Search Results (287)

Background: Chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection remain leading causes of cirrhosis and hepatocellular carcinoma (HCC) worldwide, and continue to represent a major challenge despite the growing contribution of alcohol-related and metabolic dysfunction-associated steatotic liver disease. Direct-acting antivirals now cure most patients with chronic HCV infection, while nucleos(t)ide analogues durably suppress HBV replication, producing a rapidly expanding population of treated and cured patients. Many nonetheless retain residual fibrosis, portal hypertension and long-term cancer risk, creating a need for non-invasive long-term liver assessment. Multiparametric ultrasound (MPUS) integrates the evaluation of morphology, fibrosis, steatosis, haemodynamics and perfusion within a single examination. Methods: Publications indexed in PubMed/MEDLINE, Scopus and Google Scholar between January 2000 and April 2026 were reviewed narratively, with priority given to international guidelines and consensus documents, meta-analyses, and prospective studies using histological, haemodynamic or clinical reference standards. Results: This narrative review summarises the evidence supporting MPUS in chronic viral hepatitis, covering elastographic fibrosis assessment, Baveno VII liver and spleen stiffness criteria for clinically significant portal hypertension, contrast-enhanced ultrasound characterisation of focal liver lesions, and emerging techniques such as microvascular and viscosity-sensitive imaging. Particular attention is given to the confounding effect of inflammatory activity on liver stiffness. MPUS is presented here as a proposed evaluation framework for organising complementary measurements within a single examination, and not as an approach of demonstrated clinical superiority: no comparative or outcome-based study has yet shown that acquiring these parameters together improves clinical decisions relative to the individual techniques applied according to current guidelines. Conclusions: Within this framework, the most plausible role of MPUS in the elimination era is longitudinal assessment of the treated liver, a proposition that requires prospective validation against clinical endpoints. Full article

Background/Objectives: Postmenopausal women are at increased risk of metabolic dysfunction-associated steatotic liver disease (MASLD). This study evaluated the associations of anthropometric and hormonal parameters and cardiometabolic risk-factor accumulation with steatosis and MASLD. Methods: In this cross-sectional study, 87 postmenopausal women at a university menopause clinic underwent anthropometric, biochemical, and liver imaging assessment. Hepatic steatosis was defined as CAP ≥ 248 dB/m on transient elastography, and MASLD as steatosis with ≥1 cardiometabolic risk factor (2023 consensus criteria). Anthropometry included body mass index (BMI), waist circumference, mid-upper arm circumference, and triceps skinfold thickness. Results: CAP-defined steatosis (46.0%) closely mirrored MASLD (44.8%; all but one steatotic woman met ≥ 1 criterion). Waist circumference independently correlated with steatosis (OR = 2.77, 95% CI 1.08–7.13, p = 0.035), adding value beyond BMI (Nagelkerke R² 0.202 vs. 0.140). Steatosis burden rose progressively with risk-factor number: each additional factor conferred a 30.59 dB/m CAP increase (95% CI 17.33–43.85, p < 0.001) and 3.38-fold higher odds of steatosis (95% CI 1.59–7.20, p = 0.002; ≥3 vs. 2 factors, Welch’s p = 0.004). Conclusions: MASLD and CAP-defined steatosis were largely coincident. Adiposity correlated with steatosis, but severity was determined chiefly by the accumulation of cardiometabolic risk factors, which is a key determinant of steatotic liver disease severity after menopause. Full article

Liver involvement is frequent in rheumatoid arthritis (RA) and may progress from steatosis to fibrosis, cirrhosis, or hepatocellular carcinoma. Liver fibrosis (LF) in RA is multifactorial, but the available data are limited and the impact of methotrexate (MTX) remains controversial. In this cross-sectional study, 51 RA patients (46 females; mean age of 48.8 ± 8.2 years; and a median disease duration of 12 years) were enrolled. LF was assessed using non-invasive indices (the aspartate aminotransferase-to-platelet ratio index [APRI] and fibrosis-4 index [FIB-4]) and liver stiffness measurement (LSM) using shear wave elastography. Serum endothelin-1 (ET-1) and selected organokines (namely myostatin, resistin, and osteoprotegerin) were quantified by the ELISA. Associations of the APRI, FIB-4, and LSM with organokines and endothelin-1 were analyzed using univariable and multivariable linear regression, whereas correlations with the RA-specific cardiovascular (CV) risk score (ERS-RA) and echocardiographic parameters of left ventricular diastolic dysfunction (LVDD) were assessed using Spearman’s rank correlation. Myostatin and resistin showed a significant positive and significant negative association with LSM, respectively, while FIB-4 was negatively correlated with lateral and medial e’ velocities and positively with the ERS-RA. MTX use, mean weekly dose, cumulative dose, and endothelin-1 were not associated with the APRI, FIB-4, LSM, or LVDD. These exploratory findings support the potential role of myostatin and resistin in LF-related phenotypes and suggest that FIB-4 may capture aspects of both hepatic and cardiovascular risk in RA. RA patients with elevated FIB-4 values may require echocardiographic assessment and comprehensive CV risk evaluation. In this cohort, MTX exposure and endothelin-1 were not associated with LF or LVDD. Full article

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common chronic liver disease for which lifestyle modification remains the main treatment. However, the role of specific dietary components is not fully understood. We investigated whether daily tomato consumption, a source of Mediterranean diet bioactive compounds, improves hepatic steatosis in adults with MASLD. Methods: In the randomized controlled POMOSANO trial, 79 adults with MASLD (BMI ≤ 30 kg/m²) were assigned to a tomato intervention group (n = 42), consuming 200 g/day of raw tomatoes and 50 g/day of tomato sauce, or to a control group (n = 37) following a tomato-free diet. The intervention lasted 6 weeks. Hepatic steatosis was assessed by the FibroScan^® controlled attenuation parameter (CAP). Secondary outcomes included anthropometric measures, body composition, liver stiffness, and metabolic and biochemical markers. Linear mixed-effects models were used to evaluate changes over time. Results: CAP decreased in both groups, with a greater reduction in the intervention group (median change: −35.00 vs. −18.00 dB/m). The adjusted linear mixed-effects model confirmed that the change in CAP in the control group was β = −12.81 (95% CI −25.55 to −0.08; p = 0.0490). Crucially, the treatment-by-time interaction was significant (β = −26.63, 95% CI −44.00 to −9.25; p = 0.0030), demonstrating a significantly greater reduction in hepatic steatosis in the tomato intervention group compared to the control group. CAP values were also significantly lower in the intervention group at follow-up (p = 0.0433). The adjusted linear mixed-effects model confirmed a significant reduction in CAP over time (β = −12.81, 95% CI −25.55 to −0.08; p = 0.0490) and a significant treatment-by-time interaction (β = −26.63, 95% CI −44.00 to −9.25; p = 0.0030), indicating a greater reduction in hepatic steatosis in the intervention group. No significant between-group differences were observed for liver stiffness, FIB-4 index, body weight, body composition, or most metabolic and biochemical markers. Conclusions: Daily consumption of raw tomatoes and tomato sauce reduced hepatic steatosis in adults with MASLD, supporting tomato-rich dietary strategies as a potential nutritional approach for MASLD management. Full article

Background and Objectives: To propose an integrated qualitative and quantitative US strategy for improving the diagnostic accuracy of hepatic steatosis (HS) grading. Materials and Methods: We retrospectively identified patients at a tertiary hospital who underwent B-mode US examination, attenuation imaging (ATI), hepatorenal index (HRI), and liver biopsy on the same day between 2023 and 2024. B-mode liver US images were independently reviewed by three radiologists with varying levels of experience. Each radiologist qualitatively assessed the degree of HS using a three-tier grading system: (1) no HS, (2) mild HS, and (3) moderate/severe HS. Median attenuation coefficient (AC) and HRI values were recorded. Liver biopsy pathology reports were used as the reference standard. We evaluated four strategies integrating qualitative assessment with ATI or HRI and compared their diagnostic performance. Results: Based on B-mode US, accuracies for detecting HS by the three radiologists were 87.0%, 87.0%, and 86.0%, respectively; for moderate/severe HS, the values were 79.0%, 76.0%, and 71.0%. ATI and HRI alone yielded diagnostic accuracies of 83.0% and 81.0%, respectively, for any HS and 67.0% and 53.0%, respectively, for moderate/severe HS. The highest accuracy was achieved using a strategy that retained the qualitative grade for one-grade discrepancies and assigning the intermediate grade only for two-grade discrepancies between the AC-based grade and the qualitative grade (93.0%, 87.0%, and 90.0% for any HS; 80.0%, 76.0%, and 74.0% for moderate/severe HS). Conclusions: The proposed integration strategy, which retained the qualitative grade for one-grade discrepancies and assigned the intermediate grade only for two-grade discrepancies, improved or maintained diagnostic performance, regardless of the radiologist’s level of experience. Full article

Background/Objectives: Natural bioactive compounds are promising interventions for obesity-related metabolic dysfunction. Lutein, a xanthophyll carotenoid with antioxidant and anti-inflammatory properties, may improve metabolic health, but its effects on liver function and gut microbiota in high-fat diet (HFD)-induced obesity are not fully elucidated. This study evaluated the effects of lutein supplementation on hepatic function, oxidative status, lipid metabolism, and gut microbiota composition in HFD-fed mice. Methods: Male C57BL/6J mice (6 weeks old) were randomly assigned to four groups (n = 8/group): Ctrl (low-fat diet), model (HFD), low-dose lutein (50 mg/kg/day), and high-dose lutein (100 mg/kg/day). Results: Following a 70-day intervention, lutein supplementation, particularly at the higher dose, reduced the liver index, improved serum lipid profiles, liver injury markers, and hepatic antioxidant capacity by increasing superoxide dismutase, catalase, and glutathione levels while reducing malondialdehyde content, and alleviated hepatic histopathological alterations. Lutein supplementation was also linked to elevated gut microbial richness and shifts in the relative frequency of several bacterial taxa, including partial restoration of Bacteroidota and enrichment of Roseburia and Faecalibaculum. These findings demonstrate that lutein supplementation attenuated HFD-induced metabolic and hepatic alterations, accompanied by improved antioxidant status and modulation of gut microbiota. Conclusions: Overall, lutein alleviated hepatic steatosis, oxidative stress, and metabolic dysfunction, highlighting its potential as a dietary strategy for managing obesity-related liver functions and gut dysbiosis. Full article

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) represents the hepatic manifestation of systemic metabolic dysfunction and has become one of the leading causes of chronic liver disease worldwide. Although obesity is a major determinant of MASLD, the metabolic and lifestyle context in which the disease develops may vary across different geographical and dietary environments. The present study aimed to evaluate the prevalence of MASLD among adults with metabolic dysfunction from two European cohorts, to compare the clinical, metabolic, lifestyle, and psychological characteristics of participants with MASLD from Romania and Italy, and to explore differences according to MASLD status within each cohort. In addition, intestinal permeability was exploratorily assessed in a subgroup of the Italian cohort. Methods: This prospective multicentre observational study included 132 adults undergoing metabolic and hepatic evaluation in Romania (n = 52) and Italy (n = 80). Hepatic steatosis was assessed using SteatoTest in the Romanian cohort and ultrasonography in the Italian cohort. Anthropometric and metabolic parameters were recorded in all participants. Dietary quality was evaluated using the MEDI-LITE questionnaire, physical activity using the International Physical Activity Questionnaire (IPAQ), depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9), and health-related quality of life using the 36-Item Short Form Health Survey (SF-36). Intestinal permeability was evaluated in the Italian cohort using the lactulose/mannitol absorption test. Results: MASLD was identified in 80.8% of participants from the Romanian cohort and in 66.3% of participants from the Italian cohort. Among patients with MASLD, Italian participants exhibited significantly higher body mass index, waist circumference, fasting insulin, total cholesterol, LDL cholesterol, and diastolic blood pressure compared with Romanian participants, whereas HDL cholesterol levels were significantly higher in the Romanian cohort. Sex-stratified analyses revealed significant sex-related differences in anthropometric and metabolic parameters within both cohorts. In both geographical populations, participants with MASLD demonstrated lower adherence to the Mediterranean diet, lower physical activity levels, higher depressive symptom burden, and less favorable quality-of-life indicators compared with participants without MASLD. Exploratory analyses of intestinal permeability in the Italian cohort did not reveal significant differences according to MASLD or obesity status. Conclusions: MASLD was highly prevalent in both Romanian and Italian adults with metabolic dysfunction. Patients with MASLD exhibited distinct metabolic and lifestyle profiles across the two geographical cohorts, supporting the potential contribution of environmental and lifestyle-related factors to MASLD heterogeneity. Lower adherence to the Mediterranean diet, reduced physical activity, and increased psychological burden were consistently associated with MASLD in both populations. Exploratory intestinal permeability analyses did not demonstrate significant differences according to MASLD or obesity status in the Italian cohort. Full article

Background and Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease and frequently improves after bariatric surgery. Conventional postoperative follow-up is mainly based on weight-loss outcomes, such as Body Mass Index (BMI), excess weight loss (EWL), total weight loss (TWL), and routine biochemical parameters, which may not fully characterize hepatic fat response. Ultrasound-derived fat fraction (UDFF) provides a quantitative non-invasive assessment of hepatic steatosis, while DXA-derived visceral adipose tissue (VAT) reflects central adiposity and metabolic risk. This study aimed to evaluate whether combined UDFF and DXA-VAT assessment provides complementary information to conventional bariatric follow-up parameters after bariatric surgery. Methods: We conducted a prospective longitudinal cohort study on 41 patients with severe obesity who underwent bariatric surgery between July 2025 and May 2026. Anthropometric, body composition, metabolic, hepatic, and biochemical parameters were assessed at baseline (T0) and 6 months postoperatively (T1). UDFF, utilizing a DAX ultrasound transducer, was used for hepatic steatosis assessment, while DXA was performed for VAT, android fat mass, total body fat percentage, and lean mass quantification. Correlation analyses, multivariable linear regression, and an exploratory clinical discordance analysis were performed. Results: At 6 months after surgery, patients showed significant improvements in body weight, visceral adiposity, insulin resistance, biochemical parameters, and hepatic steatosis. VAT reduction showed the strongest association with UDFF reduction, whereas conventional weight-loss outcomes, anthropometric, and metabolic parameters did not fully identify patients with residual steatosis. These findings suggest that hepatic fat improvement after bariatric surgery is more closely related to changes in visceral adiposity than to weight loss alone. Conclusions: Combined UDFF and DXA-derived VAT assessment may provide a practical dual-compartment imaging framework for postoperative MASLD monitoring. This approach captures both hepatic fat response and visceral adiposity remodeling, offering information that complements conventional bariatric follow-up based on weight-loss outcomes. Full article

Background/Objectives: Many HIV-positive (HIV+) males receiving highly active antiretroviral therapy (HAART) experience metabolic complications, including non-alcoholic fatty liver disease (NAFLD); lipodystrophy; and intestinal dysbiosis, often characterized by a Prevotella-rich enterotype. Gut microbial fermentation produces short-chain fatty acids (SCFAs), which play important roles in host metabolism. This study investigated the relationships among HAART, anthropometrics, diet, intestinal permeability, gut microbiota composition, and lipodystrophy in HIV+ males. Methods: Forty males aged 23–60 years were enrolled, including 19 HIV+ participants recruited from the East Tennessee State University (ETSU) Health Infectious Diseases Specialty Clinic and 20 HIV-negative (HIV−) controls recruited through standard methods. Participants provided a stool sample for 16S rRNA gene sequencing, SCFA analysis by gas chromatography, and proximate analysis, and completed a food frequency questionnaire. Lipodystrophy-related measures included body mass index (BMI), hip-to-waist ratio (H:W), and liver health assessment using FibroScan. Blood samples were collected by venipuncture. Serum markers of intestinal permeability, including Claudin-21, flagellin, and intestinal fatty acid-binding protein (IFABP), were quantified by enzyme-linked immunosorbent assay (ELISA). Results: HIV+ males exhibited significantly higher H:W ratios (p = 0.001) and hepatic steatosis (p = 0.0047) than HIV− controls (Welsh’s t-test). Concentrations of isobutyrate (p = 0.0024), isovalerate (p = 0.0008), and valerate (p = 0.0329) were elevated in HIV+ participants, whereas butyrate (p = 0.0014) and total acetate/propionate/butyrate (APB) (p = 0.0046) were higher in HIV− males (Welsh’s t-test). HIV+ participants also showed greater abundances of Prevotella and Lachnospiraceae (Analysis of Compositions of Microbiomes; ANCOM). Retrospective analysis revealed that all HIV+ participants were men who have sex with men (MSM). Conclusions: HIV+ males demonstrated distinct gut microbiome profiles, altered SCFA production, and markers of disrupted lipid metabolism. These findings provide a foundation for future investigations of microbiome-metabolism interactions in HIV+ MSM. Full article

Background: Diet and the gut microbiota are each associated with hepatic steatosis, but their joint variation and shared explanatory contribution are rarely quantified in older Asian community-dwelling populations. Methods: In 701 non-heavy-drinking Kyotango longevity cohort adults, habitual diet (BDHQ; 31 food groups) and stool 16S rRNA microbiome (47 genera; CLR-transformed) were related to the fatty liver index (FLI) by canonical correlation analysis (CCA), reduced-rank regression (RRR), and bootstrap mediation; FIB-4 was a secondary exploratory outcome. Results: Four dietary patterns and four microbial clusters emerged. CCA revealed multivariate diet-microbiota co-variation (four significant canonical correlations; r = 0.40–0.46; all p < 0.05). Combined RRR (n = 697 with complete FLI data) explained 11.1% of FLI variance in-sample (permutation p = 0.006), although cross-validated R² was negative, reframing the model as hypothesis-generating rather than predictive. Bootstrap mediation suggested that 12.6% of the diet-on-FLI effect was carried by the microbiota (95% bootstrap CI excluding zero). Of 1457 FDR-corrected food-genus pairs, one was significant (fruits × Eubacterium eligens; r = +0.202, q = 1.0 × 10⁻⁴). Conclusions: In this cross-sectional, hypothesis-generating analysis with no individual-level predictive utility, dietary patterns and gut microbial composition co-vary and jointly relate to FLI. The findings describe population-level covariance patterns for future prospective diet-microbiome intervention testing; external validation in independent cohorts is essential. Full article

Background/Objectives: Celiac disease (CD) is an immune-mediated enteropathy with gastrointestinal and extraintestinal manifestations. In primary care, recognition can be delayed when psychiatric symptoms, arthralgia, thyroid dysfunction, alcohol exposure, and liver-test abnormalities coexist. This case report describes a confounder-aware diagnostic approach to histologically confirmed CD in a patient with a multifactorial primary-care presentation. Methods: We report a single-patient, de-identified reflective case from routine family medicine practice, organized according to CARE case-report principles. Results: A woman in her early sixties with hypothyroidism and glaucoma presented with new low mood, anhedonia, somnolence, generalized anxiety, increased alcohol intake, poor appetite, weight loss, abdominal bloating, diarrhea, flatulence, and polyarthralgia. Initial investigations, including celiac serology obtained before gluten-free diet advice, showed mild anemia, marked hyperferritinemia, severe cholestatic and hepatocellular liver-test abnormalities, uncontrolled hypothyroidism, and strongly positive tissue transglutaminase IgA (>250 kIU/L; reference 0.0–14.9). Radiographs showed mild osteoarthritis and osteopenia without erosive arthropathy. Computed tomography excluded malignancy but showed severe diffuse hepatic steatosis and mild pancreatic atrophy. Mirtazapine was started at the index visit; after the initial laboratory results, gluten-free diet advice, alcohol-reduction counseling, and levothyroxine adjustment were undertaken. During the diagnostic episode, small-bowel biopsy demonstrated moderate-to-severe crypt hyperplastic villous atrophy with increased intraepithelial lymphocytes, and gastric biopsies showed no significant pathology; the histology was consistent with CD. Symptoms improved substantially. Longer-term objective follow-up showed persistent but improved celiac serology (tTG-IgA 49.4 kIU/L), normalization of thyroid-stimulating hormone, partial improvement in gamma-glutamyl transferase, which remained elevated, and a later iron-deficiency pattern with persistent anemia. Conclusions: This case supports targeted CD testing when anxiety or depressive symptoms occur alongside gastrointestinal symptoms, weight loss, arthralgia, hypothyroidism or documented thyroid autoimmunity, anemia, osteopenia, or liver-test abnormalities. Histology and repeat serology confirmed the diagnosis, but the psychiatric and hepatic manifestations still require cautious interpretation because hypothyroidism, alcohol exposure, steatotic liver disease, and simultaneous treatments also shaped the clinical course. Full article

Artificial feeds are considered a sustainable alternative to natural live feeds for mandarin fish (Siniperca chuatsi) aquaculture, but their impacts on hepatic metabolism and growth remain unclear. In this study, a total of 800 adult mandarin fish with an initial mean body weight of 152.4 ± 8.7 g were reared for 150 days, and we compared growth performance, liver histology and liver metabolomics of fish fed artificial (AF) or natural live feeds (NF). No significant differences were observed in body length, weight, or condition factor, but the hepatosomatic index (HSI) was significantly higher in the AF group (p < 0.01), accompanied by visible hepatomegaly, pale liver color and severe hepatic steatosis. Partial least squares-discriminant analysis (PLS-DA) showed clear separation of liver metabolomes between groups. Metabolic correlation network analysis revealed tightly connected functional modules of amino acids and lipids, and key metabolites demonstrated significant group-specific changes: energy metabolism intermediates (L-alanine, α-ketoglutarate, phosphoenolpyruvate) and stress-related indicators (cortisol, γ-aminobutyric acid) were significantly upregulated in the NF group, whereas lipid metabolites (cholesterol, phosphatidylcholine, ceramide) and progesterone were remarkably elevated in the AF group. Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis revealed upregulation of lipid-related pathways in the AF group and FoxO signaling pathway in the NF group. These findings confirm that artificial feeds drive hepatic lipid metabolism reprogramming without altering growth, but induce obvious hepatic steatosis in mandarin fish. Our findings provide a metabolic foundation for optimizing artificial feed formulations to improve hepatic health and sustainable culture of mandarin fish. Full article

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) has been linked to atrial fibrillation (AF); however, its relationship with specific AF subtypes remains unclear. This prospective, single-center, observational case–control study investigated whether MASLD is independently associated with AF presence and its subtypes. Materials: A total of 327 participants were analyzed, including 119 controls and 208 patients with AF. Comprehensive clinical history, anthropometric measures, laboratory testing, 24 h Holter ECG, and echocardiography were performed. Clinically inferred MASLD was defined according to the current EASL–EASD–EASO guidelines using clinical and non-invasive indices (Hepatic Steatosis Index, Fatty Liver Index, Fibrosis-4 Index). No liver biopsy or imaging confirmation of steatosis or fibrosis was performed, and therefore, the diagnosis represents a clinically inferred (“probable”) MASLD. To minimize systematic bias and improve baseline comparability between groups, propensity score matching and complementary regression analyses were applied. Results: Overall probable MASLD prevalence did not differ between AF and controls (42% vs. 44%, p = 0.742). A clear phenotypic gradient emerged across subtypes: lowest in permanent AF (PermAF, 27.1%) versus paroxysmal (47.1%) and persistent AF (51.4%) (p = 0.021). PermAF exhibited the most advanced comorbidity—highest CHF (78.6%), CKD (71.4%), HFpEF (48.6%), FIB-4 (median 2.67), the lowest TG/HDL–cholesterol ratio (1.93 vs. 3.32; p < 0.001), and progressive renal impairment. Statin therapy reached 80% in clinically inferred MASLD-positive PermAF. The elevated FIB-4 observed in PermAF must be interpreted with explicit caution: this group was substantially older (median 79.5 years) and carried the highest burden of chronic heart failure and chronic kidney disease; therefore, in this subgroup, FIB-4 most plausibly reflects age and cardio-renal comorbidity rather than histologically confirmed hepatic fibrosis. After matching, MASLD was not an independent predictor of AF presence (OR = 0.96; 95% CI: 0.59–1.46) or its clinical severity. Conclusions: Probable MASLD, defined by clinical and non-invasive indices, was not independently associated with AF in this cohort, but AF subtypes exhibited a clear phenotypic gradient—from a metabolically driven profile in early AF to a cardio-renal and fibrotic pattern in advanced, elderly AF. Elevated FIB-4 values in PermAF most plausibly reflect age and cardio-renal comorbidity rather than true histologically confirmed hepatic fibrosis. These findings support a phenotype- and population-dependent MASLD–AF relationship and underscore the need for imaging- and histology-verified longitudinal studies. Full article

Objectives: Occupational physical activity (OPA) and leisure-time physical activity (LTPA) have contrasting health effects, a phenomenon known as the “physical activity paradox.” We explored the domain-specific associations between physical activity and non-alcoholic fatty liver disease (NAFLD). Methods: This cross-sectional study included 20,584 Korean workers (10,846 women). Physical activity was assessed using the Global Physical Activity Questionnaire, and NAFLD was assessed using the hepatic steatosis index and the presence of metabolic dysfunction. Logistic regression models were employed to explore the association between each domain of physical activity and NAFLD. The associations are presented as odds ratios (ORs) and 95% confidence intervals (CIs). Results: The prevalence of NAFLD was 30.6% in men and 18.1% in women. For male workers, ≥300 min/week of OPA was positively associated with NAFLD (OR: 1.41; 95% CI: 1.15–1.72), while ≥300 min/week of LTPA was negatively associated with NAFLD (OR: 0.79; 95% CI: 0.67–0.93). In female workers, LTPA was negatively associated with NAFLD from a lower level (OR: 0.63; 95% CI: 0.52–0.78 for 1–149 min/week; OR: 0.71; 95% CI: 0.56–0.89 for 150–299 min/week; OR: 0.58; 95% CI: 0.43–0.78 for ≥300 min/week of LTPA), while OPA had no clear association with NAFLD. Conclusions: OPA and LTPA were differentially associated with NAFLD in workers. Domain- and sex-specific effects of physical activity should be considered for the prevention and management of NAFLD. Full article

Background/Objectives: To evaluate the diagnostic performance of ultrasound-guided attenuation parameter (UGAP) for the assessment of hepatic steatosis in a population at risk for metabolic dysfunction-associated steatotic liver disease (MASLD), using MRI proton density fat fraction (PDFF) as the reference standard, and to also derive optimal population-specific diagnostic thresholds. Methods: In this single-center prospective study, 64 adults at risk for MASLD underwent UGAP measurement and MRI-PDFF. UGAP was performed according to standardized manufacturer-recommended protocols and standardized on the right hepatic lobe. Hepatic steatosis was staged using established MRI-PDFF thresholds. Diagnostic performance was evaluated using receiver operating characteristic (ROC) analysis. Cohort-UGAP cut-offs were derived using the Youden index. Associations between UGAP and clinical parameters were assessed using correlation and regression analyses. Results: UGAP correlated strongly with MRI-PDFF (ρ = 0.82, p < 0.001). The areas under the ROC curve (AUCs) for detecting mild, moderate, and severe steatosis were 0.86, 0.96, and 0.96, respectively. Right-lobe acquisitions outperformed left-lobe measurements, while four-region averaging yielded the highest diagnostic performance. UGAP values were associated with BMI, waist circumference, and liver enzymes. Conclusions: UGAP provides an accurate noninvasive assessment of hepatic steatosis, demonstrating high overall diagnostic agreement with MRI-PDFF. Right-lobe acquisition and multi-regional averaging further improve its performance. While cohort-specific threshold optimization may enhance clinical applicability, larger studies are needed to fully confirm its accuracy in advanced stages. Full article