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Introducción: La enfermedad del hígado graso no alcohólico (EHGNA) o hígado graso se caracteriza por una excesiva acumulación de grasa en el hígado, es un desorden metabólico con una prevalencia mundial cercana al 25 %, con un espectro de daño hepático que abarca la esteatosis sin fibrosis, esteatohepatitis con fibrosis variable y la cirrosis o grado máximo de fibrosis, dicha fibrosis determina el pronóstico y los desenlaces de la enfermedad. Objetivo: evaluar la asociación entre el índice de masa corporal (IMC) y el grado de fibrosis hepática en pacientes con diagnóstico de hígado graso en un centro de hepatología en la ciudad de Bogotá, Colombia. Pacientes y métodos: se realiza un estudio de casos y controles de pacientes con diagnóstico de hígado graso, a quienes se les haya realizado elastografía en tiempo real (Supersonic). Se tomó la información de pacientes con diagnóstico de hígado graso que cumplieron criterios de inclusión. Las variables continuas se describieron utilizando medidas de tendencia central y desviación estándar. Las variables categóricas se describieron con números y porcentajes. Se consideró un intervalo de confianza (IC) del 95 % como estadísticamente significativo. Resultados: se incluyeron 361 pacientes, de los cuales el 95,2 % (n = 344 pacientes) presentó algún grado de alteración (12 % fibrosis mínima, 33 % fibrosis moderada, 34 % fibrosis grave y 16 % cirrosis) y solo el 5 % mostró un hígado normal. No tener un adecuado peso se relaciona con fibrosis grave F3, odds ratio (OR): 3,24 (IC: 1,03-10) y cirrosis F4, OR: 2,33 (IC: 2,33-42,99). No se encontraron diferencias estadísticamente significativas entre la alteración del IMC y cualquier grado de fibrosis (OR: 2,74; IC: 0,90-8,40). La presencia de diabetes mellitus (DM) presenta una probabilidad de riesgo de 10 veces de terminar en cirrosis F4, en especial, con mal control de la enfermedad (OR: 5,16; IC: 1,23-30,33). Conclusión: existe una asociación entre el IMC, el perfil glicémico anormal y el desarrollo de fibrosis grave y avanzada. En la práctica clínica, son necesarias una mayor vigilancia y evaluación de los pacientes con hígado graso, con el fin de evitar la progresión de la fibrosis.

Introduction: Non-alcoholic fatty liver disease (NAFLD) or fatty liver, is characterized by an excessive accumulation of fat in the liver, is a metabolic disorder with a worldwide prevalence close to 25%, with a spectrum of liver damage that covers the steatosis without fibrosis, steatohepatitis with variable fibrosis and cirrhosis or maximum degree of fibrosis, this fibrosis determines prognosis and outcomes in the disease. Objective: To evaluate the association between body mass index and the degree of liver fibrosis in patients diagnosed with fatty liver in a hepatology center in the city of Bogotá, Colombia. Patients and methods: A case-control study is carried out with patients diagnosed with fatty liver, who have undergone real-time elastography (Supersonic). Information was taken from patients diagnosed with fatty liver who met the inclusion criteria. Continuous variables were described using measures of central tendency and standard deviation. Categorical variables were described with numbers and percentages. A 95% confidence interval was considered statistically significant. Results: 361 patients were included, of which 95.2% (n=344) presented some degree of alteration (12% minimal fibrosis, 33% moderate fibrosis, 34% severe fibrosis and 16% cirrhosis) and only 5% showed a liver normal. Not having an adequate weight is related to severe fibrosis F3 OR 3.24 (1.03-10) and cirrhosis F4 OR 2.33 (2.33-42.99). No statistically significant differences were found between altered body mass index and any degree of fibrosis OR 2.74 (0.90-8.40). The presence of DM presents a 10-fold risk probability of ending in F4 cirrhosis, especially with poor disease control OR 5.16 (1.23-30.33). Conclusion: There is an association between abnormal body mass index and glycemic profile and the development of severe and advanced fibrosis. It is necessary in clinical practice, greater surveillance and evaluation of patients with fatty liver, in order to prevent the progression of fibrosis. [ABSTRACT FROM AUTHOR]

Introduction: Obesity is associated with nonalcoholic fatty liver disease (NAFLD) in children. Our aim was to analyze the association of dietary and sociodemographic factors with NAFLD in obese children and adolescents. Materials and methods: Thirty-three obese patients from 6-16 years of age were included in the present analytic cross-sectional study. Obesity was diagnosed with a body mass index z-score > 2 SD. NAFLD was estimated by liver ultrasound, serum amino transferases, and elastography. The sociodemographic variables were evaluated using validated questionnaires. Diet was estimated through two 24-h recall dietary surveys focused on the quantity of food energy, simple sugars, polyunsaturated fatty acids (PUFAs), and antioxidants. Results: Hepatic steatosis was identified by abdominal ultrasound in 13 patients (39.4%) and the serum alanine aminotransferase level was above the upper reference value in 54.2%. A higher educational level in both parents, greater monthly food expenditure, and a higher socioeconomic level were associated with NAFLD. Overall, simple sugar and saturated fat consumption was above the recommended daily intake, whereas vitamin E and PUFA consumption was below those parameters. Conclusions: NAFLD was identified in one-third of the cases. There was an association between NAFLD and sociodemographic variables. Both groups had an increased intake of simple sugars and a reduced intake of PUFAs. The selective occurrence of NAFLD could be related to a genetic predisposition that has been demonstrated in a Mexican population. Resumen: Introducción y objetivo: La obesidad se asocia con el hígado graso no alcohólico (HGNA) en niños. El objetivo fue explorar la asociación de factores dietéticos y sociodemográficos con el HGNA en niños y adolescentes obesos. Material y métodos: Treinta y tres pacientes obesos de 6-16 años fueron incluidos en este estudio transversal analítico. El diagnóstico de obesidad se realizó con puntuación z del índice de masa corporal > 2 DE. El HGNA se estimó con ultrasonido hepático, aminotransferasas séricas y elastografía. Las variables sociodemográficas se evaluaron con cuestionarios validados. La dieta se estimó mediante dos encuestas dietéticas por recordatorio de 24 horas enfocadas a la cantidad de energía, azúcares simples, ácidos grasos poliinsaturados (PUFAS) y antioxidantes. Resultados: En 13 pacientes (39.4%) se identificó esteatosis hepática por ultrasonido abdominal; 54.2% tuvieron una concentración sérica de alanina aminotransferasa por arriba de la referencia. El nivel educativo superior de ambos padres, el mayor gasto familiar mensual en alimentos y el mayor nivel socioeconómico se asociaron con HGNA. En el grupo total, el consumo de azúcares simples y grasas saturadas fue excesivo y el consumo de vitamina E y PUFAS estuvo por debajo del parámetro. Conclusiones: Se identificó HGNA en un tercio de los casos. Se demostró asociación entre HGNA y variables sociodemográficas. Ambos grupos tuvieron una ingesta aumentada de azúcares simples y disminuida de PUFAs. La ocurrencia selectiva de HGNA se podría relacionar a predisposición genética demostrada en población mexicana.

La obesidad es actualmente un problema de salud pública a nivel mundial. Ésta se caracteriza por afectar a múltiples órganos, entre ellos el hígado, desarrollándose enfermedades como la enfermedad de hígado graso no alcohólico (EHGNA), la cual predispone al desarrollo de carcinoma hepatocelular. En esta revisión se discute la asociación entre la obesidad y la EHGNA, enfatizando un abordaje preventivo y de intervención en etapas tempranas de la enfermedad, así como los potenciales efectos de algunos compuestos bioactivos presentes en la dieta. Al respecto es recomendable centrar la intervención en mejorar el IMC, a través de un programa de actividad física, educación nutricional y de salud, y cambios en los patrones dietéticos. La inclusión de alimentos ricos en compuestos bioactivos, como los compuestos fenólicos, fibra y vitaminas pueden proveer de un efecto antioxidante, antiinflamatorio y anti-obesogénico que podrían obstaculizar la progresión de la EHGNA, y otras comorbilidades y complicaciones.

Copyright of Revista de Investigación en Salud VIVE is the property of Revista de Investigacion en Salud VIVE and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medicina (Buenos Aires) is the property of Medicina (Buenos Aires) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction. Fatty liver disease has become the most common cause of liver injury; it is considered as the hepatic manifestation of metabolic syndrome, and its prevalence is rapidly increasing worldwide. Our objective was to determine if fatty liver disease was the main cause of consultation in our Research Center for Gastrointestinal and Liver Diseases, Hidalgo, Mexico, during the years 2015-2017. Material and Methods. Descriptive, transversal, observational and retrospective study. We revised and collected medical records from all the patients that attended for medical consultation at our Research Center during the study period. We obtained data related to findings compatible with fatty liver disease in any of its spectrum (NAFLD, NASH, cirrhosis), and we performed statistical analysis by using central tendency and dispersion measures. Results. From 1,936 revised medical files, we found data compatible with fatty liver in any of its varieties in 454 (23.4%), being 212 male (46.7%) and 242 female (53.3%), with an average age of 46.3 years; data compatible with NASH were found in 131 (6.7%), being female 63 (48.1%) and 68 were male (51.9%), with an average age of 47.9 years. 91 patients presented fatty liver-related cirrhosis (4.7%), being female 54 (59.3%) and male 37 (40.7%), with an average age of 62.2 years. Discussion. In our Research Center, fatty liver disease, in any of its varieties, covers the 23.4% from the total of causes of medical care, constituting the main cause of attention. It presents predominantly in women, and its NAFLD variety was found to be the most common. [ABSTRACT FROM AUTHOR]

Symposium 9: Hepatic involvement in diabetes: beyond the liver Diabetes management of the patient with fatty liver thinking about the pandemic In the last years, we have witnessed great advances in pharmacological treatments for patients with type 2 diabetes (T2D). Due to a higher availability of therapeutic options, choosing a pharmacological treatment requires an exhaustive analysis of the clinical characteristics of each patient. The presences of cardiovascular diseases, heart failure, chronic kidney disease and hypoglycemia risk are the most important considerations when choosing the best therapeutic option for the T2D patient. Unfortunately, the presence of non-alcoholic fatty liver (NAFLD) is a complication of T2D that is frequently overlooked by the healthcare team and its presence could lead to therapeutic implications. Patients with T2D not only show a higher risk of developing NAFLDs, but they also show a higher progression to severe forms of the disease, including advanced liver fibrosis, cirrhosis and hepatocellular carcinoma. Epidemiologic studies estimate that around a 55% of the patients with T2D have NAFLD, and, from that figure, a 70% have the form with inflammation and necrosis, known as non-alcoholic steatohepatitis (NASH). As a consequence of the increase of obesity and T2D prevalence in the world, NASH has become the second most frequent cause of liver transplant, and will probably soon consolidate as the first cause. We are facing a pandemic; a real problem for public health.

La enfermedad hepática por depósito de grasa adquiere cada vez una importancia mayor como entidad y, al mismo tiempo, como factor de riesgo aislado o asociado al síndrome metabólico. Con el objetivo de actualizar algunos aspectos relacionados con esta hepatopatía, tales como su actual nomenclatura y nuevo enfoque etiopatogénico, se efectuó la presente revisión bibliográfica desde una perspectiva clínica, la que incluye datos elementales sobre la fisiopatología y las características de presentación de la entidad, así como las principales armas utilizadas en su diagnóstico, control o terapéutica. Se demuestra, además, que la visión sobre el tema ha cambiado en los últimos años y constituye fuente de investigación en múltiples grupos prestigiosos por las particularidades de su evolución

En este estudio sometimos a ratas Wistar a dietas hipercalóricas por el consumo de solución de sacarosa al 30% en sustitución del agua de beber, alimento con 20% de grasa en forma de manteca de cerdo y la combinación de estas dos durante 2, 4 y 6 meses. Los animales que consumieron estas dietas desarrollaron un aumento de grasa retroperitoneal e hiperleptinemia, así como alto contenido de triglicéridos en el hígado, aunque no desarrollaron sobrepeso. Encontramos una disminución en expresión de proteínas formadoras de uniones estrechas (Claudina 5 y ZO-1) en el hipocampo, lo que es considerado como un indicador de pérdida de la integridad de la barrera hematoencefálica, así como un incremento en la expresión de la proteína ácida Fibrilar Glial (GFAP), que es un marcador de activación de microglia cerebral e inflamación en los animales que recibieron las dietas altas en sacrosa y sacarosa+grasa. Nuestros resultados indican que estas dietas indujeron una obesidad de tipo moderada y modificaciones en el sistema nervioso central que podrían ser marcadores de daño neurológico temprano, además de que una dieta hipercalórica puede generar marcadores de obesidad sin que sea necesario desarrollar sobrepeso. [ABSTRACT FROM AUTHOR]

El hígado graso no alcohólico (HGNA) es una complicación frecuente en pacientes obesos y se correlaciona con insulino resistencia (IR) y diabetes mellitus tipo 2 (DM2). Alanino aminotransferasa (ALT) se ha reconocido como un marcador bioquímico de HGNA y es utilizada para tamizaje de esta enfermedad. Objetivos: Evaluar la asociación entre niveles plasmáticos de aminotransaminasas, con variables antropométricas, marcadores de insulino resistencia e inflamación en población pediátrica. Sujetos y Métodos: Se estudiaron 348 sujetos (52,7% mujeres), con edades entre los 4,9 y 15,6 años. Se realizó antropometría y determinación sérica de: Aspartato aminotransferasa (AST), ALT, glicemia, insulina, perfil lipídico, PCR us, TNF-α, IL-6 y adiponectina. Se calculó el hOmA-IR, QUICKI y el HOMA-β. Los resultados se expresaron como mediana y rango intercuartil. Las variables fueron transformadas Log10 previo estudio con correlación de Pearson. Resultados: ALT se correlacionó positivamente con: IMC-puntaje z (r = 0,335), razón cintura / talla (r = 0,358), insulina (r = 0,33), HOMA-IR (r = 0,33), HOMA-β (r = 0,26), TG /HDL-Col (r = 0,2), PCR us (r = 0,3) y negativamente con QUICKI (r= -0,25) y adiponectina (r = -0,113). No fueron significativas las correlaciones de ALT con glicemia, TNF-α e IL-6. Conclusión: En este estudio demostramos que ALT, se correlacionó significativamente con insulino resistencia y marcadores de inflamación, todos ellos son reconocidos como factores de riesgo para pre-diabetes. ALT debe ser parte de la evaluación de todo niño obeso, especialmente en aquellos con otros riesgos cardiometabólicos, dado que podría predecir desarrollo posterior de DM2. Estudio de imágenes son necesarios para confirmar presencia de HGNA en esta población.

One of the most commonly used sweeteners is fructose. Fructose is directly metabolized in the liver and can be converted into glucose, later stored as glycogen constituting a source of energy for the hepatocytes. All excess fructose is converted into lipids by exerting a toxic effect on the liver, similar to that produced by excess of alcohol, and can cause nonalcoholic fatty liver (NAFLD). The aim of this review is to gather recent findings regarding the effect of fructose intake at high concentrations and its relationship with NAFLD. [ABSTRACT FROM AUTHOR]

Los pacientes con Hígado Graso No Alcohólico (HGNA), presentan un incremento en la mortalidad por enfermedad coronaria aterosclerótica, siendo la misma, la segunda causa más frecuente de muerte en los pacientes con HGNA. En general, el Engrosamiento de la Íntima Media Carotídea (EIMC), el cual constituye una evidencia de aterosclerosis subclínica, es mayor en los pacientes con HGNA que en las personas sanas. Los individuos con HGNA están en riesgo de aterosclerosis carotídea, independientemente de la presencia del Síndrome Metabólico y de factores clásicos de riesgo coronario aterosclerótico, por lo tanto la detección del HGNA, nos debe alertar de la existencia del incremento del riesgo de enfermedad aterosclerótica.Patients with non alcoholic fatty liver (NAFLD) present an increase in mortality duo to atherosclerotic coronary disease, being this, the second most common cause of death in patients with (NAFLD). In general, the intima-media thickening, which constitutes an evidence of subclinical atherosclerosis, is higher in patients with NAFLD than in healthy people. The individuals with NAFLD are at risk of suffering from carotid atherosclerosis independently of both the presence of Metabolic Syndrome and classical factors of atherosclerotic coronary risk. That's why the detection of NAFLD should alert us to the existence of an increase in the risk of suffering from atherosclerotic disease.

Introducción. La acumulación de grasa visceral se asocia al desarrollo de enfermedad hepática. La elastografía hepática es un método novedoso no invasivo para evaluar fibrosis hepática. Objetivo. Evaluar la relación entre el volumen de tejido adiposo visceral (VAT), volumen de tejido adiposo subcutáneo (SAT) medido por resonancia magnética (RM), con índices de elastografía hepática (EH) utilizando ARFI (fuerza de impulso de radiación acústica) en pacientes con Diabetes Mellitus tipo 2 (DM2). Métodos. Fueron incluidos 20 pacientes (edad promedio: 62 años, rango: 55-75 años, peso promedio: 77,8 kg, rango: 61,5-97 kg) con DM2. Los pacientes se sometieron a un examen de RM en un resonador Philips Intera 1.5T. Al protocolo de RM se agregó una secuencia de excitación espectral centrada en el peak de grasa. La secuencia incluyó 32 cortes transversales, grosor 7mm, desde la cúpula diafragmática hasta el borde inferior renal. En las imágenes se midió VAT utilizando el software Image J (freeware). En cada paciente se realizó una EH, utilizando ARFI con 10 medidas en lóbulo hepático derecho. Finalmente, se realizó un análisis estadístico a través de la correlación de Pearson entre los volúmenes de grasa abdominal y ARFI. Resultados. El promedio de VAT fue 2472 ± 861 cc, (1173-4020 cc), el promedio de ARFI fue 1,62 ± 0,8 m/s, (0,8-3,4 m/s). Se obtuvieron correlaciones de r=-0,08 entre VAT y ARFI (p=0,72), de 0,13 entre SAT y ARFI (p=0,57), y de -0,06 entre (VAT+SAT) con ARFI (p=0,77). Subdividiendo el universo muestral, se encontró que el grupo con ARFI mayor que 1,6 m/s (7 pacientes) obtuvo una correlación de 0,63 entre VAT y ARFI (p=0,12), de 0,66 entre SAT y ARFI (p=0,10), y de 0,94 entre (VAT+SAT) con ARFI (p=0,001). En el subgrupo con ARFI inferior a 1,6 m/s (13 pacientes) la correlación fue 0,11 entre VAT y ARFI (p=0,71), de 0,26 entre SAT y ARFI (p=0,38), y de 0,32 entre (VAT+SAT) y ARFI (p=0,28). Al ajustar por género en el subgrupo de mujeres con ARFI mayor que 1,6 m/s (6 pacientes), se encontró que la correlación de ARFI y VAT fue de 0,79 (p=0,05), y de 0,92 (p=0,009) para VAT+SAT. Conclusiones. En los pacientes DM2 con índices ARFI superior a 1,6 m/s habría una buena correlación con VAT y VAT+ SAT, indicando que aquellos con mayor daño hepático tendrían más acumulación de grasa abdominal.Background. Increase in visceral fat is associated to the development of fatty liver and liver fibrosis. Hepatic elastography is a novel noninvasive method for assessing liver fibrosis. Objective. To evaluate the relationship between visceral adipose tissue volume (VAT), subcutaneous adipose tissue volume (SAT) as measured by Magnetic Resonance Imaging (MRI) and transient elastography (TrE) values using ARFI (Acoustic Radiation Force Impulse) in type 2 Diabetic Mellitus patients (DM2). Methods. We included 20 DM2 patients (mean age: 62 years, range: 55-75, mean weight: 77.8 kg, range: 61.5-97). Patients underwent an MRI study in a Philips Intera 1.5T scanner. MR imaging protocol included a spectral excitation sequence centered on the fat peak. The sequence included 32 cross sections, 7mm thick, from the diaphragmatic cupula to the inferior border of the kidney. VAT was measured by using the semiautomatic Image J software. Each patient underwent a hepatic elastograpy (HE); 10 ARFI measurements were performed in the right hepatic lobe. Finally, a statistical analysis was performed by applying Pearson correlation between abdominal fat volumes and ARFI scores Results. Mean VAT was 2472 ± 861 cc, (1173-4020 cc), whilst the mean ARFI was 1.62 ± 0.8 m/s, (0.8-3.4 m/s). Correlations obtained were r=0.08 between VAT and ARFI (p=0.72); 0.13 between SAT and ARFI (p=0.57), and -0.06 between (VAT+SAT) and ARFI (p=0.77). By subdividing the sample universe, we observed that the group with ARFI scores greater than 1.6 m/s (7 patients) had a correlation of 0.63 between VAT and ARFI (p=0.12); of 0.66 between SAT and ARFI (p=0.10), and of 0.94 between VAT+SAT and ARFI (p=0.001). In the subgroup with ARFI values inferior to 1.6 m/s (13 patients), the correlation was of 0.11 between VAT and ARFI (p=0.71); of 0.26 between SAT and ARFI (p=0.38), and of 0.32 between ( VAT+SAT) and ARFI (p=0.28). When adjusted for gender, ARFI scores greater than 1.6m/s (6 patients) in the subgroup of female patients revealed a correlation of 0.79 (p=0.05) between ARFI and VAT, and of 0.92 (p=0.009) for VAT+SAT. Conclusions. In DM2 patients, ARFI values greater than 1.6 m/s seem to be indicative of a good correlation between VAT and VAT+SAT, thus indicating that those with greater liver damage may present increased abdominal fat accumulation.

Pediatric obesity has increased dramatically all over the world and nonalcoholic fatty liver disease (NAFLD) is one of the most frequent complications associated with excess adiposity. NAFLD causes serum transaminase elevation and liver disease, which could end up in fibrosis, cirrhosis and eventually hepatocellular carcinoma. NAFLD seems to be associated with the metabolic complications of obesity, mainly insulin resistance. The aim of the present article is to review the role of serum liver enzyme assessment as a suitable non invasive predictor of NAFLD in children. Although serum liver enzyme elevation does not accurately measure liver damage, it may be a valuable and non invasive test to screen NAFLD in children and adolescents and a marker to control NAFLD evolution. To detect NAFLD in obese children and adolescents, transaminases serum concentrations should be routinely determined in these patients. In this sense, it seems necessary to obtain transaminase reference standards for children and adolescents.La prevalencia de obesidad en niños ha aumentado considerablemente en todo el mundo y el hígado graso no alcohólico (HGNA) es una de las complicaciones más frecuentemente asociadas al exceso de adiposidad. El HGNA provoca elevación de las transaminasas hepáticas y una alteración hepática que pueden desencadenar fibrosis, cirrosis e incluso malignización. El HGNA aparece asociado a las complicaciones metabólicas de la obesidad, sobre todo a la resistencia a la insulina. El objetivo del presente artículo es revisar el rol que tienen las enzimas hepáticas como predictor no invasivo del HGNA en niños. Aunque la elevación de las enzimas hepáticas no valora con exactitud el daño hepático, pueden suponer un test no invasivo para el screening del HGNA en niños y adolescentes y un marcador de su evolución. Las transaminasas hepáticas deben ser determinadas de rutina en el diagnóstico del HGNA en niños y adolescentes. En este sentido, parece necesario encontrar unos estándares de referencia para los niveles de transaminasas en niños y adolescentes.

Objective: to evaluate the usefulness of a non-invasive clinical score to predict liver fibrosis in the steatosis associated with morbid obesity. Patients and methods: we included 88 patients, who underwent bariatric surgery in the Sanitary Area of León, Spain, and who showed a liver biopsy with steatosis greater than 5%. This is a retrospective study in which the rate of fibrosis is calculated from tests performed during the preoperative period, and is then compared to data from intraoperative hepatic biopsies. The analysis population was grouped according to the presence of advanced fibrosis in the liver biopsy (grade 3-4) or its absence (grade 0-2). The cutoff used for diagnosing advanced fibrosis was 0.676 (high cutoff point), and the cutoff point to exclude advanced fibrosis was -1.455 (low cutoff). Results: the prevalence of advanced fibrosis in the histological samples was 5.5%, and 65.9% of patients had no fibrosis. The cutoff for a low negative predictive value was 100%, and sensitivity was 100%. The cutoff point for a high positive predictive value was 1.7%, and specificity was 31.3%. Conclusions: this scoring system for morbidly obese patients eligible for bariatric surgery allows to identify those without advanced fibrosis, but cannot predict who may have advanced fibrosis.Objetivo: evaluar la utilidad de un índice de puntuación clínica no invasivo para predecir fibrosis hepática en la esteatosis asociada a la obesidad mórbida. Pacientes y métodos: se incluyeron 88 pacientes, intervenidos de cirugía bariátrica en el área sanitaria de León, que presentaron en la biopsia hepática una esteatosis mayor del 5%. Se trata de un estudio retrospectivo en el que se calculó el índice de fibrosis a partir de los datos analíticos del preoperatorio, y se comparó su resultado con los datos de la biopsia hepática intraoperatoria realizada. Para el análisis los pacientes fueron agrupados según presentaban en la biopsia hepática fibrosis avanzada (grado 3-4) o no (grado 0-2). El punto de corte usado para diagnosticar fibrosis avanzada fue 0,676 (punto de corte alto), y el punto de corte para excluir fibrosis avanzada fue -1,455 (punto de corte bajo). Resultados: la prevalencia de fibrosis avanzada en las muestras histológicas fue del 5,5% y el 65,9% de los pacientes no presentaban fibrosis. Para el punto de corte bajo el valor predictivo negativo fue del 100% y la sensibilidad del 100%. Para el punto de corte alto el valor predictivo positivo fue del 1,7% y la especificidad del 31,3%. Conclusiones: el sistema de puntuación analizado permite, en los pacientes con obesidad mórbida candidatos a cirugía bariátrica, detectar aquellos sin fibrosis avanzada, pero no permite predecir aquellos que pueden tener una fibrosis avanzada.

La enfermedad del hígado graso no alcohólico es una enfermedad inflamatoria hepática de carácter crónico de gran relevancia en la actualidad por su fuerte asociación con enfermedades de incidencia creciente como la obesidad y la diabetes mellitus tipo 2. En este trabajo se recoge buena parte del conocimiento existente sobre los mecanismos moleculares implicados en el establecimiento de la esteatosis hepática, el primer estadio de la enfermedad, y en su progreso a esteatohepatitis. Se ha prestado una atención especial al hígado graso asociado a la obesidad, clínica y experimental. En este caso, se valora la rata fa/fa, un modelo animal de obesidad con rasgos fenotípicos similares a los de la obesidad humana, incluyendo la resistencia a la insulina y la dislipemia. La esteatosis hepática se revela como una situación compleja, eminentemente metabólica, en la que se simultanean procesos metabólicos aparentemente contradictorios, así como estrés oxidativo, estrés de retículo endoplasmático, disfunción mitocondrial y descenso en la expresión de genes de supervivencia. En buena medida, en su base se sitúan señales extrahepáticas, como las producidas en una situación de resistencia periférica a la insulina asociada a un aumento de la masa adiposa y de ácidos grasos libres sistémicos, e internas, causantes de un desajuste de las funciones glucostática y lipidostática del hígado y de una mayor vulnerabilidad a otras agresiones.Non-alcoholic fatty liver disease is a chronic inflammation liver condition that is currently highly relevant because of its strong association with increasingly incident diseases such as obesity and type-2 diabetes mellitus. The primary purpose of this paper is to discuss the best part of current knowledge on the molecular mechanisms involved in hepatic steatosis development, the condition's initial stage, and on progression to steatohepatitis. Special attention has been paid to clinical and experimental obesity-related fatty liver. In the latter, the fa/fa rat is assessed, which constitutes an animal model for obesity with phenotype features similar to human obesity, including insulin resistance and dyslipemia. Hepatic steatosis is a complex, mainly metabolic condition where apparently non-compatible metabolic processes concur, in addition to oxidative stress, endoplasmic reticulum stress, mitochondrial dysfunction, and decreased expression of survival genes. Extrahepatic signals underlie the disorder, such as those arising from peripheral insulin resistance associated with an increase in adipose mass and systemic free fatty acids, together with intrahepatic signals leading to derangement of liver glycostatic and lipidostatic functions, as well as to greater vulnerability to other aggressions.

Aim: This work aims to assess the effect of weekly subcutaneous semaglutide on biomarkers of metabolic-associated fatty liver disease (MAFLD), namely the hepatic steatosis index (HSI) and the fibrosis-4 (FIB-4) index, at 24 weeks in outpatients attended to in internal medicine departments., Methods: This study analyzed patients in an ongoing, multicenter, prospective, pre-post, uncontrolled cohort registry that enrolls unique, consecutive patients with type 2 diabetes treated with weekly subcutaneous semaglutide. Steatosis/fibrosis were determined by HSI (<30 ruled out, >36 steatosis) and FIB-4 (<1.3 ruled out, >2.67 fibrosis), respectively., Results: The sample included 213 patients (46.9% women) with a median age of 64 (19) years. The median baseline body mass index and weight were 36.1 (8.4) kg/m 2 and 98 (26.9) kg, respectively. A total of 99.9% had HSI values indicating steatosis, with a mean HSI of 47.9 (8.2). Additionally, 10.8% had fibrosis (FIB-4 > 2.67) and 42.72% had values in intermediate ranges (FIB-4 1.3-2.67). At 24 weeks, there was a significant reduction in HSI (-2.36 (95%CI 1.83-2.9) p < 0.00001) and FIB-4 (-0.075 (95%CI 0.015-0.14) p < 0.016), mainly related to declines in body weight, triglyceride levels, insulin resistance (estimated by the triglyceride-glucose index), and liver enzymes., Conclusion: These results show that weekly subcutaneous semaglutide had a beneficial effect on liver steatosis that went beyond glucose control. Its effects were mainly related to weight loss, a decline in biomarkers, and improvements in insulin sensitivity. For many patients, early detection is essential for improving MAFLD outcomes and may allow for selecting the most efficient treatment options., (Copyright © 2022. Published by Elsevier España, S.L.U.)

Background: clinical data on impact of the Mediterranean diet on the the stage of non alcoholic fatty liver disease are limited and these studies have heterogeneous designs.Aim: we decide to explore any potential associations between adherence to the Mediterranean diet and histological characteristics of patients with NAFLD.Methods: a sample of 82 patients was analyzed in a cross sectional study. To evaluate the level of adherence to the Mediterranean dietary pattern the 14-Item Mediterranean Diet Assessment Tool was used.Results: thirty five patients (42.7%) had a low grade of steatosis (grade 1 of classification) and 47 patients (57.3%) had a high grade of steatosis (grade 2 and 3). Fifty-six patients (68.3%) had liver steatohepatitis and forty-two patients (51.2%) had liver fibrosis. In the logistic regresion analysis, one unit of the 14-Item Mediterranean Diet Assessment Tool was associated with a lower likehood of having steatohepatitis odds ratio 0.43 (CI:95%: 0.29-0.64) and steatosis 0.42 (CI:95%: 0.26- 0.70). Secondly, one unit of HOMA-IR was associated with higher likehood of having steatosis odds ratio 2.01 (CI:95%: 1.08-3.71) and liver fibrosis 1.38 (CI:95%: 1.10-1.80) .Conclusions: greater adherence to the Mediterranean diet was associated with lower likelihood of high grade of steatosis and presence of steatohepatitis. [ABSTRACT FROM AUTHOR]

The hepatic disease due to fat deposit acquires greater importance as entity and, at the same time, as isolated or associated risk factor to the metabolic syndrome. With the objective of updating some aspects related to this hepatopathy, such as its current nomenclature and new etiopathogenic approach; the present literature review was carried out from a clinical perspective, which includes elementary data on the pathophysiology and the presentation characteristics of the entity, as well as the main tools used in its diagnosis, control or therapy. It is also demonstrated, that the vision on the topic has changed in the last years and it constitutes an investigation source in multiple noted groups due to the particularities of its clinical course. [ABSTRACT FROM AUTHOR]

Background: Morbidly obese patients usually present vitamin D deficiency or secondary hyperparathyroidism. Low vitamin I) levels have been recently related to non-alcoholic fatty liver disease (NAFLD). The aim of this study was to analyse the relationship between vitamin I), bone turnover markers and non-alcoholic fatty liver disease and metabolic syndrome in severely obese patients. Methods: One hundred and ten patients who underwent bariatric surgery were included. Liver biopsy was taken during surgery. Two univariate analyses were carried out in order to i) analyse the relationship between liver histology and vitamin D-bone turnover markers (intact parathyroid hormone (PTH), osteocalcin and Carboxy-terminal collagen crosslinks) and ii) establish the association between metabolic syndrome components-insulin resistance (HOMA) and vitamin D-bone turnover markers. Results: 70% of the patients had lower levels of vitamin D or secondary hyperparathyroidism. None of the components of liver histology were associated with levels of vitamin D or with bone turnover parameters. Patients with metabolic syndrome showed lower levels of PTH and osteocalcin (72,42 (29,47) vs 61.25(19.59) p-Value: 0.022; 19.79 (10.43) vs 16.87(10.25) p-Value: 0,028, respectively). HOMA was not related to Vitamin D or bone turnover markers. Conclusion: Low levels of vitamin 1) or hyperparathyroidism are common in severely obese patients. Vitamin D and bone metabolism markers were associated neither to NAFLD nor with metabolic syndrome in our series of obese morbid patients. [ABSTRACT FROM AUTHOR]

Background: The role of thyroid functional disorders in non-alcoholic fatty liver disease has not been completely defined. Thyroid hormones play a fundamental role in the metabolism of lipids. Hypothyroidism causes hypercholesterolemia, and has been associated with metabolic syndrome, for this reason, it could have an essential role in the pathogenesis of non-alcoholic fatty liver disease. Objective: To find the prevalence of non-alcoholic fatty liver disease in patients with hypothyroidism. Material and method: A case-control study was made, in which we reviewed patient's files who had a medical preventive exam in the Diagnostic and Treatment Integral Center of Medica Sur, Mexico City, during 2012; taking as cases patients with hypothyroidism in its entire spectrum. Upper abdominal ultrasonography was used to establish the presence of fatty liver and the degree of fibrosis was calculated using the non-alcoholic fatty liver disease fibrosis score. Results: Fatty liver disease was associated with hypothyroidism independently of whether it was in a subclinical or manifested form; it was present in a 62% in patients with hypothyroidism vs 52% in those with euthyroidism. The association between hypothyroidism and mild steatosis was significant: 51% of hypothyroid patients vs 31% of euthyroid patients (p=0.0180), and even higher for the under substituted subjects (62%, p= 0.0253). Conclusion: Hypothyroidism can predict a mild degree of steatosis, independently of other components of the metabolic syndrome. The study strongly suggests hypothyroidism as an independent risk factor for liver steatosis since it took place in a healthy population with similar, determinant metabolic components of non-alcoholic fatty liver disease in all groups. [ABSTRACT FROM AUTHOR]

Non alcoholic fatty liver disease (NAFLD) is associated with obesity, insulin resistance (IR) and increased type 2 diabetes (T2D). Alanine aminotransferase (ALT) is recognized as biochemical marker of NAFLD, currently used as screening for this disease. Objective: To estimate the associations between (ALT) with anthropometric variables, insulin resistance and inflamatory markers in pediatric population. Patients and Method: we studied 348 subjects (52.7% females), aged between 4.9 and 15.6 years. Blood samples for measuring: AST, ALT, glycaemia, insulin, lipid profile, hsCRP TNF-α, IL-6 and adiponectin. We calculate HOMA-IR, QUICKI y el HOMA-β. The results are expressed are expressed as median interquartile range. Variables were log10 transformed before Pearson correlations analyze. Results: Serum ALT levels were positively associated with BMI-SDS (r = 0.335), waist/ height ratio (r = 0.358), insulin (r = 0.33), HOMA-IR (r = 0.33), HOMA-β (r = 0.26), TG/HDL-c (r = 0.2) , hsCRP (r = 0.3); and a negative association with QUICKI (r = -0.25) and adiponectin (r = -0.113). Non-association with ALT, glycaemia, TNF-α and IL-6 was found. Conclusion: Our study demonstrated that ALT, but not AST, was significantly correlated with of insulin resistance and inflamatory markers, all of them recognized as risk parameters of pre diabetes stage. ALT should be part of the evaluation of all obesity children, mainly those with other cardiometabolic risk factors, since it could predict later development of T2DM. Further imaging studies are necessary to confirm fatty liver disease in this population. [ABSTRACT FROM AUTHOR]

Non-alcoholic fatty liver disease (NAFLD) is a chronic disease that may lead to cirrhosis and hepatocellular carcinoma; its close relationship with obesity and the metabolic syndrome involves an increasing prevalence. Invasive liver biopsy is the gold standard diagnosis technique for NAFLD but entails risks. Therefore, transient elastography, a non-invasive technique with high reliability, is frequently used in clinical practice. Bariatric surgery is the only effective treatment for long-term weight loss and obesity-related metabolic conditions improvement. Although studies report encouraging results of bariatric surgery as a valuable therapy for NAFLD, guidelines for its use in NAFLD are ambiguous. Indeed, the mechanisms driving this improvement are largely unknown, but likely involve weight loss-dependent and independent factors including anatomic and hormonal changes. This review aims to update the relationship between NAFLD and bariatric surgery, focusing on the indications for surgery and the mechanisms implied in NAFLD improvement., (Copyright © 2022 Elsevier España, S.L.U. All rights reserved.)

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Background: patients with type 2 diabetes mellitus (T2DM) appear to have an increased risk of developing nonalcoholic fatty liver disease (NAFLD) and have higher risk to develop hepatic fibrosis and cirrhosis. The aim was to determine the prevalence of NAFLD in health workers with T2DM by liver ultrasound. Methods: health workers with T2DM attended at the Family Medicine Unit No. 77, Madero City, Tamaulipas, Mexico, were screened. Risk factors, BMI, % of body fat (% BF), fat mass, waist circumference (WC), blood pressure, HbA1C and lipid profile, were evaluated. The patients were categorized into two groups according to NAFLD status. Differences between groups were assessed by independent t test and χ² test. Results: the NAFLD prevalence found in females on ultrasound examination was 40 % and 17.1 % in males. NAFLD patients were more obese (p < 0.001) and they had significantly higher values of % BF (p < 0.001), fat mass (p < 0.01) and WC (p < 0.01). They also had significantly higher values of HbA1C (p < 0.04) and triglycerides (p < 0.03) than patients without NAFLD. Conclusions: NAFLD is common among health workers with T2DM. It is important to prevent NAFLD progression. [ABSTRACT FROM AUTHOR]

Copyright of MedULA is the property of Facultad de Medicina, Universidad de los Andes, Venezuela and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Metabolic síndrome (MS) is a group of abnormalities which favor the development of cardiovascular, hepatic, and degenerative complications; frequently showing a subclinical evolution. Non-alcoholic fatty liver (NAFL), featured by hepatic fat accumulation, is a common condition among patients with MS. It has been associated with cardiovascular risk, suggesting a predictive role. Material and methods: A cross sectional, comparative, observational study was carried out with the approval of the Institutional Ethics Committee. Patients with MS from the Internal Medicine Department, Hospital General Regional "Lic. Adolfo López Mateos ", ISSSTE, were included. Patients were not consuming hepatotoxic drugs or alcohol intake higher than 30 grams a day. After informed consent was signed, the following studies were obtained: clinical data, liver function tests, lipids profile and hepatic echography. With this information it was possible to determine the presence of NAFL and cardiovascular risk, assessed by the atherogenic index and risk scale (euro-score). Results. Fifty five patients were studied, mean age 47.4 ± 11.8 years old. The prevalence of NAFL was 36%, a third from which showed high cardiovascular risk. NAFL was not significantly associated with cardiovascular risk (whole relative risk [RR]=0.5, IC95%=0.23-1.26, p=0.1; atherogenic index RR= .82, CI95%=0.48-1.41, p=0.3, and euro-score RR=0.48, IC95%= 0.15-1.51, p=0.1) there was neither significant correlation with other variables (multiple regression associated to body mass index, p=0.44; triacyglycerides, p=0.32). Conclusion: We found a low association between NAFL and cardiovascular risk, assessed by atherogenic index and clinical scale; nevertheless, the influence of age, sex, body mass index, and dyslipidemia is not ruled out. [ABSTRACT FROM AUTHOR]

Non-Alcoholic Fatty Liver Disease (NAFLD) includes hepatic steatosis, non-alcoholic steatohepatitis (NASH), cirrhosis, and hepatocellular carcinoma in its clinical presentation and evolution. It is related to obesity, especially abdominal, type 2 diabetes mellitus, and Metabolic Syndrome (SM). Overnutrition, sedentarism, genetic factors, and insulin resistance have been involved in its physiopathology. The prevalence of NAFLD ranges from 17 to 33%. NASH is present in 30% of these cases, 20 to 25% of which become hepatocellular carcinoma. NAFLD is one of the most frequent causes of alterations in hepatic function tests in asymptomatic patients. In its early stage, its main features are abdominal discomfort, fatigue, alanine-aminotransferase (ALAT) increase, gammaglutamyl transpeptidase (GGT), hepatomegaly, and hepatic hyperechogenicity on ultrasound scan. It is not a benign disease, since 32% of patients develop fibrosis, 20% fibrosis, and death risk related to hepatic dysfunction is 12% at 10 years. Therapeutic alternatives aim at modifying the life style and diet, and also include the prescription of drugs, all this affects the disease physiopathology, especially insulin resistance and metabolic syndrome. [ABSTRACT FROM AUTHOR]

Pediatric obesity has increased dramatically all over the world and nonalcoholic fatty liver disease (NAFLD) is one of the most frequent complications associated with excess adiposity. NAFLD causes serum transaminase elevation and liver disease, which could end up in fibrosis, cirrhosis and eventually hepatocellular carcinoma. NAFLD seems to be associated with the metabolic complications of obesity, mainly insulin resistance. The aim of the present article is to review the role of serum liver enzyme assessment as a suitable non invasive predictor of NAFLD in children. Although serum liver enzyme elevation does not accurately measure liver damage, it may be a valuable and non invasive test to screen NAFLD in children and adolescents and a marker to control NAFLD evolution. To detect NAFLD in obese children and adolescents, transaminases serum concentrations should be routinely determined in these patients. In this sense, it seems necessary to obtain transaminase reference standards for children and adolescents. [ABSTRACT FROM AUTHOR]

Copyright of MedULA is the property of Facultad de Medicina, Universidad de los Andes, Venezuela and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)