No abstract available.
Aged ; Cholecystitis/*diagnosis/radiography/ultrasonography ; Endosonography ; Fatty Liver/pathology ; Female ; Humans ; Recurrence ; Tomography, X-Ray Computed

OBJECTIVETo study the pathological and clinical features of nonalcoholic fatty liver disease (NAFLD).

METHODSGrades and stages of liver lesions in 41 patients with NAFLD were analyzed. The relationships between pathohistological features of the livers, serum biochemical parameters, ultrasound examination and other clinical data of the patients were studied.

RESULTSAmong the 41 patients with NAFLD (there were 21 with their liver fatty degeneration in grade 1, 15 in grade 2, and 5 in grade 3). There were 2 of grade 0, grade 1 had 25, grade 2 had 10, grade 3 had 3, and grade 4 had 1. Stage 0 of fibrosis was 20, stage 1 was 14, stage 2 was 4, stage 3 was 2, and stage 4 was 1. Degree of fatty degeneration was not positively associated with the body mass index (BMI) of the patients and the ultrasound findings in their livers. Grading of the inflammation was positively related to the alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels in the blood and ultrasound findings in their livers, but negatively to the platelet counts. Staging of fibrosis of the livers was positively related to the blood ALT, AST, GGT, and ALP, and negatively to triglyceride levels and platelet counts.

CONCLUSIONSDegree of liver fatty degeneration was not associated with grades of inflammation and staging of fibrosis of the liver. BMI, ALT and AST level, platelet counts, and ultrasound grades of fatty liver were associated with the liver histopathological changes of NAFLD patients. Liver biopsy is the essential way to make a diagnosis of NAFLD.

Adolescent ; Adult ; Biopsy, Needle ; Fatty Liver ; diagnosis ; diagnostic imaging ; pathology ; Female ; Humans ; Liver ; diagnostic imaging ; pathology ; physiopathology ; Male ; Middle Aged ; Ultrasonography

The prevalence of non-alcoholic fatty liver disease (NAFLD) is estimated to be 25-30% of the population, and is the most common cause of elevated liver enzymes in Korea. NAFLD is a "hot potato" for pharmaceutical companies. Many clinical trials are underway to develop a first-in-class drug to treat NAFLD. However, there are several challenging issues regarding the diagnosis of NAFLD. Currently, liver biopsy is the gold standard method for the diagnosis of NAFLD and steatohepatitis. Ideally, globally recognized standards for histological diagnosis and methods to optimize observer agreement on biopsy interpretation should be developed. Liver biopsy is the best method rather than a perfect one. Recently, multi-parametric magnetic resonance imagery can estimate the amount of intrahepatic fat successfully and is widely used in clinical trials. But no diagnostic method can discriminate between steatohepatitis and simple steatosis. The other unresolved issue in regard to NAFLD is the absence of satisfactory treatment options. Vitamin E and obeticholic acid have shown protective effects in randomized controlled trials, but this drug has not been approved for use in Korea. This study will provide a description of diagnostic methods and treatments that are currently recommended for NAFLD.
Biomarkers/analysis ; Chenodeoxycholic Acid/analogs & derivatives/therapeutic use ; Clinical Trials as Topic ; Fatty Liver/diagnosis ; Fibrosis ; Humans ; Liver/diagnostic imaging/pathology ; Magnetic Resonance Imaging ; Non-alcoholic Fatty Liver Disease/*diagnosis/drug therapy ; Tomography, X-Ray Computed ; Ultrasonography ; Vitamin E/therapeutic use

Liver biopsy is the gold standard for diagnosing non-alcoholic steatohepatitis (NASH), but liver biopsy in children is not available in many institutes and many parents are reluctant to agree with the procedure. We investigated the correlation of clinical and pathologic parameters with the severity of non-alcoholic fatty liver disease (NAFLD) in pediatric patients using ultrasonographic examination methods and measured the prevalence of fatty pancreas in pediatric NAFLD.METHODS: Liver biopsy and abdominal ultrasound (US) examinations were performed in 58 children (42 boys, 16 girls; mean age, 12 years; age range, 4–19 years) between March 2006 and August 2017. Fatty liver and fatty pancreas were evaluated by two independent radiologists using US according to 4- and 3-point scales, respectively. We then analyzed the correlations of clinical, laboratory, and histopathologic parameters with the ultrasonographic grade of steatosis.RESULTS: Forty-two children showed simple steatosis (NAFLD activity score [NAS] ≤ 5) while 16 showed NASH (NAS > 5). Higher body mass index (BMI) percentile, waist circumference, hematocrit, insulin resistance, and lower insulin sensitivity index were significantly positively correlated with the grade of fatty liver. NAFLD activity score, amount of steatosis, and fibrosis significantly worsened as the fatty liver grade increased. Higher BMI, lower insulin sensitivity index, and boy were significantly positively correlated with the fatty pancreas grade.CONCLUSION: Altogether, ultrasonographic severity of fatty liver shows good correlation with that of clinical parameters and hepatic pathology.]]>
Academies and Institutes ; Biopsy ; Body Mass Index ; Child ; Fatty Liver ; Female ; Fibrosis ; Hematocrit ; Humans ; Insulin Resistance ; Liver ; Male ; Non-alcoholic Fatty Liver Disease ; Pancreas ; Parents ; Pathology ; Prevalence ; Ultrasonography ; Waist Circumference ; Weights and Measures

BACKGROUND/AIMS: Nonalcoholic steatohepatitis (NASH) is the progressive form of non-alcoholic fatty liver disease (NAFLD), and its prevalence is increasing worldwide. Liver biopsy remains the best way to diagnose NASH and establish the presence of fibrosis, but has not been performed easily in children because of its invasiveness. We analyzed the ultrasonographic and histopathologic findings of pediatric NAFLD patients, and studied to find their association with clinical characteristics and laboratory findings. METHODS: The study involved 18 obese children ranging from 7 to 15 years of age, who were diagnosed with NASH by liver biopsy. We performed the abdomen ultrasonography before the liver biopsy. We reviewed their pathology slides and classified them by NASH CRN (Clinical Research Network) scoring system. We also reviewed the abdomen ultrasonographic findings of the patients and classified them into grade of 1, 2, and 3. We reviewed the medical records of the patients and investigated their clinical characteristics and laboratory findings. RESULTS: The ultrasonographic grades had significant association with NAFLD activity score, grade of steatosis amount, ballooning change, and portal inflammation. Serum triglyceride level was significantly higher in patients who showed high grade steatosis and high NAFLD activity score. CONCLUSIONS: This study showed that serum triglycerides and ultrasonographic findings are highly correlated with pathologic findings in children with NAFLD.
Adolescent ; Biopsy, Fine-Needle ; Child ; Disease Progression ; Fatty Liver/diagnosis/pathology/ultrasonography ; Female ; Humans ; Male ; Obesity/complications ; Retrospective Studies ; *Severity of Illness Index ; Triglycerides/blood

No abstract available.
Citric Acid Cycle/physiology ; Cytochrome P-450 Enzyme System/metabolism ; Fatty Liver/diagnosis/pathology/ultrasonography ; Humans ; Obesity/*complications ; Severity of Illness Index

OBJECTIVETo explore demographic and metabolic factors associated with increased alanine aminotransferase (ALT) activity in non-diabetic non-alcoholic fatty liver disease (NAFLD) patients.

METHODSOverall 372 patients who consecutively attended to Gastroenterology Clinic of Baqiyatallah University of Medical Sciences, Tehran, Iran awere diagnosed as NAFLD entered into analysis. Exclusion criteria were having diabetes mellitus and fasting blood glucose over 126 mg/dL, active hepatitis B virus infection, having hepatitis C virus positive serology, and to be under corticosteroid therapy. ALT levels were considered pathologically high when it was over 30 IU/L for men and over 19 IU/L for women.

RESULTSBivariate analyses using t test and chi-square test showed that patients with pathologically augmented ALT levels had significantly higher NAFLD grades in their ultrasonographic evaluations (P=0.003). Moreover, these patients represented significantly higher homeostatic model assessment levels (P=0.003), levels of serum insulin (P=0.002), fasting blood glucose (P<0.001), and uric acid (P=0.02). The prevalence of insulin resistance was also higher in patients with increased serum ALT concentrations. Multifactorial logistic regression models showed that ultrasonographic grading of NAFLD (P=0.027) and insulin resistance (P=0.013) were the only variables significantly associated with abnormal ALT levels.

CONCLUSIONSThis study shows that the associations of increased ALT serum levels in NAFLD patients are different from what are supposed before. By excluding diabetic patients from our population, we find that increased ALT levels are not associated with dyslipidemias but are independently associated with insulin resistance and NAFLD grading on ultrasonographic evaluations. Further studies are needed to confirm our results.

Adult ; Alanine Transaminase ; metabolism ; Blood Glucose ; Dyslipidemias ; metabolism ; Female ; Humans ; Insulin Resistance ; Male ; Middle Aged ; Non-alcoholic Fatty Liver Disease ; diagnostic imaging ; metabolism ; pathology ; Risk Factors ; Ultrasonography

PURPOSE: We examined the relationship between portal venous velocity and hepatic-abdominal fat in patients with nonalcoholic fatty liver disease (NAFLD), using spectral Doppler ultrasonography (US) and magnetic resonance imaging (MRI). MATERIALS AND METHODS: In this prospective study, 35 patients with NAFLD and 29 normal healthy adults (control group) underwent portal Doppler US. The severity of hepatic steatosis in patients with NAFLD was assessed by MRI through chemical shift imaging, using a modification of the Dixon method. Abdominal (intra-abdominal and subcutaneous) fat was measured by MRI. RESULTS: The difference in portal venous velocity between the patients with NAFLD and the control group was significant (p < 0.0001). There was no correlation between the degree of abdominal or hepatic fat and portal venous velocity (p > 0.05). There were strong correlations between the hepatic fat fraction and subcutaneous adiposity (p < 0.0001), intraperitoneal fat accumulation (p = 0.017), and retroperitoneal fat accumulation (p < 0.0001). CONCLUSION: Our findings suggest that patients with NAFLD have lower portal venous velocities than normal healthy subjects.
Abdominal Fat/pathology ; Adult ; Aged ; Blood Flow Velocity/*physiology ; Case-Control Studies ; Fatty Liver/*physiopathology/*ultrasonography ; Female ; Humans ; Image Interpretation, Computer-Assisted ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Obesity/complications ; Overweight/complications ; Portal Vein/*ultrasonography ; Prospective Studies ; *Ultrasonography, Doppler

BACKGROUND/AIMS: The red-blood-cell distribution width (RDW) is a newly recognized risk marker in patients with cardiovascular disease, but its role in nonalcoholic fatty liver disease (NAFLD) has not been well defined. The aim of the present study was to determine the association between RDW values and the level of fibrosis in NAFLD according to BARD and FIB-4 scores. METHODS: This study included 24,547 subjects who had been diagnosed with NAFLD based on abdominal ultrasonography and questionnaires about alcohol consumption. The degree of liver fibrosis was determined according to BARD and FIB-4 scores. The association between RDW values and the degree of fibrosis in NAFLD was analyzed retrospectively. RESULTS: After adjusting for age, hemoglobin level, mean corpuscular volume, history of hypertension, history of diabetes, and high-sensitivity C-reactive protein, the RDW values were 12.61+/-0.41% (mean+/-SD), 12.70+/-0.70%, 12.77+/-0.62%, 12.87+/-0.82%, and 13.25+/-0.90% for those with BARD scores of 0, 1, 2, 3, and 4, respectively, and 12.71+/-0.72%, 12.79+/-0.66%, and 13.23+/-1.52% for those with FIB-4 scores of <1.30, 1.31-2.66, and > or =2.67, respectively (P<0.05). The prevalence of advanced fibrosis (BARD score of 24 and FIB-4 score of > or =1.3) increased with the RDW [BARD score: 51.1% in quartile 1 (Q1) vs. 63.6% in Q4; FIB-4 score: 6.9% in Q1 vs. 10.5% in Q4; P<0.001]. After adjustments, the odds ratio of having advanced fibrosis for those in Q4 compared to Q1 were 1.76 (95%CI=1.55-2.00, P<0.001) relative to BARD score and 1.69 (95%CI=1.52-1.98, P<0.001) relative to FIB-4 score. CONCLUSIONS: Elevated RDW is independently associated with advanced fibrosis in NAFLD.
Adult ; Alcohol Drinking ; C-Reactive Protein/analysis ; Diabetes Mellitus/pathology ; Erythrocyte Indices ; Fatty Liver/complications/*diagnosis/ultrasonography ; Female ; Humans ; Hypertension/pathology ; Liver Cirrhosis/*diagnosis/epidemiology/etiology ; Male ; Middle Aged ; Odds Ratio ; Prevalence ; Questionnaires ; Severity of Illness Index

No abstract available.
Carotid Arteries/pathology/ultrasonography ; Carotid Artery Diseases/diagnosis/*etiology ; Diabetes Mellitus, Type 2/complications/diagnosis ; Fatty Liver/*complications/diagnosis/ultrasonography ; Humans ; Metabolic Syndrome X/complications/diagnosis ; Obesity/complications/diagnosis ; Risk Factors