Adherence and barriers to Mediterranean diet in Tunisian patients with nonalcoholic fatty liver disease.

Aim: The burden of non alcoolic fatty liver disease (NAFLD) is globally increasing. While crucial for management, NAFLD patient adherence to the Mediterranean diet (MD) is underexplored, especially in Mediterranean countries such as Tunisia. Materials & methods: A prospective study (Nov 2022-Feb 2023) supervised MD introduction by a nutritionist, evaluated adherence with MEDAS scores (≥10 for good compliance), and explored barriers to good adherence. Results: Among 41 patients (11 male/30 female, mean age 56 [29-70]), 63% had low education and 51% had metabolic syndrome. Good MD adherence stood at 14.6%. Poor adherence tied to diet-induced higher costs (p = 0.021) and difficulty to new-diet adoption (p = 0.026). Conclusion: Tunisian NAFLD patients had low MD adherence due to financial constraints and dietary adaptation challenges.

The study focused on nonalcoholic fatty liver disease (NAFLD), a widespread liver disease with increasing prevalence. It aimed to assess Tunisian NAFLD patients' adherence to the Mediterranean diet (MD), an essential aspect of NAFLD management that lacked sufficient investigation in this context. Over a 3-month period, a nutritionist introduced and supervised the MD. Adherence was measured using MEDAS scores, with scores of 10 or higher indicating good compliance. Additionally, patients answered six questions about barriers. Only 14.6% of the 41 patients adhered well to the MD. The study underscores that Tunisian NAFLD patients face challenges in adhering to the MD, primarily due to financial constraints and dietary adaptation issues, highlighting the need for tailored support in managing their condition.

Limited short-term adherence to the Mediterranean Diet in Tunisian NAFLD patients. Major hurdles: extra food costs & adapting to a new diet. Personalized, extended support is the key to better adherence. #Nutrition #Health #NAFLD #MediterraneanDiet.

Prevalence and prognosis of Computed-Tomography defined sarcopenia in Tunisian cirrhotic patients.

INTRODUCTION: Sarcopenia is an underdiagnosed and understudied complication of cirrhosis, especially in patients not undergoing liver transplantation. AIM: To evaluate the prevalence and prognostic impact of radiological sarcopenia in non-transplanted cirrhotic patients. METHODS: Longitudinal retrospective study including cirrhotic patients explored by an abdominal CT scan, over a period of 6 years, in a single gastroenterology department in Tunisia. Sarcopenia was defined according to transversal psoas muscle thickness normalized to height (TPMT/h) in the sagittal CT slice. Two groups were defined: Group 1 with sarcopenia (TPMT/h <16.8mm/m); and Group 2 without sarcopenia (TPMT/h ≥16.8mm/m). RESULTS: Seventy patients were included (mean age=62 years). The mean MELD score was 12.81 and the mean TPMT/h of 13.56 mm/m. Forty-four patients were sarcopenic (63%). When included, the 2 groups' baseline characteristics were comparable except for women predominance and refractory ascites in group 1. After an average of 21-month follow-up, sarcopenia was associated with a higher number of complications per patient (p=0.013) and a longer average hospital stay duration per patient (p=0.001). Overall survival was significantly decreased in sarcopenic patients (p=0.035). Survival rates at 6 months, 1 year, and 2 years were respectively 42%, 30%, and 24% in Group 1 versus 67%, 40%, and 27% in Group 2. Sarcopenia was an independent factor of mortality in multivariate analysis (OR=2.5; 95% IC [1.02-6.16]; p=0.045). CONCLUSION: Sarcopenia is frequent and an independent poor prognostic factor in cirrhosis. TPMT/h is an easy and often available method for sarcopenia diagnosis.

Cannabis: a rare cause of acute pancreatitis.

CONTEXT: Drugs of all types are related to the etiology of pancreatitis in approximately 2% of cases. However, there have been very few reports of acute pancreatitis associated with cannabis use in the general population. CASE REPORT: This report is the first such case in our country, and involves a 22-year-old North African man who presented to our emergency department with transfixiant epigastric abdominal pain, nausea and vomiting. The patient denied any past or familial medical history, was taking no medications chronically and had no history of trauma. The patient admitted to smoking one pack of cigarettes a day and occasional cannabis use, and no alcohol consumption. Biological and morphological explorations found Balthazar grade-A acute pancreatitis with no biliary dilatation or obstruction. The etiological workup was normal and, on repeat questioning, the patient admitted to being a regular and excessive user of cannabis, and to having done so 2 days before the abdominal pain. CONCLUSION: The use of cannabis is frequently seen worldwide and even in North Africa, and regular users, especially young adults, should be informed of the risk of this possible cannabis-induced pancreatic disease. This case should also be borne in mind, although the association of cannabis with pancreatitis is problematic because of the difficulty in monitoring cannabinoids in the body and the illegality of cannabis use and, consequently, getting patients to admit to using it.