Knowing What's Out There: Awareness of Non-Alcoholic Fatty Liver Disease.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is the most common hepatic disorder, which poses a significant health burden in the western countries. As the epidemic of obesity slides health downward, the incidence of NAFLD is evidently increasing. AIM: We aimed to ascertain the awareness of NAFLD and its risk factors in the general population, which may be helpful in designing educational tools to promote prevention, early detection, and treatment of this disorder. METHODS: A survey of 5000 non-institutionalized residents of Brooklyn, NY, USA was conducted. Sixteen items were included in the survey questionnaire including awareness of fatty liver, predisposing factors of NAFLD, awareness of cirrhosis, and conditions that advance to cirrhosis. The questionnaire also addressed awareness of prevention, diagnostic methods and treatment of NAFLD, and education of physicians to their patients about NAFLD. RESULTS: Overwhelming majority of the subjects was not aware of NAFLD and stated that their physicians did not have a discussion about NAFLD. CONCLUSION: Non-alcoholic fatty liver disease is a preventable liver disorder with limited treatment options. Thorough counseling by primary care physicians can be of paramount importance in preventive strategy for NAFLD. We should target our teenage population in an era of obesity epidemics of all times.

Impaired fat-induced thermogenesis in obese subjects: the NUGENOB study.

OBJECTIVES: To study energy expenditure before and 3 hours after a high-fat load in a large cohort of obese subjects (n = 701) and a lean reference group (n = 113). RESEARCH METHODS AND PROCEDURES: Subjects from seven European countries underwent a 1-day clinical study with a liquid test meal challenge containing 95% fat (energy content was 50% of estimated resting energy expenditure). Fasting and 3-hour postprandial energy expenditures, as well as metabolites and hormones, were determined. RESULTS: Obese subjects had a reduced postprandial energy expenditure after the high-fat load, independent of body composition, age, sex, research center, and resting energy expenditure, whereas within the obese group, thermogenesis increased again with increasing BMI category. Additionally, insulin resistance, habitual physical activity, postprandial plasma triacylglycerols, and insulin were all independently positively related to the postprandial energy expenditure. Resting energy expenditure, adjusted for fat-free mass, increased with degree of obesity, a difference that disappeared after adjustment for fat mass. Furthermore, insulin resistance, fasting plasma free fatty acids, and cortisol were positively associated, whereas fasting plasma leptin and insulin-like growth factor-1 were negatively associated, with resting energy expenditure. DISCUSSION: The 3-hour fat-induced thermogenic response is reduced in obesity. It remains to be determined whether this blunted thermogenic response is a contributory factor or an adaptive response to the obese state.

Fat oxidation before and after a high fat load in the obese insulin-resistant state.

BACKGROUND: Obesity may be associated with a lowered use of fat as a fuel, which may contribute to the enlarged adipose tissue stores. AIM: The aim of the present study was to study fatty acid use in the fasting state and in response to a high fat load in a large cohort of obese subjects (n = 701) and a lean reference group (n = 113). METHODS: Subjects from eight European centers underwent a test meal challenge containing 95 en% fat [energy content 50% of estimated resting energy expenditure (EE)]. Fasting and postprandial fat oxidation and circulating metabolites and hormones were determined over a 3-h period. RESULTS: Postprandial fat oxidation (as percent of postprandial EE, adjusted for fat mass, age, gender, center, and energy content of the meal) decreased with increasing body mass index (BMI) category (P < 0.01), an effect present only in those obese subjects with a relatively low fasting fat oxidation (below median, interaction BMI category x fasting fat oxidation, P < 0.001). Fasting fat oxidation increased with increasing BMI category (P < 0.001), which was normalized after adjustment for fat-free mass and fat mass. Furthermore, insulin resistance was positively associated with postprandial fat oxidation (P < 0.05) and negatively associated with fasting fat oxidation (expressed as percent of EE), independent of body composition. CONCLUSIONS: The present data indicate an impaired capacity to regulate fat oxidation in the obese insulin-resistant state, which is hypothesized to play a role in the etiology of both obesity and insulin resistance.

Metabolic responses to exercise after carbohydrate loads in healthy men and women.

PURPOSE: This study aimed to investigate gender differences in i) pancreatic insulin secretory (beta-cell sensitivity) and whole body insulin sensitivity responses to an intravenous carbohydrate (CHO) load, and (ii) metabolic responses to exercise after both intravenous and oral CHO loads. METHODS: Seven untrained healthy men and seven age-, body mass-, and VO2max-matched women performed two trials. In one trial they cycled for 60 min at 50% VO2max, starting 60 min after ingestion of a carbohydrate-rich meal (ME trial). In the other trial, subjects were infused with 20% dextrose solution to maintain blood glucose concentration at approximately 8 mmol x L(-1) for 60 min (INF trial), then the infusion rate was maintained constant during the following 60 min while exercising at 50% VO2max. RESULTS: There was no gender effect on beta-cell sensitivity (serum insulin: 161 +/- 37 and 159 +/- 28 pmol x L(-1) for men and women, respectively) and whole body insulin sensitivity (155 +/- 24 and 135 +/- 29 mg x KgFFM(-1) x min(-1) per pmol x L(-1) x 100 for men and women, respectively). This may explain the similarity in glycemic, substrate oxidation and other metabolic responses to exercise after both intravenous and oral CHO loads in men and women. CONCLUSION: These results suggest that moderate exercise performed in the postprandial state presents a similar challenge to the ability of healthy, untrained men and women to perform exercise without a substantial decline in plasma glucose concentration below fasting values.

Pulmonary hyalinizing granuloma associated with Aspergillus infection.

A 38-year-old immunocompetent man with occupational exposure to Aspergillus presented with dyspnea, pleuritic chest pain, and hemoptysis. Chest roentgenograms and computed tomography scans demonstrated multiple pulmonary nodules bilaterally. An initial set of bronchial washing cultures grew Aspergillus fumigatus, serologic testing showed an elevated anti-Aspergillus titer, and immunodiffusion testing was positive for antibody against A. fumigatus and A. niger. There was no microbiologic or serologic evidence of infection by other pathogens, and no clinical or laboratory evidence of autoimmune disease. An open lung biopsy was diagnostic of pulmonary hyalinizing granuloma. This novel association with Aspergillus infection not only expands the spectrum of pathogens linked to pulmonary hyalinizing granuloma but also documents a new pattern of lung disease that can be caused by Aspergillus.