Metabolic dysfunction-associated steatotic liver disease (MASLD) has an increasing prevalence, morbidity, and mortality both within the United States and globally. Here, we review newer evidence demonstrating racial and ethnic disparities that exist in the incidence of MASLD in the United States Many studies demonstrate that Hispanic populations have the highest prevalence of MASLD within the United States, followed by non-Hispanic White populations and then non-Hispanic Black populations. In addition, we present the latest research investigating specific factors that contribute to these disparities, including genetics, environmental exposures, diet, physical activity, and socioeconomic disparities. Finally, we discuss future directions and interventions needed to increase knowledge of racial and ethnic disparities in MASLD and reduce future disparities. The necessary strategies include increasing diversity and documentation of race and ethnicity in MASLD clinical studies, and increased screening and preventative health education for MASLD in vulnerable populations.
In 1980, there was the first description of patients with nonalcoholic steatohepatitis (NASH), most of whom were overweight and had type 2 diabetes. In the following years, there has been a growing appreciation that metabolic dysfunction underpins this liver disease, and metabolic dysfunction also contributes to the increased risk of extrahepatic complications, manifest in nonalcoholic fatty liver disease (NAFLD) as a multisystem disease. In 2020 & 2023, it was proposed that NAFLD should be renamed and reclassified as metabolic dysfunction-associated fatty liver disease (MAFLD) or metabolic dysfunction-associated steatotic liver disease (MASLD), respectively. Despite subtle differences between MAFLD and MASLD, there is excellent congruence between NAFLD, MAFLD, and MASLD definitions, and affected patients usually meet the criteria for all. The following is a perspective of the authors’ views as to the challenges and advantages of the new fatty liver disease terminology and classification.
The increasing prevalence of worldwide obesity calls for a comprehensive understanding of available treatment options. Bariatric surgery remains a very effective obesity treatment, showing substantial effects on obesity-related complications, including type 2 diabetes mellitus and cardiovascular disease, mainly related to significant long-term weight loss. Besides the benefits, weight loss can lead to some deleterious consequences, such as gallstones, constipation, muscle mass loss, bone fractures, vitamin deficiencies, peripheral neural palsy, suicide, eating disorders, alcohol dependency syndrome, and increased divorce. Those consequences may also be seen after long-term effective pharmacotherapy for obesity. Understanding these risks will lead to improved awareness and successful treatment with both surgical and nonsurgical treatments.
Aim: We aimed to study the effectiveness and safety of primary banded Roux-en-Y gastric bypass (B-RYGB), primary banded long-limb RYGB (B-LLRYGB), and revisional B-RYGB to address insufficient post-RYGB excess weight loss (≤ 50.0%) or weight regain.
Methods: This was a single-center, retrospective, comparative analysis of weight loss and postoperative complications in patients with class III obesity [body mass index (BMI, kg/m2) ≥ 40.0 - ≤ 50.0] who received the MIDCAL® non-adjustable calibration ring during primary B-RYGB or B-LLRYGB, or as part of a revisional banding procedure.
Results: Between July 2017 and January 2021, the B-RYGB + B-LLRYGB cohort of 104 patients (median
Conclusions: At one-year follow-up in patients with class III and IV (≥ 50.0 - ≤ 60.0) obesity, B-RYGB, B-LLRYGB, and revisional B-RYGB were effective in attaining weight loss with a low rate of complications. Band-related complications were more frequent in revisions than in primary cases, likely due to the use of smaller-sized bands.
Vitamin D (VD) has a potential role in calcium homeostasis in the human body. It is also considered a strong immunomodulator, affecting both arms of the immune system (Innate and adaptive immunity). VD can also lower the risk of diabetes, improve pregnancy outcomes, reduce the risk of acute respiratory infection (e.g., COVID-19), and decrease the risk of cancer. No doubt that VD deficiency (VDD) is a health condition that spreads out all over the globe. VDD is linked to many health problems ranging from fatigue and skeleton pain to serious conditions such as rickets, osteomalacia, diabetes, autoimmune disease, cardiovascular diseases, and cancer. This review aims to provide a whole picture of the status of 25- hydroxycholecalciferol [25-(OH)D] as well as the frequency of 25-(OH)D deficiency (VDD) among Libyans in various regions of the country and to discuss the correlation between VDD and other health problems. The prevalence of VDD reached up to 80% among healthy individuals in the Middle East region. Libya is a big Mediterranean country and is sunny most of the year. In the western part of Libya, particularly in Tripoli (the capital city), the prevalence of severe VDD [25-(OH)D < 10 ng/mL] was as high as 50.8%, whereas only 27.5% had moderate VDD [25-(OH)D; 10-20 ng/mL]. In Benghazi (second largest city), the VDD prevalence was also high (76%). The highest prevalence of VDD was reported at 79% in the biggest southern city of Sebha. In the whole country, the VDD prevalence was high (among males and females), ranging from 45.4% to 87%, with a mean of 55.58%. The mean prevalence of VDD among males was 54.3% and for females was 53.29%. As clear from these data, VDD prevalence was high in the entire country. However, the available data were obtained from small cross-sectional studies and it becomes a necessity to conduct nationally representative studies and establish national nutrition surveys to accurately assess the prevalence of VDD. Moreover, the data included in this review invites the health authorities in Libya to take preventive measures to reduce the high prevalence of VDD, which will decrease VDD-associated health problems in the future.
Hypogonadism is a relatively rare condition in men, which increases in frequency as men age, but also as they become less active and gain weight. In the past 20 years, developing knowledge on the relationship between hypogonadism and cardiovascular and cerebrovascular health and on aspects of metabolic health has become clearer. The relationship between hypogonadism and specific endocrine abnormalities of spermatogenesis is much longer established. Long- and short-term testosterone replacement therapies have well-recognised effects on cardiovascular and cerebrovascular health and on aspects of metabolic health. This leads to a sense of safety when it comes to considering these options as ways of managing the recognised symptoms of hypogonadism and the hidden adverse findings. That confidence has yet to be proven by long-term randomised controlled studies. The use of exogenous gonadotrophins to raise endogenous testosterone levels is a cost-efficient method of achieving spermatogenesis but is not suitable for long-term testosterone maintenance therapy.
Aim: The purpose is to determine the risk ratios (RR) for both major adverse foot events (MAFEs) and the presence of moderate and severe functional mobility deficits in participants with diabetic peripheral neuropathy across the stages of chronic kidney disease (CKD).
Methods: We studied 284 participants with diabetes mellitus, peripheral neuropathy, and CKD. MAFEs including foot fracture, ulcerations, Charcot neuropathic arthropathy (CN), osteomyelitis, and minor foot amputations were collected from foot x-ray reports in the medical records of 152 participants; functional mobility deficits were assessed in 132 participants using the modified physical performance test (mPPT). Moderate mobility deficit was categorized as mPPT scores 22-29 and severe mobility deficit as < 22. Unadjusted and adjusted (age, body weight, race, HbA1c) RR were calculated across each stage of CKD, with stage 1 CKD used as the reference group.
Results: The RR for neuropathic foot fracture, CN, and diabetic foot ulceration remained consistent across CKD stages. The RR of minor amputation is greater in CKD stages 4 and 5. The RR of moderate or severe mobility deficit is greater in CKD stages 3 and 5 and in CKD stages 3, 4, and 5, respectively. An inverse association was observed between MAFE prevalence and mPPT scores across CKD stages.
Conclusion: Major adverse foot events and functional mobility deficits are prevalent in individuals with DPN and diabetic kidney disease. The risks for minor foot amputation and functional mobility deficits increase as early as stage 3 CKD and increase further in stages 4 and 5.
Chronic kidney disease (CKD) and nonalcoholic fatty liver disease (NAFLD), metabolic dysfunction-associated fatty liver disease (MAFLD) and metabolic dysfunction-associated steatotic liver disease (MASLD) account for substantial financial burden worldwide. These alarming features call for enhanced efforts to prevent and manage the development and progression of CKD. Accumulating evidence supporting a causal role of NAFLD/MAFLD/MASLD-in CKD opens new horizons to achieve this aim. Recent epidemiological studies and meta-analyses exploring the association of NAFLD/MAFLD/MASLD with CKD and the characteristics of NAFLD/MAFLD/MASLD associated with the odds of incident CKD are discussed. The involved pathomechanisms, including the common soil hypothesis, genetics, gut dysbiosis, and portal hypertension, are examined in detail. Finally, lifestyle changes (diet and physical exercise), direct manipulation of gut microbiota, and drug approaches involving statins, renin-angiotensin-aldosterone system inhibitors, GLP-1 Receptor Agonists, Sodium-glucose cotransporter-2, pemafibrate, and vonafexor are examined within the context of prevention and management of CKD among those with NAFLD/MAFLD/MASLD. The evolving NAFLD/MAFLD/MASLD nomenclature may generate confusion among practicing clinicians and investigators. However, comparative studies investigating the pros and contra of different nomenclatures may identify the most useful definitions among NAFLD/MAFLD/MASLD and strategies to identify, prevent, and halt the onset and progression of CKD.
Aims: Clinical and experimental evidence has shown that females in humans and other mammals have higher glutathione (GSH) levels than males, which are caused by higher levels of estradiol. Understanding how hepatic GSH level and synthesis velocity depend on the sex hormones is an extremely important question since oxidative stress contributes to the risk for heart disease and cancer, and oxidative stress is reduced by GSH. Our aim is to develop a systems approach to understanding GSH metabolism and use this to explain the causes of GSH differences in males and females, how GSH changes during the menstrual cycle, and why women may be less susceptible to acetaminophen toxicity.
Methods: We use mathematical models for hepatic glutathione metabolism, including one-carbon metabolism and acetaminophen detoxification, to investigate how the activation of certain enzymes by estradiol leads to dramatic changes in reaction velocities and metabolite concentrations.
Results: The models explain why women of childbearing age have higher glutathione than men, and that this is caused by the balance of activation of glutamyl cysteine synthetase (GCL) and glutathione peroxidase (GPX) by estradiol. The steady-state concentration of glutathione in women depends on the strength of the activation of GCL and GPX and is quite homeostatic over a wide range of activations.
Conclusions: During the menstrual cycle, the GSH concentration changes daily but over a relatively narrow range. We explain how this dynamic homeostasis depends on the biochemical network that produces GSH. The model is also consistent with published results that show that female mice are less susceptible than males to hepatotoxicity due to acetaminophen overdose and suggests that this might also be true for humans, though the human epidemiological data are contradictory.