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Background: Despite substantial attention paid to the epidemic of nonalcoholic fatty liver disease (NAFLD) in adults, data on the burden and sexual dimorphism of NAFLD in Asian children have not yet been synthesized. Methods: We conducted a literature search of 735 references up to April 2021. Pooled analyses, stratified analyses and meta-regression were all performed. Results: Thirty-three study populations were finally included. Nine of them comprising 20 595 children showed an overall NAFLD prevalence of 5.53% (95% CI 3.46%-8.72%), in which, 36.64% (95% CI, 27.99%-46.26%) NAFLD subjects had elevated levels of ALT. The prevalence rate of NAFLD increased about 1.6-fold from 2004 to 2010 to the last decade. Male predominant trends were observed in paediatric NAFLD (boys: 8.18%, 95% CI 4.93%-13.26%; girls: 3.60%, 95% CI 1.60%-7.87%). Moreover, meta-analysis showed that after 10 years of age, boys were more prone to have NAFLD than girls (OR = 1.75; P = .0012). In addition, the pooled prevalence of NAFLD increased sequentially in normal-weight (1.49%, 95% CI 0.88%-2.51%, n = 2610), overweight (16.72%, 95% CI 7.07%-34.65%, n = 1265) and obese children (50.13%, 95% CI 41.99%-58.27%, n = 6434 individuals). After full covariate adjustment, the multivariate meta-regression also showed that boy percentage (P = .0396) and body mass index (P < .0001) were positively correlated with prevalent NAFLD. Conclusions: In Asia, paediatric NAFLD is becoming prevalent over the recent decades, particularly among obese children and boys after 10 years old. The hormonal and chromosomal origins of paediatric NAFLD dimorphism need further investigation. [ABSTRACT FROM AUTHOR]

The article offers information on the 2010 revised guidelines for the diagnosis and management of alcoholic liver disease (ALD) in China. It states that the intention of these guidelines is for clinicians to be able to make correct decisions on the treatment and diagnosis of ALD. It adds the risk factors of ALD, which had been identified in overseas and domestic studies, including years of drinking, nutritional status, and accumulated alcohol consumption.

The article presents the 2010 guidelines in diagnosing and managing nonalcoholic fatty liver disease (NAFLD). It explains the prevalence of NAFLD in terms of countries and population as well as its risk factors. It mentions that diagnostic criteria include liver biopsy's histological results, mixed hepatocellular steatosis, and vascular blurring seen in abdominal ultrasonography. Furthermore, NAFLD treatment measures include health education, weight gain control, and anti-inflammatory drugs.

OBJECTIVE: To investigate the expression and significance of thioredoxin messenger ribonucleic acid (mRNA) in the development of non-alcoholic fatty liver disease (NAFLD) induced by a high fat diet. METHODS: A total of 48 male Wistar rats were divided into a normal control group and a model group, which were both divided into three subgroups (at weeks 9, 13 and 18, respectively). The levels of serum tumor necrosis factor-α (TNF-α), free fatty acid (FFA), total cholesterol (TC) and triglyeride (TG), changes in the serum and hepatic tissue superoxide dismutase (SOD), reduced glutathione hormone (GSH) and malondialdehyde (MDA) were measured. The expression of thioredoxin mRNA in rat livers were detected with reverse transcriptase polymerase chain reaction (RT-PCR). Meanwhile, the pathological changes of liver tissue were observed by hematoxylin-eosin stain. RESULTS: Simple fatty liver was observed in model group at week 9. From weeks 13 to 18, liver histopathology showed steatohepatitis. Compared with corresponding normal groups, in the model groups the levels of TNF-α, FFA, TC, TG in serum, and MDA in serum and liver increased significantly, while the vitality of SOD and GSH content in serum and liver decreased remarkably. Meanwhile, in the model group, the expression of hepatic thioredoxin mRNA was significantly decreased at week 9 compared with the normal group ( P < 0.01), then increased gradually, but were lower than the corresponding normal groups at all times ( P < 0.01). CONCLUSION: The expression of thioredoxin mRNA is significantly lower in the liver of rats with NAFLD and might reach the lowest point after developing simple fatty liver. Meanwhile the downregulation of thioredoxin mRNA may cause the inflammatory injury initially in NAFLD. [ABSTRACT FROM AUTHOR]

Although chronic infection with hepatitis B virus and/or hepatitis C virus are the most important risk factors for hepatocellular carcinoma (HCC) worldwide, other causes of cirrhosis can also lead to HCC. Given the high prevalence of alcoholism and the worldwide obesity epidemic, the relevant importance of nonviral liver disease-related HCC is expected to increase in the future. Some evidence supports mechanistic interactions between host or environmental factors and chronic viral hepatitis in the development of HCC. For example, food- and water-borne carcinogens have contributed to unusually high rates of HCC in parts of China and sub-Saharan Africa. With some of these conditions, appropriate public health measures to reduce the population's exposure to known etiologic agents, or early therapeutic intervention for ‘at-risk’ individuals before development of cirrhosis (e.g. hereditary hemochromatosis) can prevent HCC. Community-based programs to discourage and deal with excessive alcohol intake, to promote tobacco smoking awareness, to avoid exposure to aflatoxin and other food toxins, and measures to reduce the pandemic of obesity and diabetes are vital for effective interruption of the rising tide of HCC from nonviral liver disease. [ABSTRACT FROM AUTHOR]

The article points out that based on studies, having visceral adipose tissue (VAT) negatively affects the liver but having subcutaneous adipose tissue (SAT) does not affect the liver. It is observed that people with VAT or abdominal fat have a higher risk for developing metabolic syndrome than people who have SAT in their lower bodies.

Insulin resistance is the basis of both non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome (MetS), the two conditions are often found in the same individual. The mortality of patients with NAFLD is significantly higher than that among the general population and cardiovascular risk may compete with liver-related risk in dictating the final outcome. Recent prospective studies have reported that NAFLD is associated with an increased incidence of MetS and type 2 diabetes mellitus, independent of obesity and other components of MetS. Thus, NAFLD may not only be a liver disease but also an early mediator of type 2 diabetes mellitus and MetS. The biological mechanisms by which NAFLD contributes to a higher risk of developing metabolic disorders are not fully understood. However, the fatty liver could contribute in the same way as visceral adipose tissue to insulin resistance, systemic inflammation and oxidative stress, while the decreased serum adiponectin concentrations might also be part of the mechanism. In contemporary clinical practice, it has become mandatory to evaluate the metabolic risk factors in NAFLD patients and to consider careful surveillance and aggressive treatment, not only of the resultant liver disease, but also of the possible underlying metabolic and vascular complications. Future studies might address the question whether earlier adjustment to a more efficient lifestyle or a pharmacological treatment that mobilizes fat out of the liver could reduce these risks. [ABSTRACT FROM AUTHOR]

The article presents information on several guidelines for the diagnosis and treatment of nonalcoholic fatty liver disease (NAFLD), proposed by the Fatty Liver and Alcoholic Liver Disease Study Group of the Chinese Society of Hepatology. NAFLD can be diagnosed, if there is no past record of drinking alcohol, or ethanol intake per week is less than 140 gram in men and 70 gram in women, and if metabolic syndrome constituents, such as, hyperglycemia and hypertension occur.

The article presents information on several guidelines for the diagnosis and treatment of alcoholic liver disease (ALD), proposed by the Fatty Liver and Alcoholic Liver Disease Study Group of the Chinese Society of Hepatology. It informs that these guidelines just aim to help physicians in making correct decision for diagnosing and treating ALD and is not a compulsory standard. It mentions that these guidelines cannot resolve all problems in the diagnosis and treatment of ALD.

Background and Aim: Nonalcoholic fatty liver disease (NAFLD) is considered to be the liver component of metabolic syndrome. However, the impact of NAFLD on metabolic syndrome is unclear. The aim of this study was to explore the influence of NAFLD on the development of metabolic disorders. Methods: Patients with NAFLD and an age, sex, and occupation-matched control group were recruited from employees of Bao-Steel Group (Shanghai, China) who had received medical check-ups biennially between 1995 and 2002. Anthropometric and laboratory data, and incidence of metabolic disorders were assessed at baseline and at follow-up of at least 4 years. SPSS 11.5 was used for statistical analysis. Results: The study consisted of 358 patients (326 men and 32 women) and 788 matched controls (711 men and 77 women) with a similar mean age of 39.0 years and median follow-up of 6 years. At the end of follow-up, incidence of obesity (47.6% vs 19.5%), hypertension (69.6% vs 16.3%), hypertriglyceridemia (39.1% vs 16.3%), hypercholesterolemia (24.5% vs 17.3%), impaired fasting glucose (IFG) (25.1% vs 11.6%), diabetes mellitus (20.3% vs 5.2%) and multiple metabolic disorders (MMD) (56.3% vs 16.3%) were significantly higher in the fatty liver group than the control group. Interestingly, the mean alanine aminotransferase (ALT) level in patients with fatty liver significantly decreased at follow-up compared with baseline (28.56 ± 18.86 vs 31.51 ± 18.34 U/L, P < 0.05). To separate the effects of obesity from fatty liver, the subjects were re-classified according to the presence of obesity and fatty liver at baseline. The incidence of hypertension (61.1% vs 41.3%), hypertriglyceridemia (38.1% vs 15.0%), hypercholesterolemia (29.9% vs 16.6%), IFG (21.3% vs 10.0%) and diabetes (11.1% vs 4.3%) were significantly higher in the fatty liver group without obesity ( n = 84) than in the group with without fatty liver or obesity ( n = 614). In addition, the incidence of hypertension (72.9% vs 57.4%), hypertriglyceridemia (39.4% vs 22.7%) and diabetes (23.2% vs 8.4%) was higher in the group with fatty liver and obesity ( n = 274) than in the group with obesity alone ( n = 174). Conclusions: The presence of NAFLD might predict the development of metabolic disorders due to insulin resistance, rather than obesity itself. ALT levels decreased over time in patients with fatty liver. [ABSTRACT FROM AUTHOR]

Background and Aim: To explore the relationship between fatty liver and the metabolic syndrome in the adults of Shanghai and evaluate the value of fatty liver as a marker for risk factor clustering. Methods: Questionnaires, physical examinations, laboratory tests (blood lipid and glucose) and real-time liver ultrasonographies were performed in Shanghai adults and analyzed using randomized, multistage, stratified cluster sampling. Prevalence of the metabolic syndrome was defined by the National Cholesterol Education Program–Adult Treatment Panel III (NCEP-ATPIII) criteria with the exception of abdominal obesity (waist circumference > 90 cm in men and > 80 cm in women); fatty liver was diagnosed in accordance with the presence of an ultrasonographic pattern consistent with ‘bright’ liver (brightness and posterior attenuation of liver). Results: The study population consisted of 3175 subjects (1218 men) with a mean (± SD) age of 52.4 ± 15.1 years. Metabolic syndrome and fatty liver were found in 726 (22.87%) and 661 (20.82%) of sampled cases, respectively. After adjustment by age and sex, the prevalence of the metabolic syndrome and fatty liver in the general population of Shanghai were 15.30 and 17.29%, respectively. The risk for fatty liver in subjects with abdominal obesity, diabetes, dyslipidemia and hypertension increased 32.78-fold (95% confidence interval (CI) 14.85–72.35), 31.58-fold (95% CI 14.18–70.35), 22.64-fold (95% CI 10.26–49.99) and 23.25-fold (95% CI 10.54–51.30), respectively, compared with controls, whereas the risk for fatty liver in subjects with metabolic syndrome was increased by 39.33-fold (95% CI 17.77–87.05). After the 661 patients with fatty liver had been stratified by body mass index (BMI), the prevalence of abdominal obesity, hypertension and the metabolic syndrome were increased from 25.0, 47.2 and 36.1%, respectively, in people with normal BMI to 81.0, 73.8 and 55.4%, respectively, in obese persons. However, the prevalence of hypertriglyceridemia, high fasting glucose and low high-density lipoprotein–cholesterol showed no significant changes with increased BMI. Moreover, among fatty liver patients with normal BMI, the detection rate for one or more features of metabolic disorders was as high as 83.3% and that for five features was 2.8%. Compared with obesity (BMI ≥ 25 kg/m2) and abdominal obesity, fatty liver had the highest clustering rate, specificity, positive predictive value and attributable risk percentage in detecting risk factor clustering in both sexes. Conclusions: There is a high prevalence of metabolic syndrome and fatty liver among Shanghai adults. Metabolic disorders are closely related to fatty liver; moreover, fatty liver appears to be a good predictor for the clustering of risk factors for metabolic syndrome. [ABSTRACT FROM AUTHOR]

The author examines the prevalence of hepatic steatosis, its probable origins and its potential clinical implications in hepatitis B virus-infected individuals. He says that hepatic steatosis is directly attributable to the hepatitis C virus due to enhanced fatty acid uptake from lipoproteins. There is also strong connection between hepatic steatosis, insulin resistance and triglyceride levels. The disease's implications for individuals with chronic hepatitis B, however, needs further studies.

An introduction to the journal is presented in which the editors discuss an article on the use of non-invasive tools for diagnosis of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) by Leon A. Adams and Ariel E. Feldstein, an article on the relationship of metabolic syndrome with NAFLD by Arthur J. McCullough, and an article on severe alcoholic steatohepatitis diagnosis and management by McCullough and colleagues.

An obituary for gastroenterologist Guang-bi Yao is presented.

A letter to the editor is presented which discusses the relationship between diabetes mellitus (DM) and the recurrence for hepatocellular carcinoma (HCC) in patients with non-B non-C hepatitis undergoing surgical resection or radiofrequency ablation.