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Background/Objectives: This study evaluated the impact of continuous positive airway pressure (C-PAP) therapy combined with a rigorous diet regimen on obese patients with obstructive sleep apnea syndrome (OSAS). Methods: Sixty obese patients (BMI ≥ 30) diagnosed with severe OSAS were recruited in order to establish the evaluation of CPAP therapy with different extents of adherence to a rigorous diet regimen. After one year, significant improvements were observed. Results: BMI reduced by 12.32%, apnea–hypopnea index (AHI) by 22.04%, oxygen desaturation index (ODI) by 15.87%, total sleep time with oxygen saturation below 90% (TST90%) by 25.2%, and Epworth Sleepiness Scale (ESS) scores by 21.74%. Patients were, then, divided into three groups, based on adherence to the restricted diet, as well as to the correct use of the nocturnal C-PAP, showing different reductions in BMI, AHI, ODI, TST90%, and ESS, according to their adherence, based on the sum of % reduction in BMI + AHI into three groups. Conclusions: These findings underscore the effectiveness of combining C-PAP therapy with a strict diet in improving OSAS symptoms and overall health in obese patients. Future studies with larger cohorts and longer follow-up periods are needed to confirm these results and explore the long-term benefits of this integrated approach. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) is the most common liver cancer as well as the most prevalent cause of death in the adult patient population with cirrhosis. The occurrence of HCC is primarily caused by chronic liver inflammation that might occur because of a viral infection, non-alcoholic fatty liver disease (NAFLD), or various lifestyle-associated factors. The objective of this review was to summarize the current knowledge regarding the microenvironment of HCC, indicating how immune- and non-immune-cell stroma might affect the onset and progression of HCC. Therefore, in the following narrative review, we described the role of tumor-infiltrating neutrophils, bone-marrow-derived cells, tumor-associated mast cells, cancer-associated fibroblasts, tumor-associated macrophages, liver-sinusoidal endothelial cells, lymphocytes, and certain cytokines in liver inflammation and the further progression to HCC. A better understanding of the HCC microenvironment might be crucial to introducing novel treatment strategies or combined therapies that could lead to more effective clinical outcomes. [ABSTRACT FROM AUTHOR]

In the past thirty years, childhood obesity rates have risen significantly worldwide, affecting over 340 million children in affluent nations. This surge is intricately tied to metabolic disorders, notably insulin resistance, type 2 diabetes mellitus (T2DM), and the continually evolving spectrum of metabolic-associated (dysfunction) steatotic liver disease (MASLD). This review underscores the alarming escalation of childhood obesity and delves comprehensively into the evolving and dynamic changes of nomenclature surrounding diverse conditions of hepatic steatosis, from the initial recognition of non-alcoholic fatty liver disease (NAFLD) to the progressive evolution into MASLD. Moreover, it emphasizes the crucial role of pediatric endocrinologists in thoroughly and accurately investigating MASLD onset in children with T2DM, where each condition influences and exacerbates the progression of the other. This review critically highlights the inadequacies of current screening strategies and diagnosis, stressing the need for a paradigm shift. A proposed solution involves the integration of hepatic magnetic resonance imaging assessment into the diagnostic arsenal for children showing insufficient glycemic control and weight loss post-T2DM diagnosis, thereby complementing conventional liver enzyme testing. This holistic approach aims to significantly enhance diagnostic precision, fostering improved outcomes in this vulnerable high-risk pediatric population. [ABSTRACT FROM AUTHOR]

This article provides information on the diagnosis and management of cardiac amyloidosis (CA), a condition characterized by abnormal protein deposits in the heart tissue. CA can be caused by two main types of amyloidosis: light chain (AL) and transthyretin (ATTR) amyloidosis. The article highlights the challenges in diagnosing CA due to its varied symptoms and involvement of multiple organs. It suggests that internal medicine physicians, experienced in managing multisystemic disorders, can play a crucial role in early detection and treatment. The article discusses the latest guidelines, including the use of Tafamidis and Patisiran as treatment options, and emphasizes the importance of imaging techniques for diagnosis. It also emphasizes the need for a multidisciplinary approach and ongoing support for CA patients. [Extracted from the article]

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common condition with heterogeneous outcomes difficult to predict at the individual level. Feared complications of advanced MASLD are linked to clinically significant portal hypertension and are initiated by functional and mechanical changes in the unique sinusoidal capillary network of the liver. Early sinusoidal vasoregulatory changes in MASLD lead to increased intrahepatic vascular resistance and represent the beginning of portal hypertension. In addition, the composition and function of gut microbiota in MASLD are distinctly different from the healthy state, and multiple lines of evidence demonstrate the association of dysbiosis with these vasoregulatory changes. The gut microbiota is involved in the biotransformation of nutrients, production of de novo metabolites, release of microbial structural components, and impairment of the intestinal barrier with impact on innate immune responses, metabolism, inflammation, fibrosis, and vasoregulation in the liver and beyond. The gut–liver axis is a conceptual framework in which portal circulation is the primary connection between gut microbiota and the liver. Accordingly, biochemical and hemodynamic attributes of portal circulation may hold the key to better understanding and predicting disease progression in MASLD. However, many specific details remain hidden due to limited access to the portal circulation, indicating a major unmet need for the development of innovative diagnostic tools to analyze portal metabolites and explore their effect on health and disease. We also need to safely and reliably monitor portal hemodynamics with the goal of providing preventive and curative interventions in all stages of MASLD. Here, we review recent advances that link portal metabolomics to altered sinusoidal vasoregulation and may allow for new insights into the development of portal hypertension in MASLD. [ABSTRACT FROM AUTHOR]

Overweight and obesity are progressively increasing at all ages and worldwide, as also related mortality, morbidity (mainly cardio-metabolic risk and cancer) and health costs. In recent decades, the fight against obesity has been solely aimed at obtaining weight loss by changing lifestyle, by pharmacological treatments and/or bariatric surgery or endoscopy. Epidemiological evidence certifies the failure of this approach, which however remains the major recommendation in current clinical guidelines. Lifestyle changes produce poor and frustrating effects in the long-term. The most innovative anti-obesity drugs (GLP1 agonists, double GIP/GLP-1 agonists, triple GLP-1, GIP and glucagon receptor agonists) generate up to 20% weight loss. However, emerging limitations (i.e., high cost of therapy, weight gain after interruption of treatment, adverse events) and socio-economic risks (economic sustainability, inequity in the access to therapies) are generating concerns about their adequacy as the preferential answer to the obesity epidemic. Obesity derives from inadequate individual behavior but also from living in an unhealthy environment, able to disrupt the metabolic homeostasis. The available guidelines appear inadequate and ineffective, since they are merely oriented towards individual behavior and therapy, largely neglecting primary prevention measures to counteract an inadequate food production system, an unsustainable food market and the progressive rise of environmental obesogens. Specific and effective strategies should also target food production and marketing, as also the unsustainable production and release of toxic chemicals into the environment, to improve food safety and public health. [ABSTRACT FROM AUTHOR]

Non-alcoholic fatty liver disease (NAFLD) is a condition in which the pathological cumulation of fat with coexisting inflammation and damage of hepatic cells leads to progressive dysfunctions of the liver. Except for the commonly well-known major causes of NAFLD such as obesity, dyslipidemia, insulin resistance, or diabetes, an unbalanced diet and imbalanced nutritional status should also be taken into consideration. In this narrative review, we summarized the current knowledge regarding the micro- and macronutrient status of patients suffering from NAFLD considering various diets and supplementation of chosen supplements. We aimed to summarize the knowledge indicating which nutritional impairments may be associated with the onset and progression of NAFLD at the same time evaluating the potential therapy targets that could facilitate the healing process. Except for the above-mentioned objectives, one of the most important aspects of this review was to highlight the possible strategies for taking care of NAFLD patients taking into account the challenges and opportunities associated with the micronutrient status of the patients. The current research indicates that a supplementation of chosen vitamins (e.g., vitamin A, B complex, C, or D) as well as chosen elements such as zinc may alleviate the symptoms of NAFLD. However, there is still a lack of sufficient data regarding healthy ranges of dosages; thus, further research is of high importance in this matter. [ABSTRACT FROM AUTHOR]

The article discusses the potential benefits of Ramadan intermittent fasting (RIF) on gut microbiota and metabolic disturbances. The study found that RIF led to beneficial changes in gut microbiota, including increased diversity and a decrease in the Firmicutes/Bacteroidetes ratio, which is associated with gut dysbiosis. These changes were accompanied by improvements in anthropometric indices and serum cholesterol and triglyceride levels. The study suggests that RIF may be a promising modulator of gut microbiota and could have potential therapeutic applications in metabolic disorders. However, further research is needed to confirm these findings and explore the mechanisms underlying the effects of RIF on gut microbiota and metabolic homeostasis. [Extracted from the article]