Liver-related and extrahepatic events in patients with non-alcoholic fatty liver disease: a retrospective competing risks analysis

Background & Aim: Non-alcoholic fatty liver disease (NAFLD), and especially fibrotic non-alcoholic steatohepatitis, is associated with high risks of liver-related events (LRE) and extrahepatic events (EHE). We evaluated the competitive risk occurrence of LRE and EHE in a large cohort of biopsy-proven NAFLD stratified according to baseline severity of fibrosis. Methods: Two thousand one hundred thirty-five patients with biopsy-proven NAFLD were enrolled. Observed cumulative incidence functions (CIFs) were used to evaluate the risk of LRE and EHE; cause-specific Cox model and predicted CIFs were fitted to identify predictors of LRE and EHE. A replication cohort of NAFLD patients with liver fibrosis severity estimated by liver stiffness measurement by transient elastography was also enrolled. Results: Observed CIFs indicated that the 60-month probabilities of LRE and EHE were 0.2% and 3% in F0-F1, 2% and 3.8% in F2 and 9.7% and 6.4% in F3-F4 patients, respectively. The cause-specific Cox model indicated that in F0-F1 and F2 patients, age > 50 years (HR 2.7) was the only predictor of LRE, while age > 50 years (HR 2.96), previous cardiovascular events (CVE, HR 2.07), and previous extra-hepatic cancer (HR 2.36) were independent risk factors for EHE. In F3-F4 patients, age > 55 years (HR 1.73), obesity (HR 1.52), PLT < 150 000/mmc (HR 3.66) and log(GGT) (HR 1.77) were associated with LRE, while age > 55 years (HR 1.74) and previous CVE (HR 2.51) were independent predictors of EHE. Predicted CIFs for HE and EHE in F0-F1, F2 and F3-F4 patients stratified the risk of events. The results were externally replicated. Conclusion: The likelihood of EHE in NAFLD patients is relevant and increases according to the severity of liver fibrosis, while the risk of LRE is negligible in F0-F1, low but clinically relevant in F2 and high in F3-F4 patients

Argan [Argania spinosa (L.) Skeels] oil

Argan oil is extracted from the kernels of Argania spinosa (L.) Skeels, a tree that almost exclusively grows endemically in southern Morocco. If argan oil was initia11y only known around its traditional production area, major efforts combining chemical, agronomic and human sciences have led to its international recognition and marketing. In addition, to ensure the sustainable production of a sufficient quantity of argan kernels, a vast and unprecedented program that led to the reforestation of large areas of drylands has been developed in Morocco. Therefore, argan oil production is considered as an economic and ecologic success. Edible argan oil is prepared by cold-pressing roasted argan kernels. Unroasted kernels afford an oil of cosmetic grade, showing a bitter taste. Both oils, which are not refined and are virgin oils, share a similar fatty acid content that includes oleic and linoleic acids as major components. Additiona11y, argan oil is rich in antioxidants. Together, these components likely contribute to the oil pharmacological properties that, in humans, traditionally included cardiovascular disease and skin protection. Recent scientific studies have greatly expanded the scope of these pharmacological activities. Argan oil is now rewarded with a "Geographic Indication" that certifies its exclusive and authentic Moroccan origin and the compliance with strict production rules. In addition, the quality of argan oil can nowadays be ascertained by using an array of physicochemica1 methods. By-products, generated in large quantity during argan oil production, are also finding promising development routes