Encouraging

Encouraging PCI-32765 clinical trial playing with food, other messy play and regular times outside of meal to try new foods may be of benefit. “
“We read with interest the article by Ghouri et al.,1 who reviewed data from recent prospective studies evaluating the associations of nonalcoholic fatty liver disease (NAFLD) with incident

diabetes and cardiovascular disease (CVD). The authors concluded that there is a large and broadly consistent body of evidence establishing serum liver enzymes as predictors of incident diabetes. In contrast, although strong associations between serum liver enzymes and incident CVD have been described in several prospective studies and some studies have linked imaging-defined and biopsy-confirmed NAFLD with CVD risk, they concluded that the current evidence is inconsistent

because of few incident CVD events, insufficient potential confounders, or both.1 We believe that the current evidence for a significant association between NAFLD and diabetes is no stronger than the evidence for the association observed between NAFLD and CVD. The same degrees of uncertainty and the same criticisms raised by the authors (e.g., the heterogeneity of the studies, the paucity of study outcomes, and the Decitabine mw varying degrees of baseline adjustments for potential confounders) with respect to interpreting the results of the published studies that link NAFLD and CVD apply to those that link NAFLD and diabetes. Moreover, no studies have used liver biopsy to MCE公司 ascertain NAFLD and its association with diabetes, and only a few retrospective studies (all performed in Asian populations) have assessed ultrasound-diagnosed NAFLD as a determinant of incident diabetes.2-5 With respect to the association between NAFLD and CVD, the authors did not discuss the plentiful data linking NAFLD to an increased prevalence of clinical and subclinical CVD.6, 7 Again, they did not discuss recent data supporting potential pathophysiological and causative mechanisms linking

NAFLD and CVD.6 Overall, we believe that the increased CVD morbidity and mortality rates are some of the most important clinical features associated with NAFLD. To date, there is a growing body of evidence suggesting that NAFLD patients carry multiple CVD risk factors; CVD is much more common than liver disease as a cause of death in NAFLD patients, especially in those with more advanced stages of disease; and NAFLD is linked to an increased risk of incident CVD events.6 However, further study is needed to determine whether NAFLD poses an independent risk above and beyond known risk factors. There is a suggestion in that direction, but the studies are too few and are methodologically not rigorous. Additional large-scale studies are also needed to elucidate whether ameliorating NAFLD will ultimately prevent or slow the development and progression of CVD.

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