scholarly journals Microbiota analysis and transient elastography reveal new extra-hepatic components of liver steatosis and fibrosis in obese patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Nicolas Lanthier ◽  
Julie Rodriguez ◽  
Maxime Nachit ◽  
Sophie Hiel ◽  
Pierre Trefois ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Transient Elastography ◽  
Fasting Blood Glucose ◽  
Liver Steatosis ◽  
Liver Stiffness ◽  
Multivariate Logistic Regression Analysis ◽  
Rrna Gene ◽  
Obese Patients ◽  
Skeletal Muscle Index ◽  
Linear Discriminant

AbstractObesity could lead to metabolic dysfunction-associated fatty liver disease (MAFLD), which severity could be linked to muscle and gut microbiota disturbances. Our prospective study enrolled 52 obese patients whose MAFLD severity was estimated by transient elastography. Patients with severe steatosis (n = 36) had higher ALAT values, fasting blood glucose levels as well as higher visceral adipose tissue area and skeletal muscle index evaluated by computed tomography. Patients with fibrosis (n = 13) had higher ASAT values, increased whole muscle area and lower skeletal muscle density index. In a multivariate logistic regression analysis, myosteatosis was the strongest factor associated with fibrosis. Illumina sequencing of 16S rRNA gene amplicon was performed on fecal samples. The relative abundance of fecal Clostridium sensu stricto was significantly decreased with the presence of liver fibrosis and was negatively associated with liver stiffness measurement and myosteatosis. In addition, 19 amplicon sequence variants were regulated according to the severity of the disease. Linear discriminant analysis effect size (LEfSe) also highlighted discriminant microbes in patients with fibrosis, such as an enrichment of Enterobacteriaceae and Escherichia/Shigella compared to patients with severe steatosis without fibrosis. All those data suggest a gut-liver-muscle axis in the pathogenesis of MAFLD complications.

scholarly journals High Prevalence of Advanced Liver Fibrosis Assessed by Transient Elastography Among U.S. Adults With Type 2 Diabetes

2020 ◽  
Author(s):  
Stefano Ciardullo ◽  
Tommaso Monti ◽  
Gianluca Perseghin
Keyword(s):  
Type 2 Diabetes ◽  
African American ◽  
Risk Factor ◽  
Transient Elastography ◽  
Liver Steatosis ◽  
Liver Stiffness ◽  
Diabetic Patients ◽  
Advanced Fibrosis ◽  
American Ethnicity

<b>Objective:</b> Type 2 diabetes mellitus (T2DM) is an important risk factor for the progression of metabolic liver disease to advanced fibrosis. Here, we provide an estimate of the prevalence of steatosis and fibrosis in US adults with T2DM based on transient elastography (TE) and identify factors associated with these conditions. <p><b>Research Design and Methods: </b>This is a cross-sectional study of US adults with T2DM participating in the 2017-2018 cycle of the National Health and Nutrition Examination Survey who were evaluated by TE. Hepatic steatosis and fibrosis were diagnosed by the median value of Controlled Attenuation Parameter (CAP) and Liver Stiffness Measurement (LSM), respectively.</p> <p><b>Results:</b> Among the 825 patients with reliable TE exams, 484 (53.7%) were assessed using the M probe and 341 (46.3%) using the XL probe. Liver steatosis (CAP≥274 dB/m), advanced fibrosis (LSM≥9.7 Kpa) and cirrhosis (LSM≥13.6 Kpa) were present in 73.8% (95% CI 68.5%-78.5%), 15.4% (95% CI 12.2%-19.0%) and 7.7% (95% CI 4.8%-11.9%) of patients, respectively. Mean age of patients with advanced fibrosis and cirrhosis was 63.7 ± 2.2 years and 57.8 ± 1.6 years, respectively. In the multivariable logistic regression model, body mass index (BMI), non-African American ethnicity and alanine aminotransferase levels were independent predictors of steatosis, while BMI, non-African American ethnicity, aspartate aminotransferase and gamma-glutamyltranspeptidase levels were independent predictors of advanced fibrosis.</p> <p><b>Conclusions:</b> Prevalence of both liver steatosis and fibrosis are high in patients with T2DM from the US and obesity is a major risk factor. Our results support the screening of these conditions among diabetic patients.</p>

scholarly journals Effect of Postoperative Oral Intake Status on Sarcopenia Six Months After Esophageal Cancer Surgery

2021 ◽  
Author(s):  
Nanako Hijikata ◽  
Aiko Ishikawa ◽  
Satoru Matsuda ◽  
Michiyuki Kawakami ◽  
Kaori Muraoka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Skeletal Muscle ◽  
Esophageal Cancer ◽  
Nutritional Status ◽  
Handgrip Strength ◽  
Tube Feeding ◽  
Multivariate Logistic Regression Analysis ◽  
Oral Intake ◽  
Skeletal Muscle Index ◽  
Swallowing Assessment

Abstract Purpose: In patients with esophageal cancer, skeletal muscle mass has been reported to decrease progressively after surgery and be independently associated with a poor prognosis. The purpose of this study was to investigate perioperative changes in dysphagia, oral intake status, and nutritional status and identify factors related to sarcopenia six months after esophagectomy.Methods: A total of 134 patients who underwent radical resection for thoracic esophageal cancer between March 2016 and July 2019 were analyzed retrospectively. The diagnosis of sarcopenia was made by CT taken six months postoperatively using the cut-off criteria of skeletal muscle index (SMI) <52.4 cm2/m2 for male and SMI <38.5 cm2/m2 for female patients. As factors related to postoperative sarcopenia, dysphagia, oral intake status, nutritional status, and physical function were extracted from the medical records. Multivariate logistic regression analysis was performed to identify perioperative risk factors related to sarcopenia six months after surgery.Results: Of the 134 patients, 34.3% were judged to be unable to start oral intake on swallowing assessment. At discharge, 30.6% received tube feeding with or without oral intake. In the non-oral intake group on swallowing assessment, a significantly higher proportion of patients received tube feeding at discharge (p=0.014). Preoperative BMI, postoperative handgrip strength, and tube feeding at discharge were independent risk factors for sarcopenia six months after esophagectomy in male patients.Conclusions: Oral intake status at discharge is significantly related to postoperative sarcopenia in patients with esophageal cancer. Identifying high-risk groups might allow early detection of malnutrition and provision of appropriate care.

scholarly journals Association of Body Composition and Sarcopenia with NASH in Obese Patients

2021 ◽  
Vol 10 (15) ◽  
pp. 3445
Author(s):  
Sophia Marie-Therese Schmitz ◽  
Lena Schooren ◽  
Andreas Kroh ◽  
Alexander Koch ◽  
Christine Stier ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Body Composition ◽  
Fat Mass ◽  
Inflammatory Diseases ◽  
Statistical Significance ◽  
Bioelectrical Impedance ◽  
Impedance Analysis ◽  
Obese Patients ◽  
Skeletal Muscle Index ◽  
P Values

Obese patients often suffer from sarcopenia or sarcopenic obesity (SO) that can trigger inflammatory diseases including non-alcoholic steatohepatitis (NASH). Sarcopenia and SO can be diagnosed through measuring parameters of body composition such as skeletal muscle mass (SMM), skeletal muscle index (SMI) and fat mass (FM) obtained by bioelectrical impedance analysis (BIA). The aim of this study was to assess the relationship of body composition and NASH in patients with obesity. A total of 138 patients with obesity that underwent bariatric surgery were included in this study. BIA was used to estimate body composition. A liver biopsy was taken intraoperatively and histological assessment of NASH was performed. A total of 23 patients (17%) were classified as NASH and 65 patients (47%) met the criteria for borderline NASH. Body mass index (BMI) was significantly higher in patients with NASH compared to borderline NASH and no NASH (56.3 kg/m2 vs. 51.6 kg/m2 vs. 48.6 kg/m2, p = 0.004). Concerning body composition, FM, but also SMM and SMI were significantly higher in patients with NASH (p-values 0.011, 0.005 and 0.006, resp.). Fat mass index (FMI) and weight-adjusted skeletal muscle index (SMI_weight) failed to reach statistical significance (p-values 0.067 and 0.661). In patients with obesity, higher FM were associated with NASH. Contrary to expectations, SMM and SMI were also higher in patients with NASH. Therefore, higher body fat, rather than sarcopenia and SO, might be decisive for development of NASH in patients with obesity.

scholarly journals The Prevalence of Liver Steatosis and Fibrosis Assessed by Vibration-Controlled Transient Elastography and Controlled Attenuation Parameter in Apparently Healthy Romanian Medical Students

Diagnostics ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 2341
Author(s):  
Robert Nastasa ◽  
Carol Stanciu ◽  
Sebastian Zenovia ◽  
Ana-Maria Singeap ◽  
Camelia Cojocariu ◽  
...  
Keyword(s):  
Medical Students ◽  
Transient Elastography ◽  
Liver Steatosis ◽  
Liver Stiffness ◽  
Moderate Degree ◽  
Advanced Fibrosis ◽  
Controlled Attenuation Parameter ◽  
Significant Fibrosis ◽  
Attenuation Parameter ◽  
Associated Risk Factors

Vibration-Controlled Transient Elastography (VCTE) with Controlled Attenuation Parameter (CAP) is used as a non-invasive method for evaluating liver steatosis and fibrosis simultaneously. In this prospective study, we aimed to assess the prevalence of liver steatosis and fibrosis, as well as the associated risk factors in Romanian medical students by VCTE and CAP score. We used a cut-off CAP score of ≥248 dB/m for the diagnosis of mild steatosis (S1), ≥268 dB/m for moderate steatosis (S2), and ≥280 dB/m to identify severe steatosis (S3). For liver fibrosis, the cut-off values were: ≤5.5 kPa, indicating no fibrosis (F0), 5.6 kPa for mild fibrosis (F1), 7.2 kPa for significant fibrosis (F2), 9.5 kPa for advanced fibrosis (F3), and 12.5 kPa for cirrhosis (F4). In total, 426 Romanian medical students (67.8% females, mean age of 22.22 ± 1.7 years) were evaluated. Among them, 352 (82.6%) had no steatosis (S0), 32 (7.5%) had mild steatosis (S1), 13 (3.1%) had a moderate degree of steatosis (S2), and 29 (6.8%) had severe steatosis (S3). Based on liver stiffness measurements (LSM), 277 (65%) medical students did not have any fibrosis (F0), 136 (31.9%) had mild fibrosis (F1), 10 (2.4%) participants were identified with significant fibrosis (F2), 3 (0.7%) with advanced fibrosis (F3), and none with cirrhosis (F4). In conclusion, the prevalence of liver steatosis and fibrosis is low among Romanian medical students.

scholarly journals Association of endothelial dysfunction with sarcopenia and muscle function in a relatively young cohort of kidney transplant recipients

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e12521
Author(s):  
Siok-Bin Khoo ◽  
Yu-Li Lin ◽  
Guan-Jin Ho ◽  
Ming-Che Lee ◽  
Bang-Gee Hsu
Keyword(s):  
Skeletal Muscle ◽  
Endothelial Dysfunction ◽  
Kidney Transplant ◽  
Muscle Mass ◽  
Gait Speed ◽  
Vascular Reactivity ◽  
Multivariate Logistic Regression Analysis ◽  
Reactivity Index ◽  
Young Cohort ◽  
Skeletal Muscle Index

Background Sarcopenia and endothelial dysfunction are both common among kidney transplant (KT) recipients. We aimed to evaluate the association between endothelial dysfunction and sarcopenia, as well as its individual components. Methods Vascular reactivity index (VRI), skeletal muscle index (SMI = skeletal muscle mass/height2), handgrip strength (HGS), and 6-meter usual gait speed (GS) were measured in 95 KT recipients. Low SMI was defined as SMI less than 10% of the sex-specific reference values from Chinese adults; low HGS as HGS < 28 kg for men and < 18 kg for women; slow GS as GS below 1.0 m/s. Sarcopenia was diagnosed based on the presence of low SMI as an essential criterion, accompanied by either low HGS or slow GS. Vascular reactivity was classified as being indicative of poor (VRI < 1.0), intermediate (1.0 ≤ VRI < 2.0), or good (VRI ≥ 2.0) vascular reactivity. Results Of the 95 patients, aged 45.2 ± 10.9 years, 11.6% had sarcopenia and 13.7% had poor vascular reactivity. Patients with sarcopenia were lower in body mass index (p = 0.001) and VRI (p = 0.041), and have a higher proportion of low muscle mass (p < 0.001), low HGS (p < 0.001), and slow GS (p = 0.001). Patients with poor vascular reactivity have a higher proportion of sarcopenia (p = 0.005), low HGS (p = 0.006), and slow GS (p = 0.029). Multivariate logistic regression analysis showed that patients in the poor VRI group were significantly associated with sarcopenia (odds ratio, OR = 6.17; 95% confidence interval [1.06–36.04]; p = 0.043), comparing to those with good VRI. We further analysed the effects of VRI on individual components of sarcopenia and found that VRI predicted slow GS significantly (OR = 0.41; 95% CI = [0.21–0.79]; p = 0.007), but not low SMI (OR = 1.15; 95% CI [0.53–2.49]; p = 0.718) and HGS (OR = 0.59; 95% CI [0.31–1.16]; p = 0.125). Conclusions We concluded that endothelial dysfunction is a key determinant of sarcopenia in KT recipients. Furthermore, endothelial dysfunction is more closely related to gait speed than muscle mass and strength.

scholarly journals Liver and Nonliver-Related Outcomes at 2 Years Are Not Influenced by the Results of the FIB-4 Test and Liver Elastography in a Real-Life Cohort of Patients with Type 2 Diabetes

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Ivica Grgurevic ◽  
Nermin Salkic ◽  
Sanda Mustapic ◽  
Tomislav Bokun ◽  
Kristian Podrug ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Liver Fibrosis ◽  
Fatty Liver ◽  
Transient Elastography ◽  
Liver Steatosis ◽  
Liver Stiffness ◽  
Real Life ◽  
Adverse Outcomes ◽  
Advanced Fibrosis

Aims. To investigate morbidity and mortality in a real-life cohort of patients with type 2 diabetes (T2D) in relation to prevalence and severity of nonalcoholic fatty liver disease (NAFLD). Methods. Patients with T2D were referred for assessment of liver fibrosis by the FIB-4 test and liver stiffness measurement (LSM) by vibration-controlled transient elastography (VCTE). Liver steatosis was quantified by the controlled attenuation parameter (CAP). These patients were followed until death or censored date. Results. Among 454 patients (52% males, mean age 62.5 years, BMI 30.9 kg/m2), 82.6% was overweight, 77.8% had fatty liver, and 9.9% and 3.1% had LSM and FIB-4 values suggestive of advanced fibrosis, respectively. During the follow-up period of median 2 years, 106 (23%) patients experienced adverse event (11% cardiovascular) and 17 (3.7%) died, whereas no liver-related morbidity or mortality was observed. Independent predictors of adverse outcomes were age and higher platelet count, while FIB-4, LSM, and CAP were not. Conclusion. In a cohort of T2D patients, no liver-related morbidity or mortality occurred during 2 years. Our patients probably have low real prevalence of advanced fibrosis which is likely overestimated by LSM ≥ 9.6 kPa. Liver fibrosis may be safely reassessed in the 2 years interval in noncirrhotic patients with T2D.

NAFLD and liver fibrosis are not associated with reduced femoral bone mineral density in the general US population

2021 ◽  
Author(s):  
Stefano Ciardullo ◽  
Emanuele Muraca ◽  
Francesca Zerbini ◽  
Giuseppina Manzoni ◽  
Gianluca Perseghin
Keyword(s):  
Bone Mineral Density ◽  
Liver Fibrosis ◽  
Femoral Neck ◽  
Bone Mineral ◽  
Transient Elastography ◽  
Univariate Analysis ◽  
Liver Steatosis ◽  
Liver Stiffness ◽  
Mineral Density ◽  
Femoral Bone Mineral Density

Abstract Context It is still debated whether nonalcoholic fatty liver disease (NAFLD) may be a risk factor for reduced bone mineral density (BMD), and it is not known whether liver fibrosis, which is the major predictor of future development of liver-related events in patients with NAFLD, has an influence on BMD. Objective To assess whether liver steatosis and fibrosis are associated with reduced BMD in the general US population. Design Cross-sectional analysis of the population-based 2017-2018 cycle of the National Health and Nutrition Examination Survey (NHANES), in which vibration controlled transient elastography (VCTE) and dual-energy x-ray absorptiometry (DXA) of the femoral neck were simultaneously available. Controlled attenuation parameter (CAP) ≥ 274 dB/m was considered indicative of liver steatosis, while a median liver stiffness measurement (LSM) ≥ 8 kPa indicated the presence of significant liver fibrosis. Patients We included all participants older than 50 with reliable VCTE and femoral neck DXA results (925 men and 859 women). Main Outcomes Femoral neck BMD values indicative of osteopenia or osteoporosis. Results Steatosis and significant fibrosis were highly prevalent in the studied population, being present in 53.1% and 9.6%of men and 44.2% and 8.0% of women, respectively. In univariate analysis, liver steatosis was associated with a lower prevalence of osteoporosis in both men and women, while no difference was noted according to the degree of liver fibrosis. After adjustment for potential confounders including age, BMI, race-ethnicity, cigarette smoke and diabetes, neither CAP, nor LSM were significantly associated with reduced BMD in both sexes. Conclusions Liver steatosis and fibrosis are not associated with femoral DXA-based diagnosis of osteopenia or osteoporosis in the US population older than 50 years.

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