Increased risk of MAFLD and Liver Fibrosis in Inflammatory Bowel Disease Independent of Classic Metabolic Risk Factors.

BACKGROUND & AIMS: There is conflicting evidence regarding the prevalence of and risk factors for metabolic-associated fatty liver disease (MAFLD) in patients with inflammatory bowel disease (IBD). We aimed to determine MAFLD prevalence and risk factors in IBD patients. METHODS: Cross-sectional, case-control study included all consecutive IBD patients treated at 2 different university hospitals. Controls were subjects randomly selected from the general population and matched by age, sex, type 2 diabetes status, and body mass index in a 1:2 ratio. MAFLD was confirmed by controlled attenuation parameter. Liver biopsies were collected when MAFLD with significant liver fibrosis was suspected. In addition, age- and fibrosis stage-paired non-IBD patients with biopsy-proven MAFLD served as a secondary control group. RESULTS: Eight hundred thirty-one IBD patients and 1718 controls were included. The prevalence of MAFLD and advanced liver fibrosis (transient elastography ≥9.7 kPa) was 42.00% and 9.50%, respectively, in IBD patients and 32.77% and 2.31%, respectively, in the general population (P < .001). A diagnosis of IBD was an independent predictor of MAFLD (adjusted odds ratio, 1.99; P < .001) and an independent risk factor for advanced liver fibrosis (adjusted odds ratio, 5.55; P < .001). Liver biopsies were obtained from 40 IBD patients; MAFLD was confirmed in all cases, and fibrosis of any degree was confirmed in 25 of 40 cases (62.5%). Body mass index and type 2 diabetes prevalence were significantly lower in IBD-MAFLD patients than in severity-paired patients with biopsy-proven MAFLD. CONCLUSIONS: MAFLD and liver fibrosis are particularly prevalent in IBD patients, regardless of the influence of classic metabolic risk factors.

Massive impact of coronavirus disease 2019 pandemic on gastroenterology and hepatology departments and doctors in Spain.

BACKGROUND AND AIM: Significant human and material resources have been diverted to coronavirus disease 2019 (COVID-19). Healthcare workers are at high risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We assess the impact of the COVID-19 pandemic on gastroenterology and hepatology departments and specialists in Spain. METHODS: This study involves a nationwide survey addressing the impact of COVID-19 on resources, procedures, and physicians of gastroenterology and hepatology departments in 81 hospitals representative of the Spanish National Health Service. RESULTS: Overall, 41.8% of hospital beds and 40.7% of gastroenterology and hepatology beds were allocated to COVID-19 patient care, as well as 24.8% of gastroenterologists and 58.3% of residents. Outpatient visits, abdominal ultrasounds, and endoscopies were reduced by 81.8-91.9%. Nine large university hospitals had 75% and 89% reductions in therapeutic endoscopies and hepatocellular carcinoma surgery, respectively, with cancelation of elective liver transplant and transjugular intrahepatic portosystemic shunt. Prevalence of infected physicians was 10.6% and was dependent on regional population incidence (r = 0.74, P = 0.001), with 11% hospitalized and one physician dying. Up to 63.4% of physicians may have been infected before or shortly after Spain entered lockdown, 57% of them having recently performed endoscopies. Adequate protection was acknowledged in > 80% hospitals, but only 2.9% performed regular SARS-CoV-2 testing. CONCLUSIONS: The impact of the COVID-19 pandemic on healthcare delivery has been massive. A wave of gastroenterology-related complications is expected because of resource diversion. Gastroenterologists have a high prevalence of infection, although they may have been infected during a first phase of lower awareness and protection. Regular SARS-CoV-2 screening, adequate protection, and quick reorganization of healthcare resources are still needed.

Long-Term Patient Symptoms and Quality of Life in Adults After COVID-19: A Real Life Study.

Objective: To characterize long-term patient-reported symptoms and quality of life, in adults after COVID-19. Material and methods: Cross-sectional study in Cantabria (Northern Spain) including adults with PCR-confirmed SARS-CoV-2 infection (n = 694) with a time period between 4.7 and 24 month post-SARS-CoV-2 diagnosis, and their close contacts (n = 663) (PCR negative and without suspected infection) obtained from simple random sampling of a total of 47,773 cases and 94,301 close contacts. The ISARIC survey was used as screening tool with self-reported "non-feeling fully recovery (NFFR)" defined as primary outcome. Results: 16.57% (n = 115/694) reported NFFR. Most prevalent symptoms were in order of frequency: Fatigue (54.8%); Loss of smell (40.9%); Problems speaking or communicating (29.6%); Loss of taste (28.7%); Confusion/lack of concentration (27.8%); Persistent muscle pain (24.3%) and Shortness of breath/breathlessness (23.5%). When comparing the three ordinal groups (Close contacts, COVID-19 feeling recovered, and COVID-19 NFFR) the prevalence of these symptoms was increasingly higher among each ordinal group (p < 0.001). Female gender was significantly associated with NFFR: (adjusted odds ratio (aOR) = 1.56); as well as older age: aOR per 10 year increment = 1.15. Lastly, they scored on average 9.63 points less in Euroquol. Conclusions: More than 15% of patients in our real-life population-based study, reported NFFR, being female sex and older age independent predictors of this condition. Most symptoms in these patients were in accordance with WHO definition of post COVID-19 condition in adults, and were less prevalent in COVID-19 feeling recovered and close contact respectively, with a statistically significant dose-response pattern, and with a large decrease in quality of life according to Euroquol.

Objetivo: Caracterizar los síntomas y la calidad de vida informados a largo plazo después de un episodio agudo de COVID-19. Métodos: Estudio transversal en Cantabria (norte de España) que incluye adultos con infección por SARS-CoV-2 confirmada por PCR (n = 694) tras un periodo entre 4,7 y 24 meses desde el diagnóstico y sus contactos estrechos (n = 663), obtenidos por muestreo aleatorio simple a partir de 47.773 casos y 94.301 contactos. Se utilizó la encuesta ISARIC, estableciéndose como variable resultado principal la respuesta «no-sentirse completamente recuperado (NSCR)¼. Resultados: El 16,57% (n = 115/694) declararon NSCR. Los síntomas más prevalentes fueron, por orden de frecuencia: fatiga (54,8%), pérdida del olfato (40,9%), problemas para hablar o comunicarse (29,6%), pérdida del gusto (28,7%), confusión/falta de concentración (27,8%), dolor muscular persistente (24,3%) y dificultad para respirar/falta de aire (23,5%). Al comparar los tres grupos ordinales (contactos estrechos, COVID-19 recuperados y COVID-19 NSCR), la prevalencia de estos síntomas fue mayor en cada grupo (p < 0,001). El sexo femenino se asoció significativamente con NSCR: Odds Ratio ajustada (aOR) = 1,56), así como la edad avanzada: aOR por cada 10 años = 1,15. Por último, obtuvieron en Euroquol una puntuación media de 9,63 puntos menos. Conclusiones: Más del 15% de los pacientes reportaron NSCR, siendo el sexo femenino y la edad factores predictores independientes. La mayoría de los síntomas en estos pacientes coincidieron con los de la definición de condición post-COVID-19 de la OMS y fueron menos prevalentes en contactos estrechos y COVID-19 que se sintieron recuperados, con un patrón dosis respuesta, y con una menor calidad de vida según Euroquol.

Clinical and molecular characterization of steatotic liver disease in the setting of immune-mediated inflammatory diseases.

Background & Aims: Growing evidence suggests an increased prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) in the context of immune-mediated inflammatory diseases (IMIDs). We aimed to clinically and mechanistically characterize steatotic liver disease (SLD) in a prospective cohort of patients with IMID compared to controls. Methods: Cross-sectional, case-control study including a subset of patients with IMID. Controls from the general population were age-, sex-, type 2 diabetes-, and BMI-matched at a 1:2 ratio. SLD was established using controlled attenuation parameter. Liver biopsies were obtained when significant liver fibrosis was suspected. Total RNA was extracted from freshly frozen cases and analyzed by RNA-seq. Differential gene expression was performed with 'limma-voom'. Gene set-enrichment analysis was performed using the fgsea R package with a preranked "limma t-statistic" gene list. Results: A total of 1,456 patients with IMID and 2,945 controls were included. Advanced SLD (liver stiffness measurement ≥9.7 kPa) (13.46% vs. 3.79%; p <0.001) and advanced MASLD (12.8% vs. 2.8%; p <0.001) prevalence were significantly higher among patients with IMID than controls. In multivariate analysis, concomitant IMID was an independent, and the strongest, predictor of advanced SLD (adjusted odds ratio 3.318; 95% CI 2.225-4.947; p <0.001). Transcriptomic data was obtained in 109 patients and showed 87 significant genes differentially expressed between IMID-MASLD and control-MASLD. IMID-MASLD cases displayed an enriched expression of genes implicated in pro-tumoral activities or the control of the cell cycle concomitant with a negative expression of genes related to metabolism. Conclusions: The prevalence of advanced SLD and MASLD is disproportionately elevated in IMID cohorts. Our findings suggest that IMIDs may catalyze a distinct MASLD pathway, divergent from classical metabolic routes, highlighting the need for tailored clinical management strategies. Impact and implications: The prevalence of steatotic liver disease with advanced fibrosis is increased in patients with immune-mediated inflammatory diseases, independent of classic metabolic risk factors or high-risk alcohol consumption. Transcriptomic analysis revealed a unique gene expression signature associated with cellular activities that are compatible with a liver condition leading to an accelerated and aggressive form of steatotic liver disease. Our findings underscore the importance of heightened screening for advanced liver disease risk across various medical disciplines overseeing patients with immune-mediated inflammatory diseases.

Can household storage conditions reduce food waste and environmental impact? A broccoli case study.

The consumption stage has been identified as the largest producer of food waste (FW) across the food supply chain (FSC), with fruit and vegetables being the most affected product category. The present study aims to determine the optimal storage scenario at household level to avoid food waste and which has the lowest environmental footprint. Broccoli was stored under different storage conditions: unbagged or bagged (periodically opened) in bioplastic bags inside a domestic refrigerator at 5 or 7 °C for 34 days and then analysed for relative humidity (RH), sensory properties and bioactive compounds. A life cycle assessment (LCA) was conducted to evaluate the environmental profile of 1 kg of broccoli purchased by the consumer (cradle-to-grave). At day 0 (base scenario) the carbon footprint was 0.81 kg CO2 eq/kg, with the vegetable farming being the main contributor to this environmental impact, mostly driven by fertiliser (production and its emissions to air and water) and irrigation (due to electricity consumption for water pumping). Quality and food waste depended on time and storage conditions: For short storage times, within three days, the best quality combined with the lowest environmental footprint was for unbagged broccoli at 7 °C and no household food waste. However, this scenario had the highest food waste level from day 3 onwards, with increased resource loss and overall environmental footprint. For long-term storage, using a bag and storing at 5 °C helped to reduce food waste with the lowest environmental footprint. For example, at 16 days, this scenario (bagged at 5 °C) could save 4.63 kg/FU of broccoli and 3.16 kg CO2 eq/FU compared to the worst scenario (unbagged at 7 °C). Consumers are the key to reducing household food waste and this research provides the knowledge for improvement.

Environmental and economic sustainability of fresh-cut and pre-cooked vegetables.

Due to the growing awareness about the environmental and economic sustainability of food products, the present research aims to evaluate the sustainability of fresh-cut and pre-cooked vegetables, a niche market with growing demand. An analysis was carried out using a detailed material, energy, and economic inventory based on a commercial food processing plant located in northeast Spain. The environmental sustainability was determined using process-based environmental life cycle assessment (E-LCA), applying a cradle-to-market approach, and using the EF3.0 impact assessment methodology to quantify impacts on five midpoint categories (climate change, photochemical ozone formation, acidification, freshwater eutrophication, and fossil resource use) and an aggregated single score. Additionally, an environmental life cycle costing (E-LCC) was performed. The pre-cooked vegetable products showed a higher environmental footprint than the fresh-cut products in all the impact categories (between 14.0 % and 39.9 %) and involved higher life cycle costs (15.2 %), due to the increased demand for ingredients, packaging materials, and electricity consumption per FU (kg of product). The carbon footprint (CF) and the cost for the fresh-cut products were 0.72 kg CO2 eq/kg and 2.62 €/kg, respectively, compared to 0.86 kg CO2/kg and 3.02 €/kg for the pre-cooked vegetables. The environmental profiles of both products were rather similar, with a dominance of the Upstream stage (production of ingredients and packaging materials), followed by the Core stage (mainly due to electricity consumed during vegetable processing). The relevance of the Core stage is amplified in the economic analysis due to the incorporation of certain processes which were not included in the process-based E-LCA (e.g., labour, capital, insurance, maintenance costs, etc.). To integrate the economic and environmental analyses, an eco-efficiency index was calculated that describes the carbon emissions per unit of monetary cost, resulting in 0.27 kg CO2eq/€ for the fresh-cut and 0.28 kg CO2 eq/€ for the pre-cooked vegetables.

Optimizing the environmental sustainability of alternative post-harvest scenarios for fresh vegetables: A case study in Spain.

The aim of this research is to define different scenarios that optimize the environmental sustainability of the post-harvest stage of vegetable products (cauliflower and brassicas mix). These scenarios considered different packaging materials; energy generation technologies for the processing plant (standard electricity mix vs. renewable options); organic waste management (composting, anaerobic digestion, and animal feeding); and refrigerated transportation (local, national, and international, using diesel, natural gas, and hybrid trucks and railway). The analysis has been carried out based on a foreground inventory provided by a company that operating internationally, in accordance with the International Organization for Standardization (ISO) 14,040 methodological framework and following the latest Product Environmental Footprint (PEF) protocols. The analysis describes four midpoint categories, single score (SS) using EF3.0 life cycle impact assessment (LCIA) methodology and the Cumulative Energy Demand. The carbon footprint (CF) of the post-harvest stage for a base case scenario ranged between 0.24 and 0.29 kg CO2 eq/kg of vegetable, with a strong contribution associated to the production of packaging materials (57.8-65.2 %) and the transport stage (national range in conventional diesel vehicles) (31.5-38.0 %). Comparatively, lower emissions were associated with the energy consumed at the processing factory (up to 4.1 %) while the composting of organic waste management produced some impact savings (up to -3.5 %). Although certain differences were observed, the dominance of the transport stage and the packaging materials is sustained in all the other environmental impact and energy categories evaluated. The most effective measures to reduce the environmental footprint of the post-harvest stage involve: i) using reusable packaging materials; ii) reducing the transport range and using vehicles running on natural gas or hybrid technologies; iii) the incorporation of renewable energy to supply the factory; and iv) the utilization of the organic residues in higher value applications such as animal feeding. Implementing the measures proposed in this study would reduce the post-harvest CF of fresh vegetables by 90 %.

Reusable Plastic Crates (RPCs) for Fresh Produce (Case Study on Cauliflowers): Sustainable Packaging but Potential Salmonella Survival and Risk of Cross-Contamination.

The handling of fresh fruits and vegetables in reusable plastic crates (RPCs) has the potential to increase the sustainability of packaging in the fresh produce supply chain. However, the utilization of multiple-use containers can have consequences related to the microbial safety of this type of food. The present study assessed the potential cross-contamination of fresh cauliflowers with Salmonella enterica via different contact materials (polypropylene from RPCs, corrugated cardboard, and medium-density fiberboard (MDF) from wooden boxes). Additionally, the survival of the pathogenic microorganism was studied in cauliflowers and the contact materials during storage. The life cycle assessment (LCA) approach was used to evaluate the environmental impact of produce handling containers made from the different food-contact materials tested. The results show a higher risk of cross-contamination via polypropylene compared with cardboard and MDF. Another outcome of the study is the potential of Salmonella for surviving both in cross-contaminated produce and in contact materials under supply chain conditions. Regarding environmental sustainability, RPCs have a lower environmental impact than single-use containers (cardboard and wooden boxes). To exploit the potential environmental benefits of RPCs while ensuring food safety, it is necessary to guarantee the hygiene of this type of container.

Feasibility of large-scale population testing for SARS-CoV-2 detection by self-testing at home.

The simplicity and low cost of rapid point-of-care tests greatly facilitate large-scale population testing, which can contribute to controlling the spread of the COVID-19 virus. We evaluated the applicability of a self-testing strategy for SARS-CoV2 in a population-based, cross-sectional study in Cantabria, Spain, between April and May 2020. For the self-testing strategy, participants received the necessary material for the self-collection of blood and performance of a rapid antibody test using lateral flow immunoassay at home without the supervision of healthcare personnel. A total of 1,022 participants were enrolled. Most participants correctly performed the COVID-19 self-test the first time (91.3% [95% CI 89.4-92.9]). Only a minority of the participants (0.7%) needed the help of healthcare personnel, while 6.9% required a second kit delivery, for a total valid test result in 96.9% of the participants. Incorrect use of the self-test was not associated with the educational level, age over 65, or housing area. Prevalence of IgG antibodies against SARS-CoV2 for subjects with a valid rapid test result was 3.1% (95% CI 2.2-4.4), similar to the seroprevalence result obtained using a conventional approach carried out by healthcare professionals. In conclusion, COVID-19 self-testing should be considered as a screening tool.

Changes in Circulating Lysyl Oxidase-Like-2 (LOXL2) Levels, HOMA, and Fibrosis after Sustained Virological Response by Direct Antiviral Therapy.

BACKGROUND: we aimed to assess the influence of metabolic syndrome on fibrosis regression (using liver-stiffness measurement (LSM) and serological scores) and the relationship with the expression of lysyl oxidase-like-2 as a potential goal of antifibrotic therapy. METHODS: We included 271 patients treated with Direct Antiviral Therapy (DAAs) in our hospital who achieved a sustained virological response (SVR); physical examination, blood tests, and LSM were made at baseline (B) and 24 months (24 M) after SVR. Hemodynamic studies and transjugular liver biopsies were performed on 13 patients. RESULTS: At B, 68 patients were F1 (25.1%); F2 n = 59 (21.7%); F3 n = 44 (16.05%); and 100 were F4 (36.9%). Although the LSM (absolute value) improved in 82% of patients (n = 222), it progressed in 17.5% of patients (n = 48). At 24 M, 48 patients met the metabolic syndrome (MetS) criteria and there was an increase in patients with a BMI of >25 kg/m2 (p < 0.001). At B and 24 M, a BMI of >25 kg/m2 is a risk factor for significant fibrosis or steatosis at 24 M (p < 0.05) and progression on LSM (p < 0.001), as well as MetS at B and 24 M (OR 4.1 IC (1.4-11.7), p = 0.008; and OR 5.4 IC (1.9-15.4), p = 0.001, respectively). Regarding the correlation between LSM and the liver biopsy, we found that only six out of 13 patients had a matching LSM and biopsy. We found a statistically significant decrease in LOXL2 levels at 24 M with respect to B (p < 0.001) with higher serological value in patients with elastography of >9 kPa vs. <9 kPa (p = 0.046). CONCLUSION: Regression of LSM was reached in 82% of patients. Downregulated LOXL2 was demonstrated post-SVR, with overexpression in cirrhotic patients being a potential therapy goal in selected patients.