1,721,104 research outputs found
Response to: Comment to “EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease”
No full textWe thank Jorge Fonseca et al. for their comments, which give us the opportunity to clarify the controversial issue of dietary approach to NAFLD, an issue that did not receive adequate attention in the Clinical Practice Guidelines (CPG) due to space constraints. They are concerned about the sentence suggesting ‘‘low-to-moderate fat and moderate-to-high carbohydrate intake” as a reasonable option for NAFLD cases. Indeed, no recommendation on nutrient composition of the diet was issued within the CPG, but a formal recommendation reads ‘‘Dietary recommendations should consider energy restriction and exclusion of NAFLD-promoting components (processed food, and food and beverages high in added fructose). The macronutrient composition should be adjusted according to the Mediterranean diet (B1)” [1]. This recommendation is based on a single experimental study [2] and a lot of indirect evidence, granting the B1 grade. On the contrary, the sentence in Table 5 is a mere suggestion derived from literature review, also considering the mandatory need for calorie restriction and weight loss
Does the liver accelerate ageing: Talking muscles and liver?
Get PDFDespite what the general media would like us to believe, we live in a time of unparalleled health. People are living longer; the increase in longevity has been driven by a decline in early life mortality as a result of improved hygiene and nutrition in the early 20th century, with the advent of new drugs delivering a decline in late life mortality in the 21st century [1]. As a consequence of our success in ageing, we are now facing a new problem, how to live well as well as longer
From liver fat to full-blown metabolic disorder: the kidney as target organ
No full textabstract not available (Editorial
Breakthrough in the Treatment of Metabolic Associated Steatotic Liver Disease: Is it all over?
Get PDFOn March 14, 2024, after more than 25 years of intense research and a long series of failures, the Food and Drug Administration approved resmetirom as first drug for the treatment of non-alcoholic steatohepatitis (NASH) with fibrosis (now Metabolic-Associated Steatotic Liver Disease - MASLD). The present review covers this difficult process, finally providing a drug to complement lifestyle intervention, that has long been the sole approved therapeutic intervention. However, the availability of a drug shown to reduce disease progression in advanced stages of diseases opens a series of questions that deserve even more intense research. How to continue ongoing trials? How to generate an appropriate use of resmetirom in the community, limiting treatment according to predefined criteria and according to individual risk assessment? How to guarantee that both hepatic and non-hepatic comorbidities are appropriately targeted? How to define cost-effective strategies that might prevent the generation of unacceptable differences within the population, given the high costs of novel drugs and the extremely high numbers of candidates to treatment? Only a close surveillance of drug use in the real world, generated by insurance databases and national healthcare system registries, might provide adequate answers to these compelling questions. (c) 2024 The Authors. Published by Elsevier Ltd on behalf of Editrice Gastroenterologica Italiana S.r.l. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/
Editorial: Does knowledge about liver disease enhance adherence to lifestyle recommendations? Authors' reply
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NAFLD-Associated Hepatocellular Carcinoma: a Threat to Patients with Metabolic Disorders
No full textHepatocellular carcinoma (HCC) is one of the most common cancers worldwide, and its prevalence is increasing in relation to the epidemics of obesity and type 2 diabetes mellitus, via non-alcoholic fatty liver disease (NAFLD). Unhealthy lifestyles associated with metabolic disorders are per se risk conditions for NAFLD progression, and specific gene polymorphisms may also favor oncogenesis, particularly in the presence of advanced fibrosis or cryptogenic cirrhosis. However, NAFLD-associated HCC may also develop in noncirrhotic NAFLD and is frequently diagnosed at a more advanced tumor stage, compared with virus/alcohol-related HCC. This highlights the need for screening programs and long-term surveillance for earlier HCC detection in patients with metabolic risk factors, a policy hindered by the large
number of cases at risk, with costs unaffordable by National health systems. New screening tools and cost-utility studies are eagerly awaited to develop more appropriate programs for early detection and treatment of NAFLD-associated HCC
Cryptogenic vs. NASH-cirrhosis: The rose exists well before its name...
No full text‘Stat rosa pristina nomine, nomina nuda tenemus’
Introduction of “The name of the rose” by Umberto Eco
Evolution of language is as old as language itself and the ever-changing terminology in the medical sciences remains a challenge for all of us except perhaps the very newest trainees who will soon find their common terms to have all too soon transitioned to anachronisms. Such language evolution is indeed relevant to the diagnosis of ‘NASH-cirrhosis’ and ‘cryptogenic cirrhosis’. The recognition that NASH cirrhosis progresses to an advanced state characterized by loss of a vital histological hallmark – steatosis and thus to loss of an even more foundational biopsy finding of ‘steatohepatitis’ was a conceptual sea-change. Early epidemiological studies indicated that this process was characteristic of the transition of NASH-cirrhosis to cryptogenic cirrhosis (Powell, Caldwell, Thulavath). Indeed, the progression of NASH is now known to be associated with loss of fat (perhaps through changes in blood flow and insulin exposure) and diminished serum aminotransferases albeit with increasing fibrosis (ref, ref). In the absence of a prior diagnosis of NASH or at least NAFLD, liver histology at this stage appears as cirrhosis of unknown cause or ‘cryptogenic cirrhosis’. Following a transition period of about 10-15 years from around 2000 to 2014, the term ‘cryptogenic’ cirrhosis has come to be essentially equated to ‘NASH-cirrhosis’. This may well be the most likely situation in the majority of cases however the authors of the present study raise a wise caution flag regarding the need to consider other possibilities
Body composition, dual-energy X-ray absorptiometry and obesity: the paradigm of fat (re)distribution
No full textThe amount of lean and fat tissues in different body compartments is likely to drive the cardiovascular risk. The longitudinal effects of changes of lean and fat mass, particularly following weight loss programs, cannot be reliably identified by the sole measurement of anthropometry. We discuss this problem on the basis of data collected in obese females with the use of dual-energy X-ray absorptiometry (DXA), anthropometry and laboratory
Hepatic encephalopathy and health-related quality of life
No full text: The impact of overt hepatic encephalopathy on health-related quality of life is well defined, but it remains to be demonstrated how much the presence of minimal hepatic encephalopathy (MHE) might impair patients' perceived health status. MHE reduces cognitive abilities, with specific impairment in manual abilities, which can lead to a depressed mood that impairs perceived health status. Therefore, all subjects with cirrhosis should be systematically screened for MHE by validated tools. Early detection and treatment is mandatory to improve the quality of life of patients with advanced cirrhosis, their social isolation, and their daily lives
The treatment of diabetes in advanced liver disease: change of a paradigm
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