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Non-alcoholic fatty liver disease (NAFLD), a major cause of chronic liver disease, is known to affect a quarter of the global adults. Natural history of NAFLD shows interindividual variation, traditionally it progresses from simple steatosis to steatohepatitis to fibrosis/cirrhosis and finally yet rarely to hepatocellular carcinoma. It is largely a lifestyle-related disease and is often labeled as the hepatic manifestation of metabolic syndrome. Both prevention and control of NAFLD include controlling risk factors (obesity, diabetes mellitus, hypertension and dyslipidemia), through lifestyle modification and medications. Drug therapy for NAFLD per se is still evolving and till date, no drugs are approved. It is clinically silent, especially in the early stages, and is a diagnosis of exclusion. Certain easily calculated indices can stratify cases into high or low risk for advanced fibrosis, thereby dictating appropriate monitoring and treatment measures. In addition to complications specific to liver disease in those who do progress to advanced fibrosis or cirrhosis, an increased risk of nonliver disease-related morbidity and mortality is also present. Challenges are manifold and include rising burden due to ever-growing epidemic of diabetes and obesity, low public awareness, fragmented healthcare, no approved drugs, and dearth of data on magnitude and epidemiology of the disease. The recent integration of NAFLD into the National Program for Prevention and Control of Non-Communicable Diseases (NPCDCS) by the Ministry of Health and Family Welfare of India is a welcome step in this direction as the contributory factors are mostly the same for all diseases and controlling any one or all of them will have a desired impact on the prevalence of all the diseases under this program. [ABSTRACT FROM AUTHOR]

Background/Objectives: Atopic dermatitis (AD) is a chronic inflammatory skin disorder that affects children worldwide, with potential associations to metabolic syndrome (MetS) and non‐alcoholic fatty liver disease (NAFLD). Limited research exists on the interplay between AD, MetS, and NAFLD in the pediatric population. This study aimed to investigate the prevalence and potential relationships among AD, MetS, and NAFLD in children. Methods: A case–control study design was employed, recruiting 50 children with AD (median age: 9.5 years) and 50 age‐ and sex‐matched healthy controls (median age: 11.5 years, p =.051). Data on demographic characteristics, clinical features, disease severity, treatment history, anthropometric measurements, and laboratory evaluations were collected. MetS and NAFLD were diagnosed based on established criteria. Results: The prevalence of MetS was significantly higher in children with AD compared with controls (24% vs. 2%, p =.002). Significant differences for systolic blood pressure (p <.001), diastolic blood pressure (p =.012), and waist circumference (p =.040) were observed between AD patients and controls. Children with AD had higher triglyceride levels (p =.005). NAFLD was exclusively seen in moderate to severe AD cases (6% vs. 0%, p =.242). AD severity showed associations with increased body mass index (p =.020). Conclusion: This study highlights the increased prevalence of MetS and the potential association with NAFLD in children with AD. The findings suggest that AD may contribute to the development of metabolic abnormalities at an early age. Further research is needed to elucidate the underlying mechanisms and explore preventive strategies for these interconnected conditions. [ABSTRACT FROM AUTHOR]

Introduction: Non-alcoholic steatohepatitis (NASH) represents a clinicopathological condition characterized by histological alterations akin to those induced by excessive alcohol consumption, despite the absence of alcohol abuse. This investigation aims to assess the clinical, biochemical, and histological characteristics of NASH within a tertiary healthcare facility situated in India. Materials and Methods: This study adopted an observational, prospective, single-center approach involving patients of varied ages and genders, presenting with heightened liver echogenicity upon routine ultrasound examination. Clinical, biochemical, and histological profiles of the patients were studied. Results: A cohort of 89 patients participated in the study, comprising 53 males and 36 females. Predominantly, individuals aged between 41 and 50 years constituted the majority. The most prevalent symptom reported was fatigue and malaise, succeeded by right upper abdominal discomfort, jaundice, ascites, and upper gastrointestinal bleeding. Notably, 30 patients remained asymptomatic at the time of diagnosis, with abnormalities detected via sonographic examination and liver function tests conducted during investigations for alternative etiologies. Hyperlipidemia, diabetes mellitus, obesity, and overweight conditions emerged as the leading associated risk factors. Biopsies were performed on 10 patients, majority revealing fatty changes. Conclusion: This investigation underscores the heightened prevalence of features indicative of the metabolic syndrome among individuals diagnosed with NASH. These findings suggest a significant overlap with systemic disorders associated with insulin resistance syndrome, including hyperlipidemia, hypertension, obesity, type 2 diabetes mellitus, and hepatic steatosis. [ABSTRACT FROM AUTHOR]

Background: Non alcoholic fatty liver disease(NAFLD) is emerging as an important cause of liver disease in India. The prevalence of NAFLD in Indian population is reported to be between 9-32% which is almost comparable to the Western countries. NAFLD is considered the hepatic manifestation of the metabolic syndrome and shares a strong association with Type 2 diabetes mellitus. Materials and methods - It is a Prospective Observational study, conducted between October 2018 to April 2020 on 200 NAFLD patients detected with fatty liver on abdominal ultrasound examination. Results- In our study, the mean age of NAFLD patients is 47. 9 years. The prevalence of NAFLD increases with increasing age. The prevalence of NAFLD in men is higher with 117(58. 5%) males and 87(41. 5%) female. The prevalence of components of metabolic syndrome, i. e Obesity/overweight, hypertension, dyslipidemia and T2DM is 39. 5%, 18. 5%, 69% and 46% respectively. Based on Fibroscan examination the mean stiff ness score is 7. 09 (SD 5. 07) kpa. Conclusion- The combined use of Fibroscan with other non invasive biomarkers is useful in detecting the advanced fibrosis in NAFLD patients and also for the follow up of patients with minimal disease, thus avoiding the need for liver biopsy. [ABSTRACT FROM AUTHOR]

Background: Non-alcoholic fatty liver disease (NAFLD) has become the most common liver disease in the world mainly because of the obesity pandemic. Objective: to assess the prevalence and association of NAFLD in Type II Diabetics with one or more components of the metabolic syndrome. Methods: The present observational cross sectional study was carried out at tertiary care center of central India from November 2020 to October 2022. Results: There were 46(59.7%) males and 31(40.3%) females. The mean age of cases with NAFLD was found to be 52.89±10.61 years. There is an increased risk of 1.667 times was observed for those with high BMI in association to with NAFLD which is statistically not significant. The mean HbA1C was higher in cases with NAFLD than in cases without NAFLD which is not statistically significant. Among the cases, 34 were diabetics with no other component of metabolic syndrome and 38.23% (13/34) of them had NAFLD; Conclusions: There is high period prevalence of NAFLD in type 2 Diabetic males. Study did not observe significant association between NAFLD and components of metabolic syndrome. [ABSTRACT FROM AUTHOR]

Background and Aim: There is currently no published study comparing prevalence of non-alcoholic fatty liver disease (NAFLD) and associated factors among diabetics of different ethnicity in the Asia-Pacific region., Methods: Cross-sectional study of consecutive patients in the Diabetic Clinic in University of Malaya Medical Centre. The Global Physical Activity Questionnaire and a semiquantitative food-frequency questionnaire were used to assess physical activity and dietary intake, respectively. Diagnosis of NAFLD was ultrasound-based and following exclusion of significant alcohol intake., Results: Data for 399 patients were analyzed (mean age 62.3 ± 10.5 years, 43.1% men). The racial distribution was Chinese 43.6%, Indian 33.1%, Malay 22.3%, and others 1.0%. The prevalence of NAFLD was 49.6%. On univariate analysis, factors associated with NAFLD were age < 65 years, race, obesity, central obesity, glycated hemoglobin ≥ 7.0%, and elevated serum alanine aminotransferase (ALT) and gamma-glutamyl transpeptidase levels. Patients with low physical activity were more likely to have NAFLD (odds ratio [OR] = 1.67, 95% confidence interval [CI] = 1.06-2.63, P = 0.020). The prevalence of NAFLD was highest among Malays (60.7%), followed by Indians (51.5%), and lowest among Chinese (42.0%) consistent with higher prevalence of central obesity and higher percentage calorie intake from fat in the former groups of patients. On multivariate analysis, independent factors associated with NAFLD were central obesity (OR = 2.20, 95% CI = 1.29-3.75, P = 0.004) and elevated serum ALT level (OR = 1.98, 95% CI = 1.21-3.25, P = 0.007)., Conclusions: NAFLD was seen in half of a cohort of diabetic patients and was independently associated with central obesity and elevated serum ALT level. Prevalence of NAFLD was different and paralleled the difference in prevalence of central obesity and in percentage calorie intake from fat among the different ethnic groups., (© 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.)

Objectives: Association between sub-clinical inflammation and non-alcoholic fatty liver disease (NAFLD) has not been studied in Asian Indians. In this case-control study, we aimed to analyse association of NAFLD with the sub-clinical inflammation and metabolic profile in Asian Indians in north India., Methods: Ultrasound diagnosed 120 cases of NAFLD were compared to 152 healthy controls without NAFLD. Anthropometric profile [body mass index (BMI), waist circumference (WC), hip circumference (HC)], high-sensitivity C-reactive protein (hs-CRP), metabolic profile [fasting blood glucose (FBG), lipid profile] and hepatic function tests [alanine aminotransferase (ALT) and aspartate aminotransferase (AST)] were recorded., Results: Metabolic parameters [FBG, total cholesterol (TC), serum triglycerides (TG),low-density lipoprotein (LDL-c)], hs-CRP and prevalence of the metabolic syndrome were higher in cases as compared to controls (p-value<0.05 for all). The median (range) of hs-CRP (mg/L) for cases [2.6(0.2-13.4)] were significantly higher than in controls [1.4(0.03-11.4), p = 0.01]. Similarly, higher values of hs-CRP were obtained when subgroups of cases with obesity, abdominal obesity and the metabolic syndrome were compared to controls [2.75 (0.03-14.3) vs. 1.52 (0.04-14.3), p = 0.0010; 2.8 (0.03-14.3) vs. 1.5 (0.06-14.3), p = 0.0014 and 2.7 (0.5-14.3) vs. 1.6 (0.06-8.5), p = 0.0013, respectively. On multivariate logistic regression analysis BMI (p = 0.001), WC (p = 0.001), FBG (p = 0.002), TC (p = 0.008), TG (p = 0.002), blood pressure (p = 0.005), metabolic syndrome (p = 0.001) and hs-CRP (p = 0.003) were significantly and independently associated with NAFLD. After adjusting for significant variables, the association between high hs-CRP and NAFLD remained large and statistically significant [adjusted OR = 1.17, 95% confidence interval (CI) = 1.05-1.29]. An increase in 1 mg/dl of hs-CRP level calculated to increase the risk of developing NAFLD by 1.7 times as compared to controls after adjusting for significant variables associated with NAFLD., Conclusions: In this cohort of Asian Indians in North India, presence of NAFLD showed independent relationships with sub-clinical inflammation.

Background: Genetics of non-alcoholic fatty liver (NAFLD) in Asian Indians has been inadequately studied. We investigated the association of polymorphisms C161T and Pro12Ala of peroxisome proliferator-activated receptor gamma (PPARγ) with clinical and biochemical parameters in Asian Indians with NAFLD., Methods: In this case-control study, 162 NAFLD cases and 173 controls were recruited. Abdominal ultrasound, clinical and biochemical profiles, fasting insulin levels and value of homeostasis model assessment of insulin resistance were determined. Polymerase chain reaction-restriction fragment length polymorphisms of two polymorphisms were performed. The association of these polymorphisms with clinical and biochemical parameters was analysed., Results: Higher frequency of Ala and T alleles of PPARγ was obtained in cases. Ala/Ala genotype of PPARγ (Pro12Ala) was associated with significantly higher serum triglycerides (TG), alkaline phosphatase (ALK) and waist-hip ratio in cases as compared to controls. In C161T polymorphism, TT genotype was significantly increased TG (p=0.04), total cholesterol (p=0.01), ALK (p=0.04) and gamma-glutamyl transpeptidase (p=0.007) in cases. The linkage disequilibrium for these two single-nucleotide polymorphisms of PPARγ was differed in cases (D1=0.1; p=0.006) and controls (D1=0.07; p=0.1). Using a multivariate analysis after adjusting for age, sex and body mass index, the presence of NAFLD was linked to these two polymorphisms (odds ratio 1.64 (95% CI: 1.09-2.45, p=0.05)]., Conclusion: Asian Indians in north India carrying the alleles Ala and T of PPARγ (Pro12Ala and C161T) polymorphisms are predisposed to develop NAFLD., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Objective: We aim to determine whether a simple Indian diabetes risk score (IDRS) is associated with individuals with non-alcoholic fatty liver disease (NAFLD) among nondiabetic Asian Indians., Methods: Nondiabetic participants (n = 409) were selected from the Chennai Urban Rural Epidemiology Study. Mean age was 40 ± 11.9 years, mean body mass index was 23.2 ± 3.9 kg/m(2), and 224 (54.8%) were women. The IDRS was classified as high (≥60), medium (30-50), and low (<30) risk. Non-alcoholic fatty liver disease was assessed by high-resolution β mode ultrasonography. To determine the factors associated with NAFLD, a univariate analysis was first done and a stepwise logistic regression analysis was done based on the factors associated with NAFLD. Biochemical and anthropometric measurements were obtained using standardized procedures., Results: The overall prevalence of NAFLD was 24.7% (101/409 participants), and it was significantly higher among those with a high (30.4%) and medium IDRS (21%) compared with the low IDRS group (15.8%; trend chi square; p = .022). In stepwise logistic regression, IDRS was associated with NAFLD with an adjusted odds ratio of 1.78 (95% confidence interval 1.04-3.06), even after adjusting for potential confounders., Conclusions: The IDRS can be used as the initial step to screen individuals at high risk of NAFLD in the community., (© 2012 Diabetes Technology Society.)

A cross sectional study was conducted in 100 children, aged 5 to 12 years, to find the prevalence of non-alcoholic fatty liver diseases (NAFLD), at New Delhi. Those with fatty liver on ultrasonography with no apparent etiology, were labeled as NAFLD. Three (3%) children had evidence of fatty liver on ultrasonography.

Background & Objectives: The cytokines, adipokines, and oxidative stress have been implicated in the pathogenesis of non-alcoholic fatty liver disease (NAFLD); however, such data remain scarce in India. The present study evaluated pro-inflammatory cytokines, adipokines, and markers of oxidative stress in patients with non-alcoholic fatty liver disease (NAFLD), and their association with degree of adiposity, insulin resistance and markers of disease severity., Methods: The present prospective cross-sectional pilot study included 79 subjects; 34 NAFLD, 22 chronic hepatitis B (CH-B) and 23 healthy controls (HC). The parameters studied were adiponectin, leptin, tumour necrosis factor α (TNFα), interleukin-1 and 6 (IL-1, IL-6), and systemic markers of oxidative stress., Results: The mean body mass index (kg/m 2 ) in NAFLD patients, CHB, and HC were 26.4±3.7, 21.3±2.3, and 22.3±2.7, respectively. The median serum levels of all pro-inflammatory cytokines were significantly higher (P<0.001) in NAFLD compared to control groups. Compared to HC, levels of adiponectin and leptin were significantly (P<0.05, P<0.01) reduced in both NAFLD and CHB. IL-6 showed marked and selective increase only in NAFLD patients. The levels of IL-6 were significantly (P<0.02) higher in NAFLD patients with advanced histology grade and correlated with IR (r=0.42, P=0.02). In a sub-group, markers of oxidative stress were significantly higher, and that of antioxidant potential were significantly lower among NAFLD patients compared to control subjects., Interpretation & Conclusions: Patients with NAFLD revealed significantly elevated levels of pro-inflammatory cytokines, increased oxidative stress, and a significant association of IL-6 with IR and advanced histopathology.

Background: Genetics of non-alcoholic fatty liver (NAFLD) in Asian Indians has been inadequately investigated. This study aims to determine the association of the 1784G>C polymorphism in the SREBP-2 gene with NAFLD in Asian Indians in north India., Methods: In this study, (n=335); 162 obese with NAFLD, 91 obese without NAFLD and 82 non-obese without NAFLD subjects were recruited. Abdominal ultrasound, clinical profile, anthropometry, metabolic profile, serum levels of alanine aminotransferase, aspartate aminotransferase, fasting insulin and high sensitivity C-reactive protein (hs-CRP) were analysed. Polymerase chain reaction and restriction fragment length polymorphism were used to identify individual genotypes, and the association of this polymorphism with clinical and biochemical parameters was assessed., Results: The observed frequency of G allele was 0.73 and C allele was 0.27. Frequency of C/C genotype was higher in NAFLD as compared to obese and non-obese subjects (p=0.003). In NAFLD subjects 57.4% were G/G homozygous, 31.5% G/C heterozygous and 11.1% were C/C homozygous. The SREBP-2 genotype frequencies deviated from the Hardy Weinberg Equilibrium (X² = 6.39, p = 0.0114). Mean values of TG (p = 0.002), TC (p =0.002), ALT (p =0.04) and AST (p =0.03) levels were significantly higher in NAFLD subjects with G/C genotype as compared to G/G genotypes in obese and non-obese groups. Fasting insulin (p =0.03), HOMA (p =0.009) and hs-CRP levels were significantly higher in NAFLD subjects with G/C genotype as compared to obese and non obese subjects with G/G genotypes., Conclusion: In this study, conducted for the first time in Asian Indians, SREBP-2 1784 G>C genotype was associated with NAFLD.

Background and Objectives: The purpose of research was to investigate the incidence of non-alcoholic fatty liver disease, also known as fatty liver, in diabetic patients. Methods: The research was done from June 2019 to May 2020 at Department of General Medicine, Katuri Medical College and Hospital, Guntur, Andhra Pradesh, India. 85 type 1 and type 2 diabetics were examined. IPD and OPD patients participated. The study group included 20 males and 65 females, ages 19 to 73. Results: 3 males (3.5%) had fatty liver and 30 females (35.3%). In 36 of 85 diabetics tested, fatty liver was detected. Patients with fatty liver and central obesity (waist-hip ratio >1): 25 (69.44%). Patients with fatty liver had >180 triglycerides 31 (86.1%). Overweight patients with fatty liver numbered 24 (66.67%). 12 fatty liver patients had normal BMIs (33.33%). Patients with fatty liver and high cholesterol (>200 mg %): 23 (69.69%). No change in serum protein or albumin globulin ratio. Conclusion: Non-alcoholic fatty liver disease was 42.35% frequent, especially in type 2 diabetics. It affected women (35.3%) more than males. NAFLD is more common in extremely obese and centrally obese people. 90% of fatty liver sufferers had dyslipidaemia's (particularly hypertriglyceridemia). [ABSTRACT FROM AUTHOR]

Introduction: Obesity is a risk factor for the development of diabetes, and these two are directly implicated in an individual's risk of developing Non Alcoholic Fatty Liver Disease (NAFLD), which is a major factor in Metabolic Syndrome (MS). NAFLD and Type 2 Diabetes Mellitus (T2DM) are known to frequently coexist and act synergistically to elevate the risk of hepatic as well as extrahepatic complications. Aim: To determine the levels of renal profile, electrolytes, Glycosylated Haemoglobin (HbA1c), and Body Mass Index (BMI) in T2DM patients with and without NAFLD, as well as in control subjects, and to assess the correlation of BMI and HbA1c with renal profile and electrolytes in T2DM patients with and without NAFLD. Materials and Methods: This case-control study was conducted in the Department of Biochemistry and the Diabetes Speciality Clinic in the Department of General Medicine at MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India, from December 2021 to March 2023. The study included a total of 90 subjects divided into three groups (30 in each): Group 1-Control, Group 2-T2DM with NAFLD, and Group 3-T2DM without NAFLD. Aseptic blood collection was performed, and Renal Function Test (RFT), electrolytes, and HbA1c levels were analysed. Group comparisons were done using unpaired t-tests, and correlation analysis was conducted using Pearson's correlation with Statiistical Package for Social Sciences (SPSS) software version 25.0. Results: The authors found that 57% of the total enrolled population were female, while the remaining 43% were male, with a mean age of (49.03±5.09) years. Mean levels of HbA1c (9.55±1.78, 8.61±1.42%), BMI (28.84±4.19, 23.51±2.09) kg/m², Urea (31.62±6.28, 33.02±5.11) mg/dL, Creatinine (1.29±0.18, 1.36±0.10) mg/dL, and Uric acid (6.74±1.19, 6.01±0.83) mg/dL were found to be significantly higher in Group 2 and Group 3, respectively, compared to controls. A positive significant correlation of BMI with uric acid, HbA1c with urea, creatinine, and uric acid in Group 2 and 3 was observed. However, no derangement was observed concerning electrolytes in any group. Conclusion: The correlation of urea, creatinine, and uric acid with HbA1c provides the authors with information on impaired renal function in diabetic as well as NAFLD participants. Hyperuricaemia in these individuals can aggravate the risk of T2DM and NAFLD, leading to its progression in Non Alcoholic Steatohepatitis (NASH), respectively. [ABSTRACT FROM AUTHOR]

Non-alcoholic fatty liver disease (NAFLD) contributes to a large proportion of liver disease burden in the world. Several groups have studied the prevalence of NAFLD in the Indian population. A systematic review of the published literature and meta-analysis was carried out to estimate the prevalence of NAFLD in the Indian population. English language literature published until April 2021 was searched from electronic databases. Original data published in any form which had reported NAFLD prevalence in the Indian population were included. The subgroup analysis of prevalence was done based on the age (adults or children) and risk category, i.e., average-risk group (community population, participants of control arm, unselected participants, hypothyroidic individuals, athletes, aviation crew, and army personnel) and high-risk group (obesity or overweight, diabetes mellitus, coronary artery disease, etc.). The prevalence estimates were pooled using the random-effects model. Heterogeneity was assessed with I2. Sixty-two datasets (children 8 and adults 54) from 50 studies were included. The pooled prevalence of NAFLD was estimated from 2903 children and 23,581 adult participants. Among adults, the estimated pooled prevalence was 38.6% (95% CI 32–45.5). The NAFLD prevalence in average-risk and high-risk subgroups was estimated to be 28.1% (95% CI 20.8–36) and 52.8% (95% CI 46.5–59.1), respectively. The estimated NAFLD prevalence was higher in hospital-based data (40.8% [95% CI 32.6–49.3%]) than community-based data (28.2% [95% CI 16.9–41%]). Among children, the estimated pooled prevalence was 35.4% (95% CI 18.2–54.7). The prevalence among non-obese and obese children was 12.4 (95% CI 4.4–23.5) and 63.4 (95% CI 59.4–67.3), respectively. Available data suggest that approximately one in three adults or children have NAFLD in India. [ABSTRACT FROM AUTHOR]

Background: Non-alcoholic fatty liver disease (NAFLD) is becoming one of the most common liver diseases among the Indian population. The predisposing factors for NAFLD are diet, lifestyle modifications, and lack of exercise. There is a paucity of research on NAFLD in the South Indian population. Hence, the present study aimed to assess the prevalence of NAFLD among the urban adult population in Chennai. Material and Methods: This analytical cross-sectional study was conducted in General Medicine outpatient departments at a tertiary care center in Chennai. The study included 510 non-alcoholic adults (both male and female) aged between 21 and 40 years. Ultrasonography was performed to rule out fatty liver in all participants. All the results obtained were statistically analyzed using SPSS software version 22.0. The frequency was given in percentage. Results: The proportion of participants who screened positive for NAFLD was 61.5%. The participants with higher body mass index (BMI) were found to be significantly 23.09 times higher risk of developing NAFLD. An increase in age was also found to be a predictor of NAFLD. This study also supports that males are more prone to develop NAFLD and are at a 1.59% higher risk of developing the disease than females. Conclusion: Fatty liver has become one of the common non-communicable diseases in India, the high prevalence of NAFLD in the present study supports it. Therefore, people should have regular screening and diagnosis to rule out fatty liver disease. Proper diet patterns and exercise must be followed to prevent fatty liver. [ABSTRACT FROM AUTHOR]

Background: Non-alcoholic fatty liver disease (NAFLD) is a spectrum of disease ranging from simple steatosis, non-alcoholic steatohepatitis (NASH), through to advanced fibrosis and cirrhosis. We assessed the prevalence, spectrum, and determinants of NAFLD among adults in urban and rural North India. Methods: A representative sample of adults aged 30–60 years were recruited from urban Delhi and rural Ballabhgarh during 2017–2019. Participants underwent abdominal ultrasonography (USG) and vibration controlled transient elastography (VCTE) with FibroScan to assess fatty liver and fibrosis, respectively. We estimated the age- and sex-standardised prevalence of NAFLD and its spectrum. The factors associated with 'ultrasound-diagnosed NAFLD' were identified using multivariate logistic regression. Results: A total of 828 urban (mean ± SD age: 45.5 ± 8.0 years; women: 52.7%) and 832 rural (mean ± SD age: 45.1 ± 7.9 years; women: 62.4%) participants were recruited. The age- and sex-standardized prevalence of ultrasound-diagnosed NAFLD was 65.7% (95%CI: 60.3–71.2) in the urban and 61.1% (55.8–66.5) in the rural areas, respectively. The prevalence of NAFLD with elevated alanine transaminase (≥40IU/L) was 23.2% (19.8–26.6), and 22.5% (19.0–26.0) and any fibrosis by liver stiffness measurement on transient elastography (≥6.9 kPa) was 16.5% (13.8–19.8) and 5.2% (3.8–6.7) in urban and rural participants, respectively. In both urban and rural areas, diabetes, central obesity and insulin resistance were significantly associated with NAFLD. Conclusion: NAFLD prevalence was high among rural and urban North Indian adults, including fibrosis or raised hepatic enzymes. The strong association of metabolic determinants confirms its linkage with metabolic syndrome. [ABSTRACT FROM AUTHOR]

Objective: To study hepatic gluconeogenesis pathway in non-diabetic Asian Indian males having non-alcoholic fatty liver disease (NAFLD) using in vivo ((31)P) phosphorous magnetic resonance spectroscopy (MRS) and correlate these data with anthropometry and insulin resistance., Research Design and Methods: Forty non-diabetic patients with NAFLD and 20 healthy controls were divided into (i) obese with NAFLD (group I, n=20), (ii) non-obese with NAFLD (group II, n=20) and (iii) non-obese without NAFLD (group III, n=20). Anthropometric and biochemical profiles, short insulin tolerance test (SITT), liver ultrasound, and (31)P MRS (to determine hepatic gluconeogenesis metabolite; phosphomonoesters (PMEs), inorganic phosphate (Pi) and their ratios with respect to ATP) were done., Results: Insulin resistance (Kitt value) was highest in group I (p<0.05; compared to other two groups), but was also higher in group II as compared to group III (p=ns). The values of PME/Pi, PME/gammaATP, PME/betaATP, PME/tATP ratios were higher (p<0.05) in group I compared to other two groups. Interestingly, non-obese subjects with NAFLD also showed more derangements of hepatic gluconeogenesis metabolites than non-obese subjects without NAFLD. Positive correlation was observed between PME and other ratios in relation to body mass index, waist circumference, body fat percentage and fasting serum insulin levels in all the three groups., Conclusions: Derangements in hepatic gluconeogenesis as assessed non-invasively using (31)P MRS, was observed in obese and non-obese, non-diabetic Asian Indians with NAFLD. Further research is warranted whether this investigation in NAFLD subjects could be developed as a non-invasive tool to assess those predisposed to develop hyperglycemia.

Post-transplant non-alcoholic fatty liver disease (NAFLD) is common but is not well described in the living donor liver transplantation (LDLT) setting. The study was conducted at a large volume LDLT center in north India. Adult (age >18 years at the time of transplant) liver transplantation (LT) recipients were included. Patients with any history of alcohol use were excluded. The study was conducted prospectively from July 2022 to April 2023, and all patients with a minimum of 1-year follow-up after transplant attending outpatient services were included. NAFLD was diagnosed by ultrasound showing steatosis in the absence of other etiologies. The study cohort included 103 males and 14 females, aged 48 ± 10 years at the time of LT and 53 ± 10 years at the time of inclusion in the study. The median follow-up from LT was 62 (32–97 months). A total of 39 (33%) patients suffered from post-LT NAFLD. NAFLD was recurrent in 9/23 (39%, in patients with NASH or cryptogenic cirrhosis as etiology of LT) and de novo in 30/94 (31%). Pre and post-LT higher body mass index, presence of diabetes and higher serum triglycerides values were associated with the development of post-LT NAFLD. Post-transplant metabolic syndrome was present in 58/95 (61%) LDLT recipients using HbA1c 5.7 to 6.4 as a marker of prediabetes. Post-LT NAFLD was present in one-third of the patients and metabolic syndrome in the majority of the patients at a median follow-up of 62 months after LDLT. [ABSTRACT FROM AUTHOR]

Background: Non-alcoholic fatty liver disease (NAFLD) has become an Important entity globally, including in India and other Asian countries. Morphological evaluation of a liver biopsy is necessary for the diagnosis, staging and possibly management of this disease. However, the spectrum of changes in the liver, their evolution, Interrelationships and implications are incompletely understood. We aimed to study the spectrum of histological abnormalities in NAFLD., Methods: The study material was drawn from a pool of 80 liver biopsies diagnosed in our laboratory as NAFLD, 67 retrieved retrospectively from our records and 13 obtained prospectively with complete clinical data. After comprehensive histological assessment, a detailed analysis was done of 32 of those categorized as definitive NAFLD on the basis of a dependable history of no alcohol Intake and seronegativity for hepatitis virus B and C Infections., Results: Fatty change was preferentially seen in acinar zones 2 and 3, more so in the former. Steatotic cells varied in size; some large ones were non-spherical. Steatosis alone was present in more than a quarter of the cases and steatosis along with inflammation was present in half. The magnitude of steatosis correlated with inflammation, while both these seemed to correlate with hepatocyte Injury and fibrosis., Conclusion: A proportion of patients with NAFLD show only hepatic steatosis. An Increasing grade of steatosis is associated with greater Inflammation, hepatocyte injury and acinar fibrosis. Preferential involvement of acinar zone 2 by steatosis, the morphology of the steatotic cells, and nature and location of inflammation are important in the diagnosis of NAFLD and its differentiation from other causes of fatty liver.

Background and Aim: Non-alcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease and liver transplantation in western countries. Increasing incidence of NAFLD has been well documented from Asian countries like Japan and China. Diabetes mellitus (DM), obesity, hyperinsulinemia are predisposing factors for NAFLD. There is increase in incidence of DM, obesity and insulin resistance in India in last two decades. Hence it is logical to expect increase in incidence of NAFLD in India. There is limited data on the prevalence of NAFLD from India. Majority of data comes from hospital based studies including small number of patients. Therefore this study was planned to estimate the prevalence of NAFLD in general population., Material and Methods: Residents of two Railway colonies were evaluated on history, clinical examination, anthropometric measurements, biochemical tests and abdominal ultrasound., Results: 1,168 participants were evaluated. Persons with any amount of alcohol consumption, HBs Ag positive, Anti HCV positive, persons with other known liver diseases and taking medications causing liver disease were excluded. Prevalence of NAFLD on ultrasound was 16.6%. Out of 730 subjects above the age of 20 years (341 male 384 female 389) mean age 39.08 +/- 12.3 years, 4% had diabetes, 57% had central obesity. Prevalence of NAFLD based on the ultrasound above 20 years of age was 18.9%. NAFLD was more prevalent in male than female (24.6% vs 13.6%, p < 0.001). Risk factors associated with NAFLD were age more than 40 years, male gender, central obesity, high BMR > 25, elevated fasting blood sugar, raised AST and ALT., Conclusion: Prevalence of NAFLD in Indian population is comparable to the west.

Aim: To evaluate the clinical and biochemical profile of patients with non alcoholic fatty liver disease (NAFLD) and to assess their histological severity at presentation., Methods: Consecutive patients presenting to the liver clinic of All India Institute of Medical Sciences (AIIMS) with raised transaminases to at least 1.5 times upper limit of normal, and histologically confirmed non-alcoholic fatty liver disease were included. Patients who had significant alcohol intake or positive markers of other liver diseases or who were taking drugs known to produce fatty liver were excluded. The clinical, biochemical and histological profile of this group was studied., Results: Fifty-one patients with NAFLD formed the study population. Their median age and BMI were 34(17-58) years and 26.7(21.3-32.5) kg/m(2) respectively and 46 (90.1%) were males. The majority of the patients had mild inflammation, either grade 1 [32 (63%)] or grade 2 [16 (31%)] and only 3 (6%) patients had severe (grade 3) inflammation. Twenty-three (45%), 19 (37%), 8(16%) and 1(2%) patient had stage 0, 1, 2 and 3 fibrosis respectively on index biopsy and none had cirrhosis. On univariate analysis, triglyceride levels more than 150 mg % (OR = 7.1; 95% CI: 1.6-31.5, P = 0.002) and AST/ALT ratio>1 (OR = 14.3; 95% CI: 1.4-678.5, P = 0.008) were associated with high grades of inflammation and none was associated with advanced fibrosis. On multivariate logistic regression analysis, hypertriglyceridemia >150 mg% was the only factor independently associated with presence of high grade of inflammation (OR = 1.6; 95% CI: 1.3-22.7, P = 0.02), while none was associated with advanced fibrosis. Triglyceride levels correlated positively with inflammatory grade (r = 0.412; P = 0.003)., Conclusion: NAFLD in North Indian patients is a disease of young over-weight males, most of whom are insulin resistant and they tend to have a mild histological disease at presentation.

Background: Over the years, increasing obesity, hypertension and diabetes mellitus have led to higher incidence and prevalence of Non-alcoholic Fatty Liver Disease (NAFLD) in India, which was initially thought to be a disease of developed countries. NAFLD is the most common cause of chronic liver disease in the western countries and now it is in rapid rise in India. Liver biopsy is a gold standard in NAFLD diagnosis. As liver biopsy is an invasive procedure various noninvasive markers are being explored to assist in diagnosis of NAFLD. One such promising marker which is being studied is Mean Platelet Volume (MPV). Nevertheless, studies utilizing MPV for the diagnosis of NAFLD are rare. Aim and Objectives: To measure levels of MPV in NAFLD patients and compare with healthy controls. Material and Methods: A total of 86 subjects, 43 NAFLD and 43 healthy controls, were included. Baseline variables, laboratory parameters and MPV recorded were compared between both the groups. Results: Demographic variables [Body Mass Index (BMI), waist circumference], laboratory variables (total leukocyte count, plateletcrit, MPV), liver function tests (alanine transferase, alkaline phosphatase, gamma glutaryl transferase) and lipid parameters (high-density lipoprotein, low-density lipoprotein, very low-density lipoprotein) were significantly higher in the NAFLD group. MPV correlated positively with aspartate aminotransferase (r: 0.2834, p=0.0082), alanine transferase level (r: 0.2834; p=0.0082) and the presence of NAFLD (0.6019; p<0.001). After adjusting all the covariates, only NAFLD was found to be the independent predictor of increased MPV [Odds Ratio (OR) =8.22 95% Confidence Interval (CI)(2.75 - 27.95) P < 0.001]. A cut‐off MPV >10.6 fL yielded 72.09% sensitivity, 76.74% specificity, 75.61% positive predictive value and 73.33% negative predictive value. Conclusion: The study results show an increase in MPV in patients with NAFLD. [ABSTRACT FROM AUTHOR]

Introduction: Non Alcoholic Fatty Liver Disease (NAFLD) is one of the major leading causes of liver diseases, comprising a spectrum of conditions ranging from simple steatosis to cirrhosis. In the era of preventive medicine, it is of utmost importance to recognise the subset of NAFLD patients at high risk of progressing to liver cirrhosis. A newly emerging concept of myosteatosis is now suspected to be an early manifestation of NAFLD disease progression. Aim: To find the correlation between myosteatosis and liver fibrosis among patients with NAFLD. Materials and Methods: This was a cross-sectional study conducted in the Department of Radiodiagnosis and Department of Gastroenterology at Amala Institute of Medical Sciences in Thrissur, Kerala, India, from January 2021 to June 2022. A total of 57 subjects with Magnetic Resonance Imaging-proven (MRI) NAFLD were included in the study. Body weight and height were measured. Liver fat and myosteatosis were measured using the MRI-derived Proton Density Fat Fraction (PDFF) method {Iterative Decomposition of Water and Fat with Echo (IDEAL-IQ sequence)}. Liver fibrosis was assessed using 2D shear wave elastography. The proportion of myosteatosis and liver fibrosis among NAFLD patients was estimated. Partial correlation, controlling for gender, was evaluated using partial Spearman's rho correlation coefficients. An Reciever Operating Characteristic (ROC) curve was plotted to assess muscle fat fraction in predicting liver fibrosis outcome among patients. Results: Out of the 57 subjects studied, 17 were females and 40 were males. The median Interquartile Range (IQR) age of the subjects was 43.0 (16.5). The median MRI hepatic fat fraction was 10.8. The median muscle PDFF in males was 8.4, and in females, it was 16.9. The median H-PDFF was 18.8. Myosteatosis correlated positively with liver fibrosis (r=0.558; p<0.001). It also negatively correlated with hepatic steatosis (r=-0.321; p=0.02). A statistically significant correlation was not found between liver fat and liver fibrosis. An ROC curve was plotted to predict the liver fibrosis outcome by muscle fat fraction {Area Under Curve (AUC: 0.605; p-value: 0.204)}, which showed a sensitivity of 0.615 and a specificity of 0.389 at a cutoff score of 10.43. Conclusion: Myosteatosis positively correlated with liver fibrosis and negatively with liver steatosis. [ABSTRACT FROM AUTHOR]

Objective: We analysed the associations of 25 hydroxy vitamin D [25(OH) D] and parathyroid hormone (PTH) levels with clinical, anthropometric, biochemical and body composition parameters in Asian Indians with nonalcoholic fatty liver disease (NAFLD)., Methods: In this case-control study, 162 cases and 173 age and sex matched controls were recruited. Clinical, anthropometric, biochemical parameters and liver ultrasound were done. Percentage body fat (%BF), lean body mass and bone mineral density (BMD) were assessed by dual energy X-ray absorptiometry (DXA). Fasting insulin levels, value of homeostasis model assessment of insulin resistance (HOMA-IR), serum 25(OH) D, calcium and PTH levels were measured., Results: Subjects with NAFLD had lower serum 25(OH) D (19.4 ± 8.5 vs. 27.8 ± 9.4 ng/ml, p = 0.0001) and higher serum PTH (54.9 ± 19.5 vs.41.5 ± 18.3 pg/ml, p = 0.0001) levels as compared to controls. We observed significantly high values of systolic blood pressure (p = 0.002), waist circumference (p = 0.05), serum triglycerides (p = 0.002), total cholesterol (p = 0.002), alanine transaminase (p = 0.05), fasting insulin (p = 0.02) and HOMA-IR (p = 0.03) in the lowest 25(OH) D quartile. Multivariable-logistic regression showed that low serum 25(OH) D [OR (95%CI): 4.46 (2.58-7.72), p = 0.0001] and high PTH [OR (95%CI): 2.21 (1.50-3.30), p = 0.0001] level were independently associated with NAFLD., Conclusion: Low serum 25(OH) D and high PTH levels were independently associated with the presence of NAFLD in Asian Indians residing in north India., (Crown Copyright © 2013 Published by Elsevier Ireland Ltd. All rights reserved.)

Aims: This study was designed to compare the characteristics of nonobese and overweight/obese subjects with nonalcoholic fatty liver disease (NAFLD) in an urban South Indian population., Subjects and Methods: The study group comprises 541 subjects drawn from the Chennai Urban Rural Epidemiology Study (CURES), which was carried out on a representative sample of Chennai city in southern India. NAFLD was diagnosed by ultrasonography. Subjects with NAFLD were classified as nonobese (body mass index of ≤22.9 kg/m(2)) and overweight/obese (body mass index of ≥23 kg/m(2)) based on World Health Organization Asia Pacific guidelines. Coronary artery disease (CAD) was assessed by a resting 12-lead electrocardiogram that was Minnesota-coded. Insulin resistance was assessed by using the homeostasis assessment model (HOMA-IR) using the following formula: fasting insulin (μIU/mL)×fasting glucose (mmol/L)/22.5., Results: In total, 173 of 541 (32%) subjects had NAFLD, of whom 48 (27.7%) had nonobese NAFLD and 125 (72.3%) had overweight/obese NAFLD. Compared with overweight/obese NAFLD patients, fasting blood glucose (104±29 vs. 119±45 mg/dL; P<0.05) and HOMA-IR (2.1±1.8 vs. 2.9±1.8; P<0.001) were lower and high-density lipoprotein cholesterol (43±9 vs. 39±8 mg/dL; P<0.001) was higher among nonobese NAFLD subjects. Multiple logistic regression analysis showed a significant association between nonobese NAFLD and CAD (P=0.013) even after adjusting for age, diabetes, hypercholesterolemia, HOMA-IR, and hypertension., Conclusions: This study suggests that even nonobese NAFLD subjects have an association with CAD.

Background: The association of the rs738409 polymorphism of patatin-like phospholipase-3 (PNPLA3) with nonalcoholic fatty liver disease (NAFLD) has been suggested in other populations, but not in Asian Indians. We investigated the association of the rs738409 polymorphism of PNPLA3 with clinical, anthropometric, and biochemical profiles in Asian Indians with NAFLD., Methods: In this case-control study, 162 cases and 173 controls were recruited. Abdominal ultrasound, clinical, anthropometry, and biochemical profiles were determined. Fasting insulin levels and values for homeostasis model assessment of insulin resistance (HOMA-IR) were determined. Polymerase chain reaction and restriction fragment length polymorphism of the PNPLA3 gene were performed. The associations of this polymorphism with clinical, anthropometric, and biochemical profiles were investigated., Results: A higher frequency of C/G and G/G genotypes of the rs738409 polymorphism was obtained in cases as compared to controls (P=0.04), and as a consequence the frequency of the minor allele G was significantly higher in cases (P=0.003). In this study, the G allele was associated with significantly higher fasting insulin (P=0.002), HOMA-IR (P=0.05), alanine transaminase (P=0.003), and aspartate transaminase (P=0.04) values only in cases, but not in the controls. The values of serum triglycerides and total cholesterol were slightly higher in cases with G/C+G/G genotypes but statistically not significant (P>0.05). Using a multivariate logistic regression model after adjusting for age, sex, body mass index, and fasting insulin, subjects with the G/G genotype showed higher risk of NAFLD [odds ratio (OR), 1.98, 95% confidence interval (CI) 1.43-2.73, P=0.04). The relationships of the rs738409 polymorphism with the metabolic parameters were not significant after adjustment for multiple comparisons., Conclusion: Asian Indians in north India carrying the allele rs738490 of PNPLA3 is predispose to develop NAFLD.

Background and Aim: Non-alcoholic fatty liver disease (NAFLD) has emerged as the commonest hepatic problem in both developed and developing countries. This study was conducted to delineate the clinical profile of incidentally detected NAFLD patients., Methods: A retrospective analysis of clinical, biochemical and histological parameters was performed for 632 patients in whom fatty liver was diagnosed by ultrasonography during 2006-2010. Every patient's clinical presentation, history, liver function tests, blood sugar, lipid profile, ultrasonogram, histology and other relevant investigations were analyzed. Patients referred for transaminitis or overt chronic liver disease were excluded., Results: Out of 632 consecutive NAFLD patients, 484 (76.6%) were males and 148 (23.4%) were females. Mean age of our patients was 42.44 +/- 10.18 years. Their mean body mass index (BMI) was 26.14 +/- 3.38 kg/m2. Obesity (BMI > 25), diabetes mellitus, hypertension, hyperlipidemia, metabolic syndrome and insulin resistance were present in 61.7%, 15.2%, 19.8%, 62.0%, 40.0%, and 54.4% patients, respectively. SGOT and SGPT were elevated in 38.29% and 55.1% patients, respectively. The common primary diseases for which these patients sought consultation were non-ulcer dyspepsia (NUD) (54.5%) and irritable bowel syndrome (IBS) (29.4%). Of the 64 patients who underwent liver biopsy, one-fourth had definite NASH while one-third patients had fibrosis., Conclusion: In India, incidentally detected NAFLD (IDNAFLD) patients are predominantly middle aged males, most of whom are not lean. Most of these patients seek consultation for functional bowel disease.

Background and Aims: The risk of development of hepatocellular carcinoma (HCC) in hepatitis B virus (HBV) and hepatitis C virus (HCV) infection is well established and is being recognized increasingly in non-alcoholic steatohepatitis (NASH)-related cirrhosis. This study aimed to assess the risk of development of HCC in patients with NASH-related cirrhosis., Methods: From January 2010 to October 2011, we prospectively enrolled 585 patients with liver cirrhosis (men:women ratio 4.4:1, mean age 50.1 +/- 6.1 years, aetiology HBV 19%, HCV 14.2%, NASH-related 7%, cryptogenic cirrhosis 17.8%, already diagnosed cirrhosis 48.2%, and the remaining were newly diagnosed cases). The cumulative follow-up was for 5.9 +/- 0.5, 6.1 + 0.8 and 6.8 + 1.2 years for HBV, HCV and NASH-related cirrhosis, respectively. Patients with advanced cirrhosis, Child class C and associated comorbid conditions where survival was < 1 year were excluded from the study. The remaining patients were followed up 6-monthly with ultrasound examination and alpha-fetoprotein (AFP) test. Patients suspected of HCC underwent triple-phase computed tomography (CT) scan and liver biopsy was done to confirm the diagnosis., Results: A total of 54 patients developed HCC, of which 26 had HBV, 14 had HCV, 9 had- cryptogenic and 6 had- NASH-related cirrhosis. The annual rate of development of HCC was 1.5%, 3.6%, 0.6% and 0.46 in HBV, HCV, cryptogenic and NASH-related cirrhosis, respectively., Conclusions: The incidence of HCC was highest in HCV and lowest in NASH-related cirrhosis. These figures suggest an intermediate risk of development of HCC when compared to western countries and Japan.

Introduction: Non Alcoholic Fatty Liver Disease (NAFLD) is one of the common liver disease characterised by fat accumulation in hepatocytes. NAFLD is a broad spectrum of simple steatosis, Non Alcoholic Steatohepatisis (NASH), cirrhosis and hepatocellular carcinoma. Triglycerides (TG) are exported in the form of Very Low Density Lipoprotein (VLDL). VLDL are formed by incorporation of TG into apo-B by Microsomal Triglyceride Transfer Protein (MTP). Therefore, MTP is a key protein for lipid transport. Estimation of MTP protein levels and its correlation with simple steatosis and steatohepatisis can be helpful in understanding its role in NAFLD progression. Aim: To estimate the serum levels of MTP in simple steatosis and steatohepatisis and also to check its correlation with TG and VLDL in NAFLD patients with and without co-morbidities. Materials and Methods: The present cross-sectional study was carried out in Department of Cell Biology and Molecular Genetics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India, between November 2019 to January 2021. Study participants included 60 NAFLD subjects which were divided into simple steatosis (group 1, n=10) and steatohepatisis (group 2, n=50). These subjects were further subdivided into cases with co-morbidities and cases without co-morbidities. Serum levels of MTP, high sensitivity C-Reactive Protein (hs-CRP), Fasting Blood Sugar (FBS), liver enzymes, lipid profile were assessed. Statistical analysis was done by using unpaired Student's t-test and Pearson's correlation. results: The mean age was 46.5 years in steatosis group and 48.85 years in steatohepatisis group. In steatosis group, there were 5 (50%) males and 5 (50%) females, whereas in steatohepatisis group 32 (64%) were females and 18 (36%) were males. The serum levels of MTP were significantly decreased in simple steatosis cases with co-morbidities as compared to cases without co-morbidities (p=0.006). A significant negative correlation was observed between MTP vs TG and MTP v/s VLDL (r=-0.665, p=0.036) in simple steatosis cases with and without co-morbidities. Same trend was observed in steatohepatisis cases but the correlation was insignificant (r=-0.08, p=0.563). conclusion: The serum levels of MTP decreases as the NAFLD progresses. A significant decrease in serum levels of MTP was also observed in cases with co-morbidities as compared to cases without co-morbidities. Serum levels of MTP showed negative correlation with TG and VLDL in simple steatosis cases. [ABSTRACT FROM AUTHOR]

Objective: We examined the association of subclinical atherosclerosis and endothelial dysfunction with nonalcoholic fatty liver disease (NAFLD) in Asian Indians., Methods: This study included 40 non-diabetic subjects with NAFLD and 40 apparently healthy controls without NAFLD with similar age, gender and body mass index. Measurements included anthropometric parameters, oral glucose tolerance test, fasting and 2 h insulin, lipid profile, C-reactive protein, sICAM-1, VCAM-1, carotid intima-media thickness (CIMT) and brachial artery flow mediated dilatation (FMD)., Results: Subjects with NAFLD had higher average and maximum CIMT (0.6 ± 0.12 and 0.684 ± 0.16 mm, respectively, vs 0.489 ± 0.1 and 0.523 ± 0.1 mm, respectively; p < 0.05), and had higher prevalence of atherosclerotic plaques (20% vs 5%, p < 0.05) than controls. Significantly greater degree of impairment in FMD and higher levels of hs-CRP and sICAM-1 were observed in NAFLD patients than controls. The presence of NAFLD was observed to be the independent predictor of having high average CIMT (OR 4.8; 95% CI: 1.8-12.8), high maximum CIMT (OR 5.4; 95% CI: 2.0-14.4) and impaired FMD (OR 11.7; 95% CI: 1.4-96.5) even after adjusting for obesity, metabolic syndrome, insulin resistance and lipid parameters., Conclusion: In Asian Indians NAFLD is significantly associated with subclinical atherosclerosis and endothelial dysfunction independent of obesity and metabolic syndrome. Elevated levels of hs-CRP and sICAM-1 may be useful as indicators of liver injury in NAFLD., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Background: There is sparse literature on the association of adipose tissue with liver histology in patients with nonalcoholic fatty liver disease (NAFLD)., Aim: To study the correlation of visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) and total adipose tissue (TAT) with liver histology in Indian patients with NAFLD., Material and Methods: A single slice CT scan at the level of L4-L5 vertebrae was done to assess the abdominal VAT and SAT volumes in 21 patients with histological diagnosis of NAFLD. Adult treatment panel III criteria with modified abnormal waist were used to define metabolic syndrome (MS). Histological grading was done according to the NAFLD activity score (NAS)., Results: Twenty-one patients with NAFLD [13 males, median age: 35 years, median BMI: 25.97 kg/m(2)] were included prospectively. Even though overweight/obese patients had severe liver disease, there was no difference in the volume of VAT adjusted for BMI between 6 (28.5%) lean and 15 (71.5%) overweight/obese patients. Patients with NASH and borderline NASH were older, obese with higher VAT and SAT volumes than no-NASH group. SAT volume (SATV) correlated significantly with hepatic steatosis but none of the adipose tissue volumes had any correlation with other histological variables. Both SATV and TAT volume (TATV) correlated significantly with severity of liver disease as determined by NAS score whereas presence of MS or insulin resistance had no correlation with histological severity., Conclusion: Both subcutaneous and total adipose tissue volume are related to the disease severity as determined by NAFLD activity score in Indian patients with NAFLD.

Nonalcoholic fatty liver disease (NAFLD) is emerging as an important cause of liver disease in India. Epidemiological studies suggest prevalence of NAFLD in around 9% to 32% of general population in India with higher prevalence in those with overweight or obesity and those with diabetes or prediabetes. Clinicopathological studies show that NAFLD is an important cause of unexplained rise in hepatic transaminases, cryptogenic cirrhosis and cryptogenic hepatocellular carcinoma in Indian patients. There is high prevalence of insulin resistance and nearly half of Indian patients with NAFLD have evidence of full-blown metabolic syndrome. Though oxidative stress is involved in the pathogenesis of NAFLD/nonalcoholic steatohepatitis, serum or liver iron and HFE gene mutations appear not to play a role in the pathogenesis of NAFLD in Indian patients. Imaging modalities are not useful in differentiating simple steatosis from NASH and liver biopsy may be useful in those with risk factors for significant liver disease. Pilot studies on treatment strategies have shown that weight reduction and exercise, ursodeoxycholic acid, metformin, vitamin E and pentoxyfylline are effective in normalizing transaminases and or in improving hepatic steatosis and inflammation in Indian patients with NAFLD. Randomized controlled treatment trials involving large number of patients with histological end point are required to assess the efficacy of different modalities. In conclusion, a lot has been done, yet more is required to understand various aspects of NAFLD in India.

There is an ongoing debate on the change of terminology of non-alcoholic fatty liver disease (NAFLD) to metabolic associated fatty liver disease (MAFLD). Experts from the Indian National Association for Study of the Liver (INASL) and the South Asian Association for Study of the Liver (SAASL) involved in diagnosing, managing, and preventing NAFLD met in March 2022 to deliberate if the name change from NAFLD to MAFLD is appropriate, as proposed by a group of experts who published a "consensus" statement in 2020. Proponents of name change to MAFLD opined that NAFLD does not reflect current knowledge, and the term MAFLD was suggested as a more appropriate overarching term. However, this "consensus" group which proposed the name change to MAFLD did not represent the views and opinions of gastroenterologists and hepatologists, as well as perceptions of patients across the globe, given the fact that change of nomenclature for any disease entity is bound to have multidimensional impact on all aspects of patient care. This statement is the culmination of the participants' combined efforts who presented recommendations on specific issues concerning the proposed name change. The recommendations were then circulated to all the core group members and updated based on a systematic literature search. Finally, all the members voted on them using the nominal voting technique as per the standard guidelines. The quality of evidence was adapted from the Grades of Recommendation, Assessment, Development and Evaluation system. [Display omitted] • INASL–SAASL consensus group was constituted with experts from different parts of India and South Asia. • They participated in a consensus development process on name change of NAFLD, to enable establishment of an updated document on nomenclature of NAFLD. • The INASL–SAASL consensus group felt that proponents of MAFLD neither represented views of hepatologists nor perceptions of patients across the globe. • The group resolved that the term NAFLD should not be changed to MAFLD since there are no cogent reasons to justify a name change. • The INASL–SAASL consensus group also felt that a name change from NAFLD to MAFLD is replete with demerits. [ABSTRACT FROM AUTHOR]

Introduction: Evidence related to carotid artery F‑fluorodeoxyglucose‑positron emission tomography (FDG ‑PET) and non‑alcoholic fatty liver disease (NAFLD) is limited from a low‑resource setting. The present study aims to examine the association between FDG‑PET uptakes by the carotid arteries in patients having different grades of NAFLD. Materials and Methods: An analytical cross‑sectional study was done in a tertiary care center in South India for 1 year. Sonographically confirmed NAFLD patients of the age group 18 years and above were consecutively enrolled for the study after getting informed consent. Anthropometric measurements, ultrasonography for identifying the grades of fatty liver and FDG‑PET were performed in the study participants. The data for the study were collected by the research personnel and entered in Microsoft Excel. The data were analyzed in the IBM SPSS version 20.0 software. Results: A total of 24 patients were in the final analysis. The mean age of patients in this study was 56.79 (11.26) years. Among the 24 patients, 95.83% (n = 23) were males. The mean FDG‑PET uptake in the carotids was 1.75 (0.42) units. The FDG uptake was higher in the moderate NAFLD group (1.46 [0.40] v/s 2.04 [0.14]) and the difference was statistically significant with P < 0.001. The FDG uptake between the coronary artery disease (CAD) with NAFLD and non CAD with NAFLD groups was not statistically significant (1.60 [0.46] v/s 1.86 [0.36], P = 0.17). The FDG uptake in CAD patients with mild and moderate NAFLD had no statistical significance between the two groups (1.43 [0.45] v/s 2.00 [0.00], P = 0.06). Conclusion: The findings of this study showed increased uptake of FDG‑PET in carotids in subjects with moderate fatty liver when compared with those with mild fatty liver. [ABSTRACT FROM AUTHOR]

Justification: The last guidelines for pediatric obesity were released in 2004 by Indian Academy of Pediatrics (IAP). Since then, there has been an alarming increase in prevalence and a significant shift in our understanding in the pathogenesis, risk factors, evaluation, and management of pediatric obesity and its complications. Thus, it was decided to revise and update the previous recommendations. Objectives: To review the existing literature on the burden of childhood obesity and its underlying etiology and risk factors. To recommend evaluation of childhood obesity and suggest optimum prevention and management strategies of childhood obesity. Process: The following IAP chapters (Pediatric and Adolescent Endocrinology, Infant and Young Child feeding, Nutrition, Non-Communicable Disease and Adolescent Health Academy) were invited to nominate members to become part of the writing committee. The Committee held discussions on various aspects of childhood obesity through online meetings between February and August, 2023. Recommendations were then formulated, which were analyzed, revised and approved by all members of the Committee. Recommendations: Exogenous or primary obesity accounts for the majority of cases of childhood obesity. It is important to differentiate it from endogenous or secondary obesity as evaluation and management changes depending on the cause. In Indian, in children under 5 years of age, weight for length/height using WHO charts, and in children 5–18 years, BMI using IAP 2015 charts is used to diagnose overweight and obesity. Waist circumference should be routinely measured in all overweight and obese children and plotted on India specific charts, as it is a key measure of cardio-metabolic risk. Routine evaluation for endocrine causes is not recommended, except in short and obese children with additional diagnostic clues. All obese children more than ten years old should be evaluated for comorbidities like hypertension, dyslipidemia, hyperglycemia and non-alcoholic fatty liver disease/metabolic dysfunction associated steatotic liver disease (NAFLD/MASLD). Prevention and management of childhood obesity mainly involves healthy diet practices, daily moderate to vigorous physical activity and reduced screen time. Pharmacotherapy may be offered as an addition to lifestyle interventions only in cases of class 3 obesity or if there are any life-threatening comorbidities. Finally, surgical management may be offered in children older than 12 years of age with class 2 obesity and associated comorbidities or class 3 obesity with/without comorbidities, only after failure of a proper trial of intense lifestyle modifications and pharmacotherapy for at least 6 months. [ABSTRACT FROM AUTHOR]

Atezolizumab-bevacizumab (atezo/bev) combination is a recommended first-line systemic therapy for unresectable hepatocellular carcinoma (uHCC). There are no studies from India reporting the safety and efficacy of this drug in real-world settings where most patients present in an advanced stage. In this retrospective study from two centers in India, we included patients with uHCC who received atezo/bev as first-line systemic therapy. Comparison of overall survival (OS) among the different Child–Turcotte–Pugh (CTP) classes was the primary objective, while progression-free survival (PFS), radiologic response, and adverse events to the therapy were secondary objectives. The median age of the 67 patients who received atezo/bev therapy was 61 (29–82) years, and 86% were males. Nonalcoholic steatohepatitis (55.2%) was the commonest cause of cirrhosis, and most patients belonged to BCLC-C (74.6%%). There were 24 patients in CTP A, 36 in CTP B, and 7 in CTP C. The median OS was 12 (95%CI, 8.16–15.83) months in the cohort. The median OS in CTP class A, B, and C was 21 (95%CI, 0–42.06) months, 9 (95%CI, 5.46–12.53) months, and 4 (95%CI, 2.14–5.85) months, respectively (P < 0.001). The median PFS in the whole cohort was 8 (95%CI, 6.03–9.96) months. The median PFS in Child A, B, and C was 18 (95%CI, 0.16–35.84) months, 8 (95%CI, 6.14–9.85) months, and 2 (95%CI, 1.77–2.23) months (P < 0.001). On mRECIST evaluation, 12.9% had achieved a complete response, 25.8% had a partial response, 27.41% had stable disease, and the rest had progressed. The objective response rate was 38.7%, and the disease control rate was 66.12%. Of the 64% who developed adverse events, 13.43% discontinued the drug. The incidence of grade ≥3 events was significantly higher in CTP C (85.7%) compared to CTP A (12.5%) and CTP B (14%) (P < 0.001). Atezolizumab-bevacizumab is safe and effective in uHCC in real-world settings. Candidate selection is of utmost importance in treating uHCC with atezolizumab-bevacizumab to achieve a good response. Current evidence strongly suggests limited use of atezolizumab-bevacizumab in patients with CTP C, and such individuals should not be considered for this combination therapy. [ABSTRACT FROM AUTHOR]

Nonalcoholic fatty liver disease (NAFLD) is a major cause of chronic liver disease globally and in India. The already high burden of NAFLD in India is expected to further increase in the future in parallel with the ongoing epidemics of obesity and type 2 diabetes mellitus. Given the high prevalence of NAFLD in the community, it is crucial to identify those at risk of progressive liver disease to streamline referral and guide proper management. Existing guidelines on NAFLD by various international societies fail to capture the entire landscape of NAFLD in India and are often difficult to incorporate in clinical practice due to fundamental differences in sociocultural aspects and health infrastructure available in India. A lot of progress has been made in the field of NAFLD in the 7 years since the initial position paper by the Indian National Association for the Study of Liver on NAFLD in 2015. Further, the ongoing debate on the nomenclature of NAFLD is creating undue confusion among clinical practitioners. The ensuing comprehensive review provides consensus-based, guidance statements on the nomenclature, diagnosis, and treatment of NAFLD that are practically implementable in the Indian setting. [ABSTRACT FROM AUTHOR]

Introduction: Non Alcoholic Fatty Liver Disease (NAFLD) is a commonly encountered problem which affects one third of the general population. Saroglitazar, a Peroxisome Proliferator Activated Receptor (PPAR) alpha a and gamma ? agonist has been recently approved for treatment of NAFLD. Aim: To assess the efficacy of saroglitazar in non diabetic NAFLD patients. Materials and Methods: It was a retrospective observational study, conducted from October 2020 to March 2021 on 45 non diabetic NAFLD patients, at a tertiary care centre in northeastern India. Liver enzymes, liver fibrosis and liver fat content were compared before and after receiving saroglitazar for 24 weeks. Multiple regression analysis was used to assess percent change in Alanine Transaminase (ALT), Aspartate Transaminase (AST), ALP, bilirubin, Liver Stiffness Measurement (LSM) and Controlled Attenuation Parameter (CAP). The p-values <0.05 were considered as statistically significant. Results: Mean age of the study population was 46±8.20 years, and there were 24 males and 21 females. Reduction in liver enzymes like Alanine Transaminase (ALT) and Aspartate Transaminase (AST) and fibroscan parameters like Liver Stiffness Measurement (LSM) and Controlled Attenuation Parameter (CAP) were seen. Mean values of ALT and AST at pretreatment status were 85.52±17.12 U/L and 70.02±19.10 U/L, and after treatment were 40.20±12.11 U/L and 37.32±8.31 U/L, respectively (p-value <0.0001 for both ALT and AST). Pretreatment and post treatment mean values for LSM and CAP were 8.11±2.18 kPa (kilopascal), 365.84±56.22 d/m (decibel/meter) and 7.20±1.80 kPa, 345.21±35.22 d/m, respectively (p-value=0.021 for LSM and 0.036 for CAP). Conclusion: Twenty four weeks saroglitazar was effective in treatment of non diabetic NAFLD. It not only reduces hepatocellular inflammation, but also liver fibrosis and liver fat. [ABSTRACT FROM AUTHOR]

NAFLD was earlier believed to be the disease of adults only however in 1983, the existence of this disease was seen in paediatric population. Nearly four decades have passed since the first description of the Paediatric NAFLD (P-NAFLD), yet it is one of the areas which is given least priority in the country. The P-NAFLD is reversible and can be prevented by lifestyle and behaviour modification and hence there is a need to this review highlights the importance of P-NAFLD in the country and need for formulating strategies for prevention and control of P-NAFLD in the country. All published articles in the MEDLINE database on P-NAFLD in India were included. The important findings were summarized and critically analysed. The existing review suggests, the prevalence of P-NAFLD is uncertain in the country. NAFLD is a phenotypic product of complex interaction of heredity (nature) and environment (nurture). This review summarizes the importance of P-NAFLD in India and discusses the predisposition of these risk factors in Indian children. Further population-based studies on prevalence and incidence are required on general paediatric population to quantify the magnitude of the disease in India for better management of the condition. [ABSTRACT FROM AUTHOR]

Nonalcoholic fatty liver disease (NAFLD) is the commonest type of liver disease worldwide. We aimed to assess the incidence and predictors of liver-related events (LREs) and mortality in NAFLD patients. NAFLD patients (n = 957) evaluated between January 2000 and November 2021 were included. Patients were categorised as noncirrhosis (NC), compensated cirrhosis (CC) and decompensated cirrhosis (DC), and the incidence of LRE and mortality were estimated and compared. The proportions of NC, CC and DC were 87.8% (n = 840), 8.8% (n = 84) and 3.4% (n = 33), respectively. The median follow-up duration was 3.9 (3.0–5.7) years, and the total cumulative duration was 4633 person-years. The incidence of LRE per 100 person-years was 0.14, 2.72 and 10.24 in patients with NC, CC and DC, respectively. The incidence of mortality was 0.12, 1.05 and 4.24 per 100 person-years, respectively, in the 3 groups. The causes of mortality in the 3 groups were liver related in 1/5 (20%), 3/4 (75%) and 6/9 (66.7%), respectively. Overall, the mortality rate was higher in those with diabetes than those without diabetes (log-rank P value = 0.005). On further analysis, diabetes was associated with poor outcomes only in NC group (log-rank P value = 0.036), and not in CC (log-rank P value = 0.353) or DC groups (log-rank P value = 0.771). On multivariate Cox proportional hazard analysis, age (hazard ratio [HR] 1.070), hypertension (HR 4.361) and DC (HR 15.036) were independent predictors of poor outcomes. Liver stiffness measurement, bilirubin, CC and DC were independent predictors of LRE. In our study of NAFLD from India, the incidence of LRE was found to be similar to that seen in Western studies. In NC NAFLD, diabetes was associated with poor outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Non-Alcoholic Fatty Liver Disease (NAFLD) is the excessive accumulation of fat primarily in form of triacylglycerols in more than 5% of the hepatocytes without significant consumption of alcohol and other known causes of steatosis. Literature suggests an association of NAFLD with Insulin Resistant (IR) Metabolic Syndrome (MetS). In clinical settings, ultrasonography is commonly used for diagnosis of NAFLD as opposed to expensive biopsy procedures. Aim: To assess the diagnostic utility of the surrogate markers of IR in ultrasonographically diagnosed cases of NAFLD. Materials and Methods: The cross-sectional study was carried out at College of Medicine and Sagore Dutta Hospital (CMSDH), Tertiary Care Hospital and Teaching Institute in Kolkata, West Bengal, India. Ultrasonographically diagnosed 116 cases (aged 32-65 years) of NAFLD were selected and 100 apparently healthy age and sex-matched individuals were recruited as controls. Overnight fasting blood samples were analysed for fasting glucose, insulin, glycated haemoglobin (HbA1C), lipid profile and transaminases levels. IR was estimated with the Homeostasis Model Assessment index for Insulin Resistance (HOMA-IR). One-way analysis variance (ANOVA) was used for normally distributed data and Kruskal Wallis for a non-parametric data. Receiver Operator Curve (ROC) were generated to identify the cut-off values of HOMA-IR, Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), the AST/ALT ratio and fasting triglycerides to predict the existence of fatty liver. Adjusted Odds Ratio (OR) was also calculated to measure the independent effect of the risk factors. Results: Statistically significant differences were observed in insulin (p-value=0.033), HOMA-IR (p-value=0.049), triglycerides (p-value=0.00008), HbA1C (p-value=0.030), AST/ALT ratio (p-value=0.012), AST (p-value=0.015), ALT (p-value 0.00001) levels among cases and controls. The predictive cut-off for possibility of existence of fatty liver was HOMA-IR was >2.9 (sensitivity was 63.27%, specificity of 93.94), triglycerides ≥137 mg/dL, (60.67% sensitivity and 60.98% specificity) and AST/ALT ratio of 0.74 (specificity of 65.15% and a sensitivity of 62.50%). For HOMA-IR >2.5, the relative risk was 5.56 and OR was 7.15. For triglycerides >150 mg/dL, the relative risk was 1.88 and OR was 2.87. Conclusion: While ultrasound remains method of choice for diagnosis of NAFLD, assessment of parameters like IR, AST/ALT ratio aids in detection of associated MetS such as Cardiovascular Disorders (CVD) and Diabetes Mellitus (DM) that warrants proper lifestyle modification and therapeutic intervention. [ABSTRACT FROM AUTHOR]

Introduction: Non-alcoholic fatty liver disease (NAFLD) is widely prevalent in the Gujarati population and also shares risk factors with other Non-communicable diseases (NCDs) such as diabetes, obesity, and metabolic syndrome. Hence, more established screening tools like Indian Diabetes Risk Score (IDRS) may be considered for screening of NAFLD. Aim: To evaluate the prevalence of NAFLD in Anand, Gujarat and to assess whether IDRS may be used as a screening tool for NAFLD in Gujarat. Materials and Methods: A cross-sectional observational study involving 217 participants with a mean age of 56.83±11.39 years was conducted at the Health Check-up department at Shree Krishna Hospital, Anand, Gujarat, India. Participants were classified as having NAFLD using the USG parameters. Their IDRS score was calculated and applied to the participants following which its ability to screen NAFLD was compared with that of screening tools such as BMI, W/H Ratio and HBA1c, and risk factors associated with NAFLD. The IDRS was classified as high (≥60), medium (30-50), and low (<30) risk. Using univariate analysis in STATA (14.2), factors associated with NAFLD were identified, following which stepwise logistic regression analysis was performed. Differences between the risk groups of IDRS were tested using the chi-square test and analysis of variance. Results: The prevalence of NAFLD (37.79%) was significantly higher among those with a high (67.7%) and medium IDRS (16%) compared to the low IDRS group (7.4%) (trend chi-square; p<0.001). In stepwise logistic regression, IDRS was associated with NAFLD with an adjusted odds ratio of 1.03 (95% confidence interval 1.00-1.07 with a p-value of 0.036), even after adjusting for potential confounders. Conclusion: IDRS score can be used to screen for the prevalence of NAFLD. [ABSTRACT FROM AUTHOR]