Novel multi-parametric diagnosis of non-alcoholic fatty liver disease using ultrasonography,body mass index,and Fib-4 index

BACKGROUND Shear wave speed(SWS),shear wave dispersion(SWD),and attenuation imaging(ATI)are new diagnostic parameters for non-alcoholic fatty liver disease.To differentiate between non-alcoholic steatohepatitis(NASH)and non-alcoholic fatty liver(NAFL),we developed a clinical index we refer to as the“NASH pentagon”consisting of the 3 abovementioned parameters,body mass index(BMI),and Fib-4 index.AIM To investigate whether the area of the NASH pentagon we propose is useful in discriminating between NASH and NAFL.METHODS This non-invasive,prospective,observational study included patients diagnosed with fatty liver by abdominal ultrasound between September 2021 and August 2022 in whom shear wave elastography,SWD,and ATI were measured.Histological diagnosis based on liver biopsy was performed in 31 patients.The large pentagon group(LP group)and the small pentagon group(SP group),using an area of 100 as the cutoff,were compared;the NASH diagnosis rate was also investigated.In patients with a histologically confirmed diagnosis,receiveroperating characteristic(ROC)curve analyses were performed.RESULTS One hundred-seven patients(61 men,46 women;mean age 55.1 years;mean BMI 26.8 kg/m2)were assessed.The LP group was significantly older(mean age:60.8±15.2 years vs 46.4±13.2 years;P<0.0001).Twenty-five patients who underwent liver biopsies were diagnosed with NASH,and 6 were diagnosed with NAFL.On ROC curve analyses,the areas under the ROC curves for SWS,dispersion slope,ATI value,BMI,Fib-4 index,and the area of the NASH pentagon were 0.88000,0.82000,0.58730,0.63000,0.59333,and 0.93651,respectively;the largest was that for the area of the NASH pentagon.CONCLUSION The NASH pentagon area appears useful for discriminating between patients with NASH and those with NAFL.

Dietary counseling based on artificial intelligence for patients with nonalcoholic fatty liver disease

BACKGROUND About 25%of the general population in Japan are reported to have nonalcoholic fatty liver disease(NAFLD).NAFLD and nonalcoholic steatohepatitis carry a risk of progressing further to hepatocellular carcinoma.The primary treatment for NAFLD is dietary therapy.Dietary counseling plays an essential role in dietary therapy.Although artificial intelligence(AI)-based nutrition management software applications have been developed and put into practical use in recent years,the majority focus on weight loss or muscle strengthening,and no software has been developed for patient use in clinical practice.AIM To examine whether effective dietary counseling is possible using AI-based nutrition management software.METHODS NAFLD patients who had been assessed using an AI-based nutrition management software application(Calomeal)that automatically analyzed images of meals photographed by patients and agreed to receive dietary counseling were given dietary counseling.Blood biochemistry tests were performed before(baseline)and 6 mo after(6M follow-up)dietary counseling.After the dietary counseling,the patients were asked to complete a questionnaire survey.RESULTS A total of 29 patients diagnosed with NAFLD between August 2020 and March 2022 were included.There were significant decreases in liver enzyme and triglyceride levels at the 6M follow-up compared to baseline.The food analysis capability of the AI used by Calomeal in this study was 75.1%.Patient satisfaction with the AIbased dietary counselling was high.CONCLUSION AI-based nutrition management appeared to raise awareness of dietary habits among NAFLD patients.However,it did not directly alleviate the burden of registered dietitians,and improvements are much anticipated.