Gastroenterologia y hepatologia最新文献

Objective: The purpose of this review was to examine evidence on the association between poor sleep quality and disease activity in inflammatory bowel disease (IBD).

Patients and methods: PubMed, Embase, Scopus, and the Web of Science were searched till July 15, 2025, for studies reporting an association between sleep quality and IBD. Outcomes were pooled as Odds ratio (OR) in a random-effects meta-analysis model.

Results: Twenty studies were included. Most studies were cross-sectional. The majority used the Pittsburgh Sleep Questionnaire Index for assessing sleep quality. Meta-analysis showed that poor sleep quality was significantly associated with active disease in IBD (OR: 2.54 95% CI: 1.85, 3.49 I²=80%). Subgroup analysis showed a significant association between poor sleep quality and active disease in CD, but not in UC. In subgroup analyses based on study design, results were significant only in cross-sectional studies, not in cohort studies. Meta-regression analysis using the moderators: sample size, age, males, body mass index, disease duration, prevalence of active disease and poor sleep quality, IBD surgery, and Newcastle Ottawa scale score did not show significant results.

Conclusions: Low-quality evidence, mostly from cross-sectional data, suggests an association between poor sleep quality and active disease in IBD. However, the findings were not replicated by prospective cohort studies. Given the predominance of cross-sectional data, the possibility of reverse causation, whereby active disease itself leads to impaired sleep quality, cannot be excluded. Further robust studies are needed to support these findings.

Objective: To evaluate the diagnostic accuracy of five non-invasive fatty liver indices and their association with obesity in a large cohort of Spanish workers, stratified by sex.

Patients and methods: A cross-sectional analysis was conducted on 386,924 workers (232,814 men and 154,110 women) who underwent routine occupational health assessments between 2009 and 2019. Anthropometric, clinical, and biochemical parameters were collected following standardized procedures. Physical activity and adherence to the Mediterranean diet were assessed using validated IPAQ and PREDIMED questionnaires. Diagnostic performance was evaluated using ROC curves and area under the curve (AUC) values for each fatty liver index.

Results: All indices showed significant sex-based differences. FLI and LAP presented the highest AUC values for identifying obesity in both sexes (FLI: AUC 0.907 in men and 0.972 in women; LAP: AUC 0.836 in men and 0.878 in women). FLI also demonstrated the strongest association with higher obesity prevalence across tertiles. ZJU showed good performance, whereas HSI and FLD exhibited lower accuracy, particularly among men. Lifestyle factors and education level influenced index values, with sedentary behavior, low adherence to the Mediterranean diet, and lower educational attainment associated with worse index performance.

Conclusions: FLI and LAP are the most accurate non-invasive indices for identifying obesity-associated fatty liver in this large Spanish working population. Their performance varies by sex and is influenced by sociodemographic and lifestyle factors. These findings support the relevance of FLI and LAP for large-scale screening and highlight the importance of integrating lifestyle assessments into occupational health evaluations.

Objective:  Malnutrition is a serious complication of inflammatory bowel disease (IBD), associated with increased morbidity, postoperative complications, and reduced quality of life. While well-documented in Western populations, data on nutritional status in understudied IBD populations remain scarce. This study aims to comprehensively evaluate the nutritional status of an IBD cohort at a tertiary referral center in Algeria using multiple assessment tools, to identify factors associated with malnutrition, and to explore the relationship between inflammatory activity and nutritional parameters.

Patients and methods:  A prospective cross-sectional study was conducted at a tertiary referral center. Nutritional assessment included anthropometric measurements, biochemical parameters, and four validated scores: CONUT, McClave, HALP, and GLIM criteria. Disease activity was assessed using the Harvey-Bradshaw Index for Crohn's disease and the Partial Mayo Score for ulcerative colitis.

Results:  Ninety patients were included forming a Crohn's-dominant cohort (94.4% Crohn's disease). Mean age was 39.5 ± 13.7 years, 53.3% female. Overall, 24.4% had active disease. Nutritional assessment revealed: 18.9% had low BMI (<18.5 kg/m²). Malnutrition prevalence varied by tool: CONUT 46.7%, McClave 20.6%, HALP 26.8%, and GLIM 14.6%. Active disease significantly correlated with nutritional deterioration and worse nutritional scores (p<0.01). Multivariate logistic regression analysis was performed indicates that although clinical flare and hospitalization were associated with malnutrition in univariate analysis, none of the variables reached statistical significance in the multivariate analysis Conclusions: Malnutrition is highly prevalent in IBD patients, particularly during active disease. The inflammatory process plays a crucial role in nutritional deterioration. Systematic nutritional screening using composite scores should be integrated into routine management, especially during disease flares.