Few studies on humans have comprehensively evaluated the intake composition of methyl-donor nutrients (MDNs: choline, betaine, and folate) in relation to visceral obesity (VOB)-related hepatic steatosis (HS), the hallmark of non-alcoholic fatty liver diseases. In this case–control study, we recruited 105 patients with HS and 104 without HS (controls). HS was diagnosed through ultrasound examination. VOB was measured using a whole-body analyzer. MDN intake was assessed using a validated quantitative food frequency questionnaire. After adjustment for multiple HS risk factors, total choline intake was the most significant dietary determinant of HS in patients with VOB (Beta: −0.41, p = 0.01). Low intake of choline (<6.9 mg/kg body weight), betaine (<3.1 mg/kg body weight), and folate (<8.8 μg/kg body weight) predicted increased odds ratios (ORs) of VOB-related HS (choline: OR: 22, 95% confidence interval [CI]: 6.5–80; betaine: OR: 14, 95% CI: 4.4–50; and folate: OR: 19, 95% CI: 5.2–74). Combined high intake of choline and betaine, but not folate, was associated with an 81% reduction in VOB-related HS (OR: 0.19, 95% CI: 0.05–0.69). Our data suggest that the optimal intake of choline and betaine can minimize the risk of VOB-related HS in a threshold-dependent manner.

Previous studies have indicated that HBV infection and T2DM are the factors that increase the risk of developing HCC. The experimental evidence has shown that antiglycemic agents may reduce the risk of HCC. However, the effect of dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors) on the risk of HCC in T2DM patients with chronic HBV infection remains unclear. In this retrospective cohort study, we extracted patients with T2DM and chronic HBV infection from the National Health Insurance Research Database (NHIRD) in Taiwan. The cases were divided into DPP-4 inhibitors use and non-use groups, according to whether they received DPP-4 inhibitors treatment, and the risk of HCC was compared between the two groups. At the end of the follow-up, approximately 2.33% of DPP-4 inhibitors users had received an HCC diagnosis compared with 3.33% of non-DPP-4 inhibitors users (p < 0.0001). After multivariate adjustment, DPP-4 inhibitors users showed a significant reduction in HCC risk (adjusted hazard ratios (aHRs): 0.53; 95% confidence intervals (CIs): 0.44–0.65). In conclusion, this population-based retrospective cohort study indicated that, in T2DM patients with chronic HBV infection, the use of DPP-4 inhibitors significantly reduced the risk of developing HCC compared with non-DPP-4 inhibitors use.

Adequate bowel preparation is an essential part of a high-quality colonoscopy. Recent studies showed that the small-volume bowel cleansing agent Bowklean performs better in terms of tolerability and acceptability. However, its split-dose regimen is sometimes confusing to the patient. To promote Bowklean in Fu Jen Catholic University Hospital, dedicated staff for patient education on bowel preparation were provided by Universal Integrated Corporation (Taiwan), but not in every period because of the clinic room availability and manpower capacity. This provided us an opportunity to compare the quality of colonoscopy between those with and without the dedicated patient education. This study aimed to compare various quality indices between the two groups. We set bowel preparation quality as the primary endpoint, assessed by modified Aronchick scale, and other quality indices including procedure time and adenoma detection rate as the secondary endpoints. We performed a single institution retrospective study. All patients who received colonoscopy from an outpatient setting with Bowklean as the bowel cleansing agent from October 2020 to November 2020 were reviewed. Primary and secondary endpoints were then compared between the conventional group and the dedicated staff group, with StataSE 14 by Wilcoxon rank sum test or logistic regression. Four hundred ten patients were recruited, including 217 patients with dedicated patient education and 193 without. The proportion of bowel preparation quality “Excellent + Good + Fair” was significantly higher in dedicated staff group than conventional group (97.7% vs 93.3%, P = .03; logistic regression coefficient = 1.12). The cecal intubation time was significantly shorter in the dedicated staff group (3.68 ± 2.02 minutes vs 4.52 ± 3.25 minutes, P < .01). After excluding those with polypectomy or biopsy, the total procedure time tended to be shorter in the dedicated staff group (10.2 ± 3.35 minutes vs 9.40 ± 2.43 minutes, P = .06). There was no significant difference regarding adenoma detection rate between the two groups. Our study shows that patient education by dedicated staff can improve bowel preparation quality and has the potential to decrease procedure time. Further large-scale prospective trials are still needed to evaluate if it can also achieve a better adenoma detection rate.