Nutraceutical approach to Non-alcoholic fatty liver disease (NAFLD): the available clinical evidence.

Non-alcoholic fatty liver disease (NAFLD) is a clinical condition characterized by lipid infiltration of the liver, highly prevalent in the general population affecting 25% of adults, with a doubled prevalence in diabetic and obese patients. Almost 1/3 of NAFLD evolves in Non-Alcoholic SteatoHepatitis (NASH), and this can lead to fibrosis and cirrhosis of the liver. However, the main causes of mortality of patients with NAFLD are cardiovascular diseases. At present, there are no specific drugs approved on the market for the treatment of NAFLD, and the treatment is essentially based on optimization of lifestyle. However, some nutraceuticals could contribute to the improvement of lipid infiltration of the liver and of the related anthropometric, haemodynamic, and/or biochemical parameters. The aim of this paper is to review the available clinical data on the effect of nutraceuticals on NAFLD and NAFLD-related parameters. Relatively few nutraceutical molecules have been adequately studied for their effects on NAFLD. Among these, we have analysed in detail the effects of silymarin, vitamin E, vitamin D, polyunsaturated fatty acids of the omega-3 series, astaxanthin, coenzyme Q10, berberine, curcumin, resveratrol, extracts of Salvia milthiorriza, and probiotics. In conclusion, Silymarin, vitamin E and vitamin D, polyunsaturated fatty acids of the omega-3 series, coenzyme Q10, berberine and curcumin, if well dosed and administered for medium\u2013long periods, and associated to lifestyle changes, could exert positive effects on NAFLD and NAFLD-related parameters. View Full-Tex

Solución de alto rendimiento para el geoportal de turismo de la Comunitat Valenciana

La Agència Valenciana de Turisme ha emprendido el proyecto de actualización de la web de promoción de la Comunidad Valenciana, el portal http://www.comunitatvalenciana.com. Este portal es una referencia internacional para todos los visitantes de la Comunidad Valenciana y por tanto un proyecto clave en su promoción turística. En esta ponencia se presentará la elaboración de un geoportal turístico atractivo y preparado para soportar un número elevado de visitas. En el contexto del proyecto se han abordado problemas como la visualización de información vectorial (puntos de interés) en un elevado número mediante la técnica de agregación o clustering. Por otro lado dicha información vectorial se procesa de tal forma que el visitante de la web obtiene un rendimiento en los tiempos de respuesta bastante elevado gracias al uso de técnicas de multirresolución en el visor web. La información de partida se migra a una base de datos espacial libre y se procesa para generar archivos en formato JSON. Por otro lado, el geoportal ofrece un flexible motor de búsquedas, preparado igualmente para soportar una carga elevada de peticiones mediante el uso de la indexación con el soporte para consultas espaciales. Este motor de búsquedas igualmente se ha preparado para utilizarse como servidor para ofrecer toda la información del portal a través de Layar, un servicio de realidad aumentada para móviles. Este servicio está completamente basado en componentes libres como el framework Spring o el soporte de búsquedas Lucene. Se presentará por tanto cómo se ha abordado la realización de una solución completa de presentación de información de un portal turístico de exigencias de rendimiento elevadas, centrando la atención en los componentes del servidor, todos ellos basados en software libre

The Fatty Liver Index: a simple and accurate predictor of hepatic steatosis in the general population

BACKGROUND: Fatty liver (FL) is the most frequent liver disease in Western countries. We used data from the Dionysos Nutrition & Liver Study to develop a simple algorithm for the prediction of FL in the general population. METHODS: 216 subjects with and 280 without suspected liver disease were studied. FL was diagnosed by ultrasonography and alcohol intake was assessed using a 7-day diary. Bootstrapped stepwise logistic regression was used to identify potential predictors of FL among 13 variables of interest [gender, age, ethanol intake, alanine transaminase, aspartate transaminase, gamma-glutamyl-transferase (GGT), body mass index (BMI), waist circumference, sum of 4 skinfolds, glucose, insulin, triglycerides, and cholesterol]. Potential predictors were entered into stepwise logistic regression models with the aim of obtaining the most simple and accurate algorithm for the prediction of FL. RESULTS: An algorithm based on BMI, waist circumference, triglycerides and GGT had an accuracy of 0.84 (95%CI 0.81–0.87) in detecting FL. We used this algorithm to develop the "fatty liver index" (FLI), which varies between 0 and 100. A FLI < 30 (negative likelihood ratio = 0.2) rules out and a FLI ≥ 60 (positive likelihood ratio = 4.3) rules in fatty liver. CONCLUSION: FLI is simple to obtain and may help physicians select subjects for liver ultrasonography and intensified lifestyle counseling, and researchers to select patients for epidemiologic studies. Validation of FLI in external populations is needed before it can be employed for these purposes

Reliability of Multisensor Armband in Estimating Energy Expenditure According to Degree of Obesity

Resting energy expenditure (REE) represents the amount of calories required by the body to maintain vital bodyfunctions. One of the most commonly used methods for estimating REE is indirect calorimetry. Recent studies ondifferent populations have validated a highly innovative instrument, the SenseWear® Armband (SWA), which evaluatestotal energy expenditure and, when used in resting conditions, could also evaluate REE. The purpose of this study wasto determine the agreement of the SWA in assessing REE in obese subjects and, see how this agreement varies withdifferent obesity degree.89 obese subjects (59 women and 30 men), with an age range from 35-65 years and body mass index (BMI)34.5 4.5 kg/m2 were studied. REE was measured by IC Sensor Medics Vmax (SM-29N) and by SWA. Fat mass(FM) and fat-free mass (FFM) was determined by anthropometry and bio-impedance measurements. No statisticaldifference was found between REE measured by SWA (1693±276) and REE measured by SM-29N (1627±293). Thetwo methods showed similar assessments (r=0.8, p 35 kg/m2), the agreement decreases (r =0.6 p 35

Influence of lifestyle habits, nutritional status and insulin resistance in NAFLD

Non alcoholic fatty liver disease (NAFLD) is associated with obesity, diabetes and insulin resistance (IR). The aim of our study was to assess the relationship between IR, anthropometry, lifestyle habits, resting energy expenditure (REE) and degree of fatty liver at ultrasound in 48 overweight patients with NAFLD as compared to 24 controls without fatty liver, matched for age. Nutritional status, alcohol intake and physical activity were assessed by skinfold thickness measurements, a 7-day diary, and SenseWear armband (SWA). REE was assessed by both SWA (REE-SWA) and a Vmax metabolic cart (REE-Vmax). Fatty liver was measured by US and the Doppler Power Index was calculated. IR was assessed using the HOMA index. There was significant correlation between waist circumference, HOMA, Doppler power index and fatty liver grade at US. Multivariate analysis showed that alteration of waist circumference, Doppler power index, and HOMA were the major significant predictors of fatty liver. Our data demonstrated a significant association between NAFLD and central adiposity and IR

Toward Hole-Spin Qubits in Si p -MOSFETs within a Planar CMOS Foundry Technology

Hole spins in semiconductor quantum dots represent a viable route for the implementation of electrically controlled qubits. In particular, the qubit implementation based on Si p-MOSFETs offers great potentialities in terms of integration with the control electronics and long-term scalability. Moreover, the future down scaling of these devices will possibly improve the performance of both the classical (control) and quantum components of such monolithically integrated circuits. Here, we use a multiscale approach to simulate a hole-spin qubit in a down-scaled Si-channel p-MOSFET, the structure of which is based on a commercial 22-nm fully depleted silicon-on-insulator device. Our calculations show the formation of well-defined hole quantum dots within the Si channel and the possibility of a general electrical control, with Rabi frequencies of the order of 100MHz for realistic field values. A crucial role of the channel aspect ratio is also demonstrated, as well as the presence of a favorable parameter range for the qubit manipulation

Socioeconomic deprivation, urban-rural location and alcohol-related mortality in England and Wales

Background: Many causes of death are directly attributable to the toxic effects of alcohol and deaths from these causes are increasing in the United Kingdom. The aim of this study was to investigate variation in alcohol-related mortality in relation to socioeconomic deprivation, urban-rural location and age within a national context. Methods: An ecological study design was used with data from 8797 standard table wards in England and Wales. The methodology included using the Carstairs Index as a measure of socioeconomic deprivation at the small-area level and the national harmonised classification system for urban and rural areas in England and Wales. Alcohol-related mortality was defined using the National Statistics definition, devised for tracking national trends in alcohol-related deaths. Deaths from liver cirrhosis accounted for 85% of all deaths included in this definition. Deaths from 1999-2003 were examined and 2001 census ward population estimates were used as the denominators. Results: The analysis was based on 28,839 deaths. Alcohol-related mortality rates were higher in men and increased with increasing age, generally reaching peak levels in middle-aged adults. The 45-64 year age group contained a quarter of the total population but accounted for half of all alcohol-related deaths. There was a clear association between alcohol-related mortality and socioeconomic deprivation, with progressively higher rates in more deprived areas. The strength of the association varied with age. Greatest relative inequalities were seen amongst people aged 25-44 years, with relative risks of 4.73 (95% CI 4.00 to 5.59) and 4.24 (95% CI 3.50 to 5.13) for men and women respectively in the most relative to the least deprived quintiles. People living in urban areas experienced higher alcohol-related mortality relative to those living in rural areas, with differences remaining after adjustment for socioeconomic deprivation. Adjusted relative risks for urban relative to rural areas were 1.35 (95% CI 1.20 to 1.52) and 1.13 (95% CI 1.01 to 1.25) for men and women respectively. Conclusions: Large inequalities in alcohol-related mortality exist between sub-groups of the population in England and Wales. These should be considered when designing public health policies to reduce alcohol-related harm

Clinical update on non-alcoholic fatty liver disease and steatohepatitis

clusion of less common causes of fatty liver such as Hepatitis B or C infection, drugs and autoimmune disorders, fatty liver is classified as non-alcoholic (NAFLD) or alcoholic fatty liver disease (AFLD) on the basis of daily ethanol intake. The agreed threshold of ethanol intake used to separate NAFLD from AFLD is 20 g/day, equivalent to 12 drinks per week. 2 The term NAFLD covers a wide spectrum of liver injury, ranging from simple steatosis, i.e. fatty infiltration of hepatocytes > 5%, to non-alcoholic steatohepatitis (NASH). At liver biopsy NASH is characterized by necro-inflammation and/or fibrosis, and is histologically indistinguishable from alcoholic steatohepatitis. The histological classification of NAFLD and NASH is being continuously improved and a refined scoring system has been recently proposed by the National Institutes of Health. 3 NAFLD is presently regarded as the most common liver disease in Western countries and virtually impacts all fields of clinical medicine, being considered a risk factor for advanced liver disease, type 2 diabetes and cardiovascular disease. Although NAFLD had long been recognized as a frequent clinical entity, only recently its importance as a potential cause of progressive and severe liver disease has been fully acknowledged. NAFLD prevalence in the general population ranges from 16 to 25% in adults 4 and from 10 to 19% in children. 5 It increases with age, shows different gender specificity according to geographic areas (generally more prevalent in women in US and viceversa in men in Europe and Japan) and varies with ethnicity, with the highest prevalence among the Hispanic population and the lowest among the AfroAmerican one. 6 Prevalence rates of NAFLD are strikingly increased in certain subpopulations, such as patients with obesity, type 2 diabetes mellitus and dyslipidemia, and the whole spectrum of NAFLD is commonly associated with the metabolic syndrome. The true prevalence of NASH remains largely unknown. According to data derived from autopsy or liver biopsy studies, about 10-15% of NAFLD patients meet the current diagnostic criteria for NASH, pointing to a prevalence of 2-3% in the general population. The incidence and natural course of NAFLD are also difficult to assess because most of the available studies are retrospective and/or performed on clinical series. The few prospective studies are too short to exclude late complications. While simple steatosis has a benign prognosis, NASH may progress to cirrhosis in 30% of cases and is responsible for liver-related death in 3-8%. In clinical series, up to 70% of patients with cryptogenic cirrhosis have clinical features suggestive of NASH.

A simple index of lipid overaccumulation is a good marker of liver steatosis

<p>Abstract</p> <p>Background</p> <p>Liver steatosis is often found in association with common cardiometabolic disorders, conditions that may all occur in a shared context of abdominal obesity and dyslipidemia. An algorithm for identifying liver steatosis is the fatty liver index (FLI). The lipid accumulation product (LAP) is an index formulated in a representative sample of the US population to identify cardiometabolic disorders. Because FLI and LAP share two components, namely waist circumference and fasting triglycerides, we evaluated the ability of LAP to identify liver steatosis in the same study population from the Northern Italian town where FLI was initially developed.</p> <p>Methods</p> <p>We studied 588 individuals (59% males) aged 21 to 79 years. Liver steatosis was detected by ultrasonography and coded ordinally as none, intermediate and severe. 44% of the individuals had liver steatosis. Using proportional-odds ordinal logistic regression, we evaluated the ability of log-transformed LAP (lnLAP) to identify liver steatosis. We considered the benefits to our model of including terms for sex, age, suspected liver disease and ethanol intake. We calculated the 3-level probability of liver steatosis according to lnLAP and sex, providing tables and nomograms for risk assessment.</p> <p>Results</p> <p>An ordinal proportional-odds model consisting of lnLAP and sex offered a reasonably accurate identification of liver steatosis. The odds of more severe <it>vs. </it>less severe steatosis increased for increasing values of lnLAP (odds ratio [OR] = 4.28, 95%CI 3.28 to 5.58 for each log-unit increment) and was more likely among males (OR = 1.88, 95%CI 1.31 to 2.69).</p> <p>Conclusion</p> <p>In a study sample of adults from Northern Italy, the simple calculation of LAP was a reasonably accurate approach to recognizing individuals with ultrasonographic liver steatosis. LAP may help primary care physicians to select subjects for liver ultrasonography and intensified lifestyle counseling, and researchers to select patients for epidemiologic studies. A more thorough assessment of LAP's potential for identifying liver steatosis will require its cross-evaluation in external populations.</p