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Screening and interventions to prevent nonalcoholic fatty liver disease/nonalcoholic steatohepatitis-associated hepatocellular carcinoma

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World Journal of Gastroenterology 2023年第2期29卷 286-309页

作者： simona cernea Danusia Onișor Department M3/Internal Medicine I George Emil Palade University of MedicinePharmacyScience and Technology of Târgu MureșTârgu Mureş540139Romania Diabetes Nutrition and Metabolic Diseases Outpatient UnitEmergency County Clinical HospitalTârgu Mureş540136Romania Department ME2/Internal Medicine VII George Emil Palade University of MedicinePharmacyScienceand Technology of Târgu MureşTârgu Mureş540139Romania Gastroenterology Department MureșCounty Clinical HospitalTârgu Mureș540072Romania

Liver cancer is the sixth most commonly diagnosed cancer worldwide,with hepatocellular carcinoma(HCC)comprising most *** hepatitis B and C viral infections,heavy alcohol use,and nonalcoholic steatohepatitis(NASH)-associated advanced fibrosis/cirrhosis,several other risk factors for HCC have been identified(*** age,obesity,insulin resistance,type 2 diabetes).These might in fact partially explain the occurrence of HCC in non-cirrhotic patients without viral *** surveillance through effective screening programs is still an unmet need for many nonalcoholic fatty liver disease(NAFLD)patients,and identification of pre-cirrhotic individuals who progress to HCC represents a substantial challenge in clinical practice at the *** with NASHcirrhosis should undergo systematic HCC surveillance,while this might be considered in patients with advanced fibrosis based on individual risk *** this context,interventions that potentially prevent NAFLD/NASH-associated HCC are *** paper provided an overview of evidence related to lifestyle changes(*** loss,physical exercise,adherence to healthy dietary patterns,intake of certain dietary components,etc.)and pharmacological interventions that might play a protective role by targeting the underlying causative factors and pathogenetic ***,well-designed prospective studies specifically dedicated to NAFLD/NASH patients are still needed to clarify the relationship with HCC risk.

关键词： Nonalcoholic fatty liver disease Nonalcoholic steatohepatitis Hepatocellular carcinoma Risk stratification Lifestyle interventions Prevention

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Metabolic dysfunction-associated steatotic liver disease-associated fibrosis and cardiac dysfunction in patients with type 2 diabetes

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World Journal of Cardiology 2024年第10期16卷 580-594页

作者： simona cernea Danusia Onișor Andrada Larisa Roiban Theodora Benedek Nora Rat Department M3/Internal Medicine I George Emil Palade University of MedicinePharmacyScience and Technology of Târgu MureșTârgu Mureş540142Romania Diabetes Nutrition and Metabolic Diseases Outpatient UnitEmergency County Clinical HospitalTârgu Mureş540136Romania Department ME2/Internal Medicine VII George Emil Palade University of MedicinePharmacyScience and Technology of Târgu MureşTârgu Mureş540142Romania Gastroenterology Clinic MureșCounty Clinical HospitalTârgu Mureş540103Romania Diabetes Compartment MediașMunicipal HospitalMediaș551030Romania Doctoral School of Medicine and Pharmacy George Emil Palade University of MedicinePharmacyScienceand Technology of Târgu MureşTârgu Mureş540142Romania Department M3/Internal Medicine VI George Emil Palade University of MedicinePharmacyScienceand Technology of Târgu MureşTârgu Mureş540142Romania Department of Cardiology Emergency County Clinical HospitalTârgu Mureş540136Romania

BACKGROUND Metabolic dysfunction-associated steatotic liver disease(MASLD),particularly in the presence of liver fibrosis,increases the risk of cardiovascular morbidity and mortality,but the nature of the cardio-hepatic interaction in the context type 2 diabetes mellitus(T2DM)is not fully *** To evaluate the changes in cardiac morphology and function in patients with T2DM and MASLD-associated liver *** T2DM patients with MASLD underwent a medical evaluation that included an assessment of lifestyle,anthropometric measurements,vital signs,an extensive laboratory panel,and a standard *** fibrosis was evaluated using two scores[Fibrosis-4(FIB4)and Non-alcoholic fatty liver disease-Fibrosis Score(NFS)],and subjects were classified as having advanced fibrosis,no fibrosis,or an indeterminate *** correlations between structural and functional cardiac parameters and markers of liver fibrosis were evaluated through bivariate and multiple regression *** significance was set at P<*** Data from 267 T2DM-MASLD subjects with complete assessment was *** with scores indicating advanced fibrosis exhibited higher interventricular septum and left ventricular(LV)posterior wall thickness,atrial diameters,LV end-systolic volume,LV mass index(LVMi),and epicardial adipose tissue thickness(EATT).Their mean ejection fraction(EF)was significantly lower(49.19%±5.62%vs 50.87%±5.14%vs 52.00%±3.25%;P=0.003),and a smaller proportion had an EF≥50%(49.40%vs 68.90%vs 84.21%;P=0.0017).Their total and mid LV wall motion score indexes were higher(P<0.05).Additionally,they had markers of diastolic dysfunction,with a higher E/e’ratio[9.64±4.10 vs 8.44(2.43-26.33)vs 7.35±2.62;P=0.026],and over 70%had lateral e’values<10 cm/second,though without significant differences between *** multiple regression analyses,FIB4 correlated with left atrium diameter(LAD;β=0.044;P<0.05),and NFS with both LAD(β=0.039;P<0.05)and right

关键词： Metabolic dysfunction-associated steatotic liver disease Type 2 diabetes mellitus Liver fibrosis Cardiac dysfunction Sex-hormone binding protein

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