[ Diabetes Type 1 ]

Diagnosis and Evaluation of Nonalcoholic Fatty Liver Disease

Your liver health can be measured by a blood test for a protein called gamma-glutamyl transpeptidase (GGT) — if your levels are high, it suggests that your liver is under pressure and is usually taken as a sign that you are drinking too much alcohol. Meanwhile, an earlier study published in March 6, 2015, in The Endocrine Society indicates that the extract of onion bulb, Allium cepa, strongly lowered high blood glucose (sugar) and total cholesterol levels in diabetic rats when given with the anti-diabetic drug metformin. Thediversity of applications for lemons also far exceeds general knowledge. Cirrhosis of the liver has caused Rezulin patients to need liver transplants and has led to numerous deaths. Using the same variables, a liver fat equation was developed, from which the liver fat percentage could be estimated [91]. Once further studies are performed to explore the underlying protective mechanisms of SCs and the advantages and disadvantages of its application, there will be a greater understand of the mechanism and therapeutic potential. Increasing rates of NAFLD in the U.S.

“Supporting the report’s recommendations, which include more complete collection of data, trials of hospital and community treatment programs, and screening for the more serious forms of liver disease, makes both human and economic sense,” says Prof McCaughan. At the beginning of the study, 124 women reported that they developed diabetes while they were pregnant. But until now, Cusi said, there was little urgency to diagnose NASH because there were no available medications. This index was reported to be associated with liver steatosis in patients with chronic hepatitis C, making it a candidate predictor of NAFLD [94]. In general, the term haemosiderosis is used to indicate the pathological effect of iron accumulation in any given organ, which mainly occurs in the form of the iron-storage complex haemosiderin.[35][36] Sometimes, the simpler term siderosis is used instead. The NHS defines binge-eating as a disorder where the sufferer feels “compelled to overeat”. Palekar et al.

If tissue necrosis develops, oral anticoagulant therapy should be discontinued promptly and vitamin K or frozen plasma administered at once. The AUROC for this model was 0.76. The presence of 3 or more of these factors had a sensitivity and specificity for a NASH diagnosis of 74% and 66%, respectively. Unsaturated fats are a healthier choice, especially monounsaturated fats like olive, canola, sesame and peanut oils. These panels should be thus investigated to validate them in different populations. The Nash Test combines 13 biochemical and clinical variables to predict the presence of NASH, achieving specificity, sensitivity, PPV, and NPV of 94%, 33%, 66%, and 81%, respectively [98]. Pelekar et al.


combined 8-epi-PGF2α, TGF-β, HA, and adiponectin in a model that predicted NASH with favorable sensitivity of 73.7%, specificity of 65.7%, PPV of 68.2%, and a NPV of 68.2% [96]. Terrault, M.D., M.P.H. The healthy liver also gathers and stores important substances for your body to use later, such as sugar and vitamins. The NAFLD fibrosis score (NFS) is generated using a panel including six variables of age, hyperglycaemia, BMI, platelet count, albumin, and AST/ALT ratio (AAR), which was created using a large cohort of biopsy-proven NAFLD patients [100]. McPherson et al. reported the NFS to demonstrate an AUROC of 0.81 with NPV 92% and PPV 72% for the detection of advanced fibrosis [101]. Calès et al.

demonstrated an AUROC of 0.884 for significant fibrosis, 0.932 for severe fibrosis, and 0.902 for cirrhosis [102]. In a recent meta-analysis, NFS showed AUROC, sensitivity, and specificity of 0.85, 0.90, and 0.97 for the identification of NASH with advanced fibrosis [103]. The original ELF (European Liver Fibrosis) test is a panel of automated immunoassays to detect three markers: HA, tissue inhibitor of metalloproteinase 1 (TIMP1), and aminoterminal peptide of procollagen III (P3NP), used in combination with age [104]. The simplified ELF panel excluded age, but did not change the diagnostic performance of the panel. The addition of five markers, including the BMI, presence of diabetes/impaired fasting glucose, AAR, platelet count, and albumin concentration, to the ELF test improved its diagnostic accuracy, with AUROCs of 0.98, 0.93, and 0.84 for the diagnosis of severe, moderate and no fibrosis, respectively [105]. They also gave metformin and onion extract to three groups of non-diabetic rats with normal blood sugar, for comparison. It combines three variables; the BMI, AAR, and the presence of diabetes [106].

A study of the BARD score in 138 patients with biopsy-proven NAFLD demonstrated an AUROC of 0.67, with sensitivity, specificity, PPV, and NPV of 51%, 77%, 45%, and 81%, respectively [107]. The AST-to-platelet ratio index (APRI) was initially used as a marker of fibrosis in patients with hepatitis C [108]. Using this score, Calès et al. reported an AUROC of 0.866 for significant fibrosis, 0.861 for severe fibrosis, and 0.842 for cirrhosis in a study of NAFLD subjects [102], although significantly lower values were obtained in other studies [101, 109, 110]. The AAR [111] is easily calculated using two laboratory liver function tests. Not only is the AAR used as an individual marker, but it is also a component of several other fibrosis scoring systems, including the NFS and BARD score. Using a cut-off of 0.8, AAR alone showed an AUROC of 0.83, with a sensitivity of 74%, specificity of 78%, and a NPV of 93% for the diagnosis of advanced fibrosis in NAFLD [101].

In another study, a combination of serum AST, ALT, and the AAR had an AUROC of 0.59 for predicting steatosis, but was able to predict cirrhosis with an AUROC of 0.81. However, the addition of demographic data, comorbidities, and several other routinely measured laboratory tests increased the AUROCs to 0.79 for NASH and 0.96 for cirrhosis [112]. The components of the FIB-4 test are age with three biochemical values; the platelet count, ALT, and AST, to detect fibrosis [113]. In NAFLD patients, the FIB-4 demonstrated an AUROC of 0.86, sensitivity of 85%, specificity of 65%, and an NPV of 95% for the diagnosis of advanced fibrosis [101]. Interestingly, in a comparison of several markers of fibrosis in NAFLD subjects, FIB-4 had the highest AUROC (0.802) for the diagnosis of advanced fibrosis, followed by the AUROCs for the NAFLD fibrosis score, AAR, APRI, and AST: platelet ratio and BARD score of 0.768, 0.742, 0.73, 0.72 and 0.70, respectively [114]. The FibroMeter combines seven variables: age, weight, fasting glucose, AST, ALT, ferritin, and the platelet count [115]. In a study of 235 NAFLD patients, it had AUROCs of 0.943 for significant fibrosis, 0.937 for severe fibrosis, and 0.904 for cirrhosis, respectively.

The sensitivity, specificity, PPV, and NPV of the FibroMeter for diagnosing significant fibrosis were 79%, 96%, 88%, and 92% [102].

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