Background: The triglyceride–glucose index (TyG) and a combination of body mass index (BMI) and waist circumference (WC) have been proposed as predictive scores for liver steatosis (LS). The aim of this study was to determine the diagnostic accuracy of these indices compared with controlled attenuation parameters (CAPs) and other predictive scores of LS. Methods: A retrospective analysis of patients who attended a check-up unit in 2021 was performed. LS was determined by CAP. Anthropometric and biochemical parameters for calculating TyG, TyG-BMI, TyG-WC, fatty liver index, and hepatic steatosis index were obtained. ROC curve was used to establish the best cut-off point of each TyG index for LS detection. The accuracy was determined for all patients, as well as for overweight and diabetic patients. Results: Medical records of 855 patients with a median age of 48 [IQR, 44–54] years and a BMI of 25.7 [IQR 23.4–28.1] kg/m² were included. According to CAP, LS prevalence was 31.8% (n = 272). TyG-BMI and TyG-WC show better AUCs compared with CAP (0.82, 0.81), FLI (0.96, both), and HSI (0.93, 0.85). For diabetic patients, TyG-WC shows an AUC of 0.70. Meanwhile, TyG-BMI shows better accuracy (0.75) compared with CAP. Conclusions: TyG-BMI and TyG-WC showed a superior predictive accuracy for detecting LS compared with the TyG index.

Background: Non-alcoholic fatty liver disease (NAFLD) is considered the hepatic manifestation of metabolic syndrome. Recently, the term metabolic dysfunction-associated fatty liver disease (MAFLD) has been proposed and adapted to body mass index (BMI). This study describes the impact on prevalence of the application of both criteria in overweight and lean patients. Methods: Patients who were evaluated for liver steatosis by transient elastography were included and divided according to BMI (≥25 kg/m² and <25 kg/m²) and classified as NAFLD or MAFLD, according to metabolic abnormalities. Differences in prevalence were evaluated applying both criteria. A multivariate analysis was performed to evaluate independent associations of metabolic abnormalities and liver steatosis in lean patients. Results: 3847 patients were included. In overweight patients (61%), the prevalence NAFLD was 63.6% and 65.3% for MAFLD (p = 0.22). In contrast, the prevalence of MAFLD was lower (7.9% vs. 18.3%, p ≤ 0.001) in lean patients. In this group, higher age, fasting glucose, triglycerides, and waist circumference showed independent association with liver steatosis. Conclusion: The application of NAFLD/MAFLD criteria did not show prevalence differences in overweight patients. With MAFLD criteria, the prevalence is lower in lean patients, but patients with high risk of progression of liver disease for steatosis were identified, according to their metabolic abnormalities.

Nowadays, non-alcoholic fatty liver disease is one of the first causes of liver transplant worldwide; many efforts have been done to find the perfect drug for this multifactorial disease. Presently we just have a few drugs that could be used in specific and limited clinical scenarios. Current evidence suggests that bariatric endoscopic and surgical therapies could be strategies with optimal outcomes, with high impact in quality of life, decrease of cardiovascular risk, and improvement in metabolic profile, despite being considered expensive procedures. This review proposes to consider these therapies early together with liver fibrosis evaluation, with long term cost-effectiveness benefits in the absence of response to lifestyle modifications and pharmacological treatments.

Non-alcoholic fatty liver disease (NAFLD) is a highly prevalent metabolic disease, although prevalence could change according to region, nowadays is considered a public health problem whose real impact on the health system is unknown. NAFLD has a multifactorial and complex pathophysiology, due to this, developing a unique and effective pharmacological treatment has not been successful in reverting or avoiding the progression of this liver disease. Even though NAFLD pathophysiology is known, all actual treatments are focused on modifying or regulating the metabolic pathways, some of which interplay with obesity. It has been known that impairments in hunger and satiety signals are associated with obesity, however, abnormalities in these signals in patients with NAFLD and obesity are not fully elucidated. To describe these mechanisms opens an additional option as a therapeutic target sharing metabolic pathways with NAFLD, therefore, this review aims to describe the hormones and peptides implicated in both hunger-satiety in NAFLD. It has been established that NAFLD pharmacological treatment cannot be focused on a single purpose; hence, identifying interplays that lead to adding or modifying current treatment options could also have an impact on another related outcome such as hunger or satiety signals.

Background: Although body composition (BC) has been associated with Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), there is little evidence of differences in BC in patients with MASLD regarding body mass index (BMI). The aim of this study was to determine differences in BC in terms of BMI and metabolic comorbidities in patients with MASLD.Materials and methods: It is a cross-sectional study with patients who attended the check-up unit. Liver steatosis was evaluated by controlled attenuation parameter, and patients were classified into five groups according to BMI, presence of MASLD, and metabolic characteristics: <25 kg/m² non-MASLD; <25 kg/m²-MASLD; Overweight-MASLD; Metabolically Healthy Obese (MHO)-MASLD; and Metabolically Unhealthy Obese (MUO)-MASLD. BC was assessed by bioelectrical impedance and a Bioimpedance Vectorial Analysis (BIVA) was carried out. Differences in BC were analyzed by a One-Way ANOVA test. Univariate and multivariate analyses were performed for factors associated with abnormal BC.Results: A total of 316 patients were included. 59% (n = 189) were male, with a mean age of 49 ± 10 years. Fat% significantly higher according to BMI was not different between BMI <25 kg/m²-MASLD and Overweight-MASLD groups. Skeletal muscle mass (SMM) was significantly lower in obesity groups with respect to overweight and normal weight groups (p < 0.05); however, no differences were observed in the post-hoc analysis. Extracellular Water/Intracellular Water ratio was significantly higher in the MHO-MASLD group and MUO-MASLD group compared with the BMI <25 kg/m² non-MASLD group and with the BMI <25 kg/m²-MASLD group. Abnormal Waist Circumference (WC) and liver steatosis were independent factors associated with abnormal BC.Conclusion: BC in MASLD patients varies according to BMI increase; changes could be explained by loss of SMM and not necessarily by the presence of metabolic abnormalities. High WC and the presence of steatosis are independent factors associated with altered BC.