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Chua KY, Li H, Lim WS, Koh WP. Consumption of Coffee, Tea, and Caffeine at Midlife, and the Risk of Physical Frailty in Late Life. J Am Med Dir Assoc 2023; 24:1655-1662.e3. [PMID: 37488031 DOI: 10.1016/j.jamda.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVES Our study evaluated the prospective association between the consumption of caffeine-containing beverages at midlife and the risk of physical frailty at late life within a population-based cohort of Chinese adults living in Singapore over a follow-up period of 20 years. DESIGN Prospective cohort study. SETTING AND PARTICIPANTS We used data from 12,583 participants from the baseline and third follow-up interviews of the Singapore Chinese Health Study (SCHS). Participants had a mean age of 53 years at baseline (1993-1998), and a mean age of 73 years during the third follow-up (2014-2017). METHODS At baseline, habitual consumption of caffeine-containing beverages was evaluated using a validated semi-quantitative food-frequency questionnaire. During the third follow-up, physical frailty was assessed using the modified Cardiovascular Health Study phenotype. RESULTS Compared with non-daily drinkers, those who drank 4 or more cups of coffee daily had reduced odds of physical frailty [odds ratio (OR), 0.54; 95% CI, 0.38-0.76]. Similarly, compared with those who hardly drank tea, participants who drank tea everyday also had reduced odds (OR, 0.82; 95% CI, 0.71-0.95). Total daily caffeine intake at midlife was associated with reduced likelihood of frailty at late life in a dose-response relationship (Ptrend < .001). Relative to their counterparts in the lowest quartile of daily caffeine intake (0-67.6 mg/d), participants in the highest quartile (223.0-910.4 mg/d) had an OR of 0.77 (95% CI, 0.66-0.91). Higher caffeine consumption was associated with lower likelihood of being in the slowest quintile for timed up-and-go (TUG) and weakest quintile for handgrip strength. CONCLUSIONS AND IMPLICATIONS In this cohort of Chinese adults, higher consumption of caffeine at midlife, via coffee and tea, was associated with a reduced likelihood of physical frailty in late life.
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Affiliation(s)
- Kevin Y Chua
- Integrative Sciences and Engineering Programme, NUS Graduate School, National University of Singapore, Singapore
| | - Huiqi Li
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wee-Shiong Lim
- Department of Geriatric Medicine, Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital, Singapore
| | - Woon-Puay Koh
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A∗STAR), Singapore.
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2
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Méndez-Sánchez N, Pal SC, Córdova-Gallardo J. How far are we from an approved drug for non-alcoholic steatohepatitis? Expert Opin Pharmacother 2023; 24:1021-1038. [PMID: 37092896 DOI: 10.1080/14656566.2023.2206953] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Metabolic associated fatty liver disease (MAFLD) previously known but still debatable, as non-alcoholic fatty liver disease (NAFLD) is one of the main causes of chronic liver disease and subsequent cirrhosis worldwide, accounting for around 30% of liver diseases. The change in its nomenclature has been brought about by the novel discoveries regarding its pathogenesis, in which metabolic dysfunction plays the most important role. It is widely known that for every disease, the treatment should always be targeted toward the underlying etiology and pathogenesis. AREAS COVERED MAFLD/NAFLD pathogenesis is heterogeneous, and includes multiple gene polymorphisms, presence of insulin resistance, as well as concomitant diseases that contribute to the disease onset and progression. As a result of this, even though lifestyle modification (owing to metabolic abnormalities) is the first line of treatment, multiple drugs have been tested to target each of the known pathways leading to MAFLD/NAFLD and progression of steatohepatitis. We aim to review the most relevant information regarding previous and ongoing research and recommendations regarding treatment of MAFLD/NAFLD. EXPERT OPINION Combination therapies associated to weight loss and exercise will be the optimal approach for these patients. It is important to evaluate each patient to select the specific combination according to patient characteristics.
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Affiliation(s)
- Nahum Méndez-Sánchez
- Liver Research Unit, Medica Sur Clinic & Foundation, 14050 Mexico, Mexico
- Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Shreya C Pal
- Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Jacqueline Córdova-Gallardo
- Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
- Department of Hepatology, Service of Surgery, General Hospital "Dr. Manuel Gea González", 14080 Mexico City, Mexico
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3
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Llamosas-Falcón L, Tran A, Jiang H, Rehm J. Liver holidays? A meta-analysis of drinking the same amount of alcohol daily or non-daily and the risk for cirrhosis. Drug Alcohol Rev 2023; 42:119-124. [PMID: 36274528 PMCID: PMC10749115 DOI: 10.1111/dar.13563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Several alcohol drinking guidelines indicate that daily alcohol consumption should be avoided because of its negative impact on the liver and to avoid the development of alcohol use disorders. Evidence that supports this recommendation is scarce. Our aim was to compare daily versus non-daily drinking and its association with liver cirrhosis. METHODS We conducted a review using PubMed/Medline and Embase as databases, selecting longitudinal or case control studies. A random effects meta-analysis was conducted. RESULTS Five mainly large-scale studies were retrieved. Daily drinking was associated with a significant increase in risk of liver cirrhosis compared to non-daily drinking, with a pooled relative risks of 1.71 (95% confidence interval 1.23-2.23) for men and 1.56 (95% confidence interval 1.39-1.74) for women. DISCUSSION AND CONCLUSIONS The consistent exposure to acetaldehyde and other toxins for daily drinkers may explain our findings. There should be days of abstinence to allow the liver to recover, especially for heavier drinkers.
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Affiliation(s)
- Laura Llamosas-Falcón
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Alexander Tran
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Huan Jiang
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute of Clinical Psychology and Psychotherapy and Center of Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany
- World Health Organization/Pan American Health Organization Collaborating Centre, Centre for Addiction and Mental Health, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
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4
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Niemelä O, Aalto M, Bloigu A, Bloigu R, Halkola AS, Laatikainen T. Alcohol Drinking Patterns and Laboratory Indices of Health: Does Type of Alcohol Preferred Make a Difference? Nutrients 2022; 14:4529. [PMID: 36364789 PMCID: PMC9658819 DOI: 10.3390/nu14214529] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/23/2022] [Accepted: 10/25/2022] [Indexed: 09/10/2023] Open
Abstract
Although excessive alcohol consumption is a highly prevalent public health problem the data on the associations between alcohol consumption and health outcomes in individuals preferring different types of alcoholic beverages has remained unclear. We examined the relationships between the amounts and patterns of drinking with the data on laboratory indices of liver function, lipid status and inflammation in a national population-based health survey (FINRISK). Data on health status, alcohol drinking, types of alcoholic beverages preferred, body weight, smoking, coffee consumption and physical activity were recorded from 22,432 subjects (10,626 men, 11,806 women), age range 25-74 years. The participants were divided to subgroups based on the amounts of regular alcohol intake (abstainers, moderate and heavy drinkers), patterns of drinking (binge or regular) and the type of alcoholic beverage preferred (wine, beer, cider or long drink, hard liquor or mixed). Regular drinking was found to be more typical in wine drinkers whereas the subjects preferring beer or hard liquor were more often binge-type drinkers and cigarette smokers. Alcohol use in all forms was associated with increased frequencies of abnormalities in the markers of liver function, lipid status and inflammation even at rather low levels of consumption. The highest rates of abnormalities occurred, however, in the subgroups of binge-type drinkers preferring beer or hard liquor. These results demonstrate that adverse consequences of alcohol occur even at moderate average drinking levels especially in individuals who engage in binge drinking and in those preferring beer or hard liquor. Further emphasis should be placed on such patterns of drinking in policies aimed at preventing alcohol-induced adverse health outcomes.
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Affiliation(s)
- Onni Niemelä
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital and Tampere University, 60220 Seinäjoki, Finland
| | - Mauri Aalto
- Department of Psychiatry, Seinäjoki Central Hospital, Tampere University, 33100 Tampere, Finland
| | - Aini Bloigu
- Center for Life Course Health Research, University of Oulu, 90570 Oulu, Finland
| | - Risto Bloigu
- Infrastructure of Population Studies, Faculty of Medicine, University of Oulu, 90570 Oulu, Finland
| | - Anni S. Halkola
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital and Tampere University, 60220 Seinäjoki, Finland
| | - Tiina Laatikainen
- Department of Public Health Solutions, National Institute for Health and Welfare (THL), 00271 Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70210 Kuopio, Finland
- Joint Municipal Authority for North Karelia Social and Health Services, 80210 Joensuu, Finland
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5
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Cheng Z, Luo X, Zhu Z, Huang Y, Yan X. Furfural Produces Dose-Dependent Attenuating Effects on Ethanol-Induced Toxicity in the Liver. Front Pharmacol 2022; 13:906933. [PMID: 35754511 PMCID: PMC9214037 DOI: 10.3389/fphar.2022.906933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Alcohol-associated liver disease (ALD) increases the health burden worldwide, but effective drugs to prevent ALD are lacking. Furfural is a small molecule that can limit alcohol production in microorganisms and may have the capacity to attenuate ethanol-induced toxicity. Methods: Human HepG2 cells were incubated with ethanol and furfural, and cell viability, NAD+/NADH ratio, and mitochondrial function assays were performed. RNA sequencing (RNA-seq) data were used to annotate enriched pathways, and these findings were confirmed by reverse transcription-quantitative PCR (RT–qPCR) and Western blotting. C57BL/6J mice were fed a Lieber-DeCarli liquid diet. After 4 weeks, biochemical analysis of mouse serum and histological analysis of mouse livers were performed. Results: Different concentrations of furfural exerted different effects on mitochondria: low-dose furfural reduced reactive oxygen species (ROS) production, maintained mitochondrial transmembrane potential, and inhibited apoptosis pathway activation, while high-dose furfural led to the opposite effects. In mice, furfural mitigated transaminase increases and attenuated the lipid metabolism disorder that had been induced by ethanol. Conclusion: Low-dose furfural reduced ethanol-induced toxicity in the liver. Consuming food or beverages containing the appropriate level of furfural when drinking alcohol may be a convenient and useful way to prevent ALD.
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Affiliation(s)
- Zhuo Cheng
- The Department of Gastroenterology and Hepatology, Peking University Third Hospital, Beijing, China
| | - Xuanmei Luo
- National Center of Gerontology, Beijing Hospital, Beijing, China
| | - Zixin Zhu
- Department of Infectious Diseases, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yonghui Huang
- The Department of Gastroenterology and Hepatology, Peking University Third Hospital, Beijing, China
| | - Xiue Yan
- The Department of Gastroenterology and Hepatology, Peking University Third Hospital, Beijing, China
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6
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Liu Z, Mao DRH, Fook-Chong S, Mak CCM, Tan XXE, Wu JT, Tan KB, Ong MEH, Siddiqui FJ. Nationwide Alcohol-related visits In Singapore's Emergency departments (NAISE): A retrospective population-level study from 2007 to 2016. Drug Alcohol Rev 2022; 41:1236-1244. [PMID: 35437844 DOI: 10.1111/dar.13472] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/09/2022] [Accepted: 03/14/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Excessive alcohol consumption is associated with increased morbidity and mortality, and its societal impact is substantial. The Nationwide Alcohol-related visits In Singapore Emergency departments study aims to characterise trends in ED visits involving acute and chronic alcohol consumption between 2007 and 2016. METHODS Data from the Singapore Ministry of Health, comprising all ED visits in Singapore from 2007 to 2016, were used. The data were aggregated by year and analysed for changes in prevalence and rates of ED visits for acute and chronic alcohol consumption, broken down by age, gender and ethnicity. RESULTS Over the study period, the number of ED visits involving alcohol consumption increased 98.3%, from 2236 in 2007 to 4433 in 2016. During the same period, the rate per 100 000 population increased 62.4% from 48.7 to 79.1, and total ED-related costs rose by 140%, from 528 680 to 1 269 638 SGD. The increase in alcohol-related visits rates and costs was higher than non-alcohol-related visits rates and costs, which increased by 12.1% and 115% respectively. While trends in acute and chronic alcohol-related ED visits stayed stable amongst women, they rose substantially in men. Older men aged 50-69 show the highest rates and rate of increase for both acute and chronic alcohol-related ED visits. DISCUSSION AND CONCLUSIONS Alcohol-related visits contributed disproportionately to the increasing number of ED visits in Singapore between 2007 and 2016. Older men form the demographic with the highest rates and increase in rates of alcohol-related ED visits and form a potential group for targeted intervention.
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Affiliation(s)
- Zhenghong Liu
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | | | - Stephanie Fook-Chong
- Prehospital and Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore
| | - Charles Chia Meng Mak
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Xi Xiang Esther Tan
- Department of Emergency Medicine, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Jun Tian Wu
- Health Services Research Centre, SingHealth, Singapore, Singapore.,Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Kelvin B Tan
- Future Systems Office, Infocomms, Technology and Data Group, Ministry of Health, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Centre for Regulatory Excellence, Duke-NUS Medical School, Singapore, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.,Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Fahad J Siddiqui
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
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7
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The prognostic impact of different stages of acute kidney injury in patients with decompensated cirrhosis: a prospective cohort study. Eur J Gastroenterol Hepatol 2021; 33:e407-e412. [PMID: 33731594 DOI: 10.1097/meg.0000000000002120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM To assess the impact of the different stages of acute kidney injury (AKI) on the prognosis of patients hospitalized with decompensated cirrhosis. METHODS This was a prospective cohort study of consecutive patients admitted in two tertiary hospitals in southern Brazil. Participants were considered eligible if they were admitted for acute decompensation of cirrhosis. The main exposure factor was the onset of AKI. AKI stages were defined according the European recommendations. The outcomes evaluated were survival time and death rates at 28 and 90 days from hospital admission. A χ2 test was used to compare mortality between groups. Kaplan-Meier survival analyses were undertaken assessing time to event as days from AKI diagnosis to death or liver transplant. RESULTS Two hundred and five patients were included in the study, and 121 met the criteria for AKI. Patients with AKI 1b, AKI 2 and AKI 3 had higher 90-day mortality than patients without AKI (P = 0.008, P < 0.001 and P < 0.001, respectively). However, there was no difference in 90-day mortality when patients with AKI 1a were compared with those without AKI (P = 0.742). The mean survival of patients without AKI was higher than that of patients with AKI 1b (591.4 and 305.4 days, respectively, P = 0.015), while there was no significant difference between the mean survival of patients without AKI and that of patients with AKI 1a (591.4 and 373.6 days, respectively, P = 0.198). CONCLUSION Only AKI ≥1b seems to substantially impact mortality of patients hospitalized for acute decompensation of cirrhosis.
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8
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Pearson MM, Kim NJ, Berry K, Moon AM, Su F, Vutien P, Green PK, Williams EC, Ioannou GN. Associations Between Alcohol Use and Liver-Related Outcomes in a Large National Cohort of Patients With Cirrhosis. Hepatol Commun 2021; 5:2080-2095. [PMID: 34601829 PMCID: PMC8631097 DOI: 10.1002/hep4.1776] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 05/10/2021] [Accepted: 06/13/2021] [Indexed: 11/11/2022] Open
Abstract
Alcohol use can cause hepatic necroinflammation and worsening portal hypertension in patients with cirrhosis. We aimed to evaluate the associations between degree of alcohol use and clinical liver‐related outcomes according to etiology of cirrhosis. In this retrospective cohort analysis, 44,349 U.S. veterans with cirrhosis from alcohol‐associated liver disease (ALD), chronic hepatitis C virus (HCV) infection, or nonalcoholic fatty liver disease were identified who completed the Alcohol Use Disorders Identification Test Consumption questionnaire in 2012. Based on this score, level of alcohol use was categorized as none, low level, or unhealthy. Multivariable Cox proportional hazards regression was used to assess for associations between alcohol use and mortality, cirrhosis decompensation (new ascites, encephalopathy, or variceal bleeding), and hepatocellular carcinoma (HCC). At baseline, 36.4% of patients endorsed alcohol use and 17.1% had unhealthy alcohol use. During a mean 4.9 years of follow‐up, 25,806 (57.9%) patients died, 9,409 (21.4%) developed a new decompensation, and 4,733 (11.1%) developed HCC. In patients with ALD‐cirrhosis and HCV‐cirrhosis, unhealthy alcohol use, compared with no alcohol use, was associated with higher risks of mortality (adjusted hazard ratio [aHR] = 1.13, 95% confidence interval [CI] = 1.07‐1.19 and aHR = 1.14, 95% CI = 1.08‐1.20, respectively) and decompensation (aHR = 1.18, 95% CI = 1.07‐1.30 and aHR = 1.08, 95% CI = 1.00‐1.16, respectively). Alcohol use was not associated with HCC, regardless of cirrhosis etiology. Conclusion: Unhealthy alcohol use was common in patients with cirrhosis and was associated with higher risks of mortality and cirrhosis decompensation in patients with HCV‐cirrhosis and ALD‐cirrhosis. Therefore, health care providers should make every effort to help patients achieve abstinence. The lack of association between alcohol use and HCC merits further investigation.
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Affiliation(s)
- Meredith M Pearson
- Division of Gastroenterology and Hepatology, University of Washington, Seattle, WA, USA
| | - Nicole J Kim
- Division of Gastroenterology and Hepatology, University of Washington, Seattle, WA, USA
| | - Kristin Berry
- Health Service Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Andrew M Moon
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
| | - Feng Su
- Division of Gastroenterology and Hepatology, University of Washington, Seattle, WA, USA
| | - Philip Vutien
- Division of Gastroenterology and Hepatology, University of Washington, Seattle, WA, USA
| | - Pamela K Green
- Health Service Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Emily C Williams
- Health Service Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
| | - George N Ioannou
- Division of Gastroenterology and Hepatology, University of Washington, Seattle, WA, USA.,Division of Gastroenterology, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
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9
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Glyn-Owen K, Böhning D, Parkes J, Roderick P, Buchanan R. The combined effect of alcohol and body mass index on risk of chronic liver disease: A systematic review and meta-analysis of cohort studies. Liver Int 2021; 41:1216-1226. [PMID: 33283434 DOI: 10.1111/liv.14754] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/25/2020] [Accepted: 12/01/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Increasingly populations are both overweight/obese and consume alcohol. The risk of liver disease from the combination of these factors is unclear. We performed a systematic review and meta-analysis to address this important gap in evidence. Protocol registered with PROSPERO(CRD42016046508). METHODS We performed electronic searches of Ovid Medline, Embase Classic + Embase, until 17th June 2020 for cohort studies of adults without pre-existing liver disease. Primary outcome was morbidity/mortality from chronic liver disease. Exposures were alcohol consumption categorised as within or above UK recommended limits (14 units/112 g per week) and BMI categorised as normal, overweight or obese. Non-drinkers were excluded. A Poisson regression log-linear model was used to test for statistical interaction between alcohol and BMI and to conduct a one-stage meta-analysis. RESULTS Searches identified 3129 studies-16 were eligible. Of these, nine cohorts (1,121,514 participants) had data available and were included in the analysis. The Poisson model showed no significant statistical interaction between alcohol consumption and BMI on the risk of chronic liver disease. Compared to normal weight participants drinking alcohol within UK recommended limits, relative risk of chronic liver disease in overweight participants drinking above limits was 3.32 (95% CI 2.88 to 3.83) and relative risk in obese participants drinking above limits was 5.39 (95% CI 4.62 to 6.29). CONCLUSIONS This meta-analysis demonstrated a significantly increased risk of chronic liver disease in participants who were both overweight/obese and consumed alcohol above UK recommended limits. This evidence should inform advice given to patients and risk stratification by healthcare professionals.
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Affiliation(s)
- Kate Glyn-Owen
- Department of Primary Care, Population Sciences & Medical Education, University of Southampton, Southampton, UK
| | - Dankmar Böhning
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, UK
| | - Julie Parkes
- Department of Primary Care, Population Sciences & Medical Education, University of Southampton, Southampton, UK
| | - Paul Roderick
- Department of Primary Care, Population Sciences & Medical Education, University of Southampton, Southampton, UK
| | - Ryan Buchanan
- Department of Primary Care, Population Sciences & Medical Education, University of Southampton, Southampton, UK
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Li H, Liang H, Yang H, Zhang X, Ding X, Zhang R, Mao Y, Liu Z, Kan Q, Sun T. Association between intake of sweetened beverages with all-cause and cause-specific mortality: a systematic review and meta-analysis. J Public Health (Oxf) 2021; 44:516-526. [PMID: 33837431 DOI: 10.1093/pubmed/fdab069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 01/12/2021] [Accepted: 02/19/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Conclusions remain controversial between the consumption of sugar and artificially sweetened beverages (SSBs and ASBs) and mortality. METHODS We systematically searched the PubMed, Embase, Cochrane Library and Web of Science databases from their inception date to 1st January 2020, prospective cohort studies researching the mortality risk and SSBs or ASBs consumption were included. Random effects meta-analyses and dose-response analyses were performed to measure the association. Subgroup analyses and sensitivity analyses were further performed to explore the source of heterogeneity. Publication bias was assessed by Funnel plots and Egger's regression test. RESULTS Across all 15 cohorts, 1211 470 participants were included. High SSB consumption was associated with a higher risk of all-cause mortality (hazard ratio [HR], 1.12; 95% confidence interval [CI], 1.06-1.19, P < 0.001; and cardiovascular disease [CVD] mortality [HR 1.20, 95% CI, 1.05-1.38, P < 0.001]), and high ASBs consumption showed similar result (HR 1.12, 95% CI, 1.04-1.21, P = 0.001 for all-cause mortality and HR 1.23, 95% CI, 1.00-1.50, P = 0.049 for CVD mortality), both showed a linear dose-response relationship. CONCLUSIONS High consumption of both ASBs and SSBs showed significant associations with a higher risk of CVD mortality and all-cause mortality. This information may provide ideas for decreasing the global burden of diseases by reducing sweetened beverage intake.
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Affiliation(s)
- Hongyi Li
- General Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University; Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis; Henan Engineering Research Center for Critical Care Medicine, Zhengzhou 450052, China.,Translational Medicine Platform, Academy of Medical Sciences of Zhengzhou University, Zhengzhou 450052, China
| | - Huoyan Liang
- General Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University; Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis; Henan Engineering Research Center for Critical Care Medicine, Zhengzhou 450052, China.,Translational Medicine Platform, Academy of Medical Sciences of Zhengzhou University, Zhengzhou 450052, China
| | - Han Yang
- Department of Respiratory Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou 450052, China
| | - Xiaojuan Zhang
- General Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University; Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis; Henan Engineering Research Center for Critical Care Medicine, Zhengzhou 450052, China
| | - Xianfei Ding
- General Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University; Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis; Henan Engineering Research Center for Critical Care Medicine, Zhengzhou 450052, China.,Translational Medicine Platform, Academy of Medical Sciences of Zhengzhou University, Zhengzhou 450052, China
| | - Ruifang Zhang
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Yimin Mao
- Department of Respiratory Medicine, First Affiliated Hospital of Henan University of Science and Technology, Luoyang 471000, China
| | - Zhangsuo Liu
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Quancheng Kan
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Tongwen Sun
- General Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University; Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis; Henan Engineering Research Center for Critical Care Medicine, Zhengzhou 450052, China.,Translational Medicine Platform, Academy of Medical Sciences of Zhengzhou University, Zhengzhou 450052, China
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Lin XN, Lin QX, Li SM, Xie KP, Hou J, Chen R. Hepatitis E virus re-infection accelerates hepatocellular carcinoma development and relapse in a patient with liver cirrhosis: A case report and review of literature. World J Hepatol 2020; 12:1358-1366. [PMID: 33442461 PMCID: PMC7772737 DOI: 10.4254/wjh.v12.i12.1358] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/04/2020] [Accepted: 10/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatitis E virus (HEV) superinfection is a suspected promoting factor for hepatocellular carcinoma (HCC) in patients with chronic hepatitis and cirrhosis. However, to date, very few cases of HEV-related HCC have been reported. Nevertheless, the role of HEV re-infection in cirrhotic liver without other chronic hepatitis infections has rarely been explored.
CASE SUMMARY A 53-year-old male farmer was diagnosed with liver cirrhosis and splenomegaly in August 2016, accompanied with negative HEV-IgM and positive HEV-IgG. No evidence of hepatitis B virus or hepatitis C virus infection was found. Since then the patient was evaluated for liver function and viral parameters every 3 mo. In June 2017, the patient presented severe fatigue with whole body itching and was diagnosed with HCC. Afterwards this patient experienced quick HCC development, progression, relapse, and metastasis in the following 8 mo, and presented persistent dual positivity of HEV-IgM and HEV-IgG. This patient had a long history of smoking and alcohol consumption.
CONCLUSION This unique case invokes the importance of HEV surveillance and treatment among cirrhotic patients, HCC cases, and blood donors.
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Affiliation(s)
- Xiao-Na Lin
- The Laboratory of Computational Medicine and Systems Biology, School of Medicine, South China University of Technology, Guangzhou 510006, Guangdong Province, China
| | - Qiu-Xiong Lin
- Department of Infectious Disease, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - Shu-Mei Li
- Department of Infectious Disease, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - Ke-Ping Xie
- School of Medicine, South China University of Technology, Guangzhou 510000, Guangdong Province, China
| | - Jun Hou
- The Laboratory of Computational Medicine and Systems Biology, School of Medicine, South China University of Technology, Guangzhou 510006, Guangdong Province, China
| | - Ren Chen
- Department of Infectious Disease, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
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Gow P, Spelman T, Gardner S, Hellard M, Howell J. Estimates of the global reduction in liver disease-related mortality with increased coffee consumption: an analysis of the Global Burden of Disease Dataset. Aliment Pharmacol Ther 2020; 52:1195-1203. [PMID: 32794601 DOI: 10.1111/apt.16020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/10/2020] [Accepted: 07/16/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND Epidemiological data suggest that coffee has a dose-dependent protective effect on liver-related mortality. AIM To estimate the potential impact of increased per capita coffee consumption on global liver-related mortality. METHODS Using the Global Burden of Disease 2016 dataset (adults > 15 years), we modelled the impact of increased per capita coffee consumption on liver-related mortality in 2016 for 194 countries using published risk ratios for >2 cups coffee/ day (RR 0.54, 95% CI 0.42-0.69) and ≥4 cups/ day (RR 0.29, 95% CI 0.17-0.50), adjusted for confounders and tested model assumptions using sensitivity analyses. RESULTS Worldwide, there were an estimated 1,240,201 (95% CI 118 4300-1 354 410) adult liver-related deaths in 2016. Median global liver mortality rate in 2016 was 15 deaths/ 100 000 population/ year (all ages, both genders; IQR 11-21 deaths per 100 000). If all countries with per capita coffee intake ≤2 cups/ day increased to >2 cups/ day, the predicted total number of liver-related deaths would have been 630 947 in 2016 (95% CI 629 693-631 861) with 452 861 (95% CI 451 948-454 116) deaths averted (PPR 7.8 liver-related deaths/ 100 000/ year). If per capita consumption was ≥ 4 cups/ day, the predicted number of liver-related deaths in 2016 would have been 360 523 (95% CI 359 825-361 992) with 723 287 (95% CI 721 817-723 984) deaths averted (PPR 12.1 liver-related deaths/100 000/year). CONCLUSION Increasing per capita coffee consumption to > 2 cups per day on a population level has the potential to avert hundreds of thousands of liver-related deaths annually if the impact of coffee on liver-related mortality is confirmed in clinical trials.
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Affiliation(s)
- Paul Gow
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Vic., Australia.,Department of Medicine, University of Melbourne, Melbourne, Vic., Australia
| | - Tim Spelman
- Disease Elimination, Burnet Institute, Melbourne, Vic., Australia
| | - Sarah Gardner
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Vic., Australia.,Department of Medicine, University of Melbourne, Melbourne, Vic., Australia
| | - Margaret Hellard
- Disease Elimination, Burnet Institute, Melbourne, Vic., Australia.,Department of Infectious Diseases, Alfred Hospital, Melbourne, Vic., Australia.,Centre for Disease Prevention and Epidemiology, Monash University, Melbourne, Vic., Australia
| | - Jessica Howell
- Department of Medicine, University of Melbourne, Melbourne, Vic., Australia.,Disease Elimination, Burnet Institute, Melbourne, Vic., Australia.,Department of Infectious Diseases, Alfred Hospital, Melbourne, Vic., Australia.,Department of Gastroenterology, St Vincent's Hospital, Melbourne, Vic., Australia
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Pattison RJ, Esteban JP, Sempokuya T, Kewcharoen J, Kalathil S, Kuwada SK. Nonalcoholic Fatty Liver Disease: An Important Consideration for Primary Care Providers in Hawai'i. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2020; 79:180-186. [PMID: 32524096 PMCID: PMC7281344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide. NAFLD is a broad term for both non-alcoholic fatty liver (NAFL), which describes simple fatty liver without inflammation, and non-alcoholic steatohepatitis (NASH), the more severe phenotype with hepatocellular inflammation. The population of Hawai'i is particularly vulnerable to the NAFLD and obesity epidemics due to its large proportions of high-risk ethnic minorities exposed to varying degrees of westernization. Unfortunately, primary care providers (PCPs) often face a lack of awareness on the diagnosis and disease spectrum of NAFLD. Early initiation of treatment for NAFLD is crucial to slow its progression and prevent liver-related morbidity and mortality. This review aims to raise awareness for NAFLD among PCPs in Hawai'i by summarizing the disease's epidemiology, diagnosis, and treatment. The diagnostic workup of NAFLD in the primary care setting involves exclusion of other liver disease etiologies and staging assessment of fibrosis and steatosis through non-invasive means such as serum biomarkers or elastography. Patients with overt signs and symptoms of cirrhosis or a high likelihood of advanced hepatic fibrosis should be referred to liver disease specialists. The role of PCPs in NAFLD management involves facilitating weight loss through therapeutic lifestyle modifications and treatment of comorbid cardiovascular conditions. Evidence-based pharmacologic therapies for NAFLD are available, such as vitamin E and pioglitazone, with more currently in development.
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Affiliation(s)
- Robert J. Pattison
- Internal Medicine Residency Program, John A. Burns School of Medicine University of Hawai‘i, Honolulu, HI (RJP, JK)
| | | | | | - Jakrin Kewcharoen
- Internal Medicine Residency Program, John A. Burns School of Medicine University of Hawai‘i, Honolulu, HI (RJP, JK)
| | | | - Scott K. Kuwada
- John A. Burns School of Medicine University of Hawai‘i, Honolulu, HI (SKK)
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Caffeine, alcohol, khat, and tobacco use during pregnancy in Butajira, South Central Ethiopia. PLoS One 2020; 15:e0232712. [PMID: 32384102 PMCID: PMC7209255 DOI: 10.1371/journal.pone.0232712] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 04/20/2020] [Indexed: 01/19/2023] Open
Abstract
Background The use of excessive caffeine and consumption of alcohol, cigarette, and khat during pregnancy can result in adverse health effects on the fetus. The World Health Organization (WHO) recommends a daily caffeine intake not exceeding 300 mg. Likewise, pregnant women are recommended to avoid alcohol, khat and tobacco use. However, the prevalence’s of the use of substances among pregnant women were not well studied in developing countries such as Ethiopia. Therefore, the study aimed to estimate the prevalence of caffeine and alcohol consumption, khat chewing, and tobacco use during pregnancy and identify key factors associated with excess caffeine consumption. Methods We conducted a community based cross-sectional study and used a random sampling technique to recruit 352 pregnant women. We adapted a questionnaire from Caffeine Consumption Questionnaire-Revised (CCQ-R), Alcohol Use Disorder Identification Test (AUDIT), Global Adult Tobacco Survey (GATS), and Ethiopian Demographic Health Survey 2016 for caffeine, alcohol consumption, tobacco use, and khat chewing assessment, respectively. We conducted non-consecutive two days 24-hour recall to determine the habitual intake of caffeine from caffeinated beverages and foods. Prevalence with 95% confidence interval was estimated for excess caffeine intake per day, alcohol consumption, khat chewing, and passive tobacco smoking. We ran a multivariable binary logistic regression model to identify factors associated with excess caffeine intake. Results Almost all pregnant women (98.2%) consumed caffeine as estimated using the 2 days 24-hour average. The median daily caffeine intake was 170.5 mg and ranged from 0.00 mg to 549.8 mg per day. In addition, 17.6% (95% CI: 13.9%, 22.0%) of them had a daily caffeine consumption of 300 mg and above exceeding the WHO recommended daily caffeine intake during pregnancy. The prevalence of alcohol consumption and Khat chewing were 10.0% (95% CI: 7.2%, 13.7%) and 35.8% (95% CI: 30.8, 41.0%) respectively. None of the pregnant women were active tobacco smokers. However, 23.2% (95% CI: 19.0, 28.0%) were passive tobacco smokers. We found that pregnant women in the richest wealth quintile (AOR = 3.66; 95% CI: 1.13, 11.88), and the first trimester of pregnancy (AOR = 4.04; 95% CI: 1.26, 13.05) had higher odds of consuming excessive caffeine. Conclusions The study showed a considerable magnitude of substance use among pregnant women in the study area. Given this findings, we recommend, programs and services focusing on pregnant women to consider addressing substance use.
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Tanaka K, Tamakoshi A, Sugawara Y, Mizoue T, Inoue M, Sawada N, Matsuo K, Ito H, Naito M, Nagata C, Kitamura Y, Sadakane A, Tsugane S, Shimazu T. Coffee, green tea and liver cancer risk: an evaluation based on a systematic review of epidemiologic evidence among the Japanese population. Jpn J Clin Oncol 2020; 49:972-984. [PMID: 31790152 DOI: 10.1093/jjco/hyz097] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/07/2019] [Accepted: 06/11/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Coffee and green tea, two popular drinks in the Japanese, have recently drawn much attention as potential protective factors against the occurrence of liver cancer. METHODS We systematically reviewed epidemiologic studies on coffee, green tea and liver cancer among Japanese populations. Original data were obtained by searching the MEDLINE (PubMed) and Ichushi databases, complemented with manual searches. The evaluation was performed in terms of the magnitude of association in each study and the strength of evidence ('convincing', 'probable', 'possible', or 'insufficient'), together with biological plausibility. RESULTS We identified four cohort and four case-control studies on coffee and liver cancer and six cohort and one case-control studies on green tea and liver cancer. All cohort and case-control studies on coffee reported a weak to strong inverse association, with a summary relative risk (RR) for one cup increase being 0.72 (95% confidence interval [CI] 0.66-0.79). Conversely, all studies but two cohort studies on green tea reported no association, with a corresponding summary RR of 0.99 (95% CI 0.97-1.01, P = 0.37). CONCLUSION Coffee drinking 'probably' decreases the risk of primary liver cancer among the Japanese population whereas the evidence on an association between green tea and liver cancer is 'insufficient' in this population.
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Affiliation(s)
- Keitaro Tanaka
- Department of Preventive Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Akiko Tamakoshi
- Department of Public Health, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yumi Sugawara
- Division of Epidemiology, Department of Health Informatics and Public Health, Tohoku University School of Public Health, Graduate School of Medicine, Sendai, Japan
| | - Tetsuya Mizoue
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Manami Inoue
- Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Norie Sawada
- Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Keitaro Matsuo
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Hidemi Ito
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Mariko Naito
- Department of Oral Epidemiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Chisato Nagata
- Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yuri Kitamura
- Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Atsuko Sadakane
- Department of Epidemiology, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Shoichiro Tsugane
- Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Taichi Shimazu
- Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
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Abstract
OBJECTIVES To systematically summarize the risk relationship between different levels of alcohol consumption and incidence of liver cirrhosis. METHODS MEDLINE and Embase were searched up to March 6, 2019, to identify case-control and cohort studies with sex-specific results and more than 2 categories of drinking in relation to the incidence of liver cirrhosis. Study characteristics were extracted and random-effects meta-analyses and meta-regressions were conducted. RESULTS A total of 7 cohort studies and 2 case-control studies met the inclusion criteria, providing data from 2,629,272 participants with 5,505 cases of liver cirrhosis. There was no increased risk for occasional drinkers. Consumption of one drink per day in comparison to long-term abstainers showed an increased risk for liver cirrhosis in women, but not in men. The risk for women was consistently higher compared to men. Drinking ≥5 drinks per day was associated with a substantially increased risk in both women (relative risk [RR] = 12.44, 95% confidence interval [CI]: 6.65-23.27 for 5-6 drinks, and RR = 24.58, 95% CI: 14.77-40.90 for ≥7 drinks) and men (RR = 3.80, 95% CI: 0.85-17.02, and RR = 6.93, 95% CI: 1.07-44.99, respectively). Heterogeneity across studies indicated an additional impact of other risk factors. DISCUSSION Alcohol is a major risk factor for liver cirrhosis with risk increasing exponentially. Women may be at higher risk compared to men even with little alcohol consumption. More high-quality research is necessary to elucidate the role of other risk factors, such as genetic vulnerability, body weight, metabolic risk factors, and drinking patterns over the life course. High alcohol consumption should be avoided, and people drinking at high levels should receive interventions to reduce their intake.
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17
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Liver enzymes in alcohol consumers with or without binge drinking. Alcohol 2019; 78:13-19. [PMID: 30890357 DOI: 10.1016/j.alcohol.2019.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND While alcohol use is linked with a wide variety of health problems, the question of whether differences in drinking patterns could yield different outcomes has remained unclear. PATIENTS AND METHODS We measured liver enzymes (ALT, GGT) from alcohol consumers with or without binge drinking from a population-based sample in Finland, where binge-type drinking is common. Data on alcohol use, diet, body weight, lifestyle (smoking, coffee consumption, physical activity), and health status were collected from 19225 subjects (9492 men, 9733 women), aged 25-74 years. The participants were subsequently classified to subgroups, both according to the frequencies of binge drinking and the amounts of regular alcohol intake (low-, medium-, and high-risk drinking). RESULTS The quantity of regular alcohol use was roughly linearly related with GGT and ALT activities. ANOVA analyses of the trends according to the frequency of binge drinking showed a significant GGT increase in both men (p < 0.0005) and women (p < 0.0005), and a significant increase of ALT in men (p < 0.0005). In those with low-risk overall consumption, markedly higher GGT (p < 0.0005) and ALT (p < 0.0005) occurred in those with binge drinking more than once a month, compared with those with no such occasions. Binge drinking occurring ≤1/month also resulted in higher GGT (p < 0.0005) and ALT (p < 0.05) activities. CONCLUSIONS These results emphasize possible adverse consequences of binge drinking on hepatic function even in those with low-risk overall consumption. The pattern of drinking should be more systematically implicated in clinical recommendations for drinking reduction.
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Prognosis of cirrhotic patients admitted to Emergency Departments: A multicenter study. Am J Emerg Med 2019; 37:1317-1321. [DOI: 10.1016/j.ajem.2018.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 10/01/2018] [Accepted: 10/10/2018] [Indexed: 11/19/2022] Open
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Simpson RF, Hermon C, Liu B, Green J, Reeves GK, Beral V, Floud S. Alcohol drinking patterns and liver cirrhosis risk: analysis of the prospective UK Million Women Study. Lancet Public Health 2019; 4:e41-e48. [PMID: 30472032 PMCID: PMC6323353 DOI: 10.1016/s2468-2667(18)30230-5] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/22/2018] [Accepted: 10/25/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Alcohol is a known cause of cirrhosis, but it is unclear if the associated risk varies by whether alcohol is drunk with meals, or by the frequency or type of alcohol consumed. Here we aim to investigate the associations between alcohol consumption with meals, daily frequency of consumption, and liver cirrhosis. METHODS The Million Women Study is a prospective study that includes one in every four UK women born between 1935 and 1950, recruited between 1996 and 2001. In 2001 (IQR 2000-03), the participants reported their alcohol intake, whether consumption was usually with meals, and number of days per week it was consumed. Cox regression analysis yielded adjusted relative risks (RRs) for incident cirrhosis, identified by follow-up through electronic linkage to routinely collected national hospital admission, and death databases. FINDINGS During a mean of 15 years (SD 3) of follow-up of 401 806 women with a mean age of 60 years (SD 5), without previous cirrhosis or hepatitis, and who reported drinking at least one alcoholic drink per week, 1560 had a hospital admission with cirrhosis (n=1518) or died from the disease (n=42). Cirrhosis incidence increased with amount of alcohol consumed (≥15 drinks [mean 220 g of alcohol] vs one to two drinks [mean 30 g of alcohol] per week; RR 3·43, 95% CI 2·87-4·10; p<0·0001). About half of the participants (203 564 of 401 806) reported usually drinking with meals and, after adjusting for amount consumed, cirrhosis incidence was lower for usually drinking with meals than not (RR 0·69, 0·62-0·77; p<0·0001; wine-only drinkers RR 0·69, 0·56-0·85; all other drinkers RR 0·72, 0·63-0·82). Among 175 618 women who consumed seven or more drinks per week, cirrhosis incidence was greater for daily consumption than non-daily consumption (adjusted RR 1·61, 1·40-1·85; p<0·0001). Daily consumption, together with not drinking with meals, was associated with more than a doubling of cirrhosis incidence (adjusted RR 2·47, 1·96-3·11; p<0·0001). INTERPRETATION In middle-aged women, cirrhosis incidence increases with total alcohol intake, even at moderate levels of consumption. For a given weekly intake of alcohol, this excess incidence of cirrhosis is higher if consumption is usually without meals, or with daily drinking. FUNDING UK Medical Research Council and Cancer Research UK.
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Affiliation(s)
- Rachel F Simpson
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK.
| | - Carol Hermon
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Bette Liu
- School of Public Health and Community Medicine, University of New South Wales, Sydney 2052, Australia
| | - Jane Green
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Gillian K Reeves
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Valerie Beral
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Sarah Floud
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
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Coffee and wine consumption is associated with reduced mortality from alcoholic liver disease: follow-up of 219,279 Norwegian men and women aged 30–67 years. Ann Epidemiol 2018; 28:753-758. [DOI: 10.1016/j.annepidem.2018.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/08/2018] [Accepted: 08/21/2018] [Indexed: 12/22/2022]
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Lew QLJ, Jafar TH, Jin A, Yuan JM, Koh WP. Consumption of Coffee but Not of Other Caffeine-Containing Beverages Reduces the Risk of End-Stage Renal Disease in the Singapore Chinese Health Study. J Nutr 2018; 148:1315-1322. [PMID: 29986029 PMCID: PMC6075197 DOI: 10.1093/jn/nxy075] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/02/2018] [Accepted: 03/23/2018] [Indexed: 12/13/2022] Open
Abstract
Background Cross-sectional studies suggest that coffee drinking is associated with better renal function. However, to our knowledge, no prospective study has examined its relation with the risk of end-stage renal disease (ESRD). Objective We examined the relations between coffee, tea, soda, and total caffeine consumption and the risk of ESRD among middle-aged and older Chinese in Singapore. Methods We used data from the Singapore Chinese Health Study, a prospective cohort of 63,257 men and women aged 45-74 y at recruitment from 1993 to 1998. Baseline information on the consumption of caffeinated coffee and other caffeinated beverages (tea and sodas), habitual diet, medical history, and lifestyle factors was obtained via in-person interviews. The standard serving size of 1 cup was assigned as 237 mL in the questionnaire. Incident ESRD cases were identified via linkage with the nationwide registry. We used multivariable Cox regression models to estimate HRs and 95% CIs of ESRD risk associated with the consumption of caffeinated beverages, with adjustment for potential confounders. Results After a mean follow-up of 16.8 y, 1143 cohort subjects developed ESRD. Compared with those who drank coffee less than daily, the HR (95% CI) was 0.91 (0.79, 1.05) for those who drank 1 cup of coffee/d and 0.82 (0.71, 0.96) for those who drank ≥2 cups/d (P-trend = 0.012). When stratified by sex, this association was observed in men but not in women. Compared with those who drank less than daily, the HR (95% CI) for drinking ≥2 cups/d was 0.71 (0.57, 0.87) among men and 0.97 (0.78, 1.19) among women (P-interaction = 0.03). Conversely, intakes of tea, soda, or total caffeine were not associated with the risk of ESRD in multivariable models. Conclusion The consumption of ≥2 cups of coffee/d may reduce the risk of ESRD in the general population, especially among men. This study was registered at http://www.clinicaltrials.gov as NCT03356340.
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Affiliation(s)
| | - Tazeen Hasan Jafar
- Health Services and Systems Research, Duke–NUS Medical School Singapore, Singapore
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Aizhen Jin
- National Registry of Diseases Office, Health Promotion Board, Singapore
| | - Jian-Min Yuan
- Division of Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute, Pittsburgh, PA
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA
| | - Woon-Puay Koh
- Health Services and Systems Research, Duke–NUS Medical School Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Neelakantan N, Koh WP, Yuan JM, van Dam RM. Diet-Quality Indexes Are Associated with a Lower Risk of Cardiovascular, Respiratory, and All-Cause Mortality among Chinese Adults. J Nutr 2018; 148:1323-1332. [PMID: 29982724 PMCID: PMC6075575 DOI: 10.1093/jn/nxy094] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 04/13/2018] [Indexed: 02/07/2023] Open
Abstract
Background Diet-quality indexes have been associated with a lower risk of chronic disease mortality in Western populations, but it is unclear whether these indexes reflect protective dietary patterns in Asian populations. Objective We examined the association between Alternative Healthy Eating Index-2010 (AHEI-2010), alternate Mediterranean diet (aMED), Dietary Approaches to Stop Hypertension (DASH), and Healthy Diet Indicator (HDI) scores and the risk of all-cause cardiovascular disease (CVD), cancer, and respiratory disease mortality. Methods We used data from a prospective cohort of 57,078 Singapore Chinese men and women (aged 45-74 y) who were free of cancer and CVD at baseline (1993-1998) and who were followed up through 2014. The diet-quality index scores were calculated on the basis of data from a validated 165-item food-frequency questionnaire. Cox regression models with adjustment for potential confounders including sociodemographic and lifestyle variables, body mass index, and medical history were used to estimate HRs and 95% CIs. Results During a total of 981,980 person-years of follow-up, 15,262 deaths (CVD: 4871; respiratory: 2690; and cancer: 5306) occurred. Comparing the highest with the lowest quintiles, the multivariable adjusted HRs (95% CIs) for all-cause mortality were 0.82 (0.78, 0.86) for AHEI-2010, 0.80 (0.76, 0.85) for aMED, 0.80 (0.75, 0.84) for DASH, and 0.88 (0.83, 0.92) for HDI scores (all P-trend < 0.001). Higher diet index scores were associated with a 14-28% lower risk of CVD and respiratory mortality, but only a 5-12% lower risk of cancer mortality. Higher consumption of vegetables, fruit, nuts, and long-chain n-3 (ω-3) fatty acids, lower consumption of red meat, and avoidance of high alcohol consumption were the diet index components associated with a lower risk of mortality. Conclusion Adherence to several recommended dietary patterns that emphasize healthy plant-based foods was associated with a substantially lower risk of chronic disease mortality in an Asian population. The Singapore Chinese Health Study was registered at www.clinicaltrials.gov as NCT03356340.
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Affiliation(s)
| | - Woon-Puay Koh
- Saw Swee Hock School of Public Health,Duke-NUS Medical School, Singapore
| | - Jian-Min Yuan
- Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Center, Pittsburgh, PA,Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Rob M van Dam
- Saw Swee Hock School of Public Health,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore,Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA,Address correspondence to RMvD (e-mail: )
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Bajaj JS, Idilman R, Mabudian L, Hood M, Fagan A, Turan D, White MB, Karakaya F, Wang J, Atalay R, Hylemon PB, Gavis EA, Brown R, Thacker LR, Acharya C, Heuman DM, Sikaroodi M, Gillevet PM. Diet affects gut microbiota and modulates hospitalization risk differentially in an international cirrhosis cohort. Hepatology 2018; 68:234-247. [PMID: 29350768 DOI: 10.1002/hep.29791] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/14/2017] [Accepted: 01/16/2018] [Indexed: 12/17/2022]
Abstract
UNLABELLED The relative ranking of cirrhosis-related deaths differs between high-/middle-income countries. Gut microbiome is affected in cirrhosis and is related to diet. Our aim was to determine the effect of differing dietary habits on gut microbiota and clinical outcomes. Outpatient compensated/decompensated patients with cirrhosis and controls from Turkey and the United States underwent dietary and stool microbiota analysis. Patients with cirrhosis were followed till 90-day hospitalizations. Shannon diversity and multivariable determinants (Cox and binary logistic) of microbial diversity and hospitalizations were studied within/between groups. Two hundred ninety-six subjects (157 U.S.: 48 controls, 59 compensated, 50 decompensated; 139 Turkey: 46 controls, 50 compensated, 43 decompensated) were included. Patients with cirrhosis between cohorts had similar Model for End-Stage Liver Disease (MELD) scores. American patients with cirrhosis had more men, greater rifaximin/lactulose use, and higher hepatitis C/alcohol etiologies. Coffee intake was higher in Americans whereas tea, fermented milk, and chocolate intake were higher in Turkey. The entire Turkish cohort had a significantly higher microbial diversity than Americans, which did not change between their controls and patients with cirrhosis. In contrast, microbial diversity changed in the U.S.-based cohort and was the lowest in decompensated patients. Coffee, tea, vegetable, chocolate, and fermented milk intake predicted a higher diversity whereas MELD score, lactulose use, and carbonated beverage use predicted a lower microbial diversity. The Turkish cohort had a lower risk of 90-day hospitalizations. On Cox and binary logistic regression, microbial diversity was protective against 90-day hospitalizations, along with coffee/tea, vegetable, and cereal intake. CONCLUSION In this study of patients with cirrhosis and healthy controls from the United States and Turkey, a diet rich in fermented milk, vegetables, cereals, coffee, and tea is associated with a higher microbial diversity. Microbial diversity was associated with an independently lower risk of 90-day hospitalizations. (Hepatology 2018;68:234-247).
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Affiliation(s)
- Jasmohan S Bajaj
- Internal Medicine, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA
| | - Ramazan Idilman
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
| | - Leila Mabudian
- Microbiome Analysis Center, George Mason University, Manassas, VA
| | - Matthew Hood
- Microbiome Analysis Center, George Mason University, Manassas, VA
| | - Andrew Fagan
- Internal Medicine, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA
| | - Dilara Turan
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
| | - Melanie B White
- Internal Medicine, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA
| | - Fatih Karakaya
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
| | - Jessica Wang
- Microbiome Analysis Center, George Mason University, Manassas, VA
| | - Rengül Atalay
- Bioinformatics Department, Graduate School of Informatics, Middle East Technical University, Ankara, Turkey
| | - Phillip B Hylemon
- Microbiology, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA
| | - Edith A Gavis
- Internal Medicine, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA
| | - Robert Brown
- Microbiome Analysis Center, George Mason University, Manassas, VA
| | - Leroy R Thacker
- Biostatistics, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA
| | - Chathur Acharya
- Internal Medicine, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA
| | - Douglas M Heuman
- Internal Medicine, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA
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Do Coffee Polyphenols Have a Preventive Action on Metabolic Syndrome Associated Endothelial Dysfunctions? An Assessment of the Current Evidence. Antioxidants (Basel) 2018; 7:antiox7020026. [PMID: 29401716 PMCID: PMC5836016 DOI: 10.3390/antiox7020026] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 01/30/2018] [Accepted: 02/01/2018] [Indexed: 12/14/2022] Open
Abstract
Epidemiologic studies from several countries have found that mortality rates associated with the metabolic syndrome are inversely associated with coffee consumption. Metabolic syndrome can lead to arteriosclerosis by endothelial dysfunction, and increases the risk for myocardial and cerebral infarction. Accordingly, it is important to understand the possible protective effects of coffee against components of the metabolic syndrome, including vascular endothelial function impairment, obesity and diabetes. Coffee contains many components, including caffeine, chlorogenic acid, diterpenes and trigonelline. Studies have found that coffee polyphenols, such as chlorogenic acids, have many health-promoting properties, such as antioxidant, anti-inflammatory, anti-cancer, anti-diabetes, and antihypertensive properties. Chlorogenic acids may exert protective effects against metabolic syndrome risk through their antioxidant properties, in particular toward vascular endothelial cells, in which nitric oxide production may be enhanced, by promoting endothelial nitric oxide synthase expression. These effects indicate that coffee components may support the maintenance of normal endothelial function and play an important role in the prevention of metabolic syndrome. However, results related to coffee consumption and the metabolic syndrome are heterogeneous among studies, and the mechanisms of its functions and corresponding molecular targets remain largely elusive. This review describes the results of studies exploring the putative effects of coffee components, especially in protecting vascular endothelial function and preventing metabolic syndrome.
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Singal AK, Bataller R, Ahn J, Kamath PS, Shah VH. ACG Clinical Guideline: Alcoholic Liver Disease. Am J Gastroenterol 2018; 113:175-194. [PMID: 29336434 PMCID: PMC6524956 DOI: 10.1038/ajg.2017.469] [Citation(s) in RCA: 463] [Impact Index Per Article: 77.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 11/08/2017] [Indexed: 02/07/2023]
Abstract
Alcoholic liver disease (ALD) comprises a clinical-histologic spectrum including fatty liver, alcoholic hepatitis (AH), and cirrhosis with its complications. Most patients are diagnosed at advanced stages and data on the prevalence and profile of patients with early disease are limited. Diagnosis of ALD requires documentation of chronic heavy alcohol use and exclusion of other causes of liver disease. Prolonged abstinence is the most effective strategy to prevent disease progression. AH presents with rapid onset or worsening of jaundice, and in severe cases may transition to acute on chronic liver failure when the risk for mortality, depending on the number of extra-hepatic organ failures, may be as high as 20-50% at 1 month. Corticosteroids provide short-term survival benefit in about half of treated patients with severe AH and long-term mortality is related to severity of underlying liver disease and is dependent on abstinence from alcohol. General measures in patients hospitalized with ALD include inpatient management of liver disease complications, management of alcohol withdrawal syndrome, surveillance for infections and early effective antibiotic therapy, nutritional supplementation, and treatment of the underlying alcohol-use disorder. Liver transplantation, a definitive treatment option in patients with advanced alcoholic cirrhosis, may also be considered in selected patients with AH cases, who do not respond to medical therapy. There is a clinical unmet need to develop more effective and safer therapies for patients with ALD.
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Affiliation(s)
- Ashwani K. Singal
- Division of Gastroenterology and Hepatology, University of Alabama at Birmingham School of Medicine , Birmingham , Alabama , USA
| | - Ramon Bataller
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Liver Research Center , Pittsburgh , Pennsylvania , USA
| | - Joseph Ahn
- Division of Gastroenterology and Hepatology, Oregon Health and Science University , Portland , Oregon , USA
| | - Patrick S. Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic , Rochester , Minnesota ,USA
| | - Vijay H. Shah
- Division of Gastroenterology and Hepatology, Mayo Clinic , Rochester , Minnesota ,USA
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Where should the safe limits of alcohol consumption stand in light of liver enzyme abnormalities in alcohol consumers? PLoS One 2017; 12:e0188574. [PMID: 29206836 PMCID: PMC5716536 DOI: 10.1371/journal.pone.0188574] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 11/09/2017] [Indexed: 12/12/2022] Open
Abstract
Objectives To estimate the prevalence and risk factors for abnormal liver enzymes in a large age- and gender stratified population-based sample of apparently healthy individuals with or without alcohol consumption and other health-related risk factors (adiposity, physical inactivity, smoking). Methods Data on alcohol use, smoking, diet and physical activity were recorded using structured questionnaires from 13,976 subjects (6513 men, 7463 women, aged 25–74 years) in the national FINRISK studies. Alcohol data was used to categorize the participants into abstainers, light drinkers, moderate drinkers and heavy drinkers. Serum gamma-glutamyltransferase (GGT) and alanine aminotransferase (ALT) activities were measured using standard kinetic methods. Results Male light drinkers, moderate drinkers and heavy drinkers showed significantly higher relative risks of abnormal GGT than abstainers: 1.37 (95% confidence interval 1.11 to 1.71, p < 0.01), 2.72 (2.08 to 3.56, p < 0.0005), and 6.10 (4.55 to 7.17, p < 0.0005), respectively. Corresponding values for women were 1.22 (0.99 to 1.51, p = 0.065), 1.90 (1.44 to 2.51, p < 0.0005), and 5.91 (3.80 to 9.17, p < 0.0005). Estimated threshold doses for a significant GGT elevation was 14 standard weekly alcohol doses for men and 7 for women. Excess body weight and age over 40 years modulated the thresholds towards smaller quantities of alcohol. The risk of abnormal GGT was also significantly influenced by physical inactivity and smoking. The relative risks of abnormal ALT activities were increased in male heavy drinkers, especially in those presenting with adiposity and sedentary lifestyle. Conclusions Alcohol use markedly increases the risk for abnormal liver enzyme activities in those presenting with age over 40 years, obesity, smoking or sedentary lifestyle. The data should be considered in public health recommendations and in the definitions of safe limits of alcohol use.
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28
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Coffee and the risk of hepatocellular carcinoma and chronic liver disease: a systematic review and meta-analysis of prospective studies. Eur J Cancer Prev 2017; 26:368-377. [DOI: 10.1097/cej.0000000000000252] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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29
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Abstract
The prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing rapidly with the obesity and diabetes mellitus epidemics. It is rapidly becoming the most common cause of liver disease worldwide. NAFLD can progress to serious complications such as cirrhosis, hepatocellular carcinoma and death. Therefore, it is important to recognise this condition so that early intervention can be implemented. Lifestyle modifications and strict control of metabolic risk factors are the mainstay of treatment. As disease progression is slow in the majority of NAFLD patients, most can be managed well by primary care physicians. NAFLD patients with advanced liver fibrosis should be referred to specialist care for further assessment.
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Affiliation(s)
- Jing Hieng Ngu
- Singapore General Hospital, Singapore.,Duke-NUS Medical School, Singapore
| | | | | | - Roy Soetikno
- Singapore General Hospital, Singapore.,Duke-NUS Medical School, Singapore
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30
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Petta S, Marchesini G. Coffee and tea breaks for liver health. J Hepatol 2017; 67:221-223. [PMID: 28578838 DOI: 10.1016/j.jhep.2017.04.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 04/25/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Salvatore Petta
- Section of Gastroenterology and Hepatology, Di.Bi.M.I.S., University of Palermo, Italy.
| | - Giulio Marchesini
- Department of Medical and Surgical Sciences (DIMEC), "Alma Mater" University, Bologna, Italy
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31
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Soh AZ, Pan A, Chee CBE, Wang YT, Yuan JM, Koh WP. Tea Drinking and Its Association with Active Tuberculosis Incidence among Middle-Aged and Elderly Adults: The Singapore Chinese Health Study. Nutrients 2017; 9:nu9060544. [PMID: 28587081 PMCID: PMC5490523 DOI: 10.3390/nu9060544] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 05/17/2017] [Accepted: 05/23/2017] [Indexed: 12/02/2022] Open
Abstract
Experimental studies showed that tea polyphenols may inhibit growth of Mycobacterium tuberculosis. However, no prospective epidemiologic study has investigated tea drinking and the risk of active tuberculosis. We investigated this association in the Singapore Chinese Health Study, a prospective population-based cohort of 63,257 Chinese aged 45–74 years recruited between 1993 and 1998 in Singapore. Information on habitual drinking of tea (including black and green tea) and coffee was collected via structured questionnaires. Incident cases of active tuberculosis were identified via linkage with the nationwide tuberculosis registry up to 31 December 2014. Cox proportional hazard models were used to estimate the relation of tea and coffee consumption with tuberculosis risk. Over a mean 16.8 years of follow-up, we identified 1249 incident cases of active tuberculosis. Drinking either black or green tea was associated with a dose-dependent reduction in tuberculosis risk. Compared to non-drinkers, the hazard ratio (HR) (95% confidence interval (CI)) was 1.01 (0.85–1.21) in monthly tea drinkers, 0.84 (0.73–0.98) in weekly drinkers, and 0.82 (0.71–0.96) in daily drinkers (p for trend = 0.003). Coffee or caffeine intake was not significantly associated with tuberculosis risk. In conclusion, regular tea drinking was associated with a reduced risk of active tuberculosis.
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Affiliation(s)
- Avril Zixin Soh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore.
| | - An Pan
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Cynthia Bin Eng Chee
- Singapore Tuberculosis Control Unit, Tan Tock Seng Hospital, Singapore 308089, Singapore.
| | - Yee-Tang Wang
- Singapore Tuberculosis Control Unit, Tan Tock Seng Hospital, Singapore 308089, Singapore.
| | - Jian-Min Yuan
- Division of Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute, and Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 15261, USA.
| | - Woon-Puay Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore.
- Office of Clinical Sciences, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore.
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32
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Goh GBB, Pan A, Chow WC, Yuan JM, Koh WP. Reponse to the association between diabetes mellitus and cirrhosis mortality. Liver Int 2017; 37:467. [PMID: 28240839 DOI: 10.1111/liv.13258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- George Boon-Bee Goh
- Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - An Pan
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wan-Cheng Chow
- Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Jian-Min Yuan
- Division of Cancer Control and Population Science, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA.,Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Woon-Puay Koh
- Duke-NUS Medical School, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Hagström H, Nasr P, Ekstedt M, Kechagias S, Önnerhag K, Nilsson E, Rorsman F, Sheikhi R, Marschall HU, Hultcrantz R, Stål P. Low to moderate lifetime alcohol consumption is associated with less advanced stages of fibrosis in non-alcoholic fatty liver disease. Scand J Gastroenterol 2017; 52:159-165. [PMID: 27650916 DOI: 10.1080/00365521.2016.1239759] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Moderate alcohol consumption has been associated with a lower risk of disease severity in non-alcoholic fatty liver disease (NAFLD). It is unclear if this reflects current or lifetime drinking, or can be attributed to confounders such as diet and exercise. We evaluated the impact of lifetime alcohol consumption on fibrosis severity in NAFLD. METHODS We prospectively enrolled 120 subjects with biopsy-proven NAFLD and through detailed questionnaires examined lifetime alcohol consumption, diet and physical activity. Main outcome measures were odds ratios (OR) for fibrosis stage, calculated through ordinal regression after adjustment for body mass index, diabetes mellitus type 2, smoking and age at biopsy. A biomarker for recent alcohol consumption, phosphatidyl ethanol (PEth) was sampled. RESULTS An increase in median weekly alcohol consumption to a maximum of 13 drinks per week was associated with lower fibrosis stage (adjusted OR for each incremental unit, 0.86; 95% CI, 0.76-0.97; p = .017). The lowest risk for fibrosis was found with the lowes`t odds seen in the top quartile of alcohol consumption (aOR 0.23; 95% CI 0.08-0.66; p = .006). Adding soft drink and coffee consumptions, and physical activity to the model did not change the estimates. Subjects with PEth ≥0.3 μmol/L had higher ORs for a higher fibrosis stage (aOR 2.77; 95% CI 1.01-7.59; p = .047). CONCLUSION Lifetime alcohol consumption with up to 13 units per week is associated with lower fibrosis stage in NAFLD. Elevated PEth is associated with higher stages of fibrosis.
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Affiliation(s)
- Hannes Hagström
- a Centre for Digestive Diseases, Division of Hepatology , Karolinska University Hospital , Stockholm , Sweden.,b Department of Medicine , Karolinska Institutet , Stockholm , Sweden
| | - Patrik Nasr
- c Department of Gastroenterology and Hepatology , Linköping University , Linköping , Sweden.,d Department of Medical and Health Sciences , Linköping University , Linköping , Sweden
| | - Mattias Ekstedt
- c Department of Gastroenterology and Hepatology , Linköping University , Linköping , Sweden.,d Department of Medical and Health Sciences , Linköping University , Linköping , Sweden
| | - Stergios Kechagias
- c Department of Gastroenterology and Hepatology , Linköping University , Linköping , Sweden.,d Department of Medical and Health Sciences , Linköping University , Linköping , Sweden
| | - Kristina Önnerhag
- e Department of Gastroenterology and Hepatology , Skåne University Hospital, Malmö/Lund , Sweden
| | - Emma Nilsson
- e Department of Gastroenterology and Hepatology , Skåne University Hospital, Malmö/Lund , Sweden
| | - Fredrik Rorsman
- f Department of Gastroenterology and Hepatology , Uppsala University Hospital , Uppsala , Sweden
| | - Reza Sheikhi
- f Department of Gastroenterology and Hepatology , Uppsala University Hospital , Uppsala , Sweden
| | - Hanns-Ulrich Marschall
- g Department of Molecular and Clinical Medicine, Sahlgrenska Academy , Institute of Medicine, University of Gothenburg , Gothenburg , Sweden
| | - Rolf Hultcrantz
- a Centre for Digestive Diseases, Division of Hepatology , Karolinska University Hospital , Stockholm , Sweden.,b Department of Medicine , Karolinska Institutet , Stockholm , Sweden
| | - Per Stål
- a Centre for Digestive Diseases, Division of Hepatology , Karolinska University Hospital , Stockholm , Sweden.,b Department of Medicine , Karolinska Institutet , Stockholm , Sweden
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Friedrich K, Smit M, Wannhoff A, Rupp C, Scholl SG, Antoni C, Dollinger M, Neumann-Haefelin C, Stremmel W, Weiss KH, Schemmer P, Gotthardt DN. Coffee consumption protects against progression in liver cirrhosis and increases long-term survival after liver transplantation. J Gastroenterol Hepatol 2016; 31:1470-5. [PMID: 26880589 DOI: 10.1111/jgh.13319] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 01/25/2016] [Accepted: 02/10/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Therapeutic options to treat progression of end-stage liver disease (ESLD) or improve long-term survival after liver transplantation remain scarce. We investigated the impact of coffee consumption under these conditions. METHODS We recorded coffee consumption habits of 379 patients with ESLD awaiting liver transplantation and 260 patients after liver transplantation. Survival was analyzed based on coffee intake. RESULTS One hundred ninety-five patients with ESLD consumed coffee on a daily basis, while 184 patients did not. Actuarial survival was impaired (P = 0.041) in non-coffee drinkers (40.4 ± 4.3 months, 95% confidence interval [CI]: 32.0-48.9) compared with coffee drinkers (54.9 ± 5.5 months, 95% CI: 44.0-65.7). In subgroup analysis, the survival of patients with alcoholic liver disease (ALD; P = 0.020) and primary sclerosing cholangitis (PSC; P = 0.017) was increased with coffee intake while unaffected in patients with chronic viral hepatitis (P = 0.517) or other liver disease entities (P = 0.652). Multivariate analysis showed that coffee consumption of PSC and ALD patients retained as an independent risk factor (odds ratio [OR]: 1.94; 95% CI: 1.15-3.28; P = 0.013) along with MELD score (OR: 1.13; 95% CI: 1.09-1.17; P = 0.000). Following liver transplantation, long-term survival was longer in coffee drinkers (coffee: 61.8 ± 2.0 months, 95% CI: 57.9-65.8) than non-drinkers (52.3 ± 3.5 months, 95% CI: 45.4-59.3; P = 0.001). CONCLUSIONS Coffee consumption delayed disease progression in ALD and PSC patients with ESLD and increased long-term survival after liver transplantation. We conclude that regular coffee intake might be recommended for these patients.
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Affiliation(s)
- Kilian Friedrich
- Department of Internal Medicine IV, University Hospital of Heidelberg, Heidelberg, Germany
| | - Mark Smit
- Department of Internal Medicine IV, University Hospital of Heidelberg, Heidelberg, Germany
| | - Andreas Wannhoff
- Department of Internal Medicine IV, University Hospital of Heidelberg, Heidelberg, Germany
| | - Christian Rupp
- Department of Internal Medicine IV, University Hospital of Heidelberg, Heidelberg, Germany
| | - Sabine G Scholl
- Department of Social Psychology, University of Mannheim, Mannheim, Germany
| | - Christoph Antoni
- Department of Medicine II (Gastroenterology, Hepatology and Infectious Diseases), University Hospital of Heidelberg at Mannheim, Mannheim, Germany
| | - Matthias Dollinger
- Department of Internal Medicine I, University of Ulm, Ulm, Baden-Wuerttemberg, Germany
| | - Christoph Neumann-Haefelin
- Department of Medicine II, Freiburg University Medical Center, University of Freiburg, Freiburg, Germany
| | - Wolfgang Stremmel
- Department of Internal Medicine IV, University Hospital of Heidelberg, Heidelberg, Germany
| | - Karl Heinz Weiss
- Department of Internal Medicine IV, University Hospital of Heidelberg, Heidelberg, Germany
| | - Peter Schemmer
- Department of Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Daniel Nils Gotthardt
- Department of Internal Medicine IV, University Hospital of Heidelberg, Heidelberg, Germany
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Kennedy OJ, Roderick P, Buchanan R, Fallowfield JA, Hayes PC, Parkes J. Systematic review with meta-analysis: coffee consumption and the risk of cirrhosis. Aliment Pharmacol Ther 2016; 43:562-74. [PMID: 26806124 DOI: 10.1111/apt.13523] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 11/10/2015] [Accepted: 12/20/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Liver cirrhosis is a large burden on global health, causing over one million deaths per year. Observational studies have reported an inverse association between coffee and cirrhosis. AIMS To perform a systematic review and meta-analysis to characterise the relationship between coffee consumption and cirrhosis. METHODS We searched for studies published until July 2015 that reported odds ratios, relative risks (RR) or hazard ratios for cirrhosis stratified by coffee consumption. We calculated RRs of cirrhosis for an increase in daily coffee consumption of two cups for each study and overall. We performed analyses by study design, type of cirrhosis and mortality. We assessed the risk of bias in each study and the overall quality of evidence for the effect of coffee on cirrhosis. RESULTS We identified five cohort studies and four case-control studies involving 1990 cases and 432 133 participants. We observed a dose-response in most studies and overall. The pooled RR of cirrhosis for a daily increase in coffee consumption of two cups was 0.56 (95% CI 0.44-0.68; I(2) 83.3%). The RR pooled from cohort studies for a daily increase of two cups was 0.58 (95% CI 0.41-0.76; I(2) 91.1%) and from case-control studies it was 0.52 (95% CI 0.40-0.63; I(2) 0.0%). The pooled RR of alcoholic cirrhosis for a daily increase of two cups was 0.62 (95% CI 0.51-0.73; I(2) 0%) and of death from cirrhosis it was 0.55 (95% CI 0.35-0.74; I(2) 90.3%). CONCLUSION This meta-analysis suggests that increasing coffee consumption may substantially reduce the risk of cirrhosis.
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Affiliation(s)
- O J Kennedy
- Primary Care & Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - P Roderick
- Primary Care & Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - R Buchanan
- Primary Care & Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - J A Fallowfield
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - P C Hayes
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - J Parkes
- Primary Care & Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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Salomone F, Godos J, Zelber-Sagi S. Natural antioxidants for non-alcoholic fatty liver disease: molecular targets and clinical perspectives. Liver Int 2016; 36:5-20. [PMID: 26436447 DOI: 10.1111/liv.12975] [Citation(s) in RCA: 177] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 09/18/2015] [Indexed: 12/11/2022]
Abstract
Non-alcoholic steatohepatitis (NASH), the progressive form of non-alcoholic fatty liver disease (NAFLD), is emerging as a main health problem in industrialized countries. Lifestyle modifications are effective in the treatment of NAFLD; however, the long-term compliance is low. Therefore, several pharmacological treatments have been proposed but none has shown significant efficacy or long-term safety. Natural polyphenols are a heterogeneous class of polyphenolic compounds contained in vegetables, which are being proposed for the treatment of different metabolic disorders. Although the beneficial effect of these compounds has traditionally related to their antioxidant properties, they also exert several beneficial effects on hepatic and extra-hepatic glucose and lipid homeostasis. Furthermore, natural polyphenols exert antifibrogenic and antitumoural effects in animal models, which appear relevant from a clinical point of view because of the association of NASH with cirrhosis and hepatocellular carcinoma. Several polyphenols, such anthocyanins, curcumin and resveratrol and those present in coffee, tea, soy are available in the diet and their consumption can be proposed as part of a healthy diet for the treatment of NAFLD. Other phenolic compounds, such as silymarin, are commonly consumed worldwide as nutraceuticals or food supplements. Natural antioxidants are reported to have beneficial effects in preclinical models of NAFLD and in pilot clinical trials, and thus need clinical evaluation. In this review, we summarize the existing evidence regarding the potential role of natural antioxidants in the treatment of NAFLD and examine possible future clinical applications.
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Affiliation(s)
- Federico Salomone
- Division of Gastroenterology, Ospedale di Acireale, Azienda Sanitaria Provinciale di Catania, Catania, Italy
| | - Justyna Godos
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Shira Zelber-Sagi
- The Liver Unit, Gastroenterology Department, Tel-Aviv Medical Center, Tel Aviv, Israel.,School of Public Health, University of Haifa, Haifa, Israel
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Jaroszewicz J, Flisiak-Jackiewicz M, Lebensztejn D, Flisiak R. Current drugs in early development for treating hepatitis C virus-related hepatic fibrosis. Expert Opin Investig Drugs 2015; 24:1229-39. [DOI: 10.1517/13543784.2015.1057568] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Abnet CC, Corley DA, Freedman ND, Kamangar F. Diet and upper gastrointestinal malignancies. Gastroenterology 2015; 148:1234-1243.e4. [PMID: 25680671 PMCID: PMC4414068 DOI: 10.1053/j.gastro.2015.02.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 02/02/2015] [Accepted: 02/05/2015] [Indexed: 02/06/2023]
Abstract
Diet is believed to modulate cancer risk and this relationship has been widely studied in the gastrointestinal tract. Observational epidemiologic studies have provided most of the evidence about the effects of diet on cancer risk because clinical trials to determine nutritional exposures are often impossible, impractical, or unaffordable. Although a few foods or nutrients are thought to protect against specific types of cancer, it seems clear that the strength and even direction of dietary associations (increasing or decreasing risk) is organ-site- and even histology-specific, along the gastrointestinal tract. Although some hypotheses are supported by a substantial body of observational data (drinking hot maté [an infusion of the herb Ilex Paraguarensis] contributes to esophageal cancer), there are not much data to support others. We discuss some highly touted hypotheses and draw interim conclusions about what is known and what could be done to improve the level of evidence. The complex nature of diet and its associations can be productively investigated with disease-specific studies. However, public health recommendations for normal-risk individuals regarding diet and gastrointestinal cancer should probably emphasize the importance of eating for overall health rather than eating specific foods to reduce risk for specific cancers.
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Affiliation(s)
- Christian C. Abnet
- Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD,Address for Correspondence: Christian Abnet, PhD, MPH, Senior Investigator, Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr Rm 6e344 MSC 9768, Bethesda MD 20892, Office: (240) 276-7213, Mobile: (240) 505-6299,
| | - Douglas A. Corley
- Division of Research, Kaiser Permanente of Northern California, Oakland, CA
| | - Neal D. Freedman
- Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Farin Kamangar
- Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, MD,Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Setiawan VW, Wilkens LR, Lu SC, Hernandez BY, Le Marchand L, Henderson BE. Association of coffee intake with reduced incidence of liver cancer and death from chronic liver disease in the US multiethnic cohort. Gastroenterology 2015; 148:118-25; quiz e15. [PMID: 25305507 PMCID: PMC4274222 DOI: 10.1053/j.gastro.2014.10.005] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 10/02/2014] [Accepted: 10/03/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND & AIMS Coffee consumption has been proposed to reduce risk for hepatocellular carcinoma (HCC) and chronic liver disease (CLD), but few data are available from prospective, US multiethnic populations. We evaluated the association of coffee intake with HCC and CLD in 162,022 African Americans, Native Hawaiians, Japanese Americans, Latinos, and whites in the US Multiethnic Cohort (MEC). METHODS We collected data from the MEC, a population-based prospective cohort study of >215,000 men and women from Hawaii and California, assembled in 1993-1996. Participants reported coffee consumption and other dietary and lifestyle factors when they joined the study. During an 18-year follow-up period, there were 451 incident cases of HCC and 654 deaths from CLD. Hazard rate ratios (RRs) and 95% confidence intervals (CIs) were calculated using Cox regression, adjusting for known HCC risk factors. RESULTS High levels of coffee consumption were associated with reduced risk of incident HCC and CLD mortality (Ptrend ≤ .0002). Compared with non-coffee drinkers, those who drank 2-3 cups per day had a 38% reduction in risk for HCC (RR = 0.62; 95% CI: 0.46-0.84); those who drank ≥4 cups per day had a 41% reduction in HCC risk (RR = 0.59; 95% CI: 0.35-0.99). Compared with non-coffee drinkers, participants who consumed 2-3 cups coffee per day had a 46% reduction in risk of death from CLD (RR = 0.54; 95% CI: 0.42-0.69) and those who drank ≥4 cups per day had a 71% reduction (RR = 0.29; 95% CI: 0.17-0.50). The inverse associations were similar regardless of the participants' ethnicity, sex, body mass index, smoking status, alcohol intake, or diabetes status. CONCLUSIONS Increased coffee consumption reduces the risk of HCC and CLD in multiethnic US populations.
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Affiliation(s)
- Veronica Wendy Setiawan
- Department of Preventive Medicine, Keck School of Medicine, and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California.
| | - Lynne R Wilkens
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Shelly C Lu
- Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Brenda Y Hernandez
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Loïc Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Brian E Henderson
- Department of Preventive Medicine, Keck School of Medicine, and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
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Selected Literature Watch. JOURNAL OF CAFFEINE RESEARCH 2014. [DOI: 10.1089/jcr.2014.1243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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