Search

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]

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]

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]

Alcoholic liver disease, resulting from chronic alcohol use, includes conditions like fatty liver, alcoholic hepatitis, and cirrhosis. This study assessed TNF-α and leptin levels in 45 alcoholic liver disease patients, explored their relationship, and examined the rs1137101 polymorphism in the leptin receptor gene. Participants (mean age 40.13 ± 10.36) had consumed alcohol for an average of 15.31 ± 9.49 years at a daily intake of 253.33 ± 118.25 mL. TNF-α increased with age, while no age-leptin correlation was observed. TNF-α and leptin showed a negative correlation. The study identified a 48% minor allele G frequency for rs1137101. The findings highlight a significant correlation between TNF-α and leptin levels in alcoholic liver disease, suggesting potential roles as inflammatory mediators. More prospective studies are needed to enhance our understanding of these factors and improve disease management, potentially reducing morbidity and mortality rates. [ABSTRACT FROM AUTHOR]

Background: Extrahepatic portal vein obstruction (EHPVO) is caused by occlusion and cavernomatous transformation of the portal vein. The EHPVO is well characterized in children. However, the same is not valid for adults. We aimed to evaluate the clinico-etiological profile along with the management of adult patients. Aims and Objectives: We evaluated the clinicoetiological profile along with the management and outcomes of adult patients presenting with EHPVO. Materials and Methods: In a descriptive, observational study, patients between ages 15 and 75 years diagnosed with EHPVO on ultrasonography abdomen were included in the study. Liver cirrhosis and malignancy were considered as an exclusion criterion. There was evaluation of clinical and imaging findings along with biochemical analysis, workup for thrombophilia, treatment given to the patients, and follow-up. Results: Out of total 109 patients enrolled in the study, the median age of patients was ±40.25. Main clinical features were dyspepsia, abdominal discomfort, and splenomegaly. Out of 109, 27.5% patients showed fatty liver and 5.5% had both splanchnic vein thrombosis and fatty liver. Idiopathic EHPVO in majority of patients (80%), adult EHPVO with polycythemia rubra vera in 7.33% patients, adult EHPVO with heterozygous MTHFR mutation in 7.33% patients, and adult EHPVO with antiphospholipid antibody in 3.66%. No mortality was seen in this 5-year observational study and majority of the patients, i.e., 96 (88.1%) did not require any treatment. Conclusion: Relatively benign nature of adult EHPVO was found in the selected group of patients. Majority of the cases in our study were idiopathic and few had positive thrombophilia profile. [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]

Introduction: Women exhibit a distinct natural history of chronic liver disease compared to men, particularly regarding progression and outcomes. Although liver disease prevalence is generally higher in men, the incidence of non ethanol-related liver disease is increasing among females. Metabolic syndromes and their consequences are less recognised in the female population until they develop end-stage cirrhosis. Limited studies have explored the differences between male and female cirrhosis. The present study aimed to address the knowledge gap in female Decompensated Chronic Liver Disease (DCLD). Aim: To identify the differences in presentation and outcomes between females and males with non ethanol-related cirrhosis. Materials and Methods: The present retrospective cohort study was conducted in the Department of Medical Gastroenterology and Hepatology,Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India, involving 27 males and 33 females with non ethanol-related decompensated cirrhosis. A comparison was made between the aetiologies, presenting symptoms, complications, laboratory values, Model for End-stage Liver Disease (MELD) score, and in-hospital mortality during the first decompensation. Data analysis was performed using Statistical Packages for Social Sciences (SPSS) version 24.0 Quantitative variables were expressed as mean and Standard Deviation, while qualitative variables were expressed as frequency and percentage. The association between categorical variables was analysed using the Chi-square test, and the comparison of continuous variables between the two groups was analysed using independent sample t-test. A p-value of <0.05 was considered statistically significant. Results: The mean age of decompensation was 56.5 years for men and 50.9 years for women. The most common aetiology in men was Non Alcoholic Fatty Liver Disease (NAFLD) (63%), while in females, it was NAFLD (45%) and cryptogenic cirrhosis (45%) (p=0.020). Diabetes Mellitus (DM) was more prevalent in males (55.6% versus 33.3%). Variceal bleed was more common in females (66.7% versus 48.1%). Jaundice was more frequently observed in males (44.4% versus 21.2%) (p=0.05). Ascites was more prominent in males (70.4% versus 45.5%) (p=0.05). Hepatic Encephalopathy (HE) was more prevalent in males (22.2% versus 15.2%). Females had a lower MELD scores compared to males (12.4±6.1 versus 15.2±6.4). Mortality was higher in males (22.2% versus 12.1%). Conclusion: Women with Decompensated Chronic Liver Disease tend to decompensate at a younger age compared to males and have a higher risk of Upper Gastrointestinal (UGI) bleeding. NAFLD was the most common aetiology in both groups. Ascites and HE were more commonly observed in men. Females had lower MELD scores, resulting in a longer waiting period on the transplant list compared to males. Mortality was higher in males. [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]

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]

Introduction: In the modern world, owing to rapid urbanisation and changes in lifestyles and dietary habits, obesity has emerged as a leading problem. As a result, various morbid conditions have come into the picture which have severe effects on an individual's life expectancy. Visceral fat plays an important role in causing fatty liver. Aim: To determine the relationship between visceral fat area and liver fat using Computed Tomography (CT). Materials and Methods: A retrospective analytical study was conducted at Dr. D.Y. Patil Medical College, Hospital, and Research Centre Pune, Maharashtra, India. The CT scans of 134 patients who underwent CT scans of the abdomen pelvis and CT KUB/CT IVU between January 2022 and June 2022 were assessed by two experienced body imaging medical doctors. Subjects aged between 18 and 75 years were included without any co-morbidities like diabetes or hypertension. Waist circumference, subcutaneous fat area, and visceral fat area were calculated at the umbilical level. The CT attenuation value was measured in the right hepatic lobe, devoid of focal lesions and vessels, using a standard ROI of approximately 200 mm2. Similarly, as an internal control, splenic attenuation was also recorded. Statistical tests were employed to determine the significance of the obtained values, including Spearman's coefficient and Cohen's criteria. Results: The CT attenuation of the liver (fatty liver) showed a moderate correlation with visceral fat (Spearman's coefficient: 0.329). The association was statistically significant (p-value=0.0001). The CT attenuation of the liver (fatty liver) showed a weak correlation with subcutaneous fat (Spearman's coefficient: -0.269). The association was statistically significant (p-value=0.0016). The CT attenuation of the liver (fatty liver) demonstrated a weak-moderate correlation with waist circumference (Spearman's coefficient: -0.305). The association was statistically significant (p-value=0.0003). Conclusion: Visceral fat area has a stronger correlation with fatty liver than waist circumference and subcutaneous fat. Visceral fat should be considered a risk factor in the development of fatty liver, which may further lead to metabolic syndrome, in order to reduce mortality and morbidity related to it. [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]

Introduction: For centuries, alcohol use has been a significant social and health issue globally. based on a January 2015 WHO report.Each year, alcohol abuse leads to 3.3 million fatalities. Economic position, cultural background, educational attainment, physical and psychological health, geography, religion, and other environmental conditions are just a few of the elements that have been found to have an impact on alcohol consumption patterns. India’s alcohol consumption varies greatly by area. Alcoholic liver disease (ALD) can present with steatosis, liver cirrhosis, or any combination of these symptoms. Cirrhosis or hepatitis only affect 15–25% of long-term heavy alcohol users. Materials and Methodology: The Inpatients Department of General Medicine at PGIMER & CH, Bhubaneswar, Odisha, India, is the site of this hospitalbased observational questionnaire study. Every hospitalised patient with liver illness at our facility who has ever used alcohol was tested. After obtaining their informed consent, the patients were questioned. Patients and their families were requested to provide a thorough personal and family history. Every patient's use of alcohol, including native alcoholic beverages, was recorded and converted to an average weekly gram intake. To confirm the diagnosis, every standard examination as well as supplementary research were conducted. The patient's data was gathered using a pre-made proforma. Including the specifics such age, gender, marital status, employment, yearly income, eating habits, drinking pattern, age at which drinking began, and amount of time spent drinking. The modified Kuppuswamy Scale was used to assess socioeconomic class. Results: The research comprised 186 patients, with a median age of 46 years. Of them, 139 (74.7%) were men, and the male to female ratio was 3:1. Compared to rural populations (39.24%), urban populations have a higher prevalence of alcoholic liver disease (60.75%). Alcoholic liver disease affects people in the Lower Socioeconomic Class (50.53%) more than in any other group. Men consume alcohol at higher rates (>700 gm/wk), and married individuals use alcohol at significantly higher rates. When a female consumes 140–280 grammes of alcohol per week for ten to fifteen years, she is at a significantly earlier risk of developing alcoholic liver disease than a guy who consumes more than fifteen years of alcohol at a rate of >700 grammes per week. Conclusions: The research comprised 186 patients, with a median age of 46 years. Of them, 139 (74.7%) were men, and the male to female ratio was 3:1. Compared to rural populations (39.24%), urban populations have a higher prevalence of alcoholic liver disease (60.75%). Alcoholic liver disease affects people in the Lower Socioeconomic Class (50.53%) more than in any other group. Men consume alcohol at higher rates (>700 gm/wk), and married individuals use alcohol at significantly higher rates. When a female consumes 140–280 grammes of alcohol per week for ten to fifteen years, she is at a significantly earlier risk of developing alcoholic liver disease than a guy who consumes more than fifteen years of alcohol at a rate of >700 grammes per week. [ABSTRACT FROM AUTHOR]

Introduction: Multiple organ systems are affected due to the metabolic dysregulation associated with Diabetes Mellitus (DM). Altered lipoprotein metabolism and liver enzymes have been identified as independent risk factors for the development of Cardiovascular Disease (CVD). Routine screening of liver function and ultrasound imaging of the liver should be done at the time of diagnosis of type 2 DM and thereafter at regular intervals. Aim: To determine the association between liver function parameters and glycemic status in type 2 diabetics. Additionally, the study aimed to correlate liver enzymes and lipid profiles in Type 2 DM patients. Materials and Methods: A cross-sectional study was conducted from August 23rd, 2021 to October 23rd, 2021 on 100 Type 2 diabetic patients attending the diabetic Outpatient Department of Biochemistry, at Annapoorana Medical College and Hospital, Salem, Tamil Nadu, India. Fasting glucose, total cholesterol, triglyceride, and High-Density Lipoprotein Cholesterol (HDL) were measured using the direct enzymatic method, while Low-Density Lipoprotein Cholesterol (LDL) was calculated using Friedewald's formula. Total bilirubin, Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), Alkaline Phosphatase (ALP), total protein, and albumin were analysed using the ERBA EM-200 auto analyser based-on the wet chemistry principle. Pearson's correlation analysis was performed to examine the relationship between variables. Results: Among the total of 100 type 2 diabetic patients who participated in present study, 59 were males and 41 were females. The mean±SD age of diabetic patients was 51.23±10.810 years, ranging between 35 and 76 years. The frequency of altered liver enzymes in the study sample was found to be 33, with 25 being males and 8 being females. The mean fasting blood sugar levels with normal liver function and abnormal liver function were observed to be 128.37±13.16 mg/dL and 133.79±15.68 mg/dL, respectively, but the difference was not statistically significant. The mean values of total cholesterol, triglyceride, and low-density lipoprotein with normal liver function were observed to be 137.18±34.44 mg/dL, 175.12±65.19 mg/dL, and 75.55±9.78 mg/dL, respectively, while with abnormal liver function, they were observed to be 196.05±52.67 mg/dL, 143.28±47.63 mg/dL, and 138.83±38.11 mg/dL, respectively, showing statistical significance. Conclusion: The present study found a strong association between deranged liver enzymes with fasting blood sugar and dyslipidaemia. [ABSTRACT FROM AUTHOR]

Background: Chronic and excessive alcohol ingestion is one of the major causes of liver disease in the industrialized nations. Alcoholic Liver Disease(ALD) is one of the leading social problem arising in the young individuals of India. It is frequently associated with haematological & biochemical abnormalities and causes complications including bleeding and infection which can increase morbidity and mortality rate. Dietary deficiencies, bleeding, alcoholism and abnormalities in hepatic synthesis or proteins used for blood formation or coagulation add to the problem of liver disease. Objective: This study studies the correlation between abnormalities in haematological & biochemical parameters and severity of alcoholic liver disease. Material & method: In this study, fifty alcoholic patients with or without radiologic and/or clinical evidence of cirrhosis were studied and then evaluated to identify the role of various biochemical, haematological parameters. Result: The mean Hb, RBC count, Protein, Albumin & MCHC were significantly decreased while the mean MCV, lymphocyte count, Total and Direct Bilirubin, SGOT & SGPT were significantly increased in ALD patients ('P' value < 0.05). There were no significant change in renal function test parameters. Conclusion: Higher values of MCV, lymphocytes and bilirubin have independent role of positive association with the complications developed in the ALD. Early evaluation and management of these easily available parameters are more appropriate in prevention of development of complications among ALD cases. [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]

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]

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]

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]

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]

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]

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]

Background & objectives: Polycystic Ovary Syndrome (PCOS) is becoming an area of global and national health concern. It requires a life cycle approach from adolescence to menopause. To comprehensively address the wide spectrum of this disorder, a multidisciplinary model of care was established for women with PCOS in a government setting in India with an objective to screen and manage multifaceted manifestations of PCOS and to diagnose and treat associated comorbidities such as metabolic syndrome, dermatologic manifestations and psychological issues. Methods: A model of integrated multidisciplinary PCOS clinic was implemented for services and research at ICMR-National Institute for Research in Reproductive and Child Health (NIRRCH), Mumbai Maharashtra, India. This is a one-stop holistic centre for managing menstrual, cosmetic, infertility, obesity, metabolic and psychological concerns of women affected with PCOS. Two hundred and twenty six women diagnosed with PCOS using the Rotterdam criteria were screened for metabolic comorbidities with anthropometry, ultrasonography, hormonal and biochemical tests and for psychological problems. Analysis was performed using SPSS version 19.0. Results: Mean body mass index (BMI) was 26.1 kg/m2, higher for Asians. Hirsutism was observed in 53.6 per cent of women. Metabolic syndrome was seen among 35.3 per cent and non-alcoholic fatty liver in 18.3 per cent. Psychological issues such as anxiety and depression were identified in majority of the women 31.4 per cent of women could achieve pregnancy at the end of one year of multidisciplinary management. Interpretation & conclusions: The results of the present study suggest that an integrated multidisciplinary approach led to the early identification and treatment of comorbidities of PCOS, especially metabolic syndrome. There is hence an urgent need to implement multidisciplinary PCOS clinics in government health facilities. [ABSTRACT FROM AUTHOR]

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]

Introduction: An arsenal of Antiepileptic Drugs (AED) is used in the management of childhood seizure disorders. Most of them are taken long-term. These drugs have the potential to cause hyperlipidemia by inducing the P450 enzyme system. The alteration in lipid profile caused by long-term use of antiepileptic drugs in children needs to be studied to reduce the risk of future atherosclerosis. Aim: To analyse the effect of antiepileptic drugs on serum lipid profile in children with epilepsy in a tertiary care. Materials and Methods: This prospective descriptive study was conducted in the Outpatient and Inpatient Wards of the Department of Paediatrics and Neurology, Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu, India, from February 2017 to September 2017. The study involved a total of 155 children, who were on monotherapy antiepileptic drugs for at least 6 months (33 on phenytoin, 42 on phenobarbitone, 20 on levetiracetam, 20 on carbamazepine, 40 on sodium valproate). A corresponding numbers of children, who attended the General Outpatient Department for acute upper respiratory tract and were otherwise healthy, were included as controls. A blood sample (3 mL) was drawn after an overnight fast for serum glucose, liver enzymes, total cholesterol, High Density Lipoprotein-Cholesterol (HDL-C), Low Density Lipoprotein-Cholesterol (LDL-C), Very Low Density Lipoprotein (VLDL) cholesterol and Triglycerides (TG) measurement. Chi-square test was performed to find out the significance of association and independent t-test was used to compare the mean between various groups. Results: Cytochrome P450 (CYP) enzyme inducers like carbamazepine, phenytoin and phenobarbitone significantly modified serum lipids in epileptic children when compared to healthy controls. In children on long-term phenytoin monotherapy, mean cholesterol levels were significantly higher in the cases compared to controls (156.73±31.93 mg/dL vs 105.03±8.60 mg/dL, p-value <0.0001), significantly elevated triglycerides (123.48±25.99 mg/dL vs 87.88±12.16 mg/dL, p-value <0.0001), and HDL-C level was significantly lower (44.52±10.14 mg/ dL vs 56.73±12.56 mg/dL, p-value <0.0001) than in controls. Phenobarbitone use was associated with significantly higher levels of cholesterol (164.97±34.41 mg/dL vs 107.76±9.28 mg/dL, p-value <0.0001), LDL (155.27±28.55 mg/dL vs 93.36±6.81 mg/ dL, p-value <0.0001), and triglycerides (125.55±42.19 mg/dL vs 86.30±8.12 mg/dL, p-value <0.001) and lower HDL (46.30±9.47 mg/dL vs 57.73±14.41 mg/dL, p-value <0.0001). Levetiracetam was not associated in significant alteration in both liver enzymes and lipid profile (p-value >0.05). Carbamazepine monotherapy was associated with higher levels of cholesterol (180.50±28.06 mg/dL vs 112.15±13.55 mg/dL, p-value <0.0001), LDL (138.85±22.55 mg/dL vs 82.45±12.12 mg/dL, p-value<0.0001) and triglycerides (142.80±9.48 mg/dL vs 85.40±6.29 mg/dL, p-value <0.0001) when compared to healthy controls. There was no alteration in lipid profile in valproate monotherapy. Valproate monotherapy was associated with significant increase in levels of SGOT and SGPT when compared to mean levels (40.35±11.208 (IU/L), and 40.70±8.809 (IU/L), respectively) observed in other AEDs and significant increase in SGPT levels when compared to healthy controls (36.50±10.61(IU/L) in cases vs 40.70±8.81 (IU/L) in controls). Conclusion: Levetiracetam did not produce significant changes in the serum lipid profile and liver enzymes and appears to be safe to use in children for long-term epilepsy management especially in children with baseline deranged lipid profile. [ABSTRACT FROM AUTHOR]

Fatty liver has been shown to be associated with severe COVID-19 disease without any impact on mortality. This is based on heterogenous criteria for defining both fatty liver as well as the severity parameters. This study aimed to study the impact of fatty liver on the mortality and severity of disease in patients with COVID-19 pneumonia. In a case control study design, patients with COVID-19 pneumonia (COVID-19 computed tomography severity index [CTSI] on high-resolution computed tomography chest of ≥1) with fatty liver (defined as liver to spleen attenuation index ≤5 on noncontrast computed tomography cuts of upper abdomen) were compared with those without fatty liver. The primary outcome measure was in-hospital mortality, and the secondary outcome measures were CTSI score, need for intensive care unit (ICU) care, need for ventilatory support, duration of ICU stay, and duration of hospital stay. Of 446 patients with COVID-19 pneumonia, 289 (64.7%)admitted to Max Hospital, Saket, India, between January 1, 2021, and October 30, 2021, had fatty liver. Fifty-nine of 446 patients died during the index admission. In-hospital mortality was not different between patients with fatty liver (38 [13.24%]) or without fatty liver (21 [13.81%]). COVID-19 CTSI score was found to be significantly higher among patients who had fatty liver (13.40 [5.16] vs 11.81 [5.50]; P = 0.003). There was no difference in the requirement of ICU (94 [32%] vs 62 [39.49%]; P = 0.752), requirement of ventilatory support (27 [9.34%] vs 14 [8.91%]; P = 0.385), duration of ICU stay (8.29 [6.87] vs 7.07 [5.71] days; P = 0.208), and duration of hospital stay (10.10 [7.14] vs 10.69 [8.13] days; P = 0.430) between the groups with fatty liver or no fatty liver. Similarly, no difference was found in primary or secondary outcomes measure between the group with severe fatty liver vs mild/moderate or no fatty liver. High total leucocyte count and Fibrosis-4 (FIB-4) index were independently associated with mortality. Fatty liver may not be associated with increased mortality or clinical morbidity in patients who have COVID-19 pneumonia. [ABSTRACT FROM AUTHOR]

Introduction: Patients with Cerebrovascular Accidents (CVA) may present with Gastrointestinal (GI) complications, negatively affecting the prognosis. However, the whole spectrum of GI complications in CVA patients is unknown. Aim: To assess GI complications in CVA patients and their association with risk factors of CVA. Materials and Methods: The retrospective, facility-based, observational study was conducted in Department of Medicine at Gandhi Medical College and associated Hamidia Hospital, Bhopal, Madhya Pradesh, India, from March 2019 to August 2021. Total 100 patients with CVA (age >13 years) were studied based on their medical records and laboratory examinations. Details on socio-demographic variables and clinical history were obtained. Detailed general and systemic examination and vitals were documented. Complete blood picture, liver function test, renal function test, lipid profile and magnetic resonance imaging scan was also performed. A Chi-square t-test was applied to assess the association of GI complications with various variables. A p-value <0.05 was considered statistically significant. Results: Most CVA patients were males (51%). Mean age of study population was 71.49±11.46 years. A history of hypertension and diabetes mellitus was observed in 60% and 54% of cases. Constipation (43%) was the most common GI complication, followed by dysphagia (25%). No significant association of GI complications with age (p-value=0.261), gender (p-value=0.217), hypertension (p-value=0.540) and diabetes mellitus (p-value=0.257) was observed in CVA patients. However, raised serum bilirubin, serum glutamic-oxaloacetic transaminase, and serum glutamic pyruvic transaminase in 47%, 23%, and 37% cases with CVA was observed. Conclusion: Gastrointestinal complications are commonly observed in stroke patients irrespective of stroke but are more common in patients with ischemic stroke. Constipation and dysphagia were the most common. Faecal incontinence, abdominal pain, hiccups, and melena may also be seen in patients with CVA. [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]

Ultrasound of the liver is not good to pick up mild steatosis. Controlled attenuation parameter (CAP) evaluated in transient elastography (FibroScan) is widely available in India. However, data regarding the diagnostic accuracy and optimal cut-off values of CAP for diagnosing hepatic steatosis are scarce in Indian population. MRI-PDFF is an accurate technique for quantifying hepatic steatosis. Thus, this study examined the diagnostic accuracy and optimal cut-off values of CAP for diagnosing steatosis with MRI-PDFF as reference standard. A total of 137 adults underwent CAP and MRI-PDFF measurements prospectively. A subset of participants (n = 23) underwent liver biopsy as part of liver transplantation evaluation. The optimal cut-off values, area under the receiver operating characteristic (AUROC) curves, sensitivity, and specificity for CAP in detecting MRI-PDFF ≥5% and ≥10% were assessed. The mean age and body mass index (BMI) were 44.2 ±10.4 years and 28.3 ±3.9 kg/m2, respectively. The mean hepatic steatosis was 13.0 ±7.7% by MRI-PDFF and 303 ±54 dB/m by CAP. The AUROC of CAP for detecting hepatic steatosis (MRI-PDFF ≥5%) was 0.93 (95% CI, 0.88–0.98) at the cut-off of 262 dB/m, and of MRI-PDFF ≥10% was 0.89 (95% CI, 0.84–0.94) at the cut-off of 295 dB/m. The CAP of 262 dB/m had 90% sensitivity and 91% specificity for detecting MRI-PDFF ≥5%, while the CAP of 295 dB/m had 86% sensitivity and 77% specificity for detecting MRI-PDFF ≥10%. The optimal cut-off of CAP for the presence of liver steatosis (MRI-PDFF ≥5%) was 262 dB/m in Indian individuals. This CAP cut-off was associated with good sensitivity and specificity to pick up mild steatosis. [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]

Saroglitazar—a unique dual peroxisome proliferator-activated receptor agonist was approved marketing authorization in India in 2013 for diabetic dyslipidemia. Postmarketing studies have additionally shown improvement in liver parameters in diabetic dyslipidemia patients with nonalcoholic fatty liver disease (NAFLD) who received saroglitazar. The aim of this study was to evaluate the effect of saroglitazar on liver function test, liver fibrosis score by FibroScan, lipid profiles, HbA1c in NAFLD patients with diabetic dyslipidemia in southern India. A prospective, interventional, pilot study was performed to study the safety and efficacy of saroglitazar in NAFLD patients having type 2 diabetes mellitus. About 97 patients were screened, of which 85 patients were involved in the study based on the inclusion criteria. The clinical parameters and liver stiffness were measured at the baseline and also after 12 weeks of treatment with administration of saroglitazar 4 mg once daily. The change in the parameters at the baseline and after the end of the treatment was measured and was subjected to statistical analysis using SPSS software. The recruited patients received saroglitazar and were followed up for a period of 12 weeks. The clinical parameters such as fasting blood sugar, postprandial blood sugar, HbA1c, total cholesterol, triglycerides, SGPT, and liver stiffness showed significant difference after 12 weeks of treatment when compared with the baseline values. No adverse drug reaction was reported in patients receiving saroglitazar during the study. Saroglitazar was found to show significant improvement in liver parameters in NAFLD patients with a significant reduction in liver fibrosis and triglycerides level. [ABSTRACT FROM AUTHOR]

Generally diagnosis of non-alcoholic fatty disease is made on imaging, however, mild steatosis is difficult to diagnose on imaging. Liver biopsy is the procedure of choice but is not carried out as it is an invasive procedure. We describe our experience of 157 liver biopsies in living liver donors with normal body mass index (BMI) <23 kg/M2 (lean). The study was conducted at a tertiary care center in north India. Data of lean living donors who underwent a liver biopsy before donation were analyzed. Data are presented as percentage, mean, or median (25–75 interquartile range). Of 718 donors who had a liver biopsy before donation, 157 (21.8%) donors were lean (BMI < 23 kg/M2). Seventy-eight percent of lean donors had no or only one metabolic risk factor. Fifty-three (33.7%) of lean donors had nonalcoholic fatty liver (NAFL) in liver biopsy. When donors with NAFL were compared to donors with normal histology, donors with NAFL had significantly higher aspartate transaminase (26.6 ± 7.5 versus 23.7 ± 5.4, p = 0.007), alanine transaminase (33.4 ± 11.7 versus 27.8 ± 10.7, p = 0.003), and gamma glutamyl transpeptidase [25 (16–40.5) versus 18 (14–23), p = 0.003]. Only triglycerides (TGs) were statistically different among metabolic factors in lean NAFL and normal histology groups, 97 (70–161) versus 86 (62.5–114.7), p = 0.043. A total of 30% donors in the lean NAFL group had TGs >150 mg/dl as compared with 12.5% in the normal histology group, p = 0.009. Other metabolic risk factors were not statistically different. One third of lean donors had NAFL. Among all metabolic risk factors, only higher TGs levels showed a significant association with NAFL. [ABSTRACT FROM AUTHOR]

Background/Aims: Type 2 diabetes mellitus (T2DM), obesity, and hyperinsulinemia are predisposing factors for nonalcoholic fatty liver disease (NAFLD). The prevalence of NAFLD in Indian subjects with T2DM is reported to range from 12.5% to 87.5%, with studies over the years showing an increasing trend. This study aimed to understand the prevalence patterns, gaps in management, and current treatment options for the management of NAFLD in Indian patients with T2DM. Methods: A 15-question survey form was used to assess physicians' practice, and attitudes regarding NAFLD in diabetic patients. Each physician provided data for 15 patients with T2DM and underlying NAFLD who were receiving treatment for NAFLD. Results: In all, 271 physicians from 93 cities responded to the survey. According to 80% of the physicians, NAFLD was prevalent in 40%-60% of patients with T2DM. Diabetes with obesity, hypertension, and dyslipidemia was reported to affect the severity of NAFLD in patients with T2DM. Most patients with T2DM and NAFLD were aged 40-60 years, and 94.5% of physicians responded that their glycated hemoglobin (HbA1c) was >7%. Only 36.5% of the physicians reported screening 40%-60% of patients with T2DM for NAFLD, with liver function tests (LFTs) and ultrasonography being the most common approach used by 78.6% of the physicians. Abnormal LFTs and fatty liver on ultrasonography were the criteria for initiating drug therapy. Lifestyle modifications with drug therapy were the most common approach for management, and ursodeoxycholic acid and vitamin E were the main drugs of choice. Only 33.9% of the physicians used LFTs every three months for follow-up of patients with NAFLD. Conclusion: Although NAFLD was observed in 40%-60% of subjects with T2DM, especially those aged 40-60 years, the percentage of patients screened, treated, and followed-up for NAFLD in routine clinical practice continues to remain low. [ABSTRACT FROM AUTHOR]

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]

Transient infantile hypertriglyceridemia (TIH) is a syndrome of hypertriglyceridemia, fatty liver, and deranged liver functions with progression to fibrosis and cirrhosis. It is an autosomal recessive disorder caused by mutations in Glycerol-3-phosphate dehydrogenase 1 gene present on Chromosome 12q12-q13, and has been reported in Israeli Arab families with high consanguinity. TIH is suspected by high serum triglyceride levels and steatosis on liver biopsy; however, diagnosis is confirmed on clinical exome sequencing. We present two cases of TIH belonging to the indigenous Hindu, hilly population of Himachal Pradesh in North India with no history of either consanguinity or family history. The parents of both the cases were counselled regarding the disease and importance of growth and lipid level monitoring. Though TIH is an extremely rare entity, awareness about it is required as it is a contributor to non-alcoholic fatty liver disease (NAFLD) in children. Any child presenting with hepatomegaly and elevated fasting triglyceride levels should be further investigated for TIH. [ABSTRACT FROM AUTHOR]

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]

Introduction: Non-Alcoholic Fatty Liver Disease (NAFLD) and Type 2 Diabetes share a bidirectional relationship. NAFLD can increase the severity of diabetic microvascular and macrovascular complications. Ultrasonography, the most commonly used method of assessment of NAFLD in India, is associated with intra-operator variability and false positives. Transient elastography and Liver Stiffness Measurement (LSM) have emerged as one of the best modalities to screen NAFLD in people with diabetes. Aim: Screening for NAFLD in people with Type 2 Diabetes and its association with age, Body Mass Index (BMI) and duration of diabetes. Materials and Methods: This was a prospective crosssectional study conducted on patients with known Type 2 Diabetes Mellitus (T2DM) who visited the study center between July 2019 and November 2019 for consultation. A total of 287 people with diabetes were subjected to FibroScan test and LSM was done. The other variables-age, gender, duration of diabetes, height, weight, BMI and HbA1c were recorded for all subjects and the collected data was correlated using Spearman rho test. Results: The study population included 61% males and 39% females. The mean age was 46.96 years and the mean duration of diabetes was 10.98 years. The mean Glycated haemoglobin (HbA1c) value was 9.28%. The median value of LSM by M probe was 7.16. Out of the total, 78 (27.2%) were identified with advanced fibrosis with LSM >9.6. Advanced fibrosis was strongly correlated with HbA1c (r=0.820), age (r=0.562) and duration of diabetes (r=0.596) and moderately with BMI (r=0.375). Conclusion: The screening of people with type 2 diabetes for NAFLD using LSM revealed 27.2% subjects with advanced fibrosis, it correlated positively with age, BMI and duration of diabetes. [ABSTRACT FROM AUTHOR]

Apart from its association with metabolic syndrome and diabetes mellitus, non-alcoholic fatty liver disease (NAFLD) has been thought to be linked with other endocrine and metabolic disorders. Recent data suggest that hypothyroidism may be a significant risk factor for development and progression of NAFLD. The present study was conducted to evaluate the presence of NAFLD in patients with hypothyroidism presenting to a rural tertiary care centre in north India. The diagnosis of NAFLD was made on the basis of radiological findings and derangement of liver enzymes. Our findings showed that ultrasonographic evidence of fatty liver as well as increase in the serum transaminase level above normal range were significantly higher in hypothyroidism patients as compared with controls. On multivariate regression analysis of the patients' data, the presence of hypothyroidism was independently associated with risk of NAFLD. We therefore conclude that hypothyroidism is a significant independent risk factor. [ABSTRACT FROM AUTHOR]

Background Liver is vulnerable to a wide variety of metabolic, toxic, microbial, circulatory and neoplastic insults. Liver disease is an insidious process found incidentally during general health check-ups, investigations for other diseases, surgery or at autopsy. The aim is to study various pathological lesions of the liver in autopsy cases and compare it with other studies. Methods The study was conducted in the Department of Pathology, Govt. Medical College, Jammu over a period of 1 year. Liver specimens were collected from 130 cases as a part of examination of multiple viscera. Results The most common pathology found in our study was steatosis (57.69%) followed by congestion (13.07%), chronic hepatitis (7.69%). Equal number of cases (2.30%) were seen in granulomatous hepatitis and cirrhosis. Maximum cases 41(31.53%) were in 41-50 years of age group with male preponderance. Conclusion Autopsy based study of liver disease is an effective tool to identify histopathological spectrum of liver diseases. [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]

Now a day's diseases pertaining to liver areamong the foremost health hazards worldwide, with liver cirrhosis and drug induced hepatotoxicity being most common. Liver disease is the tenth most common cause of death in India as per the World Health Organization and may affect every one in five Indians. Non-alcoholic steatohepatitis (NASH) is a multifactorial disease. That's whyits treatment is difficult with using a single pharmacological drug. Various formulations prepared from herbal and minerals are known for their multifaceted implications and thus can form an effective treatment schedule against NASH. Plant drugs formulations have gained importance and popularity because of their safety, efficacy and cost effectiveness. Liver disorders do not have specific treatment modalities in modern medicine even though they are the cause for death and secondary complications. No any specific safe and no hepatic damage remedy has been found in conventional medicine. Antioxidants, anti-diabetic, and antihyperlipidemic properties in herbal extracts have been shown to ameliorate symptoms of NASH. In this review article, an attempt has been made to compile the management of Yakriddalyudar (liver disorders) with Medicinal plants in alleviating NASH and may be useful to the clinicians working the field of Ayurveda. [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]

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]

Background The normal range for Aspartate and Alanine Aminotransferases (AST and ALT) levels (<40 IU/L) were set in 1950s. Recent data from certain countries suggest lower levels of AST and ALT. Aim of the study was to redefine the normal values of aminotransferases in healthy Indian adults. Methodology In a cross sectional prospective study, 1002 blood donors were evaluated to isolate a healthy cohort. Four and 9 subjects positive for HBsAg and anti-Hepatitis C Virus (HCV) respectively and three females were excluded. 986 male subjects were evaluated for levels of serum aminotransferases. Results Of total 986 subjects (Group I), 543 (55.1%) had fatty liver on ultrasound [15 (1.5%) alcoholic fatty liver and 528 (53.5%) Nonalcoholic Fatty Liver Disease (NAFLD)]. Median AST and ALT in total group (Group I) were 27.69 (Interquartile Range (IQR) 22.33–37.04) and 34.19 IU/L (IQR 23.12–54.87) and in NAFLD (Group II) were 35.67 (IQR −27.49–47.43) and 50.36 (IQR 37.70–76.58) IU/L. Of remaining 443 subjects without fatty liver, 288 had one or more components of metabolic syndrome. Out of 155 patients with no fatty liver and no component of metabolic syndrome (Group III), 103 subjects had normal Body Mass Index (BMI) and normal cholesterol and Low Density Lipoprotein (LDL) (Group III B). Median AST and ALT in Group III B were 22.56 (IQR 20.23–26.91) and 21.36 (IQR 17.49–27.21) U/L respectively with a 95th percentile of 34.28 and 36.57 U/L for AST and ALT, respectively. Conclusion Levels of AST and ALT in healthy men are lower than the conventional values in India. [ABSTRACT FROM AUTHOR]

Background: Non alcoholic fatty liver disease is an upcoming causes of chronic liver disease in pediatric population in Asia. Aims & Objective: To evaluate the potential of probiotic VSL#3 and Lifestyle modification in obese pediatrics with Non alcoholic fatty liver disease (NAFLD). Material & Methods: we conducted clinical trial in 106 obese children in age group of 5 to18 years and divided in to four groups;VSL#3 plus lifestyle intervention (n=26), VSL#3 (n=27), Lifestyle intervention (n=26) and Placebo (n=27) received interventions for four months. To identify NAFLD by ultrasonography, Body mass index (BMI), mid arm circumference (MAC), waist circumference (WC) and triceps skinfold thickness (TSF) were done. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), low-density lipoprotein cholesterol(LDL-c),high-density lipoprotein cholesterol (HDL-c), triglyceride (TG), cholesterol, fasting blood glucose(FBG), high sensitivity C-reactive protein (HSCRP), uric acid, obesity hormones were measured along with their dietary intake at baseline and post trial. Results: VSL#3 plus lifestyle intervention significantly the most pronounced therapy for reducing fatty liver grades, anthropometric with biochemical parameters and beneficial impact on obesity hormones (p<0.001) as compared to single therapy of VSL#3 and lifestyle intervention alone. Conclusion: Combined therapy of VSL#3 plus lifestyle intervention is promising treatment for management of NAFLD in Indian obese children. [ABSTRACT FROM AUTHOR]

Background: Non-alcoholic fatty liver disease (NAFLD) has been reported recently as the most frequent liver disease among obese children and adolescents in industrialized countries. Objective: Nutritional status of obese children with and without NAFLD. Methodology: We studied 160 obese children of 5-18years age. Their anthropometric, biochemical measurements and ultrasonography were carried out to identify NAFLD in them. Z-score of body mass index (Z- BMI), mid arm circumference (MAC), waist circumference (WC) and triceps skinfold thickness (TSF) were done. Serum alanine aminotranferase (ALT), aspartate aminotranferase (AST), gamma-glutamyl-transferase (GGT) low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), triglyceride (TG), cholesterol, FBG(fasting blood glucose), high sensitivity C-reactive protein (HSCRP) and uric acid were measured. Their eating habits and dietary intake were recorded. Results: These patients were divided in to two groups: group1: without NAFLD (n= 54) and group 2: with NAFLD (n=106).NAFLD was detected in 66.2% of obese children. Median Z-BMI, MAC, TSF, WC and ALT, AST, GGT, TG, FBG, HSCRP, uric acid were significantly higher in NAFLD group as compared to without NAFLD(p<0.05). HDL-c was significantly lower in NAFLD group (p<0.001). Daily consumption of soft drinks (60.4%) and fried chips (58.5%) were more in NAFLD group than without NAFLD group. Conclusion: Z-BMI, MAC, TSF, WC and ALT, AST, GGT, TG, FBG, HSCRP and uric acid were significantly higher in NAFLD and HDL-c was lower but most significant associated risk factors with NAFLD were TG and Z-BMI. Calorie intake was more in obese children but excess in NAFLD group. Early lifestyle interventional approach for the treatment of NAFLD can prevent nonalcoholic steatohepatitis (NASH) and cirrhosis. [ABSTRACT FROM AUTHOR]