Impact renaming non-alcoholic fatty liver disease to metabolic associated fatty liver disease in prevalence,characteristics and risk factors

BACKGROUND Recently,a group of hepatologists proposed to rename non-alcoholic fatty liver disease(NAFLD)as metabolic associated fatty liver disease(MAFLD)with modified diagnostic criteria.It is important to note,however,that there are some differences between the diagnostic criteria used for NAFLD and MAFLD.Since the research on MAFLD is just beginning,however,evidence on its incidence and prevalence in the general population and in speci
c subpopulations remains limited.AIM To assess epidemiology of fatty liver in new definition and compare MAFLD with NAFLD.Exploring risk factors of MAFLD individuals.METHODS This was a retrospective,cross-sectional study.A total of 85242 adults were selected from the Chinese health management database in 2017–2022.The data of general information,laboratory indicators,lifestyle management and psychological status were obtained.MAFLD was diagnosed as ultrasound diagnosis of fatty liver and at least one between these three conditions:Overweight/obesity,type 2 diabetes mellitus(T2DM)or metabolic dysregulation.Metabolic factors were not considered in NAFLD diagnosis standard.The clinical characteristics of MAFLD and NAFLD were analysed using descriptive statistics.Continuous variables normally distributed were expressed as means±SD.Categorical variables were expressed as frequencies and proportions.Binary logistic regression was used to determine risk factors of the MAFLD.RESULTS The prevalence of MAFLD and NAFLD was 40.5%and 31.0%,respectively.The MAFLD or NAFLD population is more likely to be older(M:47.19±10.82 vs 43.43±11.96;N:47.72±11.17 vs 43.71±11.66),male(M:77.21%vs 44.43%;N:67.90%vs 53.12%)and high body mass index(M:26.79±2.69 vs 22.44±2.48;N:26.29±2.84 vs 23.29±3.12)than the non-MAFLD or non-MAFLD population.In multivariate analysis,general information(e.g.,≥2 metabolic abnormalities OR=3.38,(95%CI:2.99-3.81),P<0.001;diastolic blood pressure OR=1.01,(95%CI:1.00–1.01),P=0.002),laboratory results[e.g.,total bilirubin(TBIL)OR=0.98,(95%CI:0.98-0.99),P<0.001;serum uric acid(SUA)OR=1.01,(95%CI:1.01-1.01),P<0.001],and lifestyle factors[e.g.,drink beverage OR=0.32,(95%CI:0.17-0.63),P=0.001]were influence factors for MAFLD.Our study results offer new insight into potential risk factors associated with fatty liver disease,including SUA,TBIL and creatinine,all of which are related to chronic renal disease(CKD).CONCLUSION MAFLD is more prevalent than NAFLD,with two-fifths of individuals meeting the diagnosis criteria.MAFLD and NAFLD populations have different clinical characteristics.CKD may be related with MAFLD.

Addressing the alarming link between nonalcoholic fatty liver disease and cardiovascular mortality in men

This editorial discusses the key findings presented in Batta and Hatwal’s recent paper titled“Excess cardiovascular mortality in men with non-alcoholic fatty liver disease:A cause for concern!”,which was published in the World Journal of Cardiology.Their original article highlights a notable correlation between nonalcoholic fatty liver disease(NAFLD)and increased cardiovascular mortality risk in men.The present commentary explores the implications of their findings,discussing potential mechanisms,risk factors,and the urgent need for integrated clinical approaches to mitigate the dual burden of these diseases.Emphasis should be placed on the importance of early detection,lifestyle modifications,and interdisciplinary collaboration for improving patient outcomes.This editorial aims to highlight the broad implications of NAFLD for cardiovascular health and to advocate for increased awareness and proactive management strategies within the medical community.

Prevalence of and risk factors for non-alcoholic fatty liver disease in a Chinese population: An 8-year follow-up study

AIM: To investigate the prevalence of and risk factors for non-alcoholic fatty liver disease(NAFLD) in a Chinese population.METHODS: A total of 1948 adults from China was followed for 8 years. A cross-sectional study was performed to investigate the prevalence of NAFLD at baseline, and then the participants were followed for 8 years to investigate risk factors for the development of NAFLD.RESULTS: A total of 1948 participants were enrolled at baseline, of whom 691 were diagnosed with NAFLD. During the 8-year follow-up, 337 baseline NAFLD-free participants developed NAFLD. They had a greaterincrease in body mass index(BMI), serum uric acid, fasting plasma glucose, very low-density lipoprotein cholesterol and a considerable decrease in high-density lipoprotein cholesterol. 123 participants who had NAFLD at baseline lost NAFLD during the 8-year follow-up period. They had a greater decrease in BMI, fasting plasma glucose, triglycerides, total cholesterol, low-density lipoprotein cholesterol, alanine aminotransferase, aspartate aminotransferase, and γ-glutamyl transpeptidase.CONCLUSION: NAFLD is prevalent in Chinese population with a rapidly increasing tendency. It can be reversed when patients lose their weight, control their hyperlipidemia and hyperglycemia, and reduce the liver enzyme levels.

Prevalence of fatty liver disease and its risk factors in the population of South China

AIM: To investigate the population-based prevalence of fatty liver disease (FLD) and its risk factors in Guangdong Province,China. METHODS: A cross-sectional survey with multiple-stage stratified cluster and random sampling of inhabitants over 7-year-old was performed in 6 urban and rural areas of Guangdong Province,China. Questionnaires,designed by co-working of epidemiologists and hepatologists,included demographic characteristics,current medication use,medical history and health-relevant behaviors,i.e. alcohol consumption,smoking habits,dietary habits and physical activities. Anthropometric measurements,biochemical tests and abdominal ultrasonography were carried out. RESULTS: Among the 3543 subjects,609 (17.2%) were diagnosed having FLD (18.0% males,16.7% females,P > 0.05). Among them,the prevalence of confirmed alcoholic liver disease (ALD),suspected ALD and nonalcoholic fatty liver disease (NAFLD) were 0.4%,1.8%,and 15.0%,respectively. The prevalence rate (23.0%) was significantly higher in urban areas than (12.9%) in rural areas. After adjustment for age,gender and residency,the standardized prevalence of FLD in adults was 14.5%. Among them,confirmed ALD,suspected ALD and NAFLD were 0.5%,2.3%,and 11.7%,respectively,in adults and 1.3% (all NAFLD) in children at the age of 7-18 years. The overall prevalence of FLD increased with age in both genders to the peak of 27.4% in the group of subjects at the age of 60-70 years. The prevalence rate was significantly higher in men than in women under the age of 50 years (22.4% vs 7.1%,P < 0.001). However,the opposite phenomenon was found over the age of 50 years (20.6% vs 27.6%,P < 0.05). Multivariate and logistic regression analysis indicated that male gender,urban residency,low education,high blood pressure,body mass index,waist circumference,waist to hip ratio,serum triglyceride and glucose levels were the risk factors for FLD. CONCLUSION: FLD,especially NAFLD,is prevalent in South China. There are many risk factors for FLD.

Prevalence and risk factors of fatty liver disease in Chengdu,Southwest China

BACKGROUND: Fatty liver disease (FLD) is increasingly recognized as one of the most common chronic liver diseases in China. This study aimed to investigate the prevalence and risk factors of FLD in Chengdu, Southwest China, and to provide a relevant basis for the prevention and intervention of FLD. METHODS: Altogether 9094 subjects (4721 men and 4373 women) of over 18 years old who had received a medical checkup in the West China Hospital of Sichuan University between January and December 2007 were evaluated for FLD. FLD was diagnosed by ultrasonography. Body mass index (BMI), height, body weight, blood pressure, fasting plasma glucose (FPG), triglycerides (TG), total cholesterol (TCh), alanine aminotransferase (ALT), hepatitis B surface antigen (HBsAg), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were measured using routine laboratory methods. RESULTS: The overall prevalence of FLD was 12.5%, which was more than 3-fold higher in males than in females 2 (18.9% vs. 5.7%, chi(2) =359.624, P<0.001). The prevalence increased with age in females and males of less than 50 years. The prevalence of alcoholic, suspected alcoholic, and non-alcoholic FLD was 2.6%, 3.6%, and 6.3%, respectively. Multiple logistic regression analyses showed that 10 factors (male sex, age, BMI, FPG, hypertension, TG, TCh, HDL-C, LDL-C, and ALT abnormalities) were closely related to FLD. In heavy drinkers, obesity increased the risk of FLD by 23.78-fold (95% CI, 10.22-55.33), but heavy drinking was only associated with a 2-fold (95% CI, 1.50-2.66) increased risk in obese subjects. CONCLUSIONS: The prevalence of FLD among a health-checkup population in Chengdu, Southwest China was lower than the published for other areas of China. FLD in Chengdu adults was found to be closely associated with sex, age, BMI, and other metabolic syndrome features.

Correlation between non-alcoholic fatty liver with metabolic risk factors and brachial-ankle pulse wave velocity

AIM: To assess the relationship between non-alcoholic fatty liver disease(NAFLD) with metabolic risk factors and brachial ankle pulse wave velocity(ba PWV). METHODS: A total of 8603 subjects(6662 males and 1941 females) were enrolled during an annual health check-up. Fatty liver was examined using a Philips HD 11 XE multi-function color Doppler diagnostic instrument, and ba PWV was determined using a novel arteriosclerosis detection device. Blood pressure(BP), fasting plasma glucose(FPG), waist circumference( W C), p l a s m a t r i g l y c e r i d e s( TG), h i g h- d e n s i t y lipoprotein(HDL), total cholesterol(TC), low-density lipoprotein(LDL) and uric acid(UA) were measured using standard methods. The relationship between fatty liver with metabolic risk factors and ba PWV was analyzed using regression analysis and the χ2 test. RESULTS: The values and abnormal rates of ba PWV were significantly different between NAFLD patients and non-NAFLD subjects(P < 0.001). In addition, the values of ba PWV were different by gender between NAFLD patients and non-NAFLD subjects. The OR values in females, males, and the entire population were 3.33, 1.67, and 2.13, respectively(P < 0.001). The incidence of high ba PWV increased with increasing degree of NAFLD(levels 0, 1, 2, and 3)(P < 0.001), which was 45.9%, 54.5%, 60.2%, and 71.4% in malesand 27.0%, 49.1%, 55.60%, and 60.0% in females(P < 0.001), respectively. Logistic regression analysis showed that the OR value for ba PWV in the nonmetabolic syndrome group and the metabolic syndrome group was 1.28 vs 1.14(males) and 2.55 vs 0.98(females). The OR values for ba PWV in the non-high-BP and high-BP, non-high-WC and high-WC, non-high-FPG and high-FPG, non-high-TG and high-TG, non-high-HDL and high-HDL, non-high-TC and high-TC, non-high-LDL and high-LDL, non-high-UA and high-UA groups were 3.38 vs 1.19, 3.50 vs 1.44, 2.80 vs 2.30, 3.29 vs 1.88, 3.03 vs 3.28, 3.35 vs 2.70, 3.93 vs 1.66, and 3.20 vs 2.34, respectively, in females(P < 0.001), and were 1.37 vs 1.34, 1.56 vs 1.26, 1.51 vs 1.28, 1.49 vs 1.52, 1.71 vs 1.61, 1.59 vs 1.74, 1.76 vs 1.47, and 1.73 vs 1.54, respectively, in males(P < 0.01). The OR value for ba PWV was still higher than 1.2(1.21 in males and 1.40 in females) after adjustment for the metabolic component(0, 1, 2, 3, 4, 5, 6 and above)(P < 0.01).CONCLUSION: NAFLD is closely correlated with ba PWV, particularly in females. NAFLD has a large impact on ba PWV, no matter whether the metabolic index is increased or not. NAFLD may be a useful indicator for assessing early arteriosclerosis.

Risk factors and diagnostic biomarkers for nonalcoholic fatty liver disease-associated hepatocellular carcinoma:Current evidence and future perspectives

High rates of excessive calorie intake diets and sedentary lifestyles have led to a global increase in nonalcoholic fatty liver disease(NAFLD).As a result,this condition has recently become one of the leading causes of hepatocellular carcinoma(HCC).Furthermore,the incidence of NAFLD-associated HCC(NAFLD-HCC)is expected to increase in the near future.Advanced liver fibrosis is the most common risk factor for NAFLD-HCC.However,up to 50%of NAFLDHCC cases develop without underlying liver cirrhosis.Epidemiological studies have revealed many other risk factors for this condition;including diabetes,other metabolic traits,obesity,old age,male sex,Hispanic ethnicity,mild alcohol intake,and elevated liver enzymes.Specific gene variants,such as single-nucleotide polymorphisms of patatin-like phospholipase domain 3,transmembrane 6 superfamily member 2,and membrane-bound O-acyl-transferase domaincontaining 7,are also associated with an increased risk of HCC in patients with NAFLD.This clinical and genetic information should be interpreted together for accurate risk prediction.Alpha-fetoprotein(AFP)is the only biomarker currently recommended for HCC screening.However,it is not sufficiently sensitive in addressing this diagnostic challenge.The GALAD score can be calculated based on sex,age,lectin-bound AFP,AFP,and des-carboxyprothrombin and is reported to show better diagnostic performance for HCC.In addition,emerging studies on genetic and epigenetic biomarkers have also yielded promising diagnostic potential.However,further research is needed to establish an effective surveillance program for the early diagnosis of NAFLD-HCC.

Cardiac risk factors limiting survival to liver transplantation in patients with nonalcoholic fatty liver disease

BACKGROUND Nonalcoholic fatty liver disease(NAFLD)describes the hepatic manifestations of metabolic syndrome,which is estimated to affect 25%of adults,and currently represents the second most common indication for liver transplant in the United States.Studies have shown that patients with NAFLD are at an increased risk for heart failure,arrhythmia,and coronary artery disease(CAD),which may impact outcomes of liver transplantation.However,it remains unclear whether the presence of cardiac disease affects survival prior to liver transplant.If so,this would represent an important opportunity to optimize cardiac status and improve outcomes before liver transplant.AIM To identify cardiac factors that impact survival to liver transplantation in patients with NAFLD and on the transplant waitlist.METHODS The aim of this study was to identify cardiac risk factors that limit survival to transplant in patients with NAFLD.We performed a retrospective analysis of patients with NAFLD listed for liver transplant at a tertiary academic medical center in the United States from January 2015 to January 2021,identified through United Network of Organ Sharing registry.Exclusion criteria included a concurrent etiology of liver disease and removal from the transplant list due to chemical dependency,lack of social support,improvement in liver disease,or being lost to followup.We manually reviewed patient charts including electrocardiogram,echocardiogram,and cardiac catheterization reports as well as physician notes to identify cardiac disease states(i.e.,heart failure,arrhythmia,valvular disease and CAD)and other related diagnoses.We performed a survival analysis by Cox proportional hazards regression model to analyze the association between cardiac factors at the time listed for transplant and death or clinical deterioration prior to transplant.RESULTS Between January 2015 and January 2021,265 patients with nonalcoholic fatty liver disease were listed for liver transplant at our institution.Our patient sample had a median age of 63 and an even distribution between sexes.The median Model for End-Stage Liver Disease(MELD)score was 17 and the median body mass index was 31.6.Of these 265 patients,197(74.3%)survived to transplant and 68(25.7%)died or clinically deteriorated prior to transplant.The presence of mild or moderate CAD represented a hazard ratio of 2.013(95%CI 1.078-3.759,P=0.029)for death or clinical deterioration when compared to patients without CAD,after adjustment for age,sex,and MELD.MELD represented an adjusted hazard ratio of 1.188.CONCLUSION Mild or moderate CAD represents a hazard for waitlist mortality prior to liver transplant in patients with NAFLD.Aggressive management of CAD may be needed to improve patient outcomes.

Analysis of risk factors and establishment of predictive model for elevated ALT in adult patients with nonalcoholic fatty liver disease

Objective:To explore the risk factors of elevated alanine aminotransferase(ALT)in patients with nonalcoholic fatty liver disease(NAFLD),and to establish a risk prediction model of elevated ALT in patients with NAFLD.Methods:A total of 200 NAFLD subjects were enrolled in Health Examination Center of China-Japan Friendship Hospital in Beijing. The relevant clinical indexes and TCM tongue picture data were collected standardizedly. According to the elevation of ALT,the patients were divided into ALT elevation group and ALT normal group. The independent risk factors of ALT elevation were obtained by logistic regression analysis. Based on this,the logistic regression prediction model of ALT elevation in NAFLD patients was established,and the calibration of the model was evaluated by Hosmer-Lemshow goodness-of-fit test. The area under the subject’s working characteristic curve(AUROC)was used to test the discrimination of the model. Results:The multivariate logistic regression analysis showed that the OR value of male,obesity,elevated total cholesterol(TC),elevated triglyceride(TG)and prickly tongue were 6.059,2.216,2.649,2.106,3.646,respectively,and the P-values were all < 0.05. The AUROC of logistic regression prediction Model 1(without prickly tongue)and Model 2(including prickly tongue)were 0.771(95%CI:0.703-0.840)and 0.801(95%CI:0.736-0.866),respectively,and the maximum Youden index,sensitivity and specificity were 0.414,0.829,0.585 and 0.478,0.686,0.792,respectively. Conclusion:Male,obesity,elevated TC,elevated TG and prickly tongue were independent risk factors for elevated ALT in NAFLD patients. This study established an integrated traditional Chinese and Western medicine model that includes the tongue characteristics,which have certain clinical value in predicting the risk of elevated ALT in patients with NAFLD,and are worth popularizing and applying.

From metabolic dysfunction-associated fatty liver disease to metabolic dysfunction-associated steatotic liver disease:Controversy and consensus

The newly released nomenclature of metabolic dysfunction-associated steatotic liver disease(MASLD)in the 2023 European Association for the Study of the Liver Congress has raised great clinical concerns.This marks the second instance of significant renaming of non-alcoholic fatty liver disease since the introduction of metabolic dysfunction-associated fatty liver disease(MAFLD)in 2020.The nomenclature and definitions of MASLD and MAFLD exhibit significant disparities as well as substantial consensus.The disparities regarding the framework of nomenclature,the definitions,the clinical management,and the impact on the clinical outcomes between MASLD and MAFLD were comprehensively compared in this editorial.Additionally,the consensus reached by the MASLD and MAFLD definitions also emphasizes positive diagnosis rather than negative diagnosis within the framework of establishing a diagnostic approach.Furthermore,they acknowledged the pivotal role of metabolic dysfunction in the pathogenesis of MAFLD or MASLD and the positive role of increasing the awareness of the disease in public.Fortunately,the non-invasive tests remains effective in the MASLD and MAFLD era.Elucidating these disparities would contribute to a more comprehensive comprehension of the nature of steatotic liver disease and enhance clinical practice.Thus,more efforts are required to reach more consensus about these important topics.

Mild drinking habit is a risk factor for hepatocarcinogenesis in non-alcoholic fatty liver disease with advanced fibrosis

AIM The impact of mild drinking habit(less than 20 g/d of ethanol) on the clinical course of non-alcoholic fatty liver disease(NAFLD) has not been determined. We examined the influence of a mild drinking habit on liver carcinogenesis from NAFLD. METHODS A total of 301 patients who had been diagnosed as having NAFLD by liver biopsy between 2003 and 2016 [median age: 56 years, 45% male, 56% with nonalcoholic steatohepatitis, 26% with advanced fibrosis(F3-4)] were divided into the mild drinking group withe thanol consumption of less than 20 g/d(mild drinking group, n = 93) and the non-drinking group(n = 208). Clinicopathological features at the time of liver biopsy and factors related to hepatocellular carcinoma(HCC) occurrence were compared between the groups.RESULTS We observed significant differences in male prevalence(P = 0.01), platelet count(P = 0.04), and gammaglutamyl transpeptidase(P = 0.02) between the test groups. Over 6 years of observation, the HCC appearance rate was significantly higher in the mild drinking group(6.5% vs 1.4%, P = 0.02). Multivariate survival analysis using Cox's regression model revealed that hepatic advanced fibrosis(F3-4)(P < 0.01, risk ratio: 11.60), diabetes mellitus(P < 0.01, risk ratio: 89.50), and serum triglyceride(P = 0.04, risk ratio: 0.98) were factors significantly related to HCC in all NAFLD patients, while the effect of a drinking habit was marginal(P = 0.07, risk ratio: 4.43). In patients with advanced fibrosis(F3-4), however, a drinking habit(P = 0.04, risk ratio: 4.83), alpha-fetoprotein(P = 0.01, risk ratio: 1.23), and diabetes mellitus(P = 0.03, risk ratio: 12.00) were identified as significant contributors to HCC occurrence. CONCLUSION A mild drinking habit appears to be a risk factor for hepatocarcinogenesis in NAFLD patients, especially those with advanced fibrosis.

Fatty liver is an independent risk factor for gallbladder polyps

BACKGROUND Gallbladder polyps(GBPs)are known to be associated with obesity and metabolic diseases.However,to date,the relationship between GBPs and abnormal body fat distribution,such as fatty liver,visceral obesity,or sarcopenia,has not yet been established.AIM To evaluate whether GBPs are associated with fatty liver,visceral obesity,or sarcopenia.METHODS We retrospectively reviewed the medical records of subjects who underwent various laboratory tests,body composition measurement with a non-invasive body composition analyzer,and abdominal ultrasonography during health checkups.A total of 1405 subjects with GBPs were compared with 2810 age-and sex-matched controls.RESULTS The mean age of the subjects was 46.8±11.7 years,and 63.8%were male.According to multiple logistic regression analysis,the presence of fatty liver[odds ratio(OR)1.413;95%confidence interval(CI)1.218-1.638;P<0.001]was an independent risk factor for GBP,together with low levels of alanine aminotransferase(OR 0.993;95%CI 0.989-0.996;P<0.001).Additionally,fatty liver showed both independent(OR 1.629;95%CI,1.335-1.988;P<0.001)and dosedependent(moderate to severe fatty liver;OR 2.137;95%CI,1.662-2.749;P<0.001)relationship with large GBPs(≥5 mm).The presence of sarcopenia and high visceral fat area were not significantly associated with GBPs.CONCLUSION Fatty liver was found to be closely associated with GBPs irrespective of sarcopenia and visceral obesity.

Aging is a risk factor of nonalcoholic fatty liver disease in premenopausal women

AIM: To clarify the relationship between age, menopause, and nonalcoholic fatty liver disease (NAFLD) in women. METHODS: We conducted a follow-up study on non-alcoholic fatty liver disease by using abdominal ultrasonography, and investigated the relationship of age and menopause with the development of NAFLD in women. We followed 1829 women and 2572 men (response rate, 86%) selected in 2001 to represent the non-institutionalized adult population of Gifu, Japan. Data collected included self-reported medical history, lifestyle factors, and menopausal status. The postmenopausal state was defined as beginning 1 year after the cessation of menses. We diagnosed NAFLD with the aid of abdominal ultrasonography by using diagnostic criteria describedRESULTS: The prevalence of NAFLD in women increases with age, but does not alter with age in men. Furthermore, the prevalence of NAFLD in premenopausal women (6%) was lower than that in men (24%) and in postmenopausal women (15%). The associations of the postmenopausal state and hormone replacement therapy with NAFLD were statistically significant in a univariate logistic regression model. At the follow-up examination, 67 women (5%) were newly diagnosed with NAFLD. The incidence of NAFLD was 3.5% (28/802) in premenopausal women, 7.5% (4/53) in menopausal women, 6.1% (24/392) in postmenopausal women, and 5.3% (11/206) in women receiving hormone replacement therapy. The weight gain in premenopausal women was equal to that in postmenopausal women. Metabolic syndrome and weight gain were independent risk factors for NAFLD in pre-and postmenopausal women, but age was an independent risk factor in premenopausal women only. CONCLUSION: Aging is a risk factor for NAFLD in premenopausal women, independent of weight gain or influence of metabolic syndrome.

Construction and validation of a severity prediction model for metabolic associated fatty liver disease

Objective:To analyze the independent risk factors for the occurrence of moderate-to-severe metabolic-associated fatty liver disease(MAFLD),to construct a prediction model for moderate-to-severe MAFLD,and to verify the validity of the model.Methods:In the first part,278 medical examiners who were diagnosed with MAFLD in Medical Examination Center at the Second Affiliated Hospital of Hainan University from January to May 2022 were taken as the study subjects(training set),and they were divided into mild MAFLD group(200)and moderate-severe MAFLD group(78)based on ultrasound results.Demographic data and laboratory indexes were collected,and risk factors were screened by univariate and multifactor analysis.In the second part,a dichotomous logistic regression equation was used to construct a prediction model for moderate-to-severe MAFLD,and the model was visualized in a line graph.In the third part,the MAFLD population(200 people in the external validation set)from our physical examination center from November to December 2022 was collected as the moderate-to-severe MAFLD prediction model,and the risk factors in both groups were compared.The receiver operating characteristic(ROC)curves,calibration curves,and clinical applicability of the model were plotted to represent model discrimination for internal and external validation.Results:The risk factors of moderate-to-severe MAFLD were fasting glucose(FPG),blood uric acid(UA),triglycerides(TG),triglyceride glucose index(TyG),total cholesterol(CHOL),and high-density lipoprotein(HDL-C).UA[OR=1.021,95%CI(1.015,1.027),P<0.001]and FPG[OR=1.575,95%CI(1.158,2.143),P=0.004]were independent risk factors for people with moderate to severe MAFLD.The visualized line graph model showed that UA was the factor contributing more to the risk of moderate to severe MAFLD in this model.The ROC curves showed AUC values of 0.8701,0.8686 and 0.7991 for the training set,internal validation set and external validation set,respectively.The curves almost coincided with the reference line after calibration of the model calibration degree with P>0.05 in Hosmer-Lemeshow test.The decision curve analysis(DCA)plotted by the clinical applicability of the model was higher than the two extreme curves,predicting that patients with moderate to severe MAFLD would benefit from the prediction model.Conclusion:The prediction model constructed by combining FPG with UA has higher accuracy and better clinical applicability,and can be used for clinical diagnosis.

Non-alcoholic fatty liver disease is not independent risk factor for cardiovascular disease event:A cohort study

BACKGROUND There are no consistent results between previous studies for an independent association between non-alcoholic fatty liver disease(NAFLD)and cardiovascular disease(CVD)events.AIM To determine if there is an independent association between NAFLD and CVD events.METHODS In the present study,valid outcome data of 4808 subjects were available for phase 2 of our cohort study.These subjects had been followed up for seven years from phase 1,beginning in 2009-2010 to phase 2 during 2016-2017.Simple and multiple Cox proportional models were used to determine the association between NAFLD in the primary phase of the cohort and subsequent fatal and non-fatal CVD events during follow-up.RESULTS The incidence of non-fatal CVD events in males with NAFLD was significantly higher(P=0.004)than in males without NAFLD.A positive association was demonstrated between NAFLD and non-fatal CVD events in males(Hazard ratio=1.606;95%CI:1.166-2.212;P=0.004)by the simple Cox proportional hazard model,but no independent association was detected between these in the multiple Cox models.CONCLUSION No independent association was detected between NAFLD and CVD.It is likely that diabetes mellitus and age may be the principle mediators in this regard.

Clinical epidemiology and disease burden of nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease(NAFLD) is defined as the presence of hepatic fat accumulation after the exclusion of other causes of hepatic steatosis, including other causes of liver disease, excessive alcohol consumption, and other conditions that may lead to hepatic steatosis. NAFLD encompasses a broad clinical spectrum ranging from nonalcoholic fatty liver to nonalcoholic steatohepatitis(NASH), advanced fibrosis, cirrhosis, and finally hepatocellular carcinoma(HCC). NAFLD is the most common liver disease in the world and NASH may soon become the most common indication for liver transplantation. Ongoing persistence of obesity with increasing rate of diabetes will increase the prevalence of NAFLD, and as this population ages, many will develop cirrhosis and end-stage liver disease. There has been a general increase in the prevalence of NAFLD, with Asia leading the rise, yet the United States is following closely behind with a rising prevalence from 15% in 2005 to 25% within 5 years. NAFLD is commonly associated with metabolic comorbidities, including obesity, type Ⅱ diabetes, dyslipidemia, and metabolic syndrome. Our understanding of the pathophysiology of NAFLD is constantly evolving. Based on NAFLD subtypes, it has the potential to progress into advanced fibrosis, end-stage liver disease and HCC. The increasing prevalence of NAFLD with advanced fibrosis, is concerning because patients appear toexperience higher liver-related and non-liver-related mortality than the general population. The increased morbidity and mortality, healthcare costs and declining health related quality of life associated with NAFLD makes it a formidable disease, and one that requires more in-depth analysis.

Nonalcoholic fatty liver disease is a novel predictor of cardiovascular disease

AIM:To clarify whether nonalcoholic fatty liver disease(NAFLD)increases the risk of cardiovascular disease.METHODS:We carried out a prospective observational study with a total of 1637 apparently healthy Japanese men and women who were recruited from a health check-up program.NAFLD was diagnosed by abdominal ultrasonography.The metabolic syndrome(MS)was defined according to the modified National Cholesterol Education Program(NCEP)ATP Ⅲ criteria.Five years after the baseline evaluations,the incidence of cardiovascular disease was assessed by a self-administered questionnaire.RESULTS:Among 1221 participants available for outcome analyses,the incidence of cardiovascular disease was higher in 231 subjects with NAFLD at baseline(5 coronary heart disease,6 ischemic stroke,and 1 cerebral hemorrhage)than 990 subjects without NAFLD(3 coronary heart disease,6 ischemic stroke,and 1 cerebral hemorrhage).Multivariate analyses indicated that NAFLD was a predictor of cardiovascular disease independent of conventional risk factors(odds ratio 4.12,95% CI,1.58 to 10.75,P = 0.004).MS was alsoindependently associated with cardiovascular events.But simultaneous inclusion of NAFLD and MS in a multivariate model revealed that NAFLD but not MS retained a statistically significant correlation with cardiovascular disease.CONCLUSION:Although both of them were predictors of cardiovascular disease,NAFLD but not MS retained a statistically significant correlation with cardiovascular disease in a multivariate model.NAFLD is a strong predictor of cardiovascular disease and may play a central role in the cardiovascular risk of MS.

Nonalcoholic fatty liver disease in patients with inflammatory bowel disease: Beyond the natural history

BACKGROUND Nonalcoholic fatty liver disease(NAFLD)is a frequently reported condition in patients with inflammatory bowel disease(IBD).Both intestinal inflammation and metabolic factors are believed to contribute to the pathogenesis of IBDassociated NAFLD.AIM To evaluate the prevalence of steatosis and liver fibrosis(LF)in a cohort of IBD patients and the identification of metabolic-and IBD-related risk factors for NAFLD and LF.METHODS IBD patients were consecutively enrolled from December 2016 to January 2018.Demographic,anthropometric and biochemical data were collected so as eating habits.Abdominal ultrasound and transient elastography were performed to evaluate the presence of NAFLD and LF respectively.RESULTS A total of 178 consecutive patients were enrolled and included in the analysis(95 Ulcerative colitis,83 Crohn’s disease).NAFLD was detected by imaging in 72(40.4%)patients.Comparison between patients with and without NAFLD showed no significant differences in terms of IBD severity,disease duration,location/extension,use of IBD-related medications(i.e.,steroids,anti-TNFs,and immunomodulators)and surgery.NAFLD was significantly associated with the presence of metabolic syndrome[MetS;odds ratio(OR):4.13,P=0.001]and obesity defined by body mass index(OR:9.21,P=0.0002).IBD patients with NAFLD showed higher caloric intake and lipid consumption than those without NAFLD,regardless disease activity.At the multivariate analysis,male sex,advanced age and high lipid consumption were independent risk factors for the development of NAFLD.An increased liver stiffness was detected in 21 patients(16%)and the presence of MetS was the only relevant factor associated to LF(OR:3.40,P=0.01).CONCLUSION In this study,we demonstrate that risk factors for NAFLD and LF in the IBD population do not differ from those in the general population.

Liver histology according to the presence of metabolic syndrome in nonalcoholic fatty liver disease cases

AIM:To investigate the histologic features of the liver in nonalcoholic fatty liver disease (NAFLD) cases according to the presence of metabolic syndrome or its individual components. METHODS:We enrolled 81 patients (40 male,41 fe-male) who were diagnosed with fatty liver by ultraso-nographic scan and fulfi lled the inclusion criteria. First anamnesis,anthropometric,clinical,laboratory and imaging features of all participants were recorded and then liver biopsy was performed after gaining consent from patients. Diagnosis of metabolic syndrome was dependent on patients having 3 or more out of 5 risk criteria defined by the WHO. Biopsy specimens were assessed according to Brunt et al's classification. RESULTS:Sixty-nine of the 81 patients had nonalco-holic steatohepatitis (NASH),11 had simple fatty liver and 1 had cirrhosis according to histologic evaluation. Comparisons were made between two groups of NASH patients,those with and without metabolic syndrome. We did not detect statistically significant differences in liver histology between NASH patients with and wit-hout metabolic syndrome. CONCLUSION:NASH can progress without metabolic risk factors or the presence of metabolic syndrome.

Non-alcoholic fatty liver disease and thyroid dysfunction:A systematic review

Thyroid hormones are totally involved in the regulation of body weight, lipid metabolism, and insulin resistance. Therefore it is anticipated that thyroid hormones may have a role in the pathogenesis of non alcoholic fatty liver disease(NAFLD) and non alcoholic steatohepatitis(NASH). In this study, we reviewed the current literature on the association between thyroid dysfunction and NAFLD/NASH. A search for English language medical literature reporting an association between thyroid dysfunction and NAFLD/NASH in humans was conducted across PubMed, ISI Web of Science, and Scopus in August, 2013. Out of 140 studies initially identified through the search, 11 relevant articles were included in the final review. Thyroid dysfunctions in the form of overt or subclinical hypothyroidism are prevalent among patients with NAFLD/NASH. Hypothyroidism appears to be an independent risk factor for NAFLD/NASH in some studies; however, other newly published studies failed to find such anassociation. The results of the studies on the role of thyroid abnormalities in NAFLD/NASH are inconsistent, and further research is recommended to determine the relationship between hypothyroidism and NAFLD/NASH and the underlying mechanisms.