Liver Investigation: Testing Marker Utility in Steatohepatitis (LITMUS): Assessment & validation of imaging modality performance across the NAFLD spectrum in a prospectively recruited cohort study (the LITMUS imaging study): Study protocol.

Non-alcoholic fatty liver disease (NAFLD) is the liver manifestation of the metabolic syndrome with global prevalence reaching epidemic levels. Despite the high disease burden in the population only a small proportion of those with NAFLD will develop progressive liver disease, for which there is currently no approved pharmacotherapy. Identifying those who are at risk of progressive NAFLD currently requires a liver biopsy which is problematic. Firstly, liver biopsy is invasive and therefore not appropriate for use in a condition like NAFLD that affects a large proportion of the population. Secondly, biopsy is limited by sampling and observer dependent variability which can lead to misclassification of disease severity. Non-invasive biomarkers are therefore needed to replace liver biopsy in the assessment of NAFLD. Our study addresses this unmet need. The LITMUS Imaging Study is a prospectively recruited multi-centre cohort study evaluating magnetic resonance imaging and elastography, and ultrasound elastography against liver histology as the reference standard. Imaging biomarkers and biopsy are acquired within a 100-day window. The study employs standardised processes for imaging data collection and analysis as well as a real time central monitoring and quality control process for all the data submitted for analysis. It is anticipated that the high-quality data generated from this study will underpin changes in clinical practice for the benefit of people with NAFLD. Study Registration: clinicaltrials.gov: NCT05479721.

Overall clinical and economic impact of non-alcoholic fatty liver disease.

OBJECTIVES: to establish the clinical and economic consequences (resource utilization and healthcare costs) of non-alcoholic fatty liver in the setting of the usual clinical practice in Spain. PATIENTS AND METHODS: an observational, retrospective study was performed based on a review of the medical records of adult patients ≥ 18 years of age who sought medical care from 2017 to 2018. Patients were categorized into two groups according to fibrosis stage (estimation method: FIB-4): a) F0-F2; and b) F3-F4 (advanced fibrosis). Follow-up lasted one year. Primary endpoints included comorbidity, concomitant medication, resource utilization and costs. Results were analyzed using a multivariate approach with p < 0.05. RESULTS: a total of 8,151 patients were recruited with a mean age of 61.1 years and 51.5 % were male. By group: a) mild fibrosis n = 7,127, 87.4 %; and b) advanced fibrosis n = 1,024, 12.6 % (6.8 % with liver cirrhosis). The most common comorbidities included 63 % dyslipidemia, 52 % obesity, 52 % hypertension and 35 % diabetes. The average number of drugs used was 2.1 per patient. Patients with advanced fibrosis (F3-F4) had a higher average number of concomitant medications (2.5 vs 2.1; p < 0.001) and a higher AST/ALT ratio (1.1 vs 0.8; p < 0.001). The average cost (patient-year) for subjects with advanced fibrosis, corrected for covariates, was higher (€1,812 vs €1,128, p < 0.001). Age, morbidity, concomitant medication, fibrosis stage and total costs were higher in patients with diabetes. CONCLUSIONS: patients with advanced fibrosis were associated with more comorbidity and concomitant medications, which resulted in higher healthcare costs for the National Health System.

[ASSESSMENT OF THE GENETIC MODIFICATION INDUCING DIET THROUGH BLOOD MONONUCLEAR CELLS]. / EVALUACIÓN DE LAS MODIFICACIONES GENÉTICAS QUE INDUCE LA DIETA A TRAVÉS DE LAS CÉLULAS MONONUCLEARES SANGUÍNEAS.

The term nutrigenomics was created to describe how nutrition affects genes and the functions of the protein, at the transcriptional level, proteomic, and metabolic. Using changes in gene expression in blood mononuclear cells could be a model to assess the dietary intervention studies in order to understand the underlying mechanisms and impact of diet and nutrients in atherosclerosis, resistance insulin, obesity and diabetes mellitus. There are studies that have changed the dietary intake of cholesterol, polyunsaturated fat, monounsaturated, antioxidants and decreased caloric intake showing a variety of effects on the expression of mRNA in blood mononuclear cells related to inflammation, immunity, lipid metabolism genes, etc. These molecular findings entrench awareness of our body's response to diet and open up the possibility of rapid analysis of new diagnostic pathways in this area of knowledge and even new therapeutic tools.

El término nutrigenómica fue creado para describir cómo la nutrición afecta a los genes y a las funciones de la proteínas, a nivel transcripcional, proteómico y metabólico. El uso de las modificaciones en la expresión génica en las células mononucleares sanguíneas (CMNS) podría ser un modelo que permita evaluar los estudios de intervención dietética con el objetivo de comprender los mecanismos subyacentes y la influencia de la dieta y los nutrientes en la aterosclerosis, la resistencia a la insulina, la obesidad y la diabetes mellitus. Existen trabajos que han modificado el aporte dietético de colesterol, grasas poliinsaturadas, grasas monoinsaturadas y antioxidantes, y disminuido el aporte calórico, mostrando una gran variedad de efectos sobre la expresión de RNAm en CMNS de genes relacionados con la inflamación, la inmunidad, el metabolismo lípidico, etc. Estos hallazgos moleculares afianzan el conocimiento sobre la respuesta de nuestro organismo a la dieta y abren la posibilidad del análisis rápido de nuevas vías diagnósticas e incluso de nuevas herramientas terapéuticas.

Nutritional assessment: predictive variables at hospital admission related with length of stay.

BACKGROUND: Studies indicate that 40-50% of hospitalized patients show malnutrition, a variable that is associated with length of stay and morbidity. The aim of our study was to detect nutritional parameters, which could have an influence on length of stay in hospitalized patients. MATERIAL AND METHODS: All patients with a nutritional evaluation at hospital admission were elegible for inclusion. A total of 1,088 patients were studied from January 1999 to December 2003. Length of stay (LOS) data was obtained from the patient hospital record after the patient was discharged. All patients received instruction in 24-hour written food record keeping. Albumin, prealbumin, transferrin, glucose levels and total lymphocytes, were measured in all patients. Weight, body mass index, tricipital skinfold, midarm muscle circumference and midarm muscle area were assessed in a standard way. Weight loss in the previous 3 months was recorded. RESULTS: A total of 1,088 patients were enrolled, mean age 61.8 +/- 17 years, weight 64.2 +/- 15 kg and BMI 23.9 +/- 4.6, with a weight loss 4.15 +/- 9.6 kg. The sex distribution of patients was 65.2% male and 34.8% females. Distribution of diagnosis showed leukemia and lymphoma (11.5%), solid cancer (37.4%), infections (3.5%), neurological disease (13.6%), respiratory tract disease (8.8%), and miscellaneous group (25.3%). Length of stay was 29.45 +/- 25.13 days. In whole group, the correlation analysis among length of stay (days) and predictive parameters showed a positive association between albumin and length of stay (r = -0.2; p < 0.05). In the multivariant analysis with a dependent variable (length of stay (days)) and independent variables with an association in univariant analysis adjusted by age and sex, only albumin remained as an independent predictor in the model (F = 8.8; p < 0.05), with an increase of 6.2 days (95% CI: 3.5-8.9) with each decrease of 1 g/dl of albumin. CONCLUSION: The serum albumin levels are a good marker of LOS, a decrease in admission levels produces an increase in LOS.