Chronic liver disease (CLD), including non-alcoholic fatty liver disease (NAFLD) and its advanced form, non-alcoholic steatohepatitis (NASH), affects a significant portion of the population worldwide. NAFLD is characterised by fat accumulation in the liver, while NASH is associated with inflammation and liver damage. Osteosarcopenia, which combines muscle and bone mass loss, is an emerging clinical problem in chronic liver disease that is often underappreciated. The reductions in muscle and bone mass share several common pathophysiological pathways; insulin resistance and chronic systemic inflammation are the most crucial predisposing factors and are related to the presence and gravity of NAFLD and to the worsening of the outcome of liver disease. This article explores the relationship between osteosarcopenia and NAFLD/MAFLD, focusing on the diagnosis, prevention and treatment of this condition in patients with CLD.

Introduction. The glucagon-like peptide-1 analogue liraglutide 3.0 mg is an out-of-pocket medication approved for weight management in obesity. We aimed to investigate the relationship between psychiatric symptoms (i.e., depression, anxiety, binge eating) and adherence to therapy. Methods. A clinical audit was carried out on 54 adults with obesity treated with liraglutide 3.0 mg. We retrospectively analyzed the relation between (1) psychiatric symptoms evaluated through the State-Trait Anxiety Inventory (STAI-Y1), the Beck Depression Inventory (BDI), the Binge Eating Scale (BES); and (2) adherence to therapy by assessing the maximum dosage (MD) and treatment duration (TD). Results. In the whole cohort, the average weight loss was 4.43% (± SD = 5.5). We found a negative correlation between anxiety symptoms (STAI-Y1 score) and MD (r=-,276), between depression symptoms (BDI score) and TD (r=-,276), and between a high probability of binge eating (BES score > 17) and TD (r=-,275). Linear regression analysis demonstrated that STAI-Y1 score predicted MD [R2 = .076, p = .044], BDI score predicted TD [R2 = .076, p = .044], and significant binge eating predicted TD [R2 = .076, p = .044]. Despite the lower adherence, the presence of psychiatric symptoms did not lead to a reduction in drug effectiveness on weight loss. Conclusion. Psychiatric symptoms can predict reduced adherence to liraglutide 3.0 mg therapy in real life. However, this does not appear to jeopardize its effect on weight loss. These findings suggest that persons with obesity and impaired mental health can also benefit from treatment. Level of evidence. Level V, descriptive studies.

Background: The Covid pandemic seems to have had several detrimental effects on managing patients affected by inherited metabolic diseases (IMD), although published data about the impact of COVID-19 on patients suffering from IMD are very scarce. The scope of our work was to evaluate adherence to the vaccination plan, the side effects experienced by our adult IMD patients, and the symptoms of the SARS-CoV-2 infection. Results: sixty-seven patients agreed to respond to a phone interview. The mean age was 36.5 (±11,6 SD). Regarding the vaccination campaign, fifty-five patients (82%) joined it, of whom ten have received two doses and the remaining forty-five, three. Forty-two patients (76%) reported adverse events following vaccination, the most frequent being local reaction, fever, and asthenia, which lasted an average of two days and resolved without sequelae. Regarding SARS-CoV-2 infection, twenty-seven out of sixty-seven patients (40%) have tested positive for the virus; seven of them were not vaccinated at the time of infection; on the other hand, twenty had already had at least two doses. Regarding the prevalence of long-Covid, as many as 12 patients (44%) reported symptoms that persisted after the nasopharyngeal swab tested negative and lasted an average of 81 (±74 SD) days. There were no statistically significant differences in BMI of patients who contracted the infection and patients who did not (25.15 vs 25.20, p=.861), between those who had adverse reactions to the vaccine and those who did not (24.40 vs 25.75, p=.223), between those who had long Covid and those who did not (25.9 vs 27.7, p=.183). No relation was observed between metabolic inherited disease, SARS-CoV-2 infection symptoms and adverse vaccine reactions. Conclusions: The data indicate that IMD patients adhered to the vaccination plan comparably to the general Italian population. Adverse events to the vaccine were negligible. SARS-CoV-2 infection, which occurred in most cases after receiving at least two doses of the vaccine, did not cause serious symptoms and never required hospitalisation. A non-negligible share of patients suffered from long Covid symptoms.