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1.
Liver Int ; 35(10): 2285-93, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25676459

RESUMO

BACKGROUND & AIMS: Diagnosis of preclinical compensated cirrhosis (occult cirrhosis, OC) is challenging due to lack of clinical findings. We evaluated prevalence and outcomes of OC by transient elastography (TE, Fibroscan(®)). METHODS: Eight hundred and seventy-one patients with compensated chronic liver disease (CLD) and TE examination were divided into: (i) OC (TE ≥ 13 kPa and no sign of cirrhosis, including absence of thrombocytopenia and signs of advanced liver disease on ultrasound or gastroscopy); (ii) clinically evident cirrhosis (TE ≥ 13 kPa with signs of cirrhosis); (iii) non-cirrhotic CLD (TE < 13 kPa). Outcomes included hepatocellular carcinoma (HCC), esophageal varices and ascites. Late diagnosis of outcomes was defined as HCC stage ≥intermediate by BCLC or variceal bleeding. RESULTS: Occult cirrhosis represented 12% of the cohort and 37% of cirrhotic patients. Independent predictors of OC were age [odds ratio (OR) 1.15; 95% confidence interval (CI), 1.04-1.26], HIV co-infection (OR 3.53; 95% CI, 1.85-6.76) and APRI (OR 2.63; 95 CI, 1.87-3.71). During a median follow-up of 24 (interquartile range 20-37) months, OC received less surveillance than clinically evident cirrhosis, with fewer ultrasounds (2.7 ± 1.5 vs 3.6 ± 2; P < 0.001) and gastroscopies (2 ± 0.8 vs 2.6 ± 1.4; P < 0.001). Incidence of outcomes was 3.5/100 per person-years (PY) (95% CI, 0.1-6.9) in OC, 0 in non-cirrhotic CLD and 9.8/100 PY (95% CI, 0.3-19.3) in clinically evident cirrhosis (P < 0.001). Late diagnosis occurred more in OC than clinically evident cirrhosis (60 vs 15%, P = 0.01). CONCLUSIONS: Occult cirrhosis is a frequent and under-monitored clinical entity associated with short-term risk of outcomes. TE may help early diagnosis, prompt initiation of surveillance and specific therapy for an otherwise unrecognized condition.


Assuntos
Biomarcadores/sangue , Técnicas de Imagem por Elasticidade/métodos , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico , Fígado/patologia , Adulto , Carcinoma Hepatocelular/patologia , Coinfecção/epidemiologia , Diagnóstico Precoce , Varizes Esofágicas e Gástricas/patologia , Feminino , Hemorragia Gastrointestinal/epidemiologia , Gastroscopia , Humanos , Incidência , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/patologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Modelos de Riscos Proporcionais , Estudos Retrospectivos
2.
Food Res Int ; 188: 114517, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38823849

RESUMO

Slowing the rate of carbohydrate digestion leads to low postprandial glucose and insulin responses, which are associated with reduced risk of type 2 diabetes. There is increasing evidence that food structure plays a crucial role in influencing the bioaccessibility and digestion kinetics of macronutrients. The aims of this study were to compare the effects of two hummus meals, with different degrees of cell wall integrity, on postprandial metabolic responses in relation to the microstructural and rheological characteristics of the meals. A randomised crossover trial in 15 healthy participants was designed to compare the acute effect of 27 g of starch, provided as hummus made from either intact chickpea cells (ICC) or ruptured chickpea cells (RCC), on postprandial metabolic responses. In vitro starch digestibility, microstructural and rheological experiments were also conducted to evaluate differences between the two chickpea hummus meals. Blood insulin and GIP concentrations were significantly lower (P < 0.02, P < 0.03) after the consumption of the ICC meal than the meal containing RCC. In vitro starch digestion for 90 min was slower in ICC than in RCC. Microscopic examination of hummus samples digested in vitro for 90 min revealed more intact chickpea cells in ICC compared to the RCC sample. Rheological experiments showed that fracture for ICC hummus samples occurred at smaller strains compared to RCC samples. However, the storage modulus for ICC was higher than RCC, which may be explained by the presence of intact cells in ICC. Food structure can affect the rate and extent of starch bioaccessibility and digestion and may explain the difference in the time course of metabolic responses between meals. The rheological properties were measured on the two types of meals before ingestion, showing significant differences that may point to different breakdown mechanisms during subsequent digestion. This trial was registered at clinicaltrial.gov as NCT03424187.


Assuntos
Glicemia , Cicer , Estudos Cross-Over , Digestão , Insulina , Período Pós-Prandial , Reologia , Humanos , Cicer/química , Período Pós-Prandial/fisiologia , Insulina/sangue , Insulina/metabolismo , Glicemia/metabolismo , Adulto , Masculino , Feminino , Adulto Jovem , Amido/metabolismo , Polipeptídeo Inibidor Gástrico/metabolismo , Polipeptídeo Inibidor Gástrico/sangue , Voluntários Saudáveis , Cinética
3.
Cureus ; 15(12): e49839, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38164316

RESUMO

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in women. Despite the significant burden of CVD, knowledge and awareness of its risk factors among women are low. This review aimed to identify CVD awareness, knowledge, and risk factors for women of reproductive age from different countries and variables that influence health outcomes. Studies published from 2000 to 2023 were reviewed using PubMed, ScienceDirect, Elsevier, and electronic databases. A total of 50 studies were found, and 41 were excluded. The keywords used were "Knowledge of the risk factor of heart disease," "cardiac risk factors," "cardiovascular disease," "heart disease awareness," and "heart disease," combined with "women" and "reproductive age." The review revealed significant gaps in the general awareness and knowledge of CVD risk factors among women of reproductive age. Many women were unaware of the symptoms and risk factors associated with CVD, leading to delayed diagnosis and poorer outcomes. Lack of education, low socioeconomic status, and limited access to healthcare were identified as contributing factors to this knowledge gap. Young women, particularly those with poor pregnancy outcomes, demonstrated limited awareness and perception of CVD risk. The findings suggest significant gaps in general awareness, knowledge of CVD risk, risk factors among women of reproductive age from different countries, and factors that influence their health outcomes. Targeted interventions are urgently needed to improve awareness and knowledge of CVD among women of reproductive age. Efforts should focus on educating women about CVD risk factors and prevention strategies before symptoms arise. Addressing socioeconomic and educational disparities is crucial to bridging the gap in awareness. By enhancing awareness and knowledge, women can be empowered to take preventive actions and reduce their risk of developing CVD. As a result, we recommend that there are significant opportunities to educate women about CVD risk and prevention before symptoms arise. In addition, there is a need to develop effective interventions to raise awareness among women of reproductive age to close the gap in awareness and knowledge of CVD.

4.
Nat Food ; 1(11): 693-704, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37128029

RESUMO

Elevated postprandial glucose (PPG) is a significant risk factor for non-communicable diseases globally. Currently, there is a limited understanding of how starch structures within a carbohydrate-rich food matrix interact with the gut luminal environment to control PPG. Here, we use pea seeds (Pisum sativum) and pea flour, derived from two near-identical pea genotypes (BC1/19RR and BC1/19rr) differing primarily in the type of starch accumulated, to explore the contribution of starch structure, food matrix and intestinal environment to PPG. Using stable isotope 13C-labelled pea seeds, coupled with synchronous gastric, duodenal and plasma sampling in vivo, we demonstrate that maintenance of cell structure and changes in starch morphology are closely related to lower glucose availability in the small intestine, resulting in acutely lower PPG and promotion of changes in the gut bacterial composition associated with long-term metabolic health improvements.

5.
Saudi J Gastroenterol ; 21(2): 64-70, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25843191

RESUMO

Hepatic steatosis is the buildup of lipids within hepatocytes. It is the simplest stage in nonalcoholic fatty liver disease (NAFLD). It occurs in approximately 30% of the general population and as much as 90% of the obese population in the United States. It may progress to nonalcoholic steatohepatitis, which is a state of hepatocellular inflammation and damage in response to the accumulated fat. Liver biopsy remains the gold standard tool to diagnose and stage NAFLD. However, it comes with the risk of complications ranging from simple pain to life-threatening bleeding. It is also associated with sampling error. For these reasons, a variety of noninvasive radiological markers, including ultrasound, computed tomography, magnetic resonance spectroscopy, and the controlled attenuation parameter using transient elastography and Xenon-133 scan have been proposed to increase our ability to diagnose NAFLD, hence avoiding liver biopsy. The aim of this review is to discuss the utility and accuracy of using available noninvasive diagnostic modalities for fatty liver in NAFLD.


Assuntos
Biomarcadores/análise , Diagnóstico por Imagem/métodos , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Humanos , Reprodutibilidade dos Testes
6.
PLoS One ; 10(6): e0128774, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26083565

RESUMO

BACKGROUND & AIMS: Non-invasive diagnostic methods for liver fibrosis predict clinical outcomes in viral hepatitis and nonalcoholic fatty liver disease (NAFLD). We specifically evaluated prognostic value of non-invasive fibrosis methods in nonalcoholic steatohepatitis (NASH) against hepatic venous pressure gradient (HVPG) and liver histology. METHODS: This was a retrospective cohort study of 148 consecutive patients who met the following criteria: transjugular liver biopsy with HVPG measurement; biopsy-proven NASH; absence of decompensation; AST-to-Platelets Ratio Index (APRI), fibrosis-4 (FIB-4), NAFLD fibrosis score, ultrasound, hepatic steatosis index and Xenon-133 scan available within 6 months from biopsy; a minimum follow-up of 1 year. Outcomes were defined by death, liver transplantation, cirrhosis complications. Kaplan-Meier and Cox regression analyses were employed to estimate incidence and predictors of outcomes, respectively. Prognostic value was expressed as area under the curve (AUC). RESULTS: During a median follow-up of 5 years (interquartile range 3-8), 16.2% developed outcomes, including 7.4% who died or underwent liver transplantation. After adjustment for age, sex, diabetes, the following fibrosis tools predicted outcomes: HVPG >10mmHg (HR=9.60; 95% confidence interval [CI] 3.07-30.12), histologic fibrosis F3-F4 (HR=3.14; 1.41-6.95), APRI >1.5 (HR=5.02; 1.6-15.7), FIB-4 >3.25 (HR=6.33; 1.98-20.2), NAFLD fibrosis score >0.676 (HR=11.9; 3.79-37.4). Prognostic value was as follows: histologic fibrosis stage, AUC=0.85 (95% CI 0.76-0.93); HVPG, AUC=0.81 (0.70-0.91); APRI, AUC=0.89 (0.82-0.96); FIB-4, AUC=0.89 (0.83-0.95); NAFLD fibrosis score, AUC=0.79 (0.69-0.91). Neither histologic steatosis nor non-invasive steatosis methods predicted outcomes (AUC<0.50). CONCLUSIONS: Non-invasive methods for liver fibrosis predict outcomes of patients with NASH. They could be used for serial monitoring, risk stratification and targeted interventions.


Assuntos
Transplante de Fígado , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Pressão na Veia Porta , Adulto , Idoso , Área Sob a Curva , Feminino , Fibrose , Seguimentos , Histocitoquímica , Humanos , Fígado/irrigação sanguínea , Fígado/patologia , Fígado/cirurgia , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/mortalidade , Hepatopatia Gordurosa não Alcoólica/patologia , Hepatopatia Gordurosa não Alcoólica/cirurgia , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida
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