1,721,030 research outputs found
Pharmacotherapy for MASH: Heart-Liver Co-Management
No full textMetabolic dysfunction-associated steatotic liver disease (MASLD) affects approximately 30% of adults, with about 30% of cases progressing to metabolic dysfunction-associated steatohepatitis (MASH), which can lead to cirrhosis and hepatocellular carcinoma. Cardiovascular disease (CVD) is the leading cause of death among affected patients, highlighting the need for integrated heart-liver co-management. MASLD and CVD share common pathophysiological mechanisms, including insulin resistance, low-grade inflammation, atherogenic dyslipidemia, and oxidative stress, creating a bidirectional interplay that drives disease progression. Effective management of MASLD requires addressing not only hepatic steatosis, inflammation, and fibrosis but also managing cardiovascular risk. Current clinical practice and trials face several challenges, including the underdiagnosis of MASLD, limited collaboration between hepatologists and cardiologists, and a paucity of pharmacological options that safely target both the liver and heart. This review covers three main pharmacological approaches: metabolic-targeted therapies, which improve the upstream metabolic milieu; liver-targeted therapies, which focus on MASH and fibrosis but require further evaluation for cardiovascular safety; and cardiovascular therapies, which may provide hepatoprotective effects but need further study. The review discusses the benefits and limitations of these pharmacotherapies, emphasizing the importance of an integrated heart-liver co-management approach to improve clinical outcomes for patients living with MASLD. <br/
Global burden of disease attributable to metabolic risk factors in adolescents and young adults aged 15-39, 1990-2021
No full textBackground: metabolic risk factors are a significant cause of global burden among adolescents and young adults, but there is a lack of attention to the burden attributable to these metabolic risk factors globally.Aims: this study aims to provide comprehensive estimates of five important metabolic risk factors and the attributable disease burden in people aged 15–39 years from 1990 to 2021, based on the Global Burden of Disease Study (GBD) database.Methods: global total deaths and disability-adjusted life years (DALYs) were used to describe the burden attributable to five common metabolic risk factors, including high fasting plasma glucose (FPG), high low-density lipoprotein cholesterol (LDL-C), high systolic blood pressure (SBP), high body mass index (BMI), and kidney dysfunction, in adolescents and young adults. The estimated annual percentage change (EAPC) of DALYs was utilized to depict the trends from 1990 to 2021.Results: from 1990 to 2021, the DALY rates attributable to all metabolic risk factors showed a globally significant upward trend, with EAPC reaching 33.0% (27.4-38.7). Compared to females, males had a heavier burden and a more significant increase in deaths and DALYs attributable to metabolic risk factors. High BMI and high FPG have become the top two metabolic risk factors in 2021, with summary exposure variables (SEV) rising by 84.2% and 53.6%, respectively. Low-middle socio-demographic index (SDI), middle SDI, and high SDI regions experienced upward regional trends in DALY rates, while low SDI regions remained stable. Among 204 countries and territories, 101 (49.5%) showed a significant increase in DALY rates, as indicated by the EAPC. Conclusions: there is a substantial global burden attributable to metabolic risk factors in adolescents and young adults in 2021, especially high BMI and high FPG. This calls for further investigation and intervention to address this emerging trend
Long-Term glycemic control and the risk of liver stiffness progression and liver-related events in MASLD
No full textBackground & Aims: the long-term impact of type 2 diabetes (T2D) status and long-term glycemic control on disease progression and clinical outcomes in metabolic dysfunction–associated steatotic liver disease (MASLD) remains unclear. The study sought to assess the association of diabetes status and long-term glycemic control with liver stiffness progression or regression, and liver-related events (LREs) in MASLD.Methods: we analyzed patients with MASLD from the VCTE-Prognosis cohort who underwent serial vibration-controlled transient elastography (VCTE) assessments and hemoglobin A1c (HbA1c) measurements. Long-term glycemic control was evaluated using the time-weighted average (TWA) HbA1c, which reflects both the magnitude and duration of glycemia. Patients were categorized as non-T2D, well-controlled T2D (TWA HbA1c<7%), or poorly controlled T2D (TWA HbA1c ≥7%). Liver stiffness progression, regression, and LREs were examined using Kaplan-Meier analyses and Cox proportional hazards models.Results: of 7543 patients with MASLD, 4090 had T2D (2045 well controlled, 2045 poorly controlled) and 3453 did not have T2D. Over a median follow-up of 4.1 years, patients with T2D had a higher risk of liver stiffness progression (hazard ratio [HR], 1.501, 95% confidence interval [CI]. 1.148–1.962; P = .003) and LREs (HR, 2.030; 95% CI, 1.241–3.320; P = .005), but not liver stiffness regression, compared with non-T2D patients. Among patients with T2D, poor glycemic control was associated with a higher risk of liver stiffness progression compared with good glycemic control (HR, 1.524; 95% CI, 1.182–1.965; P = .001). No differences were observed for liver stiffness regression (P = .957) or LREs (P = .625) with glycemic control. Findings were consistent across sensitivity analyses.Conclusions: T2D was independently associated with a higher risk of liver stiffness progression and LREs in MASLD. Good glycemic control was associated with slower liver stiffness progression, but not regression or LREs. <br/
Burden of disease attributable to high body mass index: an analysis of data from the Global Burden of Disease Study 2021
No full textBackground: obesity represents a major global health challenge with important clinical implications. Despite its recognized importance, the global disease burden attributable to high body mass index (BMI) remains less well understood.Methods: we systematically analyzed global deaths and disability-adjusted life years (DALYs) attributable to high BMI using the methodology and analytical approaches of the Global Burden of Disease Study (GBD) 2021. High BMI was defined as a BMI over 25 kg/m2 for individuals aged ≥20 years. The Socio-Demographic Index (SDI) was used as a composite measure to assess the level of socio-economic development across different regions. Subgroup analyses considered age, sex, year, geographical location, and SDI.Findings: from 1990 to 2021, the global deaths and DALYs attributable to high BMI increased more than 2.5-fold for females and males. However, the age-standardized death rates remained stable for females and increased by 15.0% for males. Similarly, the age-standardized DALY rates increased by 21.7% for females and 31.2% for males. In 2021, the six leading causes of high BMI-attributable DALYs were diabetes mellitus, ischemic heart disease, hypertensive heart disease, chronic kidney disease, low back pain and stroke. From 1990 to 2021, low-middle SDI countries exhibited the highest annual percentage changes in age-standardized DALY rates, whereas high SDI countries showed the lowest.Interpretation: the worldwide health burden attributable to high BMI has grown significantly between 1990 and 2021. The increasing global rates of high BMI and the associated disease burden highlight the urgent need for regular surveillance and monitoring of BMI.Funding: National Natural Science Foundation of China and National Key R&D Program of China
Cardiovascular-kidney-metabolic syndrome and the risk of liver fibrosis progression and liver-related events in MASLD
No full text<br/
Long-term liver-related outcomes and liver stiffness progression of statin usage in steatotic liver disease
No full textBackground Statins have multiple benefits in patients with metabolic-associated steatotic liver disease (MASLD). Aim To explore the effects of statins on the long-term risk of all-cause mortality, liver-related clinical events (LREs) and liver stiffness progression in patients with MASLD. Methods This cohort study collected data on patients with MASLD undergoing at least two vibration-controlled transient elastography examinations at 16 tertiary referral centres. Cox regression analysis was performed to examine the association between statin usage and long-term risk of all-cause mortality and LREs stratified by compensated advanced chronic liver disease (cACLD): baseline liver stiffness measurement (LSM) of ≥10 kPa. Liver stiffness progression was defined as an LSM increase of ≥20% for cACLD and from <10 kPa to ≥10 or LSM for non-cACLD. Liver stiffness regression was defined as LSM reduction from ≥10 kPa to <10 or LSM decrease of ≥20% for cACLD. Results We followed up 7988 patients with baseline LSM 5.9 kPa (IQR 4.6–8.2) for a median of 4.6 years. At baseline, 40.5% of patients used statins, and cACLD was present in 17%. Statin usage was significantly associated with a lower risk of all-cause mortality (adjusted HR=0.233; 95% CI 0.127 to 0.426) and LREs (adjusted HR=0.380; 95% CI 0.268 to 0.539). Statin usage was also associated with lower liver stiffness progression rates in cACLD (HR=0.542; 95% CI 0.389 to 0.755) and non-cACLD (adjusted HR=0.450; 95% CI 0.342 to 0.592), but not with liver stiffness regression (adjusted HR=0.914; 95% CI 0.778 to 1.074). Conclusions Statin usage was associated with a relatively lower long-term risk of all-cause mortality, LREs and liver stiffness progression in patients with MASLD.</p
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
- …
