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Resumen: La enfermedad por hígado graso no alcohólico (EHGNA) es actualmente una de las principales causas de hepatopatía crónica en el mundo occidental. La prevalencia mundial reportada en población general es del 25%. La adiposidad visceral y la grasa hepática propician un estado de inflamación sistémica, predisponiendo a los individuos con EHGNA a enfermedades extrahepáticas como enfermedad cardiovascular (causa más común de muerte en EHGNA), diabetes mellitus, enfermedad renal crónica, hipotiroidismo, síndrome de ovario poliquístico, apnea obstructiva del sueño, así como aumento del riesgo de presentar neoplasias gastrointestinales y extraintestinales. Diversos mecanismos se han reportado entre la EHGNA y su asociación con enfermedades extrahepáticas, y la lipotoxicidad es la principal causa de activación de vías inflamatorias que ocasionan el daño tisular extrahepático. Abstract: Non-alcoholic fatty liver disease (NAFLD) is currently one of the main causes of chronic liver disease in Western countries, with a 25% prevalence reported in the general population worldwide. Visceral adiposity and liver fat promote a state of systemic inflammation, predisposing individuals with NAFLD to the extrahepatic pathologies of cardiovascular disease (the most common cause of death in patients with NAFLD), diabetes mellitus, chronic kidney disease, hypothyroidism, polycystic ovary syndrome, obstructive sleep apnea, and an increased risk for presenting with gastrointestinal and extraintestinal neoplasias. Different mechanisms between NAFLD and its association with extrahepatic diseases have been reported, and lipotoxicity is the main cause of inflammatory pathway activation that results in extrahepatic tissue damage. Palabras clave: Esteatosis, Enfermedad por hígado graso no alcohólico, Esteatohepatitis, Síndrome metabólico, Riesgo cardiovascular, Keywords: Steatosis, Non-alcoholic fatty liver disease, Steatohepatitis, Metabolic syndrome, Cardiovascular risk

Non-alcoholic fatty liver disease (NAFLD) is currently one of the main causes of chronic liver disease in Western countries, with a 25% prevalence reported in the general population worldwide. Visceral adiposity and liver fat promote a state of systemic inflammation, predisposing individuals with NAFLD to the extrahepatic pathologies of cardiovascular disease (the most common cause of death in patients with NAFLD), diabetes mellitus, chronic kidney disease, hypothyroidism, polycystic ovary syndrome, obstructive sleep apnea, and an increased risk for presenting with gastrointestinal and extraintestinal neoplasias. Different mechanisms between NAFLD and its association with extrahepatic diseases have been reported, and lipotoxicity is the main cause of inflammatory pathway activation that results in extrahepatic tissue damage. Resumen: La Enfermedad por Hígado Graso no Alcohólico (EHGNA) es actualmente una de las principales causas de hepatopatía crónica en el mundo occidental. La prevalencia mundial reportada en población general es del 25%. La adiposidad visceral y grasa hepática propician un estado de inflamación sistémica, predisponiendo a los individuos con EHGNA a enfermedades extra-hepáticas como enfermedad cardiovascular (causa más común de muerte en EHGNA), Diabetes Mellitus, enfermedad renal crónica, hipotiroidismo, síndrome de ovario poliquístico, apnea obstructiva del sueño, así como aumento del riesgo de presentar neoplasias gastrointestinales y extraintestinales. Diversos mecanismos se han reportado entre la EHGNA y su asociación con enfermedades extra- hepáticas, siendo la lipotoxicidad la principal causa de activación de vías inflamatorias que ocasionan el daño tisular extra hepático. Keywords: Steatosis, Non-alcoholic fatty liver disease, Steatohepatitis, Metabolic syndrome, Cardiovascular risk, Palabras clave: Esteatosis, Enfermedad por hígado graso no alcohólico, Esteatohepatitis, Síndrome metabólico, Riesgo cardiovascular

BACKGROUND Anorectal manometry is the most commonly performed test of anorectal function. The cough-anorectal response is frequently assessed as part of a routine manometric investigation but has not previously been the subject of detailed analysis. This study systematically examined anorectal pressure responses to cough in health and evaluated the impact of parity and symptoms of fecal incontinence (FI) on measurements. METHODS High-resolution anorectal manometry (HR-ARM) traces from nulliparous (n = 25) and parous (n = 25) healthy volunteers (HV: aged 41, range 18-64), and 57 parous patients with FI (age 47, range 28-72) were retrospectively reviewed. Cough-anorectal pressure responses were analyzed between groups by qualitative and quantitative approaches. KEY RESULTS In health, traditional anal pressure measurements ("rest" and "squeeze") were similar between nulliparous and parous women. In contrast, incremental anal-rectal pressure difference during cough significantly differed: nulliparous 42 mm Hg (95% CI: 21-64) vs. parous 6 mm Hg (-14-25), P