Performance of Fatty Liver Index in Identifying Non-Alcoholic Fatty Liver Disease in Population Studies. A Meta-Analysis

Background. Fatty liver index (FLI) is a non-invasive tool used to stratify the risk of non-alcoholic fatty liver disease (NAFLD) in population studies; whether it can be used to exclude or diagnose this disorder is unclear. We conducted a meta-analysis to assess the prevalence of NAFLD in each FLI class and the performance of FLI in detecting NAFLD. Methods. Four databases were searched until January 2021 (CRD42021231367). Original articles included were those reporting the performance of FLI and adopting ultrasound, computed tomography, or magnetic resonance as a reference standard. The numbers of subjects with NAFLD in FLI classes <30, 30–60, and 60, and the numbers of subjects classified as true/false positive/negative when adopting 30 and 60 as cut-offs were extracted. A random-effects model was used for pooling data. Results. Ten studies were included, evaluating 27,221 subjects without secondary causes of fatty liver disease. The prevalence of NAFLD in the three FLI classes was 14%, 42%, and 67%. Sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio for positive results, likelihood ratio for negative results, and diagnostic odds ratio were 81%, 65%, 53%, 84%, 2.3, 0.3, and 7.8 for the lower cut-off and 44%, 90%, 67%, 76%, 4.3, 0.6, and 7.3 for the higher cut-off, respectively. A similar performance was generally found in studies adopting ultrasound versus other imaging modalities. Conclusions. FLI showed an adequate performance in stratifying the risk of NAFLD. However, it showed only weak evidence of a discriminatory performance in excluding or diagnosing this disorder

Analisi Quantitativa del Dispendio Energetico e delle Caratteristiche della Dieta nel Paziente con Diabete Mellito: Applicazioni Cliniche di Protocolli Innovativi

INTRODUZIONE: Gli interventi sullo stile di vita, in particolar modo l’attività fisica e la dieta, rappresentano la prima scelta terapeutica nella gestione dei pazienti diabetici. Tuttavia anche la terapia non farmacologica richiede l’adattamento e la personalizzazione al singolo individuo. Le metodiche di valutazione dell’attività fisica e di indagine nutrizionale più accurate risultano laboriose, costose ed a volte invasive e quindi mal si adattano alle necessità e alle risorse tipiche delle realtà ambulatoriali. Gli obiettivi di questo lavoro sono stati: 1) definire il dispendio da attività fisica di persone affette da vari tipi di diabete (diabete tipo 2, diabete tipo 1, diabete gestazionale) attraverso modalità di indagine validate, semplici e realizzabili su ampia scala in un setting ambulatoriale; 2) correlare i dati sull’attività fisica con i principali parametri antropometrici, metabolici e di rischio cardiovascolare; 3) verificare l’applicabilità di questo sistema di indagine in una popolazione di pazienti anziani; 4) elaborare un metodo di valutazione semplificato per l’aderenza alle indicazioni della terapia nutrizionale. MATERIALI E METODI: Sono stati reclutati 677 pazienti affetti da diabete; dei quali 101 affetti da diabete tipo 1 (DM1) e 576 affetti da diabete tipo 2 (DM2). E’ stato analizzato anche un sottogruppo di pazienti gravide con diabete: 63 pazienti gestanti affette da diabete. Per la sotto-analisi relativa alla popolazione anziana, l’intera coorte è stata suddivisa in base all’età in pazienti “giovani” (< 65anni) e “anziani” (>65 anni). In tutti i pazienti è stato valutato il dispendio energetico da attività fisica mediante l’uso di un questionario di valutazione IPAQ. In un sottogruppo di 200 pazienti, infine, è stato testato un questionario alimentare semplificato, appositamente creato, con l’obiettivo di delineare in maniera rapida le caratteristiche della dieta dei soggetti in studio. Il rischio cardiovascolare è stato stimato mediante l’algoritmo UKPDS. Il confronto tra due gruppi di medie è stato eseguito mediante test t di Student per campioni indipendenti; il confronto tra più gruppi mediante ANOVA One Way ed analisi post hoc di Tukey. Le differenze di frequenze sono state analizzate mediante tabella di contingenza 2 x 2 e test χ-quadro. È stata inoltre effettuata un’analisi di correlazione mediante test di Pearson. RISULTATI: Il 61% dei pazienti DM1 ed il 55,9 % dei DM2 hanno mostrato un livello di dispendio energetico classificato come basso. Suddividendo i pazienti in base ai quartili (q) di spesa energetica (espressa in METs) abbiamo, rilevato nei pazienti diabetici autoimmuni, differenze statisticamente significative nella distribuzione del peso (2°q: 74.86 vs 4°q: 65.16 Kg; p=0.023) e dei Trigliceridi (2°q: 98.21vs 2°q: 58.29mg/dl; p=0.014); nei DM2 abbiamo rilevato una ridotta percentuale di rischio di ictus (1°q: 15.55 vs 4°q: 10.47%; p<0.05) di patologie coronariche (1°q: 20.72 vs 4°q: 16.27%; p<0.05) e di patologie coronariche fatali (1°q: 15.84 vs 4°q: 11.5%; p<0.05) nei quartili di spesa energetica superiore al primo. Il 45% delle pazienti gravide esaminate hanno mostrato un livello di dispendio energetico basso. Suddividendo per livelli di dispendio energetico abbiamo rilevato differenze significative nella distribuzione di col tot (basso: 250.67 vs medio: 157.33mg/dl; p<0.05) e trigliceridi (basso: 194 vs medio: 53.33mg/dl; p<0.05). Tra i pazienti anziani esaminati, il 55,6% hanno mostrato un dispendio energetico basso. Analizzando i pazienti per dispendio energetico abbiamo rilevato una differenza tendenzialmente significativa nella distribuzione dell’età (basso: 73.2 vs medio: 71.7anni; p=0.052) e della durata della malattia (basso: 14.16 vs alto: 8.82anni; p=0.057). Valutando i risultati del sottogruppo di pazienti sottoposti al questionario alimentare (punteggio min: 28 max: 112 punti) abbiamo rilevato che: il 4% dei pazienti ha ottenuto un punteggio basso (50-70 punti), medio il 78,5% (71-91 punti), alto il 17,5% (92-112 punti). Il punteggio totale del questionario correla negativamente con il BMI medio (R2: -0,125; p=0,079), e con i valori di transaminasi-GTP (R2: -0,240; p=0,044). CONCLUSIONI: L’analisi dei dati conferma che la maggior parte dei soggetti in esame hanno un grado di dispendio energetico basso, e questo suggerisce che l’implementazione della modifica dello stile di vita dovrebbe essere affrontata come un problema sociale di primaria importanza. È stata evidenziata per la prima volta una correlazione diretta tra entità del dispendio energetico e riduzione del rischio cardiovascolare: ciò appare particolarmente importante, nell’ottica dell’approccio globale al paziente diabetico. Le metodiche indagate potrebbero risultare utili nell’individuazione rapida di gruppi di pazienti omogenei da indirizzare a determinati interventi terapeutici e preventivi, al fine di personalizzare sempre più le scelte terapeutiche ed ottimizzare le risorse a disposizione dei singoli ambulatori

Efficacy and safety of patient-led versus physician-led titration of basal insulin in patients with uncontrolled type 2 diabetes: a meta-analysis of randomized controlled trials

Introduction Insulin is the most effective antihyperglycemic treatment and basal insulin is the preferred initial formulation in patients with type 2 diabetes. However, its effects are dose-dependent, so adequate titration is necessary to reach targets. We performed a meta-analysis to compare the efficacy and safety of patient-led versus physician-led titration of basal insulin in patients with uncontrolled type 2 diabetes.Research design and methods Four databases were searched from database inception through March 2020. Randomized controlled studies with at least 12 weeks of follow-up of patients with type 2 diabetes allocated to patient-led versus physician-led titration of basal insulin were selected. Data on glycemic endpoints (hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), hypoglycemia) and other outcomes (insulin dose, body weight, patient-reported outcomes, adverse events, rescue medication, discontinuation) were extracted. Data were pooled using a random-effects model.Results Six studies evaluating 12 409 patients were finally included. Compared with the physician-led performance, patient-led titration was associated with a statistically significant higher basal insulin dose (+6 IU/day), leading to benefits on HbA1c (−0.1%) and FPG (−5 mg/dL), despite a higher risk of any level hypoglycemia (relative risk=1.1) and a slight increase in body weight (+0.2 kg). No difference was found for the other outcomes.Conclusions The present study showed that patient-led titration of basal insulin was not inferior to physician-led titration in patients with uncontrolled type 2 diabetes. Therefore, diabetes self-management education and support programs on basal insulin should be widely adopted in clinical practice and patients provided with tools to self-adjust their dose when necessary

Diet Quality, Obesity and Breast Cancer Risk: An Epidemiologic Study in Córdoba, Argentina

Breast cancer (BC) is a multifactorial disease. Environmental factors, specifically, obesity and diet quality, have been linked with an increased risk of BC in women. This research was aimed at assessing the association of diet quality with BC risk, considering nutritional status, in Córdoba province (Argentina). A case-control study was conducted during the period 2008–2016 (346 cases/566 controls). A diet quality score was calculated for each woman based on fifteen dietary components related to low-grade inflammation. Dietary information was obtained through a validated questionnaire. A score (0, 0.5, or 1) was assigned to each variable depending on compliance with dietary recommendations. The higher the score, the higher the degree of adherence to a poor quality diet, which carries a potential inflammatory effect. A multiple logistic regression analysis was used to assess the association between BC occurrence and diet quality, adjusting by body mass index. The mean score of women was 6.86 (1.83). Of total women studied, 20% were obese. A 39% increase in BC risk was observed for each unit of increase in the score in this group (Odds Ratio: 1.39; 95% Confidence Interval: 1086–1796). Obese women with poorer quality diet have a greater risk of BC occurrence in Córdoba (Argentina).Fil: Becaria Coquet, Julia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; ArgentinaFil: Caballero, Victor Ramón. Universidad Nacional de Córdoba. Facultad de Medicina; ArgentinaFil: Camisasso, María Cecilia. Universidad Nacional de Córdoba. Facultad de Medicina; ArgentinaFil: González, María Florencia. Universidad Nacional de Córdoba. Facultad de Medicina; ArgentinaFil: Niclis, Camila. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; ArgentinaFil: Román, María Dolores. Universidad Nacional de Córdoba. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Muñoz, Sonia Edith. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; ArgentinaFil: Leone, Carla M.. Universidad Nacional de Córdoba. Facultad de Medicina; ArgentinaFil: Procino, Filippo. National Institute Of Gastroenterology “s. de Bellis” Research Hospital; ItaliaFil: Osella, Alberto Rubén. National Institute Of Gastroenterology “s. de Bellis” Research Hospital; ItaliaFil: Aballay, Laura Rosana. Universidad Nacional de Córdoba. Facultad de Medicina; Argentin

Modified WCRF/AICR Score and All-Cause, Digestive System, Cardiovascular, Cancer and Other-Cause-Related Mortality: A Competing Risk Analysis of Two Cohort Studies Conducted in Southern Italy

Background: In real life, nutrition goes beyond purely biological domains. Primary prevention is the most efficient approach for reducing the risk of mortality. We aimed to study the association of lifestyle, as measured by a modified World Cancer Research Fund/American Institute for Cancer Research (mWCRF/AICR) scoring system with all-cause, digestive system disease-related (DSD-related), cardiovascular disease-related (CVD-related), cancer–related and other cause-related mortality using data from two population-based cohort studies conducted in Southern Italy. Methods: A random sample of 5271 subjects aged 18 years or older was enrolled in 2005–2006 and followed up until 2020. Usual food intakes were estimated using a validated dietary questionnaire. Competing risks survival models were applied. Results: High adherence to the mWCRF/AICR score was found to be statistically significant and negatively associated with all-cause mortality (HR 0.56, 95%CI 0.39; 0.82), DSD-related mortality (SHR 0.38, 95%CI 0.15; 0.97) and cancer-related mortality (SHR 0.43, 95%CI 0.19; 0.97) in the male sub-cohort and other-cause mortality (SHR 0.43, 95%CI 0.21; 0.88) only in the female group. Conclusions: This mWCRF/AICR score can be seen as a simple, easy tool for use in clinical practice to evaluate both qualitative and quantitative aspects of the diet

Effects of Some Food Components on Non-Alcoholic Fatty Liver Disease Severity: Results from a Cross-Sectional Study

Background: The high prevalence of non-alcoholic fatty liver disease (NAFLD) observed in Western countries is due to the concurrent epidemics of overweight/obesity and associated metabolic complications, both recognized risk factors. A Western dietary pattern has been associated with weight gain and obesity, and more recently with NAFLD. Methods: This is a baseline cross-sectional analysis of 136 subjects (79 males) enrolled consecutively in the NUTRIATT (NUTRItion and Ac-TiviTy) study. Study subjects had moderate or severe NAFLD diagnosed by using Fibroscan-CAP. Food Frequency Questionnaire was used to obtain information about food intake. Statistical analysis included descriptive statistics and a multivariable logistic regression model. Results: The mean age was 49.58 (&plusmn;10.18) with a mean BMI of 33.41 (&plusmn;4.74). A significant inverse relationship was revealed between winter ice-cream intake and NAFLD severity (O.R. 0.65, 95% C.I. 0.95&ndash;0.99); chickpeas intake and NAFLD severity (O.R. 0.57, 95% C.I. 0.34&ndash;0.97), and not industrial aged-cheeses type (O.R. 0.85, 95% C.I. 0.74&ndash;0.98). A statistically significant positive association also emerged between rabbit meat (O.R. 1.23, 95% C.I. 1.01&ndash;1.49), industrial type aged cheeses (O.R. 1.17, 95% C.I. 1.01&ndash;1.35), milk-based desserts (no winter ice cream) (O.R. 1.11, 95% C.I. 1.01&ndash;1.21), fats (O.R. 1.12, 95% C.I. 1.01&ndash;1.25), and NAFLD severity. Conclusion: The fresh foods from non-intensive farming and high legume intake that characterize the Mediterranean diet would seem to be beneficial for patients with NAFLD