scholarly journals Prothrombotic and Inflammatory Markers in Elderly Patients with Non-Alcoholic Hepatic Liver Disease before and after Weight Loss: A Pilot Study

2021 ◽  
Vol 10 (21) ◽  
pp. 4906
Author(s):  
Antonio Gidaro ◽  
Roberto Manetti ◽  
Alessandro Palmerio Delitala ◽  
Emanuele Salvi ◽  
Luigi Bergamaschini ◽  
...  
Keyword(s):  
Weight Loss ◽  
Liver Disease ◽  
Fatty Liver ◽  
Metabolic Diseases ◽  
Pathological Condition ◽  
Factor Vii ◽  
Alcoholic Fatty Liver ◽  
Increased Risk ◽  
Before And After ◽  
Pai 1

Background: Non-alcoholic fatty liver disease (NAFLD) is a pathological condition, ranging from fatty liver to chronic steatohepatitis (NASH), liver cirrhosis, and eventually to hepatocellular carcinoma. Recent findings suggest that patients with NAFLD have an increased risk of cardiovascular events and thromboembolism, which is independent of metabolic diseases that are frequently associated with NAFLD, such as diabetes, hyperlipidemia, and obesity. Methods: We evaluated 30 NAFLD patients, before and after weight loss. Plasma levels of C-reactive protein (CRP), fibrinogen, plasminogen activator inhibitor-1 (PAI-1), von Willebrand factor (VWF), homocysteine, coagulation protein S, Thrombin activable fibrinolysis inhibitor (TAFI), and factor VII (FVII) were assessed to evaluate whether they should be responsible of the prothrombotic state of NAFLD after weight loss. Results: At baseline, patients affected by NAFLD had a significantly higher levels of CRP, fibrinogen, PAI-1, VWF antigen, and FVII levels. After weight reduction, we observed a significant drop of inflammatory and prothrombotic markers, as well as glucometabolic, lipid profile. Conclusion: These findings provide evidence for a link between NAFLD/NASH and thromboembolism. The association seems to be linked with primitive thrombotic state and hypercoagulation due to increased levels of coagulation factors and reduced levels of PAI-1. This hypercoagulation state might explain increased levels of thrombosis and splanchnic thrombosis observed in NASH correlated cirrhosis.

Early kidney dysfunction in non-alcoholic fatty liver disease - is transient elastography useful as a screening method?

2021 ◽  
Author(s):  
Marta Freitas ◽  
Vítor Macedo Silva ◽  
Sofia Xavier ◽  
Joana Magalhes ◽  
Carla Marinho ◽  
...  
Keyword(s):  
Liver Disease ◽  
Liver Fibrosis ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Transient Elastography ◽  
Screening Method ◽  
Kidney Dysfunction ◽  
Alcoholic Fatty Liver ◽  
Increased Risk ◽  
Significant Liver Fibrosis

Introduction: Increasing evidence suggests an association between metabolic associated fatty liver disease (MAFLD) and chronic kidney disease (CKD). Timely prediction of early kidney dysfunction (EKD) is thus essential in this population, although a screening method is not stablished. We aimed to evaluate the role of transient elastography (TE) in predicting EKD in patients with MAFLD. Methods: Prospective cohort study that included patients with MAFLD scheduled for evaluation, between May/2019 and January/2020. Demographic, clinical and laboratory data, and TE parameters were obtained. EKD was defined as microalbuminuria (urinary albumin-to-creatinine ratio 30-300mg/g) and estimated glomerular filtration rate≥60mL/min/1.73m2. Significant liver fibrosis was defined as liver stiffness measurement (LSM)≥8.2kPa. Results: Included 45 patients with MALFD, 53.3% female gender, mean age of 53.5±10.9years. EKD was found in 17.8% of patients. MAFLD patients with EKD were significantly more obese (body mass index≥30) (75.0% vs 32.4%,p=0.045) and had significantly higher LSM (8.5±4.1 vs 5.8±2.2kPa,p=0.01). After adjustment of potential confounders for EKD the presence of liver fibrosis, remained a significant predictor of EKD, being associated with a 14.3-fold increased risk of EKD (p=0.04). The optimal cutoff value of LSM to predict EKD was 6.1kPa (sensitivity:85.7%; specificity:67.6%). Conclusion: Significant liver fibrosis is associated with a significant increased risk of EKD in patients with MAFLD, regardless of other comorbidities. Higher levels of LSM, particularly >6.1kPa, alert for timely identification of EKD and associated comorbidities, as well as their control, in order to prevent the development of CKD in the long term.

scholarly journals Patient disease knowledge, attitudes and behaviours related to non-alcoholic fatty liver disease: a qualitative study

2021 ◽  
Vol 8 (1) ◽  
pp. e000634
Author(s):  
Monica A Tincopa ◽  
Jane Wong ◽  
Michael Fetters ◽  
Anna S Lok
Keyword(s):  
Social Support ◽  
Weight Loss ◽  
Liver Disease ◽  
Fatty Liver ◽  
Health Behaviour ◽  
Fatty Liver Disease ◽  
Primary Therapy ◽  
Alcoholic Fatty Liver ◽  
Medical Comorbidities ◽  
Alcoholic Fatty Liver Disease

ObjectiveDespite clear evidence that weight loss via nutritional and physical activity changes improves histological outcomes in non-alcoholic fatty liver disease (NAFLD), many patients struggle to implement and maintain these health behaviour changes. The aim of this study was to characterise disease knowledge, attitudes and behaviours among persons with NAFLD and to identify the factors driving these health behaviours and perceptions.DesignWe conducted semistructured interviews among patients with NAFLD. We used purposeful sampling to enroll equivalent percentages based on age and sex, and enrolled approximately one-third of patients with cirrhosis to capture those perspectives. Interviews were conducted until thematic saturation was achieved. Transcripts were coded using NVivo software to identify themes and subthemes.ResultsA total of 29 patient interviews were completed. Ambiguity about the diagnosis and aetiology of their liver disease was a key theme, though the vast majority of patients were aware that weight loss via nutrition and exercise was the primary therapy. Most patients were asymptomatic, diagnosed incidentally, and reported low level of concern regarding their diagnosis. The primary barriers and facilitators to health behaviour change were the presence of social support, competing medical comorbidities and low motivation to change behaviours.ConclusionsAlthough patients are aware that lifestyle interventions are the primary therapy for NAFLD, there is a gap in knowledge about the condition. The presence of social support and competing medical comorbidities were the most consistent facilitators and barriers to lifestyle change. Tailoring treatment recommendations to provide relevant disease education, specific nutrition and exercise regimens, and personalised approaches based on specific individual barriers and facilitators will likely aid in uptake and maintenance of first-line therapy for NAFLD.

scholarly journals A 12-week multi-component dietary intervention improves markers of non-alcoholic fatty liver disease in Irish patients in tertiary care

2020 ◽  
Vol 79 (OCE2) ◽  
Author(s):  
Deirdre Ní Fhloinn ◽  
Ciara Wright ◽  
Sara Naimimohasses ◽  
Stephen Finn ◽  
Suzanne Norris ◽  
...  
Keyword(s):  
Weight Loss ◽  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Dietary Intervention ◽  
Tertiary Care ◽  
Intervention Group ◽  
Post Intervention ◽  
Alcoholic Fatty Liver ◽  
Alcoholic Fatty Liver Disease

AbstractNon-alcoholic fatty liver disease (NAFLD) is a significant public health concern closely linked to obesity, affecting an estimated 25% of adults in Europe. Understudied in Ireland, the aim of this research was to examine the effects of a 12-week multi-component dietary intervention on weight loss and markers of liver injury in Irish NAFLD patients in tertiary care. Biopsy confirmed NAFLD patients (n = 27) were recruited from St James’ Hospital in Dublin, Ireland. Consenting participants underwent a 12-week moderate-intensity intervention incorporating weekly group nutritional education, behavioural change and group support, as well as individualised advice and weigh-ins from a trained nutritionist. Control group participants were given routine clinical care. All participants were clinically reviewed before, immediately after, and 3 months post intervention. Individuals (n = 12) with histological evidence of steatohepatitis underwent a repeat liver biopsy on completion of the intervention. Detailed dietary assessment was performed using both a 4-day diet diary (4DDD) and a novel, recently validated, short food frequency questionnaire (SFFQ) designed specifically to assess habitual intakes of food items related to NAFLD. Nutrient intakes were analysed using myFood24TM dietary analysis software, and the Mediterranean diet quality score (MDQS) was used to assess the overall change in dietary patterns. Of the 15 participants who completed the intervention, 80% (n = 12) achieved a weight loss exceeding 5%, with 47% (n = 7) achieving > 7%. There were significant improvements from baseline to week 12 in the intervention group for the majority of clinical parameters including HbA1c (p = 0.0054), liver enzymes (ALT, p = 0.0108; GGT, p = 0.0001) and transient elastography (kPA, p = 0.0308; CAP, p = 0.0081). However, these results failed to maintain significance when analysed compared to controls. The overall dietary pattern was significantly improved after 12 weeks as assessed by the MDQS (p = 0.03), with no apparent compromise in micronutrient intake despite the energy reduction. Reductions in energy, saturated fat, carbohydrate and sugar intakes at 12 weeks, were maintained at three months follow up. Analysis of pre- and post-intervention liver biopsies in the intervention group demonstrated a clinically significant improvement in NAS score (p = 0.0273), attributable to reductions in hepatic steatosis (p = 0.0078). A significant correlation was observed between improvement in liver histology and change in sugar intake (r = 0.7534, p = 0.0093). Although results were somewhat limited by small sample size, nutritional education achieved beneficial dietary changes that persisted after the intervention ceased. Notably, achieving reductions in sugar intakes may be particularly beneficial in reducing the severity of hepatic steatosis in Irish adults with NAFLD.

scholarly journals Utility of Fibroscan XL to assess the severity of non-alcoholic fatty liver disease in patients undergoing bariatric surgery

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Andrew Yang ◽  
Melinda Nguyen ◽  
Irene Ju ◽  
Anthony Brancatisano ◽  
Brendan Ryan ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Liver Stiffness ◽  
Convincing Evidence ◽  
Alcoholic Fatty Liver ◽  
Post Surgery

AbstractSignificant weight loss can modify the progression of Nonalcoholic fatty liver disease (NAFLD) with the most convincing evidence coming from bariatric surgery cohorts. Effective ways to non-invasively characterise NAFLD in these patients has been lacking, with high Fibroscan failure rates reported. We prospectively evaluated the utility of Fibroscan using XL-probe over a two-year period. 190 consecutive patients undergoing bariatric surgery were followed as part of their routine care. All patients had Fibroscan performed on the day of surgery and at follow-up a mean of 13 months (± 6.3) later. The majority of patients were female (82%) with mean age of 42. Fibroscan was successful in 167 (88%) at baseline and 100% at follow up. Patients with a failed Fibroscan had higher body mass index (BMI) and alanine transaminase (ALT), but no difference in FIB-4/NAFLD score. Mean baseline Liver stiffness measurement was 5.1 kPa, with 87% of patients classified as no fibrosis and 4% as advanced fibrosis. Mean baseline controlled attenuation parameter was 291, with 78% having significant steatosis, 56% of which was moderate-severe. Significant fibrosis was associated with higher BMI and HbA1c. Significant steatosis was associated with higher BMI, ALT, triglycerides and insulin resistance. Mean follow up time was 12 months with weight loss of 25.7% and BMI reduction of 10.4 kg/m2. Seventy patients had repeat fibroscan with reductions in steatosis seen in 90% and fibrosis in 67%. Sixty-four percent had complete resolution of steatosis. Fibroscan can be performed reliably in bariatric cohorts and is useful at baseline and follow-up. Significant steatosis, but not fibrosis was seen in this cohort with substantial improvements post-surgery.

scholarly journals Non-alcoholic fatty liver disease: the hepatic consequence of obesity and the metabolic syndrome

2010 ◽  
Vol 69 (2) ◽  
pp. 211-220 ◽  
Author(s):  
J. Bernadette Moore
Keyword(s):  
Metabolic Syndrome ◽  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Response To Treatment ◽  
Health Concern ◽  
Alcoholic Fatty Liver ◽  
The Metabolic Syndrome ◽  
Increased Risk ◽  
Alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD) is now the most common liver disease in both adults and children worldwide. As a disease spectrum, NAFLD may progress from simple steatosis to steatohepatitis, advanced fibrosis and cirrhosis. An estimated 20–35% of the general population has steatosis, 10% of whom will develop the more progressive non-alcoholic steatohepatitis associated with markedly increased risk of cardiovascular- and liver-related mortality. Development of NAFLD is strongly linked to components of the metabolic syndrome including obesity, insulin resistance, dyslipidaemia and type 2 diabetes. The recognition that NAFLD is an independent risk factor for CVD is a major public health concern. There is a great need for a sensitive non-invasive test for the early detection and assessment of the stage of NAFLD that could also be used to monitor response to treatment. The cellular and molecular aetiology of NAFLD is multi-factorial; genetic polymorphisms influencing NAFLD have been identified and nutrition is a modifiable environmental factor influencing NAFLD progression. Weight loss through diet and exercise is the primary recommendation in the clinical management of NAFLD. The application of systems biology to the identification of NAFLD biomarkers and factors involved in NAFLD progression is an area of promising research.

scholarly journals Cardiovascular Risk in Non-Alcoholic Fatty Liver Disease: Mechanisms and Therapeutic Implications

2019 ◽  
Vol 16 (17) ◽  
pp. 3104 ◽  
Author(s):  
Claudio Tana ◽  
Stefano Ballestri ◽  
Fabrizio Ricci ◽  
Angelo Di Vincenzo ◽  
Andrea Ticinesi ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Cardiovascular Risk ◽  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Cardiovascular Events ◽  
Alcoholic Fatty Liver ◽  
The Metabolic Syndrome ◽  
Increased Risk ◽  
Alcoholic Fatty Liver Disease

New evidence suggests that non-alcoholic fatty liver disease (NAFLD) has a strong multifaceted relationship with diabetes and metabolic syndrome, and is associated with increased risk of cardiovascular events, regardless of traditional risk factors, such as hypertension, diabetes, dyslipidemia, and obesity. Given the pandemic-level rise of NAFLD—in parallel with the increasing prevalence of obesity and other components of the metabolic syndrome—and its association with poor cardiovascular outcomes, the question of how to manage NAFLD properly, in order to reduce the burden of associated incident cardiovascular events, is both timely and highly relevant. This review aims to summarize the current knowledge of the association between NAFLD and cardiovascular disease, and also to discuss possible clinical strategies for cardiovascular risk assessment, as well as the spectrum of available therapeutic strategies for the prevention and treatment of NAFLD and its downstream events.

scholarly journals Non alcoholic fatty liver disease is a predictor of subclinical Carotid Atherosclerosis in the presence of Metabolic Syndrome

2019 ◽  
Vol 16 (1) ◽  
pp. 39-45
Author(s):  
Cemal Kemaloglu ◽  
Melek Didem Kemaloglu
Keyword(s):  
Metabolic Syndrome ◽  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Carotid Atherosclerosis ◽  
Controlled Study ◽  
Control Group ◽  
Alcoholic Fatty Liver ◽  
Increased Risk ◽  
Alcoholic Fatty Liver Disease

Objective: The aim of this study is to identify the relationship between carotid intima-media thickness (c-imt) and non-alcoholic fatty liver disease (NAFLD), and to determine whether NAFLD is an independent predictor for the progression of atherosclerosis.  Method: This is a prospective randomized controlled study. 103 NAFLD patients who have hepatosteatosis with grade II and above were enrolled in this study. Patients were divided into NAFLD with metabolic syndrome (MS) and NAFLD without MS groups and compared with 50 healthy people. Basal demographic characteristics and C-imt of all patients and control group were measured.  Results: C-imt and carotid cross sectional area rates in the NAFLD groups were significantly higher than those in the control group. The mean and max. c-imt levels were significantly higher in the NAFLD group with metabolic syndrome (p<0,001). Homeostatic Model of Assessment-Insulin Resistance (HOMA-IR) levels were increased in the group with metabolic syndrome than those in the group without metabolic syndrome, with statistical significance (p<0.001). There was no difference in c-imt levels between HOMA-IR positive and negative groups (p=0.254) in patients with NAFLD and without metabolic syndrome. There was only a mild positive corelation between c-imt levels and high sensitive C-Reactive protein (hs-CRP) levels in metabolic syndrome positive group (p=0.026 r=0.30).  Conclusion: NAFLD was a significant predictor to determine the increased risk of carotid atherosclerosis. 

scholarly journals Investigating effect of Helicobacter pylori treatment on improvement of non-alcoholic fatty liver parameters: a randomized trial

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Amir Mohammad Kazemifar ◽  
Ali Akbar Shafikhani ◽  
Elaheh HajiNoormohammadi ◽  
Zahra Azarion ◽  
Aliakbar Hajiaghamohammadi
Keyword(s):  
Helicobacter Pylori ◽  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Intervention Group ◽  
Liver Function Tests ◽  
Double Blind ◽  
Alcoholic Fatty Liver ◽  
Before And After ◽  
Alcoholic Fatty Liver Disease

Abstract Background and objective The correlation between the eradication of Helicobacter pylori (HP) and non-alcoholic fatty liver disease (NAFLD) is a controversial one. The aim of this study is to investigate the effect of Helicobacter pylori treatment on liver function tests and lipid profiles and to compare its effects with exercise therapy and diet alone. Method This was a double-blind randomized clinical trial conducted at Qazvin University of Medical Sciences. One hundred patients with NAFLD having a positive test for urea breath testing were randomly assigned into one of the intervention and comparison groups. The diet and physical activity program were given to two groups of patients for 8 weeks, three sessions per week. In addition to the above therapy, the patients in the intervention group also received HP treatment for 2weeks. The data corresponding to anthropometric and clinical features before and after the intervention were collected in both groups and compared using appropriate statistical methods. Results After the treatment interventions, the variables of weight, BMI, blood glucose, triglyceride, AST, ALT, total cholesterol, and LDL-C were significantly decreased in both groups (p < .05). In the between-group comparisons, only ALT was significantly lower in the intervention group (HP) (p < .05). Conclusion Findings of this study showed that the eradication of Helicobacter pylori could significantly improve the ALT index, but it had no additional effect on changes in metabolic indicators. Trial registration Registration number: IRCT2015042020951N2 Name of trial registry: The study of treatment of Helicobacter pylori in improvement of non-alcoholic fatty liver disease The date of registration: 2015-05-12 Where the full trial protocol can be accessed: https://fa.irct.ir/trial/18489

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