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Diabetes and obesity can damage the liver to the point of failure – but few people know their risk of developing liver disease

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theconversation.com – Madona Azar, Associate Professor of Medicine, UMass Chan Medical School – 2024-07-22 07:21:55
Insulin resistance links MASLD to several other metabolic diseases.
Kateryna Kon/Science Photo Library via Getty Images

Madona Azar, UMass Chan Medical School

Liver disease is frighteningly common worldwide.

Metabolic dysfunction-associated steatotic liver disease, or MASLD, is an umbrella term describing conditions related to a buildup of fat in the liver. Formerly known as nonalcoholic fatty liver disease, this affects 1 in 4 people worldwide. Among those with type 2 diabetes, insulin resistance, obesity or all three, the prevalence of MASLD increases to 3 in 4 people.

As a diabetologist, the possibility of liver disease is on my mind every time I see a patient. Understanding your risk of developing this common yet underrecognized condition is essential to treating it.

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What is MASLD?

MASLD is a complex disorder with both environmental and genetic contributions. In its early stages, liver cells accumulate fat in a called steatosis. Major sources of this fat include adipose tissue as well as fatty acids the liver makes in response to insulin resistance and excess caloric intake. This fat accumulation can enlarge the liver and interfere with its normal functioning.

Over time, fatty acids activate enzymes, which can produce toxic byproducts capable of causing liver cell injury, inflammation and scarring. This condition is better known as MASH, or metabolic dysfunction-associated steatohepatitis. Progression to MASH is more common in the presence of other risk factors such as type 2 diabetes, insulin resistance and metabolic syndrome.

Left unaddressed, MASLD and MASH can progress to liver scarring, failure and, in some cases, cancer. They also increase risk of death from cardiovascular disease and liver-related complications.

In the U.S., MASH is the leading cause of liver transplants due to hepatic cancer among women and in those 65 and older. It is also on track to overtake hepatitis B and C as the main reason people develop liver cancer and thus need a liver transplant.

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Liver disease and type 2 diabetes

Three out of four people with type 2 diabetes have MASLD. Linking liver disease, type 2 diabetes and obesity is the key role insulin resistance plays in their genesis.

Obesity is associated with increased fat deposits around the internal organs and higher levels of fatty acids delivered to the liver. Accumulation of fat in the liver increases its resistance to insulin.

Normally, insulin suppresses glucose production in the liver when blood sugar is high. When the liver becomes resistant to insulin, it produces more glucose despite elevated blood sugar levels, which in turn contributes to the of type 2 diabetes.

A 2015 meta-analysis found that people with MASLD have a nearly twofold greater risk of developing type 2 diabetes than those without the disease. MASLD is also more likely to progress to MASH in the presence of type 2 diabetes.

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MASLD disproportionately affects certain ethnic groups. For instance, 1 in 5 people of Hispanic descent in the U.S. have MASLD, with or without diabetes. This is thought to be related to genetic mutations that affect how the liver cells process fat. One particular mutation more common in Hispanic people promotes steatosis by interfering with the cells’ ability to clear fat deposits.

Treating MASLD and MASH

The silver lining is that management of obesity and type 2 diabetes – such as through lifestyle changes – is very similar to management of MASLD. The most critical early interventions for type 2 diabetes can also help with MASLD, and this is not surprising given how closely interrelated these two conditions are.

The best way to reverse the early stages of MASLD is with weight loss through healthy eating habits and regular exercise. The aim is to shed at least 5% to 10% of initial body weight, maintain that weight loss through sustainable and realistic lifestyle choices, and avoid excess alcohol intake to limit additional liver injury.

New medications to treat diabetes, such as GLP-1 receptor agonists like Ozempic and Mounjaro, as well as SGLT2 inhibitors like Jardiance or Invokana, have also shown benefit in early stages of MASLD. These drugs promote weight loss, which in turn improves MASLD. In addition, studies have shown that Ozempic and Mounjaro could reverse MASH, even with inflammation and fibrosis.

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Older medications used for diabetes, such as pioglitazone, typically can also help reduce the progression of MASH by reducing insulin resistance.

Liver disease progresses in stages of increasing .

In people with severe obesity or who have not had with lifestyle changes and weight loss drugs, bariatric surgery is another highly effective option to treat MASLD, as it is associated with significant and sustained weight loss.

New drugs are also in the pipeline. The Food and Drug Administration recently approved a new medication called resmetirom to treat MASH with advanced liver scarring.

However, a cure for this chronic disease remains elusive. This is why it is essential to diagnose MASLD as early as possible and use proven measures that can be maintained long term. Treatments and lifestyle changes need to be deployed as early as possible, before inflammation and scarring have firmly set in. MASH gets trickier to treat in more advanced stages when liver damage becomes irreversible. For instance, while Ozempic may help treat early MASH, it doesn’t benefit with more advanced stages of liver scarring.

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Ignorance is not bliss

Very few people are aware of MASLD and its implications, including those living with it. While roughly over 35% of U.S. adults have MASLD, less than 5% are aware they have liver disease.

MASH can be difficult to diagnose because it either causes no symptoms or can be mistaken for other conditions. Patients may have the condition for years and not be aware that it is slowly and meticulously causing damage. In that sense, MASH is strikingly similar to type 2 diabetes or high cholesterol.

Child measuring blood sugar levels via finger prick on device held by a clinician
Recognizing MASLD is the first step to treating it.
supersizer/E+ via Getty Images

Young people are increasingly being diagnosed with early-onset MASLD. Indeed, MASLD with MASH is the most common pediatric liver condition, affecting nearly 8% of and adolescents and over 34% of children with obesity in the U.S. These children and adolescents are at high risk of developing type 2 diabetes and have a significantly increased lifetime risk of cardiovascular disease and cancer.

costs for people with type 2 diabetes and MASH are estimated to reach US$55 billion over the next 20 years, accounting for 65,000 liver transplants, 1.37 million cardiovascular-related deaths and 812,000 liver-related deaths.

These grim statistics need not be if MASH is tackled early and aggressively.

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If you are one of the millions of Americans with prediabetes or diabetes and are also overweight, you most likely have some degree of MASLD or MASH. Being aware of MASLD and getting checked is the first step to addressing it.

Promptly determining the best way to treat your MASLD or MASH is the next step. An early referral to a liver specialist will help you halt the progression of this challenging and common condition and take advantage of the treatment breakthroughs researchers have made in the past few years.The Conversation

Madona Azar, Associate Professor of Medicine, UMass Chan Medical School

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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The Conversation

Will your phone one day let you smell as well as see and hear what’s on the other end of a call?

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theconversation.com – Jian Liu, Assistant Professor of Electrical Engineering and Computer Science, of Tennessee – 2024-09-16 07:27:05

Phones that transmit odors seem like a great idea, but careful what you wish for!

Teo Mahatmana/iStock via Getty Images

Jian Liu, University of Tennessee

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Curious Kids is a for of all ages. If you have a question you’d like an expert to answer, send it to curiouskidsus@theconversation.com.


Is it possible to make a phone through which we can smell, like we can hear and see? – Muneeba K., age 10, Pakistan


Imagine this: You pick up your phone for a call with a friend. Not only can you see their face and hear their voice, but you can also smell the cookies they just baked. It sounds like something out of a science fiction , but could it actually happen?

I’m a computer scientist who studies how machines sense the world.

What phones do now

When you listen to music or to someone on your phone, you can hear the sound through the built-in speakers. These speakers convert digital signals into physical vibrations using a tiny component called a diaphragm. Your ears sense those vibrations as sound waves.

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Your phone also has a screen that displays images and . The screen uses tiny dots known as pixels that consist of three primary colors: red, green and blue. By mixing these colors in different ways, your phone can show you everything from beautiful beach scenes to cute puppies.

Smelling with phones

Now how about the sense of smell? Smells are created by tiny particles called molecules that float through the and reach your nose. Your nose then sends signals to your brain, which identifies the smell.

So, could your phone send these smell molecules to you? Scientists are working on it. Think about how your phone screen works. It doesn’t have every color in the world stored inside it. Instead, it uses just three colors to create millions of different hues and shades.

How your sense of smell works.

Now imagine something similar for smells. Scientists are developing digital scent technology that uses a small number of different cartridges, each containing a specific scent. Just like how pixels mix three colors to create images, these scent cartridges could mix to create different smells.

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Just like images on your phone are made of digital codes that represent combinations of pixels, smells produced by a future phone could be created using digital codes. Each smell could have a specific recipe made up of different amounts of the ingredients in the cartridges.

When you a digital scent code, your phone could mix tiny amounts of the different scents from the cartridges to create the desired smell. This mix would then be released through a small vent on the phone, allowing you to smell it. With just a few cartridges, your phone could potentially create a huge variety of smells, much like how red, green and blue pixels can create countless colors.

Researchers and companies are already working on digital odor makers like this.

The challenges to making smell phones

Creating a phone that can produce smells involves several challenges. One is designing a system that can produce thousands of different smells using only a few cartridges. Another is how to control how strong a scent should be and how long a phone should emit it. And phones will also need to sense odors near them and convert those to digital codes so your friends’ phones can send smells to you.

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The cartridges should also be easy to refill, and the chemicals in them be safe to breathe. These hurdles make it a tricky but exciting area of research.

An odiferous future

Even though we’re not there yet, scientists and engineers are working hard to make smell phones a reality. Maybe one day you’ll be able to not only see and hear your friend’s birthday party over the phone, but also smell the candles they blew out!


Hello, curious kids! Do you have a question you’d like an expert to answer? Ask an adult to send your question to CuriousKidsUS@theconversation.com. Please tell us your name, age and the where you live.

And since curiosity has no age limit – adults, let us know what you’re wondering, too. We won’t be able to answer every question, but we will do our best.The Conversation

Jian Liu, Assistant Professor of Electrical Engineering and Computer Science, University of Tennessee

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The Conversation

a double shot of US history

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theconversation.com – Kyle G. Volk, Professor of History, University of Montana – 2024-09-16 07:28:46

a beer in Raceland, La.

Russell Lee for Farm Security Administration/WPA

Kyle G. Volk, University of Montana

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Text saying: Uncommon Courses, from The Conversation

Uncommon Courses is an occasional from U.S. highlighting unconventional approaches to teaching.

Title of course:

“Intoxication Nation: Alcohol in American History”

What prompted the idea for the course?

I wanted to get excited about studying the past by learning about something that is very much a part of their own lives.

Alcohol – somewhat surprisingly to me at first – prominently in my own research on minority rights and U.S. democracy in the mid-19th century. As a result, I knew quite a bit about the temperance movement and conflicts over prohibition during that period. Designing this course allowed me to broaden my expertise.

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What does the course explore?

Prohibition is a must-do subject. Students expect it. But I several hundred years of history: from the 17th-century invention of rum – as a byproduct of sugar produced by enslaved people – to the rise of craft beer and craft spirits in the 21st century.

A faded poster with an illustration of a person about to smash a huge bottle of alcohol, and the message 'Close the saloons' at the top.

A temperance poster from the World War I era.

Office of Naval Records and Library via National Archives Catalog

Along the way, I’m thrilled when students get excited about details that allow them to a more complicated historical cocktail. For example, they learn why white women’s production of hard cider was crucial to the survival of colonial Virginia. The short answer: Potable was in short supply, alcoholic drinks were far healthier, and white men – and their indentured and enslaved workforce – were busy raising tobacco. It fell to women to turn fruit into salvation.

Why is this course relevant now?

Alcohol remains a big and almost inescapable part of American society. But of late, Americans have been drinking differently – and thinking about drinking differently.

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Examples abound. Alcohol producers, we learn, now face competition from legalized weed. Drinking l evels rose during the COVID-19 pandemic, yet interest is declining among Gen Zers. The “wine mom” culture that brought some mothers together now faces mounting criticism.

And, of course, there’s the never-ending debate about the health benefits and risks of alcohol. Of late, the risks seem to be dominating headlines.

What’s a critical lesson from the course?

Alcohol has been a highly controversial, central aspect of the American experience, shaping virtually all sectors of our society – political and constitutional, business and economic, social and cultural.

What materials does the course feature?

What will the course prepare students to do?

Like any history course, this one aims to develop student’s analytical, written, research and verbal skills. In lots of ways, the topic is just a tool to get students to grow their brains. But I also seek to grow students’ critical awareness of the place of alcohol in their own lives. The course has also informed students’ paths after graduation – including some who wound up working in the alcohol industry or recovery organizations.The Conversation

Kyle G. Volk, Professor of History, University of Montana

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Sunflowers make small moves to maximize their Sun exposure − physicists can model them to predict how they grow

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theconversation.com – Chantal Nguyen, Postdoctoral Associate at the BioFrontiers Institute, of Colorado Boulder – 2024-09-13 07:31:40

Sunflowers use tiny movements to follow the Sun’s path throughout the day.

AP Photo/Charlie Riedel

Chantal Nguyen, University of Colorado Boulder

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Most of us aren’t spending our days watching our houseplants grow. We see their signs of only occasionally – a new leaf unfurled, a stem leaning toward the window.

But in the summer of 1863, Charles Darwin lay ill in bed, with nothing to do but watch his plants so closely that he could detect their small movements to and fro. The tendrils from his cucumber plants swept in circles until they encountered a stick, which they proceeded to twine around.

“I am getting very much amused by my tendrils,” he wrote.

This amusement blossomed into a decadeslong fascination with the little-noticed world of plant movements. He compiled his detailed observations and experiments in a 1880 book called “The Power of Movement in Plants.”

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A zig-zagging line showing the movement of a leaf.

A diagram tracking the circumnutation of a leaf over three days.

Charles Darwin

In one study, he traced the motion of a carnation leaf every few hours over the course of three days, revealing an irregular looping, jagged path. The swoops of cucumber tendrils and the zags of carnation leaves are examples of inherent, ubiquitous plant movements called circumnutations – from the Latin circum, meaning circle, and nutare, meaning to nod.

Circumnutations vary in size, regularity and timescale across plant species. But their exact function remains unclear.

I’m a physicist interested in understanding collective behavior in living . Like Darwin, I’m captivated by circumnutations, since they may underlie more complex phenomena in groups of plants.

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Sunflower patterns

A 2017 study revealed a fascinating observation that got my colleagues and me wondering about the role circumnutations could play in plant growth patterns. In this study, researchers found that sunflowers grown in a dense row naturally formed a near-perfect zigzag pattern, with each plant leaning away from the row in alternating directions.

This pattern the plants to avoid shade from their neighbors and maximize their exposure to sunlight. These sunflowers flourished.

Researchers then planted some plants at the same density but constrained them so that they could grow only upright without leaning. These constrained plants produced less oil than the plants that could lean and get the maximum amount of sun.

While farmers can’t grow their sunflowers quite this close together due to the potential for disease spread, in the future they may be able to use these patterns to up with new planting strategies.

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Self-organization and randomness

This spontaneous pattern formation is a neat example of self-organization in nature. Self-organization refers to when initially disordered systems, such as a jungle of plants or a swarm of bees, achieve order without anything controlling them. Order emerges from the interactions between individual members of the system and their interactions with the .

Somewhat counterintuitively, noise – also called randomness – facilitates self-organization. Consider a colony of ants.

Ants secrete pheromones behind them as they crawl toward a food source. Other ants find this food source by the pheromone trails, and they further reinforce the trail they took by secreting their own pheromones in turn. Over time, the ants converge on the best path to the food, and a single trail prevails.

But if a shorter path were to become possible, the ants would not necessarily find this path just by following the existing trail.

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If a few ants were to randomly deviate from the trail, though, they might stumble onto the shorter path and create a new trail. So this randomness injects a spontaneous change into the ants’ system that allows them to explore alternative scenarios.

Eventually, more ants would follow the new trail, and soon the shorter path would prevail. This randomness helps the ants adapt to changes in the environment, as a few ants spontaneously seek out more direct ways to their food source.

A group of honeybees spread out standing on honeycomb.

Beehives are an example of self-organization in nature.

Martin Ruegner/Stone via Getty Images

In biology, self-organized systems can be found at a range of scales, from the patterns of proteins inside cells to the socially complex colonies of honeybees that collectively build nests and forage for nectar.

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Randomness in sunflower self-organization

So, could random, irregular circumnutations underpin the sunflowers’ self-organization?

My colleagues and I set out to explore this question by following the growth of young sunflowers we planted in the lab. Using cameras that imaged the plants every five minutes, we tracked the movement of the plants to see their circumnutatory paths.

We saw some loops and spirals, and lots of jagged movements. These ultimately appeared largely random, much like Darwin’s carnation. But when we placed the plants together in rows, they began to move away from one another, forming the same zigzag configurations that we’d seen in the previous study.

Five plants and a diagram showing loops and jagged lines that represent small movements made by the plants.

Tracking the circumnutations made by young sunflower plants.

Chantal Nguyen

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We analyzed the plants’ circumnutations and found that at any given time, the direction of the plant’s motion appeared completely independent of how it was moving about half an hour earlier. If you measured a plant’s motion once every 30 minutes, it would appear to be moving in a completely random way.

We also measured how much the plant’s leaves grew over the course of two weeks. By putting all of these results together, we sketched a picture of how a plant moved and grew on its own. This information allowed us to computationally model a sunflower and simulate how it behaves over the course of its growth.

A sunflower model

We modeled each plant simply as a circular crown on a stem, with the crown expanding according to the growth rate we measured experimentally. The simulated plant moved in a completely random way, taking a “step” every half hour.

We created the model sunflowers with circumnutations of lower or higher intensity by tweaking the step sizes. At one end of the spectrum, sunflowers were much more likely to take tiny steps than big ones, leading to slow, minimal movement on average. At the other end were sunflowers that are equally as likely to take large steps as small steps, resulting in highly irregular movement. The real sunflowers we observed in our experiment were somewhere in the middle.

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Plants require light to grow and have evolved the ability to detect shade and alter the direction of their growth in response.

We wanted our model sunflowers to do the same thing. So, we made it so that two plants that get too close to each other’s shade begin to lean away in opposite directions.

Finally, we wanted to see whether we could replicate the zigzag pattern we’d observed with the real sunflowers in our model.

First, we set the model sunflowers to make small circumnutations. Their shade avoidance responses pushed them away from each other, but that wasn’t enough to produce the zigzag – the model plants stayed stuck in a line. In physics, we would call this a “frustrated” system.

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Then, we set the plants to make large circumnutations. The plants started moving in random patterns that often brought the plants closer together rather than farther apart. Again, no zigzag pattern like we’d seen in the field.

But when we set the model plants to make moderately large movements, similar to our experimental measurements, the plants could self-organize into a zigzag pattern that gave each sunflower optimal exposure to light.

So, we showed that these random, irregular movements helped the plants explore their surroundings to find desirable arrangements that benefited their growth.

Plants are much more dynamic than people give them credit for. By taking the time to follow them, scientists and farmers can unlock their secrets and use plants’ movement to their advantage.The Conversation

Chantal Nguyen, Postdoctoral Associate at the BioFrontiers Institute, University of Colorado Boulder

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