Validity of fatty liver prediction scores for diagnosis of fatty liver by Fibroscan

Background:The Korea National Health and Nutrition Examination Survey nonalcoholic fatty liver disease(K-NAFLD)score was recently developed with the intent to operationally define nonalcoholic fatty liver disease(NAFLD).However,there remained an external validation that confirmed its diagnostic performance,especially in patients with alcohol consumption or hepatitis virus infection.Methods:Diagnostic accuracy of the K-NAFLD score was evaluated in a hospital-based cohort consisting of 1388 participants who received Fibroscan®.Multivariate-adjusted logistic regression models and the contrast estimation of receiver operating characteristic curves were used for validation of the K-NAFLD score,fatty liver index(FLI),and hepatic steatosis index(HSI).Results:K-NAFLD-moderate[adjusted odds ratio(aOR)=2.53,95%confidence interval(CI):1.13-5.65]and K-NAFLD-high(aOR=4.14,95%CI:1.69-10.13)groups showed higher risks of fatty liver compared to the K-NAFLD-low group after adjustments for demographic and clinical characteristics,and FLI-moderate and FLI-high groups revealed aORs of 2.05(95%CI:1.22-3.43)and 1.51(95%CI:0.78-2.90),respectively.In addition,the HSI was less predictive for Fibroscan®-defined fatty liver.Both K-NAFLD and FLI also demonstrated high accuracy in the prediction of fatty liver in patients with alcohol consumption and chronic hepatitis virus infection,and the adjusted area under curve values were comparable between K-NAFLD and FLI.Conclusions:Externally validation of the K-NAFLD and FLI showed that these scores may be a useful,noninvasive,and non-imaging modality for the identification of fatty liver.In addition,these scores also predicted fatty liver in patients with alcohol consumption and chronic hepatitis virus infection.

Ursodeoxycholic acid as a means of preventing atherosclerosis,steatosis and liver fibrosis in patients with nonalcoholic fatty liver disease

BACKGROUND Atherosclerotic cardiovascular disease(ASCVD)is the leading cause of mortality in patients with nonalcoholic fatty liver disease(NAFLD).Weight loss is a key factor for successful NAFLD and CVD therapy.Ursodeoxycholic acid(UDCA),which is one of the first-line therapeutic agents for treatment of NAFLD,is reported to have a beneficial effect on dyslipidemia and ASCVD risk because of antioxidant properties.AIM To evaluate the effects of 6 mo of UDCA treatment on hepatic function tests,lipid profile,hepatic steatosis and fibrosis,atherogenesis,and ASCVD risk in men and women with NAFLD,as well as to assess the impact of>5%weight reduction on these parameters.METHODS An open-label,multicenter,international noncomparative trial was carried out at primary health care settings and included 174 patients with ultrasound-diagnosed NAFLD who received 15 mg/kg/d UDCA for 6 mo and were prescribed lifestyle modification with diet and exercise.The efficacy criteria were liver enzymes,lipid profile,fatty liver index(FLI),noninvasive liver fibrosis tests(nonalcoholic fatty liver disease fibrosis score and liver fibrosis index),carotid intima-media thickness(CIMT),and ASCVD risk score.To test statistical hypotheses,the Wilcoxon test,paired t-test,Fisher’s exact test,and Pearson's chi-squared test were used.RESULTS The alanine aminotransferase(ALT)level changed by-14.1 U/L(-31.0;-5.3)from baseline to 3 mo and by-6.5 U/L(-14.0;0.1)from 3 to 6 mo.The magnitude of ALT,aspartate transaminase,and glutamyltransferase decrease was greater during the first 3 mo of treatment compared to the subsequent 3 mo(P<0.001,P<0.01,P<0.001,respectively).At 6 mo,in the total sample,we observed a statistically significant decrease in body weight and levels of FLI:84.9±10.4 vs 72.3±17.6,P<0.001,total cholesterol:6.03±1.36 vs 5.76±1.21,Р<0.001,lowdensity lipoprotein:3.86±1.01 vs 3.66±0.91,Р<0.001,and triglyceride:3.18(2.00;4.29)vs 2.04(1.40;3.16),Р<0.001.No effect on nonalcoholic fatty liver disease fibrosis score or liver fibrosis index was found.The CIMT decreased significantly in the total sample(0.985±0.243 vs 0.968±0.237,P=0.013),whereas the highdensity lipoprotein(Р=0.036)and 10-year ASCVD risk(Р=0.003)improved significantly only in women.Fifty-four patients(31%)achieved>5%weight loss.At the end of the study,the FLI decreased significantly in patients with(88.3±10.2 vs 71.4±19.6,P<0.001)and without>5%weight loss(83.5±10.3 vs 72.8±16.7,P<0.001).The changes in ALT,aspartate transaminase,glutamyltransferase,total cholesterol,and low-density lipoprotein levels were similar between the subgroups.CONCLUSION UDCA normalizes liver enzymes greatly within the first 3 mo of treatment,improves lipid profile and hepatic steatosis independent of weight loss,and has a positive effect on CIMT in the total sample and 10-year ASCVD risk in women after 6 mo of treatment.

Liver Fat Scores for Noninvasive Diagnosis and Monitoring of Nonalcoholic Fatty Liver Disease in Epidemiological and Clinical Studies

Nonalcoholic fatty liver disease(NAFLD)is strongly associated with the metabolic syndrome and type 2 diabetes and independently contributes to long-term complications.Being often asymptomatic but reversible,it would require population-wide screening,but direct diagnostics are either too invasive(liver biopsy),costly(MRI)or depending on the examiner’s expertise(ultrasonography).Hepatosteatosis is usually accommodated by features of the metabolic syndrome(e.g.obesity,disturbances in triglyceride and glucose metabolism),and signs of hepatocellular damage,all of which are reflected by biomarkers,which poorly predict NAFLD as single item,but provide a cheap diagnostic alternative when integrated into composite liver fat indices.Fatty liver index,NAFLD LFS,and hepatic steatosis index are common and accurate indices for NAFLD prediction,but show limited accuracy for liver fat quantification.Other indices are rarely used.Hepatic fibrosis scores are commonly used in clinical practice,but their mandatory reflection of fibrotic reorganization,hepatic injury or systemic sequelae reduces sensitivity for the diagnosis of simple steatosis.Diet-induced liver fat changes are poorly reflected by liver fat indices,depending on the intervention and its specific impact of weight loss on NAFLD.This limited validity in longitudinal settings stimulates research for new equations.Adipokines,hepatokines,markers of cellular integrity,genetic variants but also simple and inexpensive routine parameters might be potential components.Currently,liver fat indices lack precision for NAFLD prediction or monitoring in individual patients,but in large cohorts they may substitute nonexistent imaging data and serve as a compound biomarker of metabolic syndrome and its cardiometabolic sequelae.

Effect of Compound 962 Capsule on Liver Lipid Peroxidation and Indexes of Thymus Gland and Spleen in Rats

Objective: To investigate the effect of compound 962 capsule (abbre. as 962) on liver lipid peroxidation and indexes of thymus and spleen in aged rats. Methods: Rats were divided into young control, aged model, Piracetam, 962 middle dose (0.9 g/kg) and high dose (1.8 g/kg) groups. All test drugs were administrated for 1 month by gastrogavage. The liver lipid peroxidation was determined by thiobarbituric (TBA) method. The thymus index and spleen index were determined by weighing method. Results: 962 (middle and high dose) attenuated liver lipid peroxidation, increased the thymus index of aged rats. There was no effect on spleen index in all drug-treated groups. Conclusion: 962 could decrease liver lipid peroxidation and increase thymus index. It suggested that 962 might be beneficial in retarding aging process.

Discrepancies between Nonalcoholic and Metabolic-associated Fatty Liver Disease by Multiple Steatosis Assessment

Background and Aims:The redefinition of metabolic-as-sociated fatty liver disease(MAFLD)from nonalcoholic fat-ty liver disease(NAFLD)has caused a revolution in clinical practice,and the characteristics of patients with steatosis but not MAFLD remain unclear.The aims were to compare the diagnosis rate of MAFLD in NAFLD using different steato-sis methods and explore the features of non-MAFLD-NAFLD and MAFLD-non-NAFLD.Methods:A cross-sectional study enrolling consecutive individuals was conducted at three medical centers in southern China from January 2015 to September 2020.Steatosis was evaluated by liver biopsy or magnetic resonance imaging-based proton density fat frac-tion(MRI-PDFF),ultrasound,controlled attenuation param-eter(CAP),and fatty liver index(FLI).Fibrosis was assessed by the NAFLD fibrosis score,transient elastography,or shear wave elastography.Results:The study enrolled 14,985 Chi-nese adults.The agreement of MAFLD and NAFLD diagnoses were 83%for FLI,95%for ultrasound,94%for both CAP and MRI-PDFF,and 95%for liver biopsy.The body mass index,blood pressure and lipid levels among non-MAFLD-NAFLD pa-tients were similar metabolic parameters(p>0.05 for all),but not the alanine aminotransferase and the proportion of pa-tients with insulin resistance,which were significantly higher in non-MAFLD-NAFLD with significant fibrosis.Conclusions:The new MAFLD definition ruled out 5-17%of NAFLD cases.NAFLD and MAFLD-NAFLD involved more severe metabolic abnormalities than MAFLD and MAFLD-non-NAFLD.Non-MAFLD-NAFLD patients with significant fibrosis had more se-vere liver injury and increased glycemic dysregulation within the normal range.Attention should be paid to its progression.

Non-alcoholic fatty liver disease:a multidisciplinary clinical practice approach—the institutional adaptation to existing Clinical Practice Guidelines

Non-alcoholic fatty liver disease(NAFLD)is among the most frequently encountered chronic liver diseases in everyday clinical practice.It is considered the hepatic manifestation of metabolic syndrome.Today,liver biopsy is still the gold standard for NAFLD confirmation and assessing NAFLD’s possible progression to non-alcoholic steatohepatitis,fibrosis,cirrhosis,and hepatocellular carcinoma.Because of the high prevalence of NAFLD and potential associated risks of invasive diagnostic procedures,it is of great interest to recruit the patients for liver biopsy.However,as the presence of liver fibrosis determines the further clinical course,liver biopsy is expectedly reserved for those with increased fibrosis risk.The quality of liver biopsy recruitment and patient monitoring could be significantly improved by using non-invasive tools to assess liver fibrosis presence and interactive collaboration between general practitioners,gastroenterologists,and endocrinologists.As a result,the quality of liver biopsy recruitment and patients monitoring could be significantly improved.Here,we proposed clinical practice guidelines that could be implemented for everyday clinical practice in NAFLD patients.

利用人工神经网络建立脂肪性肝病的预测新模型

背景:人工神经网络(ANN)是以数学模型模拟神经元活动的信息处理系统,因其强大的自我学习能力和非线性信息分析能力而应用于疾病诊断,尤其适用于复杂的系统性疾病。本研究旨在借助ANN建立脂肪性肝病(FLD)的预测模型。方法:本研究纳入在浙江大学医学院附属第一医院进行体检的共7,396对性别和年龄匹配的受试者,并将体检报告中的各项检查指标作为可能的输入变量进行ANN模型的训练。采用ROC曲线下面积(AUROC)评估该模型对FLD的预测能力,其他评估指标包括准确性、敏感性、特异性、Cohen’s k系数、Brier评分和Hosmer-Lemeshow检验等。本研究还使用本组数据重新训练了其他FLD诊断模型,包括脂肪肝指数(FLI)和肝脂肪变性指数(HSI),并与本研究建立的ANN模型进行比较。结果:经训练,最终纳入8个变量(年龄、性别、体质指数、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、尿酸、甘油三酯、空腹血糖)作为ANN诊断模型的输入节点,输出区间在0-1之间(1为存在FLD,0为不存在FLD)。取0.51作为截点值,在验证队列中,ANN模型预测FLD的AUROC为0.908(95%CI:0.901-0.915),显著高于FLI模型(0.881,95%CI:0.872-0.891;P<0.05)和HSI模型(0.885,95%CI:0.877-0.893;P<0.05)。与FLI模型和HSI模型相比,本研究建立的ANN模型呈现更高的预测准确性,与超声检查结果的一致性更好,校正能力也更强。结论:本研究建立的ANN模型对FLD具有良好的预测及诊断能力,我们期待ANN模型能在未来的临床和流行病学研究中得到广泛应用。