Search Results (384)

Background: Accumulating evidence indicates a link between folate and metabolic dysfunction-associated fatty liver disease (MAFLD). Objectives: The aim of this study was to ascertain whether different serum folate forms are associated with newly defined MAFLD as well as liver fibrosis in the US general population. Methods: This cross-sectional study used data from the 2017–2020 (March) cycle and 2017–2018 cycle of the National Health and Nutrition Examination Survey (NHANES) in the US. Hepatic steatosis and fibrosis were evaluated by transient elastography, which employed controlled attenuation parameters and liver stiffness measurements as assessment indicators. Results: 7447 eligible individuals were included. The estimated prevalence of MAFLD and liver fibrosis was 51.6% (95% confidence interval [CI]: 50.4–52.7%) and 10.0% (95% CI: 9.3–10.7%). After adjusting for confounding factors, for every 1 nmol/L increase in serum 5-methyltetrahydrofolate (5-mTHF), the risk of developing liver fibrosis decreased by 1% (95% CI: 1–2%, p < 0.001), and the risk of developing MAFLD decreased by 1% (95% CI: 0–2%, p = 0.005). There were also significant differences in indicators such as alanine aminotransferase (ALT), gamma-glutamyl transaminase (GGT), and C-reactive protein (CRP) between the MAFLD group and the non-MAFLD group (all p values < 0.001). Conclusions: This study suggests the prevalence of MAFLD and liver fibrosis decreased significantly with the increase in serum 5-mTHF concentration. Full article

Background/Objectives: Insulin resistance is a key factor in the development and progression of metabolic dysfunction-associated steatotic liver disease (MASLD), but accurately measuring it in patients with type 2 diabetes (T2D) remains challenging. This study examines the relationship between a recently proposed insulin resistance index and the presence of liver steatosis and fibrosis in individuals with T2D. Methods: This cross-sectional study utilized data from the 2017–2020 National Health and Nutrition Examination Survey. Patients with T2D who did not have chronic viral hepatitis or significant alcohol intake were included. The insulin sensitivity (IS) index was calculated using a formula incorporating body mass index, urine albumin-to-creatinine ratio, triglycerides, and gamma-glutamyl transferase. Liver stiffness and steatosis were assessed through transient elastography. MASLD was defined as a controlled attenuation parameter (CAP) of ≥274 decibels/meter (dB/m), while significant liver fibrosis was defined as a liver stiffness measurement (LSM) of ≥8 kPa. Multivariable logistic regression models, adjusted for potential confounders, were used to evaluate the association between IS and these liver outcomes. Results: A total of 1084 patients with T2D were analyzed. The prevalence of MASLD and significant liver fibrosis was 74.1% (95% CI 68.7–78.9) and 25.4% (95% CI 21.2–30.2), respectively. After adjusting for age, sex, waist circumference, and race/ethnicity, lower IS scores (indicating higher insulin resistance) were independently associated with increased odds of both MASLD (quartile 1 vs. quartile 4: OR 2.66, 95% CI 1.23–5.71) and significant liver fibrosis (quartile 1 vs. quartile 4: OR 3.30, 95% CI 1.45–7.51). These findings remained consistent across subgroups stratified by age, sex, and obesity status. Conclusions: This novel IS model, derived from commonly available clinical and biochemical markers, is independently associated with liver steatosis and fibrosis. Its application may help identify patients with more advanced MASLD, facilitating early intervention and risk stratification. Full article

Liver cirrhosis continues to be a major global health issue, contributing to high morbidity and mortality due to its progressive nature and associated complications. This review explores recent advancements in the diagnosis and treatment of liver cirrhosis and its related syndromes. Non-invasive diagnostic tools, such as elastography and serum biomarkers, have significantly improved early detection, reducing the need for liver biopsies. Advanced imaging techniques, including MRI and CT, further enhance diagnostic accuracy. In parallel, molecular and genomic research is providing new insights into the pathogenesis of the disease, paving the way for precision medicine. On the treatment front, pharmacological innovations, such as antifibrotic agents and targeted therapies, show promise in slowing disease progression. Endoscopic interventions like variceal banding are improving the management of complications, while advancements in liver transplantation and artificial liver support systems offer life-saving alternatives. Regenerative medicine, particularly stem cell therapy and tissue engineering, is emerging as a promising strategy for liver repair. Managing cirrhosis-related syndromes, including portal hypertension, ascites, hepatic encephalopathy, and hepatorenal syndrome, now involves evolving therapeutic approaches such as transjugular intrahepatic portosystemic shunt (TIPS) and novel pharmacotherapies. Prognostic scoring systems like the MELD and Child–Pugh are being refined with new biomarkers for better risk stratification. The future of cirrhosis care will likely involve the integration of artificial intelligence and machine learning for early diagnosis and personalized treatments, alongside emerging therapies currently under investigation. Despite these advancements, challenges such as costs, accessibility, and healthcare disparities remain barriers to widespread adoption. This review highlights the importance of incorporating innovative diagnostic and therapeutic strategies into clinical practice to improve the outcomes for patients with liver cirrhosis and its complications. Full article

Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a major cause of chronic liver disease and is closely linked to obesity and metabolic syndrome, necessitating efficient, non-invasive diagnostic tools. Methods: This monocentric cross-sectional study included 178 patients (69.1% with MASLD, 30.9% normal subjects; 55% males; mean age 52.79 ± 12.56 years) who underwent anthropometric and biochemical assessments to determine the visceral adiposity index (VAI), triglyceride–glucose index (TyG), and lipid accumulation product (LAP), along with abdominal ultrasound and vibration-controlled transient elastography (VCTE) with controlled attenuation parameter (CAP). Results: Patients were categorized based on steatosis severity: S0–S1 (n = 64) and S2–S3 (n = 114). The TyG, VAI, and LAP values were significantly higher in S2–S3 cases (p < 0.0001) and showed moderate-to-strong correlations with both steatosis and fibrosis. Predictive models yielded AUROCs of 0.80 (TyG), 0.83 (VAI), and 0.79 (LAP) for diagnosing S2–S3 steatosis. The NAFLD fibrosis score (NFS) and FIB-4 classified fibrosis severity, but 36.8% of cases remained unclassified. Applying the TyG and VAI thresholds reduced this rate to 26.3%. Conclusions: These findings support the TyG, VAI, and LAP as valuable non-invasive biomarkers for MASLD assessment, enhancing the classification accuracy when conventional fibrosis scores are inconclusive. Full article

Background: The global rise of metabolic-associated fatty liver disease (MAFLD) in children is particularly concerning in high-risk groups such as those with Down Syndrome (DS), who have an elevated risk of obesity and insulin resistance. Despite increasing recognition of MAFLD in pediatric populations, data on its prevalence and risk factors among children with DS in Canada remain limited. Method: This retrospective study reviewed medical records of children with DS at the CHEO Down Syndrome Clinic (2013–2023). A diagnosis of MAFLD required evidence of hepatic steatosis on imaging, lab markers, or biopsy, along with the presence of metabolic risk features. Demographic, laboratory, and diagnostic data were analyzed. Results: Among 503 children with DS (231 females, 271 males; median age: 172 months), 54 (10.7%) had MAFLD. The MAFLD group was older (median age: 205 vs. 163 months, p = 0.0002) and had higher BMI (31.39 vs. 20.5, p < 0.0001). Most cases (47/54) were diagnosed via ultrasound, and 49/54 met MAFLD criteria due to excessive adiposity. Lab results showed a median ALT of 35 U/L, triglycerides of 4.4 mmol/L, and LDL cholesterol of 2.59 mmol/L. FibroScan in 13 children revealed a median transient elastography of 5.3 kPa. BMI was the strongest predictor of MAFLD (OR: 1.2, 95% CI: 1.1–1.2). Conclusions: The DS clinic-based prevalence of MAFLD underscores the need for proactive screening and early intervention. BMI was the strongest predictor, emphasizing targeted management strategies. Further research is needed to refine diagnostic approaches and improve outcomes. Full article

Novel direct antiviral-acting (DAA) molecules significantly improved efficacy and ameliorated outcomes of patients with chronic hepatitis C (CHC). The extensive use of DAA from 2015, due to large access to therapy, maximized rates of viral eradication with a safety profile in the majority of cases. Aims: We evaluated risk factors and the incidence of related clinical events and hepatocellular carcinoma (HCC) in cases with sustained virologic response (SVR) after DAA. We also aimed to apply a score assessment to identify the individual patient with unfavorable outcomes during an average follow-up (FU) of five years. Methods: In total, 470 cases consecutively recruited with CHC have been compared by non-invasive tests (NIT), as APRI, FORNS, FIB-4, LSPS, and transient elastography (TE) liver stiffness measurement (LSM), to identify cutoff related to major event onset. Results: Grouping of cases without or with related events development of both types hepatic (HE) (i.e., HCC or further cirrhosis decompensation or/with hospitalized septic state) or extrahepatic (EHE) (i.e., other tumors, bleeding, or thrombotic episodes and other organs pathologic conditions not liver related)allowed us to select the parameters to propose a novel risk stratification system (RISS) for the identification of the remnant individual patient’s risk for HCC occurrence, orthotopic liver transplant (OLT) need, or death during long-term follow-up (FU). Conclusions: Patients with cirrhosis and portal hypertension (PH) maintained a higher LSM mean value (>25 kPa), showed the lowest reduction of NIT scores, and developed events in 80/108 (74%) cases (67 and 13 of HE and EHE type), even after long-term successful DAA therapy. Furthermore, cases with RISS score ≥ 8 demonstrated a significant incidence of HCC (37/46, 80.4%) and a reduction in survival rate to 65.4% at 5-year FU. Full article

Objective: The objective of this study was to calculate the epidemiological impact of metabolic dysfunction associated with fatty liver disease (MAFLD) and hepatic fibrosis in primary care (PC). Secondarily, we assessed the correlation between serological markers (FIB-4, ELF test), abdominal ultrasound, and transient elastography in the early detection of MAFLD. Methods: An observational prospective study was designed to determine the prevalence of MAFLD and to assess the correlation between complementary tests. Patients were recruited from five health centres. Eligible participants were adults aged between 18 and 70 years with at least one metabolic risk factor, including being overweight (BMI 25–29.9 kg/m²) or obese (BMI > 30 kg/m²), or diagnosed with type 2 diabetes mellitus (T2DM), dyslipidemia, or metabolic syndrome. The prevalence of MAFLD was calculated. Correlations between diagnostic tests were evaluated using Pearson’s correlation coefficient. Results: A total of 98 patients was included. Using CAP (controlled attenuation parameter) measurements, the prevalence of MAFLD was found to be 67.7%, and the prevalence of hepatic fibrosis was 6.5%. The correlation between conventional ultrasound and CAP from FibroScan^® for the diagnosis of MAFLD was low and not statistically significant (0.160 [95% CI: −0.100; 0.400], p = 0.226). In contrast, the diagnosis of hepatic fibrosis using FibroScan^® in PC showed a high correlation with diagnoses performed in gastroenterology department (0.942 [95% CI: 0.844; 0.979], p < 0.001). The correlation with biochemical markers was low and not statistically significant for both FIB-4 (0.125 [95% CI: −0.129; 0.363], p = 0.334) and the ELF test (0.159 [95% CI: −0.111; 0.407], p = 0.246). Conclusions: Two out of three patients with metabolic risk factors were diagnosed with MAFLD, while hepatic fibrosis diagnoses were uncommon. These results reinforce the validity of using FibroScan^® in PC. Full article

Background: Existing non-invasive tests (NITs) for liver fibrosis offer moderate precision and accessibility but are often limited by complexity, reducing their practicality in routine clinical use. This study aimed to evaluate the diagnostic performance of current fibrosis assessment methods and develop a novel, simplified scoring system—the Aspartate Aminotransferase (AST)-Thrombocytopenia-Albumin (ATA) score—to enhance ease of use and clinical applicability. Methods: This study examined past cases of patients with chronic liver disease (CLD) by using magnetic resonance elastography (MRE) to evaluate fibrosis stages. Serum biomarkers were collected, and common fibrosis scores were calculated. Logistic regression identified potential predictors of significant fibrosis, forming the ATA score. Diagnostic performance was assessed, and internal validation was conducted via bootstrap resampling. Results: Among 70 patients, 31.4% had significant fibrosis. Hepatitis B was the most common cause (60.0%), followed by hepatitis C (18.6%) and nonalcoholic fatty liver disease (NAFLD, 15.7%). The ATA score demonstrated an area under the receiver operating characteristic curve (AUROC) of 0.872, comparable to the AST-to-platelet ratio index (APRI; 0.858) and fibrosis-4 index (FIB-4; 0.847). The recommended cut-offs for identifying high-risk patients were ATA score ≥ 2 (specificity 95.8%, sensitivity 50.0%), APRI ≥ 0.50 (specificity 89.6%, sensitivity 68.2%), and FIB-4 ≥ 1.3 (specificity 58.3%, sensitivity 90.9%). Internal validation confirmed model robustness, with an optimism-corrected AUROC of 0.8551. Conclusions: The ATA score offers a straightforward and efficient method for detecting significant fibrosis, demonstrating comparable diagnostic capability to APRI and FIB-4, while being more user-friendly in clinical practice. A score of 0–1 indicates low risk, suitable for clinical follow-up, whereas a score of ≥2 suggests high risk, warranting further evaluation. Integrating the ATA score into clinical workflows can enhance early detection, optimize resource utilization, and improve patient care. Full article

Background: This randomized controlled study sought to determine the effect of intermittent fasting on anthropometric measurements, fibroblast growth factor (FGF)-21, and autophagy markers, as well as on hepatic steatosis and fibrosis levels in overweight or obese patients with metabolic dysfunction-associated fatty liver disease (MAFLD). Methods: Patients were randomly assigned into two groups: received a dietary treatment involving 22–25 kcal/kg/day of energy for 8 weeks and followed the same dietary intervention and a 16:8 pattern. The extent of hepatic steatosis and fibrosis was determined using transient elastography on a FibroScan^® device. The controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), determined by transient elastography, reflect hepatic steatosis and fibrosis, respectively. In duplicate, serum levels of FGF-21, Beclin-1, and ATG-5 were determined using enzyme-linked immunosorbent assay. Results: The study included 48 patients with a mean age of 48.2 ± 1.4 years (27 female and 21 male). Improvements in anthropometric measurement and CAP and LSM levels and a decrease in serum FGF-21 levels were found in both groups (p < 0.05). Changes in the CAP and FGF-21 levels were higher in the energy + time-restricted diet group (p < 0.05). Autophagy-related protein (ATG)-5 levels increased only in the energy + time-restricted diet group [(0.74 (0.46–1.29) ng/mL vs. 0.95 (0.73–1.32) ng/mL, p = 0.03]. Conclusions: Intermittent fasting was potentially practical in the management of MAFLD. In particular, changes in FGF-21 and ATG-5 levels indicate the potential of intermittent fasting to regulate metabolic processes and autophagy. However, methodological limitations should be taken into consideration when interpreting the study results. Full article

Hepatocellular carcinoma (HCC), a common consequence of chronic liver disease, ranks among the most prevalent cancers globally and contributes significantly to cancer-related mortality. Liver fibrosis is intimately associated with hepatic function and the likelihood of future HCC occurrence. Despite the fact that liver biopsy continues to be the gold standard for diagnosing fibrosis, its utility is hindered by cost and invasiveness, along with patient unease, procedural rejection, and potential adverse effects. Liver elastography has become a leading noninvasive means of assessing tissue stiffness with considerable diagnostic precision. Malignant tumors generally exhibit higher cellularity in comparison to benign ones, resulting in increased stiffness. Elastography techniques capitalize on alterations in tissue elasticity stemming from specific pathological or physiological processes. Technological innovations, such as advanced ultrasound imaging and artificial intelligence (AI)-integrated systems, are paving the way for enhanced diagnostic accuracy and risk prediction. Recent research underscores the potential of elastography in managing HCC patients, presenting novel clinical applications, including prediction of HCC development, differentiation between malignant and benign liver lesions, evaluating treatment response, and forecasting recurrence post-treatment, though certain findings remain contentious. Therefore, this review aims to sum up the latest advancements in liver elastography for HCC patients, outlining its applications while addressing existing limitations and avenues for future progress. Full article

Background and Aims: Hepatokines have a regulatory function in adipose tissue inflammation, metabolic dysfunction-associated steatotic liver disease (MASLD), cardiovascular diseases, and atherosclerosis. Our aim was to evaluate the profile of proinflammatory cytokines and hepatokines in patients with MASLD and carotid atherosclerosis (CA). Methods: A prospective and basic research study was conducted on patients with MASLD. Clinical data were collected from a detailed medical history. Liver stiffness was measured using transient elastography, and carotid Doppler ultrasound was performed. Levels of basic biochemical parameters, systemic inflammation markers (TNF-α, IL-6, IL-10, IL-18), and hepatokines (FGF21, ANGPTL4, fetuin-A) were determined. The results were analyzed with SPSS v22.0 software. Results: Sixty-seven patients with MASLD were included, 72.1% were women, and the mean patient age was 53.9 + 11.3 years. Atherosclerosis was found in 11 patients (16.2%), and carotid intima–media thickness (CIMT) was altered in the right carotid of 13 patients (19.1%), in the left carotid of 19 (27.9%), and bilaterally in 7 (10.3%). Greater age (p = 0.001) and high blood pressure (p = 0.028) were correlated with atherosclerosis. There were no differences in systemic inflammation markers, and the hepatokines FGF21 and fetuin-A tended to increase in the presence of CIMT and CA alterations, regardless of fibrosis. Conclusions: In our population, patients with MASLD had a 16.6% prevalence of CA, and the risk increased with age and a history of high blood pressure. FGF21 tended to increase in patients with MASLD + atherosclerosis, and fetuin-A was correlated with CIMT alterations, suggesting that the combination of these markers could guide us to suspect early endothelial alterations in patients with MASLD. Full article

Metabolic dysfunction-associated steatotic fatty liver disease (MASLD) is a worsening global health issue, affecting over one-third of the adult population and representing the leading cause of liver-related morbidity and mortality. MASLD is not only a key precursor to chronic liver disease, but also a systemic condition that leads to numerous extrahepatic complications, increasing the risk of cardiovascular diseases, chronic kidney disease, type 2 diabetes, and certain cancers. The primary reference method for assessing liver fibrosis, allowing for precise determination of its location and severity, remains liver biopsy. However, it is an invasive procedure and involves certain risks. In recent years, the importance of MASLD diagnosis using noninvasive diagnostic methods has been increasing, including serological markers, methods based on multi-omics, and imaging techniques such as liver elastography. This review presents data on the diagnosis and evaluation of this disease that may find application in future clinical practice. The focus is on presenting both currently used and newly identified noninvasive diagnostic methods that open up the prospect of gradually replacing biopsy in the diagnosis of MASLD. Full article

Background/Objectives: As a result of metabolic changes and the disruption of tissue architecture and microcirculation, the regenerative potential of the liver decreases with violations at both micro and macro levels. The development of intraoperative approaches for assessing its regenerative potential is important for reducing the risk of the occurrence of post-resection liver failure. In this study, we used multimodal optical coherence tomography (MM OCT), a combination of three optical coherence tomography modalities—OCT–angiography (OCTA), attenuation coefficient mapping, and OCT–elastography (OCE) to provide real-time three-dimensional and label-free assessment of changes in microcirculation, and in the structure and stiffness of the liver during regeneration. Methods: In our study, the regeneration of a healthy liver was induced by 70% partial hepatectomy. Monitoring of changes was carried out on the 0 (normal liver), 3rd and 7th day of regeneration using modalities of MM OCT. OCT offers the benefits of higher resolution and specificity compared with other clinical imaging modalities, and can be used, even intraoperatively. Results: By the 3rd day of liver regeneration, a decreased density of all observable vessels, together with increased values of the liver tissue’s attenuation coefficient and stiffness, was revealed compared to their initial state. However, by the 7th day, the studied parameters tended to return to their normal values, except that the density of large-caliber vessels continued to increase further. Histological and biochemical blood analysis methods were used to verify the MM OCT data. Conclusions: Such data are a first step towards further investigation of liver regeneration in pathology, and, taken in perspective, this should serve as a basis for predictive intraoperative assessment of the regenerative potential of the liver in a clinical setting. Full article

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent disease influenced by dietary factors. While high sugar and fat consumption are associated with weight gain, their specific impact on liver fat accumulation remains unclear. This study aimed to evaluate the relationship between sugar and saturated fat intake and liver and body fat composition. Methods: A cross-sectional study was conducted from September 2021 to February 2023 in workers from a tertiary care center in Mexico City. Anthropometric measurements, body composition (bioelectrical impedance analysis and skinfold assessment), physical activity, and liver fat (vibration-controlled transient elastography) were measured. Dietary intake was assessed with a 24-h recall questionnaire and analyzed with specialized software. Linear and logistic regression models were fitted to study the relationship between nutrient intake and liver/body fat. Results: A total of 534 healthcare workers (median age: 41.5 years, 61.4% female) were included. Hepatic steatosis was present in 42.5% of participants. Higher carbohydrate intake was associated with increased liver fat (β = 0.23, 95% CI: 0.02–0.45), with each additional 15 g of carbohydrates increasing the odds of steatosis by 5% (OR = 1.053, 95% CI: 1.006–1.102). Fat and sugar intake were associated with higher body fat but not liver fat. Conclusions: Carbohydrate intake was linked to liver fat accumulation, whereas fat and sugar intake were primarily associated with body fat. Tailored dietary recommendations could be informed by these findings. Prospective dietary assessment methods and a nutritional geometry approach could be applied in future studies. Full article

Portal hypertension (PH) is a complication of advanced liver diseases, including cirrhosis and hepatocellular carcinoma, often leading to unfavorable outcomes. Endo-hepatology, particularly endoscopic ultrasound (EUS) has revolutionized the assessment of PH. Notably, EUS-guided portal pressure gradient (EUS-PPG) enables measurement of portal and hepatic venous pressures, offering diagnostic precision for both cirrhotic and non-cirrhotic forms of PH, including porto-sinusoidal vascular disorder (PSVD). EUS-based assessment of PH in advanced liver disease can refine diagnostic workup and prognostication, supporting therapeutic decisions. Additionally, EUS-guided liver biopsy (EUS-LB) achieves high-quality histological samples with fewer complications compared to percutaneous techniques, enabling thorough evaluation of chronic liver diseases and vascular abnormalities. EUS-shear wave elastography (EUS-SWE) further refines stiffness measurements where standard imaging fails. Moreover, EUS plays a major role in controlling variceal hemorrhage, a severe PH complication. EUS-guided coil and cyanoacrylate injection for gastric varices demonstrate a great efficacy, often surpassing conventional endoscopy. Similarly, EUS-based identification and treatment of perforator vessels feeding esophageal varices reduce rebleeding risks, particularly in challenging patients. The combination of these state-of-the-art interventions supports a “one-stop strategy”, integrating variceal screening, biopsy, and portal pressure measurement within a single procedure. Despite these advancements, refinements in sedation protocols, patient selection, and cost-effectiveness data are necessary. While noninvasive tools remain central in guidelines, EUS-based methods continue to expand their role, especially in complex cases. This review summarizes the applications and impact of EUS in evaluating PH, emphasizing its importance in contemporary hepatology and its potential as a pivotal diagnostic modality in cirrhosis complicated by PH. Full article