Prevalence of fatty liver disease and the economy in China: A systematic review

AIM: To investigate the relationship between the economy and the adult prevalence of fatty liver disease(FLD) in China's Mainland. METHODS: Literature searches on the Pub Med and Chinese National Knowledge Infrastructure databases were performed to identify eligible studies published before July 2014. Records were limited to crosssectional surveys or baseline surveys of longitudinal studies that reported the adult prevalence of FLD and recruited subjects from the general population or community. The gross domestic product(GDP) per capita was chosen to assess the economic status. Multiple linear regression and Loess regression were chosen to fit the data and calculate the 95%CIs. Fitting and overfitting of the models were considered in choosing the appropriate models. RESULTS: There were 27 population-based surveys from 26 articles included in this study. The pooled mean prevalence of FLD in China was 16.73%(95%CI: 13.92%-19.53%). The prevalence of FLD was correlated with the GDP per capita and survey years in the country(adjusted R2 = 0.8736, P GDP per capita = 0.00426, P years = 0.0000394), as well as in coastal areas(R2 = 0.9196, P GDP per capita = 0.00241, P years = 0.00281). Furthermore, males [19.28%(95%CI: 15.68%-22.88%)] presented a higher prevalence than females [14.1%(95%CI: 11.42%-16.61%), P = 0.0071], especially in coastal areas [21.82(95%CI: 17.94%-25.71%) vs 17.01%(95%CI: 14.30%-19.89%), P = 0.0157]. Finally, the prevalence was predicted to reach 20.21% in 2020, increasing at a rate of 0.594% per year. CONCLUSION: This study reveals a correlation between the economy and the prevalence of FLD in China's Mainland.

Is Helicobacter pylori infection associated with glycemic control in diabetics?

AIM:To investigate whether Helicobacter pylori(H.pylori) infection is associated with glycemic control and whether hyperglycemia is modified by eradication therapy.METHODS:The databases of Pub Med,Cochrane Library,Chinese Bio Medicine Web Base and Chinese Science and Technology Journals were searched from inception to June 2014.Studies examining the association between H.pylori infection and glycemic control and/or the effect of eradication treatment on glycemic control in diabetic humans were eligible for inclusion.Meta-analyses were conducted using the Review Manager software version 5.2.The outcome measures are presented as weighed mean differences(WMDs) with 95% confidence intervals(CIs).Statistical heterogeneity was assessed by the Cochran Q test and the I2 statistic.RESULTS:A total of 21 relevant publications were identified.A meta-analysis of 11 studies with 513 patients with diabetes mellitus(DM) showed significantly lower glycosylated hemoglobin(Hb A1c) levels in the H.pylori-negative than H.pylori-positive DM participants(WMD = 0.43,95%CI:0.07-0.79;P = 0.02).In children and adolescents with type 1 DM(T1DM),there was a positive association between H.pylori infection and Hb A1 c level(WMD = 0.35,95%CI:0.05-0.64;P = 0.02),but there was no difference in those with type 2 DM(T2DM,WMD = 0.51,95%CI:-0.63-1.65;P = 0.38).A meta-analysis of six studies with 325 T2 DM participants showed a significant difference in the fasting plasma glucose levels between H.pylori-positive and H.pylori-negative participants(WMD = 1.20,95%CI:0.17-2.23;P = 0.02).Eradication of H.pylori did not improve glycemic control in the T2 DM participants in a threemonth follow-up period(Hb A1 c decrease:WMD =-0.03,95%CI =-0.14-0.08;P = 0.57;fasting plasma glucose decrease:WMD =-0.06,95%CI:-0.36-0.23;P = 0.68).Glycemic control was significantly better in T1 DM participants who were not reinfected than in those who were reinfected(Hb A1c:WMD = 0.72,95%CI:0.32-1.13:P = 0.00).CONCLUSION:H.pylori infection is associated with poorer glycemic control in T1 DM patients,but eradication may not improve glycemic control in DM in a short-term follow-up period.

Multifocal gastrointestinal epithelioid angiosarcomas diagnosed by endoscopic mucosal resection:A case report

angiosarcoma is a vascular neoplasm that is among the most aggressive subtypes of sarcomas.Its involvement in the gastrointestinal tract is rare.We here report a case of multifocal gastrointestinal epithelioid angiosarcomas presenting with gastrointestinal bleeding.CASE SUMMARY A 77-year-old woman was admitted because of melena and dizziness for three months.Gastroscopy and colonoscopy were performed,revealing a centrally ulcerated hemorrhagic polypoid lesion in the gastric body and multiple polypoid lesions with blood clots and hemorrhagic tendency in the colon.Histopathological examination of routine endoscopic biopsy samples showed inflammation in the gastric mucosa and tubular adenomas in the colon.The polypoid lesions were removed by endoscopic mucosal resection.Immunohistochemistry suggested a final diagnosis of epithelioid angiosarcomas.The patient refused chemotherapy and died after three months.CONCLUSION Epithelioid angiosarcomas are characterized by highly vascular nature and tendency to cause gastrointestinal bleeding.Efforts to obtain histological findings using endoscopic mucosal resection are of great importance.

Metabolic dysfunction is associated with steatosis but no other histologic features in nonalcoholic fatty liver disease

BACKGROUND Recently,nonalcoholic fatty liver disease(NAFLD)has been renamed metabolicassociated fatty liver disease(MAFLD).Based on the definition for MAFLD,a group of non-obese and metabolically healthy individuals with fatty liver are excluded from the newly proposed nomenclature.AIM To analyze the histologic features in the MAFLD and non-MAFLD subgroups of NAFLD.METHODS Eighty-three patients with biopsy-proven NAFLD were separated into MAFLD and non-MAFLD groups.The diagnosis of MAFLD was established as hepatic steatosis along with obesity/diabetes or evidence of metabolic dysfunction.The histologic features were compared according to different metabolic disorders and liver enzyme levels.RESULTS MAFLD individuals had a higher NAFLD activity score(P=0.002)and higher severity of hepatic steatosis(42.6%Grade 1,42.6%Grade 2,and 14.8%Grade 3 in MAFLD;81.8%Grade 1,13.6%Grade 2,and 4.5%Grade 3 in non-MAFLD;P=0.007)than the non-MAFLD group.Lobular and portal inflammation,hepatic ballooning,fibrosis grade,and the presence of nonalcoholic steatohepatitis(NASH)and significant fibrosis were comparable between the two groups.The higher the liver enzyme levels,the more severe the grades of hepatic steatosis(75.0%Grade 1 and 25.0%Grade 2 in normal liver function;56.6%Grade 1,39.6%Grade 2,and 3.8%Grade 3 in increased liver enzyme levels;27.8%Grade 1,27.8%Grade 2,and 44.4%Grade 3 in liver injury;P<0.001).Patients with liver injury(alanine aminotransferase>3×upper limit of normal)presented a higher severity of hepatocellular ballooning(P=0.021).Moreover,the grade of steatosis correlated significantly with hepatocellular ballooning degree(r=0.338,P=0.002)and the presence of NASH(r=0.466,P<0.001).CONCLUSION Metabolic dysfunction is associated with hepatic steatosis but no other histologic features in NAFLD.Further research is needed to assess the dynamic histologic characteristics in NAFLD based on the presence or absence of metabolic disorders.