Background and Aims The effects of diet quality (DQ), physical activity (PA), and socioeconomic status (SES) on the risk of NAFLD are unclear. We examined the association among DQ, PA, SES, and NAFLD risk. Approach and Results This is a cross‐sectional analysis of the National Health and Nutrition Examination Surveys, 2017–2018, which included 3589 participants with reliable information on vibration‐controlled transient elastography (VCTE) measurements, 24‐h dietary recalls, PA, and SES. DQ was assessed by the Healthy Eating Index (HEI)‐2015. PA was determined by the Global Physical Activity Questionnaire. SES was assessed by the educational attainment and family poverty income ratio (PIR). Risk of NAFLD was considered by means of a composite outcome using VCTE measurements: non‐NAFLD versus NAFLD without clinically significant fibrosis (CSF) versus NAFLD with CSF. The NAFLD risk was lower in physically active (≥600 metabolic equivalent of task [MET] min/week) versus inactive participants (<600 MET min/week) (OR: 0.71, p = 0.043). A high‐quality diet (HQD) (HEI > 56.64) was associated with a lower risk of NAFLD (OR: 0.58, p < 0.01) compared with a non‐HQD. The lowest NAFLD risk was observed in those physically active with HQD (OR: 0.43, p < 0.01). Body mass index and waist circumference significantly mediated the effect of DQ and PA on NAFLD risk. Education (college or above) (OR: 0.65, p = 0.034), but not PIR, was associated with a reduced NAFLD risk. HQD and increased PA partially mediated the effect of education on NAFLD risk. The total effect of education on NAFLD risk mediated by DQ was 29% and by PA was 8%. Conclusions HQD, increased physical activity, and college education were associated with lower NAFLD risk in the US population.

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Background and Objectives: Controlling negative emotions and getting sufficient sleep are key factors in reducing medical errors and optimizing quality of care. The objective of this study was to measure the relationship between the emotions of medical residents and sleep as measured by a wearable device. Methods: We conducted a cross-sectional study addressing all residents of all postgraduation years and specialties at an Accreditation for Graduate Medical Educations-I accredited institution over 6 months. Sleep quantity and quality were measured by Fitbit Charge 2 device, and daily emotions by the Positive and Negative Affect Schedule questionnaire. Results: We included a total of 45 participants with a total of 1,112 observations (response rate=19.3%). The mean duration of total daily sleep was 5.9±1.6 hours, with a deep sleep time of 1.1±0.4 hours. We found a negative association between negative emotions and total sleep (rrm=-0.14, P&lt;.0001) and deep sleep (rrm=-0.11, P=.0005) using repetitive measures correlation. A linear regression model to predict the negative emotions of the residents revealed additional determinants beyond deep sleep. Conclusions: Our findings provide a further understanding of the importance of sleep quality on emotions by emphasizing deep sleep as a predictor of the second-day affect. Residency programs should strive to provide an ideal sleep environment to their residents and deliver workshops to deal with negative emotions.

Patients with chronic liver disease (CLD) may present with varying severities of liver fibrosis. Fortunately, noninvasive testing with liver elastography is now widely available. It has changed our approach to staging liver disease, providing an opportunity to detect the presence of compensated advanced CLD (cACLD). 1,2 Nevertheless, noninvasive prognosis in cACLD, particularly those with cirrhosis and portal hypertension (PH), remains imperfect. For example, the rate of decompensation (variceal bleed, hepatic encephalopathy, or ascites) in patients with NASH cirrhosis varied significantly from 3% to 19% in two recent phase 3 trials. 3,4 This observation indicates that new tools are needed to improve the prediction of clinical progression from a compensated to decompensated state in cACLD.

The impact of nutrition on HIV-infected children has been evaluated in multiple studies. Our review of the current trends of nutrition-related studies revealed that the focus has moved from simply the disease consequences of HIV to ensuring that antiretroviral therapy-treated children are well nourished to ensure growth and development. This update aims to present the state of the art regarding nutrition of HIV-infected children and the real potential for nutrition to serve as a dynamic therapy in this group. Recent World Health Organization reports indicate that the HIV/AIDS disease is curbing in incidence worldwide despite the high 1.8 million children, less than 15 years, reported in 2017. In addition, the literature supports the complexity and bidirectional relation between nutrition and HIV. HIV infection has a substantial effect on the nutritional status, in particular, the gastrointestinal side effects, which, in turn, have a profound impact on HIV infection. Advances in the field have transformed the course of the disease into a chronic illness, where more attention was given to lifestyle and quality of life including nutrition. However, achievement of food security, nutrition accessibility, and appropriate handling of nutrition-related complications of HIV infection are remarkable challenges, particularly, in resource poor environments, where most HIV infections exist.

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The prevalence of NAFLD may be as high as 40% among persons living with the human immunodeficiency virus (PLWH). Notably, Cardiovascular disease (CVDs) is an increasing concern among PLWH. However, the association of NAFLD with the risk of CVDs is unknown, and particularly, the relationship between NAFLD and CVD among PLWH has not been well elucidated. This study aimed to explore CVD events among PLWH with NAFLD compared to PLWH without NAFLD. Methods: This population-based, multicenter, retrospective cohort study was conducted using the TriNetX platform. All adult patients( .18 years) with HIV were identified, and among these, patients diagnosed with NAFLD were identified after excluding other chronic liver disease etiologies and included as the main group, and patients without NAFLD were included as controls (Non-NAFLD). We performed a 1:1 propensity score matching (PSM) for demographics, BMI, and comorbidities. The main outcome was major CVD events. Hazard ratio (HR) was calculated to compare the association of NAFLD with CVD outcomes. Results: A total of 151,868 PLWH were identified. Among these, 4,969 patients had NAFLD, and 146,899 patients without NAFLD were included in the control group. After PSM, PLWH with NAFLD and without NAFLD (4,463 patients) were well matched. The majority of the patients were men (60%) and White(70.1%) in both groups. Patients with NAFLD were more likely to have more comorbidities such as diabetes, hypertension, chronic respiratory disease, hypothyroidism, CKD, sleep apnea, and hyperlipidemia than the controls. In adjusted analysis (Table ), the risk of ischemic heart disease (