Plasma and synovial fluid osteopontin levels in patients with knee osteoarthritis: Relation to radiological grade

Aim of workTo investigate osteopontin (OPN) levels in both plasma and synovial fluid of patients with primary knee osteoarthritis (OA) and their relationship with radiological grade.Patient and methodsSixty patients had knee OA and 30 control subjects were included. Anteroposterior knee radiographs were taken to determine the disease severity of the affected knee. The radiographic grading of OA in the knee was performed by using the Kellgren–Lawrence grading. Osteopontin levels in the plasma and synovial fluid were measured using enzyme-linked immunosorbent assay and compared.ResultsOA patients had higher plasma osteopontin concentrations compared to healthy controls (p < 0.000). Osteopontin levels in synovial fluid were significantly higher with respect to plasma sample (r = 0.694, p < 0.000). The mean plasma levels of osteopontin in KL grade 4 were greater than those in KL grade 3, and the difference was statistically significant (p < 0.01). The plasma osteopontin levels significantly correlated with the severity of disease (r = 0.870, p < 0.000). The synovial fluid levels of osteopontin also correlated with disease severity as regarding the radiological grade (r = 0.817, p < 0.000).ConclusionOsteopontin in plasma and synovial fluid is related to progressive joint damage in knee OA. Osteopontin may serve as a biochemical marker for determining disease severity as regarding radiological grade.     

Systemic inflammatory response syndrome in patients with liver cirrhosis

Background and study aimsPatients with liver cirrhosis present an increased susceptibility to the systemic inflammatory response syndrome (SIRS), which is considered the cause of hospital admission in about 10% of patients and is present in about 40% of those admitted for ongoing complications. We tried to assess the prevalence of the SIRS with the possible effects on the course of the disease during hospital stay.Patients and methodsTwo hundred and three patients with liver cirrhosis were examined and investigated with close monitoring during hospital stay. The main clinical endpoints were death and the development of portal hypertension-related complications.ResultsEighty-one patients met the criteria of SIRS (39.9%). We found significant correlations between SIRS and jaundice (p = 0.005), bacterial infection (p = 0.008), white blood cell count (p < 0.001), low haemoglobin concentration (p = 0.004), high serum creatinine levels (p < 0.001), high alanine aminotransferase levels (p < 0.001), serum bilirubin levels (p < 0.001), international normalised ratio (p < 0.001), serum albumin levels (p = 0.033), high Child-Pugh score (p < 0.001). During the follow-up period, 26 patients died (12.8%), 15 developed portal hypertension-related bleeding (7.3%), 30 developed hepatic encephalopathy (14.7%), and 9 developed hepatorenal syndrome type-1 (4.4%). SIRS showed significant correlations both to death (p < 0.001) and to portal hypertension-related complications (p < 0.001).ConclusionThe systemic inflammatory response syndrome occurs in patients with advanced cirrhosis and is associated with a bad prognosis.     

A new approach to facilitate diagnosis of nonalcoholic fatty liver disease through a galactose single point method in rats with fatty liver

BackgroundLiver biopsy reliably diagnoses nonalcoholic fatty liver disease, but its invasiveness and inter- and intra-observer errors limit its usefulness in monitoring.AimsUse a galactose single point method or combined biochemical parameters to improve assessments of nonalcoholic fatty liver disease in a rat model.MethodsThree nonalcoholic fatty liver disease severities were generated in 50 rats: a control group (n = 18) on a standard diet, and 2 study groups on a choline-deficient diet (n = 18), with and without treatment with silymarin (n = 14). At weeks 4, 8, and 18, a galactose solution (0.5 g/kg/body weight) was rapidly injected intravenously. Sixty minutes later, internal artery blood was taken for biochemical analyses, including galactose. The livers were then removed for haematoxylin–eosin staining and to measure the hepatic lipid content.ResultsAlkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, albumin, and total protein were each significantly correlated with nonalcoholic fatty liver disease severity. Regarding logistic regression, galactose single point method and total protein were significantly predictive. The optimal alanine aminotransferase cutoff point for nonalcoholic fatty liver disease prediction from the receiver-operating characteristic curve had 72.4% sensitivity and 52.4% specificity; galactose single point method alone had 82.8% and 72.4%, whereas galactose single point method + total protein showed 82.8% and 81.0%.ConclusionsBoth galactose single point method and galactose single point method + total protein had greater diagnostic sensitivity and specificity for nonalcoholic fatty liver disease than traditional biochemical tests.     

Early detection of liver steatosis by magnetic resonance imaging in rats infused with glucose and Intralipid solutions and correlation to insulin levels

ObjectiveMagnetic resonance (MR) techniques allow noninvasive fat quantification. We aimed to investigate the accuracy of MR imaging (MRI), MR spectroscopy (MRS) and histological techniques to detect early-onset liver steatosis in three rat phenotypes assigned to an experimental glucolipotoxic model or a control group.Materials and MethodsThis study was approved by the institutional committee for the protection of animals. Thirty-two rats (13 young Wistar, 6 old Wistar and 13 diabetic Goto–Kakizaki rats) fed a standard diet were assigned to a 72 h intravenous infusion of glucose and Intralipid fat emulsion or a saline infusion. Plasma insulin levels were measured. Steatosis was quantified in ex vivo livers with gradient-recalled multi-echo MRI, MRS and histology as fat fractions (FF).ResultsA significant correlation was found between multi-echo MRI-FF and MRS-FF (r = 0.81, p < 0.01) and a weaker correlation was found between histology and MRS-FF (r = 0.60, p < 0.01). MRS and MRI accurately distinguished young Wistar and Goto–Kakizaki rats receiving the glucose + Intralipid infusion from those receiving the saline control whereas histology did not. Significant correlations were found between MRI or MRS and insulin plasma level (r = 0.63, p < 0.01; r = 0.57, p < 0.01), and between MRI or MRS and C-peptide concentration (r = 0.54, p < 0.01; r = 0.44, p < 0.02).ConclusionsMulti-echo MRI and MRS may be more sensitive to measure early-onset liver steatosis than histology in an experimental glucolipotoxic rat model.     

Nonalcoholic fatty liver and the severity of acute pancreatitis

AimTo explore the effect of nonalcoholic fatty liver as a hepatic manifestation of metabolic syndrome on the severity of acute pancreatitis. We hypothesized that patients with nonalcoholic fatty liver would have a more severe form of acute pancreatitis.Patients and methodsWe retrospectively analyzed 822 patients hospitalized with acute pancreatitis. We diagnosed acute pancreatitis and determined its severity according the revised Atlanta classification criteria from 2012. We assessed nonalcoholic fatty liver with computed tomography.ResultsThere were 198 (24.1%) patients out of 822 analyzed who had nonalcoholic fatty liver. Patients with nonalcoholic fatty liver had statistically higher incidence of moderately severe (35.4% vs. 14.6%; p = 0.02) and severe acute pancreatitis (20.7% vs. 9.6%; p < 0.001) compared to patients without nonalcoholic fatty liver. At the admission patients with nonalcoholic fatty liver had higher values of C-reactive protein as well as at day three, higher APACHE II score at admission and significantly higher incidence of organ failure and local complications as well as higher values of computed tomography severity index compared to patients without nonalcoholic fatty liver. We found independent association between the occurrence of moderately severe and severe acute pancreatitis and nonalcoholic fatty liver (OR 2.13, 95%CI 1.236–3.689). Compared to patients without nonalcoholic fatty liver, patients with nonalcoholic fatty liver had a higher death rate, however not statistically significant (5.6% vs. 4.3%; p = NS).ConclusionPresence of nonalcoholic fatty liver at admission can indicate a higher risk for developing more severe forms of acute pancreatitis and could be used as an additional prognostic tool.     

Can serum fibrosis markers predict medium/large oesophageal varices in patients with liver cirrhosis?

Background and study aimsNon-invasive predictors of medium/large oesophageal varices (LOVs) could reduce the number of screening endoscopies. As portal hypertension is a consequence of liver fibrosis, serum fibrosis markers were evaluated together with other variables as possible non-invasive predictors of medium OV/LOV.Patients and methodsA total of 154 cirrhotic patients with splenomegaly and 30 healthy control subjects were recruited in a prospective study in two gastroenterology centres in Upper Egypt. Clinical parameters assessed included Child–Pugh class, liver size and ascites. Laboratory parameters included complete blood count, liver function tests, and aspartate aminotransferase (AST)/platelet ratio. Transforming growth factor-β₁ (TGF-β₁), alpha₂ macroglobulin (A₂M) and hyaluronic acid (HA) were assayed. Ultrasonographic examination was done for assessment of liver span, portal vein diameter and detection of minimal ascites. Oesophageal varices were diagnosed and graded by oesophagogastroduodenoscopy.ResultsFifty-four patients (35%) had no or small varices and 100 (65%) patients had medium OV/LOV by endoscopy. On multivariate analysis, the independent predictors of medium OV/LOV were the presence of ascites (β = 0.258, p = 0.047) and serum HA (β = 0.449, p = 0.009). The receiver operating characteristic curve for HA showed the area under the curve to be 0.916. The sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of HA at a cut-off value of 207 μg l^?1 were 94%, 77.8%, 88.7%, 87.5% and 88.3%, respectively.ConclusionsThe presence of ascites and serum HA level higher than 207 μg l^?1 can predict the presence of medium OV/LOV in cirrhotic patients. This would help physicians to identify patients who would most likely benefit from screening endoscopy and thus, reduce costs and discomfort from unnecessary endoscopic procedures.     

Intestinal permeability is increased in children with non-alcoholic fatty liver disease,and correlates with liver disease severity

BackgroundIncreased intestinal permeability seems to play a major role in non-alcoholic liver disease development and progression.AimTo investigate the prevalence of altered intestinal permeability in children with non-alcoholic fatty liver disease, and to study its potential association with the stage of liver disease.MethodsWe performed a case–control study examining intestinal permeability in children using the lactulose–mannitol bowel permeability test.ResultsOverall, 39 consecutive patients (30 males, median age 12 years) and 21 controls (14 males, median age 11.8 years) were included. The lactulose/mannitol ratio resulted impaired in 12/39 patients (31%) and none of the controls. Intestinal permeability was higher in children with non-alcoholic fatty liver disease (lactulose/mannitol ratios: 0.038 ± 0.037 vs. 0.008 ± 0.007, p < 0.05). Within the non-alcoholic fatty liver disease group, intestinal permeability was increased in children with steatohepatitis compared to those with steatosis only (0.05 ± 0.04 vs. 0.03 vs. 0.03, p < 0.05). Pathological lactulose/mannitol ratio correlated with portal inflammation (p = 0.02), fibrosis (p = 0.0002), and ballooning of hepatocytes (p = 0.003). Blood lipopolysaccharides levels were higher in children with steatohepatitis (2.27 ± 0.68 vs. 2.80 ± 0.35, p < 0.05).ConclusionsIntestinal permeability is increased in children with non-alcoholic fatty liver disease, and correlates with the severity of the disease.     

Blood lipid levels in relation to glucose status in European men and women without a prior history of diabetes: The DECODE Study

ObjectiveDyslipidaemia is present not only in diabetic but also in prediabetic subjects. The purpose of this study is to investigate the relationship between lipid and glucose levels in a large European population without a prior history of diabetes.Research design and methodsData from the population-based studies of 8960 men and 10,516 women aged 35–74 years representing 15 cohorts in 8 European countries were jointly analyzed. Multivariate adjusted linear regression analyses with standardized coefficients (β) were performed to estimate the relationship between lipid and plasma glucose.ResultsIn subjects without a prior history of diabetes, positive relationships were shown between fasting plasma glucose (FPG) and total cholesterol (TC) (β = 0.06 and 0.03, respectively for men and women, p < 0.01), triglycerides (TG) (β = 0.14 and 0.12, p < 0.001), non-high-density lipoprotein cholesterol (non-HDL-C) (β = 0.06 and 0.03, p < 0.01) and TC to HDL ratio (β = 0.06 and 0.05, p < 0.001) but a negative trend between FPG and HDL-C (β = −0.02, p > 0.05 in men and β = −0.03, p < 0.05 in women). The relationship between lipid and 2-h plasma glucose (2hPG) followed a similar pattern as that for FPG, except that TC was not increased and HDL-C was reduced in both sexes in subjects with impaired glucose tolerance (IGT).ConclusionsFor cardiovascular prevention, the different lipid patterns between impaired fasting glucose (IFG) and IGT may deserve further attention to evaluate the combined risks of dyslipidaemia and elevated glucose levels below the diagnostic threshold of diabetes.     

Serum adipokine profile in Indian men with nonalcoholic steatohepatitis: Serum adiponectin is paradoxically decreased in lean vs. obese patients

BackgroundAsian Indians are known to be more insulin resistant for the same degree of weight gain. It is therefore likely that the adipokine profile in nonalcoholic fatty liver disease (NAFLD) in Asian Indian population could be different from the Western subjects.AimsTo study the serum adiponectin, resistin, leptin and TNF-α profile in NAFLD and cryptogenic cirrhosis patients.Subjects and methodsBody mass indices, insulin resistance and serum adipokine levels were studied in 56 patients; 10 with fatty liver, 30 with nonalcoholic steatohepatitis (NASH) and 16 with cryptogenic cirrhosis. Eighteen healthy controls were also included.ResultsPatients in general were obese compared to controls (mean BMI 26.9 ± 4.5 vs. 22.6 ± 2.5, respectively, p < 0.0001). In patients with NASH, adiponectin levels were lower than controls (5.4 ± 3 μg/ml vs.7.2 ± 2.9 μg/ml, p = 0.037). Insulin Resistance as assessed by homeostasis model assessment (HOMA) was higher in obese than lean, NAFLD patients (HOMA IR obese, median = 2.8, range = 0.8–16.3 and lean: median = 1.05, range = 0.51–2.75, p = 0.003). Lean NAFLD patients had adiponectin levels lower than obese patients (3 ± 1 μg/ml vs.6.7 ± 3.8 μg/ml respectively, p = 0.003). Serum resistin levels were higher in NAFLD patients (3.7 ± 3 ng/ml) than controls (2.1 ± 1.7 ng/ml, p = 0.007). This difference was significant even when cirrhotic patients were excluded (3.4 ± 2.7 ng/ml, p = 0.036). Serum leptin levels were raised in cryptogentic cirrhosis compared to NASH (p = 0.03). All adipokines tested were raised in cirrhotic patients compared to NAFLD and controls.ConclusionsA significant reduction in serum adiponectin and increase in serum resistin levels were observed in NAFLD patients, more so in lean than obese NAFLD. This paradoxical decrease of serum adiponectin as well as low frequency of insulin resistance in lean NAFLD suggests a possible different etiology for this subset of patients.     

Uric acid and high sensitive C-reactive protein are associated with subclinical thoracic aortic atherosclerosis

Background and purposeThe detection of atherosclerotic lesions in the aorta by transesophageal echocardiography (TEE) is a marker of diffuse atherosclerotic disease. Hyperuricemia is a well-recognized risk factor for cardiovascular diseases. However, no data are available concerning the relationship between serum uric acid (UA) and subclinical thoracic aortic atherosclerosis. We aimed to investigate the association between thoracic aortic atherosclerosis and serum UA level.MethodsWe studied 181 patients (mean age 46.3 ± 8 years) who underwent TEE for various indications. Four different grades were determined according to intima–media thickness (IMT) of thoracic aorta. UA and other biochemical markers were measured with an automated chemistry analyzer.ResultsTEE evaluation characterized thoracic aortic intimal morphology as Grade 1 in 69 patients, Grade 2 in 52 patients, Grade 3 in 31 patients, and Grade 4 in 29 patients. The highest UA level was observed in patients with Grade 4 IMT when compared with Grade 1 and 2 IMT groups (p < 0.001 and p = 0.014, respectively). UA levels in patients with Grade 3 and Grade 2 IMT were also higher than patients with Grade 1 IMT group (p < 0.001, for all). In multiple linear regression analysis, IMT was independently associated with UA level (β = 0.350, p < 0.001), age (β = 0.219, p = 0.001), total cholesterol (β = ?0.212, p = 0.031), low-density lipoprotein cholesterol (β = 0.350, p = 0.001), and high sensitivity C-reactive protein (hsCRP) levels (β = 0.148, p = 0.014).ConclusionUric acid and hsCRP levels are independently and positively associated with subclinical thoracic atherosclerosis.     

The positive impact of a four-week Cardiac Rehabilitation program on depression levels of cardiological patients

PurposeTo investigate the positive impact of a Cardiac Rehabilitation program on levels of depression in patients after an acute cardiac event and to verify if some socio-demographic variables, as diagnosis, gender and age, and variables related to work and social support (working occupation, marital status, presence/absence of children) could be considered as predictors of depression, both at the beginning and at the end of the Cardiac Rehabilitation.MethodsOne hundred and twenty-two patients completed the BDI-II questionnaire for evaluate depressive symptoms, before and after a four-week Cardiac Rehabilitation program. Changes in the scores were compared using paired t-test. Linear regression was used to verify predictors of depression.ResultsMean BDI-II scores decreased significantly between PRE-and POST evaluation, both in the affective factor (t = 2.66, p < 0.01), in cognitive factor (t = 3.89, p < 0.01) and in total score of BDI-II (t = 3.68, p < 0.01). Also, at PRE-evaluation levels of depression were predicted by gender (β = .312, t = 2.55, p < 0.01) and presence of children (β = .426, t = 3.08, p < 0.01).ConclusionThe decreased levels of depression showed the positive impact of Cardiac Rehabilitation program where structured activities have many beneficial effects on the psychological status of patients. The current findings suggested to consider gender difference and presence of social support to set up interventions for patients with heart disease.     

Alcohol and HBV synergistically promote hepatic steatosis

Background and aimsHepatitis virus and alcohol are the main factors leading to liver damage. Synergy between hepatitis B virus (HBV) and alcohol in promoting liver cell damage and disease progression has been reported. However, the interaction of HBV and ethanol in hepatic steatosis development has not been fully elucidated.MethodsEight-week-old male C57BL/6 mice were treated with or without HBV, ethanol, or the combination of HBV and ethanol (HBV + EtOH), followed by a three-week high-fat diet (HFD) regimen. Liver histology, serum biomarkers, and liver triglyceride levels were analysed. Furthermore, a meta-analysis of the effects of alcohol and HBV on hepatic steatosis in populations was performed.ResultsHepatic steatosis was significantly more severe in the HBV + EtOH group than in the other groups. The serum alanine aminotransferase, aspartate aminotransferase and liver triglyceride levels in the HBV + EtOH group were also significantly higher than those in the other groups. The HBeAg and HBsAg levels in the HBV + EtOH group were significantly higher than those in the pair-fed HBV-infected mice. In addition, the meta-analysis showed that alcohol consumption increased the risk of hepatic steatosis by 43% in HBV-infected patients (pooled risk ratio (RR) = 1.43, P < 0.01).ConclusionsAlcohol and HBV synergistically promote high-fat diet-induced hepatic steatosis in mice. In addition, alcohol consumption increases the risk of hepatic steatosis in HBV-infected patients.     

Transforming growth factor-β1 gene expression in hepatocellular carcinoma: A preliminary report

Background and study aimsThe transforming growth factor (TGF)-β signalling pathway plays a dual role in hepatocarcinogenesis. It has been recognised for its role as a tumour suppressor as well as a tumour promoter depending on the cellular context.The aim of this study was to investigate the clinical significance of serum TGF-β1 level and TGF-β1 messenger RNA (mRNA) in the peripheral blood of liver cirrhosis and hepatocellular carcinoma (HCC) patients as noninvasive biomarkers in diagnosing HCC.Patients and methodsTwenty patients were allocated to each of the liver cirrhosis and HCC groups, in addition to 20 healthy volunteers. TGF-β1 gene expression in peripheral blood was quantitated using real-time polymerase chain reaction (PCR), while serum TGF-β1 was analysed using enzyme-linked immunosorbent assay (ELISA).ResultsTGF-β1 gene expression was significantly lower in HCC patients (median 0.401 (0.241–0.699) fold change) than in liver cirrhosis patients (median 0.595 (0.464–0.816)) (p = 0.042) and normal controls (median 1.00 (0.706–1.426) fold change) (p = 0.001). TGF-β1 gene expression showed significant positive correlation with serum TGF-β1 (r = 0.272, p = 0.036) and significant negative correlation with alpha-fetoprotein (AFP) (r = −0.528, p = 0.001). Receiver operating characteristic (ROC) analysis was conducted for TGF-β1 gene expression in comparison with AFP. The area under the curve for TGF-β1 gene expression was 0.688 (95% CI = 0.517–0.858) (p = 0.042) and AFP was 0.869 (95% CI = 0.761–0.976) (p = 0.001). The sensitivity and specificity of TGF-β1 gene expression were 65% and 75%, respectively, at a cutoff value of 0.462 fold change.ConclusionTGF-β1 gene expression in the peripheral blood may be used as a molecular marker for the diagnosis of HCC. Additional studies on a large-scale population are necessary to gain greater insight into the impact of TGF-β1 gene expression in the pathogenesis of HCC.     

Effects of lifestyle interventions on clinical characteristics of patients with non-alcoholic fatty liver disease: A meta-analysis

Background/ObjectivesAlthough lifestyle modifications remain the cornerstone therapy for non-alcoholic fatty liver disease (NAFLD), the optimal lifestyle intervention is still controversial. The aim of this meta-analysis was to evaluate the effect of exercise and/or dietary interventions, type or intensity of exercise and type of diet, on liver function outcomes (liver enzymes, intrahepatic fat and liver histology), as well as on anthropometric and glucose metabolism parameters in NAFLD patients.Subjects/MethodsLiterature search was performed in Scopus and US National Library of Medicine databases to identify all randomized controlled clinical trials (RCTs) in adult patients with NAFLD, diagnosed through imaging techniques or liver biopsy, published in English between January 2005 and August 2016. Studies' quality was evaluated using the Cochrane Risk of Bias Tool. Heterogeneity was tested using the Cochran's Q test and measured inconsistency by I². Effect size was calculated as the standardized mean difference (SMD). The meta-analysis was performed in accordance with PRISMA guidelines.ResultsTwenty RCTs with 1073 NAFLD patients were included. Compared to standard care, exercise improved serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) (all P < 0.05). Ιntrahepatic fat also improved, irrespectively of weight change (SMD = − 0.98, 95% CI: − 1.30 to − 0.66). Regarding the type of exercise, aerobic compared to resistance exercise did not yield any superior improvements on liver parameters, whereas moderate-to-high volume moderate-intensity continuous training was more beneficial compared to continuous low-to-moderate-volume moderate-intensity training or high intensity interval training. Interventions combining exercise and diet showed decreases in ALT (P < 0.01) and improvement in NAFLD activity score (SMD = − 0.61, 95% CI: − 1.09 to − 0.13). Moderate-carbohydrate diets yielded similar changes in liver enzymes compared to low/moderate-fat diets.ConclusionsExercise alone or combined with dietary intervention improves serum levels of liver enzymes and liver fat or histology. Exercise exerts beneficial effects on intrahepatic triglycerides even in the absence of weight loss.     

Significance of plasma osteopontin in diagnosis of hepatitis C virus-related hepatocellular carcinoma

Background and study aimsAlfa fetoprotein (AFP) is widely used as a surveillance test for hepatocellular carcinoma (HCC) among patients with liver cirrhosis (LC). However, the clinical use of AFP has been shown to present some important limitations in sensitivity and specificity. Osteopontin (OPN) is a secreted matrix glycoprotein that is emerging as a significant protein in the biology of HCC. The aim of this study was to assess the diagnostic value of plasma OPN compared with that of AFP in the diagnosis of HCC among hepatitis C virus (HCV)-related LC.Patients and methodsPlasma levels of OPN and AFP were measured in 69 Egyptian patients with HCV-related LC (35 with HCC and 34 without HCC) and 20 healthy controls.ResultsBoth median AFP and OPN levels were significantly higher in the HCC group compared to LC and healthy control groups (p < 0.001 in each) and in LC compared to the control group (p < 0.001). In the HCC group, both OPN and AFP levels were significantly higher in patients with Child–Pugh class C and B compared to class A (p < 0.05 in each). There was no correlation between OPN and AFP levels. The OPN level was significantly higher in patients with multiple focal lesions than in those with single lesions (p < 0.05) and in patients with portal vein invasion compared to patients without portal vein invasion (p < 0.05). Receiver operator characteristic (ROC) curves showed that the area under the curve (AUC) for OPN and AFP was 0.824 and 0.730, respectively.ConclusionOPN is a promising tumour marker which could be used as a screening test for the diagnosis of HCC in patients with LC and, hence, improves the prognosis and survival rate of these patients. The association of OPN with the multiplicity of focal lesions and portal vein invasion suggests an additional prognostic value.     

Hepatic steatosis index: A simple screening tool reflecting nonalcoholic fatty liver disease

Background/AimsTo optimize management of nonalcoholic fatty liver disease (NAFLD), a simple screening tool is necessary. In this study, we aimed to devise a simple index of NAFLD.StudyA cross-sectional study with 10,724 health check-up subjects (5362 cases with NAFLD versus age- and sex-matched controls) was conducted. Study subjects were randomly assigned to a derivation cohort or a validation cohort.ResultsMultivariate analysis indicated that high serum alanine aminotransferase (ALT) to serum aspartate aminotransferase (AST) ratio, high body mass index (BMI), and diabetes mellitus were independent risk factors of NAFLD (all P < 0.001). Using these variables, a formula was derived by a logistic regression model: hepatic steatosis index (HSI) = 8 × (ALT/AST ratio) + BMI (+2, if female; +2, if diabetes mellitus). HSI had an area under receiver-operating curve of 0.812 (95% confidence interval, 0.801–0.824). At values of <30.0 or >36.0, HSI ruled out NAFLD with a sensitivity of 93.1%, or detected NAFLD with a specificity of 92.4%, respectively. Of 2692 subjects with HSI <30.0 or >36.0 in the derivation cohort, 2305 (85.6%) were correctly classified. HSI was validated in the subsequent validation cohort.ConclusionHSI is a simple, efficient screening tool for NAFLD that may be utilized for selecting individuals for liver ultrasonography and for determining the need for lifestyle modifications.     

Gender-specific differences in clinical and metabolic variables associated with NAFLD in a Mexican pediatric population

Introduction and ObjectivesNon-alcoholic fatty liver disease (NAFLD) is the most common liver disease in children and it is more prevalent in Hispanic males. The gender differences can be explained by body fat distribution, lifestyle, or sex hormone metabolism. We evaluated anthropometric and metabolic differences by gender in children with and without NAFLD.MethodsWe included 194 participants (eutrophic, overweight, and individuals with obesity). The presence of NAFLD was determined using ultrasonography, and we evaluated the association between this disease with metabolic and anthropometric variables by gender.ResultsThe mean age was 10.64 ± 2.54 years. The frequency of NAFLD in boys was 24.51% and in girls was 11.96% (OR = 2.39; 95%CI = 1.10–5.19; p = 0.025). For girls, NAFLD was significantly associated with triglycerides (p = 0.012), homeostatic model assessment of insulin resistance (HOMA-IR) (p = 0.048), and the visceral adiposity index (VAI) (p = 0.024). The variables related to NAFLD in a gender-specific manner were body mass index (BMI) (p = 0.001), waist circumference (WC) (p < 0.001), HDL cholesterol (p = 0.021), alanine aminotransferase (ALT) (p < 0.001), and aspartate aminotransferase (AST) (p = 0.002).ConclusionsIn our study NAFLD is more frequent in boys, only ALT, and no other clinical or metabolic variables, were associated with NAFLD in these patients. HOMA-IR, VAI, triglyceride levels, and ALT were associated with NAFLD only in girls. The ALT cut-off points for the development of NAFLD in our study were 28.5 U/L in females and 27.5 U/L in males. Our findings showed that NAFLD should be intentionally screened in patients with obesity, particularly in boys.     

Etiology of and risk factors for transient and persistent aminotransferase elevation in a population of virus-free blood donors: A multicentre study

AimWe evaluated the etiology and risk factors for transient and persistently elevated aspartate and/or alanine aminotransferase levels in virus-free blood donors.MethodsInclusion criteria: HBsAg/HBV-DNA and anti-HCV/HCV-RNA negative blood donors with elevated aspartate aminotransferase and/or alanine aminotransferase, observed in 5 blood transfusion centres in Italy from 2004 to 2005. Aspartate aminotransferase/alanine aminotransferase levels were measured at entry and every 2 months during a period of 6 months.Results291 individuals were evaluated (144 with persistent and 147 with transient abnormal aminotransferases). High body mass index was the most frequent (75.5%) etiological factor and was more common in the persistent elevated levels group, compared to the transient elevated levels group (82.0% vs 65.3%; p < 0.01). Excessive alcohol intake (>2 units/day) was reported in 23.6%, with no differences between the two groups. Instead, recent use of medication or paint exposure were most frequently associated with transient elevated levels than persistent elevated levels (61.6% vs 23.3% for drugs and 13.7% vs 4.3% for paint, p < 0.001). Considering the participants with transient elevated levels as controls, the multivariate analysis showed that high body mass index was the only independent predictor of persistent elevated aminotransferase levels (OR = 5.3; 95%CI = 1.88–13.42 for those with body mass index > 29.9).ConclusionsIn virus-free blood donors, excessive body mass index is the most frequent etiological factor of abnormal aminotransferases and it is the sole risk factor associated with persistently elevated aminotransferases.     

A new index predicts early allograft dysfunction following living donor liver transplantation: A propensity score analysis

Objective/AimThe aim of this study was to identify a new index to predict early allograft dysfunction following living donor liver transplantation.MethodsThe study enrolled 260 adult living donor liver transplantation recipients. Postoperative laboratory variables were assessed for their association with the prevalence of early allograft dysfunction using the inverse probability of treatment weighting and propensity-score matching (n = 93 pairs) analysis.ResultsForty-seven recipients (18.1%) developed early allograft dysfunction. In multivariable analysis, the alanine aminotransferase and gamma-glutamyl transpeptidase levels on postoperative day 1 were independent predictors of early allograft dysfunction. The alanine aminotransferase to gamma-glutamyl transpeptidase ratio (AGR) was developed. All cases were divided into two groups (Group 1 [AGR ≥ 8.47, n = 103] and Group 2 [AGR < 8.47, n = 157]). AGR ≥ 8.47 (OR 10.345, 95%CI 4.502–23.772, p < 0.001), hepatorenal syndrome (OR 3.016, 95%CI 1.119–8.125, p = 0.029), and graft to recipient weight ratio <0.8% (OR 2.155, 95%CI 1.004–4.624, p = 0.049) were independent risk factors for early allograft dysfunction. The prevalence of early allograft dysfunction was higher in group 1 (after adjusting for inverse probability of treatment weighting [n = 39; 37.9% vs n = 8; 5.1%] and propensity-score matching [n = 33; 35.5% vs n = 2; 2.2%]) than that in group 2 (p < 0.001).ConclusionsThe postoperative AGR is a practical index for predicting early allograft dysfunction after living donor liver transplantation.