Remnant Lipoprotein Cholesterol as a Factor Related to Adult Fatty Liver Disease

2021 ◽  
Author(s):  
Shuang Zhang ◽  
Shitong Cheng ◽  
Xue He ◽  
Wei Wang ◽  
Ke Yun ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Characteristic Curve ◽  
Health Check ◽  
Lipoprotein Cholesterol ◽  
Strong Positive Correlation ◽  
Variable Model ◽  
Remnant Lipoprotein

Abstract Context Dyslipidemia is related to fatty liver disease (FLD), whose relationship with remnant lipoprotein cholesterol (RLP-C), a component of blood lipids, remains unclear. Objective To clarify the correlation between RLP-C and the occurrence and severity of FLD and establish an FLD discriminant model based on health check indicators. Methods Retrospective study of participants who underwent health check-up in the First Affiliated Hospital of China Medical University (Shenyang, China) between January and December 2019. We categorized participants according to liver ultrasound results and analyzed the correlation between RLP-C and occurrence of FLD (n = 38 885) through logistic regression, restricted cubic spline, and receiver operating characteristic curve. We categorized the severity of FLD according to the control attenuation parameter and analyzed the correlation between RLP-C and FLD severity through multiple logistic regression; only males were included (n = 564). Results The adjusted OR (aOR) per SD between RLP-C and FLD was 2.33 (95% CI 2.21-2.46, P < .001), indicating a dose–response relationship (P < .0001). The optimal cut-off value of RLP-C was 0.45 mmol/L and the area under the curve (AUC) was 0.79. The AUC of the 8-variable model was 0.89 in both the training and the validation sets. FLD severity was related to the level of RLP-C (aOR per SD = 1.29, 95% CI 1.07-1.55, P = .008). Conclusion RLP-C has a strong positive correlation with FLD occurrence and FLD severity. These results may help clinicians identify and implement interventions in individuals with high FLD risk and reduce FLD prevalence.

scholarly journals Liver Steatosis: Better Predictor of CKD in MAFLD Than Liver Fibrosis as Determined by Transient Elastography With Controlled Attenuation Parameter

2022 ◽  
Vol 8 ◽  
Author(s):  
Luciana Marc ◽  
Adelina Mihaescu ◽  
Raluca Lupusoru ◽  
Iulia Grosu ◽  
Florica Gadalean ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Transient Elastography ◽  
Renal Involvement ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Atherogenic Dyslipidemia ◽  
Alcoholic Fatty Liver

Background: Changing the term/concept of the non-alcoholic fatty liver disease (NAFLD) to metabolic dysfunction associated fatty liver disease (MAFLD) may broaden the pathological definition that can include chronic renal involvement, and, possibly, changes chronic kidney disease's (CKD's) epidemiological association with liver disease, because CKD is associated with metabolic disorders and almost all patients with CKD present some form of an atherogenic dyslipidemia. Our study explores the relationship between MAFLD and CKD using Transient Elastography (TE) with a Controlled Attenuated Parameter (CAP).Methods: We evaluated 335 patients with diabetes with MAFLD and with high CKD risk using TE with CAP (FibroScan®). The CKD was defined according to Kidney Disease Improving Global Outcomes (KDIGO) 2012 guidelines. Logistic regression and stepwise multiple logistic regression were used to evaluate the factors associated with CKD. In addition, a receiver operating characteristic curve (ROC) analysis was used to assess the performance of CAP and TE in predicting CKD and its optimal threshold.Results: The prevalence of CKD in our group was 60.8%. Patients with CKD had higher mean liver stiffness measurements (LSM) and CAP values than those without CKD. We found that hepatic steatosis was a better predictor of CKD than fibrosis. Univariate regression showed that CAP values >353 dB/m were predictive of CKD; while the multivariate regression analysis (after adjustment according to sex, body mass index (BMI), low-density lipoprotein cholesterol (LDLc), and high-density lipoprotein cholesterol (HDLc), and fasting glucose) showed that CAP values >353 dB/m were more strongly associated with the presence of CKD compared to the LSM (fibrosis) values.Conclusion: In patients with MAFLD, CAP-assessed steatosis appears to be a better predictor of CKD compared to LSM-assessed hepatic fibrosis.

scholarly journals Association between remnant lipoprotein cholesterol levels and non-alcoholic fatty liver disease in adolescents

JHEP Reports ◽  
2020 ◽  
Vol 2 (6) ◽  
pp. 100150 ◽  
Author(s):  
Justin Chin ◽  
Trevor A. Mori ◽  
Leon A. Adams ◽  
Lawrence J. Beilin ◽  
Rae-Chi Huang ◽  
...  
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Lipoprotein Cholesterol ◽  
Alcoholic Fatty Liver ◽  
Cholesterol Levels ◽  
Remnant Lipoprotein ◽  
Alcoholic Fatty Liver Disease

Polymorphisms 677C > T and 1298A > C in the MTHFR gene and homocysteine levels in patients with non-alcoholic fatty liver disease as a component of the ontological model

2021 ◽  
Author(s):  
N. A. Nosko ◽  
O. M. Rud
Keyword(s):  
Logistic Regression ◽  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Mthfr Gene ◽  
Scientific Data ◽  
Multiple Logistic Regression ◽  
Alcoholic Fatty Liver ◽  
Significant Difference ◽  
Alcoholic Fatty Liver Disease

Objective — to systematize literature data on the presence of 677C > T and 1298A > C polymorphisms in the MTHFR gene and homocysteine levels in patients with non‑alcoholic fatty liver disease (NAFLD); to calculate the frequencies 677C > T and 1298A > C polymorphisms combinations in the MTHFR gene and their impact on NAFLD development; to compare homocysteine levels in patients with and without NAFLD. Materials and methods. The analysis has been performed for the results of investigation of 49 patients, from them 17 subjects with NAFLD and 32 without it. Clinical, laboratory, statistical and ontological methods were used in the study. The MTHFR 677C > T and MTHFR 1298A > C polymorphisms in the MTHFR gene were investigated with the use of real time polymerase chain reaction (RT‑PCR) technique. Homocysteine levels were determined with chemiluminescent immunoassay with reference values 3.7 — 13.9 µmol/L. Multiple logistic regression method was used to evaluate the effects 677C > T and 1298A > C polymorphisms in the MTHFR gene on NAFLD development. Results. The variant of combination of 667С/С/1298А/А polymorphisms in the MTHFR gene (absence of mutation) was reveled in 6 (12 %) persons, that showed a widespread prevalence of variants with the presence of mutations. The correlation between variants of 677C > T and 1298A > C polymorphism in the MTHFR gene has been established (r = 0.429; p < 0.05). The results of multiple logistic regression demonstrated absence of the significant effects of 677C > T and 1298A > C polymorphisms in the MTHFR gen on NAFLD development (p > 0.05). Comparison of the homocysteine levels in patients with and without NAFLD didn’t reveal significant difference (р > 0.05), as well as comparison in the groups with combinations of 677C > T and 1298А > С polymorphisms in the MTHFR gen (р > 0.05). This can be explained by the fact that NAFLD group consisted of manly young patients without hypertension, type 2 diabetes mellitus and severe liver fibrosis. Conclusions. Ontological systematization of the scientific data on NAFLD revealed that 677C > T and 1298A > C polymorphisms in the MTHFR gen are pathogenetically associated with the significant increase in homocysteine levels as a marker of cardiovascular pathology. Giving the multifactorial nature of hyperhomocysteinemia and wide spread of 677C > T and 1298A > C polymorphisms in the MTHFR gen in population, it seems to be impractical to use genetic investigations for MTHFR gen polymorphism in NAFLD patients routinely, but only for the purpose of differential diagnosis of hyperhomocysteinemia.  

scholarly journals A novel model for predicting fatty liver disease by means of an artificial neural network

2020 ◽  
Author(s):  
Yi-Shu Chen ◽  
Dan Chen ◽  
Chao Shen ◽  
Ming Chen ◽  
Chao-Hui Jin ◽  
...  
Keyword(s):  
Neural Network ◽  
Artificial Neural Network ◽  
Liver Disease ◽  
Diagnostic Accuracy ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Health Check ◽  
Ann Model ◽  
Artificial Neural ◽  
Input Variables

Abstract Background The artificial neural network (ANN) emerged recently as a potent diagnostic tool, especially for complicated systemic diseases. This study aimed to establish a diagnostic model for the recognition of fatty liver disease (FLD) by virtue of the ANN. Methods A total of 7,396 pairs of gender- and age-matched subjects who underwent health check-ups at the First Affiliated Hospital, College of Medicine, Zhejiang University (Hangzhou, China) were enrolled to establish the ANN model. Indices available in health check-up reports were utilized as potential input variables. The performance of our model was evaluated through a receiver-operating characteristic (ROC) curve analysis. Other outcome measures included diagnostic accuracy, sensitivity, specificity, Cohen’s k coefficient, Brier score, and Hosmer-Lemeshow test. The Fatty Liver Index (FLI) and the Hepatic Steatosis Index (HSI), retrained using our training-group data with its original designated input variables, were used as comparisons in the capability of FLD diagnosis. Results Eight variables (age, gender, body mass index, alanine aminotransferase, aspartate aminotransferase, uric acid, total triglyceride, and fasting plasma glucose) were eventually adopted as input nodes of the ANN model. By applying a cut-off point of 0.51, the area under ROC curves of our ANN model in predicting FLD in the testing group was 0.908 [95% confidence interval (CI), 0.901–0.915]—significantly higher (P &lt; 0.05) than that of the FLI model (0.881, 95% CI, 0.872–0.891) and that of the HSI model (0.885; 95% CI, 0.877–0.893). Our ANN model exhibited higher diagnostic accuracy, better concordance with ultrasonography results, and superior capability of calibration than the FLI model and the HSI model. Conclusions Our ANN system showed good capability in the diagnosis of FLD. It is anticipated that our ANN model will be of both clinical and epidemiological use in the future.

Serum SHBG Is Associated With the Development and Regression of Nonalcoholic Fatty Liver Disease: A Prospective Study

2019 ◽  
Vol 105 (3) ◽  
pp. e791-e804
Author(s):  
Xu Wang ◽  
Jiewen Xie ◽  
Juan Pang ◽  
Hanyue Zhang ◽  
Xu Chen ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Liver Disease ◽  
Fatty Liver ◽  
Nonalcoholic Fatty Liver Disease ◽  
Fatty Liver Disease ◽  
Prediction Models ◽  
Stepwise Logistic Regression ◽  
Stepwise Logistic Regression Analysis ◽  
Nonalcoholic Fatty Liver ◽  
Potential Biomarker

Abstract Context SHBG, a homodimeric glycoprotein produced by hepatocytes has been shown to be associated with metabolic disorders. Whether circulating SHBG levels are predictive of later risk of nonalcoholic fatty liver disease (NAFLD) remains unknown. In this study, we prospectively investigated the association between SHBG and NAFLD progression through a community-based cohort comprising 3389 Chinese adults. Methods NAFLD was diagnosed using abdominal ultrasonography. Serum SHBG levels were measured by chemiluminescent enzyme immunometric assay, and their relationship with NAFLD development and regression was investigated after a mean follow-up of 3.09 years using multivariable logistic regression. Results Basal SHBG was negatively associated with NAFLD development, with a fully adjusted odds ratio (OR) and its 95% confidence interval (CI) of 0.22 (0.12-0.40) (P &lt; .001). In contrast, basal SHBG was positively associated with NAFLD regression, with a fully adjusted OR of 4.83 (2.38-9.81) (P &lt; .001). Multiple-stepwise logistic regression analysis showed that SHBG concentration was an independent predictor of NAFLD development (OR, 0.28 [0.18-0.45]; P &lt; .001) and regression (OR, 3.89 [2.43-6.22]; P &lt; .001). In addition, the area under the receiver operating characteristic curves were 0.764 (95% CI, 0.740-0.787) and 0.762 (95% CI, 0.738-0.785) for the prediction models of NAFLD development and regression, respectively. Conclusions Serum SHBG concentration is associated with the development and regression of NAFLD; moreover, it can be a potential biomarker for predicting NAFLD progression, and also a novel preventive and therapeutic target for NAFLD.

scholarly journals Raw Bowl Tea (Tuocha) Polyphenol Prevention of Nonalcoholic Fatty Liver Disease by Regulating Intestinal Function in Mice

Biomolecules ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. 435 ◽  
Author(s):  
Bihui Liu ◽  
Jing Zhang ◽  
Peng Sun ◽  
Ruokun Yi ◽  
Xiaoyan Han ◽  
...  
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Density Lipoprotein ◽  
The Body ◽  
Lipoprotein Cholesterol ◽  
Intestinal Function ◽  
Alcoholic Fatty Liver ◽  
Body Tissues ◽  
Tnf Α

A high-fat diet-induced C57BL/6N mouse model of non-alcoholic fatty liver disease (NAFLD) was established. The effect and mechanism of Raw Bowl Tea polyphenols (RBTP) on preventing NAFLD via regulating intestinal function were observed. The serum, liver, epididymis, small intestine tissues, and feces of mice were examined by biochemical and molecular biological methods, and the composition of RBTP was analyzed by HPLC assay. The results showed that RBTP could effectively reduce the body weight, liver weight, and liver index of NAFLD mice. The serum effects of RBTP were: (1) decreases in alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AKP), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), D-lactate (D-LA), diamine oxidase (DAO), lipopolysaccharide (LPS), and an increase of high density lipoprotein cholesterol (HDL-C) levels; (2) a decrease of inflammatory cytokines such as interleukin 1 beta (IL-1β), interleukin 4 (IL-4), interleukin 6 (IL-6), interleukin 10 (IL-10), tumor necrosis factor alpha (TNF-α), and interferon gamma (INF-γ); (3) a decrease the reactive oxygen species (ROS) level in liver tissue; and (4) alleviation of pathological injuries of liver, epididymis, and small intestinal tissues caused by NAFLD and protection of body tissues. qPCR and Western blot results showed that RBTP could up-regulate the mRNA and protein expressions of LPL, PPAR-α, CYP7A1, and CPT1, and down-regulate PPAR-γ and C/EBP-α in the liver of NAFLD mice. In addition, RBTP up-regulated the expression of occludin and ZO-1, and down-regulated the expression of CD36 and TNF-α in the small intestines of NAFLD mice. Studies on mice feces showed that RBTP reduced the level of Firmicutes and increased the minimum levels of Bacteroides and Akkermansia, as well as reduced the proportion of Firmicutes/Bacteroides in the feces of NAFLD mice, which play a role in regulating intestinal microecology. Component analysis showed that RBTP contained seven polyphenolic compounds: Gallic acid, (-)-epigallocatechin, catechin, L-epicatechin, (-)-epigallocatechin gallate, (-)-gallocatechin gallate, and (-)-epicatechin gallate (ECG), and high levels of caffeine, (-)-epigallocatechin (EGC), and ECG. RBTP improved the intestinal environment of NAFLD mice with the contained active ingredients, thus playing a role in preventing NAFLD. The effect was positively correlated with the dose of 100 mg/kg, which was even better than that of the clinical drug bezafibrate.

scholarly journals Significant Burden of Nonalcoholic Fatty Liver Disease With Advanced Fibrosis in Iranian Population: A Cross-Sectional Analysis

2020 ◽  
Author(s):  
Behnam Hosseini Ahangar ◽  
Rojen Manouchehri ◽  
Bahareh Rezaei ◽  
Maryam Bahadori ◽  
Arefeh Ebrahimi ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Liver Disease ◽  
Liver Fibrosis ◽  
Fatty Liver ◽  
Chronic Liver Disease ◽  
Fatty Liver Disease ◽  
Advanced Fibrosis ◽  
Multivariate Logistic Regression ◽  
Cross Sectional ◽  
Significant Fibrosis

The main cause of chronic liver disease in Iran is Non-alcoholic fatty liver disease (NAFLD). A common pathological feature of chronic liver disease is fibrosis, so particular vigilance against patients with liver fibrosis is necessary to lead healthcare resource planning. The aims of the current study were to determine the prevalence and predictors of significant fibrosis and advanced ones among individuals with NAFLD. In the current cross-sectional study conducted during 2013-2016, the presence of fibrosis among NAFLD patients was assessed using the NAFLD fibrosis score (NFS) and AST to Platelet Ratio Index (APRI) systems. Multivariate logistic regression models were used to predict significant fibrosis or advanced fibrosis among NAFLD patients. Analysis of the results of over 999 patients (569 females and 430 males) with the mean age of 43.28±14.034 years in Iran during 2015-2016 showed that the overall prevalence of NAFLD among Iranian adults was 19.6%. NAFLD prevalence was not significantly higher in males compared to females (51.5% vs. 48.5%, P=0.66). On multivariate logistic regression analyses, females were less likely to have NAFLD compared to males (OR 0.32, 95% CI 0.24-0.42, P<0.001). The overall prevalence of liver fibrosis among NAFLD patients was 38.8%.20.4% and 6.12% of NAFLD patients had evidence of significant and advanced fibrosis, respectively. Our most recent dataset analysis emphasized the major burden of NAFLD among people of Iranian origin. A high prevalence of individuals with NAFLD and advanced fibrosis was observed.

scholarly journals The Validation of Conventional Non-Invasive Fibrosis Scoring Systems in Patients with Metabolic Associated Fatty Liver Disease

2020 ◽  
Author(s):  
Yinlian Wu ◽  
Rahul Kumar ◽  
Mingfang Wang ◽  
Medha Singh ◽  
Jiaofeng Huang ◽  
...  
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Characteristic Curve ◽  
Scoring Systems ◽  
Advanced Fibrosis ◽  
Discrimination Ability ◽  
Non Invasive ◽  
Nafld Fibrosis Score ◽  
The Difference

Abstract Background：Non-invasive fibrosis scores are not yet validated in the newly defined metabolic associated fatty liver disease (MAFLD). This study evaluated the diagnostic performance of four non-invasive scores including AST to platelet ratio index (APRI), fibrosis-4 index (FIB-4), BMI, AST/ALT ratio, and diabetes score (BARD), and NAFLD fibrosis score(NFS) in patients with MAFLD.Methods: Consecutive patients with histologically-confirmed MAFLD were included. The discrimination ability of different non-invasive scores was compared.Results: A total of 417 patients were included, 156 (37.4%) of them had advanced fibrosis (METAVIR ≥F3). The area under receiver operating characteristic curve (AUROC) of FIB-4, NFS, APRI and BARD for predicting advanced fibrosis were 0.736, 0.724, 0.671 and 0.609 respectively. The AUROC between FIB-4 and NFS were similar (P=0.523), while the difference between FIB-4 and APRI (P=0.001) and FIB-4 and BARD (P<0.001) was statistically significant. The best thresholds of FIB-4，NFS，APRI and BARD for diagnosis of advanced fibrosis in MAFLD were 1.05, -2.1, 0.42 and 2. A subgroup analysis showed that FIB-4, APRI and NFS performed worse in pure MAFLD than HBV-MAFLD group.Conclusions: APRI and BARD score do not perform well in MAFLD. The FIB-4 and NFS could be more useful but new threshold is needed. Novel non-invasive scoring system for fibrosis is required for MAFLD.

scholarly journals Prevalence of Significant and Advanced Hepatic Fibrosis in Metabolic Dysfunction Associated Fatty Liver Disease (MAFLD)

2021 ◽  
Author(s):  
Mimi Kim ◽  
Eileen Laurel Yoon ◽  
Seon Cho ◽  
Chul-min Lee ◽  
Bo Kyeong Kang ◽  
...  
Keyword(s):  
Liver Disease ◽  
General Population ◽  
Fatty Liver ◽  
Hepatic Fibrosis ◽  
Fatty Liver Disease ◽  
Cross Sectional Study ◽  
Health Check ◽  
Metabolic Dysfunction ◽  
Advanced Fibrosis ◽  
Cross Sectional

Abstract Background: There are several reports on the prevalence of metabolic dysfunction associated fatty liver disease (MAFLD) in the general population. But the fibrosis burden of MAFLD in general population is largely unknown. We aimed to evaluate the prevalence of significant and advanced fibrosis associated with MAFLD in a health check-up cohort.Materials and methods: Participants who underwent magnetic resonance elastography (MRE) at nationwide thirteen health check-up centers were included in this cross-sectional study. Fatty liver was evaluated using ultrasonography. Significant (≥F2) and advanced (≥F3) hepatic fibrosis were defined by MRE thresholds of 3.0 kPa (range: 2.99–3.65 kPa) and 3.6 kPa (range: 3.4–3.9 kPa), respectively. The sex- and age-standardized prevalence of MAFLD and hepatic fibrosis were estimated.Results: Total 6,775 health check-up adults included analysis. The sex- and age-standardized prevalence of MAFLD was 33.9%. Prevalence of MAFLD was higher in males than in females, and increased with age. The prevalence of diabetes in MAFLD was 13.3%, and 73.6% of subjects with diabetes had MAFLD. The sex- and age-standardized prevalence of significant (≥F2) and advanced hepatic fibrosis (≥F3) was 9.7% (range: 3.0–9.8%) and 3.0% (range: 2.6–4.6%), respectively, in MAFLD subjects. The prevalence of advanced hepatic fibrosis in diabetic with MAFLD 9.5% (range: 7.5–12.7%).Conclusion: The sex- and age-standardized prevalence of advanced fibrosis was 3.0% (range: 2.6–4.6%) in subjects with MAFLD, respectively.

scholarly journals Environmental Exposure to Cooking Oil Fume and Fatty Liver Disease

2020 ◽  
Author(s):  
Shun Zhang ◽  
Jie Lin ◽  
Saili Ni ◽  
Qili Shi ◽  
Zi Xiong ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Liver Disease ◽  
Fatty Liver ◽  
Heavy Oil ◽  
Fatty Liver Disease ◽  
Exposure Group ◽  
Odds Ratios ◽  
Disease Extent ◽  
Cooking Oil ◽  
Stratified Analysis

Abstract Background: Evidence on effect of cooking oil fume, which contains numerous carcinogens, on development of fatty liver disease is limited. The present study aims to investigate the association between exposure to cooking oil fume and the risk of fatty liver disease.Method: A total of 55959 participants aged between 40 and 75 years old participated in a community-based survey in Ningbo, China. Information on exposure to cooking oil fume and fatty liver disease were collected by face-to-face interview. Stratified analysis was used with participants being divided into two groups according to gender. Multiple logistic regression analyses were conducted to investigate the association between cooking oil fume exposure and fatty liver risk. Furthermore, ordered logistic regression was conducted to investigate the association between cooking oil fume exposure and the severity of fatty liver disease.Results: Fatty liver disease prevalence was 8.79% in none oil fume exposure group, 10.52% in light oil fume exposure group, 23.47% in moderate oil fume exposure group and 41.45% in heavy oil fume exposure group. After adjusting for confounding factors, participants in the light, moderate and heavy cooking oil fume exposure groups all had significantly higher odds ratios as compared with participants in the none oil fume exposure group. In addition, an interaction effect between cooking oil fume exposure and gender on the prevalence and severity of fatty liver disease was observed. Females with heavyoil fume exposure had the highest odds ratios of fatty liver disease and severer disease extent. In the stratified analysis, compared to participants in the smokeless group, males and females in light, moderate and heavy cooking oil fume exposure groups all had significantly higher risk of fatty liver disease and severer disease extent, while participants with heavier cooking oil fume exposure tended to have higher risk of fatty liver disease and severer disease extent.Conclusion: Exposure to cooking oil fume is associated with incident and severity of fatty liver disease in 40-75 years old Chinese. The associations might be dose-responsive. In addition, heavy oil fume exposure and female sex might have a synergistic effecton incident and severity of fatty liver disease.

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