remains low. Early detection of risk factors is crucial, but liver biopsy, the diagnostic gold standard, is invasive and costly. Non-invasive anthropometric indices provide a safer alternative. This study examines these indices to identify the most reliable predictor of NAFLD in adults. Methods In the present cross-sectional study, we used the Fasa Cohort Data, conducted on about 10,000 people, of whom 1,047 were diagnosed with NAFLD. NAFLD diagnosis in this study was confirmed by physicians based on medical history and ultrasonographic evaluations, ensuring accurate and reliable identification of cases. General, anthropometric, and dietary assessments were performed using interviews, tools, and valid questionnaires. Biochemical evaluation was also done. Waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), Body mass index (BMI), a body shape index (ABSI), body roundness index (BRI), and visceral fat index (VAI) were also calculated using these measurements and formulas. This study used descriptive tests, binary logistic regression, and ROC curve analysis. Results In both crude and adjusted models, significant associations were found between WHR, WHtR, BMI, and VAI with NAFLD. ROC analysis revealed that WHtR and BMI were the most accurate predictors of NAFLD in both genders (WHtR: men AUC = 0.750, women AUC = 0.702; BMI: men AUC = 0.754, women AUC = 0.701). BRI showed significant accuracy, but WHR (men: AUC = 0.727, women: AUC = 0.640) and VAI (men: AUC = 0.621, women: AUC = 0.622) were less effective. ABSI demonstrated poor predictive power (men: AUC = 0.530, women: AUC = 0.505) and is not recommended for NAFLD prediction. Conclusion Based on the findings, BMI and WHtR emerge as the most practical and accessible indicators for early screening of NAFLD in both men and women, while ABSI shows minor effectiveness in identifying the disease.
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Affiliation(s)
- Mina Radmehr
- Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Reza Homayounfar
- National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Noncommunicable Diseases Research Center, Fasa University of MedicalSciences, Fasa, Iran
| | - Abolghasem Djazayery
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
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Zheng H, Guo T, Zhao X, Wang K, Shan S, Xie S, Xu Y, Liu C, Lu W. Helicobacter pylori Infection Is Not Associated with Nonalcoholic Fatty Liver Disease: A Two-Year Cohort Study. Dig Dis 2024; 43:75-83. [PMID: 39496224 DOI: 10.1159/000542180] [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: 02/02/2024] [Accepted: 10/06/2024] [Indexed: 11/06/2024]
Abstract
INTRODUCTION Previous studies reported inconsistent results of the association between Helicobacter pylori infection and nonalcoholic fatty liver disease (NAFLD). METHODS A cohort study of 2,063 adults without NAFLD at baseline, who participated in a repeated health checkup including a 13C-urea breath test and abdominal ultrasonography, was conducted to evaluate the link between H. pylori infection and NAFLD development. RESULTS During a mean follow-up period of 1.7 years, we did not find a significant association between H. pylori infection and NAFLD (hazard ratio = 1.10 (0.86, 1.40), p = 0.4689). We also found that higher age, body mass index (BMI), systolic blood pressure (systolic BP), diastolic blood pressure (diastolic BP), fasting blood glucose, triglycerides, total cholesterol, low-density lipoprotein cholesterol (LDL-C), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were risk factors, and high-density lipoprotein cholesterol (HDL-C) was a protective factor for NAFLD development. CONCLUSION H. pylori infection might not be positively related to NAFLD development.
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Affiliation(s)
- Huabo Zheng
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Cardiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Tangmeng Guo
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaofang Zhao
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kun Wang
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shengshuai Shan
- Clinical and Experimental Therapeutics, College of Pharmacy, University of Georgia, Augusta, Georgia, USA
| | - Songpu Xie
- Laboratory of Experimental Cardiology, Department Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yichen Xu
- Department of Histology and Embryology, Medicine and Life Sciences, Hainan Medical University, Haikou, China
| | - Chengyun Liu
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weilin Lu
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Ichikawa T, Yamashima M, Yamamichi S, Koike M, Nakano Y, Yajima H, Miyazaki O, Ikeda T, Okamura T, Nagata K, Sawa K, Niiya K, Nakao K. Serum immunoglobulin A levels: Diagnostic utility in alcoholic liver disease and association with liver fibrosis in steatotic liver disease. Biomed Rep 2024; 21:142. [PMID: 39161940 PMCID: PMC11332156 DOI: 10.3892/br.2024.1830] [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: 05/15/2024] [Accepted: 07/09/2024] [Indexed: 08/21/2024] Open
Abstract
The relationship between immunoglobulin A (IgA) levels and chronic liver disease remains poorly understood. The present study evaluated the clinical significance of IgA in 478 new patients who visited the Outpatient Clinic of Nagasaki Harbor Medical Center (Nagasaki, Japan). Serum IgA levels in comparison to liver stiffness (LS), as measured using a FibroScan® device, were evaluated in 358 patients. Furthermore, in 270 patients, the associations between serum IgA levels and body composition were analyzed using computed tomography. The IgA levels of patients in the groups with Child-Pugh classification B and C (CPGBC), alcoholic liver disease (ALD), steatotic liver disease (SLD) or diabetes were higher than the IgA levels of patients in the groups with CPGA, non-ALD, non-SLD or no diabetes, respectively. Logistic regression analysis showed that CPGBC, ALD, high IgG (>1,700 mg/dl), high macrophage galactose-specific lectin-2 binding protein glycosylation isomer (M2BPGi) (>1 cut-off index) and diabetes were contributing factors for high serum IgA level (>410 mg/dl). The ratio of IgA level divided by IgG level was highest in patients with ALD, followed by those with metabolic dysfunction-associated SLD (MASLD) and non-SLD. In SLD, IgA level was associated more with LS than M2BPGi and fibrosis-4 (FIB-4) in multiple regression analysis. In the receiver operating characteristic analysis, IgA level, M2BPG, and FIB-4 had similar area under the curve values for discriminating high LS (>8 kPa) from low LS (≤8 kPa) in SLD. IgA levels were also associated with visceral fat, and this association was only found in women. In conclusion, elevated IgA is an indicator of liver fibrosis that also reflects the presence of diabetes and an increased visceral fat level. Therefore, IgA is considered a useful marker of liver disease severity in the current era of increased SLD.
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Affiliation(s)
- Tatsuki Ichikawa
- Department of Gastroenterology, Nagasaki Harbor Medical Center, Nagasaki 850-8555, Japan
- Department of Comprehensive Community Care Systems, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8501, Japan
- Innovation and Translational Research Center, Nagasaki Harbor Medical Center, Nagasaki 850-8555, Japan
| | - Mio Yamashima
- Department of Gastroenterology, Nagasaki Harbor Medical Center, Nagasaki 850-8555, Japan
| | - Shinobu Yamamichi
- Department of Gastroenterology, Nagasaki Harbor Medical Center, Nagasaki 850-8555, Japan
| | - Makiko Koike
- Innovation and Translational Research Center, Nagasaki Harbor Medical Center, Nagasaki 850-8555, Japan
| | - Yusuke Nakano
- Innovation and Translational Research Center, Nagasaki Harbor Medical Center, Nagasaki 850-8555, Japan
| | - Hiroyuki Yajima
- Department of Gastroenterology, Nagasaki Harbor Medical Center, Nagasaki 850-8555, Japan
| | - Osamu Miyazaki
- Department of Gastroenterology, Nagasaki Harbor Medical Center, Nagasaki 850-8555, Japan
| | - Tomonari Ikeda
- Department of Gastroenterology, Nagasaki Harbor Medical Center, Nagasaki 850-8555, Japan
| | - Takuma Okamura
- Department of Gastroenterology, Nagasaki Harbor Medical Center, Nagasaki 850-8555, Japan
- Department of Comprehensive Community Care Systems, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8501, Japan
| | - Kazuyoshi Nagata
- Department of Gastroenterology, Nagasaki Harbor Medical Center, Nagasaki 850-8555, Japan
| | - Kenichi Sawa
- Department of Gastroenterology, Nagasaki Harbor Medical Center, Nagasaki 850-8555, Japan
| | - Kazutaka Niiya
- Department of Gastroenterology, Nagasaki Harbor Medical Center, Nagasaki 850-8555, Japan
| | - Kazuhiko Nakao
- Department of Gastroenterology and Hepatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8501, Japan
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Lee V, Han Y, Toh DF, Bryant JA, Boubertakh R, Le TT, Chin CWL. Differential association of abdominal, liver, and epicardial adiposity with anthropometry, diabetes, and cardiac remodeling in Asians. Front Endocrinol (Lausanne) 2024; 15:1439691. [PMID: 39257902 PMCID: PMC11385302 DOI: 10.3389/fendo.2024.1439691] [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: 05/28/2024] [Accepted: 07/29/2024] [Indexed: 09/12/2024] Open
Abstract
Background Heterogenous deposition and homeostasis roles of physiologic and ectopic adipose tissues underscore the impact of fat compartmentalization on cardiometabolic risk. We aimed to characterize the distribution of abdominal visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), epicardial adipose tissue (EAT), and liver fat on magnetic resonance imaging (MRI), and evaluate their associations with anthropometric indices and adverse cardiac remodeling. Methods In this cross-sectional observational study, 149 Asian adults (57.0 ± 12.8 years; 65% males) with at least one cardiometabolic risk factor underwent multiparametric fat and cardiovascular MRI. Anthropometric indices included body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), and bioimpedance body fat mass (BFM). Associations between fat depots and anthropometric measures as well as cardiac remodeling features were examined as a single cohort and stratified by type 2 diabetes mellitus (T2DM) status. Results VAT and SAT had opposing associations with liver fat and EAT. Therefore the VAT/SAT ratio was explored as an integrated marker of visceral adiposity. VAT/SAT was positively associated with EAT (β=0.35, P<0.001) and liver fat (β=0.32, P=0.003) independent of confounders. Of the anthropometric measurements assessed, only WHR was independently associated with VAT/SAT (β=0.17, P=0.021). Individuals with T2DM had higher VAT and lower SAT compared to those without T2DM, translating to a significantly higher VAT/SAT ratio. EAT volume was independently associated with adverse features of cardiac remodeling: increased left ventricular (LV) mass (β=0.24, P=0.005), larger myocyte volume (β=0.26, P=0.001), increased myocardial fibrosis (β=0.19, P=0.023), higher concentricity (β=0.18, P=0.035), and elevated wall stress (β=-0.18, P=0.023). Conclusion Multiparametric MRI revealed abdominal VAT and SAT have differential associations with anthropometric indices and ectopic fats in a single cohort of Asians at risk of cardiometabolic disease. People with T2DM have expanded VAT and diminished SAT, endorsing the VAT/SAT ratio beyond usual anthropometric measurements as a marker for multiorgan visceral fat composition. Among the fat depots examined, EAT is uniquely associated with adverse cardiac remodeling, suggesting its distinctive cardiometabolic properties and implications.
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Affiliation(s)
- Vivian Lee
- National Heart Research Institute Singapore (NHRIS), National Heart Centre Singapore, Singapore, Singapore
| | - Yiying Han
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Desiree-Faye Toh
- National Heart Research Institute Singapore (NHRIS), National Heart Centre Singapore, Singapore, Singapore
| | - Jennifer A. Bryant
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Redha Boubertakh
- National Heart Research Institute Singapore (NHRIS), National Heart Centre Singapore, Singapore, Singapore
- Cardiovascular Academic Clinical Program (ACP), Duke-National University of Singapore (Duke-NUS) Medical School, Singapore, Singapore
| | - Thu-Thao Le
- National Heart Research Institute Singapore (NHRIS), National Heart Centre Singapore, Singapore, Singapore
- Cardiovascular Academic Clinical Program (ACP), Duke-National University of Singapore (Duke-NUS) Medical School, Singapore, Singapore
| | - Calvin W. L. Chin
- National Heart Research Institute Singapore (NHRIS), National Heart Centre Singapore, Singapore, Singapore
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
- Cardiovascular Academic Clinical Program (ACP), Duke-National University of Singapore (Duke-NUS) Medical School, Singapore, Singapore
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Yang F, Tian W, Luo S, Li W, Zhao G, Zhao R, Tian T, Zhao Y, Yao Z, Huang Q. Visceral to subcutaneous fat area ratio predicts severe abdominal adhesions in definitive surgery for anastomotic fistula after small intestine resection. Sci Rep 2024; 14:19063. [PMID: 39154084 PMCID: PMC11330519 DOI: 10.1038/s41598-024-69379-3] [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: 06/01/2024] [Accepted: 08/05/2024] [Indexed: 08/19/2024] Open
Abstract
Abdominal adhesions manifests following abdominal infections triggered by intestinal fistulas. The severity of such adhesions depends on the extent of fiber deposition and peritoneal fibrinolysis following peritoneal injury, which may be influenced by sustained inflammation within the abdominal cavity. In this regard, the visceral-to-subcutaneous fat area (VFA/SFA) ratio has been implicated as a potential marker of inflammation. This study aimed to explore the relationship between VFA/SFA and abdominal adhesions. This multicenter study was conducted across four tertiary institutions and involved patients who had undergone definitive surgery (DS) for intestinal fistula from January 2009 and October 2023. The presence of abdominal adhesions was determined intraoperatively. VFA/SFA was investigated as a potential risk factor for severe adhesions. The study comprised 414 patients with a median age of 50 [interquartile range (IQR) 35-66] years and a median body mass index of 20.0 (IQR 19.2-22.4) kg/m2, including 231 males with a median VFA/SFA of 1.0 (IQR 0.7-1.2) and 183 females a median VFA/SFA of 0.8 (0.6-1.1). VFA/SFA was associated with severe abdominal adhesions in males [odds ratio (OR) = 3.34, 95% CI 1.14-9.80, p = 0.03] and females (OR = 2.99, 95% CI 1.05-8.53, p = 0.04). J-shaped association between VFA/SFA ratio and severe adhesions was revealed in both sex. The increasing trend can be revealed when OR more than 0.8, and 0.6 in males and females respectively. Preoperative VFA/SFA demonstrates predictive value for statues of severe abdominal adhesions in DS for anastomotic fistula after small intestine resection.
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Affiliation(s)
- Fan Yang
- Department of General Surgery, Jinling Hospital, Zhongshan Road No. E.305, Nanjing, Jiangsu, China
| | - Weiliang Tian
- Department of General Surgery, Jinling Hospital, Zhongshan Road No. E.305, Nanjing, Jiangsu, China
| | - Shikun Luo
- Department of General Surgery, Jiangning Hospital, Hushan Road No. 169, Nanjing, Jiangsu, China
| | - Wuhan Li
- Department of General Surgery, Anhui Provincial Hospital, Hefei, Anhui, China
| | - Guoping Zhao
- Department of General Surgery, Jiangning Hospital, Hushan Road No. 169, Nanjing, Jiangsu, China.
| | - Risheng Zhao
- Department of General Surgery, Jiangning Hospital, Hushan Road No. 169, Nanjing, Jiangsu, China.
| | - Tao Tian
- Department of General Surgery, Shanghai 9th Hospital, Shanghai, China
| | - Yunzhao Zhao
- Department of General Surgery, Jiangning Hospital, Hushan Road No. 169, Nanjing, Jiangsu, China
| | - Zheng Yao
- Department of General Surgery, Jiangning Hospital, Hushan Road No. 169, Nanjing, Jiangsu, China.
| | - Qian Huang
- Department of General Surgery, Jinling Hospital, Zhongshan Road No. E.305, Nanjing, Jiangsu, China.
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Mansour A, Pourhassan S, Gerami H, Mohajeri‐Tehrani MR, Salahshour M, Abbasi A, Madreseh E, Sajjadi‐Jazi SM. Regional fat distribution and hepatic fibrosis and steatosis severity in patients with nonalcoholic fatty liver disease and type 2 diabetes. Obes Sci Pract 2024; 10:e777. [PMID: 38957476 PMCID: PMC11215980 DOI: 10.1002/osp4.777] [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: 11/08/2023] [Revised: 06/12/2024] [Accepted: 06/17/2024] [Indexed: 07/04/2024] Open
Abstract
Background Epidemiologic findings suggest that measures of body fat distribution predict health outcomes independent of the overall body fat assessed by body mass index (BMI). This study aimed to evaluate the associations of overall and regional body fat with the severity of hepatic steatosis and fibrosis in type 2 diabetic patients with non-alcoholic fatty liver disease. Methods Bioelectric impedance analysis and two newly developed anthropometric indices, namely, A Body Shape Index (ABSI) and Body Roundness Index (BRI), were used to estimate the body fat. Based on fibroscan parameters, significant hepatic fibrosis and severe steatosis were defined as ≥F2 and >66%, respectively. Results Higher total body fat (odds ratio [OR] 1.107, 95% confidence intervals (CI) 1.038-1.182, p = 0.002), trunk fat (OR 1.136, 95% CI 1.034-1.248, p = 0.008) and leg fat (OR 1.381, 95% CI 1.139-1.674, p = 0.001) were associated with liver fibrosis. However, in contrast to the total body fat (OR 1.088, 95% CI 1.017-1.164, p = 0.014) and leg fat (OR 1.317, 95% CI 1.066-1.628, p = 0.011), the trunk fat was not associated with severe hepatic steatosis. BRI performed better than trunk, leg and total body fat in predicting hepatic steatosis (OR 2.186, 95% CI 1.370-3.487, p = 0.001) and fibrosis (OR 2.132, 95% CI 1.419-3.204, p < 0.001). Moreover, the trunk to leg fat ratio and ABSI were not independent predictors of either steatosis or fibrosis (p > 0.05). Conclusion BRI revealed a superior predictive ability for identifying the degree of hepatic steatosis and stiffness than other obesity indices. Additionally, higher levels of adiposity in the trunk, legs, and overall body were linked to an increased risk of developing liver fibrosis. Although trunk fat did not show an association with severe hepatic steatosis, an increase in leg and total fat was related to liver steatosis.
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Affiliation(s)
- Asieh Mansour
- Endocrinology and Metabolism Research CenterEndocrinology and Metabolism Clinical Sciences InstituteTehran University of Medical SciencesTehranIran
| | - Saeed Pourhassan
- Department of Internal MedicineShariati HospitalTehran University of Medical SciencesTehranIran
| | - Hadis Gerami
- Endocrinology and Metabolism Research CenterEndocrinology and Metabolism Clinical Sciences InstituteTehran University of Medical SciencesTehranIran
- Nutrition and Food Security Research CenterShahid Sadoughi University of Medical SciencesYazdIran
| | - Mohammad Reza Mohajeri‐Tehrani
- Endocrinology and Metabolism Research CenterEndocrinology and Metabolism Clinical Sciences InstituteTehran University of Medical SciencesTehranIran
| | - Marziye Salahshour
- Department of Internal MedicineShariati HospitalTehran University of Medical SciencesTehranIran
| | - Ali Abbasi
- Department of CardiologyShariati HospitalTehran University of Medical SciencesTehranIran
| | - Elham Madreseh
- Department of Epidemiology and BiostatisticsTehran University of Medical SciencesTehranIran
| | - Sayed Mahmoud Sajjadi‐Jazi
- Endocrinology and Metabolism Research CenterEndocrinology and Metabolism Clinical Sciences InstituteTehran University of Medical SciencesTehranIran
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Najafi F, Pasdar Y, Nazar MM, Darbandi M. Association between obesity phenotypes and non-alcoholic fatty liver: a large population- based study. BMC Endocr Disord 2024; 24:96. [PMID: 38918729 PMCID: PMC11197192 DOI: 10.1186/s12902-024-01630-4] [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: 03/06/2024] [Accepted: 06/20/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND The aim of this study was to examine the association between different metabolic obesity phenotypes and the non-alcoholic fatty liver disease (NAFLD). METHODS This cross-sectional analysis utilized data from the baseline phase of the Ravansar non-communicable diseases (RaNCD) cohort study, which involved 8,360 adults. Participants with a Fatty Liver Index (FLI) score of ≥ 60 was classified as having NAFLD. The FLI score was calculated using liver non-invasive markers and anthropometric measurements. Participants were categorized into four phenotypes based on the presence or absence of metabolic syndrome and obesity. Logistic regression analysis was used to evaluate the association of NAFLD and obesity phenotypes. RESULTS According to the FLI index, the prevalence of NAFLD was 39.56%. Participants with FLI scores of ≥ 60 had higher energy intake compared to those in the FLI < 60 group (P = 0.033). In subjects with metabolically unhealthy phenotypes, the level of physical activity was lower compared to those with metabolically healthy phenotypes. The risk of NAFLD in males with the metabolically healthy-obese phenotype increased by 8.92 times (95% CI: 2.20, 15.30), those with the metabolically unhealthy-non-obese phenotype increased by 7.23 times (95% CI: 5.82, 8.99), and those with the metabolically unhealthy-obese phenotype increased by 32.97 times (95% CI: 15.70, 69.22) compared to the metabolically healthy-non-obese phenotype. Similarly, these results were observed in females. CONCLUSION This study demonstrated that the risk of NAFLD is higher in individuals with metabolically healthy/obese, metabolically unhealthy/non-obese, and metabolically unhealthy/obese phenotypes compared to those with non-obese/metabolically healthy phenotypes.
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Affiliation(s)
- Farid Najafi
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yahya Pasdar
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mehdi Moradi Nazar
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mitra Darbandi
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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10
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Jung I, Koo DJ, Lee WY. Insulin Resistance, Non-Alcoholic Fatty Liver Disease and Type 2 Diabetes Mellitus: Clinical and Experimental Perspective. Diabetes Metab J 2024; 48:327-339. [PMID: 38310873 PMCID: PMC11140401 DOI: 10.4093/dmj.2023.0350] [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: 10/04/2023] [Accepted: 12/26/2024] [Indexed: 02/06/2024] Open
Abstract
It has been generally accepted that insulin resistance (IR) and reduced insulin secretory capacity are the basic pathogenesis of type 2 diabetes mellitus (T2DM). In addition to genetic factors, the persistence of systemic inflammation caused by obesity and the associated threat of lipotoxicity increase the risk of T2DM. In particular, the main cause of IR is obesity and subjects with T2DM have a higher body mass index (BMI) than normal subjects according to recent studies. The prevalence of T2DM with IR has increased with increasing BMI during the past three decades. According to recent studies, homeostatic model assessment of IR was increased compared to that of the 1990s. Rising prevalence of obesity in Korea have contributed to the development of IR, non-alcoholic fatty liver disease and T2DM and cutting this vicious cycle is important. My colleagues and I have investigated this pathogenic mechanism on this theme through clinical and experimental studies over 20 years and herein, I would like to summarize some of our studies with deep gratitude for receiving the prestigious 2023 Sulwon Award.
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Affiliation(s)
- Inha Jung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Dae-Jeong Koo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changwon Fatima Hospital, Changwon, Korea
| | - Won-Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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11
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Md Shah MN, Azman RR, Chan WY, Ng KH. Opportunistic Extraction of Quantitative CT Biomarkers: Turning the Incidental Into Prognostic Information. Can Assoc Radiol J 2024; 75:92-97. [PMID: 37075322 DOI: 10.1177/08465371231171700] [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] [Indexed: 04/21/2023] Open
Abstract
The past two decades have seen a significant increase in the use of CT, with a corresponding rise in the mean population radiation dose. This rise in CT use has caused improved diagnostic certainty in conditions that were not previously routinely evaluated using CT, such as headaches, back pain, and chest pain. Unused data, unrelated to the primary diagnosis, embedded within these scans have the potential to provide organ-specific measurements that can be used to prognosticate or risk-profile patients for a wide variety of conditions. The recent increased availability of computing power, expertise and software for automated segmentation and measurements, assisted by artificial intelligence, provides a conducive environment for the deployment of these analyses into routine use. Data gathering from CT has the potential to add value to examinations and help offset the public perception of harm from radiation exposure. We review the potential for the collection of these data and propose the incorporation of this strategy into routine clinical practice.
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Affiliation(s)
- Mohammad Nazri Md Shah
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Raja Rizal Azman
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wai Yee Chan
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kwan Hoong Ng
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Faculty of Medicine and Health Sciences, UCSI University, Springhill, Negri Sembilan, Malaysia
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12
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Kim HK, Bae SJ, Lee MJ, Kim EH, Park H, Kim HS, Cho YK, Jung CH, Lee WJ, Choe J. Association of Visceral Fat Obesity, Sarcopenia, and Myosteatosis with Non-Alcoholic Fatty Liver Disease without Obesity. Clin Mol Hepatol 2023; 29:987-1001. [PMID: 37403320 PMCID: PMC10577332 DOI: 10.3350/cmh.2023.0035] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/30/2023] [Accepted: 07/05/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND/AIMS To investigate whether non-alcoholic fatty liver disease (NAFLD) in individuals without generalized obesity is associated with visceral fat obesity (VFO), sarcopenia, and/or myosteatosis. METHODS This cross-sectional analysis included 14,400 individuals (7,470 men) who underwent abdominal computed tomography scans during routine health examinations. The total abdominal muscle area (TAMA) and skeletal muscle area (SMA) at the 3rd lumbar vertebral level were measured. The SMA was divided into the normal attenuation muscle area (NAMA) and low attenuation muscle area, and the NAMA/TAMA index was calculated. VFO was defined by visceral to subcutaneous fat ratio, sarcopenia by body mass index-adjusted SMA, and myosteatosis by the NAMA/TAMA index. NAFLD was diagnosed with ultrasonography. RESULTS Of the 14,400 individuals, 4,748 (33.0%) had NAFLD, and the prevalence of NAFLD among non-obese individuals was 21.4%. In regression analysis, both sarcopenia (men: odds ratio [OR] 1.41, 95% confidence interval [CI] 1.19-1.67, P<0.001; women: OR=1.59, 95% CI 1.40-1.90, P<0.001) and myosteatosis (men: OR=1.24, 95% CI 1.02-1.50, P=0,028; women: OR=1.23, 95% CI 1.04-1.46, P=0.017) were significantly associated with non-obese NAFLD after considering for VFO and other various risk factors, whereas VFO (men: OR=3.97, 95% CI 3.43-4.59 [adjusted for sarcopenia], OR 3.98, 95% CI 3.44-4.60 [adjusted for myosteatosis]; women: OR=5.42, 95% CI 4.53-6.42 [adjusted for sarcopenia], OR=5.33, 95% CI 4.51-6.31 [adjusted for myosteatosis]; all P<0.001) was strongly associated with non-obese NAFLD after adjustment with various known risk factors. CONCLUSION In addition to VFO, sarcopenia and/or myosteatosis were significantly associated with non-obese NAFLD.
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Affiliation(s)
- Hong-Kyu Kim
- Subdivision of Endocrinology and Metabolism, Health Screening and Promotion Center, Asan Medical Center, Seoul, Korea
| | - Sung-Jin Bae
- Subdivision of Endocrinology and Metabolism, Health Screening and Promotion Center, Asan Medical Center, Seoul, Korea
| | - Min Jung Lee
- Subdivision of Endocrinology and Metabolism, Health Screening and Promotion Center, Asan Medical Center, Seoul, Korea
| | - Eun Hee Kim
- Subdivision of Endocrinology and Metabolism, Health Screening and Promotion Center, Asan Medical Center, Seoul, Korea
| | - Hana Park
- Subdivision of Gastroenterology and Hepatology, Health Screening and Promotion Center, Asan Medical Center, Seoul, Korea
| | - Hwi Seung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, Korea
| | - Yun Kyung Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, Korea
| | - Chang Hee Jung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, Korea
| | - Woo Je Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, Korea
| | - Jaewon Choe
- Subdivision of Gastroenterology and Hepatology, Health Screening and Promotion Center, Asan Medical Center, Seoul, Korea
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13
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Yari Z, Fotros D, Hekmatdoost A. Comparison of cardiometabolic risk factors between obese and non-obese patients with nonalcoholic fatty liver disease. Sci Rep 2023; 13:14531. [PMID: 37666894 PMCID: PMC10477254 DOI: 10.1038/s41598-023-41893-w] [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: 07/19/2023] [Accepted: 09/01/2023] [Indexed: 09/06/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is closely associated with cardiometabolic abnormalities. This association could be partly influenced by weight, but not entirely. This study aimed to compare the cardiometabolic risk factors between obese and non-obese NAFLD patients, and explored the relationship between adiposity and severity of fatty liver. This cross-sectional study included 452 patients with Fibroscan-proven NAFLD. Anthropometric measurements, metabolic components and hepatic histological features were evaluated. The risk of metabolic syndrome in each body mass index (BMI) category was analyzed using logistic regression. The prevalence of metabolic syndrome was 10.2%, 27.7%, and 62.1% in normal-weight, overweight and obese participants. Regression analysis showed that the risk of metabolic syndrome in overweight and obese NAFLD patients was 3.74 and 4.85 times higher than in patients with normal weight, respectively. Waist circumference (β = 0.770, P < 0.001) and serum concentration of fasting blood glucose (β = 0.193, P = 0.002) and triglyceride (β = 0.432, P < 0.001) were the determinants of metabolic syndrome occurrence in NAFLD patients. Metabolic abnormalities were similar in obese and non-obese NAFLD patients, although, the increase in BMI was associated with an increased risk of metabolic syndrome in patients.
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Affiliation(s)
- Zahra Yari
- Department of Nutrition Research, National Nutrition and Food Technology Research, Institute and Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Danial Fotros
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azita Hekmatdoost
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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14
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Pahari H, Sonavane A, Raj A, Agrawal AK, Sawant A, Gupta DK, Gharat A, Raut V. Subcutaneous Fat Obesity in a High Body Mass Index Donor Is Not a Contraindication to Living Donor Hepatectomy. Case Reports Hepatol 2023; 2023:9540002. [PMID: 37547905 PMCID: PMC10404149 DOI: 10.1155/2023/9540002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/13/2023] [Accepted: 07/21/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Living donor liver transplantation (LDLT) has revolutionized the field of transplantation without compromising donor safety. Donor safety is of paramount concern to the transplant team. BMI >35 kg/m2 is mostly considered a contraindication to liver donation. Here, we present a successful right donor hepatectomy from a donor with a BMI of 36.5 kg/m2. Case Summary. A 39-year-old wife donated her right lobe of liver to her 43-year-old husband with nonalcoholic steatohepatitis-related chronic liver disease (CLD). His indications were refractory ascites, hepatic encephalopathy, acute kidney injury, recurrent elbow and urine infections leading to cachexia. She was initially rejected due to a high BMI but failed to lose weight over the next 2 months, and the need for a transplant in her husband was imminent. With no other potential living donors, we decided to proceed with donor evaluation as she had no other comorbidity. We were surprised to find normal liver function tests and a good liver attenuation index (LAI) of +16 on a computed tomography (CT) scan. Magnetic resonance (MR) imaging revealed a fat fraction of 3%. Volumetry confirmed a remnant of 37.9% and a potential graft-to-recipient weight ratio of 1.23. V/S ratio on CT scan (visceral fat area/subcutaneous fat area at L4-level) was <0.4 confirming subcutaneous fat obesity. Both surgeries were uneventful and both donor and recipient recovered well except recipient re-exploration on postoperative day (POD)-1 due to surgical bleeding. The donor was discharged on POD-6 and recipient was discharged on POD-15. At 3 weeks of follow-up, the donor's wound is clean and well-healed, and she is already back to doing her daily life activities without any pain with normal laboratory parameters. CONCLUSION Subcutaneous fat obesity should not be considered as a contraindication to liver donation even with a BMI >35 kg/m2. A small percentage of healthy individuals will not have visceral fat obesity and may not have steatotic livers. The CT scan and MR fat fraction estimation can confirm the findings. Biopsy may be avoided if MR fat estimation is <10% in obese donors. Intraoperative visualization in these donors remains the gold standard to decide the need for biopsy. Living donor hepatectomy may be safely performed in a select group of high BMI patients (>35 kg/m2) with pure subcutaneous fat obesity in the absence of other suitable living donors.
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Affiliation(s)
- Hirak Pahari
- Department of Liver Transplant and HPB Surgery, Medicover Hospitals, Navi Mumbai, Maharashtra, India
| | - Amey Sonavane
- Department of Gastroenterology and Hepatology, Medicover Hospitals, Navi Mumbai, Maharashtra, India
| | - Amruth Raj
- Department of Liver Transplant and HPB Surgery, Medicover Hospitals, Navi Mumbai, Maharashtra, India
| | - Anup Kumar Agrawal
- Department of Radiology, Medicover Hospitals, Navi Mumbai, Maharashtra, India
| | - Ambreen Sawant
- Department of Liver Transplant Anaesthesia, Medicover Hospitals, Navi Mumbai, Maharashtra, India
| | - Deepak Kumar Gupta
- Department of Gastroenterology and Hepatology, Medicover Hospitals, Navi Mumbai, Maharashtra, India
| | - Amit Gharat
- Department of Gastroenterology and Hepatology, Medicover Hospitals, Navi Mumbai, Maharashtra, India
| | - Vikram Raut
- Department of Liver Transplant and HPB Surgery, Medicover Hospitals, Navi Mumbai, Maharashtra, India
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15
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Kim KS, Hong S, Ahn HY, Park CY. Metabolic Dysfunction-Associated Fatty Liver Disease and Mortality: A Population-Based Cohort Study. Diabetes Metab J 2023; 47:220-231. [PMID: 36631994 PMCID: PMC10040627 DOI: 10.4093/dmj.2021.0327] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/19/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND We investigated whether metabolic dysfunction-associated fatty liver disease (MAFLD) is associated with an elevated risk of all-cause and cardiovascular mortality using a large-scale health examination cohort. METHODS A total of 394,835 subjects in the Kangbuk Samsung Health Study cohort were enrolled from 2002 to 2012. Participants were categorized by the presence of nonalcoholic fatty liver disease (NAFLD) and MAFLD as follows: normal subjects; patients with both NAFLD and MAFLD; patients with NAFLD only; and patients with MAFLD only. Cox proportional hazards models were used to analyze the risk of mortality. RESULTS During a median 5.7 years of follow-up, 20.69% was patients with both NAFLD and MAFLD, 1.51% was patients with NAFLD only, and 4.29% was patients with MAFLD only. All-cause and cardiovascular death was higher in patients with MAFLD than those without MAFLD (P<0.001, respectively). In patients with MAFLD only, the hazard ratio (HR) of all-cause and cardiovascular death was 1.35 (95% confidence interval [CI], 1.13 to 1.60) and 1.90 (95% CI, 1.26 to 2.88) after adjusting for age, which lost its statistical significance by multivariable adjustments. Compared to patients with less than two components of metabolic dysfunction, patients with more than two components of metabolic dysfunction were a higher risk of cardiovascular death (HR, 2.05; 95% CI, 1.25 to 3.38) and only women with more than two components of metabolic dysfunction were a higher risk of all-cause death (HR, 1.44; 95% CI, 1.02 to 2.03). CONCLUSION MAFLD criteria could identify a high-risk group for all-cause and cardiovascular death.
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Affiliation(s)
- Kyung-Soo Kim
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Sangmo Hong
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Hong-Yup Ahn
- Department of Statistics, Dongguk University, Seoul, Korea
| | - Cheol-Young Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Corresponding author: Cheol-Young Park https://orcid.org/0000-0002-9415-9965 Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul 03181, Korea E-mail:
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16
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Shen S, Huang H, Wang J, Tang Z, Shen C, Xu C. Positive Association Between the Chinese Visceral Adiposity Index and Nonalcoholic Fatty Liver Disease in Lean Adults. Dig Dis Sci 2023; 68:656-664. [PMID: 36512267 DOI: 10.1007/s10620-022-07787-z] [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: 09/15/2022] [Accepted: 12/05/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Chinese visceral adiposity index (CVAI) is a novel indicator that precisely evaluates visceral obesity and has been shown to be significantly associated with nonalcoholic fatty liver disease (NAFLD) in the general population. However, the relationship between CVAI and NAFLD in lean adults remains unclear. AIMS This study aimed to explore the association of CVAI with NAFLD in a lean population and evaluate the diagnostic capability of CVAI for lean NAFLD. METHODS A cross-sectional study was conducted among 9,607 lean adults (body mass index < 24 kg/m2), who underwent their annual health examinations at the First Affiliated Hospital, Zhejiang University School of Medicine in 2021. NAFLD was determined by ultrasonography to the exclusion of other known etiologies. RESULTS The prevalence of NAFLD was 16.4% in this lean population. CVAI values were significantly higher in participants with NAFLD than those without NAFLD and the CVAI quartile was positively associated with the prevalence of NAFLD, which was 0.4%, 6.0%, 19.4%, and 39.8% among the participants with CVAI in quartile 1 to 4, respectively (P for trend < 0.001). Logistic regression analysis found that CVAI was positively associated with the risk of NAFLD (adjusted odds ratio: 1.025, 95% confidence interval: 1.021-1.028; P < 0.001). Furthermore, CVAI had a significantly higher area under curve value for detecting NAFLD than other visceral obesity indices. CONCLUSION Our study showed that CVAI was positively associated with the prevalence and risk of NAFLD in lean adults, and CVAI showed the highest diagnostic ability for lean NAFLD.
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Affiliation(s)
- Shuxia Shen
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China
- Zhejiang Provincial Clinical Research Center for Digestive Diseases, Hangzhou, China
| | - Hangkai Huang
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China
- Zhejiang Provincial Clinical Research Center for Digestive Diseases, Hangzhou, China
| | - Jinghua Wang
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China
- Zhejiang Provincial Clinical Research Center for Digestive Diseases, Hangzhou, China
| | - Zexi Tang
- School of Science, Hong Kong University of Science and Technology, Hong Kong, China
| | - Chao Shen
- Health Management Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chengfu Xu
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China.
- Zhejiang Provincial Clinical Research Center for Digestive Diseases, Hangzhou, China.
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17
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He DH, Zhang YZ, Xu L, Pei JJ, Zhang Y, Yan ZF. Relationship between metabolic associated fatty liver disease and body fat ratio, visceral fat area, and resting metabolic rate estimated by bioelectrical impedance analysis. Shijie Huaren Xiaohua Zazhi 2023; 31:56-65. [DOI: 10.11569/wcjd.v31.i2.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Deng-Hua He
- Department of Clinical Nutrition, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Yong-Zhan Zhang
- Department of Clinical Nutrition, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Liang Xu
- Department of Hepatology, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Jia-Jia Pei
- Department of Clinical Nutrition, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Ying Zhang
- Department of Clinical Nutrition, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Zhong-Fang Yan
- Department of Clinical Nutrition, Tianjin An Ding Hospital, Tianjin 300222, China
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18
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Song W, Yoo SH, Jang J, Baik SJ, Lee BK, Lee HW, Park JS. Association between Sarcopenic Obesity Status and Nonalcoholic Fatty Liver Disease and Fibrosis. Gut Liver 2023; 17:130-138. [PMID: 36472070 PMCID: PMC9840924 DOI: 10.5009/gnl220041] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/10/2022] [Accepted: 05/13/2022] [Indexed: 12/12/2022] Open
Abstract
Background/Aims There are no data regarding the association between sarcopenic obesity status and nonalcoholic fatty liver disease (NAFLD) and NAFLD-associated liver fibrosis. Therefore, we aimed to investigate the relationship between sarcopenic obesity status (sarcopenia only, obesity only, and sarcopenic obesity) and NAFLD and liver fibrosis in Korean adults. Methods In total, 2,191 subjects completed a health checkup program, including abdominal ultrasonography and FibroScan. Subjects were classified into the following four categories: optimal body composition (nonobese and nonsarcopenic), sarcopenia only (nonobese), obesity only (nonsarcopenic), and sarcopenic obesity. Sarcopenic obesity was stratified by the skeletal muscle mass index and body fat using bioelectrical impedance analysis. NAFLD was diagnosed by ultrasonography, and liver fibrosis was assessed using transient elastography in subjects with NAFLD. Results The prevalence of NAFLD and liver fibrosis significantly increased according to the sarcopenic obesity status. In the logistic regression analysis, after adjusting for multiple risk factors, the odds ratio (OR) for the risk of NAFLD was largest in the sarcopenic obesity group (OR, 3.68; 95% confidence interval [CI], 2.94 to 4.60), followed by the obesity only (OR, 2.25; 95% CI, 1.67 to 3.03) and sarcopenia only (OR, 1.92; 95% CI, 1.30 to 2.84) groups, when compared with the optimal group. Additionally, liver fibrosis was independently associated with sarcopenic obesity status (OR 4.69, 95% CI 1.95 to 11.29; OR 4.17, 95% CI 1.56 to 11.17; OR 3.80, 95% CI 0.86 to 16.75, respectively). Conclusions These results demonstrated that sarcopenic obesity was independently associated with NAFLD and liver fibrosis and increased the risk of NAFLD and liver fibrosis more than obesity or sarcopenia alone.
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Affiliation(s)
- Wolhwa Song
- Divisions of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Hwan Yoo
- Divisions of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jinsun Jang
- Divisions of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Su Jung Baik
- Healthcare Research Team, Health Promotion Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byoung Kwon Lee
- Healthcare Research Team, Health Promotion Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Woong Lee
- Divisions of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea,Hyun Woong Lee, ORCIDhttps://orcid.org/0000-0002-6958-3035, E-mail
| | - Jong Suk Park
- Divisions of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea,Corresponding AuthorJong Suk Park, ORCIDhttps://orcid.org/0000-0002-5385-1373, E-mail
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19
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Hao X, He H, Tao L, Wang P. Using hyperhomocysteinemia and body composition to predict the risk of non-alcoholic fatty liver disease in healthcare workers. Front Endocrinol (Lausanne) 2023; 13:1063860. [PMID: 36686421 PMCID: PMC9852987 DOI: 10.3389/fendo.2022.1063860] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/19/2022] [Indexed: 01/09/2023] Open
Abstract
Purpose This study investigated associations between serum homocysteine levels, body composition, and the probability of having nonalcoholic fatty liver disease (NAFLD) in Chinese healthcare workers. Patients and Methods A total of 4028 healthcare workers were enrolled in this study, and all underwent a physical examination. Body composition was measured using multifrequency bioelectrical impedance analysis. Results There were 1507 NAFLD patients (72.26% male, 27.74% female) and 2521 controls (39.83% male, 60.17% female). Body mass index (BMI), waistline, neck-circumference (NC), abdominal visceral fat area (AVFA), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), glucose (Glu), homocysteinemia (hcy) were higher in the NAFLD group than controls. Additionally, the skeletal-muscle was associated with a lower risk of NAFLD, whereas BMI, waistline, NC, hyperhomocysteinemia (HHcy) were associated with a higher risk of NAFLD. The best NC cut-off point for NAFLD was 34.45 cm (sensitivity 83.3% and specificity 83.9%) in women with HHcy, and the best skeletal-muscle content cut-off point for NAFLD was 41.335% (sensitivity 74.2% and specificity 65.6%) in men with HHcy. Conclusion Interactions between skeletal-muscle content, NC, and HHcy may affect the incidence of NAFLD in healthcare workers. This may provide a novel approach for diagnosing NAFLD.
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Affiliation(s)
| | | | | | - Peng Wang
- Medical examination center, Peking University, Third Hospital, Beijing, China
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20
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Waddell T, Namburete A, Duckworth P, Fichera A, Telford A, Thomaides-Brears H, Cuthbertson DJ, Brady M. Poor glycaemic control and ectopic fat deposition mediates the increased risk of non-alcoholic steatohepatitis in high-risk populations with type 2 diabetes: Insights from Bayesian-network modelling. Front Endocrinol (Lausanne) 2023; 14:1063882. [PMID: 36909341 PMCID: PMC9992174 DOI: 10.3389/fendo.2023.1063882] [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: 10/07/2022] [Accepted: 02/08/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND An estimated 55.5% and 37.3% of people globally with type 2 diabetes (T2D) will have concomitant non-alcoholic fatty liver disease (NAFLD) and the more severe fibroinflammatory stage, non-alcoholic steatohepatitis (NASH). NAFLD and NASH prevalence is projected to increase exponentially over the next 20 years. Bayesian Networks (BNs) offer a powerful tool for modelling uncertainty and visualising complex systems to provide important mechanistic insight. METHODS We applied BN modelling and probabilistic reasoning to explore the probability of NASH in two extensively phenotyped clinical cohorts: 1) 211 participants with T2D pooled from the MODIFY study & UK Biobank (UKBB) online resource; and 2) 135 participants without T2D from the UKBB. MRI-derived measures of visceral (VAT), subcutaneous (SAT), skeletal muscle (SMI), liver fat (MRI-PDFF), liver fibroinflammatory change (liver cT1) and pancreatic fat (MRI-PDFF) were combined with plasma biomarkers for network construction. NASH was defined according to liver PDFF >5.6% and liver cT1 >800ms. Conditional probability queries were performed to estimate the probability of NASH after fixing the value of specific network variables. RESULTS In the T2D cohort we observed a stepwise increase in the probability of NASH with each obesity classification (normal weight: 13%, overweight: 23%, obese: 36%, severe obesity: 62%). In the T2D and non-T2D cohorts, elevated (vs. normal) VAT conferred a 20% and 1% increase in the probability of NASH, respectively, while elevated SAT caused a 7% increase in NASH risk within the T2D cohort only. In those with T2D, reducing HbA1c from the 'high' to 'low' value reduced the probability of NASH by 22%. CONCLUSION Using BNs and probabilistic reasoning to study the probability of NASH, we highlighted the relative contribution of obesity, ectopic fat (VAT and liver) and glycaemic status to increased NASH risk, namely in people with T2D. Such modelling can provide insights into the efficacy and magnitude of public health and pharmacological interventions to reduce the societal burden of NASH.
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Affiliation(s)
- T. Waddell
- Department of Engineering Science, The University of Oxford, Oxford, United Kingdom
- Perspectum Ltd, Oxford, United Kingdom
- *Correspondence: T. Waddell,
| | - A. Namburete
- Department of Computer Science, The University of Oxford, Oxford, United Kingdom
| | - P. Duckworth
- Oxford Robotics Institute, The University of Oxford, Oxford, United Kingdom
| | | | | | | | - D. J. Cuthbertson
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - M. Brady
- Perspectum Ltd, Oxford, United Kingdom
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21
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Ha NB, Cho S, Mohamad Y, Kent D, Jun G, Wong R, Swarnakar V, Lin S, Maher JJ, Lai JC. Visceral Adipose Tissue Inflammation and Radiographic Visceral-to-Subcutaneous Adipose Tissue Ratio in Patients with Cirrhosis. Dig Dis Sci 2022; 67:3436-3444. [PMID: 34136974 PMCID: PMC8815298 DOI: 10.1007/s10620-021-07099-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 06/07/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS Accumulation of visceral adipose tissue is associated with hepatic inflammation and fibrosis, suggestive of its metabolic and inflammatory properties. We aimed to examine the histologic findings of visceral and subcutaneous adipose tissue and to associate these findings with clinical and radiologic characteristics in patients with cirrhosis. METHODS Included were 55 adults with cirrhosis who underwent liver transplantation from 3/2017-12/2018 and had an abdominal computed tomography (CT) scan within 6 months prior to transplant. Visceral-to-subcutaneous adipose tissue ratio (VSR) was calculated using visceral (VATI) and subcutaneous adipose tissue index (SATI) quantified by CT at the L3-vertebral level and normalized for height (cm2/m2). VAT (greater omentum), SAT (abdominal wall), and skeletal muscle (rectus abdominis) biopsies were collected at transplant. RESULTS Majority of patients had VAT inflammation (71%); only one patient (2%) had SAT inflammation. Patients with VAT inflammation had similar median VATI (42 vs 41 cm2/m2), lower median SATI (64 vs 97 cm2/m2), and higher median VSR (0.63 vs 0.37, p = 0.002) than patients without inflammation. In univariable logistic regression, VSR was associated with VAT inflammation (OR 1.47, 95%CI 1.11-1.96); this association remained significant even after adjusting for age, sex, BMI, HCC, or MELD-Na on bivariable analyses. CONCLUSION In patients with cirrhosis undergoing liver transplantation, histologic VAT inflammation was common, but SAT inflammation was not. Increased VSR was independently associated with VAT inflammation. Given the emerging data demonstrating the prognostic value of VSR, our findings support the value of CT-quantified VSR as a prognostic marker for adverse outcomes in the liver transplant setting.
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Affiliation(s)
- Nghiem B. Ha
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, 513 Parnassus Avenue, Box 0538, San Francisco, CA 94143, USA
| | - Soo‑Jin Cho
- Department of Pathology, University of California, San Francisco, CA, USA
| | - Yara Mohamad
- 3D Lab, Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Dorothea Kent
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, 513 Parnassus Avenue, Box 0538, San Francisco, CA 94143, USA
| | - Grace Jun
- 3D Lab, Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Randi Wong
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, 513 Parnassus Avenue, Box 0538, San Francisco, CA 94143, USA
| | - Vivek Swarnakar
- 3D Lab, Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Shezhang Lin
- 3D Lab, Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Jacquelyn J. Maher
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, 513 Parnassus Avenue, Box 0538, San Francisco, CA 94143, USA,Liver Center, University of California, San Francisco, CA, USA
| | - Jennifer C. Lai
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, 513 Parnassus Avenue, Box 0538, San Francisco, CA 94143, USA,Liver Center, University of California, San Francisco, CA, USA
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22
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Rhee EJ. The Influence of Obesity and Metabolic Health on Vascular Health. Endocrinol Metab (Seoul) 2022; 37:1-8. [PMID: 35255597 PMCID: PMC8901957 DOI: 10.3803/enm.2022.101] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/08/2022] [Indexed: 11/11/2022] Open
Abstract
The prevalence of obesity is rapidly increasing worldwide. Obesity should not be understood only as the accumulation of fat in the body, but instead as a phenomenon that exerts different effects on our health according to the place of fat deposition and its stability. Obesity is the starting point of most metabolic diseases, such as diabetes, hypertension, metabolic syndrome, sleep apnea, and eventually cardiovascular disease. There are different kinds of obesity, ranging from simple obesity to sarcopenic obesity. The main purpose of intervening to address obesity is to decrease the ultimate consequence of obesity-namely, cardiovascular disease. The main mechanism through which obesity, especially abdominal obesity, increases cardiovascular risk is the obesity-induced derangement of metabolic health, leading to the development of metabolic diseases such as diabetes, non-alcoholic fatty liver disease, and metabolic syndrome, which are the main initiators of vascular damage. In this review, I discuss the influence of various types of obesity on the risk of metabolic diseases, and how these diseases increase cardiovascular disease risk.
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Affiliation(s)
- Eun-Jung Rhee
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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23
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Yang Y, Li S, Xu Y, Ke J, Zhao D. The Perirenal Fat Thickness Was Associated with Nonalcoholic Fatty Liver Disease in Patients with Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes 2022; 15:1505-1515. [PMID: 35586202 PMCID: PMC9109981 DOI: 10.2147/dmso.s350579] [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: 01/22/2022] [Accepted: 04/27/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Obesity is an important risk factor for nonalcoholic fatty liver disease (NAFLD). Perirenal fat and paranephric fat were seldom studied in NAFLD. We aimed to explore the relationship between perirenal fat thickness (PrFT) and paranephric fat thickness (PnFT) and NAFLD in patients with type 2 diabetes mellitus (T2DM). PATIENTS AND METHODS A total of 493 diabetic patients including 231 NAFLD patients were enrolled in our study from September 2019 to December 2020. Patients with NAFLD were categorized into three subgroups according to the severity and fibrosis risk of NAFLD. Anthropometric indices and clinical characteristics were collected from clinical records. PrFT and PnFT were measured via ultrasound. Multivariate logistic regression analysis was used to assess the association between PrFT, PnFT and presence, severity and advanced fibrosis risk of NAFLD. RESULTS Compared with non-NAFLD patients, those with NAFLD had significantly higher PrFT and PnFT. The PrFT and PnFT were independently associated with presence of NAFLD and the PrFT was independently associated with the advanced fibrosis risk of NAFLD after adjusting confounding factors. CONCLUSION The PrFT was independently associated with the presence and advanced fibrosis risk of NAFLD in patients with T2DM.
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Affiliation(s)
- Yuxian Yang
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Shuting Li
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yuechao Xu
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Jing Ke
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, People’s Republic of China
- Correspondence: Jing Ke; Dong Zhao, Email ;
| | - Dong Zhao
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, People’s Republic of China
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24
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Khayyat YM. Determination of "indeterminate score" measurements in lean nonalcoholic fatty liver disease patients from western Saudi Arabia. World J Hepatol 2021; 13:2150-2160. [PMID: 35070015 PMCID: PMC8727213 DOI: 10.4254/wjh.v13.i12.2150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/24/2021] [Accepted: 10/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Noninvasive measures to estimate liver fibrosis in lieu of biopsy in nonalcoholic liver disease (NAFLD) can broadly differentiate high vs low degrees of condition extent. However, an "indeterminate score" necessitates further clinical investigation and biopsy becomes essential, highlighting the need for identification of other noninvasive factors with accuracy for this midlevel extent and its prognosis. Lean NAFLD cases are of particular interest regarding this issue, as they present as otherwise healthy, and will benefit greatly from the less invasive assessment. AIM To estimate the agreement of two noninvasive assessment tools in lean NAFLD patients, and assess factors related to indeterminate scores. METHODS Ultrasound-diagnosed NAFLD patients, without sign of other chronic liver disease (n = 1262), were enrolled from a tertiary private medical centre between 2016-2019. After grouping by body mass index (obese, overweight, and lean), each participant underwent FibroScan. NAFLD fibrosis score (NFS) was used for subclassification (lower, higher, and indeterminate). No patient underwent liver biopsy. The kappa statistic was used to assess inter-rater agreement between the three groups on liver fibrosis degree assessed via FibroScan and NFS. Indeterminate score among the three groups was assessed to identify factors that predict its determination. RESULTS The NAFLD study cohort was composed of lean (159/1262, 12.6%), overweight (365/1262, 29%) and obese (737/1262, 58.4%) individuals. The lean patients were significantly younger (49.95 ± 15.3 years, P < 0.05), with higher serum high density lipoprotein (52.56 ± 16.27 mg/dL, P < 0.001) and lower prevalences of type 2 diabetes mellitus, hypertension and hyperlipidaemia. All groups showed a predominance of lower fibrosis degree. The lean NAFLD patients showed a significantly lower NFS (P < 0.001). Degree of agreement between FibroScan and NFS was fair between the lean and obese NAFLD categories, and moderate in the overweight category. NFS was predictive of indeterminate score. Age was a factor among all the body mass index (BMI) categories; other associated factors, but with less strength, were serum alanine aminotransferase in the overweight category and BMI in the obese category. CONCLUSION Lean NAFLD patients showed lower degree and prevalence of liver fibrosis by NFS; however, follow-up biopsy is still needed.
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Affiliation(s)
- Yasir Mohammed Khayyat
- Department of Medicine, Umm Al Qura University, Makkah 13578, Saudi Arabia
- Department of Medicine, International Medical Centre, Jeddah 21451, Saudi Arabia.
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25
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Flint A, Andersen G, Hockings P, Johansson L, Morsing A, Sundby Palle M, Vogl T, Loomba R, Plum‐Mörschel L. Randomised clinical trial: semaglutide versus placebo reduced liver steatosis but not liver stiffness in subjects with non-alcoholic fatty liver disease assessed by magnetic resonance imaging. Aliment Pharmacol Ther 2021; 54:1150-1161. [PMID: 34570916 PMCID: PMC9292692 DOI: 10.1111/apt.16608] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/04/2021] [Accepted: 09/03/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Glucagon-like peptide-1 receptor agonists may be a treatment option in patients with non-alcoholic fatty liver disease (NAFLD). AIMS To investigate the effects of semaglutide on liver stiffness and liver fat in subjects with NAFLD using non-invasive magnetic resonance imaging (MRI) methods. METHODS This randomised, double-blind, placebo-controlled trial enrolled subjects with liver stiffness 2.50-4.63 kPa by magnetic resonance elastography (MRE) and liver steatosis ≥10% by MRI proton density fat fraction (MRI-PDFF). The primary endpoint was change from baseline to week 48 in liver stiffness assessed by MRE. RESULTS Sixty-seven subjects were randomised to once-daily subcutaneous semaglutide 0.4 mg (n = 34) or placebo (n = 33). Change from baseline in liver stiffness was not significantly different between semaglutide and placebo at week 48 (estimated treatment ratio 0.96 (95% CI 0.89, 1.03; P = 0.2798); significant differences in liver stiffness were not observed at weeks 24 or 72. Reductions in liver steatosis were significantly greater with semaglutide (estimated treatment ratios: 0.70 [0.59, 0.84], P = 0.0002; 0.47 [0.36, 0.60], P < 0.0001; and 0.50 [0.39, 0.66], P < 0.0001) and more subjects achieved a ≥ 30% reduction in liver fat content with semaglutide at weeks 24, 48 and 72, (all P < 0.001). Decreases in liver enzymes, body weight and HbA1c were also observed with semaglutide. CONCLUSIONS The change in liver stiffness in subjects with NAFLD was not significantly different between semaglutide and placebo. However, semaglutide significantly reduced liver steatosis compared with placebo which, together with improvements in liver enzymes and metabolic parameters, suggests a positive impact on disease activity and metabolic profile. ClinicalTrials.gov identifier: NCT03357380.
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Affiliation(s)
| | | | - Paul Hockings
- Antaros MedicalBioVenture HubMölndalSweden
- MedTech WestChalmers University of TechnologyGothenburgSweden
| | | | | | | | | | - Rohit Loomba
- University of California San Diego School of MedicineSan DiegoCaliforniaUSA
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Kai Y, Gao J, Liu H, Wang Y, Tian C, Guo S, He L, Li M, Tian Z, Song X. Effects of IL-33 on 3T3-L1 cells and obese mice models induced by a high-fat diet. Int Immunopharmacol 2021; 101:108209. [PMID: 34624652 DOI: 10.1016/j.intimp.2021.108209] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/19/2021] [Accepted: 09/27/2021] [Indexed: 12/26/2022]
Abstract
Obesity is a syndrome that attributes to many factors such as genetics, diet, lifestyle and environment, which includes an imbalance of immune regulation. IL-33, as a new member of the IL-1 family, is classically associated with type 2 immune responses. Here, IL-33 was investigated for its ability to optimize lipid aggregation and ameliorate the inflammatory response in obesity. In vitro experimental results showed that, compared with the induction group, the treatment with 30 ng/mL IL-33 displayed a reduction in the number of lipid droplets. The expression levels of AceCS1 and PPARγ also decreased in the 30 ng/mL IL-33 group compared to the induction group. For confirmation in vivo, three groups of C57BL/6 mice were treated for 14 weeks: mice in control were fed with a normal diet; mice in the HFD and IL-33 groups were fed with a high-fat diet (HFD) and with sterile PBS or recombinant IL-33, respectively. Liver, muscle, spleen and four types of adipose tissue, as well as serum, were collected for further testing. Our data demonstrated that after 4-week treatment with recombinant IL-33, metabolic parameters in mice were improved significantly (visceral fat weight, glucose and insulin tolerance, liver steatosis, expression of lipid synthesis index and inflammatory response). Moreover, IL-33 treatment regulated the original distribution of IL-33 among different tissues. Hence, IL-33 modulated lipid metabolism and inflammatory response in obesity, which would be a novel therapeutic target for obesity and related metabolic diseases.
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Affiliation(s)
- Yue Kai
- Department of Immunology, School of Basic Medical Sciences, Xinxiang Medical University, Henan Xinxiang 453003, China; Xinxiang Key Laboratory of Tumor Vaccine and Immunotherapy, Xinxiang Medical University, Xinxiang, Henan 453003, China; School of Medicine, Xinxiang University, Henan Xinxiang 453003, China
| | - Jingtao Gao
- Department of Immunology, School of Basic Medical Sciences, Xinxiang Medical University, Henan Xinxiang 453003, China; Xinxiang Key Laboratory of Tumor Vaccine and Immunotherapy, Xinxiang Medical University, Xinxiang, Henan 453003, China
| | - Hu Liu
- Department of Immunology, School of Basic Medical Sciences, Xinxiang Medical University, Henan Xinxiang 453003, China; Xinxiang Key Laboratory of Tumor Vaccine and Immunotherapy, Xinxiang Medical University, Xinxiang, Henan 453003, China
| | - Yubing Wang
- Department of Immunology, School of Basic Medical Sciences, Xinxiang Medical University, Henan Xinxiang 453003, China; Xinxiang Key Laboratory of Tumor Vaccine and Immunotherapy, Xinxiang Medical University, Xinxiang, Henan 453003, China
| | - Chenrui Tian
- Department of Immunology, School of Basic Medical Sciences, Xinxiang Medical University, Henan Xinxiang 453003, China; Xinxiang Key Laboratory of Tumor Vaccine and Immunotherapy, Xinxiang Medical University, Xinxiang, Henan 453003, China
| | - Sheng Guo
- Department of Immunology, School of Basic Medical Sciences, Xinxiang Medical University, Henan Xinxiang 453003, China; Xinxiang Key Laboratory of Tumor Vaccine and Immunotherapy, Xinxiang Medical University, Xinxiang, Henan 453003, China
| | - Ling He
- Department of ophthalmology, the 371 Affiliated Hospital of Xinxiang Medical University, Henan Xinxiang 453003, China
| | - Min Li
- Department of Microbiology, School of Basic Medical Sciences, Xinxiang Medical University, Henan Xinxiang 453003, China
| | - Zhongwei Tian
- Department of Dermatology, the First Affiliated Hospital of Xinxiang Medical University, Henan Xinxiang 453003, China
| | - Xiangfeng Song
- Department of Immunology, School of Basic Medical Sciences, Xinxiang Medical University, Henan Xinxiang 453003, China; Xinxiang Key Laboratory of Tumor Vaccine and Immunotherapy, Xinxiang Medical University, Xinxiang, Henan 453003, China.
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Brand T, van den Munckhof ICL, van der Graaf M, Schraa K, Dekker HM, Joosten LAB, Netea MG, Riksen NP, de Graaf J, Rutten JHW. Superficial vs Deep Subcutaneous Adipose Tissue: Sex-Specific Associations With Hepatic Steatosis and Metabolic Traits. J Clin Endocrinol Metab 2021; 106:e3881-e3889. [PMID: 34137897 PMCID: PMC8571813 DOI: 10.1210/clinem/dgab426] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Indexed: 01/21/2023]
Abstract
CONTEXT Subcutaneous adipose tissue (SAT) is not homogeneous, as the fascia scarpa separates the deep SAT (dSAT) from the superficial SAT (sSAT). OBJECTIVE The aim of this study is to evaluate the sex-specific associations of sSAT and dSAT with hepatic steatosis and metabolic syndrome in overweight individuals. METHODS We recruited 285 individuals with a body mass index (BMI) greater than or equal to 27 and aged 55 to 81 years. Abdominal magnetic resonance imaging was performed around level L4 to L5 to measure visceral adipose tissue (VAT), dSAT, and sSAT volumes. The amount of hepatic fat was quantified by MR spectroscopy. RESULTS Men had significantly higher volumes of VAT (122.6 cm3 vs 98.7 cm3, P < .001) and had only half the volume of sSAT compared to women adjusted for BMI (50.3 cm3 in men vs 97.0 cm3 in women, P < .001). dSAT correlated significantly with hepatic fat content in univariate analysis (standardized β = .190, P < .05), while VAT correlated significantly with hepatic steatosis in a multivariate model, adjusted for age, alcohol use, and other abdominal fat compartments (standardized β = .184, P = .037). Moreover, dSAT in men correlated negatively with HDL cholesterol (standardized β = -0.165, P = .038) in multivariate analyses. In women with a BMI between 30 and 40, in a multivariate model adjusted for age, alcohol use, and other abdominal fat compartments, VAT correlated positively (standardized β = -.404, P = .003), and sSAT negatively (standardized β = -.300, P = .04) with hepatic fat content. CONCLUSION In men, dSAT is associated with hepatic steatosis and adverse metabolic traits, such as lower HDL cholesterol levels, whereas in women with obesity sSAT shows a beneficial relation with respect to hepatic fat content.
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Affiliation(s)
- Tessa Brand
- Department of Internal Medicine, Division of Vascular Medicine 463, Radboud University Medical Center, HB Nijmegen, the Netherlands
| | | | - Marinette van der Graaf
- Department of Medical Imaging, Radboud University Medical Center, HB Nijmegen, the Netherlands
| | - Kiki Schraa
- Department of Internal Medicine, Division of Vascular Medicine 463, Radboud University Medical Center, HB Nijmegen, the Netherlands
| | - Helena Maria Dekker
- Department of Medical Imaging, Radboud University Medical Center, HB Nijmegen, the Netherlands
| | - Leonardus Antonius Bernardus Joosten
- Department of Internal Medicine, Division of Vascular Medicine 463, Radboud University Medical Center, HB Nijmegen, the Netherlands
- Department of Medical Genetics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihai Gheorghe Netea
- Department of Internal Medicine, Division of Vascular Medicine 463, Radboud University Medical Center, HB Nijmegen, the Netherlands
- Department for Genomics & Immunoregulation, Life and Medical Sciences Institute (LIMES), University of Bonn, Bonn, Germany
| | - Niels Peter Riksen
- Department of Internal Medicine, Division of Vascular Medicine 463, Radboud University Medical Center, HB Nijmegen, the Netherlands
| | - Jacqueline de Graaf
- Department of Internal Medicine, Division of Vascular Medicine 463, Radboud University Medical Center, HB Nijmegen, the Netherlands
| | - Joseph Henricus Wilhelmus Rutten
- Department of Internal Medicine, Division of Vascular Medicine 463, Radboud University Medical Center, HB Nijmegen, the Netherlands
- Correspondence: J. H. W. Rutten, MD, PhD, Department of Internal Medicine (463), Radboudumc Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands.
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Hassan NE, El-Masry SA, El-Saeed GSM, El Hussieny MS. Lipid Accumulation Product as an Index for Visceral Obesity and Cardiovascular Risk among a Sample of Obese Egyptian Women. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background:Lipid accumulation product (LAP) is one of the indices that can demonstrate cardiovascularrisk factors according to international studies. Aim: To evaluate relationship between LAP, visceral obesity and different cardio vascular risk factors among sample of obese Egyptian Women. Methods: A retrospective cross-sectional observational study included 350 obese Egyptian women; aged 25- 55 years. They were subjected to blood pressure and anthropometric assessment (weight, height and waist circumference), abdominal ultrasound (visceral fat) and laboratory tests (fasting blood sugar and lipid profile).Results: The majority of the participated women had wide WC (88.9%) and increased visceral fat (80.6%). Hyperglycemia was present among (47.4%), hypertension among 42.6%, high triglycerides among 26.6% and low HDL among 44.3%. The odds of obtaining LAP >80.74 cm.mmol/L (4th quartile) is 2.7 times higher in individuals with hypertension(BP > 130/85),and 6.79 times higher in individuals with visceral fat ≥ 5 cm. Depending on the visceral fat as a standard for classification of visceral obesity (>5 cm for women), revealed that the AUCs of LAP was 0.752 (95% CI 0.697–0.806) in women. The cutoff point of LAP;for prediction of visceral obesity among Egyptian women, was 61.69; using ROC analysis; with sensitivity 68% and specificity 75% and PPV/NPV 1.05 and accuracy 71.5% .Conclusion: LAP index had significant correlations with visceral obesity and hypertension. The cutoff point of LAP 61.69 can be used to predict visceral obesity among Egyptian women.
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Koo DJ, Lee MY, Jung I, Moon SJ, Kwon H, Park SE, Rhee EJ, Lee WY. Baseline homeostasis model assessment of insulin resistance associated with fibrosis progression in patients with nonalcoholic fatty liver disease without diabetes: A cohort study. PLoS One 2021; 16:e0255535. [PMID: 34432804 PMCID: PMC8386882 DOI: 10.1371/journal.pone.0255535] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/17/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND AIMS Fibrosis progression is the most important prognostic factor, and insulin resistance is one of the main mechanisms associated with fibrosis progression in patients with nonalcoholic fatty liver disease (NAFLD). We evaluate the association between baseline insulin resistance and future fibrosis progression in patients with NAFLD without diabetes. APPROACH AND RESULTS This retrospective longitudinal study with 8-year follow-up period included 32,606 (men, 83%) participants aged >20 years (average age, 38.0 years) without diabetes at baseline who completed at least two comprehensive health checkups from January 1, 2010 to December 31, 2018. NAFLD was diagnosed based on ultrasonography. The homeostasis model assessment of insulin resistance (HOMA-IR) was used to evaluate baseline insulin resistance. Fibrosis progression was assessed using the aspartate aminotransferase to platelet ratio index (APRI). The advanced liver fibrosis with an APRI value above the intermediate fibrosis probability (≥0.5) developed in a total of 2,897 participants during 136,108 person-years. 114 participants progressed to a high fibrosis probability stage (APRI >1.5) during 141,064 person-years. Using the lowest baseline HOMA-IR quartile group (Q1) as a reference, the multivariate-adjusted hazard ratio (HR) for development of advanced liver fibrosis (APRI ≥0.5) in the highest baseline HOMA-IR quartile group (Q4) was 1.95 (95% confidence interval [CI] 1.74-2.19; Model 4). And the HR for development of advanced liver fibrosis with high fibrosis probability was 1.95 (95% CI 1.10-3.46; Model 4). The positive association was maintained throughout the entire follow-up period. The baseline HOMA-IR model was superior to the baseline body mass index (BMI) model in predicting the progression of fibrosis probability. CONCLUSIONS In this longitudinal study, we found that the degree of baseline insulin resistance, assessed by HOMA-IR values, was positively associated with future fibrosis progression in patients with NAFLD without diabetes.
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Affiliation(s)
- Dae-Jeong Koo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changwon Fatima Hospital, Changwon, Republic of Korea
| | - Mi Yeon Lee
- Division of Biostatistics, Department of R&D Management, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Inha Jung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sun Joon Moon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyemi Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Se Eun Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun-Jung Rhee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail: (EJR); (WYL)
| | - Won-Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail: (EJR); (WYL)
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Ahadi M, Molooghi K, Masoudifar N, Namdar AB, Vossoughinia H, Farzanehfar M. A review of non-alcoholic fatty liver disease in non-obese and lean individuals. J Gastroenterol Hepatol 2021; 36:1497-1507. [PMID: 33217052 DOI: 10.1111/jgh.15353] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 10/26/2020] [Accepted: 11/10/2020] [Indexed: 12/12/2022]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of hepatic disorders. It represents a wide range of chronic liver diseases in patients with no history of significant alcohol consumption, starting with simple steatosis and progressing towards non-alcoholic steatohepatitis, cirrhosis, and ultimately hepatocellular carcinoma. NAFLD is usually associated with type 2 diabetes mellitus, dyslipidemia, metabolic syndrome, and obesity. This disease has mostly been studied in obese individuals; however, it has been widely reported and studied among the lean/non-obese population in recent years. The pathogenesis of NAFLD in non-obese patients is associated with various genetic predispositions, particularly a patatin-like phospholipase domain-containing protein 3 G allele polymorphism, which results in the accumulation of triglyceride in the liver and resistance to insulin. Additionally, dietary factors such as high fructose consumption seem to play a substantial role in the pathology of non-obese NAFLD. Although there is not enough evidence on the treatment of NAFLD in non-obese patients, the standard approach is to advise altering one's lifestyle in order to diminish visceral adiposity. Dietary modification, weight loss, and increased physical activity are highly recommended. We aimed to review and summarize the existing information on the prevalence, pathogenesis, genetic predispositions, diagnosis, and treatment of NAFLD in non-obese patients according to the latest literature.
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Affiliation(s)
- Mitra Ahadi
- Department of Gastroenterology and Hepatology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Kasra Molooghi
- School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Negin Masoudifar
- School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Beheshti Namdar
- Department of Gastroenterology and Hepatology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hassan Vossoughinia
- Department of Gastroenterology and Hepatology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammadreza Farzanehfar
- Department of Gastroenterology and Hepatology, Mashhad University of Medical Sciences, Mashhad, Iran
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Katz DA, Peck D, Lubert AM, Possner M, Zafar F, Trout AT, Palermo JJ, Anwar N, Dillman JR, Powell AW, Xanthakos SA, Opotowsky AR, Veldtman G, Alsaied T. Hepatic Steatosis in Patients With Single Ventricle and a Fontan Circulation. J Am Heart Assoc 2021; 10:e019942. [PMID: 33880928 PMCID: PMC8200742 DOI: 10.1161/jaha.120.019942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Hepatic steatosis, caused by nonalcoholic fatty liver disease, is a leading cause of chronic liver disease. The interplay between hepatic steatosis and the development of liver disease following the Fontan procedure is not well understood. This study examined the prevalence and associations of hepatic steatosis in patients with a Fontan circulation. Methods and Results This was a single‐center retrospective study of 95 patients with a Fontan circulation with liver magnetic resonance imaging performed between 2012 and 2019. The average age at magnetic resonance imaging was 21.5±8.5 years. The percent liver fat signal was determined using magnetic resonance chemical shift‐encoded proton density fat fraction imaging. Hepatic steatosis was defined as liver fat ≥5% and was present in 10.5% of the cohort. The presence of hepatic steatosis was associated with higher body mass index (29±4 versus 24±6 kg/m2, P=0.006), a higher frequency of obesity (50% versus 12%, P=0.015), lower high‐density lipoprotein cholesterol (35±9 versus 43±14 mg/dL, P=0.050), and greater subcutaneous fat thickness (2.6±0.7 versus 1.8±1.0 cm, P=0.043). There was no association between hepatic steatosis and cardiovascular imaging or hemodynamic variables from cardiac catheterization. Conclusions Risk factors for hepatic steatosis in patients with Fontan circulation include obesity and dyslipidemia, similar to what is seen in the general population. Fontan hemodynamics were not associated with hepatic steatosis.
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Affiliation(s)
- David A Katz
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH.,The Heart Institute Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Daniel Peck
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH.,The Heart Institute Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Adam M Lubert
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH.,The Heart Institute Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Mathias Possner
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH.,The Heart Institute Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Faizeen Zafar
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH
| | - Andrew T Trout
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH.,Department of Radiology Cincinnati Children's Hospital Medical Center Cincinnati OH.,Department of Radiology University of Cincinnati College of Medicine Cincinnati OH
| | - Joseph J Palermo
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH.,Department of Gastroenterology Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Nadeem Anwar
- Department of Gastroenterology University of Cincinnati Cincinnati OH
| | - Jonathan R Dillman
- Department of Radiology Cincinnati Children's Hospital Medical Center Cincinnati OH.,Department of Radiology University of Cincinnati College of Medicine Cincinnati OH
| | - Adam W Powell
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH.,The Heart Institute Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Stavra A Xanthakos
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH.,Department of Gastroenterology Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Alexander R Opotowsky
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH.,The Heart Institute Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Gruschen Veldtman
- King Faisal Specialist Hospital and Research Centre Riyadh Saudi Arabia
| | - Tarek Alsaied
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH.,The Heart Institute Cincinnati Children's Hospital Medical Center Cincinnati OH
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Norouzpour M, Marandi SM, Ghanbarzadeh M, Zare Maivan A. The effect of combined exercises on the plasma levels of retinol-binding protein 4 and its relationship with insulin resistance and hepatic fat content in postmenopausal women with nonalcoholic fatty liver disease. J Sports Med Phys Fitness 2021; 62:684-690. [PMID: 33871240 DOI: 10.23736/s0022-4707.21.12233-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evidence suggests increased serum levels of retinol-binding protein 4 (RBP4) in postmenopausal women with nonalcoholic fatty liver disease (NAFLD). This study investigated the effect of combined exercises on the plasma levels of RBP4 and its relationship with insulin resistance and hepatic fat content in these women. METHODS This quasi-experimental study randomly assigned 24 women with fatty liver and a mean age of 56.18±4.58 years to an experimental group and a control group. The experimental group participated in ten-week incremental endurance-resistance training as combined exercises three sessions a week. Fatty liver was diagnosed with ultrasound, RBP4 levels were measured and insulin resistance was determined using the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Between-group data were analyzed using ANCOVA, within-group data using the dependent t-test and Wilcoxon test and relationships between RBP4 and variables using Spearman and Pearson correlation coefficients. RESULTS Ten weeks of combined exercises significantly decreased RBP4 levels (P=0.000), HOMA-IR (P=0.011) and hepatic fat levels (P=0.000) in the experimental group compared to in the controls. The posttest showed significant correlations between RBP4 levels and hepatic fat levels (P=0.002) and no correlations between RBP4 levels and insulin resistance (P=0.116). CONCLUSIONS Combined exercises significantly reduced serum levels of RBP4 in postmenopausal women with fatty liver. RBP4 was not related to insulin resistance and effects of RBP4 on hepatic fat regulation were independent of the effects of insulin resistance.
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Affiliation(s)
- Masoumeh Norouzpour
- Exercise Physiology Department, Sport Sciences Faculty, University of Isfahan, Isfahan, Iran
| | - Sayed M Marandi
- Exercise Physiology Department, Sport Sciences Faculty, University of Isfahan, Isfahan, Iran -
| | - Mohsen Ghanbarzadeh
- Exercise Physiology Department, Sport Sciences Faculty, Shahid Chamran University of Ahvaz, Ahvaz, Iran
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MacLean MT, Jehangir Q, Vujkovic M, Ko YA, Litt H, Borthakur A, Sagreiya H, Rosen M, Mankoff DA, Schnall MD, Shou H, Chirinos J, Damrauer SM, Torigian DA, Carr R, Rader DJ, Witschey WR. Quantification of abdominal fat from computed tomography using deep learning and its association with electronic health records in an academic biobank. J Am Med Inform Assoc 2021; 28:1178-1187. [PMID: 33576413 DOI: 10.1093/jamia/ocaa342] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/30/2020] [Accepted: 01/06/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The objective was to develop a fully automated algorithm for abdominal fat segmentation and to deploy this method at scale in an academic biobank. MATERIALS AND METHODS We built a fully automated image curation and labeling technique using deep learning and distributive computing to identify subcutaneous and visceral abdominal fat compartments from 52,844 computed tomography scans in 13,502 patients in the Penn Medicine Biobank (PMBB). A classification network identified the inferior and superior borders of the abdomen, and a segmentation network differentiated visceral and subcutaneous fat. Following technical evaluation of our method, we conducted studies to validate known relationships with visceral and subcutaneous fat. RESULTS When compared with 100 manually annotated cases, the classification network was on average within one 5-mm slice for both the superior (0.4 ± 1.1 slice) and inferior (0.4 ± 0.6 slice) borders. The segmentation network also demonstrated excellent performance with intraclass correlation coefficients of 1.00 (P < 2 × 10-16) for subcutaneous and 1.00 (P < 2 × 10-16) for visceral fat on 100 testing cases. We performed integrative analyses of abdominal fat with the phenome extracted from the electronic health record and found highly significant associations with diabetes mellitus, hypertension, and renal failure, among other phenotypes. CONCLUSIONS This work presents a fully automated and highly accurate method for the quantification of abdominal fat that can be applied to routine clinical imaging studies to fuel translational scientific discovery.
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Affiliation(s)
- Matthew T MacLean
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Qasim Jehangir
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marijana Vujkovic
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yi-An Ko
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Harold Litt
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Arijitt Borthakur
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hersh Sagreiya
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark Rosen
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David A Mankoff
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mitchell D Schnall
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Haochang Shou
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Julio Chirinos
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Scott M Damrauer
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Drew A Torigian
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rotonya Carr
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel J Rader
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Walter R Witschey
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Wang X, Wang H, Li J, Gao X, Han Y, Teng W, Shan Z, Lai Y. Combined Effects of Dyslipidemia and High Adiposity on the Estimated Glomerular Filtration Rate in a Middle-Aged Chinese Population. Diabetes Metab Syndr Obes 2021; 14:4513-4522. [PMID: 34785920 PMCID: PMC8590978 DOI: 10.2147/dmso.s337190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/04/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Some studies have reported that chronic kidney disease (CKD) or the estimated glomerular filtration rate (eGFR) is significantly associated with metabolic abnormalities. METHODS Six hundred forty-six community residents aged 45-60 years without overt renal dysfunction were recruited in this cross-sectional study. eGFR was estimated by serum creatinine measurement. The visceral fat area (VFA) and subcutaneous fat area (SFA) were assessed by magnetic resonance imaging (MRI). The body mass index (BMI) and waist-hip ratio (WHR) were also evaluated. Additionally, we tested the subjects' blood lipid levels to diagnose dyslipidemia. RESULTS Compared with the subjects with neither dyslipidemia nor obesity, men with both dyslipidemia and high obesity indices, such as BMI, WHR and VFA, showed a significantly lower mean eGFR; women with dyslipidemia with high WHR, VFA or SFA also showed a significantly lower mean eGFR. Although an independent association between the metabolic variables and eGFR was not found except for BMI, some of the combined effects of each variable were related to eGFR decline. Comorbidity of dyslipidemia and high WHR was significant risk factor for eGFR reduction (β -8.805, SD 4.116, p < 0.05). Additionally, comorbidity of dyslipidemia and high obesity indices such as BMI (β -12.942, SD 5.268, p < 0.05) and VFA (β -7.069, SD 3.394, p < 0.05) were significant risk factors for eGFR reduction in men. CONCLUSION The combined effect of dyslipidemia and high obesity indices is significantly related to the decline in eGFR. The association is more profound in men.
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Affiliation(s)
- Xichang Wang
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, The NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, 110001, People’s Republic of China
| | - Haoyu Wang
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, The NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, 110001, People’s Republic of China
| | - Jiashu Li
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, The NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, 110001, People’s Republic of China
| | - Xiaotong Gao
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, The NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, 110001, People’s Republic of China
| | - Yutong Han
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, The NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, 110001, People’s Republic of China
| | - Weiping Teng
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, The NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, 110001, People’s Republic of China
| | - Zhongyan Shan
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, The NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, 110001, People’s Republic of China
| | - Yaxin Lai
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, The NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, 110001, People’s Republic of China
- Correspondence: Yaxin Lai Department of Endocrinology and Metabolism and the Institute of Endocrinology, The NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, No. 155 Nanjing North Street, Heping District, Shenyang, 110001, People’s Republic of ChinaTel +86-13804048045 Email
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Macshut M, Kaido T, Yao S, Miyachi Y, Sharshar M, Iwamura S, Hirata M, Shirai H, Kamo N, Yagi S, Uemoto S. Visceral adiposity is an independent risk factor for high intra-operative blood loss during living-donor liver transplantation; could preoperative rehabilitation and nutritional therapy mitigate that risk? Clin Nutr 2020; 40:956-965. [PMID: 32665100 DOI: 10.1016/j.clnu.2020.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Blood loss during liver transplantation (LT) is one of the major concerns of the transplant team, given the potential negative post-transplant outcomes related to it. Blood loss was reported to be higher in certain body compositions, such as obese patients, undergoing LT. Therefore, we aimed to study the risk factors for high blood loss (HBL) during adult living donor liver transplant (ALDLT) including the body composition markers; visceral-to-subcutaneous adipose tissue area ratio (VSR), skeletal muscle index and intramuscular adipose tissue content. In June 2015, an aggressive perioperative rehabilitation and nutritional therapy (APRNT) program was prescribed in our institute for the patients with abnormal body composition. METHODS We retrospectively analyzed 394 patients who had undergone their first ALDLT between 2006 and 2019. Risk factors for HBL were analyzed in the total cohort. Differences in blood loss and risk factors were analyzed in relation to the APRNT. RESULTS Multivariate risk factor analysis in the total cohort showed that a high VSR (odds ratio (OR): 1.98, 95% confidence interval (CI): 1.19-3.29, P = 0.009), was an independent risk factor for HBL during ALDLT, as well as a history of upper abdominal surgery, simultaneous splenectomy and the presence of a large amount of ascites. After the introduction of the APRNT, a significantly lower blood loss was observed during the ALDLT recipient operation (P = 0.003). Moreover, the significant difference in blood loss observed between normal and high VSR groups before the application of the APRNT (P < 0.001), was not observed with the APRNT (P = 0.85). Likewise, before the APRNT, only high VSR was a risk factor for HBL by multivariate analysis (OR: 2.34, CI: 1.33-4.09, P = 0.003). Whereas with the APRNT, high VSR was no longer a significant risk factor for HBL even by univariate analysis (OR: 0.89, CI: 0.26-3.12, P = 0.86). CONCLUSION Increased visceral adiposity was an independent risk factor for high intraoperative blood loss during ALDLT recipient operation. With APRNT, high VSR was not associated with high blood loss. Therefore, APRNT might have mitigated the risk of high blood loss related to high visceral adiposity.
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Affiliation(s)
- Mahmoud Macshut
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Hepato-Pancreato-Biliary Surgery, National Liver Institute, Menoufia University, Egypt
| | - Toshimi Kaido
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Gastroenterological and General Surgery, St. Luke's International Hospital, Tokyo, Japan.
| | - Siyuan Yao
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yosuke Miyachi
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mohamed Sharshar
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Hepato-Pancreato-Biliary Surgery, National Liver Institute, Menoufia University, Egypt
| | - Sena Iwamura
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masaaki Hirata
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hisaya Shirai
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Naoko Kamo
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shintaro Yagi
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinji Uemoto
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Narankiewicz D, Ruiz-Nava J, Buonaiuto V, Ruiz-Moreno MI, López-Carmona MD, Pérez-Belmonte LM, Gómez-Huelgas R, Bernal-López MR. Utility of Liver Function Tests and Fatty Liver Index to Categorize Metabolic Phenotypes in a Mediterranean Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103518. [PMID: 32443453 PMCID: PMC7277926 DOI: 10.3390/ijerph17103518] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 12/21/2022]
Abstract
The aim of this study was to analyze the utility of liver function tests (LFT) and fatty liver index (FLI), a surrogate marker of non-alcoholic fatty liver disease, in the categorization of metabolic phenotypes in a Mediterranean population. A cross-sectional study was performed on a random representative sample of 2233 adults assigned to a health center in Málaga, Spain. The metabolic phenotypes were determined based on body mass index (BMI) categorization and the presence or absence of two or more cardiometabolic abnormalities (high blood pressure, low high-density lipoprotein (HDL) cholesterol, hypertriglyceridemia, pre-diabetes) or type 2 diabetes. No difference was observed between metabolically healthy and metabolically abnormal phenotypes on LFT. The mean FLI of the population was 41.1 ± 28.6. FLI was significantly higher (p < 0.001) in the metabolically abnormal phenotypes in all BMI categories. The proportion of individuals with pathological FLI (≥60) was significantly higher in the metabolically abnormal overweight and obese phenotypes (p < 0.001). On a multivariate model adjusted for sex, age, and waist circumference, a significant correlation was found between pathological FLI and metabolically abnormal phenotypes in the overweight and obese BMI categories. Area under the curve (AUC) of FLI as a biomarker was 0.76, 0.74, and 0.72 for the metabolically abnormal normal-weight, overweight, and obese groups, respectively. Liver biochemistry is poorly correlated with metabolic phenotypes. Conversely, a good correlation between FLI, as a marker of non-alcoholic fatty liver disease (NAFLD), and metabolically abnormal phenotypes in all BMI ranges was found. Our study suggests that FLI may be a useful marker for characterizing metabolically abnormal phenotypes in individuals who are overweight or obese.
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Affiliation(s)
- Dariusz Narankiewicz
- Preventive Medicine Department, Virgen de la Victoria University Hospital, 29010 Malaga, Spain;
| | - Josefina Ruiz-Nava
- Internal Medicine Department, Regional University Hospital of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain; (J.R.-N.); (V.B.); (M.I.R.-M.); (M.D.L.-C.); (L.M.P.-B.)
| | - Veronica Buonaiuto
- Internal Medicine Department, Regional University Hospital of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain; (J.R.-N.); (V.B.); (M.I.R.-M.); (M.D.L.-C.); (L.M.P.-B.)
| | - María Isabel Ruiz-Moreno
- Internal Medicine Department, Regional University Hospital of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain; (J.R.-N.); (V.B.); (M.I.R.-M.); (M.D.L.-C.); (L.M.P.-B.)
| | - María Dolores López-Carmona
- Internal Medicine Department, Regional University Hospital of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain; (J.R.-N.); (V.B.); (M.I.R.-M.); (M.D.L.-C.); (L.M.P.-B.)
| | - Luis Miguel Pérez-Belmonte
- Internal Medicine Department, Regional University Hospital of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain; (J.R.-N.); (V.B.); (M.I.R.-M.); (M.D.L.-C.); (L.M.P.-B.)
| | - Ricardo Gómez-Huelgas
- Internal Medicine Department, Regional University Hospital of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain; (J.R.-N.); (V.B.); (M.I.R.-M.); (M.D.L.-C.); (L.M.P.-B.)
- Ciber Fisiopatología de la Obesidad y Nutrición. Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: (R.G.-H.); (M.R.B.-L.); Tel.: +34-951-291-169 (R.G.-H.); 34-951-290-346 (M.R.B.-L.); Fax: +34-951-290-006 (R.G.-H.); +34-951-290-302 (M.R.B.-L.)
| | - María Rosa Bernal-López
- Internal Medicine Department, Regional University Hospital of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain; (J.R.-N.); (V.B.); (M.I.R.-M.); (M.D.L.-C.); (L.M.P.-B.)
- Ciber Fisiopatología de la Obesidad y Nutrición. Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: (R.G.-H.); (M.R.B.-L.); Tel.: +34-951-291-169 (R.G.-H.); 34-951-290-346 (M.R.B.-L.); Fax: +34-951-290-006 (R.G.-H.); +34-951-290-302 (M.R.B.-L.)
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