Crosstalk between dietary patterns,obesity and nonalcoholic fatty liver disease

The prevalence of nonalcoholic fatty liver disease(NAFLD)is rising worldwide,paralleling the epidemic of obesity.The liver is a key organ for the metabolism of proteins,fats and carbohydrates.Various types of fats and carbohydrates in isocaloric diets differently influence fat accumulation in the liver parenchyma.Therefore,nutrition can manage hepatic and cardiometabolic complications of NAFLD.Even moderately reduced caloric intake,which leads to a weight loss of 5%-10%of initial body weight,is effective in improving liver steatosis and surrogate markers of liver disease status.Among dietary patterns,the Mediterranean diet mostly prevents the onset of NAFLD.Furthermore,this diet is also the most recommended for the treatment of NAFLD patients.However,clinical trials based on the dietary interventions in NAFLD patients are sparse.Since there are only a few studies examining dietary interventions in clinically advanced stages of NAFLD,such as active and fibrotic steatohepatitis,the optimal diet for patients in these stages of the disease must still be determined.In this narrative review,we aimed to critically summarize the associations between different dietary patterns,obesity and prevention/risk for NAFLD,to describe specific dietary interventions’impacts on liver steatosis in adults with NAFLD and to provide an updated overview of dietary recommendations that clinicians potentially need to apply in their daily practice.

Management of Heart Failure with Reduced Ejection Fraction Globally and in Lebanon: Where Do SGLT-2is Stand?

Heart failure (HF) is a clinical syndrome due to structural and/or functional cardiac anomalies, accompanied by elevated natriuretic peptide levels and/or cardiogenic pulmonary or systemic congestion;severely compromising patients’ health, performance and quality of life. The advancement of novel treatment and their endorsement by international medical and scientific societies have shifted the treatment of HF with reduced ejection fraction (HFrEF) towards quadruple therapy: an angiotensin receptor-neprilysin inhibitor or an angiotensin-converting enzyme inhibitor, a beta-blocker, a mineralocorticoid receptor antagonist and a sodium/glucose co-transporter-2 inhibitor (SGLT2i). This paper reviews the available literature on state-of-the-art diagnostic and therapeutic advances in HFrEF, discusses landmark trials that shifted the paradigm towards quadruple therapy in HFrEF, visits the potential challenges in Lebanon and globally, proposes an algorithm for treatment introduction and sequencing in HFrEF and highlights clinical considerations for HFrEF management and patient education and follow-up. This practical guidance could serve cardiologists and other medical specialists in identifying clinical signs of HFrEF, diagnosing patients, referring them or prescribing the components of quadruple therapy, and offering medical advice and follow-up. We highlight the role of SGLT2is in HF management and their effectiveness in reducing rates of hospitalization for HF as well as cardiovascular deaths, with satisfactory safety profile.