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Article: NAFLD Fibrosis Progression and Type 2 Diabetes: The Hepatic-Metabolic Interplay.

Cernea, Simona

2024 Volume 14, Issue 2

Abstract: The bidirectional relationship between type 2 diabetes and (non-alcoholic fatty liver disease) NAFLD is indicated by the higher prevalence and worse disease course of one condition in the presence of the other, but also by apparent beneficial effects ... ...

Abstract	The bidirectional relationship between type 2 diabetes and (non-alcoholic fatty liver disease) NAFLD is indicated by the higher prevalence and worse disease course of one condition in the presence of the other, but also by apparent beneficial effects observed in one, when the other is improved. This is partly explained by their belonging to a multisystemic disease that includes components of the metabolic syndrome and shared pathogenetic mechanisms. Throughout the progression of NAFLD to more advanced stages, complex systemic and local metabolic derangements are involved. During fibrogenesis, a significant metabolic reprogramming occurs in the hepatic stellate cells, hepatocytes, and immune cells, engaging carbohydrate and lipid pathways to support the high-energy-requiring processes. The natural history of NAFLD evolves in a variable and dynamic manner, probably due to the interaction of a variable number of modifiable (diet, physical exercise, microbiota composition, etc.) and non-modifiable (genetics, age, ethnicity, etc.) risk factors that may intervene concomitantly, or subsequently/intermittently in time. This may influence the risk (and rate) of fibrosis progression/regression. The recognition and control of the factors that determine a rapid progression of fibrosis (or its regression) are critical, as the fibrosis stages are associated with the risk of liver-related and all-cause mortality.
Language	English
Publishing date	2024-02-18
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662250-6
ISSN	2075-1729
ISSN	2075-1729
DOI	10.3390/life14020272
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Article ; Online: Screening and interventions to prevent nonalcoholic fatty liver disease/nonalcoholic steatohepatitis-associated hepatocellular carcinoma.

Cernea, Simona / Onișor, Danusia

World journal of gastroenterology

2023 Volume 29, Issue 2, Page(s) 286–309

Abstract: Liver cancer is the sixth most commonly diagnosed cancer worldwide, with hepatocellular carcinoma (HCC) comprising most cases. Besides hepatitis B and C viral infections, heavy alcohol use, and nonalcoholic steatohepatitis (NASH)-associated advanced ... ...

Abstract	Liver cancer is the sixth most commonly diagnosed cancer worldwide, with hepatocellular carcinoma (HCC) comprising most cases. Besides hepatitis B and C viral infections, heavy alcohol use, and nonalcoholic steatohepatitis (NASH)-associated advanced fibrosis/cirrhosis, several other risk factors for HCC have been identified (
MeSH term(s)	Humans ; Carcinoma, Hepatocellular/diagnosis ; Carcinoma, Hepatocellular/epidemiology ; Carcinoma, Hepatocellular/etiology ; Non-alcoholic Fatty Liver Disease/complications ; Non-alcoholic Fatty Liver Disease/diagnosis ; Non-alcoholic Fatty Liver Disease/epidemiology ; Liver Neoplasms/epidemiology ; Liver Neoplasms/etiology ; Liver Neoplasms/prevention & control ; Diabetes Mellitus, Type 2/complications ; Prospective Studies ; Liver Cirrhosis/complications ; Liver Cirrhosis/pathology ; Fibrosis
Language	English
Publishing date	2023-01-05
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2185929-2
ISSN	2219-2840 ; 1007-9327
ISSN (online)	2219-2840
ISSN	1007-9327
DOI	10.3748/wjg.v29.i2.286
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Article ; Online: Intermittent fasting for the management of NAFLD

Cernea Simona / Ruţa Florina

Acta Marisiensis - Seria Medica, Vol 69, Iss 1, Pp 3-

Is there enough evidence?

2023 Volume 10

Abstract: The pathogenesis of the non-alcoholic fatty liver disease (NAFLD) has been described as multifactorial, with genetic and environmental factors acting synergistically and causing excessive hepatic lipid accumulation, insulin resistance, and downstream ... ...

Abstract	The pathogenesis of the non-alcoholic fatty liver disease (NAFLD) has been described as multifactorial, with genetic and environmental factors acting synergistically and causing excessive hepatic lipid accumulation, insulin resistance, and downstream pathogenetic insults. High-calorie diets, particularly those rich in foods with high (saturated) fat and sugar content, and sugar-sweetened beverages, are among the behavioral risk factors with a crucial role in the disease pathogenesis. In addition, meal frequency and meal timing appear to be relevant factors associated with NAFLD. Current guidelines recommend a hypocaloric, preferably Mediterranean diet as the main dietary intervention approach, but various other dietary models have been evaluated in patients with NAFLD. Among these, several intermittent fasting regimens have shown promising results. Diets based on Time-Restricted Feeding and Intermittent Energy Restriction have demonstrated some improvements in body adiposity, liver enzymes, and hepatic steatosis, but most studies included a small number of subjects, were of relatively short-duration, and used surrogate markers of NAFLD. The best intermittent fasting regimen for NAFLD is not yet known, and further well-designed research that evaluates the feasibility (mainly on long-term), safety and efficacy outcomes of these dietary interventions is still needed. Our review has evaluated the up-to-date information regarding the intermittent fasting dietary intervention in NAFLD and generated some key-point messages that are relevant to physicians and dietitians involved in the care of patients with NAFLD.
Keywords	nafld ; dietary intervention ; intermittent fasting ; time-restricted feeding ; Medicine ; R
Subject code	610
Language	English
Publishing date	2023-03-01T00:00:00Z
Publisher	Sciendo
Document type	Article ; Online
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Article ; Online: Management of diabetic neuropathy.

Cernea, Simona / Raz, Itamar

Metabolism: clinical and experimental

2021 Volume 123, Page(s) 154867

Abstract: Diabetic neuropathy is a neurodegenerative disorder that may alter both the somatic and autonomic peripheral nervous systems in the context of diabetes mellitus (DM). It is a prevalent and burdensome chronic complication of DM, that requires timely ... ...

Abstract	Diabetic neuropathy is a neurodegenerative disorder that may alter both the somatic and autonomic peripheral nervous systems in the context of diabetes mellitus (DM). It is a prevalent and burdensome chronic complication of DM, that requires timely management. Optimized glycemic control (mainly for type 1 DM), multifactorial intervention (mainly for type 2 DM), with lifestyle intervention/physical exercise, and weight loss represent the basis of management for diabetic distal symmetrical polyneuropathy, and should be implemented early in the disease course. Despite better understanding of the pathogenetic mechanisms of diabetic peripheral neuropathy, there is still a stringent need for more pathogenetic-based agents that would significantly modify the natural history of the disease. The paper reviews the available drugs and current recommendations for the management of distal symmetrical polyneuropathy, including pain management, and for diabetic autonomic neuropathy. Evaluation of drug combinations that would perhaps be more efficient in slowing the progression of the disease or even reversing it, and that would provide a better pain management is still needed.
MeSH term(s)	Diabetic Neuropathies/physiopathology ; Diabetic Neuropathies/prevention & control ; Diabetic Neuropathies/therapy ; Duloxetine Hydrochloride/therapeutic use ; Gabapentin/therapeutic use ; Humans ; Life Style ; Pain Management/methods ; Pregabalin/therapeutic use ; Risk Factors ; Weight Loss
Chemical Substances	Pregabalin (55JG375S6M) ; Gabapentin (6CW7F3G59X) ; Duloxetine Hydrochloride (9044SC542W)
Language	English
Publishing date	2021-08-17
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	80230-x
ISSN	1532-8600 ; 0026-0495
ISSN (online)	1532-8600
ISSN	0026-0495
DOI	10.1016/j.metabol.2021.154867
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Article ; Online: The metabolic control and laboratory evaluation in patients with type 2 diabetes during the COVID-19 pandemic and the impact of telemedicine

Onea Corina Roxana / Erőss Ákos / Roiban Andrada Larisa / Cernea Simona

Romanian Journal of Laboratory Medicine, Vol 31, Iss 1, Pp 43-

a single-center experience

2023 Volume 50

Abstract: Objective: The study aimed to evaluate the metabolic control during the COVID-19 pandemic in subjects with type 2 diabetes mellitus (T2DM) and whether care through telemedicine significantly impacted it. ...

Abstract	Objective: The study aimed to evaluate the metabolic control during the COVID-19 pandemic in subjects with type 2 diabetes mellitus (T2DM) and whether care through telemedicine significantly impacted it.
Keywords	type 2 diabetes ; covid-19 ; telemedicine ; Medicine ; R
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Sciendo
Document type	Article ; Online
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Article ; Online: Heart Failure and Chronic Kidney Disease in Type 2 Diabetes

Cernea Simona

Journal of Interdisciplinary Medicine, Vol 1, Iss 3, Pp 252-

2016 Volume 258

Abstract: Complex hemodynamic, neurohormonal and biochemical changes occur in heart failure and chronic kidney disease, and hyperglycemia/diabetes further accentuate the multifactorial pathogenetic mechanisms. The acknowledgement of concomitant heart and kidney ... ...

Abstract	Complex hemodynamic, neurohormonal and biochemical changes occur in heart failure and chronic kidney disease, and hyperglycemia/diabetes further accentuate the multifactorial pathogenetic mechanisms. The acknowledgement of concomitant heart and kidney dysfunction in patients with type 2 diabetes has major clinical implications with regards to prognosis, as they significantly increase the risk of mortality, and to therapeutical strategy of both conditions, as well as of hyperglycemia. A comprehensive interdisciplinary approach is needed in these cases in order to improve the outcomes.
Keywords	type 2 diabetes ; heart failure ; chronic kidney disease ; cardiorenal syndrome ; Medicine ; R
Language	English
Publishing date	2016-12-01T00:00:00Z
Publisher	Sciendo
Document type	Article ; Online
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Article ; Online: NAFLD in type 2 diabetes mellitus: Still many challenging questions.

Cernea, Simona / Raz, Itamar

Diabetes/metabolism research and reviews

2020 Volume 37, Issue 2, Page(s) e3386

Abstract: Epidemiologic data consistently show that in patients with type 2 diabetes (T2DM) the prevalence of non-alcoholic fatty liver disease (NAFLD), including advanced fibrosis, is double compared to the general population, and it associates with high risk of ... ...

Abstract	Epidemiologic data consistently show that in patients with type 2 diabetes (T2DM) the prevalence of non-alcoholic fatty liver disease (NAFLD), including advanced fibrosis, is double compared to the general population, and it associates with high risk of liver-related morbidity (advanced fibrosis, hepatocellular carcinoma) and mortality, but also with other systemic consequences, such as cardiovascular (CV) disease, chronic kidney disease, and overall mortality. There are still many answers that need to be clarified regarding NAFLD in T2DM, including deciphering the complex pathogenetic mechanisms, the intertwined relationships with the extrahepatic organs and tissues (mainly heart, kidneys, adipose tissue, gut), the prognostic value of NAFLD for CV risk stratification, and more importantly, what would be the most appropriate screening algorithm, diagnostic method and therapeutic approach. We advocate here for proactive action, in order to identify NAFLD in a timely manner, and suggest a simple algorithm to be used in clinical practice, based on risk stratification and on experts' opinions. We discuss the current therapeutic options for NAFLD in T2DM, for which a multifactorial approach is needed, that concomitantly addresses the liver and the cardio-reno-metabolic disturbances.
MeSH term(s)	Diabetes Mellitus, Type 2/epidemiology ; Humans ; Non-alcoholic Fatty Liver Disease/epidemiology ; Non-alcoholic Fatty Liver Disease/therapy
Language	English
Publishing date	2020-08-18
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1470192-3
ISSN	1520-7560 ; 1520-7552
ISSN (online)	1520-7560
ISSN	1520-7552
DOI	10.1002/dmrr.3386
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Article: The SONAR study-is there a future for endothelin receptor antagonists in diabetic kidney disease?

Cahn, Avivit / Cernea, Simona / Raz, Itamar

Annals of translational medicine

2020 Volume 7, Issue Suppl 8, Page(s) S330

Language	English
Publishing date	2020-01-03
Publishing country	China
Document type	Editorial ; Comment
ZDB-ID	2893931-1
ISSN	2305-5847 ; 2305-5839
ISSN (online)	2305-5847
ISSN	2305-5839
DOI	10.21037/atm.2019.09.117
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Article ; Online: Pharmacological Management of Obesity: A Century of Expert Opinions in Cecil Textbook of Medicine.

Manu, Peter / Lăcătuşu, Cristina-Mihaela / Rogozea, Liliana M / Cernea, Simona

American journal of therapeutics

2022 Volume 29, Issue 4, Page(s) e410–e424

Abstract: Background: Innovations in drug therapy for obesity have had a limited impact on the body mass index, prevalence of medical complications, quality of life, and work potential of a substantial majority of affected persons.: Study question: What are ... ...

Abstract	Background: Innovations in drug therapy for obesity have had a limited impact on the body mass index, prevalence of medical complications, quality of life, and work potential of a substantial majority of affected persons. Study question: What are the milestones of the changes in the expert approach to the pharmacological management of obesity in the past century? Study design: To determine the changes in the experts' approach to the management of obesity, as presented in a widely used textbook in the United States. Data sources: The primary sources were chapters describing the management of obesity in the 26 editions of Cecil Textbook of Medicine published from 1927 through 2020. Secondary sources were publications retrieved from Medline that clarified technical issues related to the development, regulatory approval, and use of the drugs mentioned in the Cecil Textbook of Medicine. Results: Pharmacological interventions aimed at increasing caloric expenditures through thermogenesis were recommended from 1927 through 1943. Thyroid extracts were prescribed even in the absence of demonstrated hypothyroidism or decreased basal metabolic rate throughout this period. Dinitrophenol was mentioned in 1937, but was banned soon thereafter. Appetite suppression with amphetamine was considered useful from 1943 through 1988, after which the drug was replaced with other centrally acting molecules, such as fenfluramine in 1988, sibutramine in 2000, and rimonabant in 2008, which were in turn withdrawn because of major adverse effects. In the past decade, obesity has been treated with the appetite suppressants phentermine-topiramate, bupropion-naltrexone, lorcaserin, and liraglutide, and with orlistat, a drug promoting fat malabsorption. The change in weight produced by these drugs is generally modest and transient. Conclusions: The pharmacological management of obesity has remained frustratingly inefficient. The reasons for the relative lack of success may reside in the ever-growing access to dense, palatable, and relatively inexpensive food, coupled with the decrease in energy expenditure created by a sedentary lifestyle.
MeSH term(s)	Anti-Obesity Agents/adverse effects ; Expert Testimony ; Humans ; Obesity/chemically induced ; Obesity/drug therapy ; Orlistat/therapeutic use ; Quality of Life ; United States
Chemical Substances	Anti-Obesity Agents ; Orlistat (95M8R751W8)
Language	English
Publishing date	2022-07-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	1280786-2
ISSN	1536-3686 ; 1075-2765
ISSN (online)	1536-3686
ISSN	1075-2765
DOI	10.1097/MJT.0000000000001524
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Article ; Online: Pharmacological Management of Diabetes Mellitus: A Century of Expert Opinions in Cecil Textbook of Medicine.

Manu, Peter / Rogozea, Liliana M / Cernea, Simona

American journal of therapeutics

2021 Volume 28, Issue 4, Page(s) e397–e410

Abstract: Background: Drug therapy for diabetes mellitus (DM) has had a significant impact on quality of life and work potential of affected persons and has contributed to a remarkable decrease in the frequency and severity of complications, hospitalizations, and ...

Abstract	Background: Drug therapy for diabetes mellitus (DM) has had a significant impact on quality of life and work potential of affected persons and has contributed to a remarkable decrease in the frequency and severity of complications, hospitalizations, and mortality. The current approach is the result of incremental progress in using technological advances to increase the safety and effectiveness of insulin therapy and the introduction of new molecules as oral and injectable antidiabetic drugs. Study question: What are the milestones of the changes in the expert approach to the pharmacological management of DM in the past century? Study design: To determine the changes in the experts' approach to the management of DM, as presented in a widely used textbook in the United States. Data sources: The chapters on describing the management of DM in the 26 editions of Cecil Textbook of Medicine published from 1927 to 2020. Results: In 1927, DM was treated with insulin extracted from the pancreas of large animals (cattle, hogs, and sheep) and purified with alcohol to prevent the tissues' proteolytic action on the hormone. The therapeutic milestones in DM marked 2 avenues for innovation. The first created advances in insulin therapy, starting with processes that led to the production of crystalline insulin and protamine zinc insulin (1937), synthetic human insulin (1996), and prandial (2000) and basal (2004) insulin analogues. The second was an effort to develop and introduce in clinical practice in the United States oral antidiabetic drugs, starting with tolbutamide, a sulfonylurea (1955), followed by metformin, a biguanide (1996), thiazolidinediones, alpha-glucosidase inhibitors, and benzoic acid derivatives (2000), dipeptidyl peptidase-4 inhibitors and glucagon-like peptide 1 receptor agonists (2008), and sodium glucose cotransporter 2 inhibitors (2020). A latent period of 40 years between significant advances was likely because of searches for new technologies (eg, recombinant DNA for the production of synthetic insulin and analogues) and, at least in part, to the impact of the controversial University Group Diabetes Project on the development and acceptance of oral antidiabetic drugs. Conclusions: The pharmacological management of DM has progressed unevenly, with a long latency period in the second half of the last century followed by highly encouraging advances in the first 2 decades of the 21st century. In chronological order, the major advances were synthetic insulins obtained through DNA recombinant technology, adoption of metformin as first line therapy, and introduction of antidiabetic medication classes that also promote weight reduction and cardiovascular health.
MeSH term(s)	Animals ; Cattle ; Diabetes Mellitus, Type 2 ; Expert Testimony ; Hypoglycemic Agents/therapeutic use ; Quality of Life ; Sheep ; Sodium-Glucose Transporter 2 Inhibitors
Chemical Substances	Hypoglycemic Agents ; Sodium-Glucose Transporter 2 Inhibitors
Language	English
Publishing date	2021-06-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	1280786-2
ISSN	1536-3686 ; 1075-2765
ISSN (online)	1536-3686
ISSN	1075-2765
DOI	10.1097/MJT.0000000000001401
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