FAT score: an Indian insight to a novel diagnostic score to differentiate non-alcoholic steatohepatitis (NASH) from simple steatosis

Background The aim of this study was to propose a simple predictive score to differentiate NASH from simple steatosis. Results This study included 64 patients who had biopsy-proven NAFLD, of which 34 patients had steatohepatitis and 30 had simple steatosis. Clinical, anthropometric, and biochemical variables of the study population were analyzed. Univariate analysis showed platelet count, ferritin, and transaminases (ALT&AST) were predictors of NASH. This led to the proposal of a new diagnostic tool, FAT score (F signifies Ferritin, A indicates AST&ALT, T denotes t in Platelet) with AUROC of 0.95. The ROC curves for the significant variables were plotted and cutoff values were identified. Each component is awarded a score of 0 or 1, based on this cutoff value. The component is awarded a score of 1 if the component score is above the cutoff value and 0, if the score is below cutoff. The maximum score which can be obtained is 4. A score of ≥ 3 was able to predict NASH from simple steatosis with a sensitivity of 76.5% and a specificity of 100%. The score was validated with a cohort of 84 liver biopsy patients wherein a cutoff ≥ 3 was found to give a specificity of 100% in the validation cohort. Conclusions FAT score is a simple predictive model to differentiate NASH from simple steatosis (cutoff of more than or equal to 3) without performing a liver biopsy. A FAT score less than 3 rules out the need for biopsy.

Liver fibrosis indices are related to diabetic peripheral neuropathy in individuals with type 2 diabetes

The association between nonalcoholic fatty liver (NAFL) or liver fibrosis and diabetic peripheral neuropathy (DPN) has not been well studied. We aimed to investigate the association of NAFL or liver fibrosis indices and DPN in individuals with type 2 diabetes. In this observational study, we included 264 individuals with type 2 diabetes, and calculated non-alcoholic fatty liver disease (NAFLD) liver fat score, NAFLD fibrosis score, and Fibrosis-4 (FIB-4) index to evaluate the status of NAFLD or liver fibrosis. DPN was diagnosed when the Michigan Neuropathy Screening Instrument—Physical Examination score was ≥ 2.5. The NAFLD fibrosis score and FIB-4 index were significantly higher in individuals with DPN than in those without DPN. Logistic analyses showed that the NAFLD fibrosis score and FIB-4 index were associated with DPN after adjustment for covariates (adjusted odds ratio 1.474 and 1.961, respectively). In the subgroup analysis, this association was only significant in the group with a high NAFLD liver fat score (> − 0.640). Serum levels of fetuin-A, a hepatokine, were decreased in individuals with abnormal vibration perception or 10-g monofilament tests compared with their counterparts. The present study suggests that liver fibrosis might be associated with DPN in individuals with type 2 diabetes.

Effect of Post-Grazing Sward Height, Sire Genotype and Indoor Finishing Diet on Steer Intake, Growth and Production in Grass-Based Suckler Weanling-to-Beef Systems

This study evaluated the effects of post-grazing sward height (PGSH, 4 or 6 cm) on herbage production, its nutritive value, dry matter (DM) intake, grazing behaviour and growth of early- (EM) and late-maturing (LM) breed suckler steers (n = 72), and the subsequent effect of indoor finishing diet (grass silage + 3.8 kg concentrate DM/head daily (SC), or grass silage only (SO)) on performance and carcass traits. Animals rotationally grazed pasture for 196 days, followed by indoor finishing for 119 days. At pasture, daily live-weight gain (LWG) was 0.10 kg greater for PGSH-6 than PGSH-4, resulting in a tendency for carcass weight to be 11 kg heavier. Although EM had a 0.10 kg greater daily LWG at pasture than LM, carcass weight did not differ between the genotypes. There was a genotype × PGSH interaction for carcass fat score, whereby there was no difference between EM-4 (8.83, 15-point scale) and EM-6 (8.17), but LM-6 (7.28) was greater than LM-4 (6.33). Although concentrate supplementation during indoor finishing increased carcass weight (+37 kg) and fat score (1.75 units), the majority of steers (83% of EM and 78% of LM) achieved a commercially-acceptable carcass fat score (6.78) at slaughter in the grass-forage-only system.

Differences among Three Skeletal Muscle Mass Indices in Predicting Non-Alcoholic Fatty Liver Disease: Korean Nationwide Population-Based Study

Recent studies have investigated the relationship between sarcopenia and non-alcoholic fatty liver disease (NAFLD); however, there is no unified definition of sarcopenia. Thus, we aimed to investigate the differences among three skeletal muscle mass indices (SMI) in predicting NAFLD. This study included 8133 adults from the 2008–2010 Korea National Health and Nutrition Survey. SMI was calculated as appendicular skeletal muscle mass divided by height-square (hSMI), weight (wSMI), or body mass index (bSMI). The presence of NAFLD was defined by using the NAFLD-liver fat score. On the receiver operating characteristic curve analysis, the predictive power of wSMI for NAFLD was significantly higher than those of hSMI and bSMI in men (wSMI vs. hSMI, p = 0.003; wSMI vs. bSMI, p < 0.001). In women, the predictive power of hSMI was only significantly higher than that of bSMI (p = 0.023), and other predictive powers were not significantly different. In addition, hSMI was correlated with insulin resistance and NAFLD-liver fat score in the opposite direction to wSMI and bSMI in both men and women. Among the three definitions of SMI, wSMI showed the highest diagnostic performance for predicting NAFLD in men, suggesting the importance of defining sarcopenia for its association with specific diseases.

Comparison of the Nutrition Transition Among Adolescents Ages 13–18 years in Six States in India: The Multicenter Study

Objectives To compare the nutrition transition among adolescents ages 13–18 years across six states in India. Methods A validated 10-item apriori index-based Nutrition Transition Diet Score (NTDS; range 0–10) including seven food groups: packaged foods (score 1 ≥ 30 g/d), fried foods (score 1 ≥ 30 g/d), sugar-sweetened beverages (SSB) (score 1 &gt; 0 g/d), dairy (score 1 ≥ 500 ml/d), fruits and vegetables (score 1 ≤ 400 g/d), bread (score 1 ≥ 25 g/d), and added sugar (score 1 ≥ 30 g/d), and three nutrients, namely total fat (score 1 ≥ 30% of total calories), saturated fat (score 1 ≥ 10% of total calories), and sodium (score 1 ≥ 2300 mg/d), was applied to responses averaged from two 24-hour diet recalls from 937 adolescents across six Indian states [Punjab (north), Tamil Nadu (south), Maharashtra (west), Gujarat (west), Chhattisgarh (central), and Assam (north east)]. We calculated and compared differences in the average NTDS, proportions of adolescents that met the criteria for each NTDS component and daily food and nutrient intake across states using Students t tests, chi-sq tests, and ANOVA. Results The NTDS (mean ± SD) was 2.6 ± 1.4 and was highest among adolescents in Maharashtra (3.1 ± 1.6) and lowest in Gujarat (2.1 ± 1.0) (p &lt; .0001). Across regions, while the highest proportion of adolescents in the south and west (Maharashtra) each met the criteria for 3 of 10 components of the NTDS [south –saturated fat (29%), sodium (19%), SSB (4%); west –bread (62%), dairy (11%), added sugar (29%)], adolescents in Gujarat comprised the lowest proportions that met the criteria for six of 10 NTDS components [packaged foods (0%), SSB (0%), dairy (1%), sodium (2%), fat (26%), and fried foods (30%)]. Daily energy and macronutrient intake varied across regions; diets comprised 59–66% carbohydrates, 9–11% protein, and 24–31% fat. Adolescents in the south had the highest daily intake of energy (2045 ± 544 kcal/d) and macronutrients (314 ± 85 g/d carbohydrates, 54 ± 17 g/d protein, 64 ± 23 g/d fat) and those in the west (Maharashtra) had the second highest intake of energy (1810 ± 633 kcal/d), protein (46 ± 18 g/d), and fat (59 ± 26 g/d). Conclusions The nutrition transition is in early stages but most advanced among adolescents in western and southern India. Efforts are needed to study the nutrition transition among Indian adolescents over time. Funding Sources University Grants Commission, Government of India.

Internal and external features of wild birds after collisions without apparent trauma in Japan

Wild birds often require rehabilitation after collisions, even with no apparent injury. Information about aftermath of collisions is still scares. Here, we investigated external characteristics and clinical features of the internal organs of wild birds that experienced collision and compared them with birds admitted to rehabilitation center for other reasons. Necropsy was performed on 55 bird carcasses from Passeriformes and Coraciiform. Five external characteristics were recorded before necropsy including; cause of admission, keel score, life stage, fat score, and number of days before death. The median survival time was calculated by Kaplan-Meier estimates. Data on external and internal features were compared using univariate and multivariate multinomial regressions. There was no significant difference in the median survival time among the causes of admission: 1 day for collision, 2 days for trauma, and 2 days for malnutrition. Kidney discoloration was more significantly associated with collision than with other trauma (p = 0.01). Although no apparent kidney abnormality (including enlargement) were observed, anterior lobe was significantly larger than posterior lobe with collision compared with malnutrition (p = 0.045). Birds that experienced collision exhibited a higher fat score than malnourished birds (p = 0.03). Our results suggested that wild birds with abundant fat were more likely to be admitted due to collision. The gross characteristics of collision included kidney discoloration and anterior lobe extension, which was possibly due to rupture of renal blood vessels by blunt external force. From these findings, it was considered that collision caused major axis of anterior lobe significantly larger than posterior lobe, even though no abnormal finding in renal size such as hypertrophy was recognized. This was the first study to evaluate the cause of admission, necropsy results, and external characteristics in wild birds admitted to rehabilitation centers. Absolute cage rest should be adhered to restore renal function for those birds admitted due to collision, and handling and treatment should be minimized to avoid excess movement of the birds.

SHBG as a Marker of NAFLD and Metabolic Impairments in Women Referred for Oligomenorrhea and/or Hirsutism and in Women With Sexual Dysfunction

PCOS is one of the most common endocrine disorders and NAFLD is one of its most dangerous metabolic consequences. The diagnosis of NAFLD is not a practical task and the condition is at risk of being overlooked. The use of simpler but still reliable surrogate markers is necessary to identify women with a high likelihood of NAFLD. The aim of this study was to evaluate the clinical correlates of NAFLD Liver Fat Score (NAFLD-LFS) in women with oligomenorrhea and/or hirsutism. Furthermore, the study aimed to evaluate whether, among the hormonal parameters evaluated in such women, possible hallmarks of NAFLD may be identified. To this purpose, 66 women who attended our Outpatient Clinic for oligomenorrhea and/or hyperandrogenism were included in the study. In order to validate the results obtained in the first cohort, a second independent sample of 233 women evaluated for female sexual dysfunction (FSD) was analyzed. In cohort 1, NAFLD-LFS positively correlated with metabolic and inflammatory parameters. Among the hormone parameters, NAFLD-LFS showed no significant relationships with androgens but a significant negative correlation with SHBG (p&lt;0.0001) that therefore appeared as a candidate hallmark for pathologic NAFLD-LFS. The ROC analysis showed a significant accuracy (81.1%, C.I.69.1-93.0, p &lt;0.0001) for SHBG in identifying women with a pathological NAFLD-LFS. In particular, a SHBG 33.4 nmol/l was recognized as the best threshold, with a sensitivity of 73.3% and a specificity of 70.7%. In order to validate this SHBG as a marker of metabolic impairment possible related with the presence of NAFLD, we tested this threshold in cohort 2. FSD women with SHBG &lt;33.4 nmol/l had worse metabolic parameters than women with SHBG ≥33.4 nmol/l and a significantly higher NAFLD-LFS even after adjusting for confounders (B=4.18 [2.05; 6.31], p=0.001). In conclusion, this study provides a new evidence in the diagnostic process of NAFLD, showing that the measurement of SHBG, which is routinely assessed in the workup of women referred for possible PCOS, could identify women at higher metabolic risk, thus detecting those who may deserve further targeted diagnostic assessment.

Diagnosis of Nonalcoholic Steatohepatitis

The prevalence of non-alcoholic fatty liver disease (NAFLD) has increased in the last years up to 25% in the adult population. This disease includes a large spectrum of disorders, from simple fatty liver disease to cirrhosis and Hepatocellular Carcinoma (HCC), and they are related to chronic metabolic conditions. NAFLD is characterized by the presence of at least 5% of hepatic steatosis without evidence of hepatocellular injury. The diagnosis of this disease should be of exclusion and focused on its progression, treatment, and identification of the prognosis. The European Association for the Study of the Liver (EASL), the National Institute for Health and Care Excellence (NICE), the Italian Association for the Study of the Liver (AISF), and the American Association for the Study of the Liver (AASLD), published their Clinical Guidelines that have identified the criteria for the diagnosis of NAFLD, several, using imaging or histological diagnostic methods, although they imply a different approach and screening. The Fatty Liver Index and the NAFLD Liver Fat Score are used by 3 out of 5 Guidelines and they are easily calculated using blood tests and clinical information. Other non-invasive scales for NAFLD are the NAFLD fibrosis score (NFS), Fib-4, AST/ALT ratio index; also the ELF panel, Fibrometer, Fibrotest, Hepascore; and some imaging techniques that include transient elastography, magnetic resonance elastography (MRE), and shear wave elastography. Finally, proteomic’s and glycomic’s technologic biomarkers are currently under investigation and recent use, such as Cytokeratin 18 and Sirtuin 1. Still, liver biopsy remains the gold standard to distinguish between steatohepatitis and simple steatosis, using the histological classification and staging scoring systems of NAFLD Activity Score (NAS) and the Steatosis Activity Fibrosis (SAF), to evaluate the disease’s activity.