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

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.

The association between Helicobacter pylori with nonalcoholic fatty liver disease assessed by controlled attenuation parameter and other metabolic factors

Aim Existing studies have suggested an association between Helicobacter pylori (Hp) infection and nonalcoholic fatty liver disease (NAFLD). We investigated the relationship between Hp infection and NAFLD using controlled attenuation parameter (CAP) and other metabolic factors. Method We conducted a retrospective cohort study of apparently healthy individuals who underwent liver Fibroscan during health screening tests between January 2018 and December 2018. Diagnosis of Hp infection was based on a serum anti-Hp IgG antibody test and CAP values were used to diagnose NAFLD. Results Among the 1,784 subjects (mean age 55.3 years, 83.1% male), 708 (39.7%) subjects showed positive results of Hp serology. In the multivariate analysis, obesity (body mass index ≥25) (odds ratio [OR] 3.44, 95% confidence interval [CI] 2.75–4.29), triglyceride (OR 2.31, 95% CI 1.80–2.97), and the highest tertile of liver stiffness measurement (OR 2.08, 95% CI 1.59–2.71) were found to be associated with NAFLD, defined by CAP ≥248 dB/m, while Hp-seropositivity showed no association with NAFLD. Serum levels of HDL cholesterol significantly decreased in subjects with Hp-seropositivity compared to HP-seronegativity in both groups with and without NAFLD (P<0.001). Conclusion While Hp seropositivity was not associated with CAP-defined NAFLD, serum HDL cholesterol level were negatively associated with Hp-seropositivity in both groups with and without NAFLD. Further clinical and experimental studies are necessary to determine the association between Hp infection and NAFLD.

Reproducibility of Ultrasound-Guided Attenuation Parameter (UGAP) to the Noninvasive Evaluation of Hepatic Steatosis

Background and aim The aim of this study was to identify the applicability of an ultrasound-guided attenuation parameter (UGAP) for the noninvasive assessment of hepatic steatosis in clinical practice and to compare its correlation with B-mode ultrasound (US). Methods We enrolled 63 subjects with different body mass index (BMI) grades from May to July 2021. All of the participants fasted for at least 8 hours before the study. UGAP measurements were performed on liver segment V in the supine position during breath holding, free breathing, expiration, and deep inspiration, and in the lateral decubitus position when breath holding and free breathing, and on another segment in the supine position. Then, the participants were measured again 2 hours after a meal. To validate the intraoperator and interoperator agreements, additional measurements were performed in the supine position by the same radiologist A after 15 minutes intervals and by another experienced radiologist B, who was blinded to the results of radiologist A. Finally, the UGAP values were also compared with the visual grades of hepatic steatosis on B-mode US using a 4-point scale method. Results The intraclass correlation (ICC) of the UGAP values between the two radiologists was 0.862 (p<0.001), and the ICCs of the UGAP values on the same day and different days by radiologist A were 0.899 (p<0.001) and 0.910 (p<0.001), respectively. There were no significant differences in UGAP values under different breathing manipulations (p>0.05), positions (p>0.05), or diet statuses (p=0.300). The UGAP values in the fasting (supine position, segment V, 1) condition among the lean (BMI<24 kg/m2), overweight (24 kg/m2≤BMI<28 kg/m2) and obese groups (BMI≥28 kg/m2) were 0.60±0.12, 0.66±0.14, and 0.71±0.11 dB/cm/MHz, respectively, with a significant difference (p=0.006). The correlation coefficients (Rho) between the UGAP values and the visual grades of hepatic steatosis by the two reviewers were 0.845 (p<0.001) and 0.850 (p<0.001), corresponding to a strong relationship. Steatosis grades by reviewer 1 (p=0.036) and reviewer 2 (p=0.003) were significant factors determining the UGAP values according to the multivariate linear regression analysis. Conclusion UGAP demonstrated excellent intraobserver and interobserver reproducibility in the assessment of hepatic steatosis. UGAP may be a promising tool in clinical practice to predict hepatic steatosis.

The gut-liver axis in nonalcoholic fatty liver disease: association of intestinal permeability with disease severity and treatment outcomes

Objective To investigate the association between intestinal permeability and severity of nonalcoholic fatty liver disease (NAFLD), and the value of intestinal permeability in predicting the efficacy of metabolic therapy for NAFLD. Methods Disease severity was compared between patients with normal and elevated intestinal permeability; correlations between D-lactate and different NAFLD parameters were analyzed; and the effects of metabolic therapy on NAFLD patients with normal and elevated intestinal permeability were evaluated. Results A total of 190 patients with NAFLD were enrolled. NAFLD patients with elevated intestinal permeability had significantly higher levels of liver test parameters, liver ultrasonographic fat attenuation parameter, triglyceride, homeostasis model assessment of insulin resistance value and diamine oxidase (all P˂0.05) than NAFLD patients with normal intestinal permeability. Further, serum D-lactate levels were positively correlated with alanine transaminase, aspartate transaminase, gamma-glutamyl transpeptidase, total bilirubin, indirect bilirubin, fat attenuation parameter, triglyceride, and diamine oxidase (all P˂0.05). Moreover, NAFLD patients with elevated intestinal permeability showed less improvement in TG levels (P=0.014) after metabolic therapy. Conclusion Intestinal permeability correlates with the disease severity in patients with NAFLD. Moreover, intestinal permeability may have value for predicting the efficacy of metabolic therapy for NAFLD patients.