Nonalcoholic Fatty Liver Disease: Common Questions and Answers on Diagnosis and Management.

Nonalcoholic fatty liver disease (NAFLD) is the most common form of liver disease in the United States, affecting up to 30% of adults. There are two forms of NAFLD: nonalcoholic fatty liver (NAFL), defined as 5% or greater hepatic steatosis without hepatocellular injury or fibrosis, and nonalcoholic steatohepatitis (NASH), defined as 5% or greater hepatic steatosis plus hepatocellular injury and inflammation, with or without fibrosis. Individuals with obesity are at highest risk of NAFLD. Other established risk factors include metabolic syndrome and type 2 diabetes mellitus. Although NAFLD is common and typically asymptomatic, screening is not currently recommended, even in high-risk patients. NAFLD should be suspected in patients with elevated liver enzymes or hepatic steatosis on abdominal imaging that are found incidentally. Once other causes, such as excessive alcohol use and hepatotoxic medications, are excluded in these patients, risk scores or elastography tests can be used to identify those who are likely to have fibrosis that will progress to cirrhosis. Liver biopsy should be considered for patients at increased risk of fibrosis and when other liver disorders cannot be excluded with noninvasive tests. Weight loss through diet and exercise is the primary treatment for NAFLD. Other treatments, such as bariatric surgery, vitamin E supplements, and pharmacologic therapy with thiazolidinediones or glucagon-like peptide-1 analogues, have shown potential benefit; however, data are limited, and these therapies are not considered routine treatments. NAFL typically follows an indolent course, whereas patients with NASH are at higher risk of death from cardiovascular disease, cancer, and end-stage liver disease.

Assessing subsistence and its relationship to cultural complexity in the late prehistoric upper Midwest: A new perspective provided by dental health.

OBJECTIVE: Previous researchers have assumed that the Late Prehistoric Oneota were less reliant on maize agriculture than their Middle Mississippian neighbors to the south. This assumption is based on the idea that intensive maize agriculture is related to sociopolitical complexity, and that the climate of the Great Lakes region was less conducive to full-scale agriculture than that of the American Bottom. Here, we assess the diet of the Oneota using dental pathology to test the hypothesis that the Oneota in Eastern Wisconsin were highly reliant on maize agriculture. MATERIALS AND METHODS: To test our hypothesis, skeletal remains representing 187 individuals and 1,102 teeth were examined from nine Oneota sites from the Middle Fox and Koshkonong Localities, as well as the Late Woodland/Middle Mississippian site of Aztalan. Dental caries, antemortem tooth loss (AMTL), and dental abscesses were assessed for each individual in the sample. Dental pathologies in the Oneota groups were compared to each other based on Locality and to the Aztalan population using chi-squared tests. RESULTS: Dental caries rates for the Oneota, based on the tooth count approach, were observed at 16.8% for the Middle Fox Locality, and 49% for the Koshkonong Locality. Comparatively, the Late Woodland/Middle Mississippian population from Aztalan had a tooth count rate of 19.5%. AMTL rates were similar across samples. Dental abscessing was universally low. DISCUSSION: The relatively high rate of dental caries among the Oneota is comparable to Middle Mississippian populations from throughout the Midwest, suggesting similar reliance on maize between the groups.