Impact of body fat accumulation on metabolic dysfunction-associated fatty liver disease and nonalcoholic fatty liver disease in Japanese male young adults.

AIM: Nonalcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated fatty liver disease (MAFLD) are global concerns. The aim of this study was to reveal the relationship between body composition and NAFLD and MAFLD in male young adults. METHODS: We recruited 335 male graduate students from Gifu University who underwent a health checkup in April 2022. The diagnosis of NAFLD and MAFLD was based on health checkup data and ultrasonography. Muscle and fat mass were measured using bioelectrical impedance analysis and demonstrated as skeletal muscle mass index and fat mass index (FMI), respectively. We assessed factors associated with NAFLD and MAFLD using the logistic regression, decision tree, and random forest analyses. RESULTS: The median age of the participants was 22 years, and 9% were overweight or obese (body mass index ≥25 kg/m2 ), 8% had MAFLD, and 16% had NAFLD. In the multivariate logistic regression analysis, FMI was independently associated with NAFLD (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.26-1.75; p < 0.001) and MAFLD (OR, 1.93; 95% CI, 1.51-2.46; p < 0.001). The decision tree and random forest analyses revealed that the strongest classifier for NAFLD and MAFLD was FMI. Additional analyses among nonobese individuals also showed the strong relationship between FMI, NAFLD, and MAFLD. CONCLUSION: Our study revealed that fat accumulation plays a key role in the development of NAFLD and MAFLD in male young adults, even in nonobese individuals. The results could shed new light on the pathophysiology of NAFLD and MAFLD in young adults.

Acetaminophen-induced liver injury at therapeutic doses in a young adult: a case report.

Acetaminophen causes volume-dependent hepatotoxicity; however, hepatotoxicity may also occur with acetaminophen administered at normal doses. We encountered a case of allergic liver damage in a 17-year-old girl receiving acetaminophen at a regular dose. The patient was diagnosed using the Roussel Uclaf Causality Assessment Method (RUCAM) and the diagnostic scale of the Digestive Disease Week Japan 2004 workshop. She tested positive for acetaminophen on a drug-induced lymphocyte stimulation test, and liver biopsy results confirmed the diagnosis of acetaminophen-induced liver injury. Despite administering acetaminophen at normal doses, hepatotoxicity may occur, which warrants further exploration.

Changes in Mental Health among Japanese University Students during the COVID-19 Era: Differences by College Department, Graduate Level, Sex, and Academic Year.

This study compared the effects of academic year, college department, and undergraduate or graduate status on Japanese students' mental health during the COVID-19 pandemic. From 2021-2023, an online survey was conducted using the Counseling Center Assessment of Psychological Systems-Japanese (CCAPS-Japanese) to evaluate students' mental health; 9395 undergraduate students (4623 female, 4772 male) and 1169 graduate students (380 female, 789 male) responded. Undergraduate students in medicine had lower levels of depression, generalized anxiety, and social anxiety than those in other departments. Engineering students exhibited the highest level of academic distress. First-year students had the highest levels of generalized and social anxiety but the lowest level of academic distress. Second-year students had the lowest level of depression, and third-year students had the highest level of academic distress. Among graduate students, first-year students had higher levels of depression, generalized anxiety, social anxiety, academic distress, and hostility than second-year students. Undergraduates had poorer mental health than graduate students. Females had higher levels of eating concerns than males among undergraduate students. This study revealed that the mental health of university students was affected by various factors. These findings demonstrate the characteristics of university students requiring early support.

Prevalence of Steatotic Liver Disease Based on a New Nomenclature in the Japanese Population: A Health Checkup-Based Cross-Sectional Study.

This cross-sectional study examined the prevalence and characteristics of steatotic liver disease (SLD) based on a recently introduced nomenclature in the Japanese health checkup population. SLD was evaluated using liver ultrasonography, and participants were categorized into metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic dysfunction and alcohol associated steatotic liver disease (MetALD), alcohol-associated/related liver disease (ALD), and cryptogenic SLD groups. The prevalence and characteristics of the SLD subclasses were assessed, and subgroup analyses were conducted for the non-obese (body mass index [BMI] ≤ 25 kg/m2) and lean (BMI ≤ 23 kg/m2) populations. Among the 694 participants, with a median age of 47 years and comprising 54% males, the prevalence of MASLD, MetALD, ALD, and cryptogenic SLD was 26%, 2%, 1%, and 2%, respectively. A remarkable difference was observed in the prevalence of SLD subclasses according to age, sex, and BMI. Subgroup analyses revealed heterogeneous demographic, clinical, and biochemical parameters between the SLD categories. Individuals with MetALD had higher gamma-glutamyl transferase levels, lower platelet counts, and higher fibrosis-4 index than did those with MASLD. Furthermore, the prevalence of non-obese and lean MASLD was 13% and 6%, respectively. This study provides preliminary information on the prevalence of SLD based on a new nomenclature in the Japanese population.

Usefulness of a questionnaire for assessing the relationship between eating behavior and steatotic liver disease among Japanese male young adults.

This study aimed to reveal the relationship between eating behavior and nonalcoholic fatty liver disease (NAFLD)/metabolic dysfunction-associated steatotic liver disease (MASLD) in young adults and suggest a questionnaire for eating behavior assessment. We included 322 male graduate students at Gifu University. Diagnoses of NAFLD and MASLD were based on the presence of hepatic steatosis on ultrasonography. Eating behavior was assessed using the eating behavior questionnaire (EBQ) recommended by the Japan Society for the Study of Obesity. We assessed the eating behaviors associated with NAFLD and MASLD using logistic regression, decision tree, and random forest analyses. The median age of the participants was 22 years, and 16% and 11% had NAFLD and MASLD, respectively. The EBQ total score was significantly higher in participants with MASLD than in those without MASLD (102 vs. 90 points, P = 0.006) and in those with NAFLD than in those without NAFLD (97 vs. 90 points, P = 0.007). Among eating behavior categories, the decision tree and random forest analyses revealed that "perception of constitution and weight" was the strongest contributor for NAFLD/MASLD. Our study revealed that eating behavior assessed with the EBQ is robustly associated with NAFLD and MASLD in young male adults.

Usefulness of health checkup-based indices in identifying metabolic dysfunction-associated steatotic liver disease.

Aims: The application of indices in the context of metabolic dysfunction-associated steatotic liver disease (MASLD) remains unexplored. We aimed to validate the ability of alanine aminotransferase (ALT), fatty liver index (FLI), and hepatic steatosis index (HSI) to identify MASLD during health checkups. Methods: We recruited 627 participants and utilized their health checkup data and ultrasound to assess the potential of using ALT, FLI, and HSI as indices for MASLD; this was indicated by the area under the curve (AUC) and restricted cubic spline (RCS) model. The optimal, rule-out (sensitivity ≥90%), and rule-in (specificity ≥90%) cutoff values of each index for identifying MASLD were reported. Results: Among participants with a median age of 46 years, the prevalence of MASLD was 28% in total (38% in males and 18% in females). RCS models confirmed a linear association between indices and MASLD. ROC analyses indicated that the AUC of ALT in identifying MASLD was 0.79 for the total cohort, 0.81 for males, and 0.69 for females. The optimal, rule-out, and rule-in cutoff values for ALT were 21, 13, and 29, respectively. Similarly, the AUC of FLI/HSI in identifying MASLD was 0.90/0.88 for the total cohort, 0.86/0.85 for males, and 0.93/0.90 for females. Considering the reference cutoff values, distinct cutoff values were observed between the sexes for FLI, while HSI had similar cutoff values. Conclusion: This study demonstrated that ALT > 30 IU/L is a reasonable cutoff value to rule-in MASLD. ALT, FLI, and HSI are reliable indices for identifying MASLD during health checkups.

Impact of COVID-19 on the mental health of Japanese university students (years II-IV).

This study aimed to investigate the differences in mental health during COVID-19, specifically among second-, third-, and fourth-year Japanese university students (n = 2,157; n = 2,000; and n = 2,284; respectively). A one-way MANOVA was conducted to assess the association between year of enrollment (academic years 2020, 2021, and 2022) and each of the eight subscales of the counseling Center Assessment Psychological Symptoms-Japanese. For second-year students, depression and generalized anxiety mean scores were higher in 2021 than those in 2020 and 2022. Alcohol use mean scores got smaller each year. For third-year students, depression, generalized anxiety, social anxiety, hostility, and alcohol use were significantly higher in 2021 than those in 2020 and 2022. Among fourth-year students, means for all eight subscale categories were significantly higher in 2021 than those in 2020 and 2022. The findings found worsened mental health profiles during 2021, which recovered to approximate pre-pandemic levels in 2022. This study demonstrates that university students' mental health has been negatively impacted by the COVID-19 pandemic, an effect which is more salient among fourth-year students. Further, it offers insights into mental health trends among Japanese university students and a possible foundation for learning about changes among university students worldwide.

Association between Body Composition and the Risk of Portopulmonary Hypertension Assessed by Computed Tomography in Patients with Liver Cirrhosis.

The aim of this study is to investigate the impact of body composition on the risk of portopulmonary hypertension using computed tomography (CT) in patients with liver cirrhosis. We retrospectively included 148 patients with cirrhosis treated at our hospital between March 2012 and December 2020. POPH high-risk was defined as main pulmonary artery diameter (mPA-D) ≥ 29 mm or mPA-D to ascending aorta diameter ratio ≥ 1.0, based on chest CT. Body composition was assessed using CT images of the third lumbar vertebra. The factors associated with POPH high-risk were evaluated using logistic regression and decision tree analyses, respectively. Among the 148 patients, 50% were females, and 31% were found to be high-risk cases on evaluation of chest CT images. Patients with a body mass index (BMI) of ≥25 mg/m2 had a significantly higher prevalence of POPH high-risk than those with a BMI < 25 mg/m2 (47% vs. 25%, p = 0.019). After adjusting for confounding factors, BMI (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.10-1.33), subcutaneous adipose tissue index (OR, 1.02; 95% CI, 1.01-1.03), and visceral adipose tissue index (OR, 1.03; 95% CI, 1.01-1.04) were associated with POPH high-risk, respectively. In the decision tree analysis, the strongest classifier of POPH high-risk was BMI, followed by the skeletal muscle index. Body composition may affect the risk of POPH based on chest CT assessment in patients with cirrhosis. Since the present study lacked data on right heart catheterization, further studies are required to confirm the results of our study.

Usefulness of health checkup for screening metabolic dysfunction-associated fatty liver disease and alcohol-related liver disease in Japanese male young adults.

We aimed to assess metabolic dysfunction-associated fatty liver disease (MAFLD) and alcohol-related liver disease (ALD) prevalence in young male adults and the role of health checkups in disease screening. We recruited 313 male graduate students at Gifu University in April 2022. With hepatic steatosis diagnosed by ultrasonography, MAFLD and nonalcoholic fatty liver disease (NAFLD) were diagnosed based on health checkup data, and ALD was diagnosed with alcohol consumption > 30 g/day. The ability of each variable to identify MAFLD, NAFLD, and ALD was assessed using logistic regression and receiver-operating characteristic curve analyses. Participants' mean age was 23 (± 4) years, and MAFLD, NAFLD, and ALD prevalence was 11%, 17%, and 1%, respectively. Among Japanese male young adults, alanine aminotransferase (ALT) (odds ratio [OR] 1.04; 95% confidence interval [CI] 1.01-1.07; P = 0.008) and body mass index (BMI) (OR 2.02; 95% CI 1.58-2.58; P < 0.001) were independently associated with MAFLD. Furthermore, only the alcohol use disorders identification test (AUDIT) was able to identify ALD (OR 1.49; 95% CI, 1.28-1.74; P = 0.001). Our study revealed that health checkups, including measurement of ALT, BMI, and AUDIT, are important for screening MAFLD and ALD in younger generations.

A simple covert hepatic encephalopathy screening model based on blood biochemical parameters in patients with cirrhosis.

AIM: Covert hepatic encephalopathy (CHE) adversely affects clinical outcomes in patients with liver cirrhosis, although its diagnosis is difficult. This study aimed to establish a simple CHE screening model based on blood-related biochemical parameters. METHODS: This retrospective study enrolled 439 patients who were assessed for CHE using a neuropsychiatric test between January 2011 and June 2019. A simple CHE (sCHE) score was calculated with hypoalbuminemia (≤ 3.5 g/dL) and hyperammonemia (≥ 80 µg/dL) as 1 point each. The association between sCHE score and CHE or overt hepatic encephalopathy (OHE) was assessed using logistic regression and Fine-Gray competing risk regression models. RESULTS: Of 381 eligible patients, 79 (21%) were diagnosed with CHE. The distribution of sCHE scores was 48% with 0 point, 33% with 1 point, and 19% with 2 points. Patients with sCHE score ≥ 1 point had a higher prevalence of CHE than those with sCHE score of 0 (27% vs. 14%, P = 0.002). A cut-off value of 1 point showed high discriminative ability for identifying CHE, with a sensitivity of 0.67, specificity of 0.56, positive predictive value of 0.27, and negative predictive value of 0.86. During the median follow-up period of 2.2 years, 58 (15%) patients developed OHE. Multivariate analysis showed that sCHE score ≥ 1 (sub-distribution hazard ratio [SHR], 2.69; 95% confidence interval [CI], 1.41-5.15) and CHE (SHR, 2.17; 95% CI, 1.26-3.73) independently predicted OHE. CONCLUSIONS: The sCHE score is a useful screening model for identifying patients with CHE and for predicting OHE occurrence.