Dietary patterns in Brazilian patients with non-alcoholic fatty liver disease: a cross-sectional study

OBJECTIVE:

Recent evidence suggests that non-alcoholic fatty liver disease is associated with diet. Our aim was to investigate the dietary patterns of a Brazilian population with this condition and compare them with the recommended diet.

METHODS:

A cross-sectional study was conducted on 96 non-alcoholic fatty liver disease patients before any dietetic counseling. All patients underwent abdominal ultrasound, biochemical tests, dietary evaluations, and anthropometric evaluations. Their food intake was assessed by a semi-quantitative food-frequency questionnaire and 24-hour food recall.

RESULTS:

The median patient age was 53 years, and 77% of the individuals were women. Most (67.7%) participants were obese, and a large waist circumference was observed in 80.2% subjects. Almost 70% of the participants had metabolic syndrome, and 62.3% presented evidence of either insulin resistance or overt diabetes. Most patients (51.5, 58.5, and 61.7%, respectively) exceeded the recommendations for energy intake, as well as total and saturated fat. All patients consumed less than the amount of recommended monounsaturated fatty acids, and 52.1 and 76.6% of them consumed less polyunsaturated fatty acids and fiber, respectively, than recommended. In most patients, the calcium, sodium, potassium, pyridoxine, and vitamin C intake did not meet the recommendations, and in 10.5-15.5% of individuals, the tolerable upper limit intake for sodium was exceeded. The patients presented a significantly high intake of meats, fats, sugars, legumes (beans), and vegetables and a low consumption of cereals, fruits, and dairy products compared with the recommendations.

CONCLUSIONS:

Although patients with non-alcoholic fatty liver disease exhibited high energy and lipid consumption, most of them had inadequate intake of some micronutrients. The possible role of nutrient-deficient intake in the development of non-alcoholic fatty liver disease warrants investigation.     

The Risk of Abdominal Obesity according to the Degree of Non-Alcoholic Fatty Liver Disease in Korean Men

Although non-alcoholic fatty liver disease has been reported as a cardiometabolic risk factor, the effect of non-alcoholic fatty liver is yet to be clarified on abdominal obesity. Therefore, this study was conducted to investigate the longitudinal relationship of non-alcoholic fatty liver on the development of abdominal obesity. The study participants were composed of 11,212 Korean men without abdominal obesity. They were followed up from 2005 to 2010 to be monitored for the development of abdominal obesity according to their degree of non-alcoholic fatty liver disease (normal, mild, and moderate to severe). Cox-proportional hazard model was used to calculate the hazard ratios for abdominal obesity according to the degree of non-alcoholic fatty liver disease. While the average incidence was 15.5%, the incidence of abdominal obesity increased according to the degree of non-alcoholic fatty liver (normal: 11.6%, mild: 25.2%, moderate to severe: 41.0%, P < 0.001). Multivariable-adjusted hazard ratios for abdominal obesity independently increased proportionally to the degree of NAFLD (mild [1.07; 0.94-1.23], moderate to severe [1.58; 1.11-2.26], P for trend < 0.001). The risk of abdominal obesity increased proportionally to the degree of non-alcoholic fatty liver disease. This finding guarantees further studies to reveal the incidental relationship of abdominal obesity with non-alcoholic fatty liver disease.     

The association of vitamin D deficiency with non-alcoholic fatty liver disease

OBJECTIVE:

Vitamin D deficiency has been related to diabetes, hypertension, hyperlipidemia and peripheral vascular disease. In this study, we aimed to investigate the role of vitamin D status in non-alcoholic fatty liver disease.

METHODS:

We included 211 consecutive subjects to examine the presence of non-alcoholic fatty liver disease. Of these subjects, 57 did not have non-alcoholic fatty liver disease and 154 had non-alcoholic fatty liver disease.

RESULTS:

The non-alcoholic fatty liver disease group had significantly higher fasting blood glucose (p = 0.005), uric acid (p = 0.001), aspartate aminotransferase (p<0.001), alanine aminotransferase (p<0.001), γ-glutamyltransferase (p<0.0001), alkaline phosphatase (p = 0.028), HbA1c (p<0.001), ferritin (p<0.001), insulin (p = 0.016), C-peptide (p = 0.001), HOMA-IR (p = 0.003), total cholesterol (p = 0.001), triglyceride (p = 0.001) and white blood cell (p = 0.04) levels. In contrast, the non-alcoholic fatty liver disease group had significantly lower 25(OH)D levels (12.3±8.9 ng/dl, p<0.001) compared with those of the control group (20±13.6 ng/dl).

CONCLUSIONS:

In this study, we found lower serum 25(OH)D levels in patients with non-alcoholic fatty liver disease than in subjects without non-alcoholic fatty liver disease. To establish causality between vitamin D and non-alcoholic fatty liver disease, further interventional studies with a long-term follow-up are needed.     

Comparison between a Pediatric Health Promotion Center and a Pediatric Obesity Clinic in Detecting Metabolic Syndrome and Non-Alcoholic Fatty Liver Disease in Children

This study was done to evaluate the efficacy of health check-ups in children in detecting metabolic syndrome and non-alcoholic fatty liver disease (NAFLD) by comparing the pediatric health promotion center with the pediatric obesity clinic. Children who visited a pediatric health promotion center (n=218) or a pediatric obesity clinic (n=178) were included. Anthropometric data, blood pressure, laboratory tests, and abdominal ultrasonography were evaluated. Two different criteria were applied to diagnose metabolic syndrome. The prevalence of metabolic syndrome in the 2 units was 3.2%-3.7% in a pediatric health promotion center and 23%-33.2% in a pediatric obesity clinic. Significant differences were observed in the prevalence of each component of metabolic syndrome between the 2 units including abdominal adiposity, blood pressure, serum triglycerides, and fasting blood glucose (P<0.05). The prevalence of NAFLD was 8.7% and 71.9% in the 2 units according to liver enzymes and 5.9% and 61.8% according to ultrasonography (P<0.05). The prevalence of metabolic syndrome and NAFLD was higher among patients visiting the obesity clinic targeting obese children than that among patients visiting the health promotion center offering routine check-ups. An obesity-oriented approach is required to prevent obesity-related health problems in children.

Graphical Abstract

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The refit model for end-stage liver disease-Na is not a better predictor of mortality than the refit model for end-stage liver disease in patients with cirrhosis and ascites

Background/Aims

The modification of the Model for End-Stage Liver Disease (MELD) scoring system (Refit MELD) and the modification of MELD-Na (Refit MELDNa), which optimized the MELD coefficients, were published in 2011. We aimed to validate the superiority of the Refit MELDNa over the Refit MELD for the prediction of 3-month mortality in Korean patients with cirrhosis and ascites.

Methods

We reviewed the medical records of patients admitted with hepatic cirrhosis and ascites to the Konkuk University Hospital between January 2006 and December 2011. The Refit MELD and Refit MELDNa were compared using the predictive value of the 3-month mortality, as assessed by the Child-Pugh score.

Results

In total, 530 patients were enrolled, 87 of whom died within 3 months. Alcohol was the most common etiology of their cirrhosis (n=271, 51.1%), and the most common cause of death was variceal bleeding (n=20, 23%). The areas under the receiver operating curve (AUROCs) for the Child-Pugh, Refit MELD, and Refit MELDNa scores were 0.754, 0.791, and 0.764 respectively; the corresponding values when the analysis was performed only in patients with persistent ascites (n=115) were 0.725, 0.804, and 0.796, respectively. The significant difference found among the Child-Pugh, Refit MELD, and Refit MELDNa scores was between the Child-Pugh score and Refit MELD in patients with persistent ascites (P=0.039).

Conclusions

Refit MELD and Refit MELDNa exhibited good predictability for 3-month mortality in patients with cirrhosis and ascites. However, Refit MELDNa was not found to be a better predictor than Refit MELD, despite the known relationship between hyponatremia and mortality in cirrhotic patients with ascites.     

Non-alcoholic fatty liver disease: an emerging pathological spectrum

The spectrum of pathological lesions observed in non-alcoholic fatty liver disease (NAFLD) is wide and strongly resembles that of alcohol-induced liver disease. It ranges from fatty liver to steatohepatitis, progressive fibrosis and cirrhosis. Hepatocellular carcinoma is a possible complication of NAFLD, but whether it is related to frequently associated metabolic disorders (e.g., overweight, diabetes) or to underlying cirrhosis is unclear. This disease is the result of a multi-factorial process in which insulin resistance seems to play a major role in the initial accumulation of fat in the liver, whereas multiple causes of mitochondrial dysfunction and oxidative stress can induce the secondary occurrence of necroinflammatory lesions and fibrosis. Genetic factors might explain why only some patients with simple steatosis will develop steatohepatitis and fibrosis. Due to the increasing prevalence of obesity in Western countries, NAFLD will possibly be a public health problem and the liver disease of the future.     

Severe Phenotype of Non-alcoholic Fatty Liver Disease in Pediatric Patients with Subclinical Hypothyroidism: a Retrospective Multicenter Study from Korea

BackgroundIt is uncertain whether non-alcoholic fatty liver disease (NAFLD) is associated with subclinical hypothyroidism (SH) in pediatric patients. The purpose of this study was to investigated the prevalence and related factors of SH in pediatric patients with NAFLD. We also evaluate the association between liver fibrosis and SH.MethodsWe retrospectively reviewed medical records for patients aged 4 to 18 years who were diagnosed with NAFLD and tested for thyroid function from January 2015 to December 2019 at 10 hospitals in Korea.ResultsThe study included 428 patients with NAFLD. The prevalence of SH in pediatric NAFLD patients was 13.6%. In multivariate logistic regression, higher levels of steatosis on ultrasound and higher aspartate aminotransferase to platelet count ratio index (APRI) score were associated with increased risk of SH. Using receiver operating characteristic curves, the optimal cutoff value of the APRI score for predicting SH was 0.6012 (area under the curve, 0.67; P < 0.001; sensitivity 72.4%, specificity 61.9%, positive predictive value 23%, and negative predictive value 93.5%).ConclusionSH was often observed in patients with NAFLD, more frequently in patients with more severe liver damage. Thyroid function tests should be performed on pediatric NAFLD patients, especially those with higher grades of liver steatosis and fibrosis.     

Non-alcoholic Fatty Liver Disease and COVID-19 Susceptibility and Outcomes: a Korean Nationwide Cohort

BackgroundEvidence for the association between underlying non-alcoholic fatty liver disease (NAFLD), the risk of testing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive, and the clinical consequences of coronavirus disease 2019 (COVID-19) is controversial and scarce. We aimed to investigate the association between the presence of NAFLD and the risk of SARS-CoV-2 infectivity and COVID-19-related outcomes.MethodsWe used the population-based, nationwide cohort in South Korea linked with the general health examination records between January 1, 2018 and July 30, 2020. Data for 212,768 adults older than 20 years who underwent SARS-CoV-2 testing from January 1 to May 30, 2020, were obtained. The presence of NAFLDs was defined using three definitions, namely hepatic steatosis index (HSI), fatty liver index (FLI), and claims-based definition. The outcomes were SARS-CoV-2 test positive, COVID-19 severe illness, and related death.ResultsAmong 74,244 adults who completed the general health examination, there were 2,251 (3.0%) who were SARS-CoV-2 positive, 438 (0.6%) with severe COVID-19 illness, and 45 (0.06%) COVID-19-related deaths. After exposure-driven propensity score matching, patients with pre-existing HSI-NAFLD, FLI-NAFLD, or claims-based NAFLD had an 11–23% increased risk of SARS-CoV-2 infection (HSI-NAFLD 95% confidence interval [CI], 1–28%; FLI-NAFLD 95% CI, 2–27%; and claims-based NAFLD 95% CI, 2–31%) and a 35–41% increased risk of severe COVID-19 illness (HSI-NAFLD 95% CI, 8–83%; FLI-NAFLD 95% CI, 5–71%; and claims-based NAFLD 95% CI, 1–92%). These associations are more evident as liver fibrosis advanced (based on the BARD scoring system). Similar patterns were observed in several sensitivity analyses including the full-unmatched cohort.ConclusionPatients with pre-existing NAFLDs have a higher likelihood of testing SARS-CoV-2 positive and severe COVID-19 illness; this association was more evident in patients with NAFLD with advanced fibrosis. Our results suggest that extra attention should be given to the management of patients with NAFLD during the COVID-19 pandemic.     

Fatal rhabdomyolysis in a patient with liver cirrhosis after switching from simvastatin to fluvastatin

HMG-CoA reductase inhibitors (statins) are widely used to treat hypercholesterolemia. Among the adverse effects associated with these drugs are statin-associated myopathies, ranging from asymptomatic elevation of serum creatine kinase to fatal rhabdomyolysis. Fluvastatin-induced fatal rhabdomyolysis has not been previously reported. We describe here a patient with liver cirrhosis who experienced fluvastatin-induced fatal rhabdomyolysis. This patient had been treated with simvastatin (20 mg/day) for coronary artery disease and was switched to fluvastatin (20 mg/day) 10 days before admission. He was also taking aspirin, betaxolol, candesartan, lactulose, and entecavir. Rhabdomyolysis was complicated and continued to progress. He was treated with massive hydration, urine alkalization, intravenous furosemide, and continuous renal replacement therapy for acute renal failure, but eventually died due to rhabdomyolysis complicated by hepatic failure. In conclusion, fluvastatin should be used with caution in patients with liver cirrhosis, especially with other medications metabolized with CYP2C9.     

脂肪间充质干细胞移植后肝硬化大鼠血生化指标的变化

BACKGROUND:Stem cell transplantation is a promising treatment of advanced liver disease, and adipose-derived mesenchymal stem cells have become another kind of popular cells following bone marrow mesenchymal stem cells. OBJECTIVE:To investigate the influence of adipose-derived mesenchymal stem cell transplantation on blood biochemical indices of liver cirrhosis rats. METHODS:Sixty rats were equally randomized into normal control, model and cell transplantation groups. Model rats of liver cirrhosis were made in the latter two groups through intragastric administration of carbon tetrachloride. One week after successful modeling, rats were given intraperitoneal injection of adipose-derived mesenchymal stem cell suspension in the cell transplantation group, and given normal saline in the other two groups. RESULTS AND CONCLUSION:Compared with the normal control group, the model group showed a significant increase in the levels of alanine aminotransferase, aspartate aminotransferase, total bilirubin, total protein in liver tissues, serum level of malondialdehyde, 15-minute indocyanine green retention rate and degree of hepatic fibrosis, and a significant decrease in serum albumin level, serum albumin/globulin, levels of glutathione peroxidase and cyclic guanosine monophosphate in liver tissues. On the contrary, these indicators were all improved in the cell transplantation group compared with the model group. Moreover, CM-Dil-positive cells were visible in the liver tissue of rats undergoing adipose-derived mesenchymal stem cell transplantation. All these findings indicate that adipose-derived mesenchymal stem cell transplantation can reduce liver cirrhosis in rats by acting on blood biochemistry levels.     

Acute-on-chronic liver failure: a new syndrome in cirrhosis

Patients with cirrhosis who are hospitalized for an acute decompensation (AD) and also have organ failure(s) are at high risk of short-term death. These patients have a syndrome called Acute-on-Chronic Liver Failure (ACLF). ACLF is now considered as a new syndrome that it is distinct from “mere” AD not only because of the presence of organ failure(s) and high short-term mortality but also because of younger age, higher prevalence of alcoholic etiology of cirrhosis, higher prevalence of some precipitants (such as bacterial infections, active alcoholism), and more intense systemic inflammatory response. ACLF is a new syndrome also because severe sepsis or severe alcoholic hepatitis do not account for 100% of the observed cases; in fact, almost 50% of the cases are of “unknown” origin. In other words, severe sepsis, severe alcoholic hepatitis and ACLF of “unknown origin” are subcategories of the syndrome.     

A multicenter study on clinical characteristics of Acinetobacter bacteremia in patients with liver cirrhosis

BackgroundClinical characteristics and risk factors for mortality of Acinetobacter bacteremia in cirrhotic patients have not been investigated.MethodsAcinetobacter bacteremia cases from four medical centers were collected from 2009 to 2014, to compare between patients with and without liver cirrhosis. Risk factors for mortality of Acinetobacter bacteremia among cirrhotic patients were identified using multivariate logistic regression.ResultsAmong the patients with Acinetobacter bacteremia, 72 had liver cirrhosis and 816 had not. Patients with cirrhosis were younger (57.5 [50–71] vs. 72 [50.25–71], p < 0.001), had more solid tumor (51.4% vs. 31.4%, p = 0.001), lower Acute Physiology and Chronic Health Evaluation II (APACHE II) scores (17 [12–24] vs. 20 [13–28], p = 0.012), less sourced from pneumonia (19.4% vs. 35.8%, p = 0.008), and less caused by Acinetobacter baumannii (33.3% vs. 50.6%, p = 0.007) than those without. After matching for age, sex, and causative pathogens, the 30-day mortality (34.7% vs. 29.2%, p = 0.592) and APACHE II scores (17 vs. 17, p = 0.769) were not significant. APACHE II score (odds ratio [OR], 1.146; 95% confidence interval [CI], 1.035–1.268; p = 0.009), bacteremia caused by A. baumannii (OR, 20.501; 95% CI, 2.301–182.649; p = 0.007), and solid tumor (OR, 18.073; 95% CI, 1.938–168.504; p = 0.011) were independent risk factors for 30-day mortality of cirrhotic patients with Acinetobacter bacteremia.ConclusionEven though cirrhotic patients with Acinetobacter bacteremia were younger and had lower APACHE II scores than non-cirrhotic patients, the mortality rates were insignificantly different between the two groups.     

Liver lobe-based magnetic resonance diffusion-weighted imaging using multiple b values in patients with hepatitis B-related liver cirrhosis: association with the liver disease severity according to the Child-Pugh class

OBJECTIVE:To determine the associations of liver lobe-based magnetic resonance diffusion-weighted imaging findings using multiple b values with the presence and Child-Pugh class of cirrhosis in patients with hepatitis B.METHODS:Seventy-four cirrhotic patients with hepatitis B and 25 healthy volunteers underwent diffusion-weighted imaging using b values of 0, 500, 800 and 1000 sec/mm². The apparent diffusion coefficients of individual liver lobes for b_(0,500), b_(0,800) and b_(0,1000) were derived from the signal intensity averaged across images obtained using b values of 0 and 500 sec/mm², 0 and 800 sec/mm², or 0 and 1000 sec/mm², respectively, and were statistically analyzed to evaluate cirrhosis.RESULTS:The apparent diffusion coefficients for b_(0,500), b_(0,800) and b_(0,1000) inversely correlated with the Child-Pugh class in the left lateral liver lobe, the left medial liver lobe, the right liver lobe and the caudate lobe (r=–0.35 to –0.60, all p<0.05), except for the apparent diffusion coefficient for b_(0,1000) in the left medial liver lobe (r=–0.17, p>0.05). Among these parameters, the apparent diffusion coefficient for b_(0,500) in the left lateral liver lobe best differentiated normal from cirrhotic liver, with an area under the receiver operating characteristic curve of 0.989. The apparent diffusion coefficient for b_(0,800) in the right liver lobe best distinguished Child-Pugh class A from B–C and A–B from C, with areas under the receiver operating characteristic curve of 0.732 and 0.747, respectively.CONCLUSION:Liver lobe-based apparent diffusion coefficients for b_(0,500) and b_(0,800) appear to be associated with the presence and Child-Pugh class of liver cirrhosis.     

Scrub typhus in patients with liver cirrhosis: a preliminary study

Scrub typhus is a potentially fatal infectious disease caused by the organism Orientia tsutsugamushi. However, to date, there have been no clearly identified determinants or reports published on the clinical severity of scrub typhus in liver cirrhosis (LC) patients. This study was carried out by retrospectively reviewing medical records accumulated over 7 years at a tertiary hospital. Sixteen patients of 160 had underlying LC, and they were defined as ‘cases'; those without underlying LC were defined as ‘controls'. The duration of hospital stay (23.0 ± 24.8 days for cases and 6.8 ± 7.0 days for controls, p 0.020) and APACHE II scores (14.1 ± 6.0 for cases and 7.2 ± 4.6 for controls, p <0.001) were, respectively, significantly longer and significantly higher on admission in the cases than in the controls. Surprisingly, hospital mortality was significantly higher in the cases than in the controls (31.3% and 3.5%, respectively, p 0.001). Among the LC group, the highest Model for End-stage Liver Disease (MELD) score during hospitalization (MELD-Peak) (p 0.024) and the lowest blood sodium concentration during hospitalization (MELD-Na-Lo) (p 0.003) were higher in fatal cases than in the survivors (MELD-Na-to). Physicians should be aware of an adverse relationship between LC and scrub typhus, and patients with LC should be advised to avoid exposure to O. tsutsugamushi, particularly in endemic areas and epidemic seasons.     

Fibronectin decrease in liver cirrhosis is related to spleen size

Summary We found a significantly lower plasma fibronectin concentration in cirrhotic patients than in controls, a significant inverse relationship between fibronectin and spleen size, but no correlation between fibronectin and hepatic blood flow, prothrombin time, or serum albumin. We suggest that the increased degradation in the enlarged spleen is more relevant than the decreased synthesis in reducing plasma fibronectin levels during liver cirrhosis with portal hypertension.Abbreviations FDP Fibrinogen degradation products - FN Fibronectin - LSD larger spleen diameter - HBF hepatic blood flow - PT prothrombin time - SA serum albumin concentration     

Effect of cholecystokinin-pancreozymin on bile salt secretion into the duodenal juice in patients with liver cirrhosis

Summary Bile salt secretion into duodenal juice was investigated in eight normal subjects and in 12 patients with hepatic cirrhosis. Duodenal juice was quantitatively collected during a fast and following intravenous injecton of secretin and of cholecystokinin-pancreozymin (CCK).Fasting bile salt output was higher in the cirrhotics than in the controls. Following secretin administration the volume of juice increased more marked by in patients with cirrhosis of the liver than in the normal group. After injection of CCK the bile salt output increased 2–35 fold in the latter, while there was no significant alteration in the cirrhotics. It is suggested that this lack of stimulation of bile salt output after CCK is caused by impaired gall bladder function in patients with chronic liver disease.These results were presented at the International Bile-Salt Meeting, Freiburg i. Br., October 1970.     

Association between new-onset liver cirrhosis and suicide risk in South Korea: A nationwide cohort study

Background/AimsCurrent evidence suggests that liver cirrhosis (LC) causes severe psychological stress and depression, which are risk factors for suicide. Although previous studies reported the association between LC and suicidal thoughts, little is known of its effect on suicidal deaths. Therefore, this study was undertaken to investigate the effect of new-onset LC on suicide.MethodsFrom the National Health Insurance Service-National Sample Cohort of South Korea, 5,809 incident LC patients and 11,618 risk-set controls matched by propensity score were selected for follow-up. The incidence rate of suicide was estimated using a generalized estimating equation with a Poisson distribution. Effect size was presented as a hazard ratio (HR) using Cox’s proportional hazards model.ResultsThe incidence rate of suicide was 143.3 cases per 100,000 person years (95% confidence interval [CI], 100.2–205.1) among the LC cohort. The LC patients were 2.37 times more likely to commit suicide compared with matched controls (HR, 2.37; 95% CI, 1.44–3.88). Increased suicide risk was evident within the first 2 years of the follow-up period (HR, 2.59; 95% CI, 1.20–5.60) and among the 18–49-year-old age group (HR, 3.72; 95% CI, 1.45–9.56).ConclusionsOur study found increased risk of suicide in patients with new onset LC, especially during the early period following diagnosis and in younger patients. To decrease this suicide risk, a regular and continuous social support system is required.     

经肝动脉途径兔自体骨髓干细胞移植治疗肝硬化

BACKGROUND:How to make more transplanted bone marrow stem cells stay and differentiate in the liver is an important issue, which is also crucial for treatment of liver cirrhosis via the hepatic artery. OBJECTIVE:To investigate the therapeutic effect of autologous bone marrow stem cell transplantation via the hepatic artery on liver cirrhosis. METHODS:Thirty New Zealand white rabbits were equivalently randomized into normal control, stem cell transplantation and model groups. Animal models of liver cirrhosis were made in the latter two groups. Then, model rabbits in the stem cell transplantation group were subjected to autologous bone marrow stem cell transplantation via the hepatic artery. Liver function of rabbits was detected in 1, 2, 4, 8, 10 weeks after cell transplantation, and pathological detection of the liver was performed in the 10th week. RESULTS AND CONCLUSION:At 10 weeks after cell transplantation, the liver function of the rabbits was improved significantly compared with the model group, including reduced activities of serum alanine aminotransferase, total bilirubin and aspartate aminotransferase, shortened activated partial thromboplastin time, and increased albumin level (P < 0.05). Pathological examination of the liver showed that the liver cells in the stem cell transplantation group were intact with no obvious edema and still had the structure of the pseudolobule, and compared with the model group, the degree of liver fibrosis was significantly reduced in the stem cell transplantation group. Our experimental results show that the transplantation of autologous bone marrow stem cells via the hepatic artery has a certain therapeutic effect on liver cirrhosis by increasing the body albumin content in a short time and improving the liver function.     

Overweight in classical phenylketonuria children: A retrospective cohort study

PurposeThis cohort study aimed to determine the frequency of overweight and obesity in classical phenylketonuria children and to identify the possible influence of metabolic control on the BMI of the studied patients.Patients and methodsThe study group included 63 classical phenylketonuria patients (40 girls and 23 boys; aged 5–16 years). Their z-score BMI, metabolic control, educational level of parents and socioeconomic status were determined.ResultsTwenty children were overweight or obese and only three were underweight. The percentages of overweight and obese children were 31.7% for the whole group, 21.7% (5 out of 23) for boys and 37.5% (15 out of 40) for girls. Overweight and obesity in these phenylketonuria patients was statistically significantly more frequent when compared to national reference studies (p = 0.0031).The five-year index of dietary control and the percentage of spikes exceeding 6 and 12 mg/dl (Spikes 6 and 12) indicated better metabolic control in the case of normal weight children than those who were overweight and obese (p < 0.049, p < 0.041 and p < 0.011, respectively). The odds ratio of being overweight or obese for those having poorer metabolic control (values higher vs lower than mean) was statistically significantly higher than for the remaining patients (for Spikes 12: 6.926 < 95%CI: 2.011–23.854 > ; p < 0.002). These results strongly suggest a link between overweight and diet non-compliance.ConclusionsChildren with classical phenylketonuria presented higher odds of being overweight or obese as compared with reference national studies, with girls only having a higher frequency of overweight.