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Full-Text Articles in Nutritional and Metabolic Diseases

Seychelles: Diabetes, Camille Myers Jan 2018

Seychelles: Diabetes, Camille Myers

Global Public Health

One of the major health problems in Seychelles, a cluster of islands off the coast of Eastern Africa, is diabetes. There are many different types of diabetes, but the most common type to this region is Type 2 diabetes. At this time Seychelles, and many other countries in Africa, have about half of the adult population diagnosed with Type 2 diabetes. Along with the diagnosis of diabetes being a problem, people in Seychelles often go undiagnosed for a while because they are ignorant to the risks and the symptoms of the disease. Only about 50% of the population with pre-diabetic …


Palau: Obesity, Tavia Weis Jan 2018

Palau: Obesity, Tavia Weis

Global Public Health

Located in the heart of the Western Pacific Ocean is a large group of small islands that make up the country of Palau. Known for its growing tourism, beautiful landscapes, and cultural beliefs. Although the country is developing, the current health issue of obesity is a growing concern. With almost half of the population obese and the other half in jeopardy, the rising concerns of the obesity epidemic have taken global news and brought the attention of major countries to try and fix these rising issues. This public health brief will discuss the problems of obesity in Palau and the …


Type 2 Diabetes, Aj Mimlitz Jan 2018

Type 2 Diabetes, Aj Mimlitz

Global Issues in Public Health

The purpose of this two page educational document is to inform not only educators, but also students about the description of type two diabetes and what populations are affected, the epidemiology of type 2 diabetes, including how get diagnosed and how that diagnosis will affect specific outcomes, and the solutions to how we can prevent or begin to cure type 2 diabetes. This brief project shows plenty of statistics revolving around these main points. Research shows that “type 2 diabetes already causes 5 million deaths per year, expecting to become the 7th cause of death globally by 2030” (Alidrisi & …


The Impact Of Circadian Misalignment On Cardiometabolic Health, Cynthia Marie Mills Jan 2018

The Impact Of Circadian Misalignment On Cardiometabolic Health, Cynthia Marie Mills

Physician Assistant Scholarly Project Posters

The circadian system is important in all living organisms because it generates a 24-hour rhythm for physiological and behavioral processes enabling anticipation and adaptation to daily changes in the environment. The prevalence of cardiometabolic diseases, which are linked to lifestyle choices, has been rising at an alarming rate. Modernization and globalization are two of many factors to blame for lifestyle changes resulting in circadian disruption. The purpose of this literature review is to explore circadian misalignment with regards to its mechanism and impact on cardiometabolic health and to determine possible interventional measures. The primary focus is on lifestyle change, particularly …


Comparing The Effectiveness Of A Low Carbohydrate Diet And Metformin On Glycosylated Hemoglobin Reduction In Type Two Diabetes Mellitus, Ashley Schultz Jan 2018

Comparing The Effectiveness Of A Low Carbohydrate Diet And Metformin On Glycosylated Hemoglobin Reduction In Type Two Diabetes Mellitus, Ashley Schultz

Physician Assistant Scholarly Project Posters

In this study, a low carbohydrate diet and metformin pharmacotherapy were compared to determine their effect on HbA1c in the type two diabetic patient. Several high quality studies were examined along with each treatment's effect on mainly HbA1c, but also other parameters such as body weight, cholesterol, and fasting and post prandial blood glucose levels. The study showed that both the low carbohydrate diet and metformin pharmacotherapy were effective at lowering HbA1c in the type two diabetic patient. The low carbohydrate diet showed a 0.2% increase in HbA1c all the way to a 2.2% decrease in baseline HbA1c in the …


The Effects Of Wearable Fitness Devices On Pediatric Obesity: An Integrative Literature Review, Kevin Sabina Jan 2018

The Effects Of Wearable Fitness Devices On Pediatric Obesity: An Integrative Literature Review, Kevin Sabina

Honors Undergraduate Theses

Childhood obesity is a foremost concern throughout the health care community. Approximately 17.6% of the pediatric population meet the criteria for obesity, which can lead to health disparities later in life, such as hypertension, type 2 diabetes mellitus, and metabolic syndrome. Emerging mobile and wearable lifestyle tracking devices can be a viable solution to the challenging problem of childhood obesity through behavior changes, feasibility, and adherence. The purpose of this literature review was to determine the effect that mobile and wearable activity tracking devices have on the obese pediatric population. A centralized review of the literature was conducted using various …


Effect Of Empagliflozin On Insulin Sensitivity In The Lean And Obese Zucker Rat: A Model Of Metabolic Syndrome, Veda Gayatri Sushma Penta Jan 2018

Effect Of Empagliflozin On Insulin Sensitivity In The Lean And Obese Zucker Rat: A Model Of Metabolic Syndrome, Veda Gayatri Sushma Penta

Theses, Dissertations and Capstones

Metabolic syndrome is one of the fastest growing health problems in the world. The medical costs associated with treating this disorder are staggering. Allowed to proceed untreated, metabolic syndrome can lead to a markedly decreased quality of life and a variety of medical conditions including heart and kidney failure. Whether the sodium glucose co-transporter-2 (SGLT-2) inhibitor Empagliflozin can be used to prevent the development of metabolic syndrome is not well understood. This proposal is specifically designed to address this gap in our knowledge. The expected outcomes of this work will identify the time course and degree of interrelatedness between changes …


A Call To Action On Prediabetes, Joy A. Moverley, Alegria Cantillep, Kathryn Newberry, Jay H. Shubrook Jan 2018

A Call To Action On Prediabetes, Joy A. Moverley, Alegria Cantillep, Kathryn Newberry, Jay H. Shubrook

Faculty Publications & Research of the TUC College of Osteopathic Medicine

Diabetes and prediabetes have become an epidemic in the United States. The keys to battling this public health challenge are effective screening and evidence-based interventions. Studies show that intensive lifestyle interventions, medications, and weight loss surgery can reduce or delay new-onset type 2 diabetes. This article reviews the steps clinicians can take to help patients stay ahead of this disease.


Assessing Malnutrition In Liver Disease Patients Being Evaluated For Transplant Using The Nutrition Focused Physical Exam, Madison Hilgendorf Jan 2018

Assessing Malnutrition In Liver Disease Patients Being Evaluated For Transplant Using The Nutrition Focused Physical Exam, Madison Hilgendorf

Theses and Dissertations--Nutrition and Food Systems

Patients with liver disease have an increased risk for malnutrition because of side effects of the disease. The Nutrition Focused Physical Exam (NFPE) was developed for nutrition professionals to aid physicians in a nutrition-based diagnosis of malnutrition. The purpose of this study was to examine the NFPE for its validity in liver disease patients being evaluated for transplant. In addition, the NFPE was used to assess incidence and severity of malnutrition in end stage liver disease patients and compare these results to already developed malnutrition tools such as the Patient Generated-Subjective Global Assessment (PG-SGA), Triceps Skinfolds (TSF), Mid-Arm Circumference (MAC), …


Stories Of Strength: Chicago Latin@S' Navigation Of Health, Well-Being, And Chronic Disease, Lilian L. Milanés Jan 2018

Stories Of Strength: Chicago Latin@S' Navigation Of Health, Well-Being, And Chronic Disease, Lilian L. Milanés

Theses and Dissertations--Anthropology

Health inequalities take many forms related to race, gender, socioeconomic status, ethnic, language and many other axes throughout communities around the world. Type two diabetes, high blood pressure, and high cholesterol are examples of conditions (among many others) that disproportionately affect Latino@s in the U.S.. The research of this dissertation is based on fieldwork conducted throughout several predominantly Latin@ neighborhoods in Chicago, IL. This dissertation examines how Latin@s in Chicago navigate health and well-being, and how they engage in agentive strategies in the face of chronic disease. I recorded individual life histories and semi-structured interviews, focus groups, and participant observation …


Mechanisms And Potential Therapy On Disrupted Blood Pressure Circadian Rhythm In Diabetes, Tianfei Hou Jan 2018

Mechanisms And Potential Therapy On Disrupted Blood Pressure Circadian Rhythm In Diabetes, Tianfei Hou

Theses and Dissertations--Pharmacology and Nutritional Sciences

Arterial blood pressure (BP) undergoes a 24-hour oscillation that peaks in the active day and reaches a nadir at night during sleep in humans. Reduced nocturnal BP fall (also known as non-dipper) is the most common disruption of BP circadian rhythm and is associated with increased risk of untoward cardiovascular events and target organ injury. Up to 75% of diabetic patients are non-dippers. However, the mechanisms underlying diabetes associated non-dipping BP are largely unknown. To address this important question, we generated a novel diabetic db/db-mPer2Luc mouse model (db/db-mPer2Luc) that allows quantitatively measuring of mPER2 protein oscillation …


Association Of Body Mass Index With Blood Pressure Among 1.7 Million Chinese Adults, Khurram Nasir Jan 2018

Association Of Body Mass Index With Blood Pressure Among 1.7 Million Chinese Adults, Khurram Nasir

All Publications

No abstract provided.


The Impact Of Circadian Misalignment On Cardiometabolic Health, Cynthia Marie Mills Jan 2018

The Impact Of Circadian Misalignment On Cardiometabolic Health, Cynthia Marie Mills

Physician Assistant Scholarly Project Papers

The circadian system is important in all living organisms because it generates a 24-hour rhythm for physiological and behavioral processes enabling anticipation and adaptation to daily changes in the environment. The prevalence of cardiometabolic diseases, which are linked to lifestyle choices, has been rising at an alarming rate. Modernization and globalization are two of many factors to blame for lifestyle changes resulting in circadian disruption. The purpose of this literature review is to explore circadian misalignment with regards to its mechanism and impact on cardiometabolic health and to determine possible interventional measures. The primary focus is on lifestyle change, particularly …


Comparing The Effectiveness Of A Low Carbohydrate Diet And Metformin On Glycosylated Hemoglobin Reduction In Type Two Diabetes Mellitus, Ashley Schultz Jan 2018

Comparing The Effectiveness Of A Low Carbohydrate Diet And Metformin On Glycosylated Hemoglobin Reduction In Type Two Diabetes Mellitus, Ashley Schultz

Physician Assistant Scholarly Project Papers

In this study, a low carbohydrate diet and metformin pharmacotherapy were compared to determine their effect on HbA1c in the type two diabetic patient. Several high quality studies were examined along with each treatment's effect on mainly HbA1c, but also other parameters such as body weight, cholesterol, and fasting and post prandial blood glucose levels. The study showed that both the low carbohydrate diet and metformin pharmacotherapy were effective at lowering HbA1c in the type two diabetic patient. The low carbohydrate diet showed a 0.2% increase in HbA1c all the way to a 2.2% decrease in baseline HbA1c in the …


Exploring H.Pylori Seropositivity As A Risk Factor For Type 2 Diabetes, Virginia Chaidez, Yumou Qiu Jan 2018

Exploring H.Pylori Seropositivity As A Risk Factor For Type 2 Diabetes, Virginia Chaidez, Yumou Qiu

Department of Nutrition and Health Sciences: Faculty Publications

Background: In the US, the percentage of adults with diagnosed diabetes are higher in members of racial and ethnic minority groups compared to non-Latino Whites. Understanding why such disparities exist has been less forthcoming.

Methods: Secondary data analysis was conducted using the National Health and Nutrition Examination Survey (NHANES) 1999-2000 cross-sectional data.

Results: H.pylori seropositivity was highest in Mexican Americans (43.7%), lowest in non- Hispanic Whites (18.1%). Diabetes was highest in non-Hispanic Blacks (5.9%); lowest in non-Hispanic whites (4.3%). H.pylori seropositivity was associated with greater likelihood of having type 2 diabetes (1.927, 95% CI 1.142, 3.257) compared to H.pylori negative …


Evaluation Of A Handheld Gluten Detection Device, Steve L. Taylor, Julie A. Nordlee, Shyamali Jayasena, Joseph L. Baumert Jan 2018

Evaluation Of A Handheld Gluten Detection Device, Steve L. Taylor, Julie A. Nordlee, Shyamali Jayasena, Joseph L. Baumert

Department of Food Science and Technology: Faculty Publications

A portable, handheld gluten detection device, the Nima sensor, is now available for consumers wishing to determine if gluten is present in food. By United States regulation, gluten-free foods should contain < 20 ppm of gluten. Thirteen gluten-free foods (muffins, three different types of bread, three different types of pasta, puffed corn snack, ice cream, meatballs, vinegar and oil salad dressing, oatmeal, and dark chocolate) were prepared; each food was spiked on a weight-to-weight basis with gluten levels of 0, 5, 10, 20, 30, 40, and 100 ppm before processing or preparation. Unprocessed and processed foods were tested with the handheld gluten sensor and by two gluten-specific enzyme-linked immunosorbent assays (ELISAs) on the basis of the R5 and G12 monoclonal antibodies, respectively. The portable gluten detection device detected gluten in all food types at the 30-ppm addition level, failing to detect gluten in only 5 (6.4%) of 78 subsamples. At the 20-ppm addition level, the portable gluten detection device failed to detect gluten in one type of pasta but detected gluten residues in 63 (87.5%) of 72 other subsamples. The device was able to detect gluten at the 10-ppm addition level in 9 of the 13 food matrices (41 of 54 subsamples, 75.9%) but not in the three types of pasta and the puffed corn snack. The gluten-sensing device did not perform reliably at the 5-ppm addition level in 11 of 13 food matrices (exceptions: ice cream and muffins). In contrast, the ELISA methods were highly reliable at gluten addition levels of ≥ 10 ppm in all food matrices. The portable gluten detection device yielded a low percentage of false-positive results (4 of 111, 3.6%) in these food matrices. Thus, this handheld portable gluten sensor performed reliably in the detection of gluten in foods having ≥ 20 ppm of added gluten with only 18 (5.9%) of 306 failures, if results of the one type of pasta are excluded. The device worked with greater reliability as the gluten levels in the foods increased.


Pcb-Associated Steatohepatitis And The Role Of Nuclear Receptors., Heather Brooke Clair Dec 2017

Pcb-Associated Steatohepatitis And The Role Of Nuclear Receptors., Heather Brooke Clair

Electronic Theses and Dissertations

Metabolic diseases, including fatty liver disease, hyperglycemia, and obesity, result when body systems responsible for managing allostasis (dynamic homeostasis across systems) are pressured beyond their collective compensatory reserve. Nutritional excess contributes to this state, the capacity of which is limited by genetic variation, and failure of one system will gradually lead to pathological overload in the others. Agents which act directly on the communication machinery linking these connected systems can also change the point at which allostatic load becomes allostatic overload. Environmental exposure to polychlorinated biphenyls (PCBs), a class of persistent organic pollutant, is associated with a specific form of …


Comparative Effectiveness And Safety Of Empagliflozin On Cardiovascular Mortality And Morbidity In Adults With Type 2 Diabetes, Wilbert S. Aronow, Tatyana Shamliyan Dec 2017

Comparative Effectiveness And Safety Of Empagliflozin On Cardiovascular Mortality And Morbidity In Adults With Type 2 Diabetes, Wilbert S. Aronow, Tatyana Shamliyan

NYMC Faculty Publications

Background: Based on a single placebo-controlled randomized clinical trial, empagliflozin is licensed to reduce cardiovascular death in diabetes and comorbid cardiovascular disease. Methods: We examined the comparative effectiveness of empagliflozin on mortality and cardiovascular morbidity in type 2 diabetes. We conducted random-effects direct frequentist meta-analyses of aggregate data and appraised the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Our search in PubMed, EMBASE, the Cochrane Library, clinicaltrials.gov, and PharmaPendium up to May 2017 identified 11 meta-analyses, multiple publications, and unpublished data from 29 randomized controlled trials (RCTs). Results: Empagliflozin reduces all-cause mortality [relative …


A Low Carbohydrate, Ketogenic Diet For Treatment Of Type Ii Diabetes An Integrative Literature Review, Steven Lisowski Nov 2017

A Low Carbohydrate, Ketogenic Diet For Treatment Of Type Ii Diabetes An Integrative Literature Review, Steven Lisowski

Grace Peterson Nursing Research Colloquium

A Low Carbohydrate, Ketogenic Diet for Treatment

of Type II Diabetes: An Integrative Literature Review

Steven Lisowski

Faculty Sponsor: Larry Maturin

Abstract

Background: Dietary modifications are commonly prescribed initial interventions in those recently diagnosed with type II diabetes. Presently, various researchers support that there is a growing body of evidence that advises to restrict carbohydrate intake to minimum levels to achieve optimal blood glucose levels and reduce complications related to poor diabetes management.

Objectives: To explore if the low carbohydrate, ketogenic diets (LCKD), in which carbohydrate intake of any kind is restricted, are very effective at reducing obesity and controlling …


Improved Service Efficiency Improves Racial Disparity In Diabetic Care, Abel Irena, Kushal Patel, David Thompson, Gregory Schleis, Abiy Gesese, Richard Battiola Nov 2017

Improved Service Efficiency Improves Racial Disparity In Diabetic Care, Abel Irena, Kushal Patel, David Thompson, Gregory Schleis, Abiy Gesese, Richard Battiola

Journal of Patient-Centered Research and Reviews

Background: Racial disparities in diabetes care have been documented. Disparities also have been shown to affect service quality and outcome of diabetic care. Analysis of our internal medicine residency clinic diabetic care management performance across REAL-G (race, ethnicity, age, preferred language and/or gender) showed race-based disparity on two outcome measures: 1) measurement of glycohemoglobin (A1C) at least twice a year; and 2) target blood pressure of < 140/90.

Purpose: Develop interventions to decrease racial disparities in diabetes care among patients managed by an internal medicine residency clinic, as part of the Alliance of Independent Academic Medical Center’s National Initiative V project.

Methods: …


Roles Of Gabab, Muscarinic And Nicotinic Receptor Signaling In The Acquisition And Expression Of Fructose And Fat-Conditioned Flavor Preferences And Acquisition Of Quinine-Conditioned Flavor Avoidances In Rats, Francis M. Rotella Sep 2017

Roles Of Gabab, Muscarinic And Nicotinic Receptor Signaling In The Acquisition And Expression Of Fructose And Fat-Conditioned Flavor Preferences And Acquisition Of Quinine-Conditioned Flavor Avoidances In Rats, Francis M. Rotella

Dissertations, Theses, and Capstone Projects

In addition to increased intake of sweet solutions by mammals, learning, particularly classically-conditioned “Pavlovian-like” learning, also plays an important role. An orosensory conditioned flavor preference (CFP) can be elicited by pairing one novel flavor (conditioned stimulus, CS+) with a fructose solution and a second novel flavor (CS-) with a saccharin solution. Rats will prefer the CS+ flavor in a subsequent 2-bottle choice test with both flavors mixed in saccharin. Previous pharmacological analyses revealed that systemic administration of dopamine (DA) D1 and D2 as well as NMDA, but not opioid, receptor antagonists eliminated the acquisition (learning) of fructose-CFP. Further, expression of …


Association Of Obesity With Hypertension, Wilbert S. Aronow Sep 2017

Association Of Obesity With Hypertension, Wilbert S. Aronow

NYMC Faculty Publications

No abstract provided.


Treating Diabetic Ketoacidosis With Subcutaneous Insulin?, Marlene Aziza Azar Aug 2017

Treating Diabetic Ketoacidosis With Subcutaneous Insulin?, Marlene Aziza Azar

Clinical Research in Practice: The Journal of Team Hippocrates

The author examines the evidence for treating diabetic ketoacidosis with subcutaneous insulin vs IV insulin.


Strategies To Improve Control Of Blood A1c In Diabetics, Jennifer Aronson, Leanne Bellino, Elizabeth Eisenhardt, Diane Bryant, Haley Pelletier, Internal Medicine Team, Adult Outpatient Clinic Aug 2017

Strategies To Improve Control Of Blood A1c In Diabetics, Jennifer Aronson, Leanne Bellino, Elizabeth Eisenhardt, Diane Bryant, Haley Pelletier, Internal Medicine Team, Adult Outpatient Clinic

MaineHealth Maine Medical Center

A1c monitoring is an important aspect of controlling the health of a diabetic patient. An adult internal medicine clinic noted that the percentage of their diabetic patients who had an A1c higher than 9 or no reading within the past year exceeded the national average. As a result, operational excellence methods were implemented with the overall goal to reduce their percentage to 18% or less.

A root cause analysis identified several deficiencies to includelack of essential equipment, variations in

staff education and the absence of daily reminders.

Post KPI implementations, an overall decrease in the percentage of patients with poorly …


Pursuing Equity In Diabetes Population, Aisha Rawlinson Aug 2017

Pursuing Equity In Diabetes Population, Aisha Rawlinson

Master's Projects and Capstones

Abstract

Background

Poor glycemic control (HbA1c >8) overtime leads to microvascular and macrovascular complications after the first and third years respectively, ultimately resulting in death after five years (Karter, 2016). Current Kaiser Permanente (KP) data stratified by race, ethnicity, age, and gender shows a significant disparity gap between Hispanics/Latino and Caucasian populations. The Pursuing IHI initiative is over a 2-year period completed at a microsystem that is focusing on health equity practices to reduce disparity gaps.

Project aim

KP Riverside, microsystem selected has a large population of Hispanic/Latino KP members, with focus on health equity. The project aim is to …


Lifestyle Measures For Treating Hypertension, Wilbert S. Aronow Aug 2017

Lifestyle Measures For Treating Hypertension, Wilbert S. Aronow

NYMC Faculty Publications

No abstract provided.


Optimizing Heart Failure Outcomes Through Diet: A Review, Farley B. Neasman Iii Jul 2017

Optimizing Heart Failure Outcomes Through Diet: A Review, Farley B. Neasman Iii

Marshall Journal of Medicine

Heart failure is a growing epidemic that will add significant monetary and human costs to an already overtaxed health-care system. Though promising new medications have recently been approved, this complex condition is largely preventable through aggressive risk factor modification, with diet being shown to have a greater effect than exercise. An underrated component of a healthy diet is the simple addition of nuts – the anti-inflammatory fatty acids, healthy proteins, and general availability have been shown to improve survival and reduce the primary risk factors contributing to heart failure, making the addition of nuts and legumes to the diet an …


Residential Segregation, Neighborhood Social And Physical Context In Obesity Disparities In Hispanic Preschoolers: A Conceptual Model, Catherina Chang Martinez Phd(C), Nasar U. Ahmed Phd, Ruby A. Natale Phd, Psyd Jul 2017

Residential Segregation, Neighborhood Social And Physical Context In Obesity Disparities In Hispanic Preschoolers: A Conceptual Model, Catherina Chang Martinez Phd(C), Nasar U. Ahmed Phd, Ruby A. Natale Phd, Psyd

Journal of Health Disparities Research and Practice

During the last decade, there has been a significant inclusion in obesity prevention studies from individual characteristics to household factors then neighborhood factors. The study of place in the context of early childhood obesity studies has been limited to the food and physical built environment. With the persistent disparities in the prevalence of childhood obesity, and Hispanic minorities being increasingly affected, there is a need to reexamine existing models and develop new model conceptual frameworks to examine the role of place and residential segregation in the context of race, ethnicity, social position, and socioeconomic disparities. In the context of place …


A Functional Algorithm For Weight Loss And Obesity Practice: Guide For Clinical Decision-Making For Treating Women, Jennifer A. Tice Williams Jun 2017

A Functional Algorithm For Weight Loss And Obesity Practice: Guide For Clinical Decision-Making For Treating Women, Jennifer A. Tice Williams

Dissertations

ABSTRACT

Background

Overweight and obesity have significant impact and consequences on women leading to reduced quality of life, comorbid conditions and premature mortality. Many healthcare providers lack adequate training and the time to properly treat overweight and obesity. Algorithms have been shown to improve clinical knowledge and save time.

Objectives

To develop an algorithm for weight loss assessment and treatment to aid in the clinical decision-making process while improving the quality of care for overweight and obese clients in an efficient manner that can be replicated.

Methods

After an extensive literature review to identify best-practice guidelines for weight loss a …


A Lipid Binding Structure And Functional Analysis Of Human Arv1, Jessie Lee Cunningham Jun 2017

A Lipid Binding Structure And Functional Analysis Of Human Arv1, Jessie Lee Cunningham

Graduate School of Biomedical Sciences Theses and Dissertations

Metabolic Syndrome (MetS) is a combination of risk factors that can over time increase the probability of developing diseases, including cardiovascular disease, type 2 diabetes, non-alcoholic fatty liver disease (NAFLD), and non-alcoholic steatohepatitis (NASH). Acyl-coenzyme-A: cholesterol O-acyl transferase related enzyme required for viability-1, abbreviated as Arv1, is an evolutionarily conserved putative lipid binding protein. Several studies have implicated hArv1 as a critical regulator of lipid transport and trafficking.

Recent work using an Arv1 knock out (KO) mouse model have established a clear link between Arv1 function and the progression of MetS and NAFLD/NASH [unpublished data] [1]. Overall, studies show that …