Background & Aims The use of ultrasound scan (US) in non‐alcoholic fatty liver disease (NAFLD) screening overloads US waiting lists. We hypothesized and tested a hybrid two‐step method, consisting of applying a formula, to exclude subjects at low risk, before US. Methods The sample included 2970 males and females (937 with NAFLD) diagnosed by US. We selected eight formulas: Fatty Liver Index (FLI), Hepatic Steatosis Index (HIS), body mass index (BMI), waist circumference (WC), Abdominal Volume Index (AVI), waist‐to‐height ratio (WHtR), waist/height0.5 (WHT.5R) and Body Roundness Index (BRI), and calculated their performance in the two‐step method evaluating percentage reduction of the number of liver US (US reduction percentage), percentage of false negative and percentage of NAFLD identified. Results The US reductions percentage were 52.2% (WHtR), 52.1% (HIS), 51.8% (FLI), 50.8% (BRI), 50.7% (BMI and WHt_5R), 46.5% (WC) and 45.2% (AVI). The false negative percentage were 8.5% (WHtR), 7.9% (BRI), 7.3% (WHt_5R), 7.2% (BMI), 6.7% (HIS), 6.6% (FLI), 5.6% (WC) and 5.2% (AVI). The best percentage of NALFD identified was obtained using AVI (83.6%) before US, then WC (82.2%), FLI (79%), HIS (78.9%), BMI (77.3%), WHt_5R (76.9%), BRI (74.8%) and WHtR (73%). Conclusion The best formula to use in two‐step diagnostic NAFLD screening was AVI, which showed a low false negative rate and a higher percentage of identified NAFLD. Other studies evaluating the economic advantages of this screening method are warranted.

BACKGROUND Few studies have examined intestinal motility disorders, which are disabling conditions associated with chronic functional constipation, whose pathogenesis is actually not well-defined. AIM To investigate the relationship between serum 25-hydroxyvitamin D levels and functional chronic constipation associated to intestinal motility disorders. METHODS We performed a prospective case-control study, from May-June to November 2017. Glucose/lactulose breath tests, radiopaque markers (multiple capsule techniques) and wireless motility capsule analysis were used to assess colonic and oro-cecal transit time, after excluding small-intestinal bacterial overgrowth condition. Then, we measured 25-hydroxyvitamin D levels in patients with intestinal motility disorders and we further evaluated the influence of intestinal motility disorders on psychological symptoms/quality of life using validated questionnaires, the Irritable Bowel Syndrome Quality of life (IBS-QOL), the Short Form Health Survey 12, and the Hospital Anxiety and Depression Scale 14 (HADS-14 A and HADS-14 D). RESULTS We enrolled 86 patients with chronic functional constipation associated to intestinal motility disorders and 86 matched healthy subjects. Patients with intestinal motility disorders had lower 25-hydroxyvitamin D levels ( P < 0.001), and they showed a significant impairment of all health-related quality of life and psychological tests (IBS-QOL, Short Form Health Survey 12-Physical Component Summary, Short Form Health Survey 12-Mental Component Summary, HADS-14 A and HADS-14 D), as compared to the control group ( P < 0.001), which significantly correlated with low vitamin D levels ( r = - 0.57, P < 0.001; r = 0.21, P = 0.01; r = - 0.48, P < 0.001; r = - 0.57, P < 0.001; r = - 0.29, P < 0.001, respectively). At multivariate analysis vitamin D low levels remained a significant independent risk factor for the occurrence of intestinal motility disorder (odds ratio = 1.19; 95% confidence interval: 1.14-1.26, P < 0.001). CONCLUSION Vitamin D deficiency, anxiety and depression symptoms are commonly associated with chronic functional constipation induced by intestinal motility disorders. Vitamin D serum levels should be routinely measured in these patients.

Background: Irisin, a hormone-like myokine, regulates energy homeostasis and mediates the benefits of physical activity on health. Methods: To estimate the effect of different diets on irisin concentrations in subjects with the Metabolic Syndrome (MetS). Methods: Subjects with MetS were derived from a population survey; 163 subjects were enrolled and randomized to a: Low Glycaemic Index (LGID), Mediterranean (MD) or Low Glycaemic Index Mediterranean (LGIMD) Diet, and the groups were compared, also with 80 controls without MetS. Sociodemographic, medical and nutritional data were collected and fasting blood samples drawn. Subjects underwent LUS and bioimpedentiometry. Generalized Estimating Equations were performed. Results: At baseline, lower irisin concentrations were observed in MetS subjects. Mean irisin levels increased in all diet groups but only the LGID group reached statistical significance, as well as showing an interaction between LGID and time at the sixth month examination (4.57, 95% CI −1.27, 7.87). There was a positive effect of Vegetable Proteins (0.03, 95% CI −0.01,0.06) and Saturated Fatty Acids (0.04, 95% CI 0.01, 0.07) on irisin concentrations. In the LGIMD, a positive effect on Fat-Free Mass (0.38, 95% CI 0.19, 0.57) and a negative effect on the Body Mass Index (−0.75, 95% CI −1.30, −0.19) were observed. Conclusions: There seems to be a link between diet and muscle physiology. We showed that patients following a LGID had higher levels of irisin, a promising biomarker of muscle activity.

Background: The high prevalence of non-alcoholic fatty liver disease (NAFLD) observed in Western countries is due to the concurrent epidemics of overweight/obesity and associated metabolic complications, both recognized risk factors. A Western dietary pattern has been associated with weight gain and obesity, and more recently with NAFLD. Methods: This is a baseline cross-sectional analysis of 136 subjects (79 males) enrolled consecutively in the NUTRIATT (NUTRItion and Ac-TiviTy) study. Study subjects had moderate or severe NAFLD diagnosed by using Fibroscan-CAP. Food Frequency Questionnaire was used to obtain information about food intake. Statistical analysis included descriptive statistics and a multivariable logistic regression model. Results: The mean age was 49.58 (±10.18) with a mean BMI of 33.41 (±4.74). A significant inverse relationship was revealed between winter ice-cream intake and NAFLD severity (O.R. 0.65, 95% C.I. 0.95–0.99); chickpeas intake and NAFLD severity (O.R. 0.57, 95% C.I. 0.34–0.97), and not industrial aged-cheeses type (O.R. 0.85, 95% C.I. 0.74–0.98). A statistically significant positive association also emerged between rabbit meat (O.R. 1.23, 95% C.I. 1.01–1.49), industrial type aged cheeses (O.R. 1.17, 95% C.I. 1.01–1.35), milk-based desserts (no winter ice cream) (O.R. 1.11, 95% C.I. 1.01–1.21), fats (O.R. 1.12, 95% C.I. 1.01–1.25), and NAFLD severity. Conclusion: The fresh foods from non-intensive farming and high legume intake that characterize the Mediterranean diet would seem to be beneficial for patients with NAFLD.

<p><strong>Introducción: </strong>Estimar la eficiencia de dos programas de actividad física sobre la NAFLD</p><p><strong>Métodos: </strong>Sujetos con NAFLD moderada o severa que habían participado a un estudio de pobación en el sur de Italia fueron invitados a participar. Fue completado un cuestionario, se tomaron medidas antropométricas y se realizó una ecografia hepática. Cada participante proveyó el consenso informato. Los participantes fueron aleatorizados a un programa aerobico (actividad aerobica moderada per 30 minutos, 5 veces a la semana) o un programa mixto (aerobico más entrenamiento de la fuerza de los grandes grupos musculares, 60 minutos, tres veces a la semana). Fue medida la adherencia a los programas y se aplicó un modelo linear mixto a los datos.</p><p><strong>Resultados: </strong>El programa aerobico tuvo muy buena adherencia y esta aumentó con el tiempo mientras el programa mixto tuvo 100% de adherencia. No hubo diferencias estadísticamente significativas en el score de NAFLD al enrolamiento, mientras hubo diferencias estadísticamente significativas en el score medio de NAFLD después de 6 meses pero el score en el grupo del programa aerobico tuvo una reducción del 22% más intensa que el programa mixto. Este último programa por lo tanto se ha mostrado menos efectivo que el programa aerobico.</p><p><strong>Conclusión: </strong>Un programa de actividad física aerobica es un tratamiento realístico que podría ser efectuado no solo para la NAFLD sino también como prevención primaria de otras enfermedades crónicas.</p>