La librairie clinique est une base de données contenant plus de 5 384 publications soumises à des comités de lecture internationaux, méta-analyses et directives dans le domaine de l’hépatologie. Elles sont liées à FibroScan® et aux paramètres uniques des scores : LSM by VCTE™, CAP™et SSM by VCTE™. Les publications sont à votre disposition pour que vous puissiez les lire à votre convenance.* *A janvier 2025
Aspirin Use Does Not Significantly Reduce the Risk of Liver Fibrosis in Patients With Metabolic Dysfunction-Associated Steatotic Liver Disease
The effect of aspirin on liver fibrosis is still controversial. To further explore the effect of aspirin on liver fibrosis in metabolic dysfunction-associated steatotic liver disease (MASLD), we conducted this study. We applied NHANES database data to evaluate the degree of liver fibrosis through fibroscan and explored the impact of aspirin on liver fibrosis in patients with MASLD from a cross-sectional study based on the American population. Considering the shortcomings of cross-sectional studies, we also applied Mendelian randomization (MR) analysis, a novel research method, to evaluate the potential causal relationship of aspirin on liver fibrosis and cirrhosis from a genetic perspective. In a cross-sectional study of the NHANES database, we did not find that aspirin significantly improved the prognosis of liver fibrosis in MASLD patients after adjusting for possible confounding biases by multivariable logistic regression analysis. Similarly, in univariate and multivariate MR analyses, we did not observe a potential causal relationship between aspirin and liver fibrosis or cirrhosis. Our study did not find that aspirin significantly reduced the risk of liver fibrosis in MASLD patients based on cross-sectional studies of the American population and genetic associations by MR analysis.
High Prevalence of Metabolic Dysfunction-Associated Steatotic Liver Disease in Patients with Hidradenitis Suppurativa: A Guide to Easily Assess the Clinical Risk of Comorbid Liver Disease
Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition associated with considerable comorbidity. The link between HS and metabolic dysfunction-associated steatotic liver disease (MASLD) is of particular interest owing to shared inflammatory pathways. This study applies the new MASLD nomenclature in a HS cohort. Our study aims to investigate the prevalence of MASLD in HS using transient elastography and to develop a clinical algorithm for assessing the MASLD risk. A cross-sectional study was conducted involving 94 patients with HS. Noninvasive methods were employed to diagnose MASLD. The clinical diagnosis was based on altered transient elastography-controlled attenuation parameter as surrogate for liver steatosis and the presence of cardiometabolic risk factors after excluding secondary causes of steatosis. Statistical analyses included logistic regression models to identify predictors of MASLD risk. The study found a prevalence of MASLD as high as 75% measured by high-accuracy transient elastography among patients with HS. Multivariable logistic regression analysis showed a strong within-cohort association between HS and MASLD. The newly developed clinical algorithm integrating transient elastography and the Fatty Liver Index effectively stratified MASLD risk. Our findings underscore the importance of routine MASLD screening in HS. The proposed clinical algorithm offers a straightforward approach for assessing MASLD risk in HS.
Rau, Monika |
|
Germany |
JID innovations : skin science from molecules to population health
Improving MASLD Risk Stratification in Young Adults with Cardiometabolic Risk Factors and Insulin Resistance Assessment
CONTEXT
The fibrosis-4 index (FIB-4) index is recommended to identify adults with metabolic dysfunction-associated steatotic liver disease (MASLD) and clinically significant fibrosis (moderate to advanced fibrosis or ≥F2). However, it is less reliable in young adults (age <45 years).
OBJECTIVE
The aim was to assess whether cardiometabolic risk factors [CMRFs: type 2 diabetes (T2D), hypertension, obesity] or insulin resistance (IR) improved MASLD fibrosis risk stratification in young adults.
METHODS
Adults with/without T2D and no history of MASLD attending outpatient clinics underwent screening with vibration-controlled transient elastography for ≥F2 (liver stiffness measurement ≥ 8.0 kPa). Magnetic resonance elastography and/or liver biopsy were performed if indicated for diagnosis confirmation.
RESULTS
Of the 964 adults, 25% were young adults and 75% were 45 to 64 years, with the prevalence of ≥F2: 7% vs 9% (P = .29), respectively. In young adults, clinically significant fibrosis was unlikely in those without homeostatic model assessment of insulin resistance (HOMA-IR) or CMRFs [negative predictive value (NPV) 97-100; 95% confidence interval 94-100]. Performance of FIB-4 ≥ 1.3 had low sensitivity (15%) and positive predictive value (25%) but good specificity (97%) and NPV (95%), whereas having 3 CMRFs alone performed better (sensitivity 75%, specificity 71%). Adding FIB-4 ≥ 1.3 to CMRFs worsened sensitivity (8%) while improving specificity (100%). Adding the HOMA-IR to CMRFs improved the sensitivity (75% to 78%) and specificity (75% to 81%) of CMRFs alone. Adding 2 CMRFs to the FIB-4 in the older age group improved both sensitivity and specificity of the FIB-4.
CONCLUSION
In young adults, the absence of CMRFs or IR makes clinically significant fibrosis unlikely. Measuring IR improved risk stratification in young adults with CMRFs. Using CMRFs with IR may improve the detection of clinically significant fibrosis in young adults.
Sharma, Anu |
|
USA |
Journal of the Endocrine Society
Starting Age for Screening Metabolic Dysfunction-Associated Steatotic Liver Disease in Children Using Controlled Attenuation Parameter on Transient Elastography
BACKGROUND
Rising sedentary behaviour and consumption of sugar-sweetened beverages and ultra-processed foods have increased the risk and earlier onset of obesity in children.
OBJECTIVES
To define controlled attenuation parameter (CAP) cut-off values in healthy children, assess the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) in children with overweight and obesity, and establish an appropriate starting age for MASLD screening in our population.
METHODS
Healthy primary school children were recruited. Hepatic steatosis was assessed using CAP, and body composition data were collected during two periods: August 2020-March 2021 and February 2023-May 2024.
RESULTS
Of 1653 participants (mean age 9.5 ± 1.7 years), 976 children with normal weight were used to establish reference intervals. Hepatic steatosis was defined as a CAP above 247 dB/m (97.5th percentile). The prevalences of MASLD in children with overweight and obesity were 0% and 16%, respectively, in school grade 1, which increased to 19% and 75% in school grade 6 (p < 0.001).
CONCLUSIONS
Screening for hepatic steatosis associated with obesity should begin as early as school grade 1, while screening for children with overweight may be more appropriate by school grade 6. These findings emphasise the need for age- and weight-specific screening strategies for children with overweight and obesity.
Effectiveness of Saroglitazar in MASLD Patients: A Prospective, Real-World Assessment of Liver and Metabolic Health
BACKGROUND
Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is a significant health concern and is commonly associated with conditions such as dyslipidemia, insulin resistance, and increased risk of cardiovascular disease. Managing MASLD requires addressing both liver and metabolic dysfunction. Saroglitazar, a dual PPARα/γ agonist, has shown potential in addressing liver steatosis, fibrosis, and dyslipidemia.
METHODOLOGY
This prospective, single-arm, multicentric study with 50 MASLD patients with a mean age of 51.84 ± 10.66 years included 33 males. Patients received Saroglitazar magnesium 4 mg in addition to the standard of care for 6 months. The primary objective was to assess changes in liver stiffness measurement (LSM) and controlled attenuation parameter (CAP), and secondary objectives included evaluating changes in metabolic parameters such as fasting blood glucose (FBG), postprandial blood glucose (PPBG), HbA1c, triglyceride levels, and liver enzymes (ALT, alanine aminotransferase; AST, aspartate aminotransferase) at baseline and the end of the study.
RESULTS
A statistically significant improvement in hepatic parameters, including LSM and CAP scores, was observed. Concurrently, at the end of the study duration, 16% of patients showed improvement from liver fibrosis stages of F3/F4 to F0/F1/F2 (p < 0.0001), and 76% of patients with severe steatosis (S3) decreased to 38% (p < 0.0001). The key metabolic parameters also showed statistically significant reduction in FBG from 140.25 ± 51.5 mg/dL to 117.66 ± 18.17 mg/dL (p = 0.004), HbA1c from 7.46% ± 1.44% to 6.83% ± 1.08% (p = 0.0004) and triglyceride levels from 238.67 ± 168.35 mg/dL to 167.9 ± 113.89 mg/dL (p = 0.0001). However, during the study, anthropometric parameters remained stable, with a minor increase in BMI (28.91 ± 3.5 to 29.12 ± 3.67 Kg/m2).
CONCLUSION
Despite a slight increase in BMI, Saroglitazar significantly improved transient elastography parameters and hepatic parameters in MASLD patients, suggesting that this drug alone effectively manages MASLD-related metabolic and hepatic dysfunctions.
Lachhwani, Harshita |
|
India |
Endocrinology, Diabetes & Metabolism
Weight Change is Associated With Metabolic Liver Health in a General Population Extending Beyond Weight Loss Targets of International Guidelines
BACKGROUND AND AIMS
Weight loss of ≥3%-10% is recommended in metabolic dysfunction-associated steatotic liver disease (MASLD) management, according to current guidelines. We investigated the associations between weight change and impaired metabolic liver health and focused on associations beyond these recommendations.
METHODS
Adults from the National Health and Nutrition Examination Survey 2017-2020, with data on 1-year weight history, controlled attenuation parameter and/or liver stiffness measurement (LSM) were selected. Exclusion criteria were age ≥80 years, body mass index <18.5 kg/m2, excessive alcohol and viral hepatitis. Impaired metabolic liver health included MASLD (controlled attenuation parameter ≥275 dB/m with ≥1 cardiometabolic riskfactor), at-risk metabolic dysfunction-associated steatohepatitis (MASH) (FibroScan aspartate aminotransferase score ≥0.35) and LSM ≥8 kPa. Multivariate logistic regression models were adjusted for demographics and prior weight.
RESULTS
We included 6802 individuals (aged 48 years [33-62], 48.9% male). MASLD was present in 42.2%, at-risk MASH in 6.5% and LSM ≥8 kPa in 9.1%. Over 1 year, 29% gained and 28% lost ≥3% weight. Compared to stable weight, weight gain ≥3% was associated with increased MASLD prevalence (adjusted odds ratio (aOR):1.78; 95% confidence interval (CI): 1.48-1.95), at-risk MASH (aOR: 1.78; 95% CI: 1.39-2.29) and LSM ≥8 kPa (aOR:1.48; 95%CI:1.19-1.84); whilst weight loss ≥ 3% was associated with reduced MASLD prevalence (aOR: 0.54; 95% CI: 0.47-0.62), at-risk MASH (aOR: 0.72; 95% CI: 0.55-0.94) and LSM ≥8 kPa (aOR: 0.62; 95% CI: 0.49-0.78). Results were consistent when weight loss was further categorized or when assessed as continuous variable without evidence for nonlinearity.
CONCLUSION
The prevalence of impaired metabolic liver health decreased with weight loss. Greater reported weight loss was associated with lower observed risks. Hence, we should recommend losing weight beyond the currently recommended targets to further reduce the risk of advanced liver disease.
van Rossum, Elisabeth F. C. |
|
Netherlands |
Gastro Hep Advances
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