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Prognostic performance of an index based on lactic dehydrogenase and transaminases for patients with liver steatosis and COVID-19

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World Journal of Gastroenterology 2022年第37期28卷 5444-5456页

作者： Ricardo Ulises macías-Rodríguez Alberto Adrián Solís-Ortega Victoria J Ornelas-Arroyo Astrid Ruiz-margáin maria Sarai González-Huezo nestor A Urdiales-morán berenice m román-calleja Juan m mayorquín-Aguilar JoséA González-Regueiro Alejandro Campos-murguía Israel Vicente Toledo-Coronado mónica Chapa-Ibargüengoitia Bernardo Valencia-Peña Carlos Fernando martínez-Cabrera nayelli C Flores-García Department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City 14080Mexico Department of Gastroenterology Centro Médico ISSEMYMToluca 52140Mexico Department of Radiology Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City 14080Mexico

BACKGROUnD metabolic associated fatty liver disease(mAFLD)is associated with complications and mortality in patients with coronavirus disease 2019(COVID-19).However,there are no prognostic scores aimed to evaluate the risk of severe disease specifically in patients with mAFLD,despite its high prevalence.Lactate dehydrogenase,aspartate aminotransferase and alanine aminotransferase have been used as markers of liver damage.Therefore,we propose an index based on lactate dehydrogenase,aspartate aminotransferase and alanine aminotransferase for the prediction of complications and mortality in patients with mAFLD and COVID-19.AIm To evaluate the prognostic performance of an index based on lactate dehydrogenase and transaminases(aspartate aminotransferase/alanine aminotransferase)in patients with COVID-19 and mAFLD[liver fibrosis and nutrition(LnF)-COVID-19 index].mETHODS In this retrospective cohort study,two cohorts from two different tertiary centers were included.The first was the derivation cohort to obtain the score cutoffs,and the second was the validation cohort.We included hospitalized patients with severe COVID-19 and mAFLD.Liver steatosis was evaluated by computed tomography scan.Area under the receiver operating characteristic(ROC)curve analysis and survival analysis were used.RESULTS In the derivation cohort,44.6%had mAFLD;ROC curve analysis yielded a LFn-COVID-19 index>1.67 as the best cutoff,with a sensitivity of 78%,specificity of 63%,negative predictive value of 91%and an area under the ROC curve of 0.77.In the multivariate analysis,the LFn-COVID-19 index>1.67 was independently associated with the development of acute kidney injury(odds ratio:1.8,95%confidence interval:1.3-2.5,Pntubation(odds ratio:1.9,95%confidence interval:1.4-2.4,Pnd death(odds ratio:2.86,95%confidence interval:1.6-4.5,Pn both cohorts.COnCLUSIOn LFn-COVID-19 index has a good performance to predict prognosis in patients with mAFLD and COVID-19,which could be useful for the mAFLD population.

关键词： COVID-19 metabolic associated fatty liver disease Lactate dehydrogenase Transaminases Prognosis nonalcoholic fatty liver disease

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nutritional therapy for hepatocellular carcinoma

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World Journal of Gastrointestinal Oncology 2021年第10期13卷 1440-1452页

作者： Astrid Ruiz-margáin berenice m román-calleja Paulina moreno-Guillén JoséA González-Regueiro DeyaniraKúsulas-Delint Alejandro Campos-murguía nayelli C Flores-García Ricardo Ulises macías-Rodríguez Liver nutrition Clinic Department of GastroenterologyInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City 14080Mexico Liver Fibrosis and nutrition Lab MICTLÁN-Network(Mechanisms of Liver InjuryCell Death and Translational Nutrition in Liver Diseases-Research Network)Mexico City 14080Mexico Department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City 14080Mexico

Hepatocellular carcinoma(HCC)is the most frequent primary liver cancer and presents together with cirrhosis in most cases.In addition to commonly recognized risk factors for HCC development,such as hepatitis B virus/hepatitis C virus infection,age and alcohol/tobacco consumption,there are nutritional risk factors also related to HCC development including high intake of saturated fats derived from red meat,type of cooking(generation of heterocyclic amines)and contamination of foods with aflatoxins.On the contrary,protective nutritional factors include diets rich in fiber,fruits and vegetables,n-3 polyunsaturated fatty acids and coffee.While the patient is being evaluated for staging and treatment of HCC,special attention should be paid to nutritional support,including proper nutritional assessment and therapy by a multidisciplinary team.It must be considered that these patients usually develop HCC on top of long-lasting cirrhosis,and therefore they could present with severe malnutrition.Cirrhosisrelated complications should be properly addressed and considered for nutritional care.In addition to traditional methods,functional testing,phase angle and computed tomography scan derived skeletal muscle index-L3 are among the most useful tools for nutritional assessment.nutritional therapy should be centered on providing enough energy and protein to manage the increased requirements of both cirrhosis and cancer.Supplementation with branched-chain amino acids is also recommended as it improves response to treatment,nutritional status and survival,and finally physical exercise must be encouraged and adapted to individual needs.

关键词： Sarcopenia Liver Cancer Diet Branched-chain amino acids nutrition

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Clinical perspectives,assessment,and mechanisms of metabolicassociated fatty liver disease in patients with COVID-19

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World Journal of Gastroenterology 2021年第33期27卷 5502-5519页

作者： Alejandro Campos-murguía berenice m román-calleja JoséA González-Regueiro Ivonne Hurtado-Díaz-de-León Alberto Adrián Solís-Ortega nayelli C Flores-García Ignacio García-Juárez Astrid Ruiz-margáin Ricardo Ulises macías-Rodríguez Department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City 14080Mexico Liver Fibrosis and nutrition Lab(LFnLab) MICTLÁN-Network(Mechanisms of Liver InjuryCell Death and Translational Nutrition in Liver Diseases-Research Network)Mexico City 14080Mexico

metabolic diseases are highly prevalent worldwide and have been associated with adverse clinical outcomes,including mortality,in patients developing coronavirus disease(COVID-19).Because of the close relationship between metabolic diseases such as type 2 diabetes mellitus and obesity and the presence of metabolicassociated fatty liver disease(mAFLD),a high number of cases of patients affected by both mAFLD and COVID-19 would be expected,especially in highrisk populations.Some studies have shown an increased risk of adverse clinical outcomes,viral shedding,and deep vein thrombosis,especially in patients with mAFLD-related liver fibrosis.The predisposition to poor outcomes and severe acute respiratory syndrome coronavirus 2 infection in patients with mAFLD could be secondary to mechanisms common to both,including preexisting systemic chronic inflammation,endothelial dysfunction,and involvement of the renin-angiotensin system.Because of the increased risk of adverse outcomes,mAFLD should be screened in all patients admitted for COVID-19.Available computed tomography scans could be of help,assessment of liver fibrosis is also recommended,favoring noninvasive methods to limit the exposure of healthcare workers.Liver involvement in this population ranges from abnormalities in liver chemistry to hepatic steatosis in postmortem biopsies.Finally,preventive measures should be strongly advocated in patients already known to have mAFLD,including the use of telemedicine and vaccination in addition to general measures.

关键词： metabolic-associated fatty liver disease COVID-19 mortality Fibrosis Histology Epidemiology

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Effect of non-alcoholic beer,diet and exercise on endothelial function,nutrition and quality of life in patients with cirrhosis

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World Journal of Hepatology 2020年第12期12卷 1299-1313页

作者： Ricardo U macias-Rodriguez Astrid Ruiz-margain berenice m roman-calleja may E Espin-nasser nayelli CFlores-Garcia Aldo Torre Gretel Galicia-Hernandez Silvia L Rios-Torres Gabriela Fernandez-del-Rivero Arturo Orea-Tejeda Oscar A Lozano-Cruz Department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiranMexico City 14080Mexico Liver Fibrosis and nutrition Lab(LFn-Lab) MICTLÁN Network:Mechanisms of Liver InjuryCell Death and Translational Nutrition in Liver Diseases-Research NetworkMexico City 14080Mexico Department of Cardiology Instituto Nacional de Enfermedades RespiratoriasMexico City 14080Mexico Department of Internal medicine Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiranMexico City 14080Mexico

BACKGROUnD The implementation of nutritional strategies targeting several variables at once could benefit patients with cirrhosis.non-alcoholic beer has different compounds that exert antioxidant,anti-inflammatory and nutritional properties.AIm To evaluate the effect of diet+exercise and non-alcoholic beer on nutritional status,endothelial function and quality of life in patients with cirrhosis.mETHODS In this randomized open clinical trial,patients with cirrhosis were randomized into two groups:The intervention(non-alcoholic beer+diet+exercise)and control(water+diet+exercise)group.Treatment consisted of 330 mL nonalcoholic beer/day or the same amount of water,plus an individualized dietary plan and an exercise program with a pedometer-based bracelet to reach at least 5000 steps/d and>2500 above the baseline during 8 wk.Endothelial function(flow-mediated dilation,plethysmography),biochemical and nutritional variables and quality of life(CLDQ)were evaluated.RESULTS Forty-three patients were included in the study,21 in the control group and 22 in the intervention group.The mean age was 53.5±7.8 years,60%were women,the median mELD score was 8(7-10)and most patients were Child-Pugh A(88%).Adherence to the interventions was>90%in both groups,there were no adverse events and all biochemical parameters remained stable in both groups.Endothelial function improved in both groups.All measured nutritional parameters improved in the intervention group,compared to only 2 in the control group and quality of life improved in both groups;however,more domains improved in the intervention group.COnCLUSIOn The intervention consisting of non-alcoholic beer,diet and exercise seems to be safe and well tolerated in patients with cirrhosis,and shows improvement in nutritional status,endothelial function,and quality of life.These results need to be further confirmed.

关键词： Hops Portal hypertension Sarcopenia Diet Cirrhosis Antioxidants

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