Dyslipidemia as a risk factor for liver fibrosis progression in a multicentric population with non-alcoholic steatohepatitis

Background: Nonalcoholic fatty liver disease (NAFLD) is a serious worldwide health problem, with an estimated global prevalence of 24%; it has a notable relationship with other metabolic disorders, like obesity and type 2 diabetes mellitus (T2DM). Nonalcoholic steatohepatitis (NASH) is one of the most important clinical entities of NAFLD, which is associated with an increased risk of progression to liver cirrhosis and hepatocellular carcinoma (HCC). Mexico is one of the countries with the highest prevalence of metabolic diseases; therefore, we sought to investigate the impact that these clinical entities have in the progression to advanced fibrosis in Mexican patients with NASH. Methods: We performed a multicenter retrospective cross-sectional study, from January 2012 to December 2017. A total of 215 patients with biopsy-proven NASH and fibrosis were enrolled. NASH was diagnosed according NAS score and liver fibrosis was staged by the Kleiner scoring system. For comparing the risk of liver fibrosis progression, we divided our sample into two groups. Those patients with stage F0-F2 liver fibrosis were included in the group with non-significant liver fibrosis (n=178) and those individuals with F3-F4 fibrosis were included in the significant fibrosis group (n=37). We carried out a multivariate analysis to find risk factors associated with liver fibrosis progression. Results: From the 215 patients included, 37 had significant liver fibrosis (F3-4). After logistic regression analysis T2DM (p=0.044), systemic arterial hypertension (p=0.014), cholesterol (p=0.041) and triglycerides (p=0.015) were the main predictor of advanced liver fibrosis. Conclusions: In a Mexican population, dyslipidemia was the most important risk factor associated with advanced liver fibrosis and cirrhosis.

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TSH Levels as an Independent Risk Factor for NAFLD and Liver Fibrosis in the General Population

Journal of Clinical Medicine ◽

10.3390/jcm10132907 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2907

Author(s):

Alba Martínez-Escudé ◽

Guillem Pera ◽

Anna Costa-Garrido ◽

Lluís Rodríguez ◽

Ingrid Arteaga ◽

...

Keyword(s):

Risk Factor ◽

Liver Fibrosis ◽

General Population ◽

Transient Elastography ◽

Atherogenic Dyslipidemia ◽

Control Group ◽

Cross Sectional ◽

Alcoholic Fatty Liver ◽

Increased Risk ◽

Tsh Levels

Thyroid hormones may be a risk factor for the development of non-alcoholic fatty liver disease (NAFLD) and its progression to liver fibrosis. The aim of this study is to investigate the relationship between thyroid stimulating hormone (TSH) levels, NAFLD, and liver fibrosis in the general population. A descriptive cross-sectional study was performed in subjects aged 18–75 years randomly selected from primary care centers between 2012 and 2016. Each subject underwent clinical evaluation, physical examination, blood tests and transient elastography. Descriptive and multivariate logistic regression analyses were used to identify factors associated with NAFLD and fibrosis. We included 2452 subjects (54 ± 12 years; 61% female). Subjects with TSH ≥ 2.5 μIU/mL were significantly associated with obesity, atherogenic dyslipidemia, metabolic syndrome (MetS), hypertransaminasemia and altered cholesterol and triglycerides. The prevalence of NAFLD and liver fibrosis was significantly higher in subjects with TSH ≥ 2.5 (μIU/mL). We found a 1.5 times increased risk of NAFLD, 1.8 and 2.3 times increased risk of liver fibrosis for cut-off points of ≥ 8.0 kPa and ≥ 9.2 kPa, respectively, in subjects with TSH ≥ 2.5 μIU/mL compared with TSH < 2.5 μIU/mL (control group), independent of the presence of MetS. These findings remained significant when stratifying TSH, with values ≥ 10 μIU/mL.

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LECT2, A Novel and Direct Biomarker of Liver Fibrosis in Patients With CHB

Frontiers in Molecular Biosciences ◽

10.3389/fmolb.2021.749648 ◽

2021 ◽

Vol 8 ◽

Author(s):

Honghai Xu ◽

Xutong Li ◽

Zihao Wu ◽

Linyan Zhao ◽

Jiapei Shen ◽

...

Keyword(s):

Liver Fibrosis ◽

Operating Characteristic ◽

Characteristic Curve ◽

Training Group ◽

Validation Group ◽

Severe Liver ◽

Fibrosis Progression ◽

Advanced Liver Fibrosis ◽

Significant Liver Fibrosis

Chronic hepatitis B (CHB) patients with severe liver fibrosis would be more likely to progress to a poorer prognosis. Treatment is considered once the liver fibrosis reaches significant liver fibrosis (≥S2). Leukocyte cell-derived chemotaxin-2 (LECT2) has been shown to contribute to liver fibrosis progression. No research has focused on the role of LECT2 in liver fibrosis in CHB patients. This study enrolled 227 CHB patients and divided them into the training group (n = 147) and validation group (n = 80), respectively. The expression of LECT2 in serum, protein and mRNA of the human liver tissues was detected to analyze the possible associations between LECT2 and liver fibrosis. A receiver operating characteristic curve (ROC) was used to estimate the efficacy of LECT2 for predicting liver fibrosis. The data showed that there was a positive relationship between LECT2 and the progression of liver fibrosis. In the training group, LECT2 was demonstrated to have better effectiveness than APRI and FIB-4. The AUC was 0.861, 0.698, and 0.734 for significant liver fibrosis, and 0.855, 0.769, and 0.752 for advanced liver fibrosis. Besides, the efficacy of LECT2 in different statuses of patients with CHB was examined and the effectiveness of LECT2 had also been confirmed in the validation group. All the results confirmed that LECT2 could act as a perfect predictor and thus offers a novel and direct biomarker to estimate liver fibrosis more accurately.

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Cannabis use and risk of psychosis: an etiological link?

Epidemiologia e Psichiatria Sociale ◽

10.1017/s1121189x0000333x ◽

2004 ◽

Vol 13 (2) ◽

pp. 113-119 ◽

Cited By ~ 18

Author(s):

Helene Verdoux ◽

Marie Tournier

Keyword(s):

Risk Factor ◽

Epidemiological Studies ◽

Population Based ◽

Cannabis Use ◽

Psychotic Symptoms ◽

Self Medication ◽

Cross Sectional ◽

Increased Risk ◽

Population Mental Health ◽

The Impact

SummaryObjective – The nature of the link between cannabis use and psychosis remains to be clarified. Method – The paper reviews the evidence suggesting that cannabis may be a risk factor for psychosis onset. Results – Cross-sectional and retro- spective epidemiological studies show that individuals with psychosis use cannabis more often than other individuals in the gener- al population. It has long been considered that this association is explained by the self-medication hypothesis, postulating that cannabis is used to self-medicate psychotic symptoms. This hypothesis has been recently challenged by several prospective stud- ies carried out in population-based samples, showing that cannabis exposure is associated with an increased risk of psychosis, pos- sibly by interacting with a pre-existing vulnerability for these disorders. A dose-response relationship was found between cannabis exposure and risk of psychosis, and this association was independent from potential confounding factors such as exposure to other drugs and pre-existence of psychotic symptoms. However, the diagnostic specificity is weak, as cannabis exposure may be a risk factor for the occurrence of a large spectrum of psychiatric disorders, ranging from schizophrenia to mood and anxiety disorders. Conclusion – Considering the growing number of adolescents exposed to cannabis, the impact of this substance on the population mental health should be further explored.

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Subclinical steatohepatitis and advanced liver fibrosis in health examinees with nonalcoholic fatty liver disease (NAFLD) in 10 South Korean cities: A retrospective cross-sectional study

PLoS ONE ◽

10.1371/journal.pone.0260477 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0260477

Author(s):

Eun-Hee Nah ◽

Seon Cho ◽

Hyeran Park ◽

Dongwon Noh ◽

Eunjoo Kwon ◽

...

Keyword(s):

Risk Factors ◽

Liver Fibrosis ◽

Fatty Liver ◽

Liver Stiffness ◽

Multivariate Logistic Regression Analysis ◽

Lifestyle Changes ◽

Abnormal Liver Function Test ◽

Cross Sectional ◽

Nonalcoholic Fatty Liver ◽

Advanced Liver Fibrosis

Background Nonalcoholic steatohepatitis (NASH) has a risk of progressing to cirrhosis. The prevalence of NASH and its associated risk factors in community populations are relatively unknown. This study aimed to determine the prevalence of NASH and advanced liver fibrosis using magnetic resonance elastography (MRE), and determine those risk factors in health examinees with asymptomatic fatty liver. Methods This study consecutively selected subjects who underwent health checkups at 13 health-promotion centers in 10 Korean cities between 2018 and 2020. Hepatic steatosis and stiffness were assessed using ultrasonography and MRE, respectively. Stages of liver stiffness were estimated using MRE with cutoff values for NASH and advanced liver fibrosis of 2.91 and 3.60 kPa, respectively. Results The overall prevalence of NASH and advanced liver fibrosis in the subjects with fatty liver were 8.35% and 2.04%, respectively. Multivariate logistic regression analysis indicated that central obesity (OR = 5.12, 95% CI = 2.70–9.71), increased triglyceride (OR = 3.29, 95% CI = 1.72–6.29), abnormal liver function test (OR = 3.09, 95% CI = 1.66–5.76) (all P<0.001), and decreased high-density lipoprotein cholesterol (OR = 5.18, 95% CI = 1.78–15.05) (P = 0.003) were associated with NASH. The main risk factor for advanced liver fibrosis was diabetes (OR = 4.46, 95% CI = 1.14–17.48) (P = 0.032). Conclusion NASH or advanced liver fibrosis is found in one-tenth of health examinees with asymptomatic fatty liver. This suggests that early detection of NASH should be considered to allow early interventions such as lifestyle changes to prevent the adverse effects of NASH and its progression in health examinees with asymptomatic fatty liver.

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Baseline homeostasis model assessment of insulin resistance associated with fibrosis progression in patients with nonalcoholic fatty liver disease without diabetes: A cohort study

PLoS ONE ◽

10.1371/journal.pone.0255535 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0255535

Author(s):

Dae-Jeong Koo ◽

Mi Yeon Lee ◽

Inha Jung ◽

Sun Joon Moon ◽

Hyemi Kwon ◽

...

Keyword(s):

Insulin Resistance ◽

Liver Fibrosis ◽

Fatty Liver Disease ◽

Model Assessment ◽

Homeostasis Model Assessment ◽

Nonalcoholic Fatty Liver ◽

Fibrosis Progression ◽

Quartile Group ◽

Advanced Liver Fibrosis

Background and aims Fibrosis progression is the most important prognostic factor, and insulin resistance is one of the main mechanisms associated with fibrosis progression in patients with nonalcoholic fatty liver disease (NAFLD). We evaluate the association between baseline insulin resistance and future fibrosis progression in patients with NAFLD without diabetes. Approach and results This retrospective longitudinal study with 8-year follow-up period included 32,606 (men, 83%) participants aged >20 years (average age, 38.0 years) without diabetes at baseline who completed at least two comprehensive health checkups from January 1, 2010 to December 31, 2018. NAFLD was diagnosed based on ultrasonography. The homeostasis model assessment of insulin resistance (HOMA-IR) was used to evaluate baseline insulin resistance. Fibrosis progression was assessed using the aspartate aminotransferase to platelet ratio index (APRI). The advanced liver fibrosis with an APRI value above the intermediate fibrosis probability (≥0.5) developed in a total of 2,897 participants during 136,108 person-years. 114 participants progressed to a high fibrosis probability stage (APRI >1.5) during 141,064 person-years. Using the lowest baseline HOMA-IR quartile group (Q1) as a reference, the multivariate-adjusted hazard ratio (HR) for development of advanced liver fibrosis (APRI ≥0.5) in the highest baseline HOMA-IR quartile group (Q4) was 1.95 (95% confidence interval [CI] 1.74–2.19; Model 4). And the HR for development of advanced liver fibrosis with high fibrosis probability was 1.95 (95% CI 1.10–3.46; Model 4). The positive association was maintained throughout the entire follow-up period. The baseline HOMA-IR model was superior to the baseline body mass index (BMI) model in predicting the progression of fibrosis probability. Conclusions In this longitudinal study, we found that the degree of baseline insulin resistance, assessed by HOMA-IR values, was positively associated with future fibrosis progression in patients with NAFLD without diabetes.

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278-LB: Type 2 Diabetes (T2D) as a Risk Factor for NASH and Significant Liver Fibrosis (F>2) in an International Cohort of 2,363 Patients with Metabolic Steatosis

Diabetes ◽

10.2337/db19-278-lb ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 278-LB

Author(s):

BART STAELS ◽

VLAD RATZIU ◽

ARUN J. SANYAL ◽

SVEN FRANCQUE ◽

STEPHEN A. HARRISON ◽

...

Keyword(s):

Type 2 Diabetes ◽

Risk Factor ◽

Liver Fibrosis ◽

Significant Liver Fibrosis

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Faculty Opinions recommendation of A matched cross-sectional study of the association between circulating tissue factor activity, immune activation and advanced liver fibrosis in hepatitis C infection.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725439406.793505983 ◽

2015 ◽

Author(s):

Philip Rosenthal

Keyword(s):

Hepatitis C ◽

Liver Fibrosis ◽

Immune Activation ◽

Cross Sectional Study ◽

Sectional Study ◽

Factor Activity ◽

Hepatitis C Infection ◽

Cross Sectional ◽

Tissue Factor Activity ◽

Advanced Liver Fibrosis

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A Positive Relationship between Betel Nut Chewing and Significant Liver Fibrosis in NAFLD Subjects, but Not in Non-NAFLD Ones

Nutrients ◽

10.3390/nu13030914 ◽

2021 ◽

Vol 13 (3) ◽

pp. 914

Author(s):

Yu-Tsung Chou ◽

Chung-Hao Li ◽

Zih-Jie Sun ◽

Wei-Chen Shen ◽

Yi-Ching Yang ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Cardiovascular Disease ◽

Liver Fibrosis ◽

Odds Ratio ◽

Fatty Liver Disease ◽

Positive Relationship ◽

Betel Nut ◽

Nonalcoholic Fatty Liver ◽

Betel Nut Chewing ◽

Significant Liver Fibrosis

Background: Betel nut chewing is associated with oral cancer, cardiovascular disease, liver cirrhosis, and hepatocellular carcinoma (HCC). The aim of this study was to explore the association of betel nut chewing with liver fibrosis in subjects with and without nonalcoholic fatty liver disease (NAFLD). Method: A total of 5967 subjects were enrolled. NAFLD was diagnosed with ultrasonography. Betel nut chewing was classified into non-chewing, ex-chewing, and current chewing, and cumulative dosages were calculated. The aspartate aminotransferase (AST)/platelet ratio index and NAFLD fibrosis scores (NFS) were calculated for evaluation of liver fibrosis. Results: NAFLD increased the associated risk of liver fibrosis in those with (odds ratio (OR): 5.51, 95% confidence interval (CI): 3.09–9.80) and without betel nut chewing (OR: 2.33, 95% CI: 1.64–3.29). In subjects without NAFLD, betel nut chewing was not associated with liver fibrosis (OR: 1.12, 95% CI: 0.44–2.86). In subjects with NAFLD, cumulative betel nut chewing and ex- and current chewing were positively associated with NFS and significant liver fibrosis. Conclusions: In subjects with NAFLD, betel nut chewing, even ex-chewing, was associated with a higher risk of liver fibrosis, where higher cumulative levels were found to increase the risk of significant liver fibrosis. However, the associated risk of liver fibrosis due to betel nut chewing was insignificant in subjects without NAFLD.

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Nonalcoholic fatty liver disease and the risk of atrial fibrillation stratified by body mass index: a nationwide population-based study

Scientific Reports ◽

10.1038/s41598-021-83367-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

So-Ryoung Lee ◽

Kyung-Do Han ◽

Eue-Keun Choi ◽

Seil Oh ◽

Gregory Y. H. Lip

Keyword(s):

Atrial Fibrillation ◽

Body Mass Index ◽

Liver Disease ◽

Fatty Liver ◽

Nonalcoholic Fatty Liver Disease ◽

Body Mass ◽

Fatty Liver Disease ◽

Nonalcoholic Fatty Liver ◽

Increased Risk ◽

The Impact

AbstractWe evaluated the association between nonalcoholic fatty liver disease (NAFLD) and incident atrial fibrillation (AF) and analyzed the impact of NAFLD on AF risk in relation to body mass index (BMI). A total of 8,048,055 subjects without significant liver disease who were available fatty liver index (FLI) values were included. Subjects were categorized into 3 groups based on FLI: < 30, 30 to < 60, and ≥ 60. During a median 8-year of follow-up, 534,442 subjects were newly diagnosed as AF (8.27 per 1000 person-years). Higher FLI was associated with an increased risk of AF (hazard ratio [HR] 1.053, 95% confidence interval [CI] 1.046–1.060 in 30 ≤ FLI < 60, and HR 1.115, 95% CI 1.106–1.125 in FLI ≥ 60). In underweight subjects (BMI < 18.5 kg/m2), higher FLI raised the risk of AF (by 1.6-fold in 30 ≤ FLI < 60 and by twofold in FLI ≥ 60). In normal- and overweight subjects, higher FLI was associated with an increased risk of AF, but the HRs were attenuated. In obese subjects, higher FLI was not associated with higher risk of AF. NAFLD as assessed by FLI was independently associated with an increased risk of AF in nonobese subjects with BMI < 25 kg/m2. The impact of NAFLD on AF risk was accentuated in lean subjects with underweight.

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Prediction of Nonalcoholic Fatty Liver Disease Using Noninvasive and Non-Imaging Procedures in Japanese Health Checkup Examinees

Diagnostics ◽

10.3390/diagnostics11010132 ◽

2021 ◽

Vol 11 (1) ◽

pp. 132

Author(s):

Kenichiro Murayama ◽

Michiaki Okada ◽

Kenichi Tanaka ◽

Chika Inadomi ◽

Wataru Yoshioka ◽

...

Keyword(s):

Liver Disease ◽

Liver Fibrosis ◽

Fatty Liver ◽

Japanese Population ◽

Fatty Liver Disease ◽

Health Checkup ◽

Nonalcoholic Fatty Liver ◽

General Japanese Population ◽

Advanced Liver Fibrosis ◽

Zju Index

Access to imaging is limited for diagnosing nonalcoholic fatty liver disease (NAFLD) in general populations. This study evaluated the diagnostic performance of noninvasive and nonimaging indexes to predict NAFLD in the general Japanese population. Health checkup examinees without hepatitis virus infection or habitual alcohol drinking were included. Fatty liver was diagnosed by ultrasonography. The hepatic steatosis index (HSI), Zhejiang University (ZJU) index, and fatty liver index (FLI) were determined, and risk of advanced liver fibrosis was evaluated by the fibrosis-4 index. NAFLD was diagnosed in 1935 (28.0%) of the 6927 subjects. The area under the receiver operating characteristic (AUROC) curve of the HSI, ZJU index, and FLI was 0.874, 0.886, and 0.884, respectively. The AUROC of the ZJU index (p < 0.001) and FLI (p = 0.002) was significantly greater than that for the HSI. In subjects with a high risk of advanced fibrosis, the sensitivity of the HSI, ZJU index, and FLI were 88.8%, 94.4%, and 83.3% with a low cut-off value and the specificity was 98.5%, 100%, and 100% with a high cut-off value. In conclusion, all indexes were useful to diagnose NAFLD in the general Japanese population and in subjects with potentially advanced liver fibrosis.

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