Top

Published in:

04-03-2024 | Insulins | Original Article

Insulin Resistance/Sensitivity Measures as Screening Indicators of Metabolic-Associated Fatty Liver Disease and Liver Fibrosis

Authors: Mohammad E. Khamseh, Mojtaba Malek, Soodeh Jahangiri, Sohrab Nobarani, Azita Hekmatdoost, Marieh Salavatizadeh, Samira Soltanieh, Haleh Chehrehgosha, Hoda Taheri, Zeinab Montazeri, Fereshteh Attaran, Faramarz Ismail-Beigi, Fariba Alaei-Shahmiri

Published in: Digestive Diseases and Sciences | Issue 4/2024

Abstract

Background

Measures of insulin resistance (IR)/sensitivity (IS) are emerging tools to identify metabolic-associated fatty liver disease (MAFLD). However, the comprehensive assessment of the performance of various indicators is limited. Moreover, the utility of measures of IR/IS in detecting liver fibrosis remains unclear.

Aims

To evaluate the predictive ability of seventeen IR/IS and two beta cell function indices to identify MAFLD and liver fibrosis.

Methods

A cross-sectional study was conducted on individuals aged 25–75 years. Transient elastography was used to estimate liver stiffness and controlled attenuation parameter. The following measures were computed: homeostatic model assessment (HOMA/HOMA2) for IR, IS, and beta cell function; QUICKI; Bennett index; glucose/insulin; FIRI; McAuley index; Reynaud index; SPISE index; TyG; TyG-BMI; TyG-WC; TyG-WHtR; TG/HDL; and METS-IR. Subgroup analyses were performed according to age, gender, diabetes status, and body weight.

Results

A total of 644 individuals were included in our analysis. MAFLD and significant liver fibrosis were detected in 320 (49.7%) and 80 (12.4%) of the participants, respectively. All measures of IR/IS identified MAFLD and liver fibrosis. However, TyG-WC, TyG-BMI, and TyG-WHtR were the top three indicators that identified MAFLD. Measures that include insulin level in their mathematical calculation, namely, Raynaud index, HOMA-IR, HOMA 2-IR, FIRI, and QUICKI had the best performance in identifying liver fibrosis in the entire population, as well as among the study subgroups.

Conclusions

TyG-WC, TyG-BMI, and TyG-WHtR were the best predictors of MAFLD. Insulin-based measures had better performances in the detection of advanced fibrosis. This was independent of age, gender, obesity, or diabetes status.

Available only for authorised users

Younossi Z, Anstee QM, Marietti M, Hardy T, Henry L, Eslam M et al. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat Rev Gastroenterol Hepatol. 2018;15:11–20. https://doi.org/10.1038/nrgastro.2017.109.CrossRefPubMed

Araújo AR, Rosso N, Bedogni G, Tiribelli C, Bellentani S. Global epidemiology of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis: what we need in the future. Liver Int. 2018;38:47–51. https://doi.org/10.1111/liv.13643.CrossRefPubMed

Younossi ZM, Henry L. Epidemiology of non-alcoholic fatty liver disease and hepatocellular carcinoma. JHEP Rep. 2021;3:100305. https://doi.org/10.1016/j.jhepr.2021.100305.CrossRefPubMedPubMedCentral

Kitade H, Chen G, Ni Y, Ota T. Nonalcoholic fatty liver disease and insulin resistance: new insights and potential new treatments. Nutrients. 2017. https://doi.org/10.3390/nu9040387.CrossRefPubMedPubMedCentral

Koo DJ, Lee MY, Jung I, Moon SJ, Kwon H, Park SE et al. Baseline homeostasis model assessment of insulin resistance associated with fibrosis progression in patients with nonalcoholic fatty liver disease without diabetes: a cohort study. PLoS One. 2021;16:e0255535. https://doi.org/10.1371/journal.pone.0255535.CrossRefPubMedPubMedCentral

Ballestri S, Zona S, Targher G, Romagnoli D, Baldelli E, Nascimbeni F et al. Nonalcoholic fatty liver disease is associated with an almost twofold increased risk of incident type 2 diabetes and metabolic syndrome Evidence from a systematic review and meta-analysis. J Gastroenterol Hepatol. 2016;31:936–944. https://doi.org/10.1111/jgh.13264.CrossRefPubMed

Eslam M, Sanyal AJ, George J. MAFLD: a consensus-driven proposed nomenclature for metabolic associated fatty liver disease. Gastroenterology. 2020;158:1999-2014.e1. https://doi.org/10.1053/j.gastro.2019.11.312.CrossRefPubMed

Lin S, Huang J, Wang M, Kumar R, Liu Y, Liu S et al. Comparison of MAFLD and NAFLD diagnostic criteria in real world. Liver Int. 2020;40:2082–2089. https://doi.org/10.1111/liv.14548.CrossRefPubMed

Alba LM, Lindor K. Review article: non-alcoholic fatty liver disease. Aliment Pharmacol Ther. 2003;17:977–986. https://doi.org/10.1046/j.1365-2036.2003.01493.x.CrossRefPubMed

10.

Singh SP, Barik RK. NonInvasive biomarkers in nonalcoholic fatty liver disease: are we there yet? J Clin Exp Hepatol. 2020;10:88–98. https://doi.org/10.1016/j.jceh.2019.09.006.CrossRefPubMed

11.

Taheri H, Malek M, Ismail-Beigi F, Zamani F, Sohrabi M, Reza Babaei M et al. Effect of empagliflozin on liver steatosis and fibrosis in patients with non-alcoholic fatty liver disease without diabetes: a randomized, double-blind, Placebo-controlled trial. Adv Ther. 2020;37:4697–4708. https://doi.org/10.1007/s12325-020-01498-5.CrossRefPubMedPubMedCentral

12.

Chehrehgosha H, Sohrabi MR, Ismail-Beigi F, Malek M, Reza Babaei M, Zamani F et al. Empagliflozin improves liver steatosis and fibrosis in patients with non-alcoholic fatty liver disease and type 2 diabetes: a randomized, double-blind, placebo-controlled clinical trial. Diabet Ther. 2021;12:843–861. https://doi.org/10.1007/s13300-021-01011-3.CrossRef

13.

Poustchi H, Alaei-Shahmiri F, Aghili R, Nobarani S, Malek M, Khamseh ME. Hepatic steatosis and fibrosis in type 2 diabetes: a risk-based approach to targeted screening. Arch Iran Med. 2021;24:177–186. https://doi.org/10.34172/aim.2021.28.CrossRefPubMed

14.

Salavatizadeh M, Soltanieh S, Poustchi H, Yari Z, Shabanpur M, Mansour A et al. Dietary total antioxidant capacity is inversely associated with the odds of non-alcoholic fatty liver disease in people with type-2 diabetes. Front Nutr. 2022;9:1037851. https://doi.org/10.3389/fnut.2022.1037851.CrossRefPubMedPubMedCentral

15.

Newsome PN, Sasso M, Deeks JJ, Paredes A, Boursier J, Chan WK et al. FibroScan-AST (FAST) score for the non-invasive identification of patients with non-alcoholic steatohepatitis with significant activity and fibrosis: a prospective derivation and global validation study. Lancet Gastroenterol Hepatol. 2020;5:362–373. https://doi.org/10.1016/s2468-1253(19)30383-8.CrossRefPubMedPubMedCentral

16.

Eddowes PJ, Sasso M, Allison M, Tsochatzis E, Anstee QM, Sheridan D et al. Accuracy of fibroscan controlled attenuation parameter and liver stiffness measurement in assessing steatosis and fibrosis in patients with nonalcoholic fatty liver disease. Gastroenterology. 2019;156:1717–1730. https://doi.org/10.1053/j.gastro.2019.01.042.CrossRefPubMed

17.

Eslam M, Newsome PN, Sarin SK, Anstee QM, Targher G, Romero-Gomez M et al. A new definition for metabolic dysfunction-associated fatty liver disease: an international expert consensus statement. J Hepatol. 2020;73:202–209. https://doi.org/10.1016/j.jhep.2020.03.039.CrossRefPubMed

18.

Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28:412–419. https://doi.org/10.1007/bf00280883.CrossRefPubMed

19.

The Oxford Centre for Diabetes. Endocrinology & metabolism. Diabetes trial unit. HOMA calculator. http://www.dtu.ox.ac.uk.

20.

Levy JC, Matthews DR, Hermans MP. Correct homeostasis model assessment (HOMA) evaluation uses the computer program. Diabet Care. 1998;21:2191–2192. https://doi.org/10.2337/diacare.21.12.2191%JDiabetesCare.CrossRef

21.

Katz A, Nambi SS, Mather K, Baron AD, Follmann DA, Sullivan G et al. Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J Clin Endocrinol Metab. 2000;85:2402–2410. https://doi.org/10.1210/jcem.85.7.6661.CrossRefPubMed

22.

Anderson RL, Hamman RF, Savage PJ, Saad MF, Laws A, Kades WW et al. Exploration of simple insulin sensitivity measures derived from frequently sampled intravenous glucose tolerance (FSIGT) tests. The insulin resistance atherosclerosis study. Am J Epidemiol. 1995;142:724–732. https://doi.org/10.1093/aje/142.7.724.CrossRefPubMed

23.

Legro RS, Finegood D, Dunaif A. A fasting glucose to insulin ratio is a useful measure of insulin sensitivity in women with polycystic ovary syndrome1. J Clin Endocrinol Metab. 1998;83:2694–2698. https://doi.org/10.1210/jcem.83.8.5054.CrossRefPubMed

24.

Duncan MH, Singh BM, Wise PH, Carter G, Alaghband-Zadeh J. A simple measure of insulin resistance. Lancet. 1995;346:120–121. https://doi.org/10.1016/S0140-6736(95)92143-5.CrossRefPubMed

25.

McAuley KA, Williams SM, Mann JI, Walker RJ, Lewis-Barned NJ, Temple LA et al. Diagnosing insulin resistance in the general population. Diabet Care. 2001;24:460–464. https://doi.org/10.2337/diacare.24.3.460.CrossRef

26.

Raynaud E, Perez-Martin A, Brun JF, Benhaddad AA, Mercier J. Revised concept for the estimation of insulin sensitivity from a single sample. Diabet Care. 1999;22:1003–1004. https://doi.org/10.2337/diacare.22.6.1003.CrossRef

27.

Paulmichl K, Hatunic M, Højlund K, Jotic A, Krebs M, Mitrakou A et al. Modification and validation of the triglyceride-to-HDL cholesterol ratio as a surrogate of insulin sensitivity in white juveniles and adults without diabetes mellitus: the single point insulin sensitivity estimator (SPISE). Clin Chem. 2016;62:1211–1219. https://doi.org/10.1373/clinchem.2016.257436.CrossRefPubMed

28.

Guerrero-Romero F, Simental-Mendía LE, González-Ortiz M, Martínez-Abundis E, MaG Ramos-Zavala, Hernández-González SO et al. The product of triglycerides and glucose, a simple measure of insulin sensitivity comparison with the euglycemic-hyperinsulinemic clamp. J Clin Endocrinol Metab. 2010;95:3347–3351. https://doi.org/10.1210/jc.2010-0288.CrossRefPubMed

29.

Er LK, Wu S, Chou HH, Hsu LA, Teng MS, Sun YC et al. Triglyceride glucose-body mass index is a simple and clinically useful surrogate marker for insulin resistance in nondiabetic individuals. PLoS One. 2016;11:e0149731. https://doi.org/10.1371/journal.pone.0149731.CrossRefPubMedPubMedCentral

30.

Zheng S, Shi S, Ren X, Han T, Li Y, Chen Y et al. Triglyceride glucose-waist circumference, a novel and effective predictor of diabetes in first-degree relatives of type 2 diabetes patients: cross-sectional and prospective cohort study. J Transl Med. 2016;14:260. https://doi.org/10.1186/s12967-016-1020-8.CrossRefPubMedPubMedCentral

31.

Lim J, Kim J, Koo SH, Kwon GC. Comparison of triglyceride glucose index, and related parameters to predict insulin resistance in Korean adults: an analysis of the 2007–2010 Korean National Health and Nutrition Examination Survey. PLoS One. 2019;14:e0212963. https://doi.org/10.1371/journal.pone.0212963.CrossRefPubMedPubMedCentral

32.

Ren X, Chen ZA, Zheng S, Han T, Li Y, Liu W et al. Association between triglyceride to HDL-C ratio (TG/HDL-C) and insulin resistance in Chinese patients with newly diagnosed type 2 diabetes mellitus. PLoS One. 2016;11:e0154345. https://doi.org/10.1371/journal.pone.0154345.CrossRefPubMedPubMedCentral

33.

McLaughlin T, Abbasi F, Cheal K, Chu J, Lamendola C, Reaven G. Use of metabolic markers to identify overweight individuals who are insulin resistant. Annals Intern Med. 2003;139:802–809. https://doi.org/10.7326/0003-4819-139-10-200311180-00007.CrossRef

34.

Bello-Chavolla OY, Almeda-Valdes P, Gomez-Velasco D, Viveros-Ruiz T, Cruz-Bautista I, Romo-Romo A et al. METS-IR, a novel score to evaluate insulin sensitivity, is predictive of visceral adiposity and incident type 2 diabetes. Eur J Endocrinol. 2018;178:533–544. https://doi.org/10.1530/eje-17-0883.CrossRefPubMed

35.

Beran A, Ayesh H, Mhanna M, Wahood W, Ghazaleh S, Abuhelwa Z et al. Triglyceride-glucose index for early prediction of nonalcoholic fatty liver disease: a meta-analysis of 121,975 individuals. J Clin Med. 2022. https://doi.org/10.3390/jcm11092666.CrossRefPubMedPubMedCentral

36.

Wang J, Yan S, Cui Y, Chen F, Piao M, Cui W. The Diagnostic and prognostic value of the triglyceride-glucose index in metabolic dysfunction-associated fatty liver disease (MAFLD): a systematic review and meta-analysis. Nutrients. 2022;14:4969.CrossRefPubMedPubMedCentral

37.

Taheri E, Pourhoseingholi MA, Moslem A, Hassani AH, Mousavi Jarrahi A, Asadzadeh Aghdaei H et al. The triglyceride-glucose index as a clinical useful marker for metabolic associated fatty liver disease (MAFLD): a population-based study among Iranian adults. J Diabet Metab Disord. 2022;21:97–107. https://doi.org/10.1007/s40200-021-00941-w.CrossRef

38.

Khamseh ME, Malek M, Abbasi R, Taheri H, Lahouti M, Alaei-Shahmiri F. Triglyceride glucose index and related parameters (triglyceride glucose-body mass index and triglyceride glucose-waist circumference) identify nonalcoholic fatty liver and liver fibrosis in individuals with overweight/obesity. Metab Syndr Relat Disord. 2021;19:167–173. https://doi.org/10.1089/met.2020.0109.CrossRefPubMed

39.

Wang R, Dai L, Zhong Y, Xie G. Usefulness of the triglyceride glucose-body mass index in evaluating nonalcoholic fatty liver disease: insights from a general population. Lipids Dis. 2021;20:77. https://doi.org/10.1186/s12944-021-01506-9.CrossRef

40.

Song S, Son DH, Baik SJ, Cho WJ, Lee YJ. Triglyceride glucose-waist circumference (TyG-WC) is a reliable marker to predict non-alcoholic fatty liver disease. Biomedicines. 2022. https://doi.org/10.3390/biomedicines10092251.CrossRefPubMedPubMedCentral

41.

Xue Y, Xu J, Li M, Gao Y. Potential screening indicators for early diagnosis of NAFLD/MAFLD and liver fibrosis: triglyceride glucose index-related parameters. Front Endocrinol. 2022;13:951689. https://doi.org/10.3389/fendo.2022.951689.CrossRef

42.

Mota M, Banini BA, Cazanave SC, Sanyal AJ. Molecular mechanisms of lipotoxicity and glucotoxicity in nonalcoholic fatty liver disease. Metabolism. 2016;65:1049–1061. https://doi.org/10.1016/j.metabol.2016.02.014.CrossRefPubMedPubMedCentral

43.

Geng Y, Faber KN, de Meijer VE, Blokzijl H, Moshage H. How does hepatic lipid accumulation lead to lipotoxicity in non-alcoholic fatty liver disease? Hepatol Int. 2021;15:21–35. https://doi.org/10.1007/s12072-020-10121-2.CrossRefPubMed

44.

Bae JC, Beste LA, Utzschneider KM. The impact of insulin resistance on hepatic fibrosis among United States adults with non-alcoholic fatty liver disease: NHANES 2017 to 2018. Endocrinol Metab (Seoul). 2022;37:455–465. https://doi.org/10.3803/EnM.2022.1434.CrossRefPubMedPubMedCentral

45.

Chen Z, Yu R, Xiong Y, Du F, Zhu S. A vicious circle between insulin resistance and inflammation in nonalcoholic fatty liver disease. Lipids Health Dis. 2017;16:203. https://doi.org/10.1186/s12944-017-0572-9.CrossRefPubMedPubMedCentral

46.

Fujii H, Imajo K, Yoneda M, Nakahara T, Hyogo H, Takahashi H et al. HOMA-IR: An independent predictor of advanced liver fibrosis in nondiabetic non-alcoholic fatty liver disease. J Gastroenterol Hepatol. 2019;34:1390–1395. https://doi.org/10.1111/jgh.14595.CrossRefPubMed

47.

Kim MK, Kim JH, Park K, Lee SB, Nam JS, Kang S et al. Relationship between the triglyceride glucose index and the presence and fibrosis of nonalcoholic fatty liver disease in Korean adults. Am Diabet Assoc. 2018. https://doi.org/10.1530/endoabs.56.P296.CrossRef

48.

Koo DJ, Lee MY, Jung I, Moon SJ, Kwon H, Park SE et al. Changes in insulin resistance index and the risk of liver fibrosis in patients with nonalcoholic fatty liver disease without diabetes: Kangbuk Samsung Health Study. Endocrinol Metab. 2021;36:1016–1028. https://doi.org/10.3803/EnM.2021.1110.CrossRef

49.

Bril F, Lomonaco R, Orsak B, Ortiz-Lopez C, Webb A, Tio F et al. Relationship between disease severity, hyperinsulinemia, and impaired insulin clearance in patients with nonalcoholic steatohepatitis. Hepatology. 2014;59:2178–2187. https://doi.org/10.1002/hep.26988.CrossRefPubMed

50.

Hoffman RP. Indices of insulin action calculated from fasting glucose and insulin reflect hepatic, not peripheral, insulin sensitivity in African-American and Caucasian adolescents. Pediatr Diabet. 2008;9:57–61.CrossRef

51.

Borai A, Livingstone C, Kaddam I, Ferns G. Selection of the appropriate method for the assessment of insulin resistance. BMC Med Res Methodol. 2011;11:158. https://doi.org/10.1186/1471-2288-11-158.CrossRefPubMedPubMedCentral

52.

Kato K, Takeshita Y, Misu H, Zen Y, Kaneko S, Takamura T. Liver steatosis is associated with insulin resistance in skeletal muscle rather than in the liver in Japanese patients with non-alcoholic fatty liver disease. J Diabet Investig. 2015;6:158–163. https://doi.org/10.1111/jdi.12271.CrossRef

53.

Lee WH, Najjar SM, Kahn CR, Hinds TD Jr. Hepatic insulin receptor: new views on the mechanisms of liver disease. Metabolism. 2023;145:155607. https://doi.org/10.1016/j.metabol.2023.155607.CrossRefPubMed

54.

Svegliati-Baroni G, Ridolfi F, Di Sario A, Casini A, Marucci L, Gaggiotti G et al. Insulin and insulin-like growth factor-1 stimulate proliferation and type I collagen accumulation by human hepatic stellate cells: differential effects on signal transduction pathways. Hepatology. 1999;29:1743–1751. https://doi.org/10.1002/hep.510290632.CrossRefPubMed

55.

Cai CX, Buddha H, Castelino-Prabhu S, Zhang Z, Britton RS, Bacon BR et al. Activation of insulin-PI3K/Akt-p70S6K pathway in hepatic stellate cells contributes to fibrosis in nonalcoholic steatohepatitis. Dig Dis Sci. 2017;62:968–978. https://doi.org/10.1007/s10620-017-4470-9.CrossRefPubMed

56.

Masuda K, Noguchi S, Ono M, Ochi T, Munekage K, Okamoto N et al. High fasting insulin concentrations may be a pivotal predictor for the severity of hepatic fibrosis beyond the glycemic status in non-alcoholic fatty liver disease patients before development of diabetes mellitus. Hepatol Res. 2017;47:983–990. https://doi.org/10.1111/hepr.12832.CrossRefPubMed

57.

Paradis V, Perlemuter G, Bonvoust F, Dargere D, Parfait B, Vidaud M et al. High glucose and hyperinsulinemia stimulate connective tissue growth factor expression: a potential mechanism involved in progression to fibrosis in nonalcoholic steatohepatitis. Hepatology. 2001;34:738–744. https://doi.org/10.1053/jhep.2001.28055.CrossRefPubMed

58.

Zhang F, Zhang Z, Kong D, Zhang X, Chen L, Zhu X et al. Tetramethylpyrazine reduces glucose and insulin-induced activation of hepatic stellate cells by inhibiting insulin receptor-mediated PI3K/AKT and ERK pathways. Mol Cell Endocrinol. 2014;382:197–204. https://doi.org/10.1016/j.mce.2013.09.020.CrossRefPubMed

59.

Chen X, Xiao J, Pang J, Chen S, Wang Q, Ling W. Pancreatic β-cell dysfunction is associated with nonalcoholic fatty liver disease. Nutrients. 2021. https://doi.org/10.3390/nu13093139.CrossRefPubMedPubMedCentral

60.

Siddiqui MS, Cheang KL, Luketic VA, Boyett S, Idowu MO, Patidar K et al. Nonalcoholic steatohepatitis (NASH) is associated with a decline in pancreatic beta cell (β-cell) function. Dig Dis Sci. 2015;60:2529–2537. https://doi.org/10.1007/s10620-015-3627-7.CrossRefPubMedPubMedCentral

61.

Musso G, Cassader M, De Michieli F, Rosina F, Orlandi F, Gambino R. Nonalcoholic steatohepatitis versus steatosis: adipose tissue insulin resistance and dysfunctional response to fat ingestion predict liver injury and altered glucose and lipoprotein metabolism. Hepatology. 2012;56:933–942. https://doi.org/10.1002/hep.25739.CrossRefPubMed

62.

Araki N, Takahashi H, Takamori A, Kitajima Y, Hyogo H, Sumida Y et al. Decrease in fasting insulin secretory function correlates with significant liver fibrosis in Japanese non-alcoholic fatty liver disease patients. JGH Open. 2020;4:929–936. https://doi.org/10.1002/jgh3.12367.CrossRefPubMedPubMedCentral

63.

Al-Mrabeh A. β-cell dysfunction, hepatic lipid metabolism, and cardiovascular health in type 2 diabetes: new directions of research and novel therapeutic strategies. Biomedicines. 2021. https://doi.org/10.3390/biomedicines9020226.CrossRefPubMedPubMedCentral

64.

Byrne CD, Targher G. NAFLD: a multisystem disease. J Hepatol. 2015;62:S47-64. https://doi.org/10.1016/j.jhep.2014.12.012.CrossRefPubMed

65.

Watt MJ, Miotto PM, De Nardo W, Montgomery MK. The liver as an endocrine organ-linking NAFLD and insulin resistance. Endocr Rev. 2019;40:1367–1393. https://doi.org/10.1210/er.2019-00034.CrossRefPubMed

66.

Trowell J, Alukal J, Zhang T, Liu L, Maheshwari A, Yoo HY et al. How good are controlled attenuation parameter scores from fibroscan to assess steatosis, NASH, and fibrosis? Dig Dis Sci. 2021;66:1297–1305. https://doi.org/10.1007/s10620-020-06269-4.CrossRefPubMed

Title: Insulin Resistance/Sensitivity Measures as Screening Indicators of Metabolic-Associated Fatty Liver Disease and Liver Fibrosis
Authors: Mohammad E. Khamseh
Mojtaba Malek
Soodeh Jahangiri
Sohrab Nobarani
Azita Hekmatdoost
Marieh Salavatizadeh
Samira Soltanieh
Haleh Chehrehgosha
Hoda Taheri
Zeinab Montazeri
Fereshteh Attaran
Faramarz Ismail-Beigi
Fariba Alaei-Shahmiri
Publication date: 04-03-2024
Publisher: Springer US
Keywords: Insulins
Insulins
Fatty Liver
Published in: Digestive Diseases and Sciences / Issue 4/2024
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI: https://doi.org/10.1007/s10620-024-08309-9

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits

STEP AAG HeroTeaserCollection image/© Tarek / Generated with AI / Stock.adobe.com, ACC 2024 Pediatric and Congenital Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Pulmonary Vascular Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Valvular Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 HF and Cardiomyopathies: Year in Review/© 2024 American College of Cardiology, Woman out walking/© Seventyfour / stock.adobe.com (symbolic image with model), Woman checking smartwatch /© saltdium / stock.adobe.com (symbolic image with model), Cardiac catheterization/© Damian / stock.adobe.com

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Aims

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2024

Homeobox Protein BarH-like 1 Promotes Gastric Cancer Progression by Activating Coiled-Coil Domain-Containing Protein 178

Vitamin D Levels as a Potential Modifier of Eosinophilic Esophagitis Severity in Adults

A Dedicated Celiac Disease Program Improves Celiac Quality Care Metrics and Short-Term Outcomes in Real Life

Intestinal Microbiota Modulates the Antitumor Effect of Oncolytic Virus Vaccines in Colorectal Cancer

Electroacupuncture Improving Intestinal Barrier Function in Rats with Irritable Bowel Syndrome Through Regulating Aquaporins

Epidemiology and Socioeconomic Impact of Pancreatic Cancer: An Analysis of the Global Burden of Disease Study 1990–2019

Highlights from the ACC 2024 Congress

ACC 2024 Congress Coverage