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Arun J Sanyal - One of the best experts on this subject based on the ideXlab platform.
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epidemiology and natural history of Nonalcoholic Fatty Liver disease
Seminars in Liver Disease, 2015Co-Authors: Sanjaya K Satapathy, Arun J SanyalAbstract:The epidemic of obesity has resulted in a parallel incremental burden of Nonalcoholic Fatty Liver disease (NAFLD) worldwide. Nonalcoholic Fatty Liver disease includes a spectrum of Liver disease that ranges from simple fat accumulation in the Liver to necroinflammation, fibrosis, cirrhosis, and hepatocellular carcinoma, which in essence represent the stages of the natural history of NAFLD. The rising prevalence of NAFLD globally may be accounted for by changes in dietary habits and an increase in sedentary lifestyle. Nonalcoholic steatohepatitis (NASH), the aggressive form of NAFLD, is currently the second leading etiology of Liver disease among adults awaiting Liver transplantation in the United States. In the current review, the authors discuss the uncertainty around the progression from NAFL (steatosis) to NASH (steatohepatitis), the undisputed progression of NASH to cirrhosis, and the risk factors that predispose to such progression. The published literature on the long-term cardiovascular complications and Liver-related mortality of NAFLD is also discussed.
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association between metabolic syndrome and Liver histology among children with Nonalcoholic Fatty Liver disease
The American Journal of Gastroenterology, 2010Co-Authors: Heather Patton, Katherine Yates, Aynur Unalparida, Cynthia Behling, Terry T K Huang, Philip J Rosenthal, Arun J Sanyal, Jeffrey B Schwimmer, Joel E LavineAbstract:Association Between Metabolic Syndrome and Liver Histology Among Children With Nonalcoholic Fatty Liver Disease
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a lipidomic analysis of Nonalcoholic Fatty Liver disease
Hepatology, 2007Co-Authors: Puneet Puri, Rebecca Baillie, Michelle M Wiest, Faridoddin Mirshahi, Jayanta Choudhury, Onpan Cheung, Carol Sargeant, Melissa J Contos, Arun J SanyalAbstract:The spectrum of Nonalcoholic Fatty Liver disease (NAFLD) includes a Nonalcoholic Fatty Liver (NAFL) and Nonalcoholic steatohepatitis (NASH). The specific types and amounts of lipids that accumulate in NAFLD are not fully defined. The free Fatty acid (FFA), diacylglycerol (DAG), triacylglycerol (TAG), free cholesterol (FC), cholesterol ester, and phospholipid contents in normal Livers were quantified and compared to those of NAFL and NASH, and the distribution of Fatty acids within these classes was compared across these groups. Hepatic lipids were quantified by capillary gas chromatography. The mean (nmol/g of tissue) DAG (normal/NAFL/NASH: 1922 versus 4947 versus 3304) and TAG (13,609 versus 128,585 versus 104,036) increased significantly in NAFLD, but FFA remained unaltered (5533 versus 5929 versus 6115). There was a stepwise increase in the mean TAG/DAG ratio from normal Livers to NAFL to NASH (7 versus 26 versus 31, P < 0.001). There was also a similar stepwise increment in hepatic FC (7539 versus 10,383 versus 12,863, P < 0.05 for NASH). The total phosphatidylcholine (PC) decreased in both NAFL and NASH. The FC/PC ratio increased progressively (0.34 versus 0.69 versus 0.71, P < 0.008 for both). Although the levels for linoleic acid (18:2n-6) and α-linolenic acid (18:3n-3) remained unaltered, there was a decrease in arachidonic acid (20:4n-6) in FFA, TAG, and PC (P < 0.05 for all) in NASH. Eicosapentanoic acid (20:5n-3) and docosahexanoic acid (22:6n-3) were decreased in TAG in NASH. The n-6:n-3 FFA ratio increased in NASH (P < 0.05). Conclusions: NAFLD is associated with numerous changes in the lipid composition of the Liver. The potential implications are discussed. (HEPATOLOGY 2007.)
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aga technical review on Nonalcoholic Fatty Liver disease
Gastroenterology, 2002Co-Authors: Arun J SanyalAbstract:Abstract Nonalcoholic Fatty Liver disease (NAFLD) represents a spectrum of conditions characterized histologically by mainly macrovesicular hepatic steatosis and occurs in those who do not consume alcohol in amounts generally considered to be harmful to the Liver. There are 2 histologic patterns of NAFLD: Fatty Liver alone and steatohepatitis. NAFLD is an increasingly recognized cause of Liver-related morbidity and mortality. In this review, the existing literature regarding the nomenclature, clinical and histologic spectrum, natural history, diagnosis, and management of this condition are discussed. GASTROENTEROLOGY 2002;123:1705-1725
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aga technical review on Nonalcoholic Fatty Liver disease
Gastroenterology, 2002Co-Authors: Arun J SanyalAbstract:Abstract Nonalcoholic Fatty Liver disease (NAFLD) represents a spectrum of conditions characterized histologically by mainly macrovesicular hepatic steatosis and occurs in those who do not consume alcohol in amounts generally considered to be harmful to the Liver. There are 2 histologic patterns of NAFLD: Fatty Liver alone and steatohepatitis. NAFLD is an increasingly recognized cause of Liver-related morbidity and mortality. In this review, the existing literature regarding the nomenclature, clinical and histologic spectrum, natural history, diagnosis, and management of this condition are discussed. GASTROENTEROLOGY 2002;123:1705-1725
Anna Mae Diehl - One of the best experts on this subject based on the ideXlab platform.
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a longer duration of estrogen deficiency increases fibrosis risk among postmenopausal women with Nonalcoholic Fatty Liver disease
Hepatology, 2016Co-Authors: Jagpal S Klair, Joel E Lavine, Katherine Yates, Aynur Unalparida, Ju Dong Yang, Manal F Abdelmalek, Cynthia D Guy, Ryan M Gill, Jeanne M Clark, Anna Mae DiehlAbstract:UNLABELLED Postmenopausal women with Nonalcoholic steatohepatitis are at an increased risk of hepatic fibrosis compared with premenopausal women. Whether duration of estrogen deficiency in postmenopausal state dictates an individual's fibrosis risk remains uninvestigated. We assessed the associations of age at menopause and time from menopause with fibrosis severity in postmenopausal women with Nonalcoholic Fatty Liver disease. Data from 488 postmenopausal women with (1) histologic diagnosis of Nonalcoholic Fatty Liver disease and (2) self-reported information on age at menopause were analyzed. The associations of premature menopause (age at menopause of <40 years) and time from menopause (age at study enrollment - age at menopause, years) with fibrosis severity (stage 0-4) were assessed using multiple ordinal logistic regression models with and without adjusting for clinical confounders. Among the participants (age at menopause 43.7 ± 8.6 years), women with premature menopause (29.3%) were younger at enrollment (P < 0.001) and used hormone replacement therapy more often (P < 0.003). After adjusting for age at enrollment, race, waist circumference standardized by body mass index, current smoking, current alcohol use, hypertension, diabetes/impaired fasting glucose, homeostatic model assessment of insulin resistance, and hormone replacement therapy, premature menopause was associated with an increased likelihood of having more severe fibrosis (adjusted cumulative odds ratio = 1.9, 95% confidence interval 1.3-2.7, P = 0.001), while time from menopause was directly associated with an increased likelihood of having more severe fibrosis (adjusted cumulative odds ratio for 5-year unit = 1.2, 95% confidence interval 1.1-1.3, P = 0.002). CONCLUSION Duration of estrogen deficiency in postmenopausal state confers fibrosis risk among postmenopausal women with Nonalcoholic Fatty Liver disease. (Hepatology 2016;64:85-91).
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Nonalcoholic steatohepatitis and Nonalcoholic Fatty Liver disease in young women with polycystic ovary syndrome
The Journal of Clinical Endocrinology and Metabolism, 2006Co-Authors: Tracy L Setji, Anna Mae Diehl, Nicole D Holland, Linda L Sanders, Katherine Pereira, Ann J BrownAbstract:Context: Nonalcoholic Fatty Liver disease and polycystic ovary syndrome (PCOS) are both associated with insulin resistance. Thus, women with PCOS may have an increased prevalence of Nonalcoholic Fatty Liver disease, including Nonalcoholic steatohepatitis (NASH). Objective: The objective of the study was to determine the prevalence and characteristics of NASH and abnormal aminotransferase activity in women with PCOS. Design: The study is a retrospective chart review. Setting: The setting is an academic endocrinology clinic. Patients: Patients were 200 women with PCOS, defined as irregular menses and hyperandrogenism. Main Outcome Measures: Biopsy-documented NASH and aminotransferase levels were the main outcome measures. Results: Fifteen percent (29 of 200) had aspartate aminotransferase and/or alanine aminotransferase more than 60 U/liter. Women with aminotransferase elevations had lower high-density lipoprotein (HDL) (41 vs. 50 mg/dl, P = 0.006), higher triglycerides (174 vs. 129 mg/dl, P = 0.024), and h...
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tumor necrosis factor and its potential role in insulin resistance and Nonalcoholic Fatty Liver disease
Clinics in Liver Disease, 2004Co-Authors: Anna Mae DiehlAbstract:Abstract Nonalcoholic Fatty Liver disease (NAFLD) is a spectrum of hepatic pathology that resembles alcohol-induced Fatty Liver disease(AFLD), but which develops in individuals who are not heavy drinkers. In people, NAFLD is associated strongly with obesity,insulin resistance, and dysmetabolic syndrome, but the exact mechanisms that promote Liver disease in this clinical context remain poorly understood. The proinflammatory cytokine, funor necrosis factor alpha is known to be a key mediator of AFLD. This article discusses clinical and experimental evidence that tumor necrosis factor plays a role in the pathogenesis of insulin resistance syndromes, including Nonalcoholic Fatty syndromes, including Nonalcoholic Fatty Liver disease.
Vincent Waisun Wong - One of the best experts on this subject based on the ideXlab platform.
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Nonalcoholic Fatty Liver disease
Nature Reviews Disease Primers, 2015Co-Authors: Elizabeth M Brunt, Elisabetta Bugianesi, Christopher P Day, Vincent Waisun Wong, Valerio Nobili, Silvia Cristina Sookoian, Jacquelyn J Maher, Claude B Sirlin, Brent A Neuschwandertetri, Mary E RinellaAbstract:Nonalcoholic Fatty Liver disease (NAFLD) is a disorder characterized by excess accumulation of fat in hepatocytes (Nonalcoholic Fatty Liver (NAFL)); in up to 40% of individuals, there are additional findings of portal and lobular inflammation and hepatocyte injury (which characterize Nonalcoholic steatohepatitis (NASH)). A subset of patients will develop progressive fibrosis, which can progress to cirrhosis. Hepatocellular carcinoma and cardiovascular complications are life-threatening co-morbidities of both NAFL and NASH. NAFLD is closely associated with insulin resistance; obesity and metabolic syndrome are common underlying factors. As a consequence, the prevalence of NAFLD is estimated to be 10-40% in adults worldwide, and it is the most common Liver disease in children and adolescents in developed countries. Mechanistic insights into fat accumulation, subsequent hepatocyte injury, the role of the immune system and fibrosis as well as the role of the gut microbiota are unfolding. Furthermore, genetic and epigenetic factors might explain the considerable interindividual variation in disease phenotype, severity and progression. To date, no effective medical interventions exist that completely reverse the disease other than lifestyle changes, dietary alterations and, possibly, bariatric surgery. However, several strategies that target pathophysiological processes such as an oversupply of Fatty acids to the Liver, cell injury and inflammation are currently under investigation. Diagnosis of NAFLD can be established by imaging, but detection of the lesions of NASH still depend on the gold-standard but invasive Liver biopsy. Several non-invasive strategies are being evaluated to replace or complement biopsies, especially for follow-up monitoring.
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prevalence and severity of Nonalcoholic Fatty Liver disease in non obese patients a population study using proton magnetic resonance spectroscopy
The American Journal of Gastroenterology, 2015Co-Authors: Jonathan Chungfai Leung, Vincent Waisun Wong, Grace Laihung Wong, David K W Yeung, Ruth Chan, Angel Meiling Chim, Thomson Chiwang Loong, Henry Likyuen Chan, Grace Laihung Wong, Henry Likyuen Chan, Vincent Waisun WongAbstract:Prevalence and Severity of Nonalcoholic Fatty Liver Disease in Non-Obese Patients: A Population Study Using Proton-Magnetic Resonance Spectroscopy
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Liver stiffness measurement using xl probe in patients with Nonalcoholic Fatty Liver disease
The American Journal of Gastroenterology, 2012Co-Authors: Vincent Waisun Wong, Julien Vergniol, Grace Laihung Wong, J Foucher, Anthony Winghung Chan, Faiza Chermak, Paul Cheunglung Choi, Wassil Merrouche, Sophie Pesque, Henry Likyuen ChanAbstract:Liver Stiffness Measurement Using XL Probe in Patients With Nonalcoholic Fatty Liver Disease
Rohit Loomba - One of the best experts on this subject based on the ideXlab platform.
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performance characteristics of vibration controlled transient elastography for evaluation of Nonalcoholic Fatty Liver disease
Hepatology, 2018Co-Authors: Raj Vuppalanchi, Brent A Neuschwandertetri, Rohit Loomba, Mohammad S Siddiqui, Mark L Van Natta, Erin Hallinan, Danielle Brandman, Kris V Kowdley, Srinivas Dasarathy, Manal F AbdelmalekAbstract:Vibration-controlled transient elastography estimates Liver stiffness measurement (LSM) and controlled attenuation parameter (CAP), which are noninvasive assessments of hepatic fibrosis and steatosis, respectively. However, prior vibration-controlled transient elastography studies reported high failure rates in patients with Nonalcoholic Fatty Liver disease. We examined the performance characteristics of the FibroScan 502 Touch with two probes, medium (M+) and extra large (XL+), in patients with Nonalcoholic Fatty Liver disease in a multicenter setting. A total of 1,696 exams were attempted in 992 patients (body mass index, 33.6 ± 6.5 kg/m2) with histologically confirmed Nonalcoholic Fatty Liver disease. Simultaneous assessment of LSM and CAP was performed using the FibroScan 502 Touch with an automatic probe selection tool. Testing was conducted twice in patients by either a single operator (87%) or two operators (13%). Failure was defined as the inability to obtain a valid examination. An examination was considered unreliable if LSM interquartile range/median was >30%. Significant disagreement between two readings was defined as >95% limits of agreement between two readings. A total of 1,641 examinations yielded valid results with a failure rate of 3.2% (55/1,696). The proportion of unreliable scans for LSM was 3.9%. The proportion of unreliable scans with operator experience in the top quartile (≥59 procedures) was significantly lower than that in the lower three quarters combined (1.6% versus 4.7%, P = 0.02 by Fisher's exact test). The significant disagreement between first and second readings for LSM and CAP when obtained back to back was 18% and 11%, respectively. Conclusion: Vibration-controlled transient elastography for estimation of LSM and CAP can be successfully deployed in a multicenter setting with low failure (3.2%) and high reliability (>95%) rates and high reproducibility. (Hepatology 2018;67:134-144).
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genome wide associations related to hepatic histology in Nonalcoholic Fatty Liver disease in hispanic boys
The Journal of Pediatrics, 2017Co-Authors: Julia Wattacheril, Joel E Lavine, Jeffrey B Schwimmer, Elizabeth M Brunt, Rohit Loomba, Naga Chalasani, Xiuqing Guo, Soonil Kwon, Jean P Molleston, Yii Der Ida ChenAbstract:Objective To identify genetic loci associated with features of histologic severity of Nonalcoholic Fatty Liver disease in a cohort of Hispanic boys. Study design There were 234 eligible Hispanic boys age 2-17 years with clinical, laboratory, and histologic data enrolled in the Nonalcoholic Steatohepatitis Clinical Research Network included in the analysis of 624 297 single nucleotide polymorphisms (SNPs). After the elimination of 4 outliers and 22 boys with cryptic relatedness, association analyses were performed on 208 DNA samples with corresponding Liver histology. Logistic regression analyses were carried out for qualitative traits and linear regression analyses were applied for quantitative traits. Results The median age and body mass index z-score were 12.0 years (IQR, 11.0-14.0) and 2.4 (IQR, 2.1-2.6), respectively. The Nonalcoholic Fatty Liver disease activity score (scores 1-4 vs 5-8) was associated with SNP rs11166927 on chromosome 8 in the TRAPPC9 region (P = 8.7-07). Fibrosis stage was associated with SNP rs6128907 on chromosome 20, near actin related protein 5 homolog (p = 9.9-07). In comparing our results in Hispanic boys with those of previously reported SNPs in adult Nonalcoholic steatohepatitis, 2 of 26 susceptibility loci were associated with Nonalcoholic Fatty Liver disease activity score and 2 were associated with fibrosis stage. Conclusions In this discovery genome-wide association study, we found significant novel gene effects on histologic traits associated with Nonalcoholic Fatty Liver disease activity score and fibrosis that are distinct from those previously recognized by adult Nonalcoholic Fatty Liver disease genome-wide association studies.
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recommendations for diagnosis referral for Liver biopsy and treatment of Nonalcoholic Fatty Liver disease and Nonalcoholic steatohepatitis
Mayo Clinic proceedings, 2015Co-Authors: Erin K Spengler, Rohit LoombaAbstract:Nonalcoholic Fatty Liver disease (NAFLD) is the primary cause of chronic Liver disease in the United States, afflicting an estimated 80 to 100 million Americans. Nonalcoholic Fatty Liver disease is a spectrum of Liver diseases composed of Nonalcoholic Fatty Liver and Nonalcoholic steatohepatitis (NASH). Although Nonalcoholic Fatty Liver has a negligible risk of progression, patients with NASH often develop cirrhosis or hepatocellular carcinoma. Although Liver biopsy is required to diagnose NASH, only patients with a high risk of NASH or advanced fibrosis require this evaluation. Despite the high prevalence of NAFLD, well-defined screening recommendations are currently lacking. In this review, suggestions for screening, diagnosis, and initial work-up of NAFLD are given on the basis of established guidelines and recent publications. Proposed drug treatments of NASH are also discussed, highlighting the study outcomes, as well as proposed uses and limitations of these drugs. The literature was searched in PubMed using search terms Nonalcoholic Fatty Liver disease and Nonalcoholic steatohepatitis, with filters of "English language." A date range of January 1, 2000, to May 1, 2015, was used for the search. The bibliographies of key references were also searched manually, and seminal publications before the year 2000 were included.
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Nonalcoholic Fatty Liver disease mr imaging of Liver proton density fat fraction to assess hepatic steatosis
Radiology, 2013Co-Authors: An Tang, Elizabeth M Brunt, Justin Tan, Mark Sun, Gavin Hamilton, Mark Bydder, Tanya Wolfson, Anthony Gamst, Michael S Middleton, Rohit LoombaAbstract:MR imaging with proton density fat fraction (PDFF) permitted high overall accuracy with moderate sensitivity and high specificity for classification of dichotomized steatosis grade, and these results support the conduct of further studies to help validate MR imaging–PDFF as a biomarker of hepatic steatosis in Nonalcoholic Fatty Liver disease.
Nezam H Afdhal - One of the best experts on this subject based on the ideXlab platform.
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the performance of vibration controlled transient elastography in a us cohort of patients with Nonalcoholic Fatty Liver disease
The American Journal of Gastroenterology, 2016Co-Authors: Elliot B. Tapper, Tracy Challies, Imad Nasser, Nezam H AfdhalAbstract:The Performance of Vibration Controlled Transient Elastography in a US Cohort of Patients With Nonalcoholic Fatty Liver Disease
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cost effective evaluation of Nonalcoholic Fatty Liver disease with nafld fibrosis score and vibration controlled transient elastography
The American Journal of Gastroenterology, 2015Co-Authors: Elliot B. Tapper, M Myriam G Hunink, Neil Sengupta, Nezam H AfdhalAbstract:Cost-Effective Evaluation of Nonalcoholic Fatty Liver Disease With NAFLD Fibrosis Score and Vibration Controlled Transient Elastography
