Aims
Insulin resistance (IR) plays a pivotal role in the pathogenesis of Metabolic dysfunction‐Associated Fatty Liver Disease (MAFLD), which can progress to liver fibrosis. We examined the ...relationship of different IR scores with markers of MAFLD severity in obese individuals.
Materials and Methods
In this retrospective observational study, 346 non‐diabetic, overweight/obese individuals with newly diagnosed MAFLD (age 50.2 ± 13.3 years, 34% females, BMI 30.8 ± 4.4 kg/m2) underwent liver stiffness (LS) and controlled attenuation parameter (CAP) measurements by Fibroscan® to assess liver fibrosis and steatosis. Biochemical data were collected to calculate surrogate markers of IR (Homoeostasis model assessment ‐ insulin resistance index HOMA‐IR, triglyceride‐glucose index, triglyceride by HDL ratio), liver fibrosis (Nonalcoholic Fatty Liver Diseases fibrosis score, fibrosis‐4 score, Aspartate aminotransferase to platelet ratio index) and steatosis (fatty liver index, hepatic steatosis index).
Results
All three IR scores were associated with CAP, while only HOMA‐IR positively correlated with LS (r = 0.275, p < 0.0001), independent of age and sex, BMI, transaminases, and fibrosis markers. Insulin‐resistant individuals (HOMA‐IR >2.5, n = 165) had higher liver enzymes, CAP and LS, with a 4‐fold increased risk of severe liver disease (LS >9.7 kPa, OR 4.421.95–10.01, p = 0.0002). Among HOMA‐IR components, fasting plasma insulin (FPI) was independently associated with LS (r = 0.270, p < 0.0001). ROC AUC for HOMA‐IR and FPI to predict severe liver disease were virtually identical (0.748 and 0.758, respectively).
Conclusions
HOMA‐IR is independently associated with non‐invasive markers of MAFLD severity in overweight/obese individuals. This relationship is largely mediated by hyperinsulinemia, regardless of BMI. Measuring insulin levels in MAFLD individuals might be useful to identify those at risk of liver fibrosis.
Summary
Biliary hamartomas (BHs) are rare malformative cystic/cystic‐like lesions of the liver affecting the biliary tree, named after Hanns von Meyenburg who described them for the first time and ...still known with this eponym to this day. They usually lack clinical symptoms, and abnormalities in liver function tests are unusual; thus, it is typically an incidental finding of liver imaging. Despite being benign lesions, BHs can pose clinical challenges; the first one is differential diagnosis with other more relevant pathological conditions. Therefore, knowledge of MR imaging findings of BHs is helpful for a prompt and correct diagnosis, avoiding unnecessary invasive procedures and/or an excessive number of radiological investigations. This pictorial review is aimed to depict the most typical MR imaging features of multiple biliary hamartomas (von Meyenburg Complex), in order to familiarize the diagnosis and facilitate the differentiation from other hepato‐biliary cystic diseases.
HBV epidemiology is highly heterogeneous and rapidly evolving worldwide: we studied its last two-decades dynamics in a large single center cohort.
In all consecutive HBsAg-positive subjects firstly ...admitted (2000–2019) at the Pisa-University-Hospital Hepatology-Referral-Center, demographic, virologic and clinical variables were analyzed by admission decade (2000–2009 vs 2010–2019) and origin (Italian vs non-Italian natives).
Of 2003, 1878 (93.7%) subjects were eligible: 1798(95.7%) with HBV-chronic 126(7%) HDV, 72(4%) HCV, 11(0.6%) HIV co-infected and 80(4.3%) HBV-primary infections (93.7% Italians). Among 1589(88.4%) mono-infected, 496(31.2%) were immigrants, younger than Italians 34.0(5.1–77.1)-52.5(10.0–87.2) years, with female prevalence 204/496(41.1%)-340/1093(31.1%); p<0.001 increasing overtime (14.6–45.0%; p<0.001). Italians aged across decades 50.3(11.1–87.2)-56.2(10.0–86.7) years; p<0.001, HBeAg-positivity remained stable (12.3–14.5%) and acute hepatitis increased (4.0–8.0%; p = 0.003). CHB declined 439/721(60.9%)-320/868(36.9%); p<0.001 whereas HBeAg-negative infection increased 277/626(44.2%)-538/755(71.3%); p<0.001. Cirrhosis declined 195/721(27.0%)-125/868(14.4%); p<0.001, except in anti-HDV-patients 93/126(73.8%); 42(45.1%) non-Italians, younger than HBV-mono-infected (47.4–57.6 years; p<0.001).
Effective preventive health care policies and immigration flows account for increasing prevalence of HBeAg-negative infection across the last two decades. Antiviral therapy mitigated disease progression in aging Italian CHB but not in CHD patients, mainly young immigrants, emphasizing the unmet need of effective CHD therapies; HBeAg-positive CHB and acute hepatitis B persist in non-vaccinated Italian adults, prompting vaccination in the elderly with risky behaviors.
Background & Aims
The difference between the long‐term outcome of low‐viraemic (HBV‐DNA≤20 000‐IU/mL, LV‐AC) and inactive HBsAg carriers (HBV‐DNA≤2000‐IU/mL, IC) remains to be defined. We studied ...prospectively 153 HBeAg‐negative HBsAg‐carriers with baseline HBV‐DNA≤20 000‐IU/mL and normal transaminases.
Methods
IC, LV‐AC or chronic hepatitis B (CHB) (HBV‐DNA persistently ≤2000‐IU/mL, ≤20 000‐IU/mL or >20 000‐IU/mL respectively) were diagnosed after 1‐year, 3‐monthly monitoring. Thereafter IC and LV‐AC were followed‐up for additional 57.2 (8.5‐158.3) months. HBV‐DNA, HBsAg, HBV”core‐related”Antigen (HBcrAg) and total‐anti‐HBc were quantified at baseline.
Results
After the 1st year diagnostic follow‐up CHB higher HBV‐DNA (P=.005), total‐anti‐HBc (P=.012), ALT (P=.007) and liver‐stiffness (P=.021) was identified in 20 (13.1%) carriers; baseline HBsAg≤1000IU/HBV‐DNA≤2000IU/mL excluded the presence of CHB (NPV‐100%). Thereafter, during the long‐term follow‐up none of 87 IC reactivated, 19 (21.8%) cleared HBsAg older‐age (P=.004), lower HBsAg (P<.001), higher yearly HBsAg decline (P<.001). Twenty‐five of 46 (54.3%) LV‐AC remained stable, 20 (43.5%) became IC and 1 (2.2%) developed CHB. The best single‐point CHB and IC diagnostic‐accuracies were total‐anti‐HBc (84.2%, NPV‐98.2%) and HBV‐DNA/total‐anti‐HBc/HBcrAg combination (89.5%, 93%‐sensitivity, 84.8%‐specificity) respectively.
Conclusions
Viraemia persistently ≤20 000‐IU/mL predicts a benign clinical outcome: it was associated with transition to IC in 43% of LV‐AC and to Occult HBV Infection in 20% of IC within 5‐years. Nevertheless, 13.1% of individuals with low viraemia at presentation develops CHB within 1 year: 1‐year HBV‐DNA monitoring resulted the most accurate diagnostic approach that can be limited to at least a half of cases by the single point HBV‐DNA/HBsAg quantification. The IC‐diagnostic‐accuracy combining HBV‐DNA/total‐anti‐HBc/HBcrAg needs to be confirmed in further studies.
